Alcoholic hepatitis is an important type of alcohol-associated liver disease characterized by acute liver inflammation caused by pro-longed heavy alcohol use. In the present article, the pathogenesis, clinical characteristics, diagnosis, current therapies and future treatmentstrategies of alcoholic hepatitis are summarized and reviewed in order to help the hepatologists to better understand this kind of disease in clini-cal practice.

Alcoholic hepatitis ( AH) is a non-infectious inflammatory injury of the liver and often occurs on the basis of chronic liver dis-ease including fatty liver disease and liver cirrhosis. Acute exacerbation of liver disease due to heavy drinking within a short period of time isa severe manifestation of AH. The prognosis of AH depends on treatment timing and methods, and liver function can quickly recover or rap-idly deteriorate into multiple organ failure. Many clinicians lack the experience in early identification and timely treatment of AH, due to alack of typical clinical manifestations and specific auxiliary examinations, which affects clinical treatment, delays treatment, and exposessome AH patients to the risk of death. Therefore, it is imperative to conduct more clinical studies on AH, summarize real-world data, anddevelop expert consensus.

For a long time, researchers and clinicians have strictly divided fatty liver diseases into alcoholic and non-alcoholic fatty liverdisease. When one was diagnosed as alcoholic liver disease, the effects of non-alcoholic factors, including obesity, diabetes or metabolicsyndrome, on liver diseases have been neglected. Conversely, when the patient was diagnosed as non-alcoholic fatty liver disease, the im-pacts of alcohol drinking are usually ignored. In the new era, physicians and scientific researchers need to pay more attention to the dual fac-tors of alcohol and obesity, which often exist together and affect liver disease progression. This article elaborates on the clinical features of fat-ty liver disease in the new era from the aspects of changes in the clinical features of alcoholic liver disease, disease pattern of nonalcoholicfatty liver disease with drinking, and differential diagnosis of alcoholic and nonalcoholic fatty liver diseases.

Normal intestinal microflora and microecology are essential for normal physiological functions in human body. Intestinal microfloraimbalance is often observed in patients with alcoholic liver disease and manifests as abnormal number and constituent ratio of intestinal micro-flora, dysfunction of intestinal mucosal barrier, bacterial translocation, and intestinal endotoxemia, and it plays an important role in the de-velopment and progression of alcoholic liver disease. In addition, intestinal microflora also has influence on alcohol metabolism. Probiotics orfecal microbiota transplantation can regulate intestinal microflora and may play an active role in the treatment of alcoholic liver disease. Fur-ther studies are needed to discuss the standardized use of microecologics, dose selection, dosage form, and course of treatment during theprevention and treatment of alcoholic liver disease.

The pathogenesis of alcoholic liver disease remains unclear, mainly due to the lack of accurate animal models in experiments.Many different animal models have been established to mimic alcoholic liver disease in patients, which have both advantages and disadvanta-ges. Among these models, the Gao-Binge model is widely used in the experiments because it highly mimics the drinking pattern in patients.It is more persuasive that the pathogenesis and therapeutic drugs have been examined in the Gao-Bingemodel. Although there are some lim-its in the Gao-Binge model, it is no doubt that this model has high value and future prospect in the study of alcoholic liver disease becauseof short duration time, low cost and good repeatability. Finally, the Gao-Binge model has also been used to study alcohol-induced damageto other organs such as the heart, pancreas, adipose tissue etc.

Rapid progression or aggravation of jaundice, coagulation abnormalities and liver-related complications in patients with alcoholichepatitis indicates that they may develop severe alcoholic hepatitis. Some of these patients can progress acute-on-chronic liver failure withacute insults, such as infection and binge drinking and binge, showing as acute decompensation, organ failure and high 28-day mortalityrate. Early identification and effective intervention can improve the prognosis of acute-on-chronic liver failure. Intestinal barrier dysfunc-tion and liver-gut axis imbalance play an important role in the development of severe alcoholic hepatitis and acute-on-chronic liver fail-ure. It is important to improve the basic nutritional status of patients. Effective drug therapies are limited in improving the condition andprognosis of acute-on-chronic liver failure. Early liver transplantation can bring great benefits to these patients.

Objective To investigate the clinical effect of percutaneous transhepatic cholangial drainage ( PTCD) combined with biliarystent implantation in the treatment of high malignant obstructive jaundice ( MOJ) and the risk factors for survival time. Methods A retro-spective analysis was performed for the clinical data of 92 patients with high MOJ who were admitted to Department of Hepatobiliary Surgeryin Air Force General Hospital, PLA, from June 2015 to June 2017. The t-test was used for comparison of normally distributed continuousdata between two groups; an analysis of variance was used for comparison between multiple groups, and the SNK-q test was used for furthercomparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data betweentwo groups. The chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic ( ROC) curve was used to determine the optimal cut-off values of influencing factors for survival time; the patients were divided into groups accord-ing to the optimal cut-off values, and the Kaplan-Meier method was used for survival analysis. The multivariate Cox proportional hazardsmodel was used to identify the independent influencing factors for survival time. Results All patients were followed up for a median time of6 months ( range 1-10 months) . A total of 56 patients died and 36 survived during follow-up, with a median survival time of 6 months, asurvival rate of 39. 1% at the end of follow-up, and a half-year survival rate of 44. 6%. Of all 92 patients, 14 experienced postoperativecomplications, resulting in an incidence rate of complications of 15. 2%. At 3 days and 1 week after surgery, there were significant reduc-tions in total bilirubin ( TBil) , direct bilirubin, alanine aminotransferase ( ALT) , and aspartate aminotransferase ( F = 206. 264, 106. 161, 86. 332, and 166. 857, all P < 0. 05) . The ROC Curve was used to analyze the data, TBil had a sensitivity of 95. 12% and a specificity of46. 15% at the optimal cut-off value of 112. 9 μmol/L; ALT had a sensitivity of 92. 68% and a specificity of 31. 58% at the optimal cut-off value of 210 U/L; albumin had a sensitivity of 68. 29% and a specificity of 58. 33% at the optimal cut-off value of 35. 7 g/L; red blood cell count had a sensitivity of 60. 98% and a specificity of 69. 23% at the optimal cut-off value of 3. 56 × 1012/L. Child-Pugh class, TBil, and ALT showed a significant difference in predicting overall survival ( all P < 0. 05) . The multivariate Cox proportional hazards model showed that Child-Pugh class C was an independent influencing factor for survival time after PTCD combined with biliary stent implantation. Conclusion PTCD combined with biliary stent implantation has a good clinical effect in the treatment of patients with MOJ, but preoperative liver function has a great impact on survival time. Therefore, liver function should be observed dynamically to guide clinical treatment, in order to prolong the survival time of such patients.

Objective To investigate the feasibility and safety of laparoscopic radical resection in the treatment of type IV hilar cholangio-carcinoma. Methods A retrospective analysis was performed for the clinical data of 4 patients who were admitted to the Affiliated Hospitalof Chuanbei Medical College from July 2015 to September 2018, underwent laparoscopic radical resection, and were diagnosed with type IVhilar cholangiocarcinoma based on postoperative pathology. There were 2 female and 2 male patients aged 53-65 years, with a mean age of59. 4 years. All patients had varying degrees of jaundice before surgery and were given symptomatic treatment including liver-protectingtreatment, jaundice clearance, and nutritional support. Two patients underwent percutaneous transhepatic biliary drainage before surgery toalleviate jaundice. Results All 4 patients underwent a successful laparoscopic surgery, among whom 3 underwent left hemihepatectomy +total caudate lobe resection + lymph node dissection + choledochoenterostomy, and 1 underwent extensive right hemihepatectomy + total cau-date lobe resection + lymph node dissection + choledochoenterostomy. Time of operation was 5. 5-8. 5 hours, and intraoperative blood lossranged from 200 to 750 ml, with 400 ml intraoperative blood transfusion in 1 patient. After surgery, 1 patient had bile leakage and was im-proved and discharged after conservative continuous drainage; 1 patient had massive ascites and was discharged after liver-protecting anddiuretic treatment; no perioperative complication was observed in the other 2 patients. The patients were followed up for 3-24 months aftersurgery; 1 patient developed intrahepatic metastasis at 11 months after surgery and had survived with tumor for 4 months after interventionaltherapy. Conclusion With adequate preoperative assessment, strict control of surgical indications, skilled laparoscopic technique, andstandardized operation, laparoscopic radical resection is feasible and safe in the treatment of type IV hilar cholangiocarcinoma. R0 resectionis an important prognostic factor.

Objective To investigate the effect of Pien Tze Huang on bile excretion and its analgesic effect in experimental animals. Meth-ods A total of 30 guinea pigs were randomly divided into Pien Tze Huang group, ursodeoxycholic acid group, and control group. Accordingto body mass, the three groups were treated with Pien Tze Huang ( 140 mg/kg) , ursodeoxycholic acid ( 22. 5 mg/kg) , and normal saline, respectively, by gavage for 4 consecutive days. Then bile drainage was performed to measure the volume of bile secretion and the change inbile composition. Related liver function parameters were also measured. A total of 30 mice were randomly divided into Pien Tze Huang group ( 360 mg/kg) , ursodeoxycholic acid group ( 120 mg/kg) , and control group. At one hour after the last administration, the mice were givenintraperitoneal injection of 0. 6% glacial acetic acid ( 0. 15 ml/10 g) , and the writhing test was performed to observe the analgesic effect ofPien Tze Huang. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least signifi-cant difference t-test was used for further comparison between two groups. Results Compared with the control group, the Pien Tze Huanggroup and the ursodeoxycholic acid group had a significant increase in the volume of bile secretion ( P = 0. 039 and 0. 009) . There were nosignificant differences between the three groups in cholesterol, bilirubin, total bile acid, and phospholipid in bile ( all P > 0. 05) and liverfunction parameters ( alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, total bilirubin, direct biliru-bin, indirect bilirubin, and total bile acid) ( all P > 0. 05) . Compared with the control group, the Pien Tze Huang group had a significantreduction in the number of writhing times ( P < 0. 001) , suggesting that Pien Tze Huang had a marked analgesic effect. Conclusion Ani-mal experiments show that Pien Tze Huang has marked choleretic and analgesic effects, which provides theoretical and data support for theclinical application of Pien Tze Huang.

Objective To investigate the clinical features of drug-induced liver injury ( DILI) caused by antitumor drugs during the treat-ment of malignant tumors. Methods A retrospective analysis was performed for the clinical data of 56 patients who were diagnosed with ma-lignant tumors in Henan Provincial People's Hospital from January 2015 to December 2016 and experienced DILI during the treatment withantitumor drugs, including sex, age, type of primary tumor, hepatotropic virus infection, liver function, type of chemotherapeutics, onsettime of liver injury, application of liver-protecting drugs, and outcome of liver injury. Results Among the 56 patients with DILI caused byantitumor drugs, 30 ( 53. 6%) had hepatocellular injury, and 45 ( 80. 4%) had mild liver injury. FOLFOX, GP/DP, and CHOP were themost common regimens for DILI, and of all 56 patients, 50 ( 89. 3%) had DILI caused by multiple drugs. Platinum-based drugs, anti-microtubule agents, and alkylating agents were the common drugs causing DILI. Of all 56 patients, 35 ( 62. 5%) developed DILI within 1-2 weeks after medication. Conclusion DILI caused by antitumor drugs mainly has a mild degree and hepatocellular injury type is the mostcommon clinical type. Platinum-based antitumor drugs and related chemotherapeutic regimens are the most common drugs for DILI. A com-bination of multiple antitumor drugs is more likely to cause DILI, and patients with such DILI often have a good prognosis.

Objective To investigate the drugs responsible for drug-induced liver injury ( DILI) in children and related risk factors, andto provide a reference for safe drug use in children in clinical practice. Methods A retrospective analysis was performed for the clinical da-ta of 187 children with DILI, aged 0-14 years, who were treated in The Fifth Medical Center of Chinese PLA General Hospital from January2008 to December 2017, including medication history, biochemical parameters, symptoms/signs, and clinical outcome. Based on the meth-od of integrated evidence chain, 127 children with medication information were divided into Western medicine-induced DILI group ( West-ern medicine group with 75 children) , traditional Chinese medicine ( TCM) -induced DILI group ( TCM group with 15 children) , and thegroup with DILI induced by Western medicine and TCM ( TCM-Western medicine group with 37 children) . The reason for medication, medication time, latency of DILI, and drug classification were compared between groups. The Kruskal-Wallis H test was used for compari-son of continuous data with skewed distribution between multiple groups, and the Nemenyi test was used for further comparison between twogroups; the chi-square test was used for comparison of categorical data between groups. Results Of all 187 children with DILI, 116 ( 62%) had severe liver injury or above, among whom 3 underwent liver transplantation and 1 died, and 45 ( 24%) developed chronicity.In the Western medicine group and the TCM-Western medicine group, major suspected drugs for DILI were antibiotics, antipyretics, anal-gesics, and anti-inflammatory drugs, which accounted for 42%, 30%, 56%, and 31%, respectively. In the TCM group, the most com-mon TCM drugs for DILI were those used to treat skin diseases, which accounted for 47% and were mainly the preparations of Fallopia multi-flora ( 33%) . There were significant differences between the three groups in medication time ( H = 11. 658, P = 0. 003) and latency ( H =10. 945, P = 0. 004) , and the TCM group had significantly longer medication time and latency than the other two groups ( all P < 0. 05) .Conclusion Most children with DILI have serious conditions. The risk of liver injury due to medication in children should be taken serious-ly, and particular emphasis should be placed on the risk of liver injury caused by antibiotics, antipyretics, analgesics, and anti-inflamma-tory drugs and long-term use of some TCM drugs for skin diseases.

Objective To establish a microRNA-mRNA differential expression network for alcoholic hepatitis ( AH) , and to investigatenew targets for the diagnosis and treatment of AH. Methods Differentially expressed microRNAs and mRNAs between AH patients and nor-mal controls were screened out. Related software including TargetScan, DIANA, MIRDB, PICTAR, and miRWalk 2. 0 was used to searchfor the target genes of differentially expressed microRNA, and a key microRNA-mRNA network was established using the differentially ex-pressed mRNAs that changed in an opposite way to microRNA. The Database for Annotation, Visualization and Integrated Discovery wasused for the gene ontology ( GO) and Kyoto Encyclopedia of Genes and Genome ( KEGG) analyses of target genes. The GCBI online soft-ware ( www. gcbi. com. cn) was used for enrichment analysis of target genes and core network establishment. The GeneMANIA database inCytoscape software ( genemania. org) was used to perform a protein-protein interaction analysis of key target genes. The above three meth-ods were compared in terms of the search for key pathways involved in the development of AH. Results A key microRNA-mRNA networkwas established with 5 differentially expressed microRNAs including hsa-mir-21-5 p, hsa-mir-148 a-3 p, and hsa-mir-30 e-5 pand 51 target genes including collagen type IV alpha 1 chain ( COL4 A1) , thrombospondin-2 ( THBS2) , and integrin alpha 6 ( IGTA6) . Aprotein-protein interaction network of key target genes was established. The GO analysis and various pathway analyses showed that the PI3 K-Akt pathway and local adhesion were closely associated with AH. Conclusion During the development of AH, there are complex interac-tions between the related proteins of key target genes. COL4 A1 and THBS2 may promote the development of AH by activating ITGA6 to regu-late the PI3 K-Akt pathway and the process of local adhesion. The establishment of the microRNA-mRNA network reveals the key links inthe development of AH and highlights the focus of research. The discovery of the genes associated with the PI3 K-Akt pathway in AH is ex-pected to provide new targets for the diagnosis and treatment of AH.

Objective To investigate the effect of intraperitoneal transplantation of human liver-derived stem cells in the prevention and treatment of alcoholic fatty liver disease in mice. Methods A total of 30 male C57 BL/6 mice were randomly divided into blank control group ( group N) , model control group ( group M) , and stem cell transplantation group ( group S) . The mice in group N were fed a normal diet, and those in the other two groups were fed Lieber-DeCarli alcohol liquid diet; at the same time, the mice in group S were given intraperitoneal transplantation of human liver-derived stem cells twice a week. After six weeks of intervention, body weight and liver index were measured, and the serum levels of alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , total bilirubin ( TBil) , total cholesterol ( TC) , triglyceride ( TG) , high-density lipoprotein cholesterol ( HDL-C) , and low-density lipoprotein cholesterol ( LDL-C) were also measured. The levels of TG and non-esterified fatty acid ( NEFA) in the liver were measured, and liver pathological examination and oil red O staining of the liver were performed. One-way ANOVA was used for comparison of continuous data between multiple groups, and the SNK-q test was used for further comparison between two groups. Results There were significant differences in the serum levels of ALT, AST, TG, TC, and HDL-C and the content of TG and NEFA in the liver between the three groups ( F = 66. 94, 7. 15, 8. 02, 18. 64, 3. 86, 23. 14 and 30. 49, all P < 0. 05) , Compared with group N, group M showed significant increases in levels of ALT, AST, and TG in serum and levels of TG and NEFA in liver tissue ( all P < 0. 05) . Group S had significantly lower levels of ALT, AST, and TG in serum and levels of TG and NEFA in liver tissue than group M ( all P < 0. 05) . Liver HE staining and oil red O staining showed that group S had a significantly lower degree of liver steatosis than group M. Conclusion Intraperitoneal transplantation of human liver-derived stem cells has a marked effect in the prevention and treatment of alcoholic fatty liver disease in mice.

Objective To investigate the clinical effect of perioperative Gandouling intervention in patients with Wilson's disease ( WD) complicated by splenomegaly and hypersplenism and the changes in related indices. Methods A total of 60 WD patients with splenomegalyand hypersplenism who were hospitalized in Encephalopathy Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, from July 2016 to July 2018 were enrolled and randomly divided into control group and treatment group, with 30 patients in each group. Thepatients in the control group were given conventional Western medicine treatment including decoppering for 4 courses ( each course of treatmentwas 8 days) , followed by splenectomy and conventional decoppering at the end of week 1 after surgery for 2 courses; the patients in the treat-ment group were given Gandouling in addition to the treatment in the control group. Clinical outcome and changes in 24-hour urinary copper, peripheral hemogram, liver function parameters, and portal venous flow indices were observed. The two independent samples t-test was usedfor comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between twogroups. Results The treatment group had a significantly higher overall response rate than the control group [90% ( 27/30) vs 60% ( 18/30) , χ2= 4. 43, P = 0. 03]. Compared with the control group at the end of two courses of treatment after surgery, the treatment group had sig-nificantly lower 24-hour urinary copper ( t = 41. 07, P < 0. 05) and levels of alanine aminotransferase and aspartate aminotransferase ( t = 7. 29 and 6. 13, both P < 0. 01) and significantly higher levels of red blood cell count, platelet count, and hemoglobin ( t =-5. 49, -3. 43, and-3. 53, all P < 0. 01) . At the end of two courses of treatment after surgery, both groups had a reduction in portal venousflow, and the treatment group had a significantly greater improvement in portal venous flow than the control group ( t = 12. 05, P < 0. 01) .Conclusion Gandouling can improve the clinical outcome of WD patients with splenomegaly and hypersplenism after splenectomy.

Nonalcoholic fatty liver disease ( NAFLD) is the most common risk factor for diabetes mellitus and cerebrovascular and cardiovascu-lar diseases. The prevalence of NAFLD is increasing rapidly with the improvement in living. Microsome triglyceride transfer protein ( MTP) isa key enzyme for outward transport of liver lipids, and the increase in MTP promoter methylation is an important factor for liver lipid depositionin NAFLD. Traditional Chinese medicine believes that“spleen Qi transfers essence”, and the lipid transport function of MTP may be one of themanifestations of“spleen Qi transfers essence”. Clinical studies have shown that the spleen-strengthening and dampness-removing principleis of great importance in the treatment of NAFLD. By reviewing related articles, this article points out that the spleen-strengthening anddampness-removing therapy can improve NAFLD by regulating MTP promoter methylation, increasing the level of hepatic MTP, promoting theoutflow of liver lipids, and alleviating lipid deposition.

Anti-mitochondrial antibody ( AMA) is a typical serum marker for primary biliary cholangitis ( PBC) , and the diagnosis ofAMA-negative PBC may easily be neglected in clinical practice. This article analyzes the differences in epidemiology, clinical and patho-logical features, and treatment outcome between AMA-negative and AMA-positive PBC and points out that there are significant differencesbetween them in the symptom of pruritus, immunoglobulin M, and severity of bile duct injury. For patients with a clinical diagnosis of AMA-negative PBC, immunofluorescence assay combined with immunological detection should be performed to exclude the false-negative resultof AMA, and a confirmed diagnosis can be made with reference to the manifestation of cholestasis, positive results of anti-sp100, anti-gp210, and anti-ANA antibodies, and typical hyperactive cholangitis based on pathological examination. Differential diagnosis of this dis-ease with other types of bile duct injury or absence of bile duct should be taken seriously in clinical practice.

Juxta-papillary duodenal diverticula ( JPD) may easily cause biliary and pancreatic diseases. JPD changes papillary positionand shape and increases the difficulties in endoscopic retrograde cholangiopancreatography ( ERCP) intubation and stone removal, and itmay also cause a series of complications. With reference to related articles in China and foreign countries, this article briefly describes thetyping and development of JPD and its association with biliary and pancreatic diseases, analyzes the influence of common bile duct stones andJPD on ERCP, and summarizes related coping strategies, in order to provide suggestions and bases for clinical diagnosis and treatment.