Decompensated Liver Cirrhosis Impairs the Deformability of Erythrocytes and Their Ability to Pass Through Microchannels

Erythrocytes are the most numerous cell population of blood, ensuring the necessary level of oxygenation of tissues and forming the orderly movement of cells through the vessels. Disorders of physiological deformability of erythrocytes exacerbate the degree of anemia in two ways: aberrant erythrocytes are rapidly eliminated from the bloodstream due to sequestration and destruction in the spleen and liver, and poorly deformable erythrocytes have a reduced potential for gas exchange in capillaries due to decreased membrane contact area. Regardless of the etiology of hepatosis, liver cirrhosis is accompanied by the development of persistent anemia, but erythrocyte deformability disorders in patients with decompensated liver cirrhosis (DLC) have been poorly studied. Using laser diffraction, flow cytometry, and microfluidic analysis, we showed that erythrocytes from patients with DLC have significant deformability disorders caused by stress-type erythropoiesis (release of immature reticulocytes into circulation; an increase in the proportion of phosphatidylserine-presenting erythrocytes, and a decrease in cytosolic esterase activity). In DLC, erythrocytes have strongly pronounced rigidity to hypoosmotic load: induced hemolysis is incomplete, and its rate is reduced, indicating impaired deformability. The revealed violations affected the ability of erythrocytes to pass through microchannels, the transit rate decreased, a high percentage of occlusions was observed, i.e., there are signs of micro-rheological disorders. A correlation was established between erythrocyte micro-rheological impairments and the degree of DLC progression.

Objective To observe the short term effect of umbilical cord blood stem cell transplantation on liver fibrosis in patients with decompensated liver cirrhosis. Methods Sixty patients with decompensated liver cirrhosis underwent umbilical cord blood stem cell transplantation via hepatic artery into the patient’s body. The improvements in clinical symptoms were observed. The indexes of liver function and fibrosis were tested before transplantation and 2, 4, 8, 12 and 24 weeks after graft, respectively. Results The clinical symptoms, such as fatigue, abdominal distension, inappetence were improved to some extent. The serum alanine aminotransferase and type Ⅲ collagen in the patients decreased gradually from 4 weeks of transplantation and serum albumin level increased gradually, at 8 weeks from transplantation, the differences were significant(P 0.05). Conclusions Biochemical markers of liver fibrosis are improved in patients with decompensated liver cirrhosis after umbilical cord blood stem cell infusion. The best time to retransplantation may be 24 weeks from umbilical cord blood stem cell transplantation. Key words: Decompensated liver cirrhosis; Umbilical cord blood stem cell; Transplantation; Liver fibrosis

Background. Alcohol is considered to be the main risk factor for adverse event deaths around the world. In Ukraine, mortality due to alcoholic liver disease (ALD) has taken the second place in the structure of death causes from diseases of the digestive system.
 Objective. The aim of the research was to study the peculiarities of the causes of death in the patients with alcoholic liver disease at the stage of liver cirrhosis (LC) based on the analysis of protocols of pathoanatomical research.
 Methods. The analysis of 149 protocols of the pathoanatomical study of the patients, who died from alcoholic LC, has been carried out at the premises of the Pathoanatomical Department of the Ivano-Frankivsk Regional Clinical Hospital in 2006-2018.
 Results. Most people were young and middle aged. Fatal cases were caused by decompensation of the LC with the development of hepatic, hepatic-renal, cardio-pulmonary insufficiency, pancreatic necrosis, gastrointestinal bleeding (GIB), sepsis, hepatocellular carcinoma (HCC). In 37.6 % of the patients the concomitant illness was coronary heart disease (CHD), 10.7 % of the people had hypertension. In 6 % of the patients, ischemic stroke of the brain was diagnosed. In most people atherosclerotic vascular changes were revealed.
 Conclusions. Excessive consumption of alcohol and, consequently, the development of LC, can be considered as an adverse factor in the reducing social standard of living. In the majority of people, who died from the decompensation of alcoholic LC, atherosclerotic vascular lesions have been detected. This indicates a significant prevalence of lipid metabolism disturbance in the people with alcoholic LC.

Objective To evaluate the prognosis of the decompensated liver cirrhosis by means of MELD-Na score combined with serum cholesterol and endotoxin concentration.Methods Data of 156 hospitalized patients with decompensated liver cirrhosis was retrospectively analyzed.Patients were divided into survival and death group according to follow-ups at 6 months,12 months and 24 months.MELD-Na score was made among 156 patients by detecting relevant indicators.Serum cholesterol and cholesterol levels were measured,too.The relationship between decompensated liver cirrhosis prognosis and MELD-Na score combined with serum cholesterol and endotoxin concentration was analyzed.Results Ninteen patients died at the follow-up for 6 months.Fifty nine patients died at the followe-up for 12 months.Seventy seven patients died at the follow-up for 24 months.There was significant difference on MELD-Na score,endotoxin concentration and serum cholesterol between the survival group and the death group (t =-9.68,-9.22,11.4,-4.65,-19.60,16.20,-20.0,-18.7,17.3,respectively,P ＜0.05).The best critical value of MELD-Na score to predicate death in patients with decompensated liver cirrhosis was 32 points.The risk of death would rise if MELD-Na score increased.The best critical value of plasma endotoxin to predicate death in patients with decompensated liver cirrhosis was ≥ 12 ng/L.The best threshold value of serum cholesterol to predict death in patients with decompensated liver cirrhosis was ≤ 1.70 mmol/L.Conclusion MELD-Na score,serum cholesterol and serum endotoxin were of higher prognostic value to judge the prognosis of patients with decompensated liver cirrhosis. Key words: Liver cirrhosis; Cholesterol; Endotoxin; MELD-Na

Liver cirrhosis continues to be an acute problem of modern medicine due to the high rates of its prevalence and mortality. The high mortality rate is caused by the development of the number of life–threatening complications in decompensated forms of liver cirrhosis – hepatorenal syndrome, infections and varicose bleeding. Hepatorenal syndrome and infections are the result of immunological shifts occurring during decompensation of liver cirrhosis. Currently available literature data do not allow us to create a complete picture of the functional state of various links of adaptive immunity with decompensated liver cirrhosis. The aim of the research was to study the characteristic features of adaptive immunity in patients with decompensated liver cirrhosis. Material and methods. The prospective cohort study included 136 patients with decompensated liver cirrhosis, who received inpatient treatment in the hepatological department of the multidisciplinary hospital. The cohort of examined patients was divided into two groups, one of which included patients with liver cirrhosis of viral origin (n = 78), the other – patients with alcoholic liver cirrhosis (n = 58). In addition to the generally accepted standard methods, the patient examination program included immunological tests: identification of T- and B-lymphocytes, immunoregulatory and activated subpopulations of T-lymphocytes by the method of immunophenotyping peripheral blood mononuclear cells using monoclonal antibodies. The serum levels of immunoglobulins IgM, IgG, IgA, circulating immune complexes were determined by immunoturbidimetric method. Results. The study of indicators of the humoral link of adaptive immunity revealed an increase in the number of B cells, an increase in IgM, IgG, IgA and circulating immune complexes in patients with decompensated liver cirrhosis. The cellular link of adaptive immunity was characterized by an increase in the relative content of T helper cells, activated T cells against the background of a decrease in the number of immature T cells and T regulatory cells. Conclusions. The distinctive features of adaptive immunity in patients with decompensated liver cirrhosis are simultaneous activation of both humoral and cellular components, which, apparently, supports the systemic inflammatory process and the associated progressive liver fibrosis.

Background: Liver cirrhosis is an ultimate complication of all chronic liver diseases. The oral cavity especially the periodontium is affected by malnutrition, coagulation disorders, immunodeficiency which are some of the main features present in patients with liver cirrhosis. The aim of this study was to determine the prevalence and determinants of oral pathologies in patients with decompensated liver cirrhosis in two hospitals of Yaoundé Cameroon. Patients and Methods: This was a cross-sectional and analytical study comparing the oral health status of decompensated liver cirrhotic patients in Yaoundé with sex and age (±3 years) matched healthy controls from the same area. We enrolled patients with liver cirrhosis (Child Pugh score greater than or equal to 7) and their corresponding healthy controls. For each participant, socio-demographic data, clinical data on liver cirrhosis and on oral examination were collected. Oral examination evaluated the level of oral hygiene, gingival index (GI), probing depth (PD) and Clinical attachment loss (CAL), determined and identified oral mucosal lesions. The mean Decayed-Missing-Filled-Teeth (DMFT) index and prevalence of dental caries were also determined. The groups were then compared with regards to periodontal oral mucosal and dental variables using chi square test and Mantel – Haenszel odds ratio was used to determine the strength of association between decompensated liver cirrhosis and oral pathologies. The student‘s T-test was used to compare mean values of quantitative variables. A p-value ˂ 0.05 was statistically significant. Results: We included a total of 80 participants among which 40 liver cirrhotic patients and 40 sex and age (±3 years) matched controls. The mean age was 50.0(±19.0) years for the cases and 52.4(±17.9) years for the healthy controls. Hepatitis B virus (HBV) and Hepatitis C virus (HCV) were the main aetiology of liver cirrhosis representing 42.5% and 30% respectively and Child Pugh class B (65% of cases) was the most represented stage of the disease. A number of past bucco-dental consultations was significantly less frequent in the cases than the controls (09 versus 18, p = 0.03). Over 80% of cases used an inappropriate brushing technique compared to 60% of controls and 55% of cases used toothbrushes and toothpaste compared to 85% controls (p=0.09). A frequency of brushing at least twice daily was 42.5% in cases compared to 55% in controls (p=0.19). Patients with decompensated liver cirrhosis had a significantly greater prevalence of periodontal disease than the controls (95% versus 77.5%, p = 0.013). In addition, they had greater mean PI (1.8(±0.7) versus 1.6(±0.5), p = 0.182), mean GI index (1.9(±0.8) versus 1.3(±0.64), p = 0.004) and periodontal recession (77.5% versus 47.5%). Oral mucosal lesions and salivary lesions were more frequent in cirrhotic patients than in the healthy controls. These lesions include xerostomia (45% versus 17.5%, p ˂0.001), oral candidiasis (7.5% versus 0%, p = 0.120), lichen planus (17.5% versus 2.5%, p = 0.028), petechiae (57.5% versus 5%, p ˂ 0.001), halitosis (50% versus 7.5%, p ˂0.001) and sialadenitis (17.5% versus 0%, p = 0.006). Higher prevalence’s of dental and mean DMFT index were found in cases than in controls. Factors associated with the development of oral pathologies in decompensated cirrhotic patients were oral consultations (p = 0.046), presence of cytolysis (OR = 2.58, p = 0.042) and inadequate brushing technique (p = 0.004). Conclusion: The prevalence of oral pathologies is higher in patients with decompensated liver cirrhosis than corresponding age-sex matched healthy controls.

Abnormal plasma peptide YY 3–36 levels in patients with liver cirrhosis

BackgroundHepatitis B virus (HBV)-related liver disease induces liver damage by hepatic immune and inflammatory response. The association between aberrant peripheral blood mononuclear cell (PBMC) DNA methylation and progression of liver disease and fibrosis remains unclear.ResultsHere we applied Infinium 450 K BeadChip investigating PBMC genome-wide methylation profiling of 48 HBV-related liver disease patients including 24 chronic hepatitis B (CHB), 14 compensated liver cirrhosis (LC), and 10 decompensated liver cirrhosis (DLC). In total, there were 7888 differentially methylated CpG sites (36.06% hypermethylation, 63.94% hypomethylation) correlate with liver disease progression. LC was difficult to be diagnosed, intermediating between CHB and DLC. We used least absolute shrinkage and selection operator (LASSO)-logistic regression method to perform a LC predictive model. The predicted probability (P) of having LC was estimated by the combined model: P = 1/(1 − e−x), where X = 11.52 − 2.82 × (if AST within the normal range − 0.19 × (percent methylation of cg05650055) − 0.21 × (percent methylation of cg17149911 ). Pyrosequencing validation and confusion matrix analysis was used for internal testing, area under receiver operating characteristic curve (AUROC) of model was 0.917 (95% CI, 0.80–0.977). On the fibrosis progress, there were 1705 genes in LC compared with CHB, whose differentially methylated CpG sites loading within the “promoter” regions (including TSS1500, TSS200, 5′UTR, and the 1st exon of genes) subject into the enrichment analysis using Ingenuity Pathway Analysis (IPA). There were 113 enriched immune-related pathways indicated that HBV-related liver fibrosis progression caused epigenetic reprogramming of the immune and inflammatory response.ConclusionsThese data support idea that development of HBV-related chronic liver disease is linked with robust and broad alteration of methylation in peripheral immune system. CpG methylation sites serve as relevant biomarker candidates to monitor and diagnose LC, providing new insight into the immune mechanisms understanding the progression of HBV-related liver fibrosis and cirrhosis.

Dear Editor, Acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus type 1 (HIV-1) infection remains a major public health threat worldwide.1 Although the antiretroviral therapy (ART) improved the life quality and increased longevity of HIV-infected patients, comorbidities of liver diseases have assumed far greater importance as a cause of morbidity and mortality in AIDS patients.2 As their CD4+T-cell-based immune response is attenuated, HIV-infected patients are often coinfected with hepatitis B virus (HBV) or hepatitis C virus (HCV), which, in addition to the hepatotoxicity of ART, leads to the development of liver cirrhosis and failure.3, 4 Traditional treatment has low rates of sustained antiviral response in coinfected patients. Thus, effective treatment strategies tailored to meet the needs of these AIDS patients with liver cirrhosis are urgently in demand. Recent studies have employed the bone marrow-derived stem cells to treat end-stage liver diseases in clinical settings.5 However, the low efficiency in obtaining autologous stem cells hindered the progress in this application. Thus, it is considered feasible to directly transfuse fresh bone marrow (bone marrow transplantation (BMT)) to achieve therapeutic goals.6, 7 To assess the efficacy and safety of transfusing autologous bone marrow in AIDS patients accompanied by advanced liver cirrhosis, we conducted a single-arm trial. The protocol was approved by the Ethics Committee of the Public Health Clinical Center Affiliated with Fudan University. Upon obtaining informed consent, four AIDS patients with decompensated liver cirrhosis caused by HBV or HCV were recruited (Supplementary Table 1). Although the viral loads in peripheral blood of the four patients were under control after ART, their conditions were still progressing with dramatically decreased CD4+ T-cell count. Their Child-Pugh scores were B or C. Owing to portal hypertension induced by liver cirrhosis, all patients suffered from splenomegaly and hypersplenism with low counts of white blood cells and platelets. Thus, splenectomy was performed in each patient to alleviate portal vein hypertension and avoid internal blooding. During the surgical procedure, a catheter was placed in the superior mesenteric vein in preparation for BMT. One week later, 40 ml bone marrow was aspirated by puncture of the iliac crest. Bone marrow cells were suspended in saline without further manipulation and directly transfused through the attached catheter into the portal vein (Figure 1a). One or two BMTs were administrated to each patient at 1-month interval. Figure 1 (a) Schematic illustration of splenectomy and BMT in AIDS patient with decompensated liver cirrhosis. (b and c) Albumin and CD4+ T-cell count in AIDS patient with decompensated liver cirrhosis were assayed before splenectomy and at different times ... The outcome of BMT is surprisingly rewarding. During a 24-month follow-up in patient 1, 2, and 3 and a 3-month follow-up in patient 4 (the most recent patient), the portal vein transfusion of autologous bone marrow cells did not result in any observable side effect and complication. Besides recovery of serum albumin levels and diminishment of ascites, total white blood cell and platelet counts were also significantly improved (Figure 1b and Supplementary Figures 1a–c). Although the prothrombin time and total bilirubin in all patients did not recover completely, the absolute indexes demonstrated stable decrease (Supplementary Figures 1d and e). Moreover, their Child-Pugh scores became A in patient 1, 2 and 3, 1 year after the first transfusion and in patient 4, 3 months after the first transfusion (Supplementary Figure 1f). Surprisingly, 1 month after the first transfusion, CD4+ T-cell count in the peripheral blood of each patient began to increase (Figure 1c). Interestingly, this increasing tendency was maintained in the remaining follow-up period, which is extraordinary in AIDS patients with common ART. Taken together, our data demonstrated the efficacy and safety of autologous BMT on treating advanced liver cirrhosis and recovering CD4+T cells in AIDS patients. Although splenectomy might participate in regaining total white blood cells in peripheral blood, the stable increase of CD4+ T cells in AIDS patients after autologous BMT indicated a possibility that autologous BMT through the hepatic portal vein may reactivate the hematopoietic supportive capability of the liver in adult AIDS patients, which is an exciting research direction warranting further exploration. Importantly, the feasible surgical procedure will make autologous BMT an effective adjuvant therapy to bring benefits to AIDS patients.

Objective To investigate the clinical efficacy of umbilical cord blood stem cell transplantation on patients with decompensated liver cirrhosis and to detect the effect on TNF-α concentration and the expression of CD45RO+ and granulocyte, so as to provide a theoretical basis for the diagnosis and treatment of decompensated cirrhosis. Method 80 patients with decompensated cirrhosis treated in the Dastroenterology Department of Affiliated Hospital of Hubei Medical College from July 2015 to July 2016 were selected and retrospectively analyzed. 40 patients in the observation group received umbilical cord blood stem cells transplantation through hepatic artery on the basis of symptomatic and supportive treatment, and 40 patients received routine treatment were included into control group. Liver function total bilirubin (TBIL), glutamic-pyruvic transaminase (ALT), serum albumin (ALB) and glutamic oxalacetic transaminase (AST) levels were compared before treatment, and 2 months, 4 months and 6 months after treatment. And the related indicators of hepatic fibrosis and cytokines levels were also detected, including laminin (LN), hyaluronidase (HA),Ⅳ type collagenase (ⅣCol), procollagen Ⅲ (ⅢNP), tumor necrosis factor (TNF-α) and interleukin 6 (IL-6). The expression levels of CD45RO+ lymphocyte and granulocyte were detected. Comparison between two groups was done with independent sample t-test. Results The postoperative TBIL, ALT and AST levels of two groups were significantly lower than those before treatment [(33.65 ± 10.26) μmol/L vs (38.65±10.08) μmol/L; (56.76±14.27) U/L vs (64.23±14.56) U/L; (48.54± 17.04) U/L vs (58.21±17.02) U/L]; While the postoperative ALB level was significantly higher than that before treatment [(36.65±8.32) μg/L vs (32.56±8.12) μg/L]; And the difference between the two groups after treatment was statistically significant (t = 2.199, 2.652, 2.199, 2.225, P = 0.031, 0.010, 0.032, 0.029). The postoperative LN, HA,ⅣCol and ⅢNP of two groups were significantly lower than those before treatment [(126.67±15.65) g/L vs (143.65±15.21) g/L; (231.67±34.43) g/L vs (248.64 ±34.87) g/L; (172.67±25.43) g/L vs (188.67±26.56) g/L; (32.54 ±5.43) g/L vs (38.54±6.41) g/L]; And the difference between the two groups after treatment was also statistically significant (t = 4.920, 2.190, 2.752, 4.517; P = 0, 0.032, 0.007, 0). TNF-α and IL-6 decreased gradually after treatment in the two groups [(14.78 ± 4.05) pg/ml vs (16.78 ± 4.32) pg/ml; (15.87 ± 6.05) pg/ml vs (19.09 ± 6.12) pg/ml ], and the difference was statistically significant after treatment (t = 2.136, 2.367; P = 0.036, 0.020). The expression level of CD45RO+ lymphocyte and granulocyte after treatment was lower than that before treatment [ (22.54±3.65)﹪ vs (25.11 ± 3.38)﹪; (22.54 ± 6.54)﹪ vs (25.54±6.37)﹪], and the difference between the groups was statistically significant (t = 3.267, 2.078, P = 0.002, 0.041). Conclusion Application of umbilical cord blood stem cell transplantation for patients with decompensated liver cirrhosis can effectively ameliorate the liver function, and reduce the related indicators of liver fibrosis, the levels of TNF-α, IL-6 and other cytokines as well as CD45RO+ lymphocytes and granulocyte expression levels. It can be used as a new effective treatment of decompensated cirrhosis. Key words: Cord blood stem cell transplantation; Decompensated liver cirrhosis; TNF-α; CD45RO+; Granulocytes

Objective To explore the clinical application value of the prealbumin (PA), total bile acid (TBA), and red blood cell volume distribution width (RDW) in chronic liver disease. Methods Totally 393 cases of patients with chronic liver disease admitted by Xiangya Hospital of Central South University from March 2015 to March 2016 were selected as group observation, and were divided into chronic hepatitis, compensated liver cirrhosis, decompensated liver cirrhosis and primary liver cancer. At the same time, 200 cases of healthy volunteers were collected as normal control. Serum prealbumin and total bile acids were tested as well as the RDW of all cases. SPSS 17.0 software was used for data statistics processing. The receiver-operating characteristic curve (ROC) was drawn to evaluate the diagnosis value of the indexes in chronic liver disease severity. Results PA in the observation group was significantly lower than normal control, while its TBA and RDW were significantly higher than normal control. All of three parameters in patients, especially with liver cirrhosis and decompensated liver cirrhosis, had higher positive rate. When the clinical diagnosis was taken as gold standard, the best level of PA to diagnose primary liver cancer, chronic hepatitis and decompensated liver cirrhosis was 244.7 mg/L, 238.5 mg/L and 132.8 mg/L, the AUC was 0.973, 0.909 and 0.879, the sensitivity was 92.3%, 95.1% and 85.6%, and the specificity was 95.8%, 72.8% and 79.7%; the best level of RDW to diagnose primary liver cancer, chronic hepatitis and decompensated liver cirrhosis was 13.2%, 13.8% and 14.3%, the AUC was 0.816, 0.827 and 0.818, the sensitivity was 66.7%, 77.4% and 72.2%, and the specificity was 79.5%, 73.8% and 77.3%. When combined detection of PA and RDW, the diagnostic performance had improved significantly. Conclusions Serum prealbumin and total bile acid, as well as the whole blood RDW may objectively reflect the injury of liver metabolism and synthesis function, and for the early diagnosis and prognosis of patients with chronic liver disease has a important clinical significance. Key words: Prealbumin/ME/DU; Bile acids and salts/ME/DU; Erythrocyte volume; Liver diseases/DI/ME

This study aimed to determine whether serum levels of nitric oxide metabolites (nitrates and nitrites) correlate with renal dysfunction in patients with liver cirrhosis and, moreover, to assess nitric oxide metabolite (NOx) power for predicting hepatorenal syndrome (HRS) in such patients. Among patients admitted to the Tropical Medicine Department, Ain Shams University Hospital, a total of 60 patients with chronic hepatitis C-related liver cirrhosis were included in this study. Patients were divided into three groups. Group I included 20 patients with compensated liver cirrhosis (CLC). Group II included 20 patients with decompensated liver cirrhosis (DLC). Group III included 20 patients with decompensated liver cirrhosis and HRS. Twenty healthy subjects with no clinical or laboratory evidence of liver disease were enrolled as a control group (group IV). Patients with HRS had a higher mean nitrite levels followed by DLC, then CLC, and then controls. The sensitivity and specificity of NO metabolites (nitrites) were 100 % and 93.3 %, respectively, with accuracy of 95 % at cutoff value of 387 μmol/L for diagnosing patients with HRS. There was a highly significant statistical difference between patients positive and negative for nitrites as regards renal profile (p = 0.000). A strong relation between nitrite cutoff value and renal dysfunction in liver cirrhosis has been found. Also, patients with HRS had higher mean serum nitrite levels than decompensated liver cirrhosis or compensated liver cirrhosis, raising the possibility of using nitrate and nitrite levels as a predictor for HRS in HCV-related liver cirrhosis.

Background: Splenectomy has been reported to improve liver function as well as hypersplenism, but it is still controversial whether splenectomy will further damage the immune function of patients with liver cirrhosis. This study aims to evaluate the impact of splenectomy on the risk of infection in patients with liver cirrhosis. Methods: A total of 4355 patients with liver cirrhosis admitted to the First Affiliated Hospital of Nanjing Medical University from October 1, 2016 to September 30, 2020 were enrolled. The patients were first divided into the splenectomy group (SG) and the non-splenectomy group (NSG). After standardization, patients were further divided according to the stage of cirrhosis. Infection rates in different stages were calculated, respectively. Laboratory results and infection sites of patients with cirrhosis were analyzed in combination with clinical data. Continuous variables conforming to normal distribution were presented as mean ± standard deviation, compared by sample t test or paired sample t test. Non-normal variables were presented as the median (interquartile range) and compared by Mann-Whitney U test or Wilcoxon signed rank test. Results: Five hundred and two patients received splenectomy and 3853 patients did not. Bacterial infection was diagnosed in 497 of the 4355 (11.41%) hospitalizations of patients with cirrhosis. The infection rate of the compensated cirrhosis SG was higher than that of the NSG (8.06% vs. 5.18%, P < 0.05). However, the infection rate in the SG with decompensated cirrhosis was lower than that in the NSG (11.35% vs. 22.22%, P < 0.001). The peak level of leukocytes did not differ significantly between the SG with compensated liver cirrhosis and the NSG [11.97 (7.65) × 109/L vs. 12.19 (14.04) × 109/L, P > 0. 05]. The peak value of leukocytes in SG suffering from decompensated liver cirrhosis was significantly higher than that in NSG [12.29 (11.52) × 109/L vs. 6.37 (8.90) × 109/L, P = 0.004]. Patients with decompensated liver cirrhosis had a significantly higher rate of abdominal infection than patients with compensated liver cirrhosis, and splenectomy itself did not affect the sites of infection. Conclusions: Splenectomy increases the risk of infection for patients with compensated liver cirrhosis, but significantly decreases the risk in patients with decompensated liver cirrhosis.

About 60% of patients with decompensated disease have oesophageal varices. One third of these patients will experience variceal bleed. Each bleeding episode compromises the decompensated state and is associated with a 20% to 30% mortality. Bleeding from ectopic varices is rare but is generally massive and life threatening. The first two articles, “Clinicopathological features and treatment of ectopic varices with portal hypertension” and “Application of endoscopy in improving survival of cirrhotic patients with acute variceal hemorrhage” discuss the management of variceal bleeding in cirrhotic patients. “Improved survival with the patients with variceal bleed” is a review article on how new treatment modalities have improved the outlook of patients with bleeding oesophageal varices. The hepatorenal syndrome (HRS) signifies advanced liver failure and is a bad prognostic factor in patients with decompensated cirrhosis. Management of this condition is discussed in “Management of renal failure and ascites in patients with cirrhosis”. One of the features of decompensated liver disease is the occurrence of recurrent or resistant ascites. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective therapy for refractory ascites and HRS at the expense of hepatic encephalopathy and may offer an effective bridge to liver transplantation, by improving short and medium term survivals, as discussed in “Role of TIPS in improving survival of patients with decompensated liver disease”. Bacterial infection is responsible for up to a quarter of the deaths of patients with decompensated liver disease. “Prevention and management of bacterial infections in cirrhosis” discuss the high index of suspicion that is needed to prevent bacterial infections in patients with decompensated cirrhosis. These patients are immunologically compromised, and prophylactic antibiotics can prevent fatal septicemia and HRS in those with gastrointestinal bleeding. Current thoughts on how to deal with the neuropsychiatric complication of cirrhosis are discussed in “Management of hepatic encephalopathy”. Cardiomyopathy, hepatopulmonary syndrome, portopulmonary hypertension and right-sided hydrothorax complications that are often overlooked in patients with decompensated liver disease are discussed in “Management of cardiopulmonary complications of cirrhosis”. Decompensated liver cirrhosis has been traditionally considered as a prototype of hemorrhagic coagulopathy, and routinely performed coagulation profile is abnormal in the majority of these patients. In “Management of coagulopathy in patients with decompensated liver disease”, the authors discussed recent thoughts on coagulation in end-stage liver disease. The related article entitled “Determination of ADAMTS13 and its clinical significance for ADAMTS13 supplementation therapy to improve the survival of patients with decompensated liver cirrhosis” reviews the role of the deficiency of the metalloproteinase ADAMTS13 in end-stage liver cirrhosis in inducing platelet clumping or thrombi and how the resulting sinusoidal microcirculatory disturbances causes further liver damage and is closely related to further deterioration of liver function, hepatic encephalopathy, hepatorenal syndrome, and intractable ascites in advanced liver cirrhosis. Fresh frozen plasma (FFP) is a source of ADAMTS13. Liver cirrhosis is the common end stage of persistent liver injury. In the Asia Pacific region, these injuries commonly result from chronic hepatitis B and C infections as well as alcohol. The following two articles, “Treatment of hepatitis B in decompensated liver cirrhosis and treatment of decompensated alcoholic liver disease” address the management of hepatitis B and alcoholic liver disease in end stage liver disease. Pharmacotherapy in patients with decompensated liver disease is not without complications and side effects and might compromise the decompensated state. The article entitled “Prescribing medications in patients with decompensated liver cirrhosis” addresses the above conundrum. A common complication of liver cirrhosis is liver cancer, and treatment of this condition is challenging in patients with liver decompensation to say the least. The paper entitled “Screening for hepatocellular carcinoma” discusses early detection of liver cancer in these patients so that appropriate management can be arranged. Finally, liver transplantation for end-stage liver failure is discussed in “Indications and contraindications for liver transplantation”. Deepak Amarapurkar Rajiv Jalan Richard Guan Paul Kwo

The standard treatment for decompensated liver cirrhosis is liver transplantation. However, it has several limitations. Recent animal studies suggest that bone marrow stem cell transplantation can lead to regression of liver fibrosis. The objective of this study was to determine the safety and feasibility of autologous bone marrow-mesenchymal stem cell transplantation in patients with decompensated liver cirrhosis. In this phase 1 trial, four patients with decompensated liver cirrhosis were included. Their bone marrow was aspirated, mesenchymal stem cells were cultured, and a mean 31.73 x 10(6) mesenchymal stem cells were infused through a peripheral vein. Primary outcomes were evaluating the safety and feasibility of the work. Secondary outcomes were evaluating changes in the model for end-stage liver disease score, and the quality of life of the patients. There were no side-effects in the patients during follow-up. The model for end-stage liver disease scores of patients 1, and 4 improved by four and three points, respectively by the end of follow-up. Furthermore, the quality of life of all four patients improved by the end of follow-up. Using SF-36 questionnaire, the mean physical component scale increased from 31.44 to 65.19, and the mean mental component scale increased from 36.32 to 65.55. Mesenchymal stem cell transplantation seems to be feasible and safe in the treatment of decompensated liver cirrhosis.