Functional Decompensation Research Articles

Reverse electrical remodeling following pressure unloading in a rat model of hypertension-induced left ventricular myocardial hypertrophy.

Pressure overload-induced left ventricular myocardial hypertrophy (LVH) is characterized by increased proarrhythmic vulnerability. In contrast, pressure unloading leads to reverse remodeling and decreases LVH-associated arrhythmogenicity. However, cellular changes that occur during reverse electrical remodeling have been studied less. Therefore, we aimed to provide an electrocardiographic characterization of a rat model of LVH that underwent pressure unloading and to simultaneously identify the underlying cellular and functional alterations. LVH was induced in rats by abdominal aortic banding for 6 or 12 weeks. Sham-operated animals served as controls. Pressure unloading was evoked by removing the aortic constriction after week 6 (debanded). Serial echocardiography and electrocardiography were performed to investigate the development and the regression of LVH. Protein expression levels were detected by western blot. Myocardial fibrosis was assessed by Picrosirius red staining. Pressure unloading resulted in the regression of LVH in correlation with the reversion of the prolonged corrected QT interval (cQT: 68.7±1.6 vs. 91.0±1.9 ms debanded week 12 vs. AB week 12, P<0.05). Furthermore, pressure unloading prevented the functional decompensation of LVH and simultaneously preserved adequate atrioventricular conduction (PQ: 47.5±1.2 vs. 53.8±1.9 ms debanded week 12 vs. AB week 12, P<0.05). Finally, pressure unloading effectively preceded the broadening of the QRS complex (QRS: 21.8±0.5 vs. 24.9±0.7 ms debanded week 12 vs. AB week 12, P<0.05) in parallel with the attenuation of interstitial collagen accumulation. The regression of LVH with maintained cardiac function and decreased myocardial fibrosis contributes to pressure unloading-induced reverse electrical remodeling.

Asymptomatic Hepatitis C in Patient with Oral Lichen Planus: A Case Report

Lichen planus (LP) is a chronic inflammatory condition that affects the oral mucous membrane/skin with a variety of clinical presentations. Oral Lichen Planus (OLP) is considered to be associated with numerous systemic conditions one of which includes hepatitis C virus (HCV) infection. The geographic variation of the hepatitis C prevalence proved to be an important factor influencing the statistical results of the studies analyzing the association of the oral plan lichen with the hepatitis C virus. LP patients have about a fivefold higher risk than the controls of being HCV seropositive, with geographic variability, being most prevalent in the region of Japan, Mediterranean countries and the USA. Treatment outcomes in patients with oral lichen planus associated with chronic hepatitis C virus are often unsatisfactory compared to patients suffering from idiopathic oral lichen planus. Also, the evolution of oral lesions is often fluctuating, with repeated periods of relapse according to the degree of liver function decompensation. Herewith, a case of oral lichen planus in a female patient is reported, which on investigation revealed hepatitis C antibodies.

The Association between Expression of NK Cells and Prognosis of Patients with HBV Acute-on-Chronic Liver Failure in Advanced Phase

Acute-on-chronic liver failure (Acute-on-chronic liver failure, ACLF) is acute liver function decompensation on the basis of chronic liver disease. The progression of ACLF develops from advanced phase, plateau phase to remission phase. The pathophysiological basis of ACLF in different phases is various. In advanced phase, immune imbalance and systemic inflammatory reaction plays key roles. In this study, we try to assess the association between expression of NK cells and its receptors and prognosis of patients with ACLF in advanced phase. A total of 35 inpatients with HBV acute-on-chronic liver failure in advanced phase were recruited. They were divided into case group (n = 18) and control group (n = 17) according to whether the patients was dead in the 12 weeks. PBMC were detected for the frequency and expression of NK cell receptors by flow cytometric analysis. Our results demonstrated that patients who died had lower expression of NK cells and inhibitory receptor KIR3DL1, higher levels of FASL. During 12-week follow-up in those case alive, we found that NK cells increased, while expression of FASL decreased. High short-term mortality of ALCF was associated with NK cell, especially related to KIR3DL1 and FASL (PNK = 0.036, PKIR3DL1 = 0.0265, PFasL = 0.0008).

Do directly acting antiviral agents for HCV increase the risk of hepatic decompensation and decline in renal function? Results from ERCHIVES.

Directly acting antiviral agents (DAA) have been associated with hepatic decompensation, especially in patients with pre-treatment cirrhosis, but this risk is not well defined. To determine the incidence of hepatic decompensation, liver transplantation, death and worsening renal function in patients treated with a Paritaprevir/ritonavir, Ombitasvir, Dasabuvir (PrOD), sofosbuvir/simeprevir or sofosbuvir/ledipasvir regimen. We followed ERCHIVES participants treated with the above regimens for up to 12 weeks post-treatment. We excluded those with HIV, HBsAg+ and pre-existing diagnosis of hepatic decompensation and hepatocellular carcinoma. Of 3728 persons on PrOD, 1578 on sofosbuvir/simeprevir and 10 440 on sofosbuvir/ledipasvir, incidence rates (95% CI) of hepatic decompensation/1000 patient-years were 10.6 (5.89-17.36) for the PrOD, 32.4 (20.74-48.16) for the sofosbuvir/simeprevir and 13.0 (9.74-17.10) for the sofosbuvir/ledipasvir. Among those with baseline cirrhosis, these rates were 36.9 (19.1-64.5), 61.8 (38.2-94.5) and 41.1 (29.9-55.2) respectively, while among those without cirrhosis at baseline, these rates were 2.7 (0.6-8.0), 7.5 (1.5-21.8) and 2.7 (1.2-5.4). Advanced fibrosis was associated with increased risk of hepatic decompensation in all groups [HR (95% CI) per 0.5 unit increase in FIB-4 score: PrOD 1.11 (1.07-1.16); sofosbuvir/simeprevir 1.03 (1.01-1.05); sofosbuvir/ledipasvir 1.02 (1.01-1.03)]. There were no deaths. Proportion of persons with eGFR decrease >30 ml/min/1.73 m2 was higher among the PrOD group, but presence of cirrhosis did not appear to affect this. The incidence of hepatic decompensation in persons treated with PrOD, up to 12 weeks after completion of treatment, was comparable to those treated with sofosbuvir/ledipasvir regimen, and was lower than among those treated with a sofosbuvir/simeprevir regimen. Such risk was predominantly observed in those with pre-treatment cirrhosis.

IFN-free therapy for HIV/HCV-coinfected patients within the liver transplant setting.

IFN-based therapy against hepatitis C recurrence after liver transplantation (LT) has poor effectiveness and tolerability. In HIV/HCV-coinfected liver transplant recipients, the results are even poorer. Here, we report our experience using direct antiviral agents (DAAs) in 11 consecutive coinfected patients within the LT setting. Four patients with compensated cirrhosis and hepatocellular carcinoma were treated while awaiting LT and seven patients received antiviral therapy due to severe hepatitis C recurrence after LT [fibrosing cholestatic hepatitis (n = 1), fibrosis stage ≥F3 (n = 2) and decompensated cirrhosis (n = 4)]. Patients were treated with different sofosbuvir-based regimens with or without ribavirin for 12 or 24 weeks. Sustained virological response (SVR) was achieved in all patients. Two of the four patients treated while awaiting LT reached the time of transplant with undetectable HCV-RNA that remained undetectable 12 weeks after LT, one patient had detectable HCV-RNA at the time of transplant but achieved SVR after completing 12 weeks of therapy after LT and the last patient is still on the waiting list. Seven patients with severe post-LT hepatitis C recurrence were treated within 11-120 months after LT. In these patients, viral eradication was associated with an improvement in liver function and clinical decompensation. Tolerance to antiviral therapy was good and only four patients reported mild adverse events. IFN-free regimens are effective and well tolerated in HIV/HCV-coinfected patients within the LT setting, but more data are needed to confirm our promising results and to establish the best treatment option in this population.

Application of Multimodal Anesthesia in Surgical Interventions for Lung Cancer

Objective. To prove pathogenically the reasonability of multimodal anesthesia in patients with lung cancer to improve the efficacy of pain management. Materials and methods . 74 patients (59 men and 15 women) aged 46 to 60 years with lung cancer were examined and treated. 42 patients (the main group) underwent surgery under multimodal anesthesia accompanied with epidural blockade, and 32 patients (the comparison group) were subjected to a surgical intervention under inhalation and intravenous anesthesia with mechanical ventilation. The surgeries including atypical lung resection, lobectomy and pneumonectomy were performed. In preoperative, intraoperative and early postoperative periods, the systemic hemodynamics parameters were determined; adrenaline, noradrenaline, dopamine, cortisol, insulin and glucose were measured in plasma, and acidbase balance parameters — in arterial blood. Pain intensity was assessed by the visual analog scale. Data processing was carried out using Microsoft Exсel 2000, STATISTICA6.0 and Biostat software. Normality of distribution was assessed by KolmogorovSmirnov test. Since the ordered sample did not follow the normal distribution law, the data are presented as a median (Me) and interquartile amplitude (25 and 75 percentiles). Results. It has been found that the most significant pathogenic factor in patients being operated due to lung cancer under the standard anesthesia is the expressed activation of the sympathoadrenal system due to the impact of surgical stress. This is manifested by disorders of the central hemodynamic parameters, such as metabolism, nociception and oxygen balance. In surgeries carried out under multimodal anesthesia, the minimal changes of basic homeostasis parameters are registered; these changes are shorttermed, compensated and reversible. Pain syndrome upon completion of surgery and in the early postoperative period is either absent or mild. C onclusion . It is more expedient to perform surgeries to remove malignant tumors in the lungs under the multimodal anesthesia, because these interventions are distinguished by high traumatic rate and having a «fine line» between compensation and decompensation of the basic vital functions in the perioperative period.

Epidemiology and Clinical Evolution of Liver Cirrhosis in Singapore

Liver cirrhosis is a common cause of morbidity and mortality and an important burden on the healthcare system. There is limited literature on liver cirrhosis in Singapore. We aimed to describe the epidemiology and clinical characteristics of cirrhotic patients seen in an ambulatory setting in a tertiary referral centre. This is a retrospective observational cohort study of cirrhotic patients attending the ambulatory clinic of Singapore's largest tertiary hospital over 5 years. Cirrhosis was diagnosed on characteristic radiological features and/or histology. Aetiology of cirrhosis was determined by history, serology, biochemistry and/or histology. Data on decompensation events and death were retrieved from computerised hospital records. The study included 564 patients with median follow-up of 85 months. Mean age was 60.9 ± 12.5 years with 63.8% males. Main aetiologies of cirrhosis were chronic hepatitis B (CHB) (63.3%), alcohol (11.2%), cryptogenic (9%) and chronic hepatitis C (CHC) (6.9%). CHB was the predominant aetiology in Chinese and Malays whereas alcohol was the main aetiology in Indians. CHC cirrhosis was more common in Malays than other races. Majority had compensated cirrhosis with 76.8%/18.3%/5%; Child-Pugh A/B/C respectively. Decompensation events occurred in 155 patients (27.5%) and 106 of them (18.8%) died. Diagnosis of cirrhosis via surveillance ultrasound was associated with improved 10-year survival. Age at diagnosis, portal vein thrombosis, Child-Pugh class and decompensation within 1 year of diagnosis were independent predictors of mortality. CHB is the primary cause of liver cirrhosis in Singapore. The major aetiologies of cirrhosis vary amongst the different ethnic groups. Cirrhotics with advanced age, portal vein thrombosis, poorer liver function and early decompensation have a higher mortality risk.

Effects of Melatonin-Aided Therapy on the Glutathione Antioxidant System Activity and Liver Protection.

Acute hepatitis results from oxidative stress triggered by hepatotoxic drugs causing liver injury and the activation of caspases cascade. The glutathione antioxidant system protects against reactive oxygen species and mitigates development of these processes. The effectiveness of silymarin, a polyphenolic flavonoid, essenthiale, composed of phosphatidyl choline, and melaxen, a melatonin-correcting drug, as hepatoprotectors has been investigated. The variation of 6-sulfatoxymelatonin (aMT6s), resulting from the biotransformation of melatonin, and GSH has been measured. The activities of caspase-1 and caspase-3, glutathione antioxidant system, and NADPH-generating enzymes were determined. The aMT6s decreases in patients with drug hepatitis and recovers with administration of mexalen. GSH increased in the presence of the studied hepatoprotectors. Pathologically activated caspase-1 and caspase-3 decreased their activities in the presence of hepatoprotectors with melaxen showing the highest effect. The positive effect of melatonin appears to be related to the suppression of decompensation of the glutathione antioxidant system functions, recovery of liver redox status, and the attenuation of inhibition of the NADPH supply.

Pathological hypertrophy reverses β2-adrenergic receptor-induced angiogenesis in mouse heart.

β-adrenergic activation and angiogenesis are pivotal for myocardial function but the link between both events remains unclear. The aim of this study was to explore the cardiac angiogenesis profile in a mouse model with cardiomyocyte-restricted overexpression of β2-adrenoceptors (β2-TG), and the effect of cardiac pressure overload. β2-TG mice had heightened cardiac angiogenesis, which was essential for maintenance of the hypercontractile phenotype seen in this model. Relative to controls, cardiomyocytes of β2-TGs showed upregulated expression of vascular endothelial growth factor (VEGF), heightened phosphorylation of cAMP-responsive-element-binding protein (CREB), and increased recruitment of phospho-CREB, CREB-binding protein (CBP), and p300 to the VEGF promoter. However, when hearts were subjected to pressure overload by transverse aortic constriction (TAC), angiogenic signaling in β2-TGs was inhibited within 1 week after TAC. β2-TG hearts, but not controls, exposed to pressure overload for 1–2 weeks showed significant increases from baseline in phosphorylation of Ca2+/calmodulin-dependent kinase II (CaMKIIδ) and protein expression of p53, reduction in CREB phosphorylation, and reduced abundance of phospho-CREB, p300 and CBP recruited to the CREB-responsive element (CRE) site of VEGF promoter. These changes were associated with reduction in both VEGF expression and capillary density. While non-TG mice with TAC developed compensatory hypertrophy, (2-TGs exhibited exaggerated hypertrophic growth at week-1 post-TAC, followed by LV dilatation and reduced fractional shortening measured by serial echocardiography. In conclusion, angiogenesis was enhanced by the cardiomyocyte (2AR/CREB/VEGF signaling pathway. Pressure overload rapidly inhibited this signaling, likely as a consequence of activated CaMKII and p53, leading to impaired angiogenesis and functional decompensation.

My Personal View: The Current Status of Hepatic Tumor Therapy in China

Citation: Zhou C, Karcz WK (2014) My Personal View: The Current Status of Hepatic Tumor Therapy in China. MOJ Surg 1(1): 00003. DOI: 10.15406/mojs.2014.01.00003 Submit Manuscript | http://medcraveonline.com As a visiting surgeon or post graduated trainee, I was practiced and worked in several institutes of China and Europe. Most of the trainings and research projects aimed the specialty of liver tumor therapy. Those educations along with the accumulation of experiences from long time clinical practice contribute to my personal understanding for the currently status of hepatic cancer treatment in china. China is a country with high prevalence of Hepatitis B. In reports, the patients infected with hepatic virus B is about 20%. And different form western countries, amounts of liver cancer patients are results from HBV infection, while most of them with severe hepatic cirrhosis and even hepatic function decompensation. Another problem is, in china, the public routine screening is short of, and citizens are lack of educations for the necessity of self-health examinations. Therefore, plenty of HCC patients administrated with advanced even terminal condition, lose the chance for the early intervention, and suffer themselves from the heavy economical and medical burden. My personal opinion, what we should change is to put public health education into force, to enhance the investment of human resource and medical infrastructure on primary sanitary institutes, especially for the HBV carriers, the system of hepatic tumor screening should be wildly established with no delay.

The cardiorenal syndrome: pathophysiologic crosstalk, outcomes, and treatment targets.

The development of simultaneous decompensation in cardiac and renal function is a common phenomenon in patients with congestive heart failure. Termed the cardiorenal syndrome (CRS), this joint deterioration in cardiac output and renal filtration is the result of a complex interplay of hemodynamic and neurohormonal factors. Recently, endothelial dysfunction, inflammation and uremia have been recognized as contributors to the crosstalk responsible for the development of CRS. Management strategies for the treatment of CRS involve correction of hemodynamic derangements and regulation of neurohormonal pathways. Future therapies may target more newly recognized components of CRS pathophysiologic development.

A conceptual model of compensation/decompensation in lumbar segmental instability

Lumbar spinal instability (LSI) is a common spinal disorder and can be associated with substantial disability. The concept of defining clinically relevant classifications of disease or ‘target condition’ is used in diagnostic research. Applying this concept to LSI we hypothesize that a set of clinical and radiological criteria can be developed to identify patients with this target condition who are at high risk of ‘irreversible’ decompensated LSI for whom surgery becomes the treatment of choice. In LSI, structural deterioration of the lumbar disc initiates a degenerative cascade of segmental instability. Over time, radiographic signs become visible: traction spurs, facet joint degeneration, misalignment, stenosis, olisthesis and de novo scoliosis. Ligaments, joint capsules, local and distant musculature are the functional elements of the lumbar motion segment. Influenced by non-functional factors, these functional elements allow a compensation of degeneration of the motion segment. Compensation may happen on each step of the degenerative cascade but cannot reverse it. However, compensation of LSI may lead to an alleviation or resolution of clinical symptoms. In return, the target condition of decompensation of LSI may cause the new occurrence of symptoms and pain. Functional compensation and decompensation are subject to numerous factors that can change which makes estimation of an individual’s long-term prognosis difficult. Compensation and decompensation may influence radiographic signs of degeneration, e.g. the degree of misalignment and segmental angulation caused by LSI is influenced by the tonus of the local musculature. This conceptual model of compensation/decompensation may help solve the debate on functional and psychosocial factors that influence low back pain and to establish a new definition of non-specific low back pain. Individual differences of identical structural disorders could be explained by compensated or decompensated LSI leading to changes in clinical symptoms and pain. Future spine surgery will have to carefully define and measure functional aspects of LSI, e.g. to identify a point of no return where multidisciplinary interventions do not allow a re-compensation and surgery becomes the treatment of choice.

Acute liver function decompensation in a patient with sickle cell disease managed with exchange transfusion and endoscopic retrograde cholangiography.

Sickle cell intrahepatic cholestasis is a relatively uncommon complication of homozygous sickle cell anemia, which may lead to acute hepatic failure and death. Treatment is mainly supportive, but exchange transfusion is used as salvage therapy in life threatening situations. We describe a case of a 16-year-old female with homozygous sickle cell anemia who presented to the emergency room with fatigue, malaise, dark urine, lower back pain, scleral icterus and jaundice. She was found to have marked hyperbilirubinemia, which persisted after exchange transfusion. Because of the concomitant presence of gallstones and choledocholithiasis, the patient underwent endoscopic ultrasound and laparoscopic cholecystectomy followed by endoscopic retrograde cholangiography and sphincterotomy.

Correlation between standard remnant liver volume and liver function decompensation in patients after surgery for hepatocellular carcinoma

Correlation between standard remnant liver volume and liver function decompensation in patients after surgery for hepatocellular carcinoma

A clinical profile of pediatric patients admitted for thryotoxicosis in a tertiary hospital using the 1992 Burch and Wartofsky criteria

Thyrotoxicosis is the clinical syndrome of hypermetabolism that occurs with increased levels of thyroid hormones. Thyroid storm (TS) represents the extreme manifestation of thyrotoxicosis. Medical charts of all pediatric patients with the diagnosis of “Thyroid Storm or “Impending Thyroid Storm” (ITS) from 2004 to 2010 were retrieved. Patients with a BWC of 25 and above were included. Charts with incomplete data were excluded. Fourteen patients (13 females and 1 male) between 12-18 years of age were included. All had goiter and were biochemically hyperthyroid. The most common chief complaint was dyspnea(57%). The most common precipitating factors were infection and noncompliance to medicines(43%). The mean length of hospital stay was 6.2±4 days. The most common organ system dysfunctions were diarrhea(50%), tachycardia(43%) and hyperthermia(38%). Eight(57%) fit the criteria for TS and 6(43%) for ITS. The mortality rate was 29%. The hyperthyroid pediatric patients were admitted due to organ system decompensation secondary to thyrotoxicosis and/or concomitant disease. The levels of thyroid hormone did not distinguish between thyrotoxicosis and TS nor predict the outcome. The most common intercurrent diseases were pneumonia and acquired cardiac disease, the symptoms (fever, tachypnea, tachycardia) of which overlapped with symptoms of the hyperthyroid state. The clinical changes in cardiovascular hemodynamics that occur in patients in thyrotoxicosis aggravates cardiovascular disease, increasing mortality risk. The patients who were admitted with heart failure signs eventually expired. Wartofsky emphasizes that the diagnosis of ITS and TS is clinical and based on the severity of the symptoms and signs of thyrotoxicosis and presence of functional decompensation of organ systems. The potential high mortality necessitates early treatment. The mortality rate in our study is 29%(4/14 cases), which is higher than that reported among adults(11.3% of 71 cases) in the same tertiary hospital but within the range of 20-30% in the adult population in first world countries. Only two(50%) of those who died had high BWC scores(range 70-85) questioning now the usefulness of BWC as a helpful tool in assessing disease severity among adolescents. In conclusion, the clinical profile of pediatric patients in thyrotoxicosis using the BWC was reviewed. A validity study on the use and applicability of BWC for pediatric patients is recommended.

Postępowanie w okresie okołooperacyjnym u chorych z ryzykiem wystąpienia ostrego uszkodzenia nerek, poddawanych operacjom kardiochirurgicznym

Acute kidney injury is one of the most frequent and clinically important of all postoperative complications in cardiac surgery. It is estimated that almost half of subjects suffer from a deterioration of kidney function after a cardio-pulmonary by-pass. Renal insufficiency impacts upon the outcome in terms of an increase in postoperative morbidity and mortality, and a decrease in quality of life. Recently, a modified and unified classification of cardio-renal syndrome has been devised, which takes into account bilateral association between the heart and the kidneys. Because acute decompensation in heart function leads to acute kidney damage, therefore cardiac surgery-associated acute kidney injury may be recognised as a type 1 cardio-renal syndrome from a pathophysiological point of view. This paper aims to review the current data on the diagnosis of acute kidney injury and preventive strategies that can be implemented in cardiac surgery perioperative care.

Kidney Transplantation Alone in ESRD Patients With Hepatitis C Cirrhosis

We read with great interest the article titled “Kidney Transplantation Alone in ESRD Patients with Hepatitis C Cirrhosis” (1). We have recently reviewed our own experience with KTA in well-compensated cirrhotics (submitted for publication). We agree that the presence of cirrhosis in HCV-positive patients is not a significant variable affecting either graft or patient survival. In our study, we compared 18 well-compensated cirrhotics versus 103 HCV-positive noncirrhotics. Our 1- and 3-year death-censored graft survival was 89 and 78% for the cirrhotics and 95% and 81% for NC. Our patient survival at 1 and 3 years were 100% and 83% for the cirrhotic group and 91% and 83% for NC. In our study, recipient age was not a factor in any outcomes. Serum albumin and platelet count were not a factor in allograft outcomes in the cirrhotic group. Additionally, both groups did not show any statistically significant differences in multiple demographic variables, patient survival, graft survival, adherence, acute rejection at 1 year, delayed graft function and liver decompensation or infection as a cause of graft loss or death. In our study, cancer was statistically more significant in the cirrhotic group. We attributed this to the use of thymoglobulin induction (immunosuppression was not addressed by Paramesh et al.). Additionally, many of the patients who developed cancer were retransplant recipients and KTA after liver transplantation. We agree that it is imperative to maximize the use of HCV-positive donor organs. In our study, more than two thirds of the recipients received HCV+ grafts without negatively affecting patient or allograft survival. We do not limit the use of HCV+ donors to genotype 1 patients. We also do not combine ECD with HCV. None of our cirrhotic patients received ECD kidneys. Although there was no association between donor ECD versus SCD in recipient outcomes in the paper by Paramesh et al., we believe that the HR of 2.78 for graft survival is important and may become relevant with a larger cohort studied over a longer period. In summary, in our report of 121 transplants, we confirm that well-compensated cirrhosis is not a negative prognostic indicator. Additionally, we very closely studied multiple donor and recipient variables and outcomes. We found a higher incidence of cancer in our cirrhotic group, perhaps attributed to aggressive induction. We are hopeful that this may lead to timely KTA and will minimize liver allograft wastage. Stalin Campos Afshin Parsikia Radi F. Zaki Jorge A. Ortiz Department of Transplant Albert Einstein Medical Center Philadelphia, PA

Geriatric Psychiatrist Honored for Innovative Care Strategies

The vision of Yeates Conwell, M.D., dovetails with the movement toward “integrated care,” merging primary and mental health care with social services to improve service coordination and lower costs.

Psychological comorbidities in Chinese patients with acute-on-chronic liver failure

ObjectivesPatients with acute-on-chronic liver failure (ACLF) experience long-term chronic liver diseases plus an acute liver function decompensation. This study aimed to determine whether psychological symptoms in patients with hepatitis B virus (HBV)-related ACLF differ from those with other chronic liver diseases and to identify which factors could predict psychological impairment in liver patients. MethodsThis was a paired case–control study. A total of 120 inpatients, including 40 cases for HBV-related ACLF, 40 paired controls for HBV-related cirrhosis and 40 paired controls for chronic hepatitis B (CHB), as well as 40 paired healthy controls were studied. ResultsA high proportion of patients with HBV-related ACLF were classified as Child's stage C. The prevalence of depression in patients with HBV-related ACLF was significantly higher than in CHB patients and healthy controls, but was equivalent to patients with HBV-related cirrhosis. Patients with HBV-related ACLF had significantly higher level of self-esteem than those with HBV-related cirrhosis. However, there was no significant difference among the three liver patient groups and healthy controls in anxiety and suicide intent. Lower education level, anxiety, poor sleep quality and greater severity of disease were associated with elevated depression. ConclusionsPatients with HBV-related ACLF and cirrhosis are at higher risk of depression. It appears that severity of liver disease measured by Child–Pugh class, rather than additional acute liver function decompensation, significantly predicted depression among liver patients.

The techniques of 30% small-for-size liver transplantation in rats

Objective To establish a reliable and ideal model of 30% size graft liver transplantation in rats. Methods The model of 30% size graft liver transplantation in vivo was established by using male SD rats according to Kamada's two-cuff method. The operative techniques and ditails, and survival rate were explored and analyzed. Results The rate of successful surgery was 100% (40/40). The one- and two-week survival rate both were 40% (16/40), and the causes of deaths included liver function decompensation, bile duct stenosis or bile leakage, thrombosis of super inferior vena cava, liver necrosis and celiac infection.Conclusion Improved model of 30% small-for-size liver transplantation had a low hemorrhage rate of residual liver surface, reduced mechanical damage in small-for-size graft, high success rate and survival rate, and was an ideal animal model on the study of experiments related to the small-for-size liver transplantation. Key words: Liver transplantation; Small-for-size; Model,animal; Rat