In China universal vaccination program against hepatitis B virus( HBV) in newborns has led to a dramatic decline in HBs Ag prevalence from 9. 75% in 1992 to 7. 18% in 2006. However,it is estimated that there are still around 90 million patients with chronic HBV infection,including 20- 30 million with chronic hepatitis B( CHB). As recommended therapies,interferons and nucleos( t) ide analogues can effectively suppress HBV replication and thereby halt the progression of liver disease. Unfortunately,the current standard of care could not cure CHB in most cases. Developing direct antiviral agents targeting the specific steps of HBV life cycle or immunotherapy against the key steps of immune response to HBV infection will ultimately enable us to cure CHB. Chinese hepatologists have published more and more papers on HBV prevention and management,with the aim of optimizing current modalities and exploring new therapies. Adopting the public health policy to improve the accessibility and affordability of preventive and therapeutic drugs and increase the coverage of vaccination and standardized treatment is the most effective means to reduce the enormous health and socioeconomic burden of HBV- related diseases.

Objective To observe the effect of plasma exchange( PE) therapy for removing serum interleukin- 6( IL- 6),tumor necrosis factor alpha( TNFα),and interferon gamma( IFNγ) in patients with liver failure,and to assess the value of artificial liver support system in the treatment of liver failure. Methods The study included 36 patients with liver failure who were hospitalized in the First Affiliated Hospital of Bengbu Medical College from February 2012 to February 2013. Blood samples were collected before PE and the next morning after multiple treatments. Plasma TNFα,IL- 6,and IFNγ levels were measured by ELISA. Between- group comparison of measurement data before and after treatment was made by independent- samples t test,and comparison of mean values between groups was made by analysis of variance. Results All the 36 liver failure patients had significantly lower levels of TNFα( 381. 23 ± 190. 57 ng / L vs 274. 12 ± 212. 30 ng / L,P< 0. 05),IL- 6( 77. 9 ± 83. 09 ng / L vs 54. 8 ± 63. 32 ng / L,P < 0. 05),and IFNγ( 534. 65 ± 471. 19 ng / L vs 259. 65 ± 312. 26 ng / L,P< 0. 05) after treatment than before treatment. According to the severity of clinical manifestations,the patients with subacute or acute- on- chronic( subacute) liver failure were divided into early stage,middle stage,and advanced stage groups. There were significant differences in IL- 6 and TNFα decreases between the early stage,middle stage,and advanced stage groups( P < 0. 05). IFNγ decrease significantly differed between the early stage or middle stage group and advanced stage group( P < 0. 05),but not between the former two groups( P > 0. 05). After PE therapy,29 out of 36 liver failure patients recovered well,while the remaining 7 patients deteriorated. The recovered group had significantly greater decreases in TNFα( 122. 58 ± 57. 64 ng / L vs 42. 45 ± 19. 86 ng / L,P < 0. 05),IL- 6( 26. 93 ± 7. 25 ng / L vs 6. 71 ± 3. 55 ng / L,P < 0. 05),and IFNγ( 284. 06 ± 94. 31 ng / L vs 217. 47 ± 45. 76 ng / L,P < 0. 05) than the deteriorated group. The response rates of patients with acute,subacute,acute- on- chronic,and chronic liver failure were 66. 67%,85. 71%,86. 36%,and50%,respectively. Conclusion Continuous artificial liver PE therapy can effectively remove pro- inflammatory cytokines from plasma and thus improve the clinical outcomes of patients with liver failure.

Objective To investigate the relationship between zonula occludens- 1( ZO- 1) level and blood- brain barrier permeability in rats with hepatic encephalopathy( HE). Methods One hundred and eighty Sprague- Dawley rats were equally and randomly divided into control and HE( 4,8,and 12 h) groups of 45 animals each. Rats were given D- galactosamine( 400 mg / kg) and lipopolysaccharide( 100 μg/kg) by intraperitoneal injection to build an HE model. At 4,8,and 12 h after injection,blood ammonia concentration,Evans blue( EB) content,and brain water content were measured,and ZO- 1 mRNA level in the blood- brain barrier was assayed by real- time Q-PCR. Measurement data were analyzed using the least significant difference test( with homogeneous variances) and Dunnett T3 test( with heterogeneous variances). Results At 2 h after injection,the rats in the HE groups began to show HE symptoms. At 4 h after injection,the rats showed significant increases( P < 0. 001 for all) relative to the controls in blood ammonia concentration( 74. 27 ± 1. 77 μmol / L vs33. 85 ± 1. 50 μmol / L,),EB content( 4. 84 ± 0. 43 μg / g vs 3. 96 ± 0. 48 μg / g),and brain water content( 78. 63 ± 0. 46% vs 76. 07 ±0. 39%); the increases in the above three indices became more significant over time in the three HE groups( F = 5983. 36,111. 54,and737. 25,respectively; P < 0. 001 for all). In contrast,ZO- 1 mRNA expression in rat brain tissue began to decrease at 4 h after injection compared with the control( 1. 282 3 ± 0. 057 4 vs 1. 457 6 ± 0. 065 4,P < 0. 001); the decrease in the relative ZO- 1 mRNA expression level became more significant over time( F = 135. 38,P < 0. 001). Conclusion Blood- brain barrier permeability enhancement and brain edema in HE rats may be associated with the decrease in ZO- 1mRNA expression.

Hepatic alveolar echinococcosis( HAE) is a zoonotic parasitic disease that seriously threatens the population in western China and compromises patients' quality of life. With the continuous improvement in radical resection rate in recent years,late- stage HAE patients that were incurable in the past now have the opportunity for radical resection. However,patients who are not suitable candidates for radical resection still suffer from various complications and poor quality of life. Therefore,HAE is still considered a refractory and complex disease. The simple empirical treatment model provided by traditional professional discussion is unable to satisfy the treatment of advanced refractory HAE as it is unable to integrate specialized,standardized clinical skills for diagnosis and treatment. Multidisciplinary individualized treatment( MDT) organically integrates the advantages of the available treatment into a reasonable individualized comprehensive treatment regimen. This review summarizes the advances in MDT for HAE as the best option to increase long- term survival,and suggests MDT as the first- line treatment for late- stage refractory hepatic alveolar echinococcosis.