Background: To identify potential key genes predicting unfavorable prognosis in hepatitis B virus (HBV)associated hepatocellular carcinoma (HCC).Methods: Gene expression profiles of GSE121248, GSE62232, and GSE55092 from the GEO database were obtained and analyzed. Differentially expressed genes (DEGs) between HBV-associated HCC tissues and adjacent normal tissues were screened by the limma package and Venn diagram software. Functional assessment of DEGs was performed by Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG). Hub genes were selected by the protein-protein interaction (PPI) network and further validated by GSE14520 clinical data.Results: A total of 26 up-regulated genes and 76 down-regulated genes were identified by analyzing three databases. GO and KEGG analysis demonstrated that these genes were involved in cell division, metabolismrelated biological processes, the p53 pathway, and the cell cycle, among others. PPI network suggested that 14 hub DEGs (TOP2A,

Acute graft versus host disease (aGVHD) is a rare, but severe complication of liver transplantation (LT). It is caused by the activation of donor immune cells in the graft against the host shortly after transplantation, but the contributing pathogenic factors remain unclear. Here we show that human T cell lymphotropic virus type I (HTLV-1) infection of donor T cells is highly associated with aGVHD following LT. The presence of HTLV-1 in peripheral blood and tissue samples from a discovery cohort of 7 aGVHD patients and 17 control patients is assessed with hybridization probes (TargetSeq), mass cytometry (CyTOF), and multiplex immunohistology (IMC). All 7 of our aGVHD patients display detectable HTLV-1 Tax signals by IMC. We identify donor-derived cells based on a Y chromosome-specific genetic marker, EIF1AY. Thus, we confirm the presence of CD4+Tax+EIF1AY+ T cells and Tax+CD68+EIF1AY+ antigen-presenting cells, indicating HTLV-1 infection of donor immune cells. In an independent cohort of 400 patients, we verify that HTLV-1 prevalence correlates with aGVHD incidence, while none of the control viruses shows significant associations. Our findings thus provide new insights into the aetio-pathology of liver-transplantation-associated aGVHD and raise the possibility of preventing aGVHD prior to transplantation.

β-galactosidase is a critical exoglycosidase involved in the hydrolysis of lactose, the modification and degradation of glycoprotein in vivo. In this study, the β-galactosidase gene of silkworm (BmGal), whose cDNA comprises 11 exons and contains an intact ORF of 1821bp, was cloned. The protein sequence of BmGal showed high similarity with other known insect β-galactosidases. No activity of the BmGal expressed in Escherichia coli or Pichia pastoris was detected while it was successfully expressed with high enzyme activity in baculovirus–silkworm expression system, and the electrophoresis result revealed that the BmGal showed activity in oligomer mode. Enzyme activity assay showed that its optimum pH was 8.4 and its optimum temperature was 40℃. What’s more, we found that iron ions can stimulate the activity of the enzyme while cobalt, nickel or lead ions can inhibit its activity significantly. Besides, the temporal-spatial expression pattern of the BmGal mRNA level was analyzed, which showed that BmGal was expressed at the highest level in the fifth larval instar but relatively low level in the pupal and adult stage, and the highest expression level of BmGal was found in testis among all the tissues concerned.

β-galactosidase is a critical exoglycosidase involved in the hydrolysis of lactose, the modi cation and degradation of glycoprotein in vivo. In this study, the β-galactosidase gene of silkworm (BmGal), whose cDNA comprises 11 exons and contains an intact ORF of 1821bp, was cloned. The protein sequence of BmGal showed high similarity with other known insect β-galactosidases. No activity of the BmGal expressed in Escherichia coli or Pichia pastoris was detected while it was successfully expressed with high enzyme activity in baculovirus-silkworm expression system, and the electrophoresis result revealed that the BmGal showed activity in oligomer mode. Enzyme activity assay showed that its optimum pH was 8.4 and its optimum temperature was 40℃. What's more, we found that iron ions can stimulate the activity of the enzyme while cobalt, nickel or lead ions can inhibit its activity signi cantly. Besides, the temporal-spatial expression pattern of the BmGal mRNA level was analyzed, which showed that BmGal was expressed at the highest level in the fth larval instar but relatively low level in the pupal and adult stage, and the highest expression level of BmGal was found in testis among all the tissues concerned.

Purpose: The meta-analysis was conducted to evaluate the safety and feasibility of pure laparoscopic left lateral hepatectomy in comparison with open approach for pediatric living donor liver transplantation (LDLT).Methods: A systemic literature survey was performed by searching the PubMed, EMBASE and Cochrane Library databases for articles that compared pure laparoscopic left lateral living donor hepatectomy (LLDH) and open left lateral living donor hepatectomy (OLDH) by November 2021. Meta-analysis was performed to assess donors' and recipients' perioperative outcomes using RevMan 5.3 software.Results: A total of seven studies involving 489 patients were included in the analysis. The results demonstrated that LLDH group had signi cantly less blood loss (WMD=-82.12ml, 95%CI: -109.56-54.67, P<0.00001) and shorter length of hospital stay (WMD=-2.36d, 95%CI: -3.19--1.52, P<0.00001) compared with OLDH group. A reduced overall postoperative complication rate was observed in the LLDH group (OR=0.32, 95%CI: 0.15-0.68, P=0.003). In the subgroup analysis, donor bile leakage, wound infection and pulmonary complications were similar between two groups (bile leakage: OR=1.

Background: Tacrolimus (TAC) is the first choice of calcineurin inhibitors (CNIs) for recipients after pediatric LT. But there are some special pediatric recipients present an unsatisfied prognosis with the therapy of TAC. We aimed to construct a simple clinical model to predict the effectiveness of TAC in recipients after pediatric LT and help clinicians to choose CsA for an alternative quickly. Methods: Patients who received pediatric LT from 2006 to 2019 at RenJi Hospital, Shanghai Jiaotong University School of Medicine were included in this study. Retrospective data, including demographics, comorbidities, pre-operative lab values, outcome based on post-transplantation events were collected. A nomogram estimating the risk of poor curative effects of those recipients who receive an IS protocol based on TAC was constructed using multivariate logist regression analysis. Results: A total of 2032 recipients were included in this study. Seven parameters (recipient CYP type, cholangitis before LT, GRWR, spleen long diameter, serum albumin, graft volume reduction, donor CYP type) were used to construct the nomogram. The nomogram showed good discriminative performance with the area under receiver operating characteristic (ROC) curve (AUC) of 74.5%, and good calibration. Decision curve analysis demonstrated that the model had a high clinical application potential. Conclusions: A simple clinical model with well performance in predicting the risk of poor curative effects of those recipients who receive an IS protocol based on TAC was constructed. The nomogram can help clinicians quickly choose CsA as an alternative if there are high risks.

Question: A 38year-old man presented with a history of progressive jaundice and multiple intrahepatic cystic round-shaped lesions for about 3 years. He had no viral or autoimmune hepatitis, but a habit of eating raw seafood. Suspecting a parasitic infection, the patient received an anthelmintic therapy, which showed no effect. Later, the patient returned with more severe jaundice and more lesions on computed tomography images (Figure A).Laboratory tests showed the following results: alanine aminotransferase level of 26 U/L, aspartate aminotransferase level of 62 U/L, alkaline phosphatase level of 374 U/L, a bilirubin level of 36.1mg/dL, an albumin level of 3.4 g/dL, and an international normalized ratio of 1.09. In addition, there was no evidence of malignancy or other organs involvement. The orthotopic liver transplantation was performed because of hyperbilirubinemia. The long-term immunosuppressive regimen postoperatively was tacrolimus (FK506, Prograf) monotherapy.Thirteen months later, a computed tomography scan showed some new cystic lesions in the liver (Figure B). A liver biopsy confirmed the recurrence of primary disease. Similar cystic lesions were found in the lungs as well (Figure B). What is the diagnosis?See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

Purpose: The meta-analysis was conducted to evaluate the safety and feasibility of pure laparoscopic left lateral hepatectomy in comparison with open approach for pediatric living donor liver transplantation (LDLT).Methods: A systemic literature survey was performed by searching the PubMed, EMBASE and Cochrane Library databases for articles that compared pure laparoscopic left lateral living donor hepatectomy (LLDH) and open left lateral living donor hepatectomy (OLDH) by November 2021. Meta-analysis was performed to assess donors’ and recipients’ perioperative outcomes using RevMan 5.3 software.Results: A total of seven studies involving 489 patients were included in the analysis. The results demonstrated that LLDH group had significantly less blood loss (WMD=-82.12ml, 95%CI: -109.56-54.67, P<0.00001) and shorter length of hospital stay (WMD=-2.36d, 95%CI: -3.19--1.52, P<0.00001) compared with OLDH group. A reduced overall postoperative complication rate was observed in the LLDH group (OR=0.32, 95%CI: 0.15-0.68, P=0.003). In the subgroup analysis, donor bile leakage, wound infection and pulmonary complications were similar between two groups (bile leakage: OR=1.31, 95%CI: 0.43-4.02, P=0.63; wound infection: OR=0.37, 95%CI: 0.11-1.25, P=0.11; pulmonary complications: OR=0.24, 95%CI: 0.04-1.41, P=0.11). For recipients, there were no significant difference in perioperative outcomes between the LLDH and OLDH group, including mortality, overall complications, hepatic artery thrombosis, portal vein and biliary complications.Conclusion: LLDH is a safe and effective alternative to OLDH for pediatric LDLT, reducing invasiveness and benefiting postoperative recovery. Future large-scale multi-center studies are expected to confirm the advantages of LLDH in pediatric LDLT.