2018 No. 8

Research history and perspectives of autoimmune pancreatitis

Qian JiaMing, Lai YaMin

2018, 34(8): 1595-1598. DOI: 10.3969/j.issn.1001-5256.2018.08.001

Abstract(1730)

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The research on autoimmune pancreatitis ( AIP) has progressed rapidly in recent years, causing a lot of clinical concerns. This article reviews the history of the understanding of AIP and the changes in the diagnostic criteria for AIP, with highlights on the new international diagnostic criteria and the diagnostic criteria for type 1 and type 2 AIP. This article also elaborates on the new advances in the treatment of AIP, from hormone therapy to the application of immunosuppressants, points out the issues which need to be considered in clinical practice, and proposes the future research directions for AIP.

Corticosteroid therapy for autoimmune pancreatitis

Ma Juan, Liu YuLan

2018, 34(8): 1599-1603. DOI: 10.3969/j.issn.1001-5256.2018.08.002

Abstract(2221)

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Autoimmune pancreatitis ( AIP) is a special type of autoimmune-mediated chronic pancreatitis and has unique imaging, serological, and histopathological features. According to current international guidelines, AIP is classified into type I and type II. Studies have shown that glucocorticoids have a good clinical effect in the treatment AIP, and the guidelines recommend oral glucocorticoids as the preferred treatment regimen for patients without contraindications. However, no consensus has been reached on initial dosage of glucocorticoids and treatment regimens after recurrence. Therefore, with reference to recent research advances and recommendations in guidelines, this article elaborates on the selection of treatment regimens for AIP from the aspects of the selection and treatment of previously untreated AIP patients and the treatment of patients with recurrence.

Imaging diagnosis of autoimmune pancreatitis

Mou Fei, Chen FangYing

2018, 34(8): 1604-1608. DOI: 10.3969/j.issn.1001-5256.2018.08.003

Abstract(2149)

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Autoimmune pancreatitis ( AIP) is a special autoimmune-mediated pancreatitis with the clinical manifestation of obstructive jaundice, and it often has good response to steroids. At present, AIP is classified into type 1 and type 2. The imaging findings of AIP include diffuse or localized pancreatic parenchymal enlargement, and the former is also called the “sausage-shaped”appearance. Imaging examinations of AIP have their own advantages and disadvantages. Ultrasound, endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, computed tomography, magnetic resonance imaging, PET-CT, and PET-MR help with diagnosis and differential diagnosis and can be used for the monitoring and follow-up of clinical outcomes.

Application of endoscopic ultrasound in the diagnosis of autoimmune pancreatitis

Wang Lei, Zou DuoWu, Li ZhaoShen

2018, 34(8): 1609-1613. DOI: 10.3969/j.issn.1001-5256.2018.08.004

Abstract(2005)

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At present, the diagnostic criteria for autoimmune pancreatitis ( AIP) mainly rely on imaging findings. As a type of imaging examination, endoscopic ultrasound ( EUS) has not been included in the diagnostic criteria for AIP. More and more studies have shown the value of EUS in the diagnosis of AIP. As an minimally invasive procedure, EUS-guided biopsy can accurately obtain histological samples and thus avoid open biopsy or unnecessary surgeries, and therefore, it shows unique advantages in clarifying pathological diagnosis. This article reviews the role of EUS in the diagnosis of AIP, including the features of EUS images, new image enhancement pattern, and EUS-guided biopsy.

Application of immunosuppressant in IgG4-related autoimmune pancreatitis

Zhang PanPan, Zhang Wen

2018, 34(8): 1614-1618. DOI: 10.3969/j.issn.1001-5256.2018.08.005

Abstract(2109)

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At present, glucocorticoids are the first-line drugs for the treatment of type 1 autoimmune pancreatitis, which is also known as IgG4-related autoimmune pancreatitis. Combined treatment with immunosuppressant and glucocorticoids helps to reduce the dose of glucocorticoids and maintain long-term remission. There are no high-quality evidence-based prospective studies of immunosuppressant in the treatment of IgG4-related disease. No uniform standards have been developed in China and the rest of the world, and the treatment of this disease mainly draws experience from other autoimmune diseases. This article introduces the application of conventional drugs ( including azathioprine, mycophenolate mofetil, cyclophosphamide, methotrexate, leflunomide, and cyclosporine) and biological therapy ( for example, rituximab targeting B lymphocytes) in the treatment of autoimmune pancreatitis.

WS 213-2018 Diagnosis for hepatitis C

National Health and Family Planning Commission of The People’s Republic of China;

2018, 34(8): 1619-1621. DOI: 10.3969/j.issn.1001-5256.2018.08.006

Abstract(2253)

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Introduction and interpretation of EASL recommendations on treatment of hepatitis C 2018

Yang Jia, Rao HuiYing, Wei Lai

2018, 34(8): 1622-1631. DOI: 10.3969/j.issn.1001-5256.2018.08.007

Abstract(1911)

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An excerpt of EASL clinical practice guidelines for the management of patients with decompensated cirrhosis (2018)

Shi HuiMin, Li Rui, Chen Hong, Li JunFeng, Yang Li

2018, 34(8): 1632-1638. DOI: 10.3969/j.issn.1001-5256.2018.08.008

Abstract(2156)

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An excerpt of International Consensus Statements on early chronic pancreatitis (2018)

Chen Yang, Li XiaoQing

2018, 34(8): 1639-1643. DOI: 10.3969/j.issn.1001-5256.2018.08.009

Abstract(2119)

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An excerpt of the management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver

Bu Fan, Hou JunXing, Yu YueCheng

2018, 34(8): 1644-1648. DOI: 10.3969/j.issn.1001-5256.2018.08.010

Abstract(135)

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An excerpt of 2018 BTS guidelines for hepatitis B & solid organ transplantation (first edition)

Zheng WeiPing, Song HongLi, Shen ZhongYang

2018, 34(8): 1649-1653. DOI: 10.3969/j.issn.1001-5256.2018.08.011

Abstract(206)

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An excerpt of endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines (2018)

Li ManHua, Xu Wei, Xia ShiHai

2018, 34(8): 1654-1658. DOI: 10.3969/j.issn.1001-5256.2018.08.012

Abstract(204)

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A clinical study of chronic hepatitis B patients with Epstein-Barr virus infection

Huang JiangWei, Han FangZheng

2018, 34(8): 1659-1663. DOI: 10.3969/j.issn.1001-5256.2018.08.013

Abstract(1848)

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Objective To investigate the influence of Epstein-Barr virus ( EBV) infection on liver function and hepatitis B virus ( HBV) replication in chronic hepatitis B ( CHB) patients. Methods A total of 119 CHB patients who were admitted to The Affiliated Hospital of Xuzhou Medical University from January 2015 to August 2017 were enrolled, and according to the criteria for clinical grading of CHB, they were divided into mild group with 60 patients, moderate group with 38 patients, and severe group with 21 patients. Of all patients, 60 had CHB and EBV superinfection ( superinfection group) and 59 had CHB alone ( CHB group) . The two groups were compared in terms of the clinical data including sex, age, length of hospital stay, liver function parameters, HBV DNA quantification, routine blood test results, and coagulation function. The t-test and the Mann-Whitney U test were used for comparison of continuous data between two groups, and the chi-square test and the Fisher's exact test were used for comparison of categorical data between groups. Results The severe group had a significantly higher EBV DNA detection rate than the mild and moderate groups [76. 19% ( 16/21) vs 43. 33% ( 26/60) and 47. 37% ( 18/38) , χ2= 6. 727 and 4. 601, both P < 0. 05]. Compared with the CHB group, the superinfection group had significant increases in the length of hospital stay and the levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, and gamma-glutamyl transpeptidase ( t = 3. 523, 4. 085, 3. 755, 10. 976, and 8. 380, Z =-3. 474, all P < 0. 05) and significant reductions in prothrombin time activity and HBV DNA quantification ( t =-2. 501 and-6. 140, both P < 0. 05) . The superinfection group had significantly lower positive rates of HBeAg and HBV DNA than the CHB group ( both P < 0. 05) , and there were no significant differences between these two groups in lymphocyte percentage, albumin, white blood cell count, hemoglobin, and platelet count ( all P > 0. 05) . Conclusion In CHB patients, the risk of EBV superinfection or reactivation of latent EBV in the body increases with the severity of disease condition. EBV infection can aggravate patients' conditions and prolong the course of the disease, but it can reduce the serum level of HBV DNA, possibly by inhibiting the replication of HBV.

Current status of anxiety and depression among hepatitis B patients in Shanghai, China and related influencing factors

Ma XiQuan, Xiong WuJun, Liu Lu, Wang YiFei, Cheng Jie, Zhang ZhengXia, Zhao Hui, Qu LiHong

2018, 34(8): 1664-1668. DOI: 10.3969/j.issn.1001-5256.2018.08.014

Abstract(1735)

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Objective To investigate the prevalence of anxiety and depression among hepatitis B patients in Shanghai, China and related influencing factors. Methods A cross-sectional survey was performed among 917 hepatitis B patients who were treated in Shanghai East Hospital, Tongji University, Shanghai Public Health Clinical Center, and Nanhua Hospital in Pudong New Area from June to December, 2016. The Hospital Anxiety and Depression Scale ( HADS) and a self-designed social demography questionnaire were used for evaluation.The independent samples t-test and a one-way analysis of variance were used for comparison of continuous data between groups, and a multivariate linear regression analysis was used to analyze the correlation of anxiety and depression scores with demographic and socioeconomic factors. Results The prevalence rates of anxiety and depression symptoms assessed by HADS were 87. 6% and 90. 7%, respectively.The severity of anxiety in hepatitis B patients was associated with age, family income, and educational level ( F = 3. 518, 6. 416, and3. 322, all P < 0. 05) , and the severity of depression was associated with age, marital status, family income, occupation, and complications ( F = 2. 904, t = 2. 242, F = 22. 840, F = 9. 235, F = 11. 870, t = 2. 246, all P < 0. 05) . High educational level, high income, and single status were risk factors for depression ( all P < 0. 05) , and high income and the increase in age were significantly associated with anxiety ( all P < 0. 05) . Conclusion At present, the mental state of hepatitis B patients in Shanghai is not optimistic, with high prevalence rates of anxiety and depression. The results remind medical workers that they should pay attention to the mental health of hepatitis B patients.

Clinical effect of chronic disease management with traditional Chinese medicine characteristics in community patients with chronic hepatitis B

Xiao HuanMing, Zhang QiPeng, Shi MeiJie, Yang YuQi, Liu LeXin, Li Sheng, Chi XiaoLing

2018, 34(8): 1669-1673. DOI: 10.3969/j.issn.1001-5256.2018.08.015

Abstract(2053)

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Objective To investigate the clinical effect of chronic disease management with traditional Chinese medicine ( TCM) characteristics in community patients with chronic hepatitis B ( CHB) . Methods A non-randomized case-control study was performed for 84 CHB patients who visited Tianhe Community in Guangzhou from 2014 to 2016. These patients were divided into TCM chronic disease management group and control group, with 42 patients in each group. The patients in the TCM chronic disease management group were given oral entecavir tablets ( 0. 5 mg, once a day) combined with TCM chronic disease management, and those in the control group were given entecavir tablets, education on disease knowledge, and instructions on medication. The two groups were compared in terms of alanine aminotransferase ( ALT) normalization rate, HBeAg seroconversion rate, HBV DNA clearance rate, TCM symptom score, and quality-of-life score after 48 weeks of treatment. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups, and the paired t-test was used for comparison before and after treatment; the non-parametric test was used for comparison of non-normally distributed continuous data between groups. The chi-square test was used for comparison of categorical data between groups, and the Fisher's exact test was used when more than 20% of the cells have an expected frequency of less than 5. Results After 48 weeks of treatment, the TCM chronic disease management group had a significantly lower clinical syndrome score and a significantly higher overall quality-of-life score than the control group ( clinical syndrome score: 3. 66 ± 1. 92 vs 6. 42 ± 2. 48, t = 5. 563, P < 0. 001; overall quality-of-life score: 550. 75 ± 54. 24 vs 491. 08 ± 54. 21, t =-4. 888, P < 0. 001) . Compared with the control group, the TCM chronic disease management group had slightly higher 48-week ALT normalization rate ( 80. 00% vs 72. 22%, χ2= 0. 590, P = 0. 443) , HBV DNA clearance rate ( 73. 17% vs 68. 42%, P > 0. 05) , and HBeAg seroconversion rate ( 29. 27% vs 18. 42%, P > 0. 05) . Conclusion In community patients with CHB, chronic disease management with TCM characteristics can improve their clinical symptoms, quality of life, and antiviral outcome and thus holds promise for clinical application in community.

Effect of ALT level on liver stiffness measurement in patients with hepatitis B cirrhosis

Zhou JiaLing, Wu XiaoNing, Sun YaMeng, Meng TongTong, Guan QiuShuang, Wu ShanShan, Wang BingQiong, Shi YiWen, Chen ShuYan, He ZhiYing, Ma Hong, Jia JiDong, Ou XiaoJuan, You Hong

2018, 34(8): 1674-1677. DOI: 10.3969/j.issn.1001-5256.2018.08.016

Abstract(2227)

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Objective To investigate the effect of alanine aminotransferase ( ALT) level on liver stiffness measurement ( LSM) in patients with hepatitis B cirrhosis. Methods The patients who were diagnosed with hepatitis B cirrhosis by liver biopsy in Beijing Friendship Hospital from January 2012 to May 2015 and did not receive antiviral therapy were enrolled. Their demographic characteristics, routine blood test results, biochemical parameters, hepatitis B virus ( HBV) DNA level, alpha-fetoprotein level, LSM, abdominal ultrasound findings, and liver biopsy data were collected. LSM was compared between hepatitis B cirrhosis patients with different ALT levels. The one-way analysis of variance or rank sum test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data. Pearson correlation analysis and partial correlation analysis were performed. Results A total of 104 patients were recruited and divided into three groups according to their ALT levels ( ≤2 × upper limit of normal [ULN], 2-5 × ULN, and ≥5 × ULN) . There were no significant differences between the three groups in sex ratio, body mass index, HBeAg status, HBV DNA level, albumin level, and platelet count ( all P > 0. 05) . The median values of LSM for the three groups were 15. 4 k Pa, 18. 8 k Pa, and 29. 9 k Pa, respectively, suggesting that LSM increased as the ALT level increased, and there was a significant difference in LSM between the three groups ( χ2= 10. 07, P < 0. 05) . After adjusting for age, which was significantly different between the three groups, LSM was still found to be positively correlated with ALT level ( r = 0. 220, 95% confidence interval: 0. 101-0. 468, P < 0. 05) . Conclusion In patients with hepatitis B cirrhosis, LSM increased with the increasing ALT level, and the positive correlation remains after adjusting for age.

Influence of baseline HBV DNA level on the clinical outcome of patients with compensated hepatitis B cirrhosis after antiviral therapy

Wu XiaoNing, Zhang Wei, Zhou JiaLing, Wang Lin, Sun YaMeng, Meng TongTong, Wang XiaoMing, You Hong, Ou XiaoJuan, Jia JiDong

2018, 34(8): 1678-1682. DOI: 10.3969/j.issn.1001-5256.2018.08.017

Abstract(2036)

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Objective To investigate the influence of baseline HBV DNA level on the clinical outcome of patients with compensated hepatitis B cirrhosis after antiviral therapy. Methods A total of 106 patients with compensated hepatitis B cirrhosis who were treated in Liver Research Center, Beijing Friendship Hospital, Capital Medical University from 2005 to 2015 were enrolled and were given antiviral therapy with nucleos ( t) ide analogues. A three-year prospective follow-up was performed for all patients. According to the baseline HBV DNA level, the patients were divided into HBV DNA < 105 IU/ml group, 105-107 IU/ml group, and > 107 IU/ml group. The three groups were compared in terms of baseline characteristics, outcome of antiviral therapy, and incidence rate of liver-related events ( LREs) . A repeated-measures analysis of variance or the Friedman rank sum test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to calculate the incidence rates of LREs and plot survival curves, and the log-rank test was used for comparison between groups. Results There were no significant differences between the three groups in age, sex, HBeAg, biochemical parameters, liver stiffness, and Child-Turcotte-Pugh score ( all P >0. 05) . There were significant differences between the three groups in the change trend of HBV DNA level ( F = 8. 35, P < 0. 05) and the degree of such change ( F = 13. 95, P < 0. 05) . At 6 months of treatment, all three groups had a significant reduction in HBV DNA level, and the HBV DNA < 105 IU/ml group and the 105-107 IU/ml group achieved a median HBV DNA level of below the limit of detection, while the HBV DNA > 107 IU/ml group achieved such a level at 12 months of treatment. At 12 and 24 months of treatment, there was no significant difference in HBV DNA clearance rate between the three groups ( χ2= 5. 97 and 6. 84, both P > 0. 05) ; at 36 months of treatment, there was a significant difference in HBV DNA clearance rate between the three groups ( 95. 7% vs 88. 0% vs 77. 8%, χ2= 12. 75, P < 0. 05) . There was no significant difference in the incidence rate of LREs between the three groups ( P > 0. 05) . Conclusion Patients with compensated hepatitis B cirrhosis have a significant reduction in HBV DNA level after antiviral therapy. Although patients with a high level of replication have slow virologic response, baseline HBV DNA level has no influence on the incidence rate of LREs within 3 years of antiviral therapy.

Clinical effect of endoscopic dense ligation in treatment of esophageal variceal bleeding

Cui MeiLan, Jia YanSheng, Yan HuiMin, Kang HaiYan, Wang Yan, Yin ShuYing, Zheng HuanWei

2018, 34(8): 1683-1688. DOI: 10.3969/j.issn.1001-5256.2018.08.018

Abstract(1880)

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Objective To investigate the clinical effect of endoscopic dense ligation in the treatment of esophageal variceal bleeding. Methods A total of 156 patients who underwent endoscopic ligation for the first time due to esophageal variceal bleeding caused by cirrhotic portal hypertension in Shijiazhuang Fifth Hospital from July 2015 to June 2016 were enrolled, and according to the treatment method, they were divided into dense ligation group with 76 patients and non-dense ligation group with 80 patients. The patients were followed up for 1-2 years, and a statistical analysis was performed for the eradication or disappearance rate of varices, the number of times of ligation, early rebleeding rate, late-onset rebleeding rate, and the incidence rate of adverse reactions. The t-test was used for comparison of continuous data between two groups, and the chi-square test or Fisher's exact test was used for comparison of categorical data between two groups. Results There were significant differences between the dense ligation group and the non-dense ligation group in the eradication or disappearance rate of varices ( 71. 05% vs 55. 00%, χ2= 4. 300, P = 0. 038) and number of times of ligation ( χ2= 8. 511, P = 0. 014) , and there were no significant differences between the two groups in early rebleeding rate ( 5. 26% vs 2. 50%, P > 0. 05) , late-onset rebleeding rate ( 7. 89% vs 10. 00%, P > 0. 05) , recurrence rate of varices ( 13. 16% vs 18. 75%, P > 0. 05) , and incidence rate of adverse reactions ( 26. 32% vs 21. 25%, P > 0. 05) . There was a significant difference in the time to recurrence of varices between the two groups ( 11. 90 ±1. 89 months vs 7. 07 ± 1. 17 months, t = 2. 295, P = 0. 031) . Of all 156 patients, 2 ( 1. 28%) died during follow-up, with 1 patient in the dense ligation group and 1 in the non-dense ligation group. There was no significant difference in mortality rate between the two groups ( P > 0. 05) . Conclusion Endoscopic dense ligation is a safe technique for the treatment of esophageal variceal bleeding and is better than non-dense ligation in terms of the disappearance rate of varices and number of times of ligation. Endoscopic dense ligation also allows a longer time to recurrence of varices than non-dense ligation.

Clinical effect of two targeted drugs in treatment of advanced hepatocellular carcinoma: A comparative analysis

Gao BinCheng, Guo Hui, Sun Le, Zhou Jie, Jiang DongMei

2018, 34(8): 1689-1692. DOI: 10.3969/j.issn.1001-5256.2018.08.19

Abstract(2472)

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Objective To investigate the clinical effect of the targeted drug sunitinib in the treatment of advanced hepatocellular carcinoma ( HCC) . Methods A total of 48 patients with advanced HCC who were admitted to Chang'an Hospital form September 2015 to September2016 were enrolled and divided into control group and observation group, with 24 patients in each group. The patients in the control group were given oral sorafenib, and those in the observation group were given oral sunitinib. The patients were followed up for 1 year, and the clinical outcome, improvement in clinical symptoms, and adverse events were recorded. The t-test was used for comparison of continuous data between groups, and the Mann-Whitney U test was used for comparison of categorical data between groups. Results The disease control rate ( DCR) in the observation group was 68. 42% ( 13/19) , and among these 13 patients, 4 achieved effective remission and 9 had stable disease; the DCR in the control group was 76. 19%, and there was no significant difference in DCR between the two groups ( P > 0. 05) .There was a significant difference in the incidence rate of hand-foot skin reaction between the observation group and the control group ( 0%vs 12. 5%, U = 31. 07, P < 0. 05) . The observation group had a significantly higher incidence rate of neutropenia than the control group ( 25% vs 16. 67%, U = 29. 87, P < 0. 05) . Both groups experienced digestive tract reactions ( nausea and vomiting) and abnormal liver function; since the digestive tract reactions were tolerable, no special treatment was given, and the patients with abnormal liver function were given liver-protecting drugs, so all adverse events were effectively alleviated. Conclusion Sunitinib has a good clinical effect in the treatment of advanced HCC, and further studies with a larger sample size are needed to investigate the long-term clinical effect of sunitinib and combined treatment.

Clinical features of hepatocellular carcinoma in pregnancy

Zhao Han, Chen Keng, Ying RuoSu, Li PingHong, Liu HuiYuan

2018, 34(8): 1693-1696. DOI: 10.3969/j.issn.1001-5256.2018.08.020

Abstract(1752)

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Objective To investigate the clinical features, treatment, and prognosis of hepatocellular carcinoma ( HCC) in pregnancy.Methods A retrospective analysis was performed for the clinical data of two patients who were diagnosed with HCC in pregnancy from January 2011 to November 2017, 23 patients with HCC in pregnancy reported in medical literature in China and foreign countries published from2010 to 2017, and 25 non-pregnant female patients of childbearing age with HCC ( control group) who were treated from January 2011 to November 2017. Results The patients' age ranged from 18 to 45 years, and most patients had a history of hepatitis B, with normal liver function or mild to moderate elevations. The most common clinical symptom was abdominal pain, and the therapies included hepatic artery embolization, interventional therapy, chemotherapy, and liver tumor resection. The 25 patients with HCC in pregnancy had poor prognosis, among whom 17 died, and among these 17 patients, 13 had available information on overall survival time, which ranged from 1 month to 2 years, with a median survival time of 2 months; 16 patients gave birth to healthy infants by cesarean section. Among the 25 non-pregnant female patients of childbearing age with HCC, 18 died, and the survival time ranged from 4 months to 6 years, with a median survival time of 1 year; 1 patient was lost to follow-up, and 6 patients were still alive before the deadline. Conclusion Most patients with HCC in pregnancy are found to have advanced HCC at the time of diagnosis. This disease has rapid progression and poor prognosis, and surgery and interventional therapy are major treatment regimens. Early identification can increase surgical rate and the opportunity for multimodality therapy.

Application of contrast-enhanced ultrasound in microwave ablation of small hepatocellular carcinoma difficult to display on conventional ultrasonography

Wang Xi, Cheng Peng, He Fen, Deng Dan, Li Dong

2018, 34(8): 1697-1701. DOI: 10.3969/j.issn.1001-5256.2018.08.021

Abstract(273)

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Objective To investigate the value of contrast-enhanced ultrasound in microwave ablation of small hepatocellular carcinoma difficult to display on conventional ultrasonography. Methods A retrospective analysis was performed for the clinical data of the patients with liver cancer difficult to display on conventional ultrasonography who were treated in Department of Oncology in General Hospital of Chengdu Military Region from January 2015 to December 2017, and according to the results of contrast-enhanced computed tomography ( CT) , all patients had a nodule diameter of < 3. 0 cm. All patients were given contrast-enhanced ultrasound during microwave ablation to identify tumor location and size. Contrast-enhanced CT was performed at one month after surgery to evaluate the effect of ablation and the incidence of complications. For each lesion, conventional ultrasound images and contrast-enhanced CT images before surgery, contrast-enhanced ultrasound images during surgery, and contrast-enhanced CT images after surgery were analyzed to evaluate treatment outcome and postoperative follow-up. Results A total of 52 patients with 78 lesions were enrolled. Of all lesions, 73 were directly displayed on contrast-enhanced ultrasound and 5 were clarified in combination with contrast-enhanced CT, among which one was located near the diaphragm and the top of the liver and four were only slightly enhanced in the arterial phase on contrast-enhanced ultrasound. Microwave ablation was performed for all 78 lesions, and no major complications were observed. Follow-up at one month after surgery showed that all 78 lesions were completely inactivated. Conclusion Contrast-enhanced ultrasound can clearly show the location, size, and extent of infiltration of small hepatocellular carcinoma lesions which are difficult to display on conventional ultrasonography. It also helps with accurate localization for microwave ablation and has fewer complications. Therefore, it is an important auxiliary method for microwave ablation.

Clinical effect of stereotactic body radiotherapy in treatment of patients with small hepatocellular carcinoma and related prognostic factors

Li TianTian, Sun Jing, Wang Quan, Ding JunQiang, Wang Jia, Xue Hui, Zhang Tao, Duan XueZhang

2018, 34(8): 1702-1706. DOI: 10.3969/j.issn.1001-5256.2018.08.022

Abstract(2060)

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Objective To investigate the clinical effect and safety of stereotactic body radiotherapy ( SBRT) in patients with small hepatocellular carcinoma and related prognostic factors. Methods A retrospective analysis was performed for the clinical data of 64 patients with small hepatocellular carcinoma who underwent SBRT in 302 Hospital of PLA from March 2011 to October 2014. The patients were followed up for tumor control and adverse events after treatment. The Kaplan-Meier method was used to calculate survival rates, log-rank test and the Cox proportional hazards model was used to analyze the influencing factors for survival. Results A total of 64 patients with 72 lesions were enrolled in this study. The patients were followed up for 4-60 months, with a median follow-up time of 44 months. Of all lesions, 44 ( 61. 1%) achieved complete response, 20 ( 27. 8%) achieved partial response, 5 ( 6. 9%) achieved a stable state, and 3 ( 4. 2%) had progression. The objective response rate was 88. 9%. The 1-, 3-, and 5-year local control rates were 94. 4%, 88. 1%, and 78. 7%, respectively, the 1-, 3-, and 5-year cumulative survival rates were 95. 3%, 71. 6% and 55. 9%, respectively, and the 1-, 3-, and5-year progression-free survival rates were 62. 3%, 33. 5%, and 10. 8%, respectively. Most of the adverse events were grade 1-2 events. One patient experienced a grade 4 elevated bilirubin. In addition, about one fourth of the patients experienced grade 3 leukopenia and/or thrombocytopenia, which increased to the baseline level at 1 year after treatment. The multivariate analysis showed that albumin-bilirubin ( ALBI) grade and number of tumors were independent risk factors for the cumulative survival rate of patients with small hepatocellular carcinoma after SBRT. Conclusion SBRT is safe and effective in the treatment of small hepatocellular carcinoma, and ALBI grade and number of tumors are associated with the survival rate of patients after treatment.

Clinical value of fucosylated Golgi protein 73 in differential diagnosis of small hepatocellular carcinoma

Zhao YunSheng, Zhang LiNa, Huo LiJing, Pei Liu, Li QiuPing, Li HongChen, Jin Liang

2018, 34(8): 1707-1711. DOI: 10.3969/j.issn.1001-5256.2018.08.023

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Objective To investigate the clinical value of serum fucosylated Golgi protein 73 ( Fuc-GP73) in the differential diagnosis of small hepatocellular carcinoma ( s HCC) with a low level of alpha-fetoprotein ( AFP) . Methods A total of 110 patients who were treated in Qinhuangdao First Hospital from April to December, 2014 were enrolled, and among these patients, 50 had s HCC with a low level of AFP ( s HCC group) , 20 had chronic hepatitis B ( CHB group) , 20 had liver cirrhosis ( LC group) , and 20 had malignant tumor in the digestive system except liver cancer ( MTDS group) . A total of 40 individuals who underwent physical examination in our hospital were enrolled as normal controls ( NC group) . Lectin affinity chromatography and ELISA were used to measure the serum level of Fuc-GP73. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the Nemenyi test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic ( ROC) curve was plotted to analyze the value of Fuc-GP73 in the diagnosis of s HCC. The logistic regression model was used to evaluate the diagnostic efficiency of the combined measurement of Fuc-GP73 and other markers. Results There was a significant difference in the level of Fuc-GP73 between groups ( H = 87. 225, P = 0. 001) , and the s HCC group had a significantly higher level than the other groups ( all P <0. 05) . The detection rate of Fuc-GP73 was 80% ( 40/50) in the s HCC group, 0 ( 0/20) in the CHB group, 20% ( 4/20) in the LC group, 5% ( 1/20) in the MTDS group, and 0 ( 0/40) in the NC group; there was a significant difference between groups ( χ2= 92. 143, P< 0. 01) , and the s HCC group had a significantly higher detection rate than the other groups ( all P < 0. 01) . In the diagnosis of s HCC, Fuc-GP73 had a sensitivity of 80. 0%, a specificity of 95. 0%, an accuracy rate of 90. 0%, and an area under the ROC curve of 0. 892, and the combined measurement of Fuc-GP73 and other markers had a sensitivity of 96. 0%, a specificity of 98. 0%, an accuracy rate of97. 3%, and an area under the ROC curve of 0. 991. Conclusion Fuc-GP73 can be used as a glycosylated tumor marker for s HCC and is better than AFP.

Experience in laparoscopic hepatectomy in treatment of hepatocellular carcinoma

Tian Zhou, Zhang JianHuai, Sun XiTai, Liu Bin, Qi FuZhen, Wang YeBo, Wu JinSheng, Gu DianHua

2018, 34(8): 1712-1716. DOI: 10.3969/j.issn.1001-5256.2018.08.024

Abstract(317)

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Objective To summarize the clinical experience in laparoscopic hepatectomy in the treatment of hepatocellular carcinoma ( HCC) . Methods The patients with HCC who were admitted to Huaian No. 1 People's Hospital Affiliated to Nanjing Medical University, Drum Tower Hospital Affiliated to Nanjing University, and The Affiliated Hospital of Xuzhou Medical Hospital from December 2008 to December 2015 were enrolled and their clinical data were collected. According to the surgical procedure, these patients were divided into laparoscopic hepatectomy group with 391 patients ( LH group) and open hepatectomy group with 682 patients ( OR group) . The two groups were compared in terms of time of operation, incision size, intraoperative blood loss, postoperative recovery, length of postoperative hospital stay, surgery costs, hospital costs, and complications. The independent samples t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Results There were significant differences between the LH group and the OR group in intraoperative blood loss ( 165. 00 ± 79. 21 ml vs 457. 00 ± 125. 00 ml, t = 41. 64, P < 0. 05) , length of incision ( 4. 07 ± 0. 31 cm vs 20. 48 ± 2. 36 cm, t = 136. 80, P < 0. 05) , time to diet ( 1. 50 ± 0. 61 d vs 2. 43 ± 0. 40 d, t =30. 10, P < 0. 05) , time to ambulation after surgery ( 1. 36 ± 0. 31 d vs 4. 12 + 0. 82 d, t = 63. 98, P < 0. 05) , length of hospital stay ( 10. 09 ± 3. 52 d vs 15. 36 ± 4. 57 d, t = 19. 70, P < 0. 05) , surgery costs ( 9471. 00 ± 639. 73 yuan vs 5329. 12 ± 461. 40 yuan, t =122. 44, P < 0. 05) , and hospital costs ( 37 315. 17 ± 13 194. 78 yuan vs 35 007. 6 ± 10 611. 20 yuan, t = 3. 13, P < 0. 05) . The 1-, 3-, and 5-year survival rates were 89. 42%, 64. 32%, and 43. 12% in the LH group and 88. 11%, 61. 45%, and 38. 38% in the OR group, and there were no significant differences between the two groups ( P > 0. 05) . Conclusion LH has the advantages of little trauma, low intraoperative blood loss, fast recovery, and short postoperative hospital stay and does not increase complications. Therefore, it can be used as the primary therapy for peripheral liver cancer, small hepatocellular carcinoma, and liver tumor in the left lateral lobe.

Clinical effect and safety of radiofrequency ablation combined with systemic chemotherapy in treatment of unresectable or postoperative recurrent intrahepatic cholangiocellular carcinoma

Sun Wei, Ding XiaoYan, Chen JingLong, Li WenDong, Guo XiaoDi, Shen YanJun, Sun ShaSha, Teng Ying, Liu XiaoMin, Wei JianYing

2018, 34(8): 1717-1722. DOI: 10.3969/j.issn.1001-5256.2018.08.025

Abstract(2223)

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Objective To investigate the clinical effect and safety of percutaneous radiofrequency ablation ( RFA) combined with systemic chemotherapy in the treatment of unresectable or postoperative recurrent intrahepatic cholangiocellular carcinoma. Methods The patients with unresectable or postoperative recurrent cholangiocellular carcinoma who were treated from January 2011 to December 2016 were enrolled. All patients underwent CT-guided RFA, followed by systemic chemotherapy since one week after surgery, with the regimen of gemcitabine given concurrently with cisplatin ( gemcitabine 1000 mg/m2 combined with cisplatin 25 mg/m2 on days 1 and 8, for 6 cycles in total) . Treatment outcome and safety were observed. Results There were 45 lesions in total, and RFA and chemotherapy were performed for all lesions. The overall objective response rate was 79. 2%. The complete ablation rate of the lesions at one month after surgery was 86. 7% ( 39/45) . The patients were followed up for 11-67 months after surgery, and at the end of follow-up, the rate of local progression was20. 0% ( 9/45) . The median time to progression was 13. 0 months, the median survival time was 28. 6 months, and the 1-, 2-, and 3-yaer survival rates were 87. 3%, 69. 3%, and 32. 6%, respectively. Major side effects included hematological toxicity and elevated aminotransferases, and there were no serious adverse events associated with RFA. Conclusion RFA combined with systemic chemotherapy is a safe and feasible regimen for unresectable or postoperative recurrent intrahepatic cholangiocellular carcinoma.

Value of endoscopic ultrasonography in diagnosis of pancreatic space-occupying diseases

Wu Bin, Shen YiYu, Chen XuJian, Zhong Hai, Wang XiaoGuang, Song ZhengWei, Zhong ZhengXiang

2018, 34(8): 1723-1727. DOI: 10.3969/j.issn.1001-5256.2018.08.026

Abstract(2153)

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Objective To investigate the value of endoscopic ultrasonography ( EUS) in the diagnosis of pancreatic space-occupying diseases. Methods A total of 85 patients with suspected pancreatic space-occupying diseases who were treated in The Second Affiliated Hospital of Jiaxing College from January 2015 to January 2017 were enrolled. Surgical pathological results or follow-up results were used as the gold standard for evaluating the value of EUS and EUS-guided fine needle aspiration ( EUS-FNA) in the diagnosis of pancreatic space-occupying diseases. The chi-square test was used for comparison of categorical data between groups. Results EUS had an imaging detection rate of 96. 7% ( 59/61) , a specificity of 100% ( 24/24) , and an accuracy rate of 97. 6% ( 83/85) in the diagnosis of pancreatic space-occupying diseases; EUS had significantly higher detection rate and accuracy rate than abdominal ultrasound, computed tomography, and magnetic resonance imaging ( detection rate: χ2= 4. 344, 3. 873, and 15. 445, all P < 0. 05; accuracy rate: χ2= 6. 675, 8. 685, and 17. 389, all P <0. 05) . EUS-FNA had a detection rate of 81. 8% ( 45/55) and an accuracy rate of 81. 0% ( 47/58) . Among the patients who underwent surgery to have pathological results, the overall coincidence rate of preoperative EUS-FNA was 84. 2% ( 16/19) . Conclusion Compared with conventional imaging examinations, EUS has a higher diagnostic accuracy for pancreatic space-occupying diseases, and EUS-FNA can further clarify the nature and pathological type of space-occupying lesions. EUS may help with the early diagnosis and treatment of pancreatic tumors.

Risk factors for gallstones complicated by acute biliary pancreatitis

Wang XianPeng, Meng XianZhi

2018, 34(8): 1728-1732. DOI: 10.3969/j.issn.1001-5256.2018.08.027

Abstract(1859)

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Objective To investigate the risk factors for gallstones complicated by acute biliary pancreatitis ( ABP) . Methods A retrospective analysis was performed for the clinical data of patients who were admitted to Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, from January 2014 to September 2017 due to abdominal pain and then diagnosed with gallstones. The chi-square test was used for comparison of categorical data between groups, and the binary logistic regression analysis was used as multivariate analysis. Results A total of 700 patients with gallstones were enrolled, among whom 167 were complicated by ABP, resulting in an incidence rate of 23. 86%. The univariate analysis showed that sex, gallbladder size, gallbladder wall thickness, gallstone size, the number of gallstones, and presence or absence of common bile duct stones were associated with the development of ABP ( all P < 0. 05) . A multivariate analysis was performed for the factors with statistical difference identified by the univariate analysis, and the results showed that male sex ( odds ratio [OR]= 1. 879, 95% confidence interval [CI]: 1. 279-2. 758, P < 0. 05) , abnormal gallbladder size ( OR = 0. 282, 95% CI: 0. 184-0. 434, P < 0. 05) , gallbladder wall thickness ≤3 mm ( OR = 2. 245, 95% CI: 1. 490-3. 383, P < 0. 05) , gallbladder stone diameter > 1 cm ( OR = 0. 438, 95% CI: 0. 249-0. 769, P < 0. 05) , single gallstone ( OR = 0. 222, 95% CI: 0. 130-0. 378, P < 0. 05) , and presence of common bile duct stones ( OR = 2. 775, 95% CI: 1. 694-4. 546, P < 0. 05) were significantly associated with the development of ABP. Conclusion Male sex, normal gallbladder size, gallbladder wall thickness ≤3 mm, gallbladder stone diameter ≤1 cm, multiple gallstones, and presence of common bile duct stones are independent risk factors for ABP in patients with gallstones.

Effect of bilateral greater splanchnic nerve transection on hepatic injury in dogs with acute necrotizing pancreatitis

Gui Yang, Sun JunJun, Yang YanHui, Liu WeiFeng, Yang TianBao, Chu ZhiJie, Yang Cheng, Wang Du, Liu JiangBo

2018, 34(8): 1733-1739. DOI: 10.3969/j.issn.1001-5256.2018.08.028

Abstract(1959)

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Objective To investigate the effect of bilateral greater splanchnic nerve transection on hepatic injury in dogs with acute necrotizing pancreatitis ( ANP) . Methods A total of 24 healthy adult mongrel dogs were randomly divided into sham-operation group ( SO group with 8 dogs) , ANP model group ( ANP group with 8 dogs) , and ANP + bilateral greater splanchnic nerve transection group ( GSNT group with 8 dogs) . Peripheral venous blood samples were collected at 2 hours before surgery and at 12 and 24 hours and 3, 5, and 7 days after surgery to measure the serum levels of amylase ( AMY) , alanine aminotransferase ( ALT) , and aspartate aminotransferase ( AST) . The dogs were sacrificed at 7 days after surgery, and the pancreatic and hepatic tissues were harvested to observe their pathological changes by visual inspection and under a light microscope. Western blot was used to measure the protein expression of p-NF-κB p65 in liver tissue. A one-way analysis of variance and a repeated-measures analysis of variance were used for comparison between groups, and the least significant difference t-test and wilcoxon rank sum test were used for further comparison between two groups. Results At 2 hours before surgery, there were no significant differences in serum levels of AMY, ALT, and AST between the three groups ( P > 0. 05) . Compared with the SO group, the ANP group and the GSNT group had significant increases in the serum levels of AMY, ALT, and AST, pancreatic and liver pathological scores, and the protein expression of p-NF-κB p65 in liver tissue after surgery ( all P < 0. 05) . After surgery, the GSNT group had significantly lower serum levels of ALT and AST, pancreatic and liver pathological scores, and protein expression of p-NF-κB p65 in liver tissue than the ANP group ( all P < 0. 05) , while there was no significant difference in the serum level of AMY between these two groups ( P > 0. 05) . Conclusion The activation of NF-κB plays an important role in the progression of ANP in dogs. Bilateral greater splanchnic nerve transection can alleviate liver injury in dogs with ANP, and such a protective effect may be associated with the downregulation of NF-κB activity in the liver.

Therapeutical effect of local transplantation of bone marrow mesenchymal stem cells mixed with fibrin gel on rats with liver injury

Wu LinLan, Xu Bing, Wei JianWei, Zhao ZhiPing, Huang SuQin, Yang XiaoMei

2018, 34(8): 1740-1744. DOI: 10.3969/j.issn.1001-5256.2018.08.029

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Objective To investigate the method for the treatment of liver injury using bone marrow mesenchymal stem cells ( MSCs) .Methods The cryoprecipitate ( CP) rich in fibrinogen ( FIG) was extracted from rat plasma or human plasma using the freeze-thaw method and was used to make fibrin gel ( FG) . FIG, fibronectin ( Fn) , prothrombin time ( PT) , activated partial thromboplastin time ( APTT) , and factor Ⅷ activity were measured for the CP. The rat FG was mixed with rat MSCs to make FG-MSCs. The FG-MSCs were cultured in vitro, and MTT assay was used to measure the proliferation rate of MSCs. The components Ⅰ ( containing FIG and MSCs) and Ⅱ ( containing thrombin) of FG-MSCs were injected alternately into the same site of liver parenchyma tissue of the rats with liver injury to form FG-embedded MSCs, and a single dose of injection could be assigned to two or more sites. Such injection was repeated on days 21 and 28 after the first transplantation. On day 7 after the third injection, the body weight of rats was measured; the rats were sacrificed and plasma was collected to measure the levels of alanine aminotransferase ( ALT) , total bilirubin ( TBil) , and albumin ( Alb) ; the liver was weighed to calculate liver index [ ( mean liver weight/mean body weight) × 100%]. The t-test was used for comparison between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. Results The CP of human plasma had significantly higher concentrations of FIG, Fn, and factor Ⅷ than the former plasma ( t = 9. 669, 12. 317 and 9. 043, all P < 0. 01) , while there were no significant differences in PT and APTT ( both P > 0. 05) . After in vitro culture for 4 days, FG-MSCs had a slightly higher proliferation rate than MSCs ( P > 0. 05) . After the injection of FG-MSCs or MSCs into the liver tissue of the rats with liver injury, there were significant reductions in the plasma levels of ALT and TBil ( both P < 0. 05) and a significant increase in the level of Alb ( P < 0. 05) . Conclusion The injection of FG-MSCs or MSCs into the liver parenchyma tissue can significantly improve the liver function of rats with liver injury, and FG-MSCs can also prevent bleeding after injection.

Expression and significance of Th22 cells and its functional factor interleukin-22 in mice with autoimmune hepatitis

Pan Jing, Pan WenTing, Wu LiHui

2018, 34(8): 1745-1749. DOI: 10.3969/j.issn.1001-5256.2018.08.030

Abstract(1913)

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Objective To investigate the expression of Th22 cells and its functional factor interleukin-22 ( IL-22) in a mouse model of autoimmune hepatitis ( AIH) and the significance of Th22 cells and IL-22 in the pathogenesis of AIH. Methods A total of 30 male C57 BL/6 mice aged 4 weeks were randomly divided into control group with 6 mice and AIH group with 14 mice. Another 10 mice were used to extract liver-specific antigen S100. On days 1 and 7 of the experiment, the freshly extracted S100 was injected into the abdominal cavity of the mice together with an equal volume of Freund's complete adjuvant, and a mouse model of AIH was successfully established on day 28 ( 7 mice in the AIH group died during model establishment due to improper injection, presence of ascites, or infection) . The mice were given intraperitoneal injection of 5% chloral hydrate ( 0. 1 ml/10 g) for anesthesia, and then eyeballs were removed to collect blood samples.The spleen was collected, and flow cytometry was performed to measure the percentage of Th22 cells and RT-PCR was performed to measure the mRNA expression of aryl hydrocarbon receptor ( AHR) . The liver tissue was collected; HE staining was used to observe liver pathological changes, and RT-PCR and Western blotting were used to measure the expression of IL-22 and IL-22 receptor ( IL-22 R) in liver tissue. ELISA was used to measure the serum level of IL-22. The t-test was used for comparison between the two groups. Results HE staining showed that the mice in the control group had well-arranged liver tissue and clear structures of hepatic lobules, while those in the AIH group had massive inflammatory cell infiltration in the portal area and dotted and even piecemeal necrosis in liver tissue. The AIH group had a significant increase in the percentage of Th22 cells than the control group ( 0. 083% ± 0. 052% vs 1. 555% ± 0. 812%, t =-4. 405, P < 0. 05) . Compared with the control group, the AIH group had a significant increase in the relative mRNA expression of AHR ( 0. 485 ±0. 096 vs 1. 268 ± 0. 366, t =-5. 452, P < 0. 05) . Compared with the control group, the AIH group had significant increases in the relative mRNA expression of IL-22 ( 1. 146 ± 0. 227 vs 3. 813 ± 0. 478, t =-12. 458, P < 0. 001) and IL-22 R ( 0. 276 ± 0. 037 vs 1. 734 ±0. 248, t =-15. 333, P < 0. 001) and significantly higher relative protein expression of IL-22 ( 1. 040 ± 0. 261 vs 0. 410 ± 0. 077, t =-6. 324, P < 0. 05) and IL-22 R ( 1. 432 ± 0. 304 vs 0. 830 ± 0. 146, t =-0. 631, P < 0. 05) in liver tissue. The AIH group had a significantly higher level of IL-22 than the control group ( t =-15. 799, P < 0. 05) . Conclusion AIH mice have significant increases in the percentage of Th22 cells and the expression of IL-22, which may play an important role in the pathogenesis of AIH.

Drug resistance of Enterobacteriaceae bacteria causing liver abscess

Zhou YiQing, Ceng Min, Zhou Jie, Ruan YongChun, Zhang HaiWang, Su MeiXia, He Wei, Li MingHui

2018, 34(8): 1750-1753. DOI: 10.3969/j.issn.1001-5256.2018.08.031

Abstract(2057)

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Objective To investigate the drug resistance of Enterobacteriaceae bacteria which cause liver abscess, and to guide the application of antibiotics. Methods The patients with liver abscess who were hospitalized in our hospital from January 2014 to December 2017 and were found to have Enterobacteriaceae bacteria by isolation were enrolled as research subjects. Their clinical data, laboratory examination results, drug resistance data, treatment method, and outcomes were analyzed. Results Among the 53 patients, 28 ( 52. 8%) had gallbladder and biliary diseases or a surgical history, 20 ( 37. 7%) had hypertension, and 18 ( 34. 0%) had diabetes; as for clinical manifestations, 51 ( 96. 2%) had pyrexia, 33 ( 62. 3%) had liver pain or gastrointestinal symptoms, and 6 ( 11. 3%) had septic shock. Among these patients, 31 ( 58. 5%) had a leukocyte count of > 10 × 109/L, 37 ( 69. 8%) had an increase in neutrophil count, 50 ( 94. 3%) had an increase in C-reactive protein, 32 ( 60. 4%) had an increase in alanine aminotransferase, and 22 ( 41. 5%) had an increase in aspartate aminotransferase; among the 19 patients who underwent procalcitonin ( PCT) measurement, 17 ( 89. 5%) were found to have an increase in PCT. A total of 11 patients had a positive blood culture, among whom 7 ( 63. 6%) had Klebsiella pneumoniae and 4 ( 36. 4%) had Escherichia coli. Pus or bile culture identified Enterobacteriaceae bacteria strains in the 53 patients, among whom 35 ( 66. 0%) had Klebsiella pneumoniae, 12 ( 22. 6%) had Escherichia coli, 2 ( 3. 8%) had Morganella morganii subspecies, and 1 ( 1. 9%) each had Proteus penneri, Providencia rustigianii, Citrobacter freundii, and Proteus mirabilis. Among the 35 patients with Klebsiella pneumoniae, 2 had extended-spectrum beta-lactamase ( ESBL) -producing Klebsiella pneumoniae, and among the 12 patients with Escherichia coli, 9 had ESBL-producing Escherichia coli; Klebsiella pneumoniae strains were sensitive to common antibiotics, while Escherichia coli strains had high drug resistance rates to second-and third-generation cephalosporins, quinolones, and aminoglycosides. All isolates were highly sensitive to carbapenems. Conclusion Enterobacteriaceae bacteria causing liver abscess has a low ESBL-positive rate. Third-generation cephalosporins and antibiotics containing β-lactamase inhibitors are major regimens for initial empiric therapy.

A case of hepatitis B cirrhosis with human babesiosis

Pan GuoYing, Li YaPing, Zhang Wen, Zhai Song, Zhang Lei, Jia XiaoLi, Liu LaYang

2018, 34(8): 1754-1755. DOI: 10.3969/j.issn.1001-5256.2018.08.032

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Misdiagnosis of liver abscess with actinomycosis as liver cancer: A case report and literature review

Wu ChunXiang, Wang ShaoYang, Zhang XiaoJin

2018, 34(8): 1756-1757. DOI: 10.3969/j.issn.1001-5256.2018.08.033

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Microwave ablation combined with 125I particle implantation in treatment of hepatic metastasis with diaphragm perforation: A case report

Min YongFeng, Zhang Bo

2018, 34(8): 1758-1759. DOI: 10.3969/j.issn.1001-5256.2018.08.034

Abstract(1851)

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Intrahepatic biliary papillomatosis with local canceration: A case report

Li LiangTao, Wu Bo, Wang ShouQian, Yang Fan, Wang YingChao

2018, 34(8): 1760-1762. DOI: 10.3969/j.issn.1001-5256.2018.08.035

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A case of acute pancreatitis with peripancreatic infection complicated by duodenal fistula

Wang Wu, Liu Huan, Ma YuTeng, Wei Feng

2018, 34(8): 1763-1764. DOI: 10.3969/j.issn.1001-5256.2018.08.036

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Stenosing papillitis and acute biliary pancreatitis in patients with Crigler-Najjar syndrome type Ⅱ: A case report

Zhang Juan, Li YanYan, Gao RunPing

2018, 34(8): 1765-1766. DOI: 10.3969/j.issn.1001-5256.2018.08.037

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Hyperlipidemic severe acute pancreatitis during pregnancy: A report of 2 cases and literature review

Zhang Duan, Mao MiaoMiao, Wang ZhongFeng, Xin GuiJie, Gao PuJun

2018, 34(8): 1767-1770. DOI: 10.3969/j.issn.1001-5256.2018.08.038

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Primary retroperitoneal mucinous cystadenoma with solid pseudopapillary tumor of the pancreas in pregnancy: A case report and literature review

Zhang YaMeng, Gao QiYuan, Wang BaoSheng

2018, 34(8): 1771-1774. DOI: 10.3969/j.issn.1001-5256.2018.08.039

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Nonfunctional neuroendocrine tumors of the pancreas invading the superior mesenteric vein: A case report

Bai ZhiQing, Xin Qi, Zhang Ping

2018, 34(8): 1775-1776. DOI: 10.3969/j.issn.1001-5256.2018.08.040

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Misdiagnosis of pancreatic divisum in children: A case report

Gu Teng, Liu HongYong, Guan QingChun, Liu Kai

2018, 34(8): 1777-1778. DOI: 10.3969/j.issn.1001-5256.2018.08.041

Abstract(1801)

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Interaction between the stimulator of interferon genes signaling pathway and HBV

Xu ZhiQiang, Wang Qing, Pan XiuCheng

2018, 34(8): 1779-1782. DOI: 10.3969/j.issn.1001-5256.2018.08.042

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Stimulator of interferon genes ( STING) is a newly discovered adaptor protein in the innate immune system and plays an important role in innate immune response mediated by cytoplasmic DNA. Double-stranded DNA recognition receptors in cells are mediated by STING protein to produce type I interferon and other cytokines. Inadequate innate immune response and anti-hepatitis B virus ( HBV) specific immune response are important causes of chronic HBV infection. This article introduces the discovery of STING and the latest research advances in its structure, briefly elaborates on the mechanism of activation of the STING signaling pathway, summarizes the research advances in the interaction between the STING signaling pathway and HBV, and points out the potential value of STING in clinical treatment.

Research advances in noninvasive assessment of portal hypertension

Zhou Hao, Yang JianJiang, Tang ShanHong, Feng ZhiSong, Qin JianPing

2018, 34(8): 1783-1787. DOI: 10.3969/j.issn.1001-5256.2018.08.043

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Patients with decompensated cirrhosis often have varying degrees of portal hypertension, and when portal pressure reaches a certain threshold, various clinical complications may occur and even threaten patients' lives. Therefore, portal pressure assessment is important for the clinical management and prognosis of such patients. Due to the anatomical characteristics of the portal vein, it is difficult to measure portal pressure directly. At present, hepatic venous pressure gradient is used to replace portal pressure in China and foreign countries. However, the measurement of hepatic venous pressure gradient is an interventional procedure and is difficult to perform in clinical practice.Therefore, noninvasive assessment of portal hypertension has become a research hotspot. This article reviews the research advances in the roles of serum markers, ultrasound elastography, computed tomography, and magnetic resonance imaging/magnetic resonance elastography in noninvasive assessment of portal hypertension.

Increasing early diagnosis of primary liver cancer by improving the compliance with regular screening in the high-risk population

Luo XinChen, Zhou YouQian

2018, 34(8): 1788-1792. DOI: 10.3969/j.issn.1001-5256.2018.08.044

Abstract(1808)

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Most patients with primary liver cancer are in the advanced stage at diagnosis and have missed the best timing of treatment, and therefore, increasing the early diagnostic rate of primary liver cancer has great significance in improving patients' prognosis. There is a rapid progress in the research on new serum tumor markers, but their clinical application is still not satisfactory. The screening method of risk re-stratification based on the medical history of individuals at a high risk of primary liver cancer and conventional screening indices and adoption of different ways of screening based on the level of risk can improve patient compliance and thus increase the early diagnostic rate of primary liver cancer. This article reviews the research advances in the current status of early diagnosis of primary liver cancer, the early screening methods in the high-risk population, and early risk prediction.

The association between type 2 diabetes mellitus and hepatocellular carcinoma

You YuLai, Deng MingHua, Gong JianPing

2018, 34(8): 1793-1796. DOI: 10.3969/j.issn.1001-5256.2018.08.045

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Type 2 diabetes mellitus ( T2 DM) is closely associated with the development of hepatocellular carcinoma ( HCC) . T2 DM can increase the risk of HCC in many ways, which suggests that several signaling pathways or susceptibility genes might be involved in the development of these two diseases. This article discusses the role of T2 DM in the development of HCC and the association between T2 DM and HCC at genetic and molecular levels and finds that nuclear receptor co-activator 5, transcription factor 7-like 2, glycogen synthase kinase 3β, and Toll-like receptor 4 are involved in the pathogenesis of T2 DM and HCC, which is the key that links the two diseases at genetic and molecular levels.

Biological function of translationally controlled tumor protein and its role in the development and progression of hepatocellular carcinoma

Liu Qi, Liu Wei, Lin ZhiBin, Dou KeFeng

2018, 34(8): 1797-1800. DOI: 10.3969/j.issn.1001-5256.2018.08.046

Abstract(289)

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Translationally controlled tumor protein ( TCTP) is widely expressed in most animal and plant cells and is involved in various physiological activities. Studies have shown that liver cancer tissue has significantly higher expression of TCTP than normal tissue. This article introduces the main biological functions of TCTP, such as promoting cell growth and development, regulating cell cycle, inhibiting cell apoptosis, reducing cell stress response, and regulating inflammatory response. Besides changing cell cycle and inhibiting cell apoptosis, TCTP can also induce mitotic defects and chromosomal instability, mediate inflammatory response and hepatic fibrosis, and thus promote the development and progression of hepatocellular carcinoma ( HCC) . It is pointed out that TCTP might be used as a potential marker for the early diagnosis of HCC, and targeted reduction of TCTP expression might be a new method for the treatment of HCC.

Research advances in portal hypertension in patients with nonalcoholic fatty liver disease

Li Min, Mao XiaoRong

2018, 34(8): 1801-1804. DOI: 10.3969/j.issn.1001-5256.2018.08.047

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Nonalcoholic fatty liver disease ( NAFLD) is often complicated by clinically significant portal hypertension ( PHT) during its progression to liver cirrhosis, which is primarily caused by increased intrahepatic vascular resistance. The pathogenesis of PHT in NAFLD remains unclear. This article summarizes the current research status of PHT in NAFLD and related cellular and molecular mechanisms in the development of PHT, in order to provide a theoretical basis for novel preventive and therapeutic strategies for NAFLD.

Interrelation between autophagy and oxidative stress in pathogenesis of nonalcoholic fatty liver

Zhou Fan, Peng JunWei, Fan FuGang, Jiang YuanYe, Cao Qin

2018, 34(8): 1805-1808. DOI: 10.3969/j.issn.1001-5256.2018.08.048

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Nonalcoholic fatty liver disease ( NAFLD) is the result of the interaction between many factors, and“second hit”focusing on oxidative stress is a key factor for the progression of NAFLD. Autophagy has been a research hotspot in recent years, and more and more studies have shown that autophagy plays an important role in lipid metabolism in hepatocytes, inflammatory response, and liver fibrosis and is closely associated with oxidative stress. With reference to the latest research findings in China and foreign countries, this article analyzes the interrelation between autophagy and oxidative stress in the pathogenesis of NAFLD from the aspects of the association between autophagy and NAFLD and the association between oxidative stress and NAFLD. It is pointed out that the molecular mechanism of the regulation of oxidative stress by autophagy in the pathogenesis of NAFLD may be a research hotspot in future, and blockade or activation of a key pathway involved in the regulation of oxidative stress by autophagy may provide a new method for the treatment of NAFLD.

2018 No. 8

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2018 No. 8

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