2017 No. 6

Treatment of HBV/HCV co-infected patients in DAA era

Wang Cheng, Liao JiaJie

2017, 33(6): 1011-1016. DOI: 10.3969/j.issn.1001-5256.2017.06.001

Abstract(2130)

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Abstract:
Asian-pacific area, especially China, is Hepatitis B high epidemic area. Since 2011, the first generation of oral direct anti-HCV agents (DAAs) came to clinical use, the treatment of chronic hepatitis C has switched from interferon-based regimen era to DAA era.There is an increased awareness of hepatitis B (HBV) reactivation in chronic hepatitis C (CHC) patients coinfected with HBV treated with pan-oral direct-acting antivirals (DAAs) . Compared with interferon-based regimen, HBV reactivation occurred earlier and more severe among patients received DAA regimen, and even fetal cases or case end up with liver transplantation was reported. Thus, association of liver diseases called to alert the occurrence of HBV reactivation among CHC patients who received DAAs regimen. It is hence important to have HBV serology screened in all CHC patients before initiation of pan-oral DAAs therapy and the usefulness of preemptive administration of effective anti-HBV nucleos (t) ide analogues in coinfected patients need to be further studied.

The highlights of EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection

Yu LeCheng, Hou JinLin

2017, 33(6): 1017-1032. DOI: 10.3969/j.issn.1001-5256.2017.06.002

Abstract(355)

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A comparison of 2015 and 2016 EASL guidelines on treatment of hepatitis C: an analysis of direct-acting antiviral agents and drug-drug interaction

Ji WeiJia, Yan XueBing

2017, 33(6): 1033-1039. DOI: 10.3969/j.issn.1001-5256.2017.06.003

Abstract(2558)

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An interpretation of 2017 WHO guidelines on hepatitis B and C testing

Ji Fang, Pan Ting, Yan XueBing

2017, 33(6): 1040-1045. DOI: 10.3969/j.issn.1001-5256.2017.06.004

Abstract(2341)

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An excerpt of American Gastroenterological Association Institute Clinical Practice Update-Expert Review: care of patients who have achieved a sustained virologic response after antiviral therapy for chronic hepatitis C infection（2017）

Wang XiaoPing, Tang ShanHong, Jing Dan, Wu XiaoLing, Ceng WeiZheng, Jiang MingDe

2017, 33(6): 1046-1050. DOI: 10.3969/j.issn.1001-5256.2017.06.005

Abstract(167)

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An excerpt of Joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery-European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE): management and follow-up of gallbladder polyps (2017)

Lu Hao, Liu QuanDa

2017, 33(6): 1051-1055. DOI: 10.3969/j.issn.1001-5256.2017.06.006

Abstract(280)

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An excerpt of the Japanese Study Group on Congenital Biliary Dilatation (JSCBD) practice guidelines for congenital biliary dilatation (2017)

Lin JiZong, Liu Bo

2017, 33(6): 1056-1057. DOI: 10.3969/j.issn.1001-5256.2017.06.007

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Accurate clinical examination guarantees the whole management process of hepatitis C patients in the era of direct-acting antiviral agents

Wu Dan, Li ZhiWei

2017, 33(6): 1058-1062. DOI: 10.3969/j.issn.1001-5256.2017.06.008

Abstract(2514)

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Hepatitis C virus (HCV) infection is an important public health issue around the world. Direct-acting antiviral agents (DAAs) have become an important method to reduce HCV infection. DAAs can improve the clinical outcome of antiviral therapy, shorten the course of treatment, and reduce complications and have a wide range of application; therefore, they have great advantages over conventional therapies. Accurate clinical diagnosis has increasing importance in the era of DAAs and guarantees the whole management process of chronic hepatitis C patients from the aspects of disease diagnosis, therapeutic regimens, outcome evaluation, and long-term prognosis monitoring.

Value of direct-acting antivirals combined with PR regimen (PEG-IFN combined with ribavirin) in the new era of antiviral therapy for hepatitis C

Chen XinYue, Liu YaLi, Ren Shan

2017, 33(6): 1063-1066. DOI: 10.3969/j.issn.1001-5256.2017.06.009

Abstract(3145)

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Pegylated interferon (PEG-IFN) combined with ribavirin (PR regimen) has been used in China for more than 10 years. With the development of direct-acting antiviral agents (DAAs) , the therapeutic regimens for hepatitis C has become more and more diverse. In the regimen of DAAs combined with PR regimen, IFN helps to benefit the long-term prognosis of patients with chronic hepatitis C (CHC) , and the addition of DAAs may improve therapeutic effect, shorten the course of treatment, and further improve the current status of treatment of CHC. This article introduces the advantages and disadvantages of PR regimen, DAAs combined with PR regimen, and oral regimen with DAAs, in order to investigate the therapeutic regimens suitable for different CHC patients and provide a reference for clinical practice.

Adverse effects, drug interactions, and safety of direct-acting antiviral agents in treatment of hepatitis C

Zhao XiTai, Nie QingHe

2017, 33(6): 1067-1074. DOI: 10.3969/j.issn.1001-5256.2017.06.010

Abstract(3046)

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In recent years, direct-acting antiviral agents (DAAs) have achieved great success in the treatment of hepatitis C and have replaced interferon/ribavirin. However, since DAAs were launched not long ago, there lacks sufficient knowledge of their toxic and side effects, interactions with other drugs, and safety in patients complicated by other serious chronic diseases. The results of many large-scale clinical trials show that DAAs have good safety in different populations and serious toxic and side effects are rare, but drug interactions need to be taken seriously. The addition of ribavirin in DAA regimen or prolongation of DAA treatment does not increase patients' benefits and may cause more adverse events. Moreover, at the same time of DAA treatment, liver injury caused by HCV cannot be neglected, and continuous treatment should be given.

Whether antiviral therapy can reduce the incidence of hepatocellular carcinoma in patients with chronic HCV infection

Ceng QingLei, Yu ZuJiang

2017, 33(6): 1075-1078. DOI: 10.3969/j.issn.1001-5256.2017.06.011

Abstract(2179)

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In 2010, studies found that achievement of sustained virologic response after treatment in patients with chronic HCV infection meant cure; the overall cure rate of interferon combined with ribavirin around the world was about 60%, and the result of real-world study in China was 71. 1%. In 2013, the US took the lead in launching the direct-acting antiviral agents (DAAs) for HCV, and the cure rate was increased to almost 100%. However, recent studies have found that the incidence of hepatocellular carcinoma (HCC) tends to increase after the application of DAAs, and there are still controversies over whether DAAs are the major cause of this phenomenon. In our opinion, this phenomenon is caused by the fact that the indications for DAAs cover more end-stage hepatitis C patients who are intrinsically the high-risk population of HCC; however, it cannot be excluded that DAAs may lead to the change in the body's antitumor immune status. Studies are needed in the future to examine this issue at the molecular level.

The past, present and future of hepatitis C treatment

Ning HuiBin, Shang Jia

2017, 33(6): 1079-1081. DOI: 10.3969/j.issn.1001-5256.2017.06.012

Abstract(2400)

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Hepatitis C and its complications are one of the highlights in liver disease prevention and control in China, and from the clinical practice 20 years ago to a cure rate of nearly 100% at present, standardized diagnosis and treatment of hepatitis C, a large number of scientific studies, and drug research and development are the basis for the clearance of HCV. Direct-acting antiviral agents play an important role in the clearance of HCV, and the clearance of HCV does not equal to the cure of chronic hepatitis C. For patients with hepatitis C who have achieved a high sustained virologic response rate after using direct-acting antiviral agents, their long-term prognosis should be taken seriously. Correct and reasonable application of hepatitis C treatment is still a hot issue that needs to be discussed at present.

Research advances in molecular mechanism of mother-to-child transmission of HCV and related risk factors

Gao LuHua, Nie QingHe

2017, 33(6): 1082-1087. DOI: 10.3969/j.issn.1001-5256.2017.06.013

Abstract(2550)

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Hepatitis C virus (HCV) is a global health problem and people are generally susceptible to HCV. Main routes of transmission include blood transmission, sexual transmission, and mother-to-child transmission. Anti-HCV screening of blood products has substantially reduced the blood transmission of HCV. Remarkable breakthrough has been made in the treatment of hepatitis C with direct-acting antiviral agents and the trend of HCV transmission has been significantly curbed. Since HCV infection is occult, hepatitis C vaccine has not been successfully developed, and there lack effective blocking measures for mother-to-child transmission, which will become one of the major route of HCV transmission. Reducing the rate of mother-to-child transmission of HCV is very important in preventing neonatal HCV infection and reducing the incidence rate of HCV infection. In recent years, many researchers have concentrated on the detailed mechanisms and risk factors of mother-to-child transmission of HCV and made great achievements; however, there are still controversies over some issues.This article reviews the research advances in the specific mechanisms of mother-to-child transmission of HCV in China and other countries.

Change in HBsAg quantification in the nature history of hepatitis B virus infection and its clinical significance

Wang Wei, Rong Jun, Yuan MeiNa, Zhao ZhaoXia, Tang YaFang, Gao HengBo

2017, 33(6): 1088-1091. DOI: 10.3969/j.issn.1001-5256.2017.06.014

Abstract(2524)

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Objective To investigate the distribution characteristics of HBsAg quantification in different clinical status after chronic hepatitis B virus (HBV) infection and its correlation with HBV DNA level. Methods A cross-sectional study was performed for 268 patients with HBV infection who did not receive antiviral therapy in The Fifth Hospital of Shijiazhuang from January 2013 to December 2015. According to the stage of HBV infection, these patients were divided into immune tolerance group with 29 patients, immune clearance group with 169 patients, low-or non-replication group with 19 patients, and reactivation group with 51 patients. Roche electrochemical luminescence was used to measure serum HBsAg quantification and PCR was used to measure HBV DNA level. Logarithmic transformation was performed for the results of HBsAg quantification and HBV DNA level, and a statistical analysis was performed for the results of different stages. The Kruskal-Wallis H rank sum test was used for the analysis of multiple groups, and the Mann-Whitney U test was used for further comparison between any two groups; a Spearman rank correlation analysis was also performed. Results HBsAg quantification varied in different stages of HBV infection (χ2= 71. 830, P < 0. 001) ; the immune tolerance group had significantly higher HBsAg quantification than the other three groups (all P < 0. 05) , and the immune clearance group had significantly higher HBsAg quantification than the low-replication group and the reactivation group (all P < 0. 05) . There was a significant difference in HBV DNA level between groups (χ2= 117. 028, P <0. 001) ; the immune tolerance group had a significantly higher HBV DNA level than the other three groups (all P < 0. 05) , the immune clearance group had a significantly higher HBV DNA level than the low-replication group and the reactivation group (all P < 0. 05) , and the reactivation group had a significantly higher HBV DNA level than the low-replication group (both P < 0. 05) . HBsAg quantification was correlated with HBV DNA level in immune clearance stage (r = 0. 559, P < 0. 001) and reactivation stage (r = 0. 338, P = 0. 014) . Conclusion HBsAg quantification and HBV DNA level in immune tolerance stage are higher than those in the other three stages, and HBsAg quantification is correlated with HBV DNA level in immune clearance stage and reactivation stage.

Clinical effect of 3D regimen (paritaprevir/ritonavir/ombitasvir combined with dasabuvir) in treatment-naive patients with genotype 1b chronic hepatitis C

Wang BoWen, Kang Wen, Sun YongTao, Jia ZhanSheng, Xie YuMei

2017, 33(6): 1092-1095. DOI: 10.3969/j.issn.1001-5256.2017.06.015

Abstract(316)

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Objective To investigate the clinical effect of 3D regimen (paritaprevir/ritonavir/ombitasvir combined with dasabuvir) in treatment-naive patients with genotype 1b chronic hepatitis C. Methods A total of 10 patients with genotype 1b chronic hepatitis C who were treated for the first time in Department of Infectious Diseases in our hospital from September 2015 to April 2016 were enrolled. All patients were treated with 3D regimen for 12 weeks and followed up for 24 weeks after treatment. Sustained virologic response at 12 and 24 weeks (SVR12 and SVR24) was observed, and the changes in biochemical parameters and the incidence of adverse events were monitored. An analysis of variance was used for comparison of continuous data between groups. Results After 2 weeks of treatment, 70% of all patients achieved an HCV RNA level reduced to below the detection level, and after 12 weeks of treatment, HCV RNA was not detected in any patient, resulting in a biochemical response rate of 100%. Both SVR12 and SVR24 were 100%. There were significant reductions in the levels of alanine aminotransferase, aspartate aminotransferase, and the inflammatory marker interferon-inducible protein 10 after treatment (F =20. 15, 10. 83, and 13. 67, all P < 0. 05) . The most common adverse events were weakness and headache and no serious adverse events were observed. Conclusion In treatment-naive patients with genotype 1b chronic hepatitis C, 3D regimen achieves high SVR rate and biochemical response rate, improves patients' liver function, and has good safety.

Feasibility of alanine aminotransferase/aspartate aminotransferase ratio in predicting hepatic steatosis in chronic hepatitis C patients

Zhang XiuLi

2017, 33(6): 1096-1100. DOI: 10.3969/j.issn.1001-5256.2017.06.016

Abstract(2796)

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Objective To investigate the feasibility of alanine aminotransferase (ALT) /aspartate aminotransferase (AST) ratio in predicting the degree of hepatic steatosis in chronic hepatitis C (CHC) patients. Methods A total of 231 CHC patients who visited The First People's Hospital of Nanyang from May 2012 to June 2016 were enrolled, among whom 105 (45. 45%) had nonalcoholic fatty liver disease (NAFLD) and 126 (54. 55%) did not have NAFLD. According to the ultrasound score, the NAFLD group was divided into mild-to-moderate (1-2 points) hepatic steatosis group (n = 67) and severe (3 points) hepatic steatosis group (n = 38) . The two groups were compared in terms of demographic data and disease data including creatinine, fasting blood glucose, ALT, AST, ALT/AST ratio, γ-glutamyltransferase (GGT) , uric acid, low-density lipoprotein, high-density lipoprotein (HDL) , cholesterol (CHO) , and triglyceride (TG) to screen out independent risk factors for NAFLD in CHC patients. The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank sum 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; with severe NAFLD as the dependent variable, different factors were introduced into the logistic regression equation to screen out independent risk factors. Results Compared with the non-NAFLD group, the NAFLD group had significantly higher systolic pressure, diastolic pressure, fasting blood glucose, ALT/AST ratio, and levels of ALT, GGT, HDL, CHO, and TG, as well as a significantly higher proportion of patients with diabetes, hypertension, or metabolic syndrome (all P < 0. 05) . Compared with the severe hepatic steatosis group, the mild-to-moderate hepatic steatosis group had significantly lower systolic pressure, diastolic pressure, fasting blood glucose, ALT/AST ratio, and levels of ALT, GGT, HDL, CHO, and TG, as well as a significantly lower proportion of patients with diabetes, hypertension, or metabolic syndrome (all P < 0. 05) . The logistic regression analysis showed that metabolic syndrome, ALT, and ALT/AST ratio were independent risk factors for NAFLD (all P < 0. 05) , and metabolic syndrome, ALT, ALT/AST ratio, and GGT were independent risk factors for severe NAFLD (all P < 0. 05) . Conclusion ALT/AST ratio is an independent risk factor for NAFLD in CHC patients and has a certain value in evaluating the degree of NAFLD.

Changes in the function of dendritic cells after HCV loading mediated by CLEC4M

Zhu Ting, Zhao XiTai, Nie QingHe, Long ZhenZhou, Gao LuHua, Wang YuanYuan

2017, 33(6): 1101-1105. DOI: 10.3969/j.issn.1001-5256.2017.06.017

Abstract(2736)

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Objective To investigate the changes in the function of dendritic cells (DCs) after HCV adherence, possible mechanisms of HCV adherence of DCs mediated by CLEC4 M, and the impact of CLEC4 M on innate immune response mediated by DCs. Methods Peripheral blood mononuclear cells (PBMCs) were isolated from healthy people and induced to differentiate into mature DCs. Flow cytometry was used to measure the expression of CLEC4 M on the surface of DCs. Mature DCs were infected by HCVcc and positive control group, mannan interference group, CLEC4 M monoclonal antibody interference group, and blank control group were established. The supernatant was collected from each infected group, and ELISA was used to measure the changes in the levels of interleukin-10 (IL-10) and interleukin-12p70 (IL-12p70) in supernatant. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between any two groups. Results The positive rate of CLEC4 M in the surface of DCs reached 82. 6%. There were significant differences in the levels of IL-10 and IL-12p70 between the groups (F =54. 46 and 77. 72, both P < 0. 001) . The positive control group had significantly higher levels of IL-10 and IL-12p70 than the two interference groups (all P < 0. 001) , and compared with the blank control group, the positive control group, CLEC4 M monoclonal antibody interference group, and mannan interference group had significantly higher levels of IL-10 and IL-12p70 (all P < 0. 001) . Conclusion CLEC4 M mediates HCV adherence of DCs, participates in the body's immune response, and regulate the expression of DC immune molecules.

A nutritional risk screening model for patients with liver cirrhosis established using discriminant analysis

Zhu BingHua, Zhao ZhangQing, Zhou Yang, Xu LieMing

2017, 33(6): 1106-1111. DOI: 10.3969/j.issn.1001-5256.2017.06.018

Abstract(2414)

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Objective To establish a nutritional risk screening model for patients with liver cirrhosis using discriminant analysis. Methods The clinical data of 273 patients with liver cirrhosis who were admitted to Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from August 2015 to March 2016 were collected. Body height, body weight, upper arm circumference, triceps skinfold thickness, subscapular skinfold thickness, and hand grip strength were measured and recorded, and then body mass index (BMI) and upper arm muscle circumference were calculated. Laboratory markers including liver function parameters, renal function parameters, and vitamins were measured. The patients were asked to complete Nutritional Risk Screening 2002 and Malnutrition Universal Screening Tool (MUST) , and a self-developed nutritional risk screening pathway was used for nutritional risk classification. Observation scales of the four diagnostic methods in traditional Chinese medicine were used to collect patients' symptoms and signs. Continuous data were expressed as mean ± SD (x ± s) ; an 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. Discriminant analysis was used for model establishment, and cross validation was used for model verification. Results The nutritional risk screening pathway for patients with liver cirrhosis was used for the screening of respondents, and there were 49 patients (17. 95%) in non-risk group, 49 (17. 95%) in possible-risk group, and 175 (64. 10%) in risk group. The distance criterion function was used to establish the nutritional risk screening model for patients with liver cirrhosis: D1 =-11. 885 + 0. 310 × BMI + 0. 150 ×MAC + 0. 005 × P-Alb-0. 001 × Vit B12 + 0. 103 × Vit D-0. 89 × ascites-0. 404 × weakness-0. 560 × hypochondriac pain + 0. 035 ×dysphoria with feverish sensation (note: if a patient has ascites, weakness, hypochondriac pain, or dysphoria with feverish sensation, this index equals 1, and otherwise it equals 0) . Cross validation showed that the probability of misclassification of the this model was 10%.Conclusion The established screening model may provide a reference for clinical nutritional risk screening in patients with liver cirrhosis.

Liver cirrhosis and the risk of fracture: a Meta-analysis

Zhao Jian, Li Wei, Liang CaiQuan, Yao DingKang

2017, 33(6): 1112-1115. DOI: 10.3969/j.issn.1001-5256.2017.06.019

Abstract(2433)

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Objective To investigate the association between liver cirrhosis and the risk of fracture from the perspective of evidence-based medicine. Methods Pub Med, Web of Science, Embase, CNKI, Wanfang Data, Sino Med, and VIP were searched to collect published observational studies on the association between liver cirrhosis and fracture. The quality of each study was assessed and Rev Man5. 3 software was used to perform a meta-analysis of the risk of fracture, and the odds ratio (OR) and 95% confidence interval (CI) were calculated.Results Three cohort studies and two cross-sectional studies were included with 28 820 patients in liver cirrhosis group and 214 313 cases in control group. The analysis showed that compared with the control group, the liver cirrhosis group had a significant increase in the overall risk of fracture (all studies: OR = 2. 07, 95% CI: 1. 52-2. 83, P < 0. 000 01; cohort studies: OR = 2. 00, 95% CI: 1. 93-2. 07, P <0. 000 01) . When the patients were divided according to the type of fracture, compared with the control group, the liver cirrhosis group had significant increases in the risks of vertebral fracture and non-vertebral fracture (upper extremities) (OR = 2. 10, 95% CI: 1. 30-3. 40, P = 0. 003; OR = 1. 61, 95% CI: 1. 53-1. 69, P < 0. 000 01) . Conclusion Liver cirrhosis may increase the risk of fracture. However, due to the heterogeneity of these studies, the above results need to be further verified by more detailed studies.

Application of tension-free hernia repair under local anesthesia in patients with liver cirrhosis complicated by inguinal hernia

Sun LiBo, Zhang HaiTao, Zhao XiaoFei, Liu Yuan, Wu JuShan, Lin DongDong, Zang YunJin, Li Ning

2017, 33(6): 1116-1119. DOI: 10.3969/j.issn.1001-5256.2017.06.020

Abstract(2504)

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Objective To investigate the clinical effect of tension-free hernia repair under local anesthesia in patients with liver cirrhosis complicated by inguinal hernia and related application experience. Methods A retrospective analysis was performed for the clinical data of167 patients with liver cirrhosis complicated by inguinal hernia who underwent tension-free hernia repair under local anesthesia in our hospital from January 2007 to December 2015. The t-test was used for comparison of continuous data between two groups, and the chi-square test and Fisher's exact test were used for comparison of categorical data between groups. Results All tension-free hernia repair surgeries were successfully completed, with a mean time of operation of (55. 22 ± 21. 67) min and a mean postoperative hospital stay of (3. 14 ±1. 86) d. Of all patients, 25 (14. 97%) experienced complications, and there were 47 complications in total. According to the Child-Pugh class, the patients were divided into Child-Pugh class A/B group and Child-Pugh class C group, and there were significant differences in the mean postoperative hospital stay ( (2. 72 ± 1. 25) d vs (4. 43 ± 3. 11) d, t = 1. 984, P < 0. 05) and incidence rate of postoperative complications (8. 78% vs 63. 1%, χ2= 2. 861, P < 0. 05) . In the Child-Pugh class C group, there was no significant difference in the incidence rate of postoperative complications between the patients without improvement in liver function and those with improvement (100% vs 86. 7%, P > 0. 05) , but there was a significant difference in the length of postoperative hospital stay (6. 85 d vs 3. 80 d, P <0. 05) . Conclusion Tension-free hernia repair under local anesthesia is a simple, safe, and effective method for the treatment of inguinal hernia complicated by liver cirrhosis. Perioperative liver function evaluation and maintenance is important to ensure the implementation of surgery and good postoperative recovery.

Early alpha-fetoprotein response can predict the prognosis of patients with intermediate-stage hepatocellular carcinoma treated with transarterial chemoembolization

Xia DongDong, Wang EnXin, Wang WenJun, Bai Wei, Yuan Jie, Han GuoHong

2017, 33(6): 1120-1125. DOI: 10.3969/j.issn.1001-5256.2017.06.021

Abstract(2291)

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Objectives To investigate the best definition of alpha-fetoprotein (AFP) response and its association with the outcome of patients with BCLC stage B hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) . Methods A retrospective analysis was performed for the clinical data of 116 patients with intermediate-stage HCC who were treated with TACE in Department of Liver Disease and Digestive Interventional Radiology in Xijing Hospital of Digestive Disease from January 2010 to December 2014. The receiver operating characteristic curve was used to determine the optimal cut-off value of AFP change rate. The patients with a reduction in AFP greater than the cut-off value after surgery were defined as AFP response group (AFP-R group) , and the other patients were defined as AFP non-response group (AFP-NR group) . The Cox regression model was used for multivariate prognostic analyses. Results The median tumor size was 7. 5 cm, and of all patients, 112 (96. 6%) had Child-Pugh class A liver function. The optimal cut-off value was defined as a 16% reduction in AFP at 1 month after surgery, compared with baseline. The AFP-R group had a significantly longer median survival time than the AFP-NR group (26. 6 (20. 9-32. 3) months vs 7. 0 (5. 2-8. 8) months, HR = 3. 56, 95% CI: 2. 12-5. 95, P <0. 001) . The sub-group analysis showed that the AFP-NR group had significantly better prognosis than the AFP-NR group (P < 0. 05) .The multivariate analysis showed that age (HR = 0. 97, 95% CI: 0. 95-0. 99, P = 0. 003) , tumor size (HR = 1. 14, 95% CI: 1. 06-1. 22, P < 0. 001) , Eastern Cooperative Oncology Group performance score (HR = 2. 15, 95% CI: 1. 24-3. 73, P = 0. 006) , and AFP response (HR = 1. 56, 95% CI: 2. 12-5. 95, P < 0. 001) were independent risk factors for patients' survival. Conclusion Early AFP response can predict the prognosis of patients with intermediate-stage HCC treated with TACE.

Inhibitory effect of microRNA-149-5p in the proliferation and migration of HepG2 and Bel-7402 hepatoma cells

Geng YaJun, Li ShuDong, Liu ShenZheng, Ren JianJun, Zhang Tong

2017, 33(6): 1126-1130. DOI: 10.3969/j.issn.1001-5256.2017.06.022

Abstract(2395)

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Objective To investigate the expression of microRNA-149-5p (miR-149-5p) in liver cancer tissue and its molecular and biological role in hepatoma cells. Methods A total of 65 liver cancer tissue samples and corresponding adjacent tissue samples were collected from January 2010 to January 2014, in the Affiliated Hospital of Inner Mongolia Medical University. Quantitative real-time PCR was used to measure the expression of miR-149-5p in liver cancer tissue and corresponding adjacent tissue. The cells were divided into two groups; the cells in the experimental group were transfected with miR-149-5p mimic, and those in the control group were transfected with the negative control of the mimic. MTT colorimetry and wound-healing assay were performed to determine the effect of miR-149-5p on the proliferation and migration of HepG2 and Bel-7402 cells. The t-test or a one-way analysis of variance was used for comparison of continuous data between groups. Results The liver cancer tissue had significantly lower expression of miR-149-5p than the adjacent tissue (0. 14 ± 0. 06 vs 2. 56 ± 0. 42, t = 7. 79, P < 0. 05) . There were significantly differences in the expression of miR-149-5p in Hep G2 (1. 43 ± 0. 25) 、Bel-7402 (1. 77 ± 0. 32) , and the normal hepatic epithelial cells (5. 68 ± 0. 74) (F = 11. 27, P < 0. 05) . The in vitro functional experiment showed that miR-149-5p mimic significantly inhibited the proliferation of 24、48、72 hour of Hep G2 and Bel-7402 hepatoma cells (Hep G2: t = 4. 98, 5. 17, 7. 78, all P < 0. 05; Bel-7402: t = 6. 83, 7. 09, 15. 67, all P < 0. 05) and inhibited the migration of Hep G2 and Bel-7402 hepatoma cells (t = 23. 11, 17. 42, both P < 0. 05) . Conclusion The expression of miR-149-5p is downregulated in liver cancer tissue, and overexpressed miR-149-5p can inhibit the proliferation and migration of hepatoma cells, suggesting that miR-149-5p may be a promising and effective molecular target for the genetic treatment of liver cancer.

Effect of interleukin-17A on stemness of hepatoma cell lines

Li KeXin, Zang MengYa, Wang DongMei, He Huan, Wang YuTing, Qu ChunFeng

2017, 33(6): 1131-1136. DOI: 10.3969/j.issn.1001-5256.2017.06.023

Abstract(2397)

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Abstract:
Objective To investigate the effect of interleukin-17A (IL-17A) on stemness of human hepatoma cell lines Hep 3B, MHCC97 H, and MHCC97 L and the association between IL-17 A and the progression of liver cancer. Methods Human hepatoma cell lines Hep 3B, MHCC97 H, and MHCC97 L were selected, and in vitro 3D sphere formation assay was used to analyze the effect of IL-17 A on sphere formation ability. The control group with common culture solution and the experimental group with 50 ng/ml IL-17 A were established. Real-time cellular analysis was used to determine the effect of IL-17 A on the proliferation and migration of hepatoma cells with enhanced sphere formation ability; quantitative real-time PCR was used to measure the changes in the mRNA expression of IL-17 A receptors IL-17 RA and IL-17 RC and stemness-related genes SOX2, NANOG, OCT4, and BMI1 in hepatoma cells with enhanced sphere formation ability; Western blot was used to measure the expression of epithelial-mesenchymal transition-related proteins E-cadherin, N-cadherin, and vimentin. The t-test was used for comparison of continuous doota betwwen groups. Results With the presence of 50 ng/ml IL-17 A and 500 inoculated cells, Hep 3B cells had a significant increase in the number of spheres formed (113. 0 ± 10. 3 vs 180. 0 ± 7. 2, t =5. 533, P < 0. 001) , while MHCC97 H and MHCC97 L cells showed no significant changes (t = 1. 087 and 0. 279, P = 0. 325 and 0. 785) .The analysis showed that IL-17 A promoted the proliferation and migration of Hep 3B cells with an increased number of spheres formed. After the addition of 50 ng/ml IL-17 A, there was an increase in the mRNA expression of IL-17 A receptors IL-17 RA and IL-17 RC over the time of treatment; Hep 3B cells showed significant increases in the mRNA expression of stemness-related genes SOX2 (t = 4. 749, P =0. 042) , NANOG (t = 19. 600, P = 0. 003) , OCT4 (t = 37. 310, P < 0. 001) , and BMI1 (t = 16. 810, P = 0. 004) . Western blot showed no significant change in the expression of the epithelium-derived marker E-Cadherin; there was an increase in the expression of the interstitial marker N-cadherin after the treatment with 50 ng/ml IL-17 A for 48 hours (t = 17. 620, P = 0. 036) ; there was no significant change in the expression of vimentin. Conclusion To a certain degree, IL-17 A enhances the stemness of Hep 3B hepatoma cells.

Value of serum PCT in early diagnosis of bacterial infection in patients with liver failure

Wang ChuanMin, Meng ZhongJi, Chen Yue, Liu Li

2017, 33(6): 1137-1140. DOI: 10.3969/j.issn.1001-5256.2017.06.024

Abstract(2450)

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Abstract:

Objective To investigate the value of serum procalcitonin (PCT) in early diagnosis of bacterial infection in patients with liver failure. Methods A total of 463 patients with hepatitis B were selected from January to December, 2014, in the Department of Infectious Diseases, Taihe Hospital. According to the degree of liver injury, the patients were divided into four groups: mild liver injury group (n =120) , moderate liver injury group (n = 222) , sever liver injury group (n = 53) , and liver failure group (n = 68) . Serum PCT was measured for all patients, and the white blood cell count (WBC) and high-sensitivity C-reactive protein (hs CRP) were measured for patients with liver failure. The clinical manifestations were observed and recorded. The t test was used for comparison of normally distributed continuous data, while the Kruskal-Wallis H test was used for non-normally distributed continuous data; the Mann-Whitney U test was used for pairwise comparison of continuous data. The chi-square test was used for comparison of categorical data. The receiver operating characteristic (ROC) curve was used for the analysis of predictive value. Results The liver failure group had a significantly higher PCT level than the severe liver injury group, moderate liver injury group, and mild liver injury group (0. 81[0. 34-2. 15] vs 0. 53[0. 21-1. 59 ], 0. 35[0. 10-1. 18], and 0. 17[0. 10-0. 60], χ2= 25. 091, P < 0. 05) . The liver failure patients with PCT levels of < 0. 25 ng/ml (n = 10) , 0. 25-0. 5 ng/ml (n = 10) , and > 0. 5 ng/ml (n = 48) had infection rates of 20%, 30%, and 66. 7%, respectively, with a significant difference between the patients with a PCT level of > 0. 5 ng/ml and those with PCT levels of < 0. 25 ng/ml and 0. 25-0. 5 ng/ml (χ2=5. 631, 4. 650, P = 0. 018, 0. 031) . Among the liver failure patients, the infection cases had significantly higher PCT, WBC, and hs CRP than the non-infection cases (PCT: 3. 72 ± 1. 33 ng/ml vs 0. 34 ± 0. 12 ng/ml, t =-2. 547, P = 0. 015; hs CRP: 16. 70 ± 7. 03 mg/L vs11. 00 ± 6. 52 mg/L, t =-3. 458, P = 0. 001) ; the hs CRP level in both infection and non-infection cases was higher than the normal value, and the WBC in both infection and non-infection cases was lower than the normal value. In the 37 liver failure patients with infection, 13 (35. 14%) had no symptoms and signs associated with infection, but had significantly increased serum PCT. As for the predictive value of PCT for bacterial infection, the area under the ROC curve was 0. 691, with a sensitivity of 0. 737 and a specificity of 0. 700. Conclusion The patients with liver failure are susceptible to bacterial infection. Serum PCT measurement has great significance for early diagnosis of bacterial infection in patients with liver failure.

Clinical features of liver injury associated with acute Epstein-Barr virus infection in adults: an analysis of 115 cases

Yang YuYing, Wang XinHui, Wan Gang, Meng PeiPei, Zhou Yang, Wu Tong, Hou YiXin, Yu Hao, Jiang TingTing, Jiang YuYong

2017, 33(6): 1141-1144. DOI: 10.3969/j.issn.1001-5256.2017.06.025

Abstract(2614)

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Objective To investigate the clinical manifestations and features of laboratory examinations including liver function and peripheral blood lymphocyte subsets of adult patients with acute Epstein-Barr virus (EBV) infection, and to provide a basis for the diagnosis and treatment of liver injury associated with acute EBV infection in adults. Methods A retrospective analysis was performed for the clinical data of 115 adult patients with acute EBV infection and abnormal liver function who were treated from June 2009 to March 2016, and these patients were divided into two groups according to the presence or absence of jaundice. The influencing factors for jaundice were analyzed. The t-test was used for comparison of normally distributed continuous data between groups, the Wilcoxon test was used for comparison of non-normally distributed continuous data between groups, and the logistic regression analysis was used for univariate analysis. Results Of all patients, 106 (92. 2%) had pyrexia, 97 (84. 3%) had angina, 73 (63. 5%) had swelling of the tonsil, 73 (63. 5%) had superficial lymph node enlargement, and 74 (64. 4%) had splenomegaly. There were significant differences between the jaundice group and the non-jaundice group in terms of the percentage of peripheral blood lymphocytes (t =-2. 51, P = 0. 014) and the levels of alanine aminotransferase (ALT) (Z = 4. 93, P < 0. 001) , aspartate aminotransferase (AST) (Z = 5. 34, P < 0. 001) , gamma-glutamyl transpeptidase (Z =5. 26, P < 0. 001) , and alkaline phosphatase (ALP) (Z = 5. 29, P < 0. 001) . The logistic regression analysis showed that AST (OR =1. 008, 95% CI: 1. 003-1. 012, P < 0. 001) and ALP (OR = 1. 008, 95% CI: 1. 003-1. 013, P = 0. 001) were independent risk factors for the increase in total bilirubin (TBil) . Conclusion Liver injury associated with acute EBV infection mainly manifests as increases in ALT and AST, and common clinical manifestations include pyrexia, angina, swelling of the tonsil, cervical lymph node enlargement, and splenomegaly. AST and ALP are independent risk factors for the increase in TBil and provide a basis for clinical diagnosis.

A case of sarcomatoid hepatocellular carcinoma

Kou Kai, Chen YuGuo, Zhou JianPeng, Wei Feng, Wang GuangYi, Lu: GuoYue

2017, 33(6): 1145-1146. DOI: 10.3969/j.issn.1001-5256.2017.06.026

Abstract(1885)

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Hepatic tuberculosis misdiagnosed as hepatic metastasis: a case report

Zhang KaiTing, Zhang GuoFeng, Zhang Hang, Jia MingKu

2017, 33(6): 1147-1148. DOI: 10.3969/j.issn.1001-5256.2017.06.027

Abstract(2075)

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Primary hepatic neuroendocrine neoplasm: a report of 2 cases and literature review

Gao WeiHua, Xiang XiaoXing

2017, 33(6): 1149-1151. DOI: 10.3969/j.issn.1001-5256.2017.06.028

Abstract(2220)

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Pathogenesis of insulin resistance and its impact on antiviral therapy in patients with chronic hepatitis C

Liu DaJi, Chen QingFeng

2017, 33(6): 1152-1155. DOI: 10.3969/j.issn.1001-5256.2017.06.029

Abstract(2324)

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Chronic hepatitis C virus (HCV) infection is an important cause of hepatic fibrosis, liver cirrhosis, and hepatocellular carcinoma (HCC) . Insulin resistance (IR) is one of the important pathological features of HCV infection. IR can accelerate the development of hepatic fibrosis, hepatic steatosis, and HCC and affect the efficacy of antiviral therapy. Therefore, HCV-related IR can be the target of pharmacotherapy during any stage of HCV infection. This article reviews the pathogenesis of IR in patients with hepatitis C, the interaction between them, and the impact of IR on antiviral therapy.

Research advances in hepatitis C virus-related renal injury and its treatment

Lu ShuYuan, Rao HuiYing

2017, 33(6): 1156-1160. DOI: 10.3969/j.issn.1001-5256.2017.06.030

Abstract(2390)

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Hepatitis C virus (HCV) is a blood-borne virus transmitted through contact with blood and blood products, and it is a major cause of liver cirrhosis and hepatocellular carcinoma. Many epidemiological studies have confirmed the association between HCV infection and renal disease. Membranoproliferative glomerulonephritis associated with mixed cryoglobulinemia is the most common type of HCV-related renal disease manifesting as nephropathy or nephritic syndrome, proteinuria, hematuria, and reduced glomerular filtration rate. The treatment of HCV-related renal disease includes antiviral therapy, B cell clearance, and non-specific immunosuppressive therapy. At the same time, the launch of new antiviral drugs has brought hope to the patients who cannot tolerate conventional regimens. This article reviews the research advances in epidemiology, clinical manifestations, pathogenesis, and treatment of HCV-related renal injury.

Research advances in neurological complications of viral hepatitis

Han Shuai, Zhang Ye

2017, 33(6): 1161-1164. DOI: 10.3969/j.issn.1001-5256.2017.06.031

Abstract(2034)

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Neurological complications of viral hepatitis mainly include hepatic encephalopathy, hepatic myelopathy, peripheral neuropathy, meningoencephalitis, and epilepsy. Hepatic encephalopathy is a common complication with mature diagnosis and treatment methods, and the other complications are relatively uncommon and lack treatment methods. This article introduces the classification, clinical manifestation, and treatment of each complication, in order to find the optimal therapies for neurological complications of viral hepatitis.

Research advances in the pathogenesis of multiple organ dysfunction syndrome in patients with liver cirrhosis and related treatment regimens

Gu TianYi, Lu LunGen

2017, 33(6): 1165-1168. DOI: 10.3969/j.issn.1001-5256.2017.06.032

Abstract(2136)

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Recent studies have shown that complications of cirrhotic portal hypertension often involve multiple organs, which is called multiple organ dysfunction syndrome by some scholars. When multiple organ failure occurs, there is a significant increase in patients' short-term death rate, and death rate is associated with the number of organs involved. This article briefly describes the physiopathologic mechanisms of portal hypertension and visceral vasodilation and summarizes the pathological changes of vital organs including the heart, lung, kidney, brain, and liver and related pathogenesis. At present, liver transplantation remains the most effective therapy, but it still has some shortcomings. It is pointed out that further studies are needed to investigate the mechanisms of action of each link in disease development, and more targets are needed in the future to prevent and treat multiple organ dysfunction syndrome in patients with liver cirrhosis.

Role of 5-hydroxytryptamine in the pathogenesis and treatment of nonalcoholic fatty liver disease

Jin Dou, Niu ChunYan

2017, 33(6): 1169-1172. DOI: 10.3969/j.issn.1001-5256.2017.06.033

Abstract(2106)

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The prevalence rate of nonalcoholic fatty liver disease (NAFLD) has been increasing year by year. However, since the complex pathogenesis of NAFLD has not been fully clarified, there still lacks a gold standard for the diagnosis and treatment of NAFLD. 5-Hydroxytryptamine (5-HT) can affect the development and progression of NAFLD via several links and thus change the course of NAFLD.This article introduces the association between 5-HT and NAFLD, the role of 5-HT in the pathogenesis of NAFLD, and its future application in treatment.

Research advances in the pathogenesis of bile acid-related non-alcoholic fatty liver disease and related pharmacotherapy

Zhang Min, Huang MingXing, Guo LieJun

2017, 33(6): 1173-1178. DOI: 10.3969/j.issn.1001-5256.2017.06.034

Abstract(2284)

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Non-alcoholic fatty liver disease (NAFLD) has become a new health issue in the world due to its increasing incidence rate, and in particular, nonalcoholic steatohepatitis is progressive and has poor prognosis. Therefore, there is an urgent need to search for the methods for the prevention of disease progression and treatment. Bile acid, as an important metabolite and signal molecule, can adjust the metabolism of lipids and carbohydrates and energy balance inside and outside the liver. Bile acid interacts with its receptors, such as the farnesoid X receptor and Takeda G-protein coupled receptor 5, bile acid transporter, and gut microbiota and is involved in the pathogenesis of NAFLD and nonalcoholic steatohepatitis at different levels. This article summarizes the research advances in the pathogenesis of bile acid-related NAFLD and related pharmacotherapy.

Research advances in silybin in treatment of drug-induced liver injury

Shao Shuang, Liu ChunYan, Gao YanHang

2017, 33(6): 1179-1182. DOI: 10.3969/j.issn.1001-5256.2017.06.035

Abstract(2087)

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Drug-induced liver injury is commonly seen in clinical practice and is usually caused by antipsychotic drugs, antitubercular agents, paracetamol, and statins. Silybin, a substance with biological activity in silymarin extract, has antioxidant, anti-inflammatory, and anti-fibrosis effects. This article summarizes the research advances in silybin in the prevention and treatment of drug-induced liver injury.

Clinical application of indocyanine green clearance test

Wang Ming, Tang Hong

2017, 33(6): 1183-1187. DOI: 10.3969/j.issn.1001-5256.2017.06.036

Abstract(4103)

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At present, the most commonly used methods for liver function evaluation in clinical practice is static detection represented by blood biochemical examinations, with a focus on the degree of liver injury and liver dysfunction; however, such methods have significant limitations on the reflection of liver reserve function. Indocyanine green (ICG) clearance test is commonly used for the testing of liver reserve function in clinical practice and it is a minimally invasive, simple, and quick procedure available for bedside real-time monitoring and can be repeated during a short period of time. The application value of ICG clearance test in the field of liver surgery has been widely recognized.In recent years, more and more studies have been focusing on the application of ICG clearance test in the fields of internal medicine, liver interventional therapy, critically ill patients, and drug safety assessment. This article reviews the current clinical application, related advances, and future perspectives of ICG clearance test.

Advances in pharmacotherapy for primary biliary cholangitis

Lei LiuJie, Tang YingMei

2017, 33(6): 1188-1191. DOI: 10.3969/j.issn.1001-5256.2017.06.037

Abstract(1714)

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The pathogenesis of primary biliary cholangitis (PBC) remains unclear. Ursodeoxycholic acid (UDCA) is currently the only drug approved by the Food and Drug Administration for the treatment of PBC, but some patients have a poor response to UDCA. New therapies can be considered for these patients. This article reviews the advances in drugs for PBC, including 6α-ethyl-chenodeoxycholic acid, fibrates, budesonide, and biological agents, and points out that these drugs bring new hope for PBC patients, but large-scale clinical studies are needed to confirm the long-term efficacy and safety.

Advances in pathogenesis and minimally invasive therapies for extrahepatic portal biliopathy

Tian Xing, Chen YanZhen, Chen ChengLiang, Jiao Jian

2017, 33(6): 1192-1195. DOI: 10.3969/j.issn.1001-5256.2017.06.038

Abstract(1690)

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Portal biliopathy (PB) can involve the whole biliary system and this article mainly introduces extrahepatic PB that involves the extrahepatic bile duct, the cystic duct, and the gallbladder. This disease is relatively rare in clinical practice, and most doctors do not have enough knowledge of this disease. Since this disease involves the rich vascular systems and the fine biliary system, its therapeutic regimens should be selected carefully; improper therapeutic regimens may easily cause massive hemorrhage and bile duct injury, make patients' conditions worse, and even threaten their lives. At present, there is still no standard flow chart for the treatment of PB around the world. Endoscopic therapy and surgical interventional treatment are commonly used minimally invasive therapies in clinical practice. This article reviews the pathogenesis of PB and minimally invasive therapies currently used in clinical practice, in order to provide a basis for scientific diagnosis and treatment of this disease.

Advances in the diagnosis and treatment of pediatric acute pancreatitis

Wu Jie, Liu YuFei, Kong WenWen, Wang ChaoXia

2017, 33(6): 1196-1200. DOI: 10.3969/j.issn.1001-5256.2017.06.039

Abstract(2335)

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The incidence rate of acute pancreatitis (AP) has been gradually increasing in recent years, and pediatric AP is often seen in clinical practice. Pediatric AP has complex causes and diverse clinical manifestations, and infants and children cannot clearly explain their discomforts, which makes it more difficult to make an accurate diagnosis and may easily cause misdiagnosis, missed diagnosis, and delayed treatment. A deep understanding of pediatric AP helps to improve the diagnosis and treatment level of this disease. This article reviews the advances in the diagnosis and treatment of pediatric AP, in order to provide guidance to clinical practice.

2017 No. 6

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2017 No. 6

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International Database

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