Thermal ablation ranks along with surgical resection and liver transplantation as a major radical treatment for liver tumor, and more and more attention has been paid to its efficacy and minimal invasiveness.However, the majority of Chinese patients who need ablation treatment have poor liver function, so the treatment is challenging, with a high recurrence rate.That has a negative impact on the efficacy and application of this technique.The principle and strategy of standardized image-guided thermal ablation in the treatment of liver tumor were briefly reviewed, with the aim of improving the efficacy and safety of this technique.

Image-guided local thermal ablation plays an increasingly important role in the treatment of live cancer, and the safety of this therapy deserves some attention. The major complications of thermal ablation include bleeding, biliary complications, gastrointestinal perforation, infection, thoracic and diaphragmatic complications, etc. Any major complication may significantly affect the quality of life after treatment and even lead to death. Therefore, identifying the cause of each complication and mastering preventive measures and treatment methods are crucial to reducing major complications of thermal ablation.

The recent progress in radiofrequency ablation (RFA) of hepatic hemangioma was reviewed, with a focus on radiofrequency electrodes, treatment modalities, complications, and prevention strategies.The foundation for the standardization of RFA of hepatic hemangioma was laid.The standardization of RFA will help to promote its clinical application and development as an important minimally invasive technique for hepatic hemangioma.

Imaging evaluation of hepatic malignancies after ablation is an important clinical problem to be solved.Contrast enhanced ultrasound (CEUS) is a noninvasive, safe technique for acquiring the microcirculation information of treatment areas.The CEUS technique and the findings of local and distant recurrence were reviewed.Complete ablation was defined as follows: the ablation area had neither enhancement nor abnormal wash-out and was presented as perfusion deficiency in each phase of CEUS.Local residual or recurrent tumor had various patterns, and their common location was in the periphery of the lesions, being nodular or in irregular enhancement.The positive indicator of recurrence was that CEUS found abnormal enhancement in arterial phase.Most lesions with viability can be detected by this criteria.During follow-up, local recurrence or viability of tumor should be considered when the lesion was increased in size.Most current studies have demonstrated that CEUS has a similar value as contrast enhanced computed tomography in evaluating hepatic malignancies after ablation and that CEUS offers an imaging option for treatment evaluation and follow-up.

Liver function is an important influential factor for the treatment outcome and prognosis of patients with hepatocellular carcinoma (HCC) following radiofrequency ablation (RFA) and should be evaluated before operation. In order to demonstrate the clinical significance of liver function evaluation before RFA, The values of some liver function indices, such as Child-Turcotte-Pugh (CTP) score, Model for End-stage Liver Disease (MELD) score, prothrombin time, prothrombin activity, platelet count, serum albumin, bilirubin level, and hepatitis B virus DNA level were summarized, in predicting the complications and survival in HCC patients after RFA.

Primary hepatocellular carcinoma (HCC) is the most common malignant tumor of the liver.Accurate assessment of treatment outcome and prognosis in HCC patients is very important due to its high malignancy and poor prognosis.Currently, radiological imaging, though a standard method for prognostic evaluation of HCC, has a lot of limitations.As an important serological marker of HCC, alpha-fetoprotein (AFP) has been widely used in the screening, diagnosis, and prognostic evaluation of HCC.The studies regarding the prognostic value of AFP response in HCC patients were summarized.Generally, AFP has good prognostic value in HCC patients treated with radiofrequency ablation, transarterial chemoembolization, yttrium-90 radioembolization, molecular targeted agents like sorafenib, systemic chemotherapy, hepatic artery infusion chemotherapy, or concurrent chemoradiotherapy.

Advanced oxidation protein products (AOPP) are a class of oxidatively modified proteins closely associated with inflammation and oxidative stress. The progress in research on AOPP in liver diseases and discusses the source, biochemical characteristics, and biological effects of AOPP and its association with liver diseases were reviewed, in order to make a breakthrough in the pathogenesis study, treatment, and poor outcome prediction of liver diseases.

Objective To compare clinical efficacy and recurrence between surgical resection and radiofrequency ablation (RFA) in the treatment of small hepatocellular carcinoma (HCC) .Methods The clinical data of 97 patients with small HCC, who underwent surgical resection or RFA as the initial treatment in The First Hospital of Jilin University from January 2002 to December 2008, were collected.Sixty-three cases, who survived 2 years after treatment, were followed up;of the 63 cases, 34 underwent surgical resection, and 29 underwent RFA.The recurrence of these patients was analyzed retrospectively.The measurement data were analyzed by chi-square test.The Cox regression analysis was used for determining the risk factors for recurrence.The log-rank test was used for disease-free survival (DFS) difference analysis.Results The 3-month, 1-year, and 2-year intrahepatic recurrence rates for the patients who underwent surgical resection were 15%, 38%, and 64%, respectively, versus 21%, 35%, and 45% for those who underwent RFA, without significant differences between the two groups of patients.The intrahepatic recurrence after initial treatment was not significantly associated with treatment method, sex, age, Child-Pugh grade, tumor size, number of nodules, presence of cirrhosis, and alpha-fetoprotein level.There was no significant difference in DFS between the two groups of patients.Conclusion RFA produces a comparable outcome to that by surgical resection in the treatment of small HCC.RFA holds promise as a substitute for surgical resection.

Objective To compare the clinical effects of radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) in treating postoperative recurrence of hepatocellular carcinoma (HCC) and to provide reference for clinical treatment of recurrent HCC. Methods A retrospective analysis was performed on the clinical data of 175 patients who had a single recurrent lesion after surgical treatment of HCC from August 2007 to January 2010. These patients were divided into PEI group (n=101) and RFA group (n=74) according to the modalities of treatment for recurrent HCC. All cases underwent color Doppler ultrasound and contrast-enhanced ultrasound or CT before and after treatment. The two groups were compared in terms of number of treatments, complete ablation rate, and complication rate. The 1-, 2-, and 3-year survival rates after treatment were also recorded. The measurement data were subjected to t-test, while the enumeration data were subjected to chi-square test. Results The PEI group had a significantly larger mean number of treatments than the RFA group (P＜0.05). There was no significant difference in complication rate between the two groups (P＞0.05). For the recurrent lesions smaller than 2.0 cm in diameter, the complete ablation rate showed no significant difference between the RFA group and PEI group (P＞0.05), while this rate was significantly higher in the RFA group than in the PEI group for the recurrent lesions with a diameter of 2.0-5.0 cm (P＜005). Among the patients with recurrent lesions smaller than 2.0 cm in diameter, those receiving PEI had 1-, 2-, and 3-year survival rates of 89.1%, 69.1%, and 49.1%, respectively, versus 90.2%, 70.7%, and 53.7% for those receiving RFA (P＞0.05); among the patients with recurrent lesions with a diameter of 2.0-5.0 cm, those receiving PEI had significantly lower 1-, 2-, and 3-year survival rates than those receiving RFA (63.0% vs 84.8%, P＜0.05; 43.5% vs 66.7%, P＜0.05; 21.7% vs 45.5%, P＜0.05). Conclusion RFA and PEI lead to similar survival rates in patients with recurrent lesions smaller than 2.0 cm in diameter after surgical treatment of HCC, but RFA produces a better survival than PEI in those with recurrent lesions with a diameter of 2.0-5.0 cm.

Objective To evaluate the clinical efficacy of transarterial chemoembolization (TACE) combined with microwave coagulation therapy (MCT) in the treatment of advanced liver cancer and to provide a more convincing basis for the clinical application of this therapy.Methods A search was performed using Cochrane Library, PubMed, Em-base, CBM, CNKI, VIP WanFang Data as well as other sources to collect randomised controlled trials (RCTs) of TACE combined with MCT in the treatment of advanced primary liver cancer.The literature was selected according to inclusion criteria.The quality of included studies was assessed according to Cochrane review criteria.A Meta-analysis was performed on homogeneous studies using RevMan 5.0.The patients receiving TACE combined with MCT were compared with those receiving TACE alone in terms of 0.5-year, 1-year, and 2-year survival rates and negative conversion rate of alpha-fetoprotein (AFP) .Results A total of 12 RCTs involving 872 cases were included in the analysis.Compared with those receiving TACE alone, the patients receiving TACE combined with MCT had a significantly higher 0.5-year survival rate (OR=7.21, 95% CI: 1.92-27.08, P=0.003) , a significantly higher 1-year survival rate (OR=4.47, 95% CI:3.14-6.36, P<0.000 01) , a significantly higher 2-year survival rate (OR=3.66, 95% CI:2.45-4.84, P<0.000 01) , and a significantly higher negative conversion rate of AFP (OR=2.65, 95% CI:1.73-4.07, P<0.000 1) .Conclusion Compared with TACE alone, TACE combined with MCT can produce better short-term and long-term treatment outcomes and significantly improve the survival rate in patients with unresectable advanced liver cancer, according to the meta-analysis.This combination therapy might be clinically effective, but which needs to be confirmed by a large number of high-quality controlled clinical trials.

Objective To evaluate the efficacy and safety of telbivudine given from the 12th week of gestation in preventing mother-to-infant transmission of hepatitis B virus (HBV) in pregnant women with high HBV DNA load.Methods Eighty pregnant women (at 12 weeks of gestation) with chronic hepatitis B, who had a HBV DNA load higher than 1.0×107 copies/ml, were enrolled.The patients were divided into two groups according to their personal preferences: treatment group (n=38) and control group (n=42) .The treatment group received oral telbivudine (600 mg) once daily until 12 weeks after delivery and was administered compound glycyrrhizin for liver protection, while the control group was given compound glycyrrhizin for liver protection alone.All infants in both groups were vaccinated with hepatitis B immunoglobulin (200 IU) and HBV vaccine (20 μg) after birth.The mother-to-infant transmission of HBV was indicated by the presence of HBsAg and HBV DNA in infants at 7 months after birth.The HBV DNA levels in these women were measured, and the positive rate of HBsAg in infants was determined.The difference in positive rate of HBsAg was analyzed by chi-square test;the between-group comparison was analyzed by group t (t′) -test, and the before-after comparison was analyzed by paired t-test.Results The treatment group showed significantly decreased HBV DNA and alanine aminotransferase levels before delivery.The HBV DNA load of treatment group dropped rapidly after 2 weeks of treatment and then decreased slowly until delivery.The treatment group had significantly decreased HBV DNA levels before delivery and at 12 weeks after delivery (t=29.15, P<0.01;t=40.06, P<0.01) but="" the="" control="" group="" showed="" no="" significant="" changes="" p="">0.05) .The treatment group had significantly lower HBV DNA levels than the control group before delivery and at 12 weeks after delivery (P<0.01) .No infants in the treatment group were HBV-positive, versus a positive rate of 14.3% in the control group (χ2=3.99, P<0.05) .No adverse events occurred in the mothers or their infants in treatment group, but two cases of severe hepatic dysfunction were found in the control group.There were no significant differences between the two groups in terms of cesarean section rate, adverse pregnancy rate, and postpartum hemorrhage rate as well as the gestational age, body weight and height, and Apgar scores of neonates.Conclusion Telbivudine given from the 12th week of gestation can significantly decrease the serum HBV DNA level in peripheral blood among pregnant women with high HBV DNA load and reduce the infection rate of HBV in neonates, and it has high tolerability and safety.

Objective To investigate the efficacy of nucleoside analogue-based salvage therapy in patients with chronic hepatitis B (CHB) with multidrug resistance (MDR). Methods Twenty-seven CHB patients with MDR were divided into three equal groups for receipt of salvage therapy with: tenofovir (TDF) plus entecavir (ETV); TDF alone; or adefovir (ADV) plus ETV. Liver and kidney Over 24 weeks of treatment, the serum markers of liver and kidney function were assessed by enzymatic biochemistry analysis and the expression of hepatitis B virus (HBV) was assessed by quantitative real-time PCR and direct sequencing. The significance of intergroup differences was assessed by Chi-squared test. Results At week 4 of treatment, all patients (9/9) in the TDF+ETV group had levels of serum liver markers and HBV DNA below the detection limit. In contrast, the four weeks of treatment with TDF alone led to normalization of serum liver markers in all (9/9) of patients but reduction of HBV DNA below the detection limit in only two-third (6/9) of the patients. The HBV DNA level was reduced below the detection limit in the remaining three patients at 12 weeks of treatment. The group treated with ADV+ETV showed no response to treatment, even out to 24 weeks (χ2=535-640, P＜0.01). Conclusion TDF alone or in combination with ETV can be an effective salvage therapy for CHB patients with MDR, and it is better than ADV+ETV treatment.

Objective To retrospectively analyze the therapeutic effect of antiviral therapy in the chronic hepatitis B (CHB) patients with nonalcoholic fatty liver disease (NAFLD) and to investigate whether hepatocyte steatosis affects the response to antiviral therapy in CHB patients.Methods A total of 110 CHB patients and 99 CHB patients with NAFLD were enrolled in the study.Serum HBV DNA levels were measured by fluorescence quantitative PCR;serum HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb were quantified by chemiluminescence;biochemical indices were determined by automatic biochemical analyzer to evaluate the liver function.Results (1) When receiving antiviral therapy with interferon, the CHB patients had a significantly higher rate of alanine aminotransferase (ALT) /aspartate aminotransferase (AST) normalization after 24 weeks of treatment (χ2=4.069, P=0.044) and a significantly higher rate of HBV DNA clearance after 48 weeks of treatment (χ2=17.327, P=0.000) , as compared with the CHB patients with NAFLD;in all HBeAg-positive patients, those with only CHB had a significantly higher rate of ALT/AST normalization after 24 weeks of treatment (P<0.05) and significantly higher rates of HBV DNA clearance and HBeAg clearance after 24 and 48 weeks of treatment (P<0.05) 48="" as="" compared="" with="" those="" chb="" and="" but="" there="" was="" no="" significant="" difference="" in="" the="" rate="" of="" ast="" normalization="" between="" them="" after="" weeks="" treatment="" p="">0.05) . (2) When receiving antiviral therapy with nucleos (t) ide analogues, the CHB patients had a significantly higher rate of ALT/AST normalization than the CHB patients with NAFLD after 48 weeks of treatment (χ2=7.620, P=0.006) , but there was no significant difference in the rate of HBV DNA clearance between them after 24 and 48 weeks of treatment (P>0.05) ;in all HBeAg-positive patients, those with CHB and NAFLD had a significantly higher rate of HBeAg clearance after 24 weeks of treatment (P<0.05) and a significantly lower rate of ALT/AST normalization after 48 weeks of treatment (P<0.05) 24="" 48="" as="" compared="" with="" those="" only="" but="" there="" were="" no="" significant="" differences="" in="" the="" rate="" of="" ast="" normalization="" after="" weeks="" rates="" hbv="" dna="" clearance="" and="" hbeag="" treatment="" between="" them="" p="">0.05) .Conclusion To some extent, hepatocyte steatosis affects the response to antiviral therapy in CHB patients.

Objective To evaluate the expression of glucokinase (GCK) mRNA and glucose transporter-2 (GLUT2) in the liver tissues of patients with severe chronic hepatitis B and to preliminarily investigate their roles in abnormal glucose metabolism among patients with severe chronic hepatitis B.Methods The expression of GCK mRNA in the liver tissues of 10 patients with severe chronic hepatitis B and 10 patients with liver cirrhosis (Child-Turcotte-Pugh grade A) was evaluated by RT-PCR.The expression of GLUT2 in the liver tissues of the above 10 patients with severe chronic hepatitis B and 10 normal controls was evaluated by immunohistochemistry.The t-test was used for mean comparison between groups;the Pearson correlation test was used for correlation analysis.Results The expression level of GCK mRNA in liver tissue was significantly lower in the patients with severe chronic hepatitis B than in those with liver cirrhosis (1.13±0.11 vs 1.44±0.14, P<0.05) .In the patients with severe chronic hepatitis B, the level of GCK mRNA in liver tissue had a positive correlation with the oxidation rate of carbohydrates (r=0.845, P<0.01) but="" it="" had="" no="" correlation="" with="" fasting="" blood="" glucose="" r="0.03," p="">0.05) .The expression of GLUT2 was reduced in the liver tissues of patients with severe chronic hepatitis B, and it was distributed in the hepatic cells around pseudolobuli (nodules) .Conclusion The level of GCK mRNA is closely related to the oxidation of carbohydrates.The decreased expression of GCK mRNA and GLUT2 is one of the mechanisms of abnormal glucose metabolism in patients with severe chronic hepatitis B.

Objective To observe the expression of endogenous cannabinoid receptor l (CB1) in rats with non-alcoholic fatty liver disease (NAFLD) and to preliminarily investigate the role of CB1 receptors in the pathogenesis of NAFLD. Methods Forty-eight male SD rats were randomly divided into three groups: control group (receiving normal feed), model group (receiving high-sugar and high-fat feed), and rimonabant group (receiving high-sugar and high-fat feed and rimonabant). At the end of the 4th or 8th week of experiment, 8 of each group were sacrificed. The body weight was measured, and the liver index was calculated. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglyceride (TG), and total cholesterol (TC) were determined. The serum levels of leptin and tumor necrosis factor (TNF)α were determined by ELISA. The liver tissue was treated by HE staining, and the pathological changes were observed. Immunohistochemical staining was used to evaluate the CB1 receptor expression in liver tissues in different stages of NAFLD. One-way analysis of variance and t-test were used for within-group and between-group comparisons. Pearson′s linear-correlation analysis was used for evaluating the correlation between indices. Results The model group had significantly higher serum levels of ALT, AST, TC, TG, leptin, and TNF-α than the control group and rimonabant group (P＜0.05). The model group showed simple fatty degeneration of the liver after 4 weeks and diffuse fatty degeneration of the liver with inflammatory cell infiltration after 8 weeks, while the rimonabant group had less severe liver lesions at the same time. CB1 receptor expression was not detected in the control group, but was detected in the model group and rimonabant group, according to the immunohistochemical staining, and the model group had a significantly higher integral optical density than the rimonabant group (P＜0.05). Conclusion The expression of CB1 receptors is enhanced in patients with NAFLD, and it may act together with TNF-α and leptin to promote the progression of NAFLD.

Objective To evaluate the chemosensitivities of hepatocellular carcinoma (HCC) to different chemotherapy drugs by 3- (4, 5-dimethylthiazol-2-yl) -2, 5-diphenyl-2H tetrazolium bromide (MTT) assay and to provide guidance for individualized chemotherapy regimen in regional chemotherapy via the hepatic artery and portal vein.Methods Forty-two HCC samples were selected.Primary culture of HCC cells combined with MTT assay were used to evaluate the chemosensitivities of HCC to 5-fluorouracil (5-FU) , cisplatin (DDP) , mitomycin C (MMC) , adriamycin (ADM) , hydroxycamptothecine (HCPT) , gemcitabine (Gemzar) , and oxaliplatin (OXA) .Individualized chemotherapy regimens were developed according to the chemosensitivity test results to guide regional chemotherapy via the hepatic artery and portal vein in 24 of these patients (as an individualized chemotherapy group) .The therapeutic efficacy was compared with that of transcatheter arterial infusion performed in 20 patients (as a control group) .The chi-square test was used for comparison of sensitivity rate, and the rank-sum test was used for comparison of time to progression (TTP) .Results The sensitivity rates of HCC were 64.3% to OXA, 45.2% to HCPT, 40.5% to DDP, 38.1% to Gemzar, 33.3% to ADM, 21.4% to 5-FU, and 16.7% to MMC.Compared with the control group, the individualized chemotherapy group had a significantly higher objective response rate (50.0% vs 20.0%, P= 0.039) , a significantly higher disease control rate (70.8% vs 35.0%, P = 0.017) , and a significantly longer TTP ( (4.7±2.9) m vs (2.6±1.3) m, P = 0.032) .Conclusion In vitro chemosensitivity test based on MTT assay may be used to screen out the chemotherapy drugs in individualized chemotherapy for HCC and provide guidance for regional chemotherapy via the hepatic artery and portal vein, so as to improve the effect of chemotherapy.

Objective To investigate the expression of DNA methyltransferases (DNMTs) in cancerous tissues, paracancerous tissues, and cirrhotic tissues among patients with liver cancer and to analyze the relationship between HBV infection and DNMT expression.Methods Forty-four samples were divided into HBV infection group and non-HBV infection group according to whether at least one marker of HBV infection could be detected in blood or tissue.FQ-PCR was used to measure the mRNA expression levels of DNMTs in the cancerous tissues, paracancerous tissues, and cirrhotic tissues with different tumor stages and differentiations.The differences in DNMT expression between groups were determined by analysis of variance;the relationship between HBV infection and DNMT expression was evaluated by Spearman rank correlation analysis.Results Compared with the non-HBV infection group, the HBV infection group had significantly higher mRNA expression levels of DNMT1, 3A, and 3B in cancerous tissues (P=0.001, 0.006, and 0.02) and in cirrhotic tissues (P=0.007, 0.008, and 0.045) and significantly higher mRNA expression levels of DNMT1 and 3A in paracancerous tissues (P=0.01 and 0.04) .There were significant associations between HBV infection and DNMT expression (P=0.009 for DNMT1, 0.006 for DNMT3A, and 0.03 for DNMT3B) ;HBsAg, HBeAg, and HBV-DNA were closely related to DNMT1 expression (P=0.008, 0.032, and 0.006) .Conclusion The liver cancer patients with HBV infection have significantly higher mRNA expression levels of DNMT1, 3A, and 3B in cancerous and cirrhotic tissues than those without HBV infection.HBV infection may stimulate the expression of DNMTs, especially DNMT1, 3A, and 3B, thus promoting methylation of some tumor-suppressor genes.

Objective To evaluate the abnormal methylation of p14, p15, p16, and RB in the cancerous tissues of liver cancer patients and to investigate the significance of detection of multigene methylation for the early diagnosis of liver cancer. Methods Methylation-specific PCR was used to evaluate the methylation status of p14, p15, p16, and RB in the cancerous tissues of 44 liver cancer cases and the cirrhotic tissues of 41 liver cirrhosis cases as well as the paracancerous tissues of the 44 liver cancer cases. The obtained data were subjected to chi-square test and Fisher′s exact test. Results Among the 41 liver cirrhosis cases, the methylation of p14, p15, p16, and RB was detected in 7 cases (17.1%), 11 cases (28.9%), 15 cases (36.6%), and 3 cases (7.3%), respectively. Among the 44 liver cancer cases, the methylation of p14, p15, p16, and RB was detected in 15 cases (34.1%), 25 cases (56.8%), 31 cases (70.5%), and 12 cases (273%), respectively. In the 44 paracancerous tissues, p16 methylation was detected in 4 cases, and p15 methylation in 1 case. The methylation rates of the four genes were significantly higher in liver cancer tissues and liver cirrhosis tissues than in paracancerous tissues (P＜0.05). There were no significant differences in the methylation rates of the four genes among liver cancer patients with different ages, sexes, degrees of tumor differentiation, and clinical stages (P＞0.05). Conclusion The methylation of p14, p15, p16, and RB is frequent in the pathogenesis of liver cancer. The detection of multigene methylation is of certain significance for early diagnosis of liver cancer.

Objective To evaluate the relation of serum cystatin C (CysC) and urotensin II (uII) levels with presence of hepatorenal syndrome in patients with decompensated liver cirrhosis to determine the diagnostic potential for these serum markers in order to facilitate early detection of hepatorenal syndrome at subclinical stages.Methods A total of 50 patients with decompensated liver cirrhosis were recruited for study and divided into three groups according to creatinine elimination rate (Ccr) : simple liver cirrhosis, ≥80 ml/min (n=22) ;subclinical hepatorenal syndrome, 40≤Ccr<80 ml/min (n=19) ;and hepatorenal syndrome, ≤40 ml/min (n=9) .Fifteen healthy individuals were recruited for use as controls.Fasting blood samples were collected from all cases and controls for measurements of alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , total bile acid (TBA) , albumin (Alb) , serum creatinine (Scr) , CysC, and uII.For normally distributed data, single-factor analysis was carried out by One-Way ANOVA and pairwise comparisons were carried out by the Student′s t-test;for non-normally distributed data, the Kruskall-Wallis H test and Mann-Whitney U test were used, respectively.Correlation analysis was carried out with the Spearman′s rank correlation coefficient.Diagnostic accuracy was assessed by generating a receiver operating characteristic (ROC) curve and using the area under the curve (AUC) to select the optimal threshold for diagnosing subclinical hepatorenal syndrome and hepatorenal syndrome in patients with decompensated liver cirrhosis.Results Compared to the healthy controls, the cirrhosis cases had significantly higher levels of ALT, AST, TBA, ALB, Scr, CysC, and uII (all P<0.05) .However, among the cirrhotic patients, those with subclinical hepatorenal syndrome and hepatorenal syndrome had slightly, but significantly, higher levels of CysC and uII than the patients with simple cirrhosis (both P<0.05) .For subclinical hepatorenal syndrome, the AUCs of CysC and uII were 0.91 and 0.867 and the optimal thresholds were 1.40 mg/L and 299.06 pg/ml respectively.For hepatorenal syndrome, the AUCs of CysC and uII were 0.942 and 0.901 and the optimal thresholds were 2.22 mg/L and 321 pg/ml respectively.Conclusion Enhanced levels of serum CysC and uII can reflect hepatorenal damage in patients with decompensated liver cirrhosis, even when serum creatinine levels are within normal range, suggesting that these two serum markers may have diagnostic value for detecting subclinical hepatorenal syndrome and hepatorenal syndrome at early stages in this patient population.

Liver biopsy (LB) is considered the gold standard for assessing the pathological damage of the liver in nonalcoholic fatty liver disease (NAFLD) , but this technique is not widely applied in clinical diagnosis because it is invasive.Rapid progress has been made in the research on the methods for noninvasive diagnosis of nonalcoholic steatohepatitis (NASH) and advanced fibrosis in recent years.Some noninvasive methods with relatively high diagnostic values from the aspects of clinical and biochemical indices, biomarkers, and imaging techniques were reviewed.Currently, it is thought that the noninvasive diagnostic methods for NAFLD still cannot be used as a substitute for LB, but a combination of serum cytokeratin 18 fragments, NAFLD fibrosis score, and FibroScan can make for primary diagnosis of NASH with or without advanced fibrosis, so as to decide the use of LB.

The key step in the pathogenesis of hepatic fibrosis is the activation of hepatic stellate cells (HSCs) into fibroblasts and the abnormal expression of extracellular matrix (ECM) after activation.The important role of Rho/ROCK signaling pathway in the activation of HSCs is reviewed.It is summarized that RhoA, a member of the small G-protein family in Rho/ROCK signaling pathway, gets involved in hepatic fibrosis as an important cytokine for regulating the actin cytoskeleton and morphological heterogeneity of cells.It is pointed out that RhoA plays an important regulatory role in the onset and development of hepatic fibrosis and that RhoA adjusts the assembly of actin stress fibers and influences the synthesis and contraction of ECM through cascade amplification.The role of RhoA in the onset and development of hepatic fibrosis and its significance as a potential therapeutic target for hepatic fibrosis are reviewed.