Objective To evaluate the diagnostic value of liver stiffness ( LS) combined with aspartate aminotransferase- to- platelet ratio index ( APRI) for liver fibrosis due to chronic hepatitis B. Methods One hundred and forty- seven patients with chronic hepatitis B admitted to our hospital from August 2009 to January 2013 were staged and grouped according to liver fibrosis pathology. LS was determined with acoustic radiation force impulse, and APRI was calculated from the results of liver function test and routine blood examination. Comparisons between groups were conducted using the analysis of variance. Correlation analysis was performed with the Spearman test. The diagnostic value of LS for liver fibrosis was assessed with the receiver operating characteristic ( ROC) curve. The areas under the ROC curve ( AUC) of LS and APRI, either alone or in combination, for diagnoses of S ≥1 ( presence of liver fibrosis) and S ≥2 ( significant liver fibrosis) were compared. Results Age, LS, aspartate aminotransferase ( AST) , platelet count ( PLT) , and APRI differed significantly across the groups ( P<0. 05) . LS and APRI were strongly correlated with pathological stages, with correlation coefficients of 0. 793 and 0. 699 ( P <0. 05) .The correlation coefficients of AST and PLT with pathological stages were 0. 292 and- 0. 230 ( P < 0. 05) . The AUCs of LS, APRI, and LS plus APRI were 0. 843, 0. 818, and 0. 909, respectively, for diagnosis of S ≥1 and 0. 916, 0. 846, and 0. 943, respectively, for diagnosis of S ≥2, suggesting that the joint use of LS and APRI outperforms LS or APRI alone in the diagnosis of liver fibrosis ( P < 0. 05) . Conclusion LS combined with APRI improve the diagnosis of early- stage liver fibrosis.

Objective To investigate the value of acoustic radiation force impulse ( ARFI) in evaluating non- alcoholic simple fatty liver ( NAFL) . Methods Eighty- four patients with NAFL, who were admitted to our hospital from June to December 2011, were divided into mild, moderate, and severe NAFL groups according to ultrasonographic findings. Meanwhile, 36 healthy people were chosen as the control group. Both groups were subjected to virtual touch tissue quantification ( VTQ) . Differences between the control group and NAFL groups and between the NAFL groups were determined. Comparisons between two groups were made using the t test and comparisons between multiple groups were conducted using the multi- factor analysis of variance. The correlation of fatty liver severity with VTQ was examined with the Spearman rank correlation test. Results The difference in VTQ value between the NAFL groups and control group was statistically significant ( 1. 74 ± 0. 49 m / s vs 1. 18 ± 0. 22 m / s; t = 3. 436, P < 0. 01) . VTQ values differed significantly across the NAFL groups ( F =21. 266, P < 0. 01) . With the increase in severity of fatty liver, VTQ value gradually increased, suggesting a positive correlation between the two variables ( Spearman correlation coefficient 0. 542, P < 0. 001) . Conclusion ARFI can reflect the severity of NAFL and can be used for the screening of patients with NAFL in outpatient and physical examination centers, offering an accurate quantitative tool for the evaluation of NAFL.

Objective To evaluate the clinical efficacy of compound Biejia Ruangan tablets using transient elastography in patients with hepatitis B- induced compensated liver cirrhosis who are concurrently treated with entecavir. Methods In this prospective, randomized, and controlled study, 100 patients with hepatitis B- induced compensated liver cirrhosis were randomly assigned to the control group and the experimental group in a ratio of 1: 1. The patients in the control group were treated with the anti- virus drug entecavir alone, whereas the patients in the experimental group were treated with entecavir and compound Biejia Ruangan tablets for anti- fibrosis therapy. The patients were followed up at 6 and 12months. After treatment, the changes in transient elasticity values were evaluated, and the transient elasticity values were compared between the two groups. Continuous variables were compared with the t test and categorical data as well as rates were compared with the chi- square test. Results Treatment with compound Biejia Ruangan tablets led to significantly lower transient elasticity values in the experimental group than in the control group at 6 and 12 months ( t = 2. 963, P = 0. 004; t = 2. 239, P = 0. 027) . Transient elasticity values at 6 and 12 months were significantly lower than their respective baseline levels in the control group ( t = 4. 295, P < 0. 001 for comparison between values at baseline and 6months; t = 6. 109, P < 0. 001 for comparison between values at baseline and 12 months; t = 5. 394, P < 0. 001 for comparison between values at 6 and 12 months) and the experimental group ( t = 8. 505, P < 0. 001 for comparison between values at baseline and 6 months; t = 9. 882, P<0. 001 for comparison between values at baseline and 12 months; t = 7. 930, P < 0. 001 for comparison between values at 6 months and 12months) . At 12 months, the proportion of patients with liver cirrhosis in the experimental group was significantly lower than that in the control group ( χ2= 4. 058, P = 0. 044) . Conclusion Entecavir can relieve liver fibrosis to some extent. Moreover, entecavir combined with compound Biejia Ruangan tablets can lead to further improvement in liver fibrosis at 6 and 12 months.

Objective To evaluate the effectiveness and toxicities of sorafenib combined with thanscatheter artierial chemoembolzation ( TACE) in the treatment of advanced hepatocellular carcinoma ( HCC) . Methods According to the Cochrane handbook for systematic review, two reviewers independently completed the whole process of literature search, study selection, data collection, and quality assessment. A manual and computerized search was performed using the PubMed, Embase, Chinese Journal Full- text Database, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, and Chinese Medical Association Digital Periodicals to collect randomized controlled trials ( RCT) of sorafenib in the treatment of advanced HCC published up to September 2012. The obtained data were analyzed with RevMan 5. 0 software. Results Seven RCT involving 854 patients were finally included. Compared with sorafenib alone, sorafenib combined with TACE significantly prolonged the overall survival in HCC patients, but failed to reduce their mortality. The incidence of hand- foot syndrome, diarrhea, rash, and hypertension was significantly higher in combined treatment groups than in control groups, but the incidence of alopecia showed no significant difference between them. Conclusion Sorafenib combined with TACE are effective and safe in the treatment of advanced HCC.

Objective To establish a rat model of liver cirrhosis or liver cancer, to determine the liver cancer detection rates of magnetic resonance imaging ( MRI) in liver cirrhosis before and after superparamagnetic iron oxide ( SPIO) enhancement, to analyse the changes in SPIO distribution in different lesions in the process of inducing liver cirrhosis and liver cancer in rats, and to investigate the feasibility of assessing the function of Kupffer cells by SPIO- enhanced MRI. Methods Thirty male Sprague- Dawley ( SD) rats were randomly divided into experimental group ( n = 20) and control group ( n = 10) . The experimental group was given 0. 1 mg / ml diethylnitrosamine ( DENA) solution by free drinking, while the control group drank sterilized saline. At 10 or 20 weeks after treatment, 10 rats were selected from the experimental group to undergo plain MRI scans and then SPIO- enhanced MRI performed one hour after injection of SPIO; the rats were sacrificed immediately after scans. At 20 weeks after treatment, the 10 rats in control group underwent MRI scans and were then sacrificed immediately. The obtained MR images were analyzed. Blood samples were taken to measure serum alanine aminotransferase ( ALT) and aspartate aminotransferase ( AST) levels. Liver samples were taken and subjected to HE staining and Perls' blue staining for pathological examination. Results Compared with the control group, the experimental group had significantly increased ALT and AST levels at 10 weeks ( P <0. 001) , and the ALT and AST levels were significantly higher at 20 weeks than at 10 weeks in the experimental group ( P < 0. 001) . The SPIO- enhanced MRI showed that the percentage of signal intensity loss ( PSIL) was the highest in normal liver tissue, followed by simple cirrhosis tissue and cirrhosis tissue distant from liver cancer, and was the lowest in liver cancer tissue; there were significant differences in PSIL between the four tissues ( P < 0. 001) . In the experimental rats examined at 20 weeks after treatment, the liver cancer detection rate on each sequence and lesion- to- liver contrast- to- noise ratio increased significantly after SPIO enhancement ( P < 0. 05) . The Perls' blue staining showed that there was a significant linear correlation between the number of blue dye particles and PSIL on each sequence after SPIO enhancement in various liver tissues ( P < 0. 01) . Conclusion DENA induces the SD rat model of liver cirrhosis or liver cancer by the process similar to the development and progression of liver cirrhosis and liver cancer in humans. SPIO- enhanced MRI not only can indirectly reflect the changes in number and function of Kupffer cells in various lesions, but is also conducive to the early detection of liver cancer nodules in liver cirrhosis, with important value and guiding significance for clinical treatment.

Objective To investigate the time for liver stiffness measurement ( LSM) to become stable in chronic hepatitis C ( CHC) patients with elevated alanine aminotransferase ( ALT) levels after ALT normalization due to antiviral therapy. Methods CHC patients who sought initial treatment at Peking University People's Hospital were screened for elevated ALT levels from May 2011. Liver stiffness was determined by FibroScan. A total of 29 patients had been included in the study by September 2012, who were followed up regularly after antiviral treatment. ALT tests were repeated every four weeks and LSM every eight weeks until their medians did not change significantly. Comparisons of matched data at two adjacent time points were made with the non- parametric Wilcoxon test, while multiple comparisons of repeated measurements were performed using Bonferroni correction. Correlation between two variables was analyzed with the Spearman rank test. Results Patients were followed up until 24 weeks after antiviral treatment, and 24 patients were included in analysis. The median ALT levels were 64, 26, 21, 20, and 22 U / L at baseline and 4, 8, 12, and 24 weeks, respectively ( P = 0. 000, 0. 006, 0. 337, and 0. 109 for comparisons between two adjacent values) . ALT decreased significantly below 1 ULN at 4 weeks after antiviral therapy and stabilized at 8 weeks.The median LSM values were 8. 7, 7. 8, 6. 8, and 6. 7 kPa at baseline and 8, 16, and 24 weeks, respectively ( P = 0. 009, 0. 001, and0. 188 for comparisons between two adjacent values) . LSM decreased significantly within 16 weeks after antiviral therapy and stabilized afterwards. LSM stabilized 12 weeks after ALT normalization. Conclusion LSM becomes stable in CHC patients with elevated ALT levels three months after ALT normalization due to antiviral therapy.

Objective To investigate the clinical efficacy of ribavirin ( RBV) combined with different doses of interferonα-2b ( IFN α-2b) in patients with chronic hepatitis C genotypes 2 and 3. Methods Forty- six patients who were admitted for chronic hepatitis C genotypes 2 and 3 from April 2009 to January 2012 were assigned to treatment group ( n = 24) and control group ( n = 22) . Both groups received intramuscular injection of IFN α- 2b at a dose of 6 MU once daily in the first month. In the second month, the treatment group received intramuscular injection of IFN α- 2b at a dose of 6 MU once every other day, and from the third month onwards, the treatment group received intramuscular injection of IFN α- 2b at a dose of 3 MU once every other day. The control group received intramuscular injection of IFN α-2b at a dose of 6 MU once every other day from the second month onwards. In addition, both groups received oral RBV ( 900- 1200 mg) three times daily for six months. The course of treatment was six months in both groups. The patients in the two groups who achieved end-of- treatment virologic response ( ETVR) were followed up at six months after the treatment, whereas those with no response ( NR) were treated for additional three months. Rapid viral response ( RVR) , early virologic response ( EVR) , ETVR, NR, and sustained virologic response ( SVR) were compared between the two groups after the treatment. The cost of treatment and adverse reactions were also compared between the two groups. Statistical analysis was performed with SPSS 11. 0, and comparison of numeration data between the two groups was conducted using the chi- square test. Results Both groups had high rates of RVR [15 ( 62. 50%) vs 13 ( 59. 09%) , χ2= 0. 056, P >0. 05], EVR [17 ( 70. 83%) vs 15 ( 68. 18%) , χ2= 0. 038, P > 0. 05], ETVR [20 ( 83. 33%) vs 19 ( 86. 36%) , χ2= 0. 082, P >0. 05], and SVR [18 ( 75. 00%) vs 17 ( 77. 27%) , χ2= 0. 033, P > 0. 05]. The rate of NR was low in the treatment group and control group [4 ( 16. 67%) vs 3 ( 13. 64%) , χ2= 0. 082, P > 0. 05]. The use of IFN α- 2b and cost of treatment in the treatment group were nearly 30% less than those in the control group, and the treatment group also experienced milder adverse reactions. Conclusion For patients with chronic hepatitis C genotypes 2 and 3, RBV combined with IFN α- 2b at an induction dose can lead to relatively high rates of RVR and EVR, and RBV plus IFN α- 2b at a maintenance dose can also result in relatively high rates of ETVR and SVR, thereby helping to reduce financial burden on patients and minimize adverse reactions.

Objective To assess the therapeutic efficacy of central venous catheter placement via abdominal puncture in the treatment of refractory ascites. Methods Thirty- six patients with refractory ascites due to cirrhosis who were unresponsive to albumin supplement and diuretic treatment and admitted to our hospital from July 2010 to March 2011 were included in this study. Intraperitoneal catheter drainage was performed in these patients, in which generally not more than 800 ml of ascites was drained in the first session and subsequently 1500- 2000ml of ascites was drained daily; in addition, human albumin ( 10 g / d) was infused, and spironolactone ( 400 mg / d) and furosemide ( 160mg / d) were orally given. Results Reduction in ascites volume, ultrasound examination results, urine volume, and time of stable condition were monitored after 12 days of treatment. Abdominal distension was relieved in all patients after 3 days of treatment. After 12 days of treatment, 17 cases ( 47. 2%) showed a complete response, 15 cases ( 41. 7%) showed a partial response, and 4 cases ( 11. 1%) showed no response, with a response rate of 88. 9%. Conclusion The placement of a central venous catheter in the abdominal cavity reduces the number of punctures and lowers the incidence of hepatorenal syndrome. The central venous catheter offers a convenient, safe, and easy- to- use tool for sustained peritoneal drainage in the treatment of intractable ascites.

Objective To investigate the protective effect ofβ- catenin gene in hepatic ischemia- reperfusion injury among mice and the underlying mechanism. Methods Using β- catenin knockout mice and a segmental hepatic ischemia- reperfusion model, serum levels of alanine aminotransferase ( ALT) and aspartate aminotransferase ( AST) and the pathological changes in the liver were evaluated after segmental hepatic ischemia- reperfusion, and the mRNA expression levels of hypoxia- inducible factor 1α ( HIF- 1α) , tumor necrosis factor- α ( TNFα) , and interleukin- 1β ( IL- 1β) in the liver tissues of β- catenin- /-mice and wild- type ( WT) mice were determined by real- time fluorescence quantitative polymerase chain reaction six hours after reperfusion. Comparisons between groups were performed with the t test or analysis of variance. Results β- catenin- /-mice sustained severer pathological injury from ischemia- reperfusion than WT mice, as evidenced by significantly higher serum levels of ALT ( 8178. 61 ± 78. 76 U / L vs 891. 83 ± 23. 73 U / L, t = 24. 296, P < 0. 001) and AST ( 7348. 94 ± 141. 99 U / L vs 873. 50 ± 20. 27 U / L, t = 27. 854, P < 0. 001) and significantly higher mRNA expression levels of TNF- α ( 3. 14 ± 0. 37 vs 1. 00 ± 0. 19, t = 3. 676, P < 0. 01) and IL- 1β ( 3. 72 ± 0. 33 vs 1. 00 ± 0. 24, t = 4. 017, P < 0. 01) in β-catenin- /-mice compared with WT mice. In contrast, the mRNA expression of HIF- 1α was down- regulated in β- catenin- /-mice relative to WT mice ( 0. 31 ± 0. 04 vs 1. 00 ± 0. 22, t = 3. 949, P < 0. 01) . Conclusion β- catenin gene deletion aggravates hepatic ischemia- reperfusion injury by reducing the expression of HIF- 1α.