Objective: The aim of this study was to investigate the genomic features of carbapenem-resistant Citrobacter spp. carrying blaNDM-4 on a novel IncFII-116 plasmid. Methods: Carbapenem-resistant Citrobacter spp. isolates were collected from diarrheal inpatients. Antibiotic susceptibility testing was routinely performed. Whole-genome sequencing and bioinformatic analyses were conducted on the isolates with blaNDM-4 gene. Results: Whole-genome sequencing was performed on the two C. amalonaticus isolates carrying blaNDM-4. Whole-genome analysis revealed that pL5091_blaNDM-4 and pL5094_blaNDM-4belong to a new type of plasmid (IncFII-116) with lengths of 87124 bp and 87952 bp in two C. amalonaticus, respectively. Moreover, blaNDM-4 was encoded in the trpF-ble-blaNDM-4-IS15 cassette array. Conclusion: We identified a novel IncFII-116 plasmid carrying blaNDM-4 in C. amalonaticus for the first time, raising concerns about the emergence of carbapenem-resistant Citrobacter spp.

Concurrent non-alcoholic fatty liver disease (NAFLD) is common in patients with chronic HBV infection. But the impact of fatty liver on the histologic progression of HBV infection remains controversial. Consecutive HBV-infected patients who underwent liver biopsy between 2016 and 2021 were included. Alcohol consumption and other types of viral hepatitis were excluded. All biopsies were scored for grading and staging by Scheuer’s score, and the steatosis was scored as an estimate of the percentage of liver parenchyma replaced by fat. Logistic regression analyses were applied to assess the associated factors for significant liver inflammation (G ≥ 2), significant fibrosis (S ≥ 2) and advanced fibrosis (S ≥ 3). Among the 871 HBV-infected patients, hepatic steatosis was prevalent in 255 patients (29.28

BACKGROUND:Recently, nonalcoholic fatty liver disease (NAFLD) has been renamed metabolic-associated fatty liver disease (MAFLD). Based on the definition for MAFLD, a group of non-obese and metabolically healthy individuals with fatty liver are excluded from the newly proposed nomenclature. AIM:To analyze the histologic features in the MAFLD and non-MAFLD subgroups of NAFLD. METHODS:Eighty-three patients with biopsy-proven NAFLD were separated into MAFLD and non-MAFLD groups. The diagnosis of MAFLD was established as hepatic steatosis along with obesity/diabetes or evidence of metabolic dysfunction. The histologic features were compared according to different metabolic disorders and liver enzyme levels. RESULTS:MAFLD individuals had a higher NAFLD activity score (P = 0.002) and higher severity of hepatic steatosis (42.6% Grade 1, 42.6% Grade 2, and 14.8% Grade 3 in MAFLD; 81.8% Grade 1, 13.6% Grade 2, and 4.5% Grade 3 in non-MAFLD; P = 0.007) than the non-MAFLD group. Lobular and portal inflammation, hepatic ballooning, fibrosis grade, and the presence of nonalcoholic steatohepatitis (NASH) and significant fibrosis were comparable between the two groups. The higher the liver enzyme levels, the more severe the grades of hepatic steatosis (75.0% Grade 1 and 25.0% Grade 2 in normal liver function; 56.6% Grade 1, 39.6% Grade 2, and 3.8% Grade 3 in increased liver enzyme levels; 27.8% Grade 1, 27.8% Grade 2, and 44.4% Grade 3 in liver injury; P < 0.001). Patients with liver injury (alanine aminotransferase > 3 × upper limit of normal) presented a higher severity of hepatocellular ballooning (P = 0.021). Moreover, the grade of steatosis correlated significantly with hepatocellular ballooning degree (r = 0.338, P = 0.002) and the presence of NASH (r = 0.466, P < 0.001). CONCLUSION:Metabolic dysfunction is associated with hepatic steatosis but no other histologic features in NAFLD. Further research is needed to assess the dynamic histologic characteristics in NAFLD based on the presence or absence of metabolic disorders.

目的 应用随机森林模型和Logistic回归模型分析新型冠状病毒肺炎(COVID-19)发病的影响因素,为COVID-19防治提供依据.方法 选择2020年1月17日—2月17日浙江省6家医院收治的COVID-19疑似病例为研究对象,通过问卷收集人口学资料、既往基础疾病、流行病学史、临床表现、实验室检测指标和肺部影像学表现等,分别建立随机森林模型和Logistic回归模型分析COVID-19发病的影响因素.结果 共纳入786例COVID-19疑似病例,其中确诊病例336例,占42.75％.随机森林模型分析结果显示,COVID-19发病的影响因素重要性排名前十位依次是白细胞计数正常或减少、胸部影像学表现、淋巴细胞计数减少、聚集性发病、发病前14天内接触来自疫区的发热或呼吸道症状患者、乏力、发病前14天内有疫区旅居史、呼吸困难、鼻塞流涕和肌肉酸痛.多因素Logistic回归模型分析结果显示,发病前14天内有疫区旅居史(OR=8.440,95％CI:4.204～16.944)、发病前14天内接触来自疫区的发热或呼吸道症状患者(OR=2.967,95％CI:1.630～5.402)、聚集性发病(OR=25.164,95％CI:11.833～53.516)、乏力(OR=2.710,95％CI:1.490～4.930)、呼吸困难(OR=5.276,95％CI:2.076～13.410)、肌肉酸痛(OR=14.187,95％CI:1.998～100.730)、白细胞计数正常或减少(OR=1.750,95％CI:1.659～1.852)和胸部影像学表现(OR=6.291,95％CI:4.315～9.171)均与COVID-19存在统计学关联.结论 两种模型的分析结果相似,随机森林模型显示各个因素在COVID-19发病中的重要程度,Logistic回归模型可直观解释不同因素的风险度.

Early determination of coronavirus disease 2019 (COVID-19) pneumonia from numerous suspected cases is critical for the early isolation and treatment of patients. The purpose of the study was to develop and validate a rapid screening model to predict early COVID-19 pneumonia from suspected cases using a random forest algorithm in China. A total of 914 initially suspected COVID-19 pneumonia in multiple centers were prospectively included. The computer-assisted embedding method was used to screen the variables. The random forest algorithm was adopted to build a rapid screening model based on the training set. The screening model was evaluated by the confusion matrix and receiver operating characteristic (ROC) analysis in the validation. The rapid screening model was set up based on 4 epidemiological features, 3 clinical manifestations, decreased white blood cell count and lymphocytes, and imaging changes on chest X-ray or computed tomography. The area under the ROC curve was 0.956, and the model had a sensitivity of 83.82% and a specificity of 89.57%. The confusion matrix revealed that the prospective screening model had an accuracy of 87.0% for predicting early COVID-19 pneumonia. Here, we developed and validated a rapid screening model that could predict early COVID-19 pneumonia with high sensitivity and specificity. The use of this model to screen for COVID-19 pneumonia have epidemiological and clinical significance.

BACKGROUND Primary bone lymphoma (PBL) is an uncommon extranodal disease that represents approximately 1%-3% of lymphomas. Anaplastic lymphoma kinase (ALK) positive anaplastic large-cell lymphoma (ALCL) is an extremely rare type of PBL. The aim of this report is describe the symptoms, diagnosis, and treatment of primary bone ALK-positive ALCL. CASE SUMMARY A 66-year-old man presented to our hospital with neck and shoulder pain and intermittent fever that lasted for 1 mo. After extensive evaluation, positron emission tomography-computed tomography (CT) examination showed multiple osteolytic bone lesions without other sites lesions. CT-guided biopsy of the T10 vertebral body was performed, and the pathology results showed that neoplastic cells were positive for ALK-1, CD30, and CD3. A diagnosis of primary bone ALK positive ALCL was ultimately made. The patient was in partial response after four cycle soft cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy, and we planned to repeat the biopsy and radiological examination after completion of the fifth cycle of therapy. CONCLUSION Primary bone ALK positive ALCL is a rare disease and physicians should keep in mind that ALCL can present with isolated osseous involvement without nodal involvement, and lymphoma should be considered in the differential diagnosis of primary bone lesions.

Novel coronavirus pneumonia (NCP) has been widely spread in China and several other countries. Early finding of this pneumonia from huge numbers of suspects gives clinicians a big challenge. The aim of the study was to develop a rapid screening model for early predicting NCP in a Zhejiang population, as well as its utility in other areas. A total of 880 participants who were initially suspected of NCP from January 17 to February 19 were included. Potential predictors were selected via stepwise logistic regression analysis. The model was established based on epidemiological features, clinical manifestations, white blood cell count, and pulmonary imaging changes, with the area under receiver operating characteristic (AUROC) curve of 0.920. At a cut-off value of 1.0, the model could determine NCP with a sensitivity of 85% and a specificity of 82.3%. We further developed a simplified model by combining the geographical regions and rounding the coefficients, with the AUROC of 0.909, as well as a model without epidemiological factors with the AUROC of 0.859. The study demonstrated that the screening model was a helpful and cost-effective tool for early predicting NCP and had great clinical significance given the high activity of NCP.

Chronic hepatitis B (CHB) is a major global health burden. Liver fibrosis, an insidious process, is the main histopathological change in CHB that might lead to the end-stage liver disease if left untreated. The intermediate liver fibrosis (S2) is the optimal time to start antiviral therapy. The aim of the present study was to examine the proteomic changes in patients with CHB at different fibrotic stages, with a view to identify future serum biomarkers for S2. Ninety CHB patients were grouped into mild (S0-1), intermediate (S2), and severe liver fibrosis (S3-4) (61 men and 29 women; age 25-63 years). Isobaric tagging for relative and absolute quantitation was applied to screen proteins differentially expressed among the patient groups. Another 46 patients with CHB (age 25-59 years; 31 men and 15 women), and 16 healthy controls (age 26-61 years; 11 men and 5 women) were enrolled in a validation group. Enzyme-linked immunosorbent assay was used to verify the diagnostic value of the candidate biomarkers. We found 139 proteins that were differentially expressed between various fibrotic stage-paired comparisons. Five protein candidates were selected as potential biomarkers of S2 for further verification. Notably, ficolin-2 (FCN2) and carboxypeptidase B2 (CPB2) showed differential expression between patients and healthy controls. In conclusion, serum proteomic changes reported here offer new molecular leads for future research on biomarker candidates to identify liver fibrotic stages in CHB. In particular, FCN2 and CPB2 warrant further research on their possible mechanistic involvement in CHB pathogenesis.

OBJECTIVE:Phosphatidylcholine (PC) is the major surface-active phospholipid and creates a hydrophobic nature to the surface. It has been reported to reverse the progression of liver fibrosis and to improve liver function. The aim of the present study was to evaluate the effects of orally administered PC on intestinal barrier function (IBF) in rats with drug-induced liver injury.METHOD:Rats with carbon tetrachloride- (CCl4-) induced liver injury were treated with 100 mg/kg PC once daily for 21 days. The effects of PC therapy on (i) liver function and portal pressure, (ii) intestinal and hepatic histology, and (iii) plasma endotoxin, diamine oxidase (DAO), and tumour necrosis factor- (TNF-) α levels were investigated.RESULTS:PC therapy reduced portal pressure and improved the liver function in CCl4-induced liver injury. In PC-treated liver injury rats, collagen fibres were gradually decreased, while the disordered arrangement of hepatocytes and disorganized hepatic lobules were partially repaired, and inflammatory cell infiltration was decreased in the fibrous tissue. Lower inflammatory cell infiltration in the ileum improved intestinal histology, and reduced serum DAO levels were observed in PC-treated cirrhotic rats. These changes were associated with reduced inflammatory activity, as indicated by decreased serum TNF-α levels and plasma endotoxin levels.CONCLUSIONS:These results suggest that PC therapy is hepatoprotective and is able to restore IBF and reduce endotoxaemia in rats with drug-induced liver injury.

Objective To evaluate the plasma fibrinogen-like protein 1 (FLP1) level in chronic hepatitis B (CHB) patients with different fibrotic stages,and explore the value of FLP1 in the diagnosis of liver fibrosis.Methods CHB patients who underwent liver biopsy (14 subjects each in mild liver fibrosis,moderate fibrosis and severe fibrosis) in Zhejiang Provincial People's Hospital from June 2016 to January 2017,along with 14 healthy controls were collected.The clinical features,liver functions,blood routine and plasma FLP1 level were compared.The independent predictive factors of significant fibrosis (moderate fibrosis + severe fibrosis,S≥2) in CHB patients were analyzed.Results The difference of plasma FLP1 levels in healthy people and CHB patients with different fibrotic stages had statistical significance (F=7.002,P＜0.01).The FLP1 levels in mild fibrosis [(73.2±17.8) ng/mL],moderate fibrosis [(60.5±19.4) ng/mL] and severe fibrosis [(63.1±17.2) ng/mL] patients were significantly lower than that in healthy controls (t=2.267,P＜0.05;t=3.513,P＜0.01;t=3.411,P＜0.01).Older (OR=1.303,95％CI:1.113-1.526),higher alanine aminotransferase(ALT) (OR=1.042,95％CI:1.012-1.074) and lower FLP1 level (OR=0.948,95％ CI:0.905-0.995) were proved to be independent predictive factors of significant fibrosis in CHB patients.Conclusions Plasma FLP1 level is lower in liver fibrosis than in healthy people.Age,ALT and FLP1 axe independent predictive factors of significant fibrosis.

Objective To analyze the levels of serum thrombin-activatable fibrinolysis inhibitor (TAFI) in patients with chronic hepatitis B ( CHB) with different degrees of hepatic fibrosis , and to evaluate the value of TAFI in the evaluation of liver fibrosis.Methods Forty six patients with CHB who underwent liver biopsy from June 2016 to March 2017 in Zhejiang Provincial People’s Hospital were enrolled.According to liver fibrosis stage (S0－4), they were divided into mild liver fibrosis group (S0－1, n＝16), significant liver fibrosis group (S2, n＝15) and severe liver fibrosis group (S3－4, n＝15).At the same time, 16 healthy subjects were randomly selected as health controls in the physical examination center of the hospital.Serum TAFI levels were analyzed in each group , and the receiver operating curve (ROC) was used to evaluate the diagnostic value of TAFI in CHB patients with significant liver fibrosis and severe liver fibrosis (S≥2).The SPSS 23.0 software was used to analyze the data.Results Serum TAFI levels in the mild liver fibrosis group , significant liver fibrosis group, severe liver fibrosis group and health controls were (63.4 ±18.2), (43.8 ±20.4), (27.5 ±19.2) and (71.3 ±25.6) ng／mL, the difference between the four groups was statistically significant (F＝13.512, P＜0.01).The level of TAFI in the significant liver fibrosis group was lower than that in the healthy control group and the mild liver fibrosis group (t＝3.283 and 2.822, P＜0.01).The level of TAFI in the severe fibrosis group was lower than that in the significant liver fibrosis group (t＝2.260, P＜0.05).Serum TAFI levels were negatively correlated with liver fibrosis stage ( r＝－0.562, P＜0.01).The area under the ROC curve of TAFI for predicting liver fibrosis (S≥2) was 0.832, and the sensitivity and specificity were 81.3%and 78.3%, respectively. Compared with the APRI score and the FIB4 index, the difference was not statistically significant ( P ＞0.05).Conclusion The serum TAFI level is negatively correlated with the degree of liver fibrosis in CHB patients, which has a good diagnostic value for liver fibrosis (S≥2) in patients with CHB.

Objectives The aim of this study was to investigate the mechanism of linezolid resistance and evaluate the risk factors for linezolid-resistant Enterococcus faecalis (LZR-Efa) infections. Methods A total of 730 E. faecalis isolates were collected, and whole-genome sequencing and bioinformatics analysis were performed. Meanwhile, risk factors related to linezolid resistance were analyzed by binary logistic regression. Results Twenty-six LZR-Efa were isolated from various clinical samples, and 24 isolates were multidrug resistant. Four isolates were daptomycin nonsusceptible, while all LZR-Efa were susceptible to vancomycin. Thirteen different sequence types (STs) were identified, and the most prevalent type was ST16 (23.1%). The genes dfrE, lsaA, and emeA were identified in all isolates. A total of 23 E. faecalis were positive for optrA gene, and six amino acids mutations were identified among 18 LZR-Efa in OptrA. The 23S rRNA mutation was found in 16 LZR-Efa isolates. However, the presence of cfr was not identified. Furthermore, there were 41 virulence genes detected, and 10 genes (ace, bopD, cpsA, cpsB, ebpB, ebpC, efaA, fss1, fss2, and srtC) were found in all isolates. A total of nine isolates were positive for multiple virulent factors (ace, asa1, cylA, efaA, esp, and gelE). There was no difference in the number of virulence factors among different specimens (P=0.825). It is of note that all patients had not been prescribed linezolid or traveled abroad previously. Moreover, previous use of carbapenems was a risk factor for LZR-Efa infections. Conclusion The main trends of LZR-Efa, with lower level of resistance, were sporadic mainly in the department of surgery. optrA and 23S rRNA were the main resistance mechanisms. In addition, carbapenems use was an independent predictor of LZR-Efa infections.

Tuberculous meningitis (TBM) is caused by tuberculosis infection of of the meninges, which are the membrane systems that encircle the brain, with a high morbidity and mortality rate. It is challenging to diagnose TBM among other types of meningitis, such as viral meningitis, bacterial meningitis and cryptococcal meningitis. We aimed to identify metabolites that are differentially expressed between TBM and the other types of meningitis by a global metabolomics analysis. The cerebrospinal fluids (CSF) from 50 patients with TBM, 17 with viral meningitis, 17 with bacterial meningitis, and 16 with cryptococcal meningitis were analyzed using ultra high performance liquid chromatography coupled with quadrupole time of flight mass spectrometry (UHPLC-QTOF-MS). A total of 1161 and 512 features were determined in positive and negative electrospray ionization mode, respectively. A clear separation between TBM and viral, bacterial or cryptococcal meningitis was achieved by orthogonal projections to latent structures-discriminate analysis (OPLS-DA) analysis. Potential metabolic markers and related pathways were identified, which were mainly involved in the metabolism of amino acid, lipids and nucleosides. In summary, differential metabolic profiles of the CSF exist between TBM and other types of meningitis, and potential metabolic biomarkers were identified to differentiate TBM from other types of meningitis.

Tuberculous meningitis (TBM) is the most common form of central nervous system tuberculosis with a very poor prognosis. We aimed at assessing risk factors related to the prognosis of patients with TBM.Forty-five inpatients with TBM in our institution from January 2013 to December 2015 were enrolled retrospectively. The good or poor prognosis in the patients was defined, based on Glasgow Outcome Scale System at discharge. Patients with a GOS score less than 5 were defined as poor prognosis. Univariate and multivariate logistic regression analyses were performed to assess the predictors for TBM outcome.Among 45 TBM patients, 35 (77.8%) and 10 (22.2%) were in good, poor prognoses, respectively. Old age, disturbance of consciousness, moderate to severe electroencephalogram abnormality, hydrocephalus, remarkable increase of protein ( 236mg/dL) and white blood cell counts ( 243/L) in cerebral spinal fluid were associated with poor prognosis. Multivariate analysis indicated that old age (odds ratio (OR)=18.395, P=.036) and hydrocephalus (OR=32.995, P=.049) were independent factors for a poor outcome of TBM.In conclusion, old age and hydrocephalus are the predictors for poor prognosis of TBM. Patients with these risk factors should be treated promptly with a special care paid to improve their outcomes.

Background: Interest is growing in the use of non-invasive techniques for complementing liver biopsy for liver fibrosis assessment.We aimed to prospectively evaluate liver histology in chronic hepatitis B (CHB) patients with e-antigen positivity, and develop and validate a novel scoring system-e-antigen-positive CHB liver fibrosis (EPLF) score-for noninvasively predicting the fibrosis stages.Methods: We identified the baseline variables associated with fibrosis stage (MATAVIR score, F0-F4) in 212 CHB patients with e-antigen positivity.These significant variables were used to develop the EPLF scoring system.The EPLF score equation was developed based on the prediction of fibrosis stages via multivariate ordered logistic regression analysis.The diagnostic powers of the EPLF score and several non-invasive markers were assessed through an area under the receiver operating characteristic curve (AUROC) analyses.This EPLF score model was validated in another set of 208 similar patients.Results: The natural logarithms of serum albumin, HBeAg, and HBsAg levels were selected as significant independent variables for the EPLF score equation.The EPLF score had good diagnostic power (AUROC, 0.72-0.90,p<0.001) and good diagnostic accuracy (72-85%), with a high positive predictive value (80.8-92.8%)for each fibrosis stage in the test group.Similar results were observed in the validation group (AUROC, 0.73-0.89,p<0.001).The EPLF score exhibited a strong correlation with fibrosis stage (r=0.67,p<0.001), and was the preferable non-invasive marker for staging liver fibrosis.Conclusion: In e-antigen-positive patients with CHB, the EPLF score could serve as a potential non-invasive marker of liver fibrosis stage.

Rationale: Peliosis hepatis (PH) is a rare tumor-like liver lesion composed of multiple blood-filled cavities within the liver parenchyma. It is hard to differentiate PH from other liver lesions by imaging, such as carcinoma, metastases, or abscess.Patient concerns: Here, we reported 2 cases that presented with liver lesions under ultrasound and computed tomography (CT) scanning, without any history of liver diseases or drug usage traced back.Diagnoses: Liver biopsy and laparoscopy were processed, and the lesions were eventually diagnosed as PH by histopathology, which microscopically presented with multiple sinusoidal dilatations with blood-filled cystic spaces.Interventions: After the liver biopsy or laparoscopy, the patients were discharged and followed up in the clinic.Outcomes: Both patients were followed up for at least 1 year with good recovery.Lessons: PH should always be recognized in the differentiation of liver lesions, particularly indistinctive lesion(s) without any history of liver-related diseases.

Background and aim. Quantitative digital imaging analysis to evaluate liver fibrosis is accurate, but its clinical use is limited by its high cost and lack of standardization. We aimed to validate an inexpensive digital imaging analysis technique for fibrosis quantification in chronic hepatitis B patients. Material and methods. In total, 142 chronic hepatitis B patients who underwent liver biopsy and analysis of serum fibrosis markers were included. Images of Sirius red stain sections were captured and processed using Adobe Photoshop CS3 software. The percentage of fibrosis (fibrosis index) was determined by the ratio of the fibrosis area to the total sample area, expressed in pixels, and calculated automatically. Results. A strong correlation between the fibrosis index and the Ishak, Metavir, and Laennec histological staging systems were observed (r = 0.83, 0.86, and 0.84, respectively; p < 0.001). The cutoff value associated with cirrhosis was 7.7% with an area under the receiver operating characteristic curve (AUROC) of 0.95 (95% confidence interval [CI], 0.92-0.99, p < 0.001). Furthermore, the fibrosis index yielded a cutoff value of 8.9% (AUROC, 0.74; 95% CI, 0.66-0.86), 12% (AUROC, 0.84; 95% CI, 0.75-0.93), and 14% (AUROC, 0.97; 95% CI, 0.92-1.0) for the diagnosis of cirrhosis 4a, 4b, and 4c, respectively. No serum markers or fibrosis models were correlated with the fibrosis index in Metavir F2-F4. Conclusions. The present digital imaging analysis technique is reproducible and available worldwide, allowing its use in clinical practice, and can be considered as a complementary tool to traditional histological methods.

Aim: Our objective is to study the clinical characteristics of cirrhosis patients with SIRS and investigate its prognostic factors. Methods: We analyzed 285 consecutive patients and their data were evaluated retrospectively. Data were compared in patients with/without SIRS during hospitalization. Univariate and multivariate Cox regression analyses were undertaken separately for cirrhotic patients with SIRS to assess predictive factors for 90-day mortality. Results: The mortality was 38.24% (52/136) in patients with SIRS and 6.04% (9/149) in patients without SIRS for 90-day follow-up (P < 0.001). The univariate analysis showed gastrointestinal hemorrhage (P < 0.001), hepatic encephalopathy (P < 0.001), albumin < 30 g/L (P < 0.037), creatinine (Cr) > 175 mu mol/L (P < 0.001), cholinesterase(ChE) activity < 3000 U/L (P = 0.019), white blood cell count >= 10 000 (109/L) (P = 0.018), neutrophils >= 80% (P = 0.018), C-reactive protein (CRP) >= 25 mg/L (P < 0.001), procalcitonin >= 1.0 ng/mL (P = 0.007), Child-Pugh class C (P < 0.001), septicemia (P < 0.001), pulmonary infection (P < 0.001), multi-site infection (P = 0.001), acute-on-chronic liver failure (ACLF) (P < 0.001), and advanced hepatocellular carcinoma (HCC) (P < 0.001). In multivariate analysis, only Cr >= 175 mu mol/L (hazard ratio [HR] = 2.768; confidence interval [CI], 1.53-5.04; P = 0.001), C-reactive protein >= 25 mg/L (HR = 3.179; CI, 1.772-7.03; P = 0.004), multi-site infection (HR = 19.427; CI, 7.484-50.431; P < 0.001), ACLF (HR = 7.308; CI, 3.048-17.521; P < 0.001), advanced HCC (HR = 2.523; CI, 1.019-6.248; P = 0.045) were independent predictors of 90-day mortality in cirrhotic patients with SIRS. Conclusion: Cr >= 175 mu mol/L, CRP >= 25 mg/L, multi-site infection, ACLF, and advanced HCC independently predicted a higher rate of 90-day mortality in liver cirrhosis with SIRS

Chronic HBV (CHB) infected patients with intermediate necroinflammation and fibrosis are recommended to receive antiviral treatment. However, other than liver biopsy, there is a lack of sensitive and specific objective method to determine the necroinflammation and fibrosis stages in CHB patients. This study aims to identify unique serum metabolomic profile associated with histological progression in CHB patients and to develop novel metabolite biomarker panels for early CHB detection and stratification. A comprehensive metabolomic profiling method was established to compare serum samples collected from health donor (n = 67), patients with mild (G < 2 and S < 2, CHB1, n = 52) or intermediate (G ≥ 2 or S ≥ 2, CHB2, n = 36) necroinflammation and fibrosis. Multivariate models were developed to differentiate CHB1 and CHB2 from controls. A set of CHB-associated biomarkers was identified, including lysophosphatidylcholines, phosphatidylcholines, phosphatidylinositol, phosphatidylserine, and bile acid metabolism products. Stratification of CHB1 and CHB2 patients by a simple logistic index, the PIPSindex, based on phosphatidylinositol (PI) and phosphatidylserine (PS), was achieved with an AUC of 0.961, which outperformed all currently available markers. A panel of serum metabolites that differentiate health control, CHB1 and CHB2 patients has been identified. The proposed metabolomic biosignature has the potential to be used as indicator for antiviral treatment for CHB management.

Objective To investigate the prognostic influence factors of liver cirrhosis patients with systemic inflammatory response syndrome (SIRS).Methods A total of 136 liver cirrhosis patients with SIRS were analyzed retrospectively,and were divided into death group (n=52) and survival group(n=84) by the outcome of the disease.The clinical data in 2 groups were compared.The independent risk factors of death in liver cirrhosis patients with SIRS were analyzed by Logistic regression.Results The result of single-factor analysis revealed that the levels of albumin (ALB) and cholinesterase (CHE) in death group were (27.68±-4.84) g/L and (2 647.12±1 057.18) U/L,and were both lower than those in survival group (t=0.007,P＜0.0 1;t=0.0 17,P＜0.05).The levels of serum creatinine (Cr),fasting blood-glucose (FBS),total white blood cell count,serum CRP and PCT in death group were 175.40 μmol/L,5.43 mmol/L,8.10×109/L,24.00 mg/L and 1.20 μg/L,and were higher than those in survival group (Z=0.000,0.000,0.009,0.012 and 0.013,Pall ＜0.05).In addition,the neutrophil proportion,incidence rates of hepatic encephalopathy,gastrointestinal hemorrhage,Child-pugh C grade,sepsis,pulmonary infection and multiple sites of infection in death group were (76.73±14.02)％,28.85％,34.62％,44.23％,34.62％,73.08％ and 90.38％,and were higher than those in survival group (t=0.009,x2=28.950,42.81 0,18.260,16.680,41.177 and 78.440,Pall ＜0.05).Logistic regression stepwise screening results showed that Cr＞165 μmol/L (OR=6.590,95％CI:1.907-22.778),gastrointestinal hemorrhage (OR=29.207,95％CI.4.506-189.290),CRP＞25 mg/L (OR=9.757,95％CI:1.732-54.969),PCT＞1 μg/L (OR=20.350,95％CI:2.617-158.264) and multi-site infection (OR =30.760,95％ CI:2.934-322.572) were significant factors.Conclusions Cr＞165 μmol/L,gastrointestinal hemorrhage,CRP＞25 mg/L,PCT＞ μg/L and multi-site infection are regarded as independent risk factors of mortality for liver cirrhosis patients with SIRS.