Primary biliary cholangitis,once named primary biliary cirrhosis,is a chronic cholestatic liver disease characterized by immune-mediated damage of small and medium-sized bile ducts. Recently,with the improvement in the knowledge of this disease and the wide application of new immunological and pathological detection techniques,the gap between China and Western countries in the diagnosis and treatment of PBC has been gradually narrowed,and a series of innovative findings and results have also been achieved. This article reviews these achievements and points out future challenges and possible solutions.

Host immune response is a double-edged sword and participates in liver injury and viral control in patients with HBV infection.Antiviral therapy with nucleos( t) ide analogues and interferon may improve prognosis through regulating host immune response. This article describes the role of host immune response in chronic HBV infection and its features during antiviral therapy and emphasizes the importance of host immune reconstruction in sustained control of HBV infection.

After the infection with HBV,the host's antiviral immune response is a key factor for the outcome of infection. At present,it is widely believed that the host's innate immunity and acquired immunity are impaired during chronic HBV infection,because of which HBV clearance cannot be achieved. To achieve a long-lasting immune control of HBV infection,we need to comprehensively understand the mechanisms of dysfunction of innate immune response and specific immune response in chronic HBV infection. This article summarizes the research advances in the immune response mechanism of chronicity of HBV infection.

Patients with chronic hepatitis B virus( HBV) and hepatitis C virus( HCV) infection are frequently complicated by autoimmune disorders,which is commonly seen in patients with hepatitis C. This article introduces the mechanism of immune disorders in patients with chronic hepatitis C,the proportion of patients with non-organ specific autoantibody,and the clinical manifestations,diagnosis,and treatment of related immune diseases,such as mixed cryoglobulinemia,glomerulonephritis,Sjogren's syndrome,thyroid disease,and type 2 diabetes,as well as the mechanism of immune disorders,related immune manifestations,and effect of antiviral therapy in patients with chronic hepatitis B. Antiviral therapy for chronic hepatitis B and C can alleviate related immune diseases,but interferon therapy is not appropriate.Therefore,the patients with hepatitis B should be treated with nucleos( t) ide analogues,while those with hepatitis C should be treated with direct-acting antiviral agents.

In recent years,autoimmune hepatitis( AIH) has attracted more and more attention due to its unique clinicopathological features. However,its incidence and clinical features remain unclear,and systematic and in-depth studies are still needed. This article reviews the epidemiology,etiology,pathogenesis,clinical features,and diagnosis and treatment of AIH and points out that clinical studies or animal models of AIH have proved the effects of TNF-α neutralizing antibody,rituximab,all-trans retinoic acid,and regulatory T cell transplantation in the treatment of AIH.

Objective To investigate the influence of intestinal endotoxemia on Treg / Th17 imbalance in patients with chronic hepatitis B( CHB). Methods A total of 80 patients with CHB who were hospitalized and treated in The First Affiliated Hospital of Shanxi Medical University from December 2014 to October 2015 were enrolled as CHB group,and 20 healthy controls who underwent physical examination were enrolled HC group. According to the serum level of endotoxin( ET),the CHB group was further divided into ET-positive group and ET-negative group. The mRNA expression of Foxp3 and RORγt,percentages of Treg and Th17,serum level of alanine aminotransferase( ALT),and HBV DNA level in peripheral blood mononucleated cells were measured. The independent samples t-test was used for comparison of continuous data between any two groups,a one-way analysis of variance was used for comparison between multiple groups,and the SNK-q test was used for further comparison between any two groups; the chi-square test was used for comparison of categorical data between groups. Results Compared with the HC group,the CHB group showed significant increases in the percentages of Treg( 6. 51% ±1. 18% vs 5. 91% ± 1. 29%,P < 0. 05) and Th17( 4. 99% ± 1. 07% vs 4. 18% ± 0. 87%,P < 0. 05) and relative expression of Foxp3( 2. 12 ± 0. 83 vs 1. 60 ± 0. 70,P < 0. 05) and RORγt( 1. 56 ± 0. 77 vs 1. 09 ± 0. 59,P < 0. 05). Compared with the ET-negative group,the ET-positive group showed significant increases in the percentages of Treg( 6. 75% ± 1. 17% vs 6. 21% ± 1. 14%,P < 0. 05) and Th17( 5. 39% ± 1. 03% vs 4. 48% ± 0. 91%,P < 0. 05),relative expression of Foxp3( 2. 29 ± 0. 90 vs 1. 91 ± 0. 70,P < 0. 05) and RORγt( 1. 84 ± 0. 76 vs 1. 23 ± 0. 64,P < 0. 05),Th17 /Treg ratio( 0. 82 ± 0. 19 vs 0. 74 ± 0. 16,P < 0. 05),RORγt/Foxp3 ratio( 0. 95 ± 0. 38 vs 0. 74 ± 0. 54,P < 0. 05),and serum level of ALT( 220. 16 ± 115. 82 U / L vs 170. 86 ± 99. 69 U / L,P < 0. 05). The ET-positive group showed an increase in HBV DNA load compared with the ET-negative group,but there was no significant difference in HBV DNA load between the two groups. The correlation analysis showed that in CHB patients,ET was positively correlated with Th17,Treg,and ALT( r =0. 515、0. 438、0. 348,all P < 0. 05) and had no correlation with HBV DNA. Conclusion Intestinal endotoxemia in CHB patients may increase the mRNA expression of Foxp3 and RORγt and the percentages of peripheral Treg and Th17,cause Treg / Th17 imbalance,and thus result in difficult clearance of HBV and chronicity of HBV infection.

Objective To investigate the influence of hepatitis B virus( HBV) infection on intrahepatic natural killer( NK) cells and innate lymphoid cell 22( ILC22),and to provide theoretical and experimental bases for clarifying mechanisms of HBV infection in inducing innate immune response. Methods A total of 10 male BALC / c aged 6-8 weeks were divided into experimental group and control group,with 5 mice in each group. The mice in the experimental group were treated with the hydrodynamic injection of normal saline containing 10μg plasmids of complete HBV genome( the volume equaled to 9% of the body weight of the mouse) via the caudal vein,and those in the control group were only treated with normal saline. The mice were scarified 4 days later,and intrahepatic lymphocytes( IHLs) were isolated.Flow cytometry was used to determine the proportions of NK cells and ILC22 subset in IHLs,and the t-test was used for comparison between groups. Results Hydrodynamic injection of the plasmids containing complete HBV genome induced high levels of HBs Ag and HBe Ag in mice,with an increase in the serum level of alanine aminotransferase. After HBV infection,the experimental group showed a significant increase in the proportion of intrahepatic NK cells compared with the control group( 25. 90% ± 4. 92% vs 12. 98% ± 2. 13%,t = 3. 811,P =0. 003),while there were no significant differences in the proportions of CD127+and CD127-NK subsets in NK cells between the two groups. Moreover,after HBV infection,the experimental group showed a significant increase in the proportion of intrahepatic NKp46+ILC22subset compared with the control group( 36. 05% ± 6. 85% vs 10. 22% ± 3. 54%,t = 7. 372,P < 0. 001); however,there was no significant difference in the proportion of NKp46-ILC22 between the two groups. Conclusion HBV infection induces increased levels of intrahepatic NK cells and NKp46+ILC22 cells and thus promotes the innate immune response in the liver.

Objective To investigate the correlation of aspartate aminotransferase to platelet ratio index( APRI),FIB-4,Forns index,S index,and Fibro Scan with the degree of liver fibrosis,the diagnostic value of these techniques used alone or in combination,and the clinical value of these noninvasive techniques in the assessment of the degree of liver fibrosis in patients with chronic hepatitis B( CHB). Methods A retrospective analysis was performed for the clinical data of 91 patients with pathologically confirmed CHB who visited General Hospital of Ningxia Medical University and underwent liver biopsy from January 2009 to April 2015. According to the Scheuer pathological stage and liver fibrosis stage( S),the patients were divided into non-liver fibrosis group( a liver fibrosis stage of S0,32 patients),mild liver fibrosis group( a liver fibrosis stage of < S2,30 patients),and marked liver fibrosis group( a liver fibrosis stage of ≥S2,29 patients). The APRI,FIB-4,Forns index,and S index were calculated,and liver stiffness was measured by Fibro Scan. An analysis of variance was used for the comparison of normally distributed continuous data between three groups,and the Dunnett t-test was used for further comparison between any two groups. The Spearman correlation analysis was also performed. Sensitivity,specificity,and area under the receiver operating characteristic curve( AUC) were used to evaluate the value of these noninvasive techniques in the diagnosis of liver fibrosis. Results There were significant differences in age,albumin,aspartate aminotransferase,alanine aminotransferase,and platelet count between the three groups( F = 3. 552,4. 035,4. 374,and 5. 992,all P < 0. 05),and there were significant differences in these parameters between the non-liver fibrosis group and the mild and marked liver fibrosis groups( P < 0. 05). There were significant differences in APRI,FIB-4,Forns index,S index,and Fibro Scan between the three groups( F = 4. 579,5. 728,10. 501,14. 118,and 30. 039,all P < 0. 05); there were significant differences in these indices between the non-liver fibrosis group and the mild and marked liver fibrosis groups( P < 0. 05),and there was a significant difference in Fibro Scan between the mild liver fibrosis group and the marked liver fibrosis group( P < 0. 05). APRI,FIB-4,Forns index,S index,and Fibro Scan were positively correlated with the pathological stage of liver fibrosis( r = 0. 499,0. 498,0. 402,0. 395,and 0. 739,all P < 0. 05). APRI,FIB-4,Forns index,S index,or Fibro Scan alone has certain value in the diagnosis of liver fibrosis,with an AUC( 95% CI) of 0. 786( 0. 679-0. 892),0. 818( 0. 717-0. 918),0. 770( 0. 661-0. 880),0. 718( 0. 599-0. 837),or 0. 919( 0. 864-0. 974)( all P < 0. 01). When APRI,FIB-4,Forns index,or S index was combined with Fibro Scan,the AUC( 95% CI) was increased to 0. 922( 0. 868-0. 976),0. 931( 0. 881-0. 981),0. 926( 0. 873-0. 979),and 0. 918( 0. 862-0. 974),respectively. A combination of APRI,FIB-4,Forns index,S index,and Fibro Scan increased the AUC( 95% CI) to 0. 927( 0. 875-0. 979). Conclusion APRI,FIB-4,Forns index,S index,and Fibro Scan are significantly positively correlated with liver fibrosis grade. A combination of these indices can increase the accuracy of the diagnosis of liver fibrosis and has a similar value as pathological diagnosis and a certain value in the early diagnosis of liver fibrosis. Moreover,it can guide the selection of the timing of antiviral therapy in clinical practice.

Objective To investigate the role of dual-source CT low-dose whole liver perfusion imaging in evaluating the hemodynamic changes in liver parenchyma before and after transjugular intrahepatic portosystemic shunt( TIPS) in cirrhotic patients with portal hypertension. Methods A total of 52 cirrhosis patients with portal hypertension underwent whole liver perfusion CT scan 2 days before TIPS and at1 week after TIPS. The image quality was evaluated and a post-processing workstation was used to observe the changes in perfusion parameters. Paired t-test was applied for comparison between two groups,and pearson linear correlation was applied for correlation analysis. Results Hepatic arterial perfusion( HAP) increased from 19. 85 ml /( min·100 ml) ± 9. 48 ml /( min·100 ml) before TIPS to 29. 36 ml /( min·100 ml) ± 13. 65 ml/( min·100 ml) after TIPS( t =-6. 161,P = 0. 003),and the hepatic arterial perfusion index( HPI) increased from 54. 32% ± 19. 60% before TIPS to 64. 11% ± 11. 19% after TIPS( t =-6. 202,P = 0. 029). Portal vein perfusion( PVP)was reduced from 19. 75 ml /( min·100 ml) ± 10. 60 ml /( min·100 ml) before TIPS to 16. 13 ml /( min·100 ml) ± 8. 60 ml /( min·100ml) after TIPS,and total liver perfusion( TLP) increased from 36. 14 ml /( min ·100 ml) ± 16. 61 ml /( min ·100 ml) before TIPS to44. 12 ml /( min·100 ml) ± 14. 60 ml /( min·100 ml) after TIPS( both P > 0. 05). The mean effective radiation dose of whole liver perfusion scan was 16. 5 m Sv. PVP,TLP,and HPI were significantly correlated with the injection rate of contrast agent( r = 0. 992,P = 0. 001; r=-0. 903,P = 0. 036; r =-0. 899,P = 0. 038). HAP,PVP,and TLP were negatively correlated with the sample size( r =-0. 922,P =0. 026; r =-0. 943,P = 0. 016; r =-0. 998,P < 0. 001). TLP was positively correlated with the voltage of X-ray tube and scantimes( r =0. 896,P = 0. 039; r = 0. 907,P = 0. 033). Conclusion Dual-source CT low-dose whole liver perfusion can be used to observe the hemodynamic changes in cirrhotic patients with portal hypertension before and after TIPS and provide a reference for preoperative evaluation and therapeutic effect evaluation.

Objective To investigate the long-term postoperative efficacy of transjugular intrahepatic portosystemic shunt( TIPS) using polytetrafluoroethylene( PTFE)-covered stent or bare stent,and to provide a basis of evidence-based medicine for the selection of stent in TIPS. Methods CBM,Wanfang Data,CNKI,VIP,MEDLINE,and Pub Med were searched for controlled trials on TIPS in the treatment of cirrhotic portal hypertension published form 1989 to 2015; the studies which met the inclusion criteria were selected,and quality assessment was performed for these articles. Rev Man 5. 3 software was used to analyze the incidence rates of stent dysfunction and hepatic encephalopathy and 1-year survival rate after TIPS,and funnel plots were used to analyze publication bias. Results A total of 11 studies were included,consisting of 698 patients in PTFE-covered stent group and 1283 patients in bare stent group. The results of the meta-analysis showed that the PTFE-covered stent group showed a significantly lower incidence rate of stent dysfunction than the bare stent group( 14. 8% vs 47. 0%,OR = 0. 18,95% CI: 0. 13-0. 24,P < 0. 001). There was no significant difference in the incidence rate of hepatic encephalopathy between the two groups( 23. 5% vs 25. 7%,OR = 0. 88,95% CI: 0. 66-1. 17,P = 0. 37). The PTFE-covered stent group had a significantly higher 1-year survival rate than the bare stent group( 76. 9% vs 62. 7%,OR = 2. 10,95% CI: 1. 54-2. 85,P< 0. 001). The funnel plots which were plotted based on the incidence rates of stent dysfunction and hepatic encephalopathy and 1-year survival rate lacked symmetry,which suggested that a certain degree of publication bias might exist. Conclusion Compared with the bare stent,the PTFE-covered stent can improve stent dysfunction and 1-year survival rate after TIPS,while there is no significant change in the incidence rate of hepatic encephalopathy. Therefore,the PTFE-covered stent has certain advantages over the bare stent in TIPS. In future,multicenter prospective randomized controlled clinical trials with a larger sample size are needed to provide a basis of evidence-based medicine for the application of covered stent in TIPS.

Objective To investigate the clinical effects of bone marrow mesenchymal stem cell( BMSC) transplantation via different approaches in the treatment of liver cirrhosis in mice. Methods A total of 46 BALB / c mice were randomly divided into normal control group with 5 mice and liver cirrhosis model group with 41 mice. Subcutaneously injected carbon tetrachloride olive oil was used to establish the mouse model of liver cirrhosis. A total of 36 mice with liver cirrhosis were randomly divided into control group,caudal vein BMSC transplantation group,and spleen BMSC transplantation group,with 12 mice in each group. Whole bone marrow adherent culture was performed to obtain the third-generation BMSCs,and flow cytometry was used for cell surface identification. BMSCs were injected into the mice through the caudal vein or spleen. Blood samples were collected at 4 weeks after transplantation to measure liver function. HE and Masson staining and α-smooth muscle actin( α-SMA) immunohistochemistry were performed for liver sections. Liver injury and fibrosis in mice were examined. A one-way analysis of variance was used for comparison between groups. Results At 8 weeks after the establishment of the model,the mice in the model group had sparse and dark yellow hair,reduced food consumption and activity,and a reduction in body weight.After transplantation,compared with the model control group,the caudal vein BMSC transplantation group and spleen BMSC transplantation group showed a significant increase in albumin and significant reductions in alanine aminotransferase and aspartate aminotransferase( all P<0. .="" there="" were="" no="" significant="" differences="" between="" the="" two="" transplantation="" p="">0. 05). After transplantation,there were significant changes in diseased tissue,alleviated liver cirrhosis,reduced collagen fiber and necrotic area,and a good structure. Immunohistochemistry showed both transplantation groups showed significant reductions in the number of cells with positive α-SMA. Conclusion BMSC transplantation via the tail vein or spleen can improve liver function and diseased tissue in mice with liver cirrhosis and these two approaches have comparable clinical effects.

Objective To investigate the clinical effect and safety of albumin-bound paclitaxel( Nab-P) as the first-line treatment for advanced primary liver cancer. Methods A retrospective analysis was performed for the clinical data of 23 patients with advanced primary liver cancer who were admitted to the Department of Medical Oncology in Chinese PLA General Hospital from May 2014 to December 2015.According to the treatment regimen,these patients were divided into observation group and control group. The 12 patients in the observation group were treated with Nab-P,among whom 5 were treated with Nab-P combined with tegafur,gimeracil and oteracil,5 were treated with Nab-P combined with capecitabine,and 2 were treated with Nab-P alone; the 11 patients in the control group were treated with gemcitabine combined with oxaliplatin. One cycle of the treatment was 21 days for each treatment regimen; therapeutic effect was evaluated every2 cycles,and adverse events were evaluated every cycle. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups,the Kaplan-Meier survival curves were used to analyze progression-free survival,and the log-rank test was used to compare survival rates between groups. Results All the patients were eligible for evaluation of clinical outcome and adverse events.In the observation group,2 patients achieved partial remission,7 had a stable disease,and 3 had a progressive disease; in the control group,2 achieved partial remission,5 had a stable disease,and 4 had a progressive disease. There was no significant difference in disease control rate between the two groups( 75% vs 64%,χ2= 0. 350,P > 0. 05). There was also no significant difference in the median progression-free survival between the two groups [5. 1( 2. 7-6. 7) months vs 4. 3( 2. 5-5. 4) months,χ2= 0. 647,P > 0. 05]. As for adverse events,no patient experienced serious adverse events,and there were significant differences in the incidence rates of platelet toxicity and increased aspartate aminotransferase between the two groups( χ2= 5. 490 and 6. 135,P = 0. 036 and 0. 027). Conclusion In the treatment of advanced primary liver cancer,the medication based on Nab-P shows a good clinical effect and tolerable toxic and side effects; however,due to the small sample size in this study,the clinical studies with a large sample size are needed.

Objective To investigate the clinical effect of laparoscopic liver resection( LLR) versus open liver resection( OLR) in the treatment of patients with hepatocellular carcinoma( HCC) complicated by liver cirrhosis. Methods A total of 136 patients who were diagnosed with HCC complicated by liver cirrhosis in Linxia Municipal People's Hospital from January 2006 to December 2007 were enrolled and underwent LLR( LLR group,64 patients) or OLR( OLR group,72 patients). The short-term outcome,pathological factors,and long-term outcome were compared between the two groups. The t-test was used for comparison of continuous data between groups,the chi-square test was used for comparison of categorical data between groups,and the log-rank test was used for comparison of survival functions.Results There were significant differences between the LLR group and the OLR group in time of operation(( 86. 43 ± 23. 55) min vs( 62. 31 ± 19. 61) min,t = 8. 539,P < 0. 001) and length of postoperative hospital stay(( 7. 22 ± 3. 45) d vs( 12. 27 ± 5. 31) d,t =2. 764,P = 0. 024),while there were no significant differences in intraoperative blood loss,time of hepatic portal occlusion,and overall fatality rate( all P > 0. 05). There were also no significant differences in number of tumors,presence or absence of liver cirrhosis,microvascular invasion,resection margin,and maximum tumor diameter between the two groups( all P > 0. 05). As for long-term outcome,the 1-,3-,and 5-year disease-free survival rates were 83. 30%,48. 61%,and 38. 29% in the LLR group and 78. 64%,51. 26%,and43. 01% in the OLR group; the 1-,3-,and 5-year overall survival rates were 97. 42%,95. 13%,and 89. 23% in the LLR group and96. 41%,94. 28%,and 90. 06% in the OLR group. There were no significant differences in these survival rates between the two groups( all P > 0. 05). Conclusion In patients with HCC complicated by liver cirrhosis,LLR helps to achieve rapid postoperative recovery and similar long-term outcome compared with OLR; therefore,it holds promise for clinical application.

Objective To investigate the effect of continuous irradiation with~(125)I radioactive seeds in inhibiting HepG2 cell proliferation and possible mechanisms in inducing apoptosis. Methods Human hepatoma cell line HepG2 was selected as the research object and exposed to continuous irradiation with~(125)I radioactive seeds. The initial dose rate was 5. 32 c Gy / h,and HepG2 cells were exposed to a dose of 0,2,or4 Gy. A light microscope and Hoechst33258 staining were used to observe the morphological change of HepG2 cells,the colony-forming assay was used to calculate plating efficiency,the scratch test was used to evaluate the change in migration ability,flow cytometry was used to measure cell apoptosis,and Western Blot was used to measure the expression of apoptosis-related proteins. An analysis of variance was used for comparison between multiple groups,and the least significant difference method was used for further comparison between any two groups. Results After HepG2 cells were exposed to~(125)I radioactive seeds at a dose of 0 Gy,2 Gy,or 4 Gy,the 4 Gy group showed a reduction in cell density and an increase in the number of spherical free dead cells,as was shown by the light microscope; Hoechst33258 staining showed that the 4 Gy group had typical features of apoptotic cells,such as karyopyknosis,fragmentation,and margination. The colony-forming assay showed that there were significant differences in plating efficiency between the control group,2 Gy group,and 4 Gy group( 120. 00% ± 3. 61%,112. 00% ± 2. 00%,and 45. 00% ± 3. 61%,F = 508. 90,P < 0. 001). The scratch test showed that there were significant differences in cell migration rate between the control group,2 Gy group,and 4 Gy group( 21. 24% ± 4. 36%,19. 93% ± 3. 37%,and 11. 42% ± 0. 65%,F = 8. 29,P < 0. 001). The results of flow cytometry for cell apoptosis showed that there were significant differences in cell apoptosis rate between the control group,2 Gy group,and 4 Gy group( 4. 33% ± 0. 67%,6. 90% ± 1. 31%,and 17. 03% ±1. 43%,F = 110. 01,P < 0. 001). Western blot showed that ~(125)I irradiation significantly inhibited the expression of tumor proliferation-related protein PCNA,apoptosis-related protein Survivin,and Bcl-2 and promoted the expression of pro-apoptotic proteins Bak and Bax. Conclusion~(125)I radioactive seeds inhibit the growth of HepG2 cells through promoting HepG2 cell apoptosis and inhibiting proliferation and migration. The possible mechanism may be related to the inhibition of the expression of apoptosis-related proteins.

Objective To investigate the spiral CT and ultrasound findings of hepatic adenoma and the value of spiral CT and ultrasound in the diagnosis of hepatic adenoma. Methods A retrospective analysis was performed for the spiral CT and ultrasound findings of 15 patients with pathologically confirmed hepatic adenoma in Langfang Hospital of Traditional Chinese Medicine from July 2009 to December 2015. Results All the 15 patients showed hypoechoic,isoechoic,or hyperechoic ultrasound findings. Seven of these patients had single hepatic adenoma. In the 7 cases,4 had low-density lesions,1 had a slightly low-density lesion,and 2 had equal-density lesions; as for the arterial phase,5 showed obvious enhancement,1 showed moderate enhancement,and 1 showed mild enhancement; as for the portal venous phase and delayed phase,3 showed reduced enhancement,2 had equal-density lesions,and 2 showed gradual enhancement. Eight patients experienced multiple hepatic adenoma with 80 lesions in total. In the 80 lesions,4 lesions( 3 patients) showed a mixed density,40 lesions( 4patients) showed a low density,36 lesions( 4 patients) showed a slightly low density; 8 lesions( 4 patients) showed obvious enhancement in the arterial phase and reduced enhancement in the portal venous phase and delayed phase; 3 lesions( 1 patient) showed obvious enhancement in the arterial phase and an equal density in the portal venous phase and delayed phase; 18 lesions( 2 patients) showed obvious enhancement in the arterial phase and portal venous phase and reduced enhancement in the delayed phase; 49 lesions( 5 patients) showed moderate enhancement in the arterial phase and reduced enhancement in the portal venous phase and delayed phase; 2 lesions( 1 patient)showed no enhancement in any phase. The correct rates of spiral CT in the diagnosis of single hepatic adenoma and multiple hepatic adenomas were 14. 3%( 1 /7) and 87. 5%( 7 /8),respectively. Conclusion Ultrasound can only suggest space-occupying lesions,but cannot analyze the lesions qualitatively; spiral CT with three-phase enhancement scanning has a great value in the diagnosis of hepatic adenoma,especially multiple hepatic adenoma.

Objective To investigate the clinical effect of ultrasound-guided percutaneous transhepatic gallbladder drainage( PTGD) in the treatment of acute cholecystitis in elderly patients. Methods A retrospective analysis was performed for the clinical data of 62 patients who underwent PTGD in Nanjing Hospital Affiliated to Nanjing Medical University from June 2010 to June 2015. The body temperature,white blood cell( WBC) count,liver function,and gallbladder size were measured before PTGD and at 24 and 72 hours after PTGD. The paired t-test was used for comparison of continuous data before and after treatment within each group. Results All the patients achieved a one-time success in PTGD. There was no significant change in body temperature at 24 hours after PTGD( t = 0. 91,P > 0. 05). There were significant reductions in WBC count,alanine aminotransferase,and aspartate aminotransferase from 24 to 72 hours after PTGD,as well as a significant reduction in gallbladder size( all P < 0. 05). Conclusion Ultrasound-guided PTGD is a safe and effective minimally invasive method for the treatment of acute cholecystitis in critically ill elderly patients who are unable to undergo surgery.

Objective To investigate the value of laparoscopic gallbladder-preserving partial cholecystectomy in the treatment of abnormal gallbladder morphology complicated by sand-like calculous cholecystitis. Methods A total of 18 patients with abnormal gallbladder morphology complicated by sand-like calculous cholecystitis who underwent laparoscopic and choledochoscopic partial cholecystectomy in Dalian Friendship Hospital from July 2010 to January 2014 were enrolled. All the patients had abnormal gallbladder morphology manifested as folded gallbladder or adenomyosis,and the lesions were located in the distal end of the gallbladder. Before the surgery,gallbladder contraction test was performed for the diseased part and the normal part of the gallbladder to be preserved. During the surgery,choledochoscopy showed an unobstructed cystic duct and good elasticity in the gallbladder wall,and there was no marked chronic inflammation. After the diseased part of the gallbladder was removed,4-0 absorbable suture was used for two-layer consecutive suture of the gallbladder. The t-test was used for comparison of continuous data between groups. Results All the patients underwent the surgery successfully. The mean time of operation was 98. 0± 9. 0 minutes,and the mean time to first flatus was 22. 8 ± 2. 5 hours. The patients were able to get out of the bed and drink water at 6 hours after surgery and to have meals at 24 hours after surgery. They fully recovered and were discharged at 5-7 days after surgery,and no patient experienced the complications such as bile leakage. The patients were followed up for 6-80 months; the patients' preoperative clinical symptoms disappeared,and there was no recurrence of calculi. At 6-12 months after surgery,the patients experienced compensated cholecystectasis,and there was a significant increase in the mean volume of the gallbladder after surgery( 30. 29 ± 4. 23 cm3 vs 21. 72 ± 4. 34 cm3,t =-13.00,P < 0. 001). There was a significant increase in mean gallbladder contraction after surgery( 56. 9% ± 10. 9% vs 48. 5% ± 12. 7%,t =-6. 11,P < 0. 001). Conclusion In the treatment of abnormal gallbladder morphology complicated by sand-like calculous cholecystitis,laparoscopic and choledochoscopic gallbladder-preserving partial cholecystectomy plays an important role in protecting the gallbladder and its function.It may become a new surgical procedure in gallbladder-preserving surgical treatment when its indications are strictly followed.

Objective To investigate the high-risk factors for acute liver failure after radical surgery combined with hemihepatectomy for hilar cholangiocarcinoma( HC). Methods A retrospective analysis was performed for the clinical data of 126 patients who were admitted to Chongqing Cancer Institute and underwent radical surgery combined with hemihepatectomy for HC from January 2000 to December 2014,including sex,age,preoperative serum levels of total bilirubin( TBil) and albumin( Alb),preservation of hepatic artery blood supply or not,application of nonselective hepatic vascular occlusion or not,intraoperative blood loss volume,and time of operation. The chi-square test was used for comparison of categorical data between groups,and multivariate logistic regression analysis was performed to determine independent risk factors for acute liver failure after surgery. Results A total of 17 patients( 13. 49%) experienced acute liver failure,and 11 patients( 8. 73%) died. A preoperative serum TBil level of > 200 μmol / L( OR = 1. 78,95% CI: 1. 05-3. 04,P = 0. 029),an intraoperative blood loss volume of > 800 ml( OR = 2. 64,95% CI: 1. 33-3. 95,P = 0. 003),no preservation of hepatic artery blood supply( OR = 3. 57,95% CI:2. 21-5. 09,P = 0. 002),and application of nonselective hepatic vascular occlusion( OR = 1. 36,95% CI: 0. 79-1. 78,P = 0. 037) were independent risk factors for acute liver failure after surgery. Conclusion Preoperative biliary drainage,a reduced intraoperative blood loss volume,preservation of hepatic artery blood supply,and avoiding nonselective hepatic vascular occlusion have great significance in reducing acute liver failure after radical surgery combined with hemihepatectomy for HC.

Objective To investigate clinical value of serum C-reactive protein( CRP),procalcitonin( PCT),and lipase in predicting severe acute pancreatitis( SAP) during pregnancy. Methods A retrospective analysis was performed for the clinical data of 126 pregnant women with acute pancreatitis( AP) who were treated in Nongken Sanya Hospital from January 2011 to January 2016. According to the severity of AP,the patients were divided into control group( pregnancy complicated by mild-to-moderate AP,71 patients) and observation group( pregnancy complicated by SAP,55 patients). The clinical features of AP in pregnancy were compared between the two groups. The laboratory markers including venous leukocyte count,hemoglobin,plasma albumin,blood amylase,CRP,PCT,and lipase were observed. The t-test was used for comparision of continuos data between groups,and the chi-square test was used for comparision of categorial data between groups,and the receiver operating characteristic( ROC) curves were plotted for statistically significant markers to assess their sensitivities and specificities. Results The observation group had significantly higher serum levels of lipase,PCT,and CRP than the control group( lipase: 857. 73 ± 158. 61 U / L vs 590. 19 ±138. 67 U / L,χ~2= 7. 689,P < 0. 01; PCT: 10. 07 ± 4. 55 ng / ml vs 5. 89 ± 2. 13 ng / ml,χ~2= 15. 492,P < 0. 01; CRP: 269. 93 ± 63. 61 mg / L vs 202. 64 ± 39. 58 mg / L,χ~2= 7. 500,P < 0. 01). According to the ROC curves,serum lipase,PCT,and CRP had areas under the ROC curve of 0. 920,0. 841,and 0. 832,respectively,with corresponding cut-off values of 712 U / L,7. 6 ng / ml,and 262. 0 mg / L,sensitivities of 87.9%,83. 5%,and 81. 3%,and specificities of 83. 2%,86. 1%,and 78. 9%,respectively. Conclusion Increased serum levels of lipase,PCT,and CRP have a great value in the diagnosis of SAP during pregnancy.

Objective To investigate the effect of recombinant interleukin-2( r IL-2) combined with allicin in the treatment of pancreatic cancer and related mechanisms. Methods A nude mouse xenograft model was established. A total of 60 nude mice were randomized into control group,r IL-2 treatment group,allicin treatment group,and combined treatment group. At 4 weeks after treatment,peripheral blood was collected,tumor volume,tumor weight,and survival time were recorded,and survival rates were calculated. Flow cytometry was used to analyze the apoptosis of tumor cells and measure the percentages of CD4+T,CD8+T,and natural killer( NK) cells,ELISA was used to measure the level of interferonγ( IFNγ),and Western blot was used to measure the expression of Bcl-2 protein in tumor tissue. An analysis of variance was used for comparison of continuous data between groups,and SNK-q test was used for further comparison between any two groups. Results At 4 weeks after treatment,the r IL-2 treatment group,allicin treatment group,and combined treatment group showed significant reductions in tumor volume compared with the control group( all P < 0. 05),and the combined treatment group showed the greatest reduction( P < 0. 01). The combined treatment group had a tumor inhibition rate of 90. 5% and a prolonged survival time( 60% of the mice survived at 55 days). Compared with the control group,the combined treatment group showed significant increases in the apoptosis rate of tumor cells( 23. 3% ± 4. 3% vs 9. 0% ± 3. 7%,P < 0. 05) and the expression of pro-apoptotic protein Bcl-2. The treatment groups showed significant increases in the percentages of CD4+T,CD8+T,and NK cells compared with the control group( F = 23. 74,26. 38,and 19. 72,all P < 0. 001). Compared with the other three groups,the combined treatment group showed a significant increase in the IFNγlevel( F = 9. 84,P = 0. 026). Conclusion Combined treatment with allicin and r IL-2 can enhance the innate immunity and adaptive immunity and thus improve the survival of pancreatic cancer.

Objective To investigate the clinical effect of Mongolian drug Qinggan Jiuwei powder in the treatment of patients with alcoholic hepatitis. Methods A total of 63 patients with alcoholic hepatitis who were admitted to Affiliated Hospital of Inner Mongolia University for The Nationalities from May 2014 to April 2016 were enrolled. The 32 patients in the trial group were given Mongolian drug Qinggan Jiuwei powder,and the 31 patients in the control group were given reduced glutathione tablets. The course of treatment was 4 weeks for both groups,and the patients were asked to quit drinking,stay in bed,and have a rest. The t-test was used for the comparison of continuous data between groups. Results After treatment,the control group showed significant improvements in the liver function parameters alanine aminotransferase( ALT),aspartate aminotransferase( AST),and gamma-glutamyl transpeptidase( GGT)( ALT: 38. 7 ± 13. 3 U / L vs 77. 5 ±16. 7 U / L,t = 10. 21,P < 0. 01; AST: 43. 8 ± 21. 8 U / L vs 176. 6 ± 40. 1 U / L,t = 16. 90,P < 0. 01; GGT: 63. 8 ± 21. 7 U / L vs 302. 9 ±73. 3 U / L,t = 17. 40,P < 0. 01); the trial group also showed significant improvements in these parameters( ALT: 37. 6 ± 14. 6 U / L vs78. 1 ± 17. 5 U / L,t = 10. 10,P < 0. 01; AST: 39. 6 ± 15. 3 U / L vs 180. 3 ± 44. 3 U / L,t = 16. 40,P < 0. 01; GGT: 59. 9 ± 23. 8 U / L vs304. 7 ± 66. 5 U / L,t = 19. 60,P < 0. 01). After treatment,the control group showed significant improvements in the serum liver fibrosis parameters hyaluronic acid,precollagen type Ⅲ,laminin,and collagen type Ⅳ( hyaluronic acid: 122. 1 ± 36. 2 ng / ml vs 369. 2 ± 139. 8ng / ml,t = 9. 52,P < 0. 05; precollagen type Ⅲ: 118. 6 ± 43. 8 ng / ml vs 185. 9 ± 92. 7 ng / ml,t = 3. 66,P < 0. 05; laminin: 137. 2 ±49. 9 ng / ml vs 166. 1 ± 50. 4 ng / ml,t = 2. 24,P < 0. 05; collagen type Ⅳ: 128. 7 ± 48. 3 ng / ml vs 155. 1 ± 44. 5 ng / ml,t = 2. 27,P <0. 05); the trial group also showed significant improvements in these parameters( hyaluronic acid: 101. 1 ± 27. 9 ng / ml vs 367. 4 ± 149. 7ng / ml,t = 9. 88,P < 0. 01; precollagen type Ⅲ: 91. 6 ± 48. 4 ng / ml vs 188. 3 ± 100. 5 ng / ml,t = 4. 95,P < 0. 01; laminin: 94. 8 ± 34. 6ng / ml vs 167. 6 ± 48. 7 ng / ml,t = 5. 61,P < 0. 01; collagen type Ⅳ: 92. 7 ± 30. 3 ng / ml vs 161. 3 ± 62. 2 ng / ml,t = 6. 87,P < 0. 01).There were significant differences in the liver function parameters after treatment between the two groups( t = 2. 53,2. 31,3. 56,and 3. 90,all P < 0. 05). Conclusion The Mongolian drug Qinggan Jiuwei powder can improve liver function and reduce liver fibrosis parameters in patients with alcoholic hepatitis.

Objective To investigate the effect of Qianggan capsules on liver fibrosis score and insulin resistance index in patients with nonalcoholic fatty liver disease( NAFLD). Methods A total of 85 NAFLD patients who were treated in the Eighth People's Hospital of Shanghai from August 2014 to July 2015 were enrolled and randomly divided into treatment group( 45 patients) and control group( 40 patients).The patients in the treatment group were given Qianggan capsules,and those in the control group were given polyene phosphatidylcholine capsules. The course of treatment was 24 weeks for both groups. The changes in serum aminotransferases [aspartate aminotransferase( AST)and alanine aminotransferase( ALT) ],homeostasis model assessment of insulin resistance( HOMA-IR),and NAFLD fibrosis score( NAFLDFS) after treatment were observed in both groups. The t-test was used for comparison of continuous data between groups,before-after comparison within each group was made by paired t-test; and the chi-square test was used for comparison of categorical data between groups. Results Both groups showed significant improvements in ALT and AST levels after treatment( all P < 0. 01). After treatment the treatment group showed significant reductions in HOMA-IR and NAFLDFS( 3. 58 ± 0. 85 vs 2. 48 ± 0. 78,t = 6. 40,P < 0. 01;-1. 78 ±1. 24 vs-2. 35 ± 0. 98,t = 2. 40,P < 0. 01) and the treatment group had significantly lower HOMA-IR and NAFLDFS than the control group( 12. 48 ± 0. 78 vs 3. 09 ± 0. 89,t = 3. 36,P < 0. 01;-2. 35 ± 0. 98 vs-1. 48 ± 1. 08,t = 3. 80,P < 0. 01). No serious adverse events were observed during the course of treatment. Conclusion Qianggan capsules not only reduce the levels of serum aminotransferases,but also improve insulin resistance and reduce fibrosis degree in NAFLD patients.

Objective To investigate the changes in the levels of serum adiponectin( APN) and serum ferritin( SF) in patients with nonalcoholic fatty liver( NAFL) and normal populations in Qinghai,China,as well as the significance of APN and SF in the pathogenesis of NAFL. Methods A total of 39 patients diagnosed with NAFL in The Affiliated Hospital of Qinghai University from February to October,2015 were enrolled as NAFL group,and 34 healthy individuals who underwent physical examination were enrolled as control group. The anthropometric parameters and routine clinical biochemical parameters were measured and enzyme-linked immunosorbent assay and chemiluminescence immunoassay were used to measure the levels of serum APN and SF. The independent-samples t test was used for comparison between two groups,and the Pearson correlation analysis was also performed. Results Compared with the control group,the NAFL group had a significantly higher level of SF( 291. 97 ± 38. 82 ng / ml vs 93. 21 ± 8. 74 ng / ml,t = 31. 085,P < 0. 001) and a significantly lower serum level of APN( 11. 91 ± 2. 88 mg / L vs 16. 18 ± 2. 80 mg / L,t = 6. 383,P < 0. 001). The correlation analysis showed that in the NAFL group,serum APN level was negatively correlated with TG level( r =-0. 466,P < 0. 01). Conclusion The patients with NAFL in Qinghai have a reduced serum APN level and an increased SF level,and in these patients,serum APN level is negatively correlated with TG level. Serum APN monitoring may be used as a reference index to evaluate the treatment outcome of hypertriglyceridemia.

Objective To investigate the incidence of postoperative complications in laparoscopic versus open common hepatic duct-jejunal Roux-en-Y anastomosis. Methods The databases of Pub Med,Web of Science,CNKI,VIP,and Wanfang Data were searched for related studies on postoperative complications in laparoscopic or open common hepatic duct-jejunal Roux-en-Y anastomosis published up to May 20,2016. Two reviewers performed literature screening according to inclusion and exclusion criteria,data extraction,and quality assessment independently. STATA12. 0 software was used for the meta-analysis. Results A total of 9 studies with 548 patients were enrolled. Among these patients,261 underwent laparoscopic surgery and 287 underwent open surgery. The results of the meta-analysis showed that compared with the open surgery group,the laparoscopic surgery group had lower incidence rates of total complications( OR =0. 40,95% CI: 0. 24-0. 68,P = 0. 001),incision infection( OR = 0. 20,95% CI: 0. 08-0. 53,P = 0. 001),and adhesive ileus( OR= 0. 25,95% CI: 0. 06-0. 99,P = 0. 049). However,there was no significant difference in the incidence of bile leakage between the two groups( P > 0. 05). Conclusion Compared with open surgery,laparoscopic common hepatic duct-jejunal Roux-en-Y anastomosis has a lower incidence of total postoperative complications,and therefore,it is a safe and feasible surgical procedure.

Objective To investigate the clinical effect of endoscopic therapy for patients with esophagogastric variceal bleeding( EVB) after liver transplantation. Methods A retrospective analysis was performed for the clinical data of 8 patients who experienced EVB after liver transplantation and underwent endoscopic therapy,especially endoscopic features. The clinical outcome was evaluated,including hemostasis rate,change in varicose veins after treatment,and short-term recurrence and bleeding rate. Results The eight patients had a mean age of55. 00( 44. 75-61. 50) years,and the mean time from liver transplantation to bleeding was 71. 50( 18. 75-107. 25) months. As for primary diseases,6 patients had hepatitis B cirrhosis( among whom one patient each was complicated by liver cancer,alcoholic cirrhosis,and acute liver necrosis,and three were complicated by subacute liver necrosis),one had hepatitis C cirrhosis,and one had unexplained liver cirrhosis. Of all patients,2 underwent sclerotherapy,6 underwent endoscopic variceal ligation,and 6 underwent tissue adhesive treatment. The endoscopic therapy achieved successful hemostasis in all patients. No patients experienced rebleeding at discharge or the 12-month follow-up visit. One patient underwent selective endoscopic therapy due to the recurrence of varices. Conclusion Gastrointestinal bleeding remains a serious complication after liver transplantation. Besides antiviral therapy,the presence of varices should be closely monitored.

At present,nucleos( t) ide analogues and interferon-α still have limited effects in patients with chronic hepatitis B( CHB),and therefore,it is of vital importance to develop more effective therapeutic strategies to improve the treatment outcome of CHB patients. This article introduces the immunotherapy for CHB,including therapeutic vaccines( protein vaccines,DNA vaccines,and dendritic cell vaccines)and cell regulation therapy,and points out that immunotherapy is considered a promising treatment regimen for HBV infection. With further studies on the clinical outcome after HBV infection,significant advances have been achieved in immunotherapy for CHB.

The pathogenesis of chronic hepatitis B( CHB) is mainly chronicity of hepatitis B virus infection caused by specific immune impairment. Modern studies have shown that activated specific inflammatory cells and the cytokines released by these cells such as interferon-γ( IFN-γ) and interleukin-4( IL-4) play important roles in virus clearance and improvement of autoimmune function. With the constant development of traditional Chinese medicine,it has a widespread effect on the immune regulation system( especially IFN-γ and IL-4). This article reviews the research advances in immunologic mechanism if CHB in Chinese and Western medicine in recent years and provides new ideas and measures for traditional Chinese medicine to break the immune tolerance of CHB in terms of immune regulation.

In recent years,the role of immune cells in hepatitis B virus( HBV)-related liver diseases has attracted more and more attention. This article reviews the roles of regulatory T cells( Treg) and T-helper cell type 17( Th17) in the development,progression,and prognosis of HBV-related liver diseases,especially HBV-related liver fibrosis and liver failure,as well as hepatocellular carcinoma. It is pointed out that the dynamic changes of Treg and Th17 cells in different stages of HBV infection and their roles in hepatocellular carcinoma need further investigation,and future studies on the regulatory effects of various signaling pathways on Treg or Th17 cells are needed to provide a more precise direction for the treatment of HBV-related diseases.

As reported by the world health organization,about 650 thousand people die of liver failure,liver cirrhosis,and hepatocellular carcinoma caused by hepatitis B virus( HBV) infection every year. Although to a certain extent,the application of interferon and nucleos( t)ide analogues reduces the adverse outcome of chronic hepatitis B( CHB),so far no effective therapeutic method can eliminate HBV. HBV carriers have a significantly lower incidence rate of adverse outcome than active CHB patients,but they still have the risk of progression to liver cirrhosis and liver cancer. This article discusses the clinical identification and management of HBV carriers,so as to further clarify the features of chronic HBV carriers and related treatment measures in clinical practice.

Recent studies have found that microRNAs( miRNAs) can be secreted via exosomes,stay outside the cells,and keep stable in circulating blood. Various studies have shown that the changes in circulating miRNAs are associated with different pathological states,suggesting that the circulating miRNAs can be used as potential molecular targets for the diagnosis and treament of diseases. Research has shown that miRNAs are closely associated with the development and progression of liver fibrosis. This article reviews the studies on the differences in the expression of circulating miRNAs in the course of liver fibrosis and points out that circulating microRNAs can provide a new research direction for early noninvasive diagnosis and treatment of liver fibrosis.

Traditionally,liver cirrhosis has a bleeding tendency due to the reduction in blood coagulation factors,hyperfibrinolysis,thrombocytopenia,and increased portal hypertension. Some studies show that the patients with live cirrhosis are in a state of hypercoagulability and tend to develop venous thromboembolism,which greatly affects the patients' prognosis. This article reviews the epidemiological features and risk factors of venous thromboembolism,as well as the significance of prevention of venous thromboembolism in patients with liver cirrhosis,so as to guide clinical practice.

Hepatocellular adenomas( HCA) are rare benign tumors of the liver,and according to the differences in molecular genetics and pathology,HCA is categorized as inflammatory hepatocellular adenoma( IHCA),HCA with hepatocyte nuclear factor 1-alpha mutation( H-HCA),HCA with β-catenin mutation( β-HCA),and an undefined type. The incidence of these four types is 40%-50%,30%-40%,10%-15%,and 10%,respectively. In these four types of HCA,β-HCA has high risk of bleeding and malignant transformation,while H-HCA is not likely to show malignant transformation. Therefore,the accurate diagnosis of these types of HCA is very important. This article introduces the radiological features of these types of HCA on conventional MRI and hepatocyte-targeted contrast-enhanced scan and compares these findings with other types of liver solid tumors such as focal nodular hyperplasia,nodular regenerative hyperplasia,liver cancer in non-cirrhotic patients,and fibrolamellar carcinoma of the liver. It is pointed out that MRI and hepatocyte-targeted contrast agents play an important role in the diagnosis and differentiation of HCA.

Primary biliary cholangitis is an organ-specific chronic cholestatic autoimmune liver disease characterized by intrahepatic cholestasis,presence of anti-mitochondrial antibody in circulating blood,and progressive and non-suppurative damage of small intrahepatic bile ducts,which finally lead to extensive hepatic duct damage,biliary cirrhosis,and even liver failure. This article overviews the advances in the epidemiology,pathogenesis,diagnosis,and treatment of primary biliary cholangitis and points out that the safety and efficacy of the new drugs such as fibrates in the treatment of primary biliary cholangitis need to be confirmed by further studies.

In recent years,many reports on the diagnosis and treatment of IgG4-related sclerosing cholangitis have been published in China and foreign countries,but due to the small number of cases,there are few large-scale controlled clinical trials. Therefore,this article reviews the literature on the diagnosis and treatment of IgG4-related sclerosing cholangitis and points out that the diagnosis of IgG4-related sclerosing cholangitis needs complete clinical data and comprehensive pathological examinations,and its treatment relies on glucocorticoids and immunosuppressants.

Pancreatic cancer remains one of the malignant tumors with the worst prognosis,and its incidence is associated with Western diet,smoking,drinking,obesity,chronic pancreatitis,and a family history of pancreatic cancer. Currently,the treatment of pancreatic cancer focuses on surgery and chemotherapy,but no ideal therapeutic effect has been achieved. An understanding of the specific molecular mechanism of the development of pancreatic cancer helps to better prevent and treat pancreatic cancer. This article introduces the latest advances in the specific molecular mechanism of the development of pancreatic cancer and its targeted therapy and points out that molecular-targeted therapy in addition to traditional treatment helps to improve the prognosis of patients with pancreatic cancer.