Objective To determine the serum M30 and M65 levels in patients with HBV- related acute- on- chronic liver failure ( ACLF) and to investigate their association with this disease. Methods Thirty- one patients with HBV- related ACLF ( 20 cases with response to treatment and 11 cases without response to treatment) , 20 patients with chronic hepatitis B ( CHB) , and 10 healthy controls were enrolled in the study. Serum M65 and M30 levels were measured by enzyme- linked immunosorbent assay. Analysis of variance was used for comparison among groups; q- test was used for pairwise comparison. Results The serum M30 and M65 levels of ACLF patients ( 508. 65 ±340. 16 and 768. 75 ± 290. 02 U / L) were significantly higher than those of CHB patients ( 212. 27 ± 91. 33 and 384. 40 ± 134. 46 U / L) and healthy controls ( 94. 12 ± 17. 64 and 121. 99 ± 29. 25 U / L) ( P < 0. 05 for all comparisons) . In the ACLF patients, the serum level of M30was positively correlated with that of M65 ( r = 0. 78, P < 0. 05) ; no significant differences were seen between the cases with response to treatment and those without response to treatment in serum M30 and M65 levels ( 572. 38 ± 349. 45 vs 436. 14 ± 285. 59 U / L, P = 0. 29; 817. 25± 307. 66 vs 703. 90 ± 221. 37 U / L, P = 0. 31) . Conclusion Serum levels of M30 and M65 are sensitive indicators for the necrosis and apoptosis of hepatocytes. Significant increases in serum M30 and M65 levels are observed in patients with HBV- related ACLF.

Objective To evaluate the fatality and adverse event rates of prostaglandin E ( PGE) versus placebo in treating acute liver failure ( ALF) . Methods A search was performed using Cochrane Library, MEDLINE, EMBASE, VIP, CNKI, CBM, and other electronic databases to select randomized controlled trials ( RCTs) for comparing PGE and placebo in treating ALP published up to April 2012. There were no limits to language and publication. Data extraction and quality evaluation were performed independently by two researchers for the RCTs meeting inclusion criteria; a meta- analysis was performed with RevMan 5. 1 software, and the GRADE system was used to grade the quality of evidence and strength of recommendation. Results Two RCTs involving 59 cases met the inclusion criteria. Compared with the placebo, PGE could not reduce the fatality rate ( RR = 0. 99; 95% CI: 0. 62- 1. 57; P = 0. 96) , as demonstrated by the meta- analysis.Both interventions caused slightly adverse events, but no incidence rate was reported. Based on the GRADE system, the quality of evidence was low ( 2C) , and the strength of recommendation was weak. Conclusion PGE cannot reduce the fatality of ALF, according to the systematic review. Large- scale, high- quality basic and clinical researches should be performed to confirm the conclusion because the systematic review is secondary study, the literature included has low quality of evidence, and there may be bias in review.

Objective To construct a hybrid bioartificial liver support system and to investigate its safety and efficacy in patients with hepatitis B virus ( HBV) - related acute- on- chronic liver failure ( ACLF) . Methods A hollow fiber bioreactor was constructed using cultured HepG2 cells transfected with human augmenter of liver regeneration gene. Patients with HBV- related ACLF who were hospitalized in our hospital from May2009 to August 2011 were randomly divided into treatment group ( n = 10) and control group ( n = 10) . The treatment group was treated using the hybrid bioartificial liver support system, while the control group was treated with conventional plasma exchange. Comparison of means between the two groups was made by independent- samples t test, and comparison of variables before and after treatment was made by paired t test. Results Of the 10 patients in treatment group, 7 had improvement in clinical symptoms and were discharged, 1 died of hepatic encephalopathy, 1 died of hepatorenal syndrome, and 1 died of liver failure after discharge. Of the 10 patients in control group, 5 survived, 1 underwent liver transplantation, and 4 died of liver failure. Before treatment, the treatment group and control group had model for end- stage liver disease ( MELD) scores of 24. 26± 2. 54 and 24. 71 ± 2. 79, respectively, without significant difference between the two groups ( t = 1. 971, P = 0. 064) . The treatment group had MELD scores of 21. 71 ± 2. 92, 22. 10 ± 4. 46, and 19. 90 ± 5. 43 after 3 days, 1 week, and 4 weeks, respectively, of treatment. At the end of one-year follow- up, the mean serum alpha- fetoprotein levels were 14. 24 ng / ml in treatment group and 11. 32 ng / ml in control group, and no space- occupying lesions in the liver were found through abdominal ultrasound. Conclusion The constructed hybrid bioartificial liver support system is effective and safe in the treatment of HBV- related ACLF.

Objective To investigate the therapeutic strategy for spontaneous rupture of hepatocellular carcinoma ( HCC) . Methods A retrospective analysis was performed on the clinical data of 30 patients with HCC rupture hospitalized at our hospital from January 2008 to December2011, including nine patients treated by primary surgical tumor resection and 21 patients treated with emergency transcatheter arterial chemoembolization ( TACE) . Of the latter group, 10 patients underwent surgical tumor resection after TACE and the other 11 patients were treated with TACE alone. Treatment outcomes were evaluated and compared. Categorical data were compared using the chi- square test or Fisher's test. Results The success rate of hemostasis was 100% in the 21 patients treated with TACE, of whom 10 patients received tumor resection within 2- 5 weeks after TACE and HCC was confirmed by postoperative pathology. No peritoneal metastasis was noted three months after surgery. One- year survival rate was 70% ( 7 /10) . Of the nine patients treated by primary surgical tumor resection, two died during the perioperative period and five developed peritoneal or port- site metastasis within three months, and one- year survival rate was 44. 4% ( 4 /9) . For the 11 cases treated with TACE alone, one- year survival rate was 27. 3% ( 3 /11) . Conclusion TACE combined with surgical tumor resection is the preferred emergency treatment for spontaneous rupture of primary HCC. It can significantly increase the success rate of rescuing patients with HCC rupture and tumor resection rate, significantly decrease peritoneal metastasis rate, and prolong the survival of the patients.

Objective To investigate the value ofα- fetoprotein ( AFP) in the initial diagnosis of primary hepatic cancer ( PHC) . Methods A retrospective analysis was performed on the initial AFP measurement results and imaging findings of 177 patients who had relatively complete clinical data and had a confirmed diagnosis of PHC; 98 patients with chronic hepatitis B ( CHB) and 82 patients with post- hepatitis B cirrhosis ( PHBC) , who were admitted to our department in 2011, were enrolled as controls. The obtained data were subjected to statistical analysis using SAS software; the enumeration data were subjected to chi- square test. Results In the initial examination for the 177PHC patients, 93 ( 52. 54%) had a serum AFP level not lower than 400 ng / ml, 38 ( 21. 47%) had a serum AFP level between 20 ng / ml and 400 ng / ml, and 46 ( 25. 99%) had a normal serum AFP level; the abnormal rate of AFP level was 74. 01%, which was significantly higher than those of CHB group ( χ2= 106. 07, P < 0. 001) and PHBC group ( χ2= 67. 82, P < 0. 001) . Among the 177 PHC patients, 63 ( 35. 59%) had a serum AFP level lower than 400 ng/ml in the course of disease. The serum AFP level was significantly lower in patients with a tumor diameter not larger than 3 cm than in those with a tumor diameter larger than 5 cm ( χ2= 8. 62, P < 0. 005) . In the initial examination, serum AFP level yielded a significantly lower correct diagnosis rate than B- mode ultrasound ( χ2= 30. 39, P < 0. 000) and computed tomography ( χ2= 84. 83, P < 0. 000) . Conclusion The abnormal rate of AFP level is higher in PHC patients than in those with CHB and PHBC during initial examination, and the higher the serum AFP level, the higher its diagnostic value. There is a certain relationship between serum AFP level and tumor size. Attention should also be paid to those with negative results of AFP detection. Dynamic monitoring of AFP level combined with imaging examination is helpful for early and correct diagnosis.

Objective To investigate the inhibitory effect of peroxisome proliferator- activated receptor gamma ( PPARγ) on the development, progression, invasion, and metastasis of liver cancer cells. Methods Hepatocellular carcinoma ( HCC) MHCC97L cells were randomly assigned to be transfected with Ad- PPARγ or Ad- LacZ ( control) . The cells were also exposed to PPARγ agonist rosiglitazone. Cell proliferation, apoptosis, migration, and invasive ability were evaluated using MTS assay, flow cytometry, wound healing test, and transwell invasion assay. Multiple comparisons of means between groups were conducted using one- way analysis of variance with Bonferroni correction; the means of two groups were compared using the t test. Results Ad- PPARγ transfection resulted in higher expression of PPARγprotein in HCC cells compared with control cells, which suppressed cell proliferation ( P < 0. 01) , induced cell apoptosis ( P < 0. 01) , and suppressed cell migration and invasion. Moreover, the invasiveness of HCC cells transfected with Ad- PPARγ was reduced by 20% ~ 60%.Rosiglitazone enhanced the inhibitory effect of Ad- PPARγ on the growth and migration of HCC cells. Conclusion PPARγ exerts an inhibitory effect on the proliferative, invasive, and metastatic potential of HCC cells in vitro. This study sheds new light on the search for potential markers and gene therapies for liver cancer.