In order to apply the concept of enhanced recovery after surgery ( ERAS) in the optimization of perioperative management of liver transplantation for severe hepatitis, reduce complications, and promote patients'fast recovery, Study Group of Transplantation Immunology, Society of Organ Transplantation, Chinese Medical Doctor Association, Study Group of Surgery, Chinese Society of Surgery, Chinese Medical Association, and Society of Organ Transplantation, Guangdong Medical Doctor Association have developed Expert consensus on the optimization of perioperative management of liver transplantation for severe hepatitis by enhanced recovery after surgery. This consensus summarizes the clinical experience in each transplantation center from the perspective of the role of ERAS in the optimization of preoperative, intraoperative, and postoperative treatment strategies for liver transplantation for severe hepatitis and puts forward related expert consensus, in order to provide a reference for clinical optimization of perioperative management of liver transplantation for severe hepatitis.

Objective To investigate the clinical features of alcoholic liver disease, and to provide a theoretical basis for the development of control strategy for this disease. Methods The clinical data of 206 patients with alcoholic liver disease who were admitted to The Fifth Affiliated Hospital of Zhengzhou University from January 2011 to December 2016 were collected. The different types of alcoholic liver disease were analyzed, as well as the proportion of patients with alcoholic liver disease among all patients with liver diseases and its change trend from 2011 to 2016. The age distribution characteristics of patients with different types of alcoholic liver disease were analyzed, and the types of alcoholic liver disease in 2011-2013 were compared with those in 2014-2016. The chi-square test was used for comparison of categorical data between groups. Results The patients with alcoholic cirrhosis accounted for 69. 90% ( 144/206) , followed by those with alcoholic hepatitis ( 19. 42%) . The proportion of patients with alcoholic liver disease among all patients with liver diseases gradually increased from 2011 to 2016. Of all patients with alcoholic liver disease, the patients aged 40-60 years accounted for 66. 99% ( 138/206) . Patients aged 40-60 years had the highest incidence rate of alcoholic fatty liver disease, and those aged > 60 years had a significantly lower incidence rate than the other patients ( χ2= 8. 16, P = 0. 01) . Of all the patients aged 40-60 years, 18. 84% ( 26/138) had alcoholic hepatitis, 68. 84% ( 95/138) had alcoholic cirrhosis, and 5. 07% ( 7/138) had alcoholic acute-on-chronic liver failure. Among the patients with alcoholic liver disease who were admitted from 2014 to 2016, 73. 20% had alcoholic cirrhosis, which was significantly higher than the proportion of patients with alcoholic cirrhosis ( 60. 38%) from 2011 to 2013 ( χ2= 9. 24, P < 0. 05) . Conclusion Alcoholic liver disease is commonly seen in patients aged40-60 years. Early diagnosis of alcoholic liver disease should be enhanced in clinical practice to delay or reverse liver fibrosis and cirrhosis.

Objective To investigate the prevalence of alcoholic liver disease ( ALD) among the staff of Yanchang Oilfield and related risk factors. Methods The physical examination data were collected from the staff of Yanchang Oilfield in June 2016, and all the staff underwent anthropometric measurement ( body height, body weight, and blood pressure) , laboratory examinations ( routine blood test, liver function, blood lipids, blood glucose, and viral markers) , and upper abdominal ultrasound and completed the questionnaire. The chi-square test was used for comparison of categorical data between groups, and logistic regression was used for multivariate analysis. Results A total of 6723 employees participated in the study, among whom 397 had ALD, and the prevalence rate of ALD was 5. 91%. Compared with female staff, male staff had significantly higher drinking rate ( 65. 07% vs 15. 75%, χ2= 1107. 48, P < 0. 001) and prevalence rate of ALD ( 7. 20% vs 1. 11%, χ2= 75. 34, P < 0. 001) . Male population was the major group for alcohol consumption. There was a significant difference in the prevalence rate of ALD between the staff with different degrees of education ( χ2= 86. 598, P < 0. 001) . The obese group had a significantly higher prevalence rate of ALD than the non-obese group ( 17. 70% vs 9. 27%, χ2= 40. 698, P < 0. 001) . With the increases in drinking volume and drinking years, the prevalence rate of ALD gradually increased, and there was a significant difference in the prevalence rate of ALD between the staff with different daily drinking volumes and drinking years ( χ2= 1147. 428 and 116. 542, both P <0. 001) . With the increase in daily drinking volume, the abnormal rates of gamma-glutamyl transpeptidase ( GGT) , alanine aminotransferase, and aspartate aminotransferase ( AST) gradually increased ( χ2= 250. 013, 199. 027, and 151. 459, all P < 0. 001) ; with the increase in drinking years, the abnormal rates of GGT and AST gradually increased, with a significant increase in the abnormal rate of GGT ( χ2= 27. 158, P < 0. 001) . There were significant differences between the drinking group and the control group in the abnormal rates of liver function, blood pressure, blood lipids, body mass index, and mean corpuscular volume ( χ2= 51. 272, 9. 988, 316. 430, 80. 675, and 13.570, all P < 0. 05) . The multivariate analysis showed that age, male sex, obesity, daily drinking volume, drinking pattern, degree of education, GGT, AST, and mean corpuscular volume were closely associated with the development of ALD ( all P < 0. 05) . Conclusion There is a high prevalence rate of ALD among the staff of Yanchang Oilfield. Sex, age, degree of education, drinking volume, drinking pattern, and obesity are major influencing factors for ALD in adults in this region.

Objective To investigate the changes in the expression of hepcidin ( Hepc) and interleukin-6 ( IL-6) in liver inflammation process in a rat model of nonalcoholic fatty liver disease ( NAFLD) . Methods The rats were given high-fat emulsion by gavage to establish the model of NAFLD ( group M) and normal rats were given normal saline by gavage as controls ( group C) . Liver tissue samples were collected from these rats, and immunohistochemistry was used to measure the expression of Hepc and IL-6 in liver tissue in group M at 4, 8, and 12weeks ( M4, M8, and M12groups) and in group C at 12 weeks ( C12group) . The NAFLD activity score ( NAS) was assessed for both groups.The expression of Hepc and IL-6 in liver tissue was measured, and NAS was calculated. A one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for comparison between two groups. Pearson correlation analysis was also performed. Results Over the course of treatment, the M4, M8, and M12 groups had gradual increases in the expression of Hepc and IL-6, and there were significant differences between these groups and the C12group ( Hepc: 0. 372 ± 0. 216/1. 213 ± 0. 193/2. 390± 0. 192 vs 0. 166 ± 0. 192, all P < 0. 05; IL-6: 0. 499 ± 0. 218/1. 290 ± 0. 210/2. 644 ± 0. 441 vs 0. 240 ± 0. 109, all P < 0. 05) . In group M, the expression of Hepc was positively correlated with that of IL-6 ( r = 0. 944, P < 0. 05) , and the expression Hepc and IL-6 was positively correlated with NAS ( r = 0. 927 and 0. 907, both P < 0. 001) . Conclusion Based on the results of this preliminary study, liver inflammation process in NAFLD can upregulate the expression of Hepc and IL-6 in liver tissue, and Hepc is significantly correlated with the inflammatory factor IL-6. Further studies are needed to investigate the roles of Hepc and IL-6 in predicting the progression of NAFLD.