Despite different opinions on its definition and classification in the past, a consensus has gradually been reached regarding the naming, classification, and clinical diagnosis of liver failure. The classification of liver failure is described, and the definition and natural history of severe exacerbation of hepatitis B are summarized. Antiviral treatment and artificial liver support in the early stage are beneficial for clinical outcomes and prognosis.

Objective To analyze the prognostic factors in acute-on-chronic liver failure ( ACLF) patients with hepatic encephalopathy ( HE) and to explore the risk factors for prognosis. Methods A retrospective analysis was performed on106 ACLF patients with HE who were hospitalized in our hospital from January 2010 to July 2013. The patients were divided into improved group and deteriorated group. The univariate indicators including age, sex, laboratory indicators [total bilirubin ( TBil) , albumin ( Alb) , alanine aminotransferase ( ALT) , aspartate amino-transferase ( AST) , and prothrombin time activity ( PTA) ], the stage of HE, complications [persistent hyponatremia, digestive tract bleeding, hepatorenal syndrome ( HRS) , ascites, infection, and spontaneous bacterial peritonitis ( SBP) ], and plasma exchange were analyzed by chi-square test or t-test. Indicators with statistical significance were subsequently analyzed by binary logistic regression. Results Univariate analysis showed that ALT ( P = 0. 009) , PTA ( P = 0. 043) , the stage of HE ( P = 0. 000) , and HRS ( P = 0. 003) were significantly different between the two groups, whereas differences in age, sex, TBil, Alb, AST, persistent hyponatremia, digestive tract bleeding, ascites, infection, SBP, and plasma exchange were not statistically significant ( P >0. 05) . Binary logistic regression demonstrated that PTA ( b =-0. 097, P =0. 025, OR =0. 908) , HRS ( b =2. 279, P =0. 007, OR =9. 764) , and the stage of HE ( b = 1. 873, P = 0. 000, OR = 6. 510) were prognostic factors in ACLF patients with HE. Conclusion The stage of HE, HRS, and PTA are independent influential factors for the prognosis in ACLF patients with HE. Reduced PTA, advanced HE stage, and the presence of HRS indicate worse prognosis.

Objective To establish a simple scoring system for evaluating the severity of hepatitis B virus ( HBV) -related acute-on-chronic liver failure ( HBV-ACLF) . Methods A retrospective analysis was performed on the clinical data of 620 patients with HBV-ACLF who were divided into group I ( 500 patients) and group II ( 120 patients) . Seven clinical parameters, including hepatic encephalopathy, serum creatinine, prothrombin activity, serum total bilirubin, infection, dimension of liver, and maximum depth of ascites, were scored from 0-4 points for each patient according to the disease severity. The severity scoring system was established based on the total score of each patient in group I, with the cut-off point being determined. The established system was tested with group II. Results A severity scoring system was successfully developed based on chi-squared automatic interaction detector analysis of the total score of each patient in group I. There was a significant difference in the total score between the survival and death subgroups of the 500 patients ( t = 25. 78, P <0. 001) . The area under the ROC curve was 0. 963, suggesting a high validity of this scoring system. With the cut-off value of 9. 5, the sensitivity and specificity of this system were 0. 98 and 0. 83, respectively. The other 120 patients were divided into the poor prognosis ( score ≥10) and good prognosis subgroups ( score ≤9) based on the scoring system, with the mortality rates being 84.3% and 3.5%, respectively; there was a significant difference in mortality between the two subgroups ( χ2= 72. 2, P < 0. 001) . Conclusion This scoring system is simple, sensitive, and objective to evaluate the severity of HBV-ACLF.

Objective To assess the predictive value of Glasgow Prognostic Score ( GPS) system for mortality in patients with acute-on-chronic liver failure associated with hepatitis B ( HBV-ACLF) . Methods The clinical data of 437 patients who were diagnosed with HBV-ACLF and admitted to the Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical University, from April 2008 to April 2012 were retrospectively evaluated. Patients were grouped according to their GPS scores, and the mortality rates were compared between GPS groups. Continuous data in normal distribution were compared by t test between two groups and by F-test between three or more groups. Comparison of categorical data was made by chi-square test. COX proportional hazards regression was performed to identify clinical variables associated with overall survival during the follow-up period [30 ( 5-825) d]. Results The mortality rate of patients with HBV-ACLF was 68. 0% ( 297 cases) during the follow-up period. The group with higher GPS scores had significantly increased proportions of individuals with gastrointestinal bleeding, hepatic encephalopathy, and hepatorenal syndrome and higher Model of End-Stage Liver Disease scores ( P < 0. 05 across all variables) . COX proportional hazards regression analysis revealed the risk factors closely associated with the mortality of patients with HBV-ACLF, which included hepatic encephalopathy ( grade I-II vs absence of hepatic encephalopathy: hazard ratio, HR: 2. 520, 95% confidence interval, CI: 1. 479-4. 293, P = 0. 001; grade III-IV vs absence of hepatic encephalopathy: HR:3. 678, 95% CI: 1. 920-7. 047, P < 0. 001) , hepatorenal syndrome ( HR: 2. 374, 95% CI: 1. 452-3. 881, P = 0. 001) , gastrointestinal bleeding ( HR: 1. 616, 95% CI: 1. 153-2. 262, P = 0. 004) , antiviral therapy ( HR: 0. 668, 95% CI: 0. 518-0. 862, P = 0. 002) and the GPS ( 1 vs 0: HR: 2. 055, 95% CI: 1653-2. 702, P = 0. 001; 2 vs 0: HR: 4. 520, 95% CI: 3. 288-6. 932, P = 0. 007) . Conclusion The GPS system has a good predictive value for short-and long-term mortality in patients with HBV-ACLF. Elevated GPS is an independent risk factor for death in patients with chronic liver failure associated with hepatitis B.

Objective To investigate the relationship between estrogen receptor alpha ( ERα) gene polymorphism at position 29 and hepatitis B virus ( HBV) -related acute-on-chronic liver failure ( HBV-ACLF) and the genetic pathogenesis of HBV-ACLF. Methods A total of 61HBV-ACLF patients, 79 patients with chronic hepatitis B ( CHB) , and 69 patients who automatically recovered from HBV infection were included in the study. The ERα gene polymorphism at position 29 was analyzed by polymerase chain reaction-restriction fragment length polymorphism. The allele frequency was calculated by gene counting, and Hardy-Weinberg equilibrium test was performed. Confounding factors were adjusted by unconditional logistic regression analysis. Comparisons of genotype frequency and allele frequency were made by chi-square test ( R × C) . Results The frequencies of TT genotype and T allele of ERα gene at position 29 were significantly higher in HBV-ACLF patients than in CHB patients (55.7% vs 31.6%, χ2=8. 194, P =0. 004; 77. 1% vs 54. 4%, χ2=15. 341, P <0. 001) , and the risk of worsening in HBV infection patients with T allele was 2. 811 times that in HBV infection patient with C allele ( OR =2. 811, 95% CI: 1. 662-4. 753) . The frequencies of TT genotype and T allele of ERα gene at position 29 were significantly higher in HBV-ACLF patients than in patients who recovered from HBV infection ( 55. 7% vs11. 6%, χ2=28. 849, P <0. 001; 77. 1% vs 32. 6%, χ2=51. 401, P <0. 001) , and the risk of worsening in HBV infection patients with T allele was 6. 938 times that in patients with C allele ( OR =6. 938, 95% CI: 3. 995-12. 050) . Conclusion TT genotype and T allele of ERα gene at position 29 might be the susceptibility gene for HBV-ACLF.

Objective To investigate the risk factors for posthepatectomy liver failure ( PHLF) in patients with hepatocellular carcinoma ( HCC) and to provide a theoretical basis for the prediction and prevention of PHLF. Methods A meta-analysis was performed on the studies on risk factors for PHLF in HCC patients published in China from January 1990 to June 2013 by searching SinoMed, VIP, CNKI, and Wanfang Data and manual retrieval of related articles and references. Results A total of 11 studies involving 2859 patients treated with hepatectomy were included in the meta-analysis. The incidence of PHLF was significantly lower in Child-Pugh A patients than in the control group ( pooled OR = 6. 28, 95% CI: 4. 55-8. 65) . Patients with prealbumin levels less than 170 mg /dl had an increased incidence of PHLF ( pooled OR = 4. 96, 95% CI: 3. 03-8. 10) . Patients with cirrhosis had a higher incidence of PHLF than those without cirrhosis ( pooled OR = 4.14, 95%CI: 2.46-6.98) . Patients with an intraoperative blood loss less than 1000 ml had a lower incidence of PHLF than the control group ( pooled OR = 5. 62, 95% CI: 3. 46-9. 11) . The incidence of PHLF was lower in patients with a tumor diameter less than 10 cm and patients with an extent of resection less than hepatectomy than in the control group ( pooled OR = 2. 69, 95% CI: 1. 58-4. 57; pooled OR = 1. 64, 95% CI: 1. 12-2. 40) . Age ≥60 years and intraoperative blood transfusion increased the incidence of PHLF ( pooled OR = 1.73, 95% CI: 1.25-2.39; pooled OR = 3.79, 95% CI: 2.20-6.51) . Sex and hepatic inflow occlusion were not significantly associated with the development of PHLF ( P > 0. 05) Conclusion Advanced age, advanced preoperative Child-Pugh class, low prealbumin level, high intraoperative blood loss, large tumor diameter, large extent of hepatectomy, cirrhosis, and intraoperative blood transfusion are risk factors for the development of PHLF.

Objective To investigate the clinical efficacy of plasma exchange ( PE) in the treatment of liver failure. Methods A retrospective analysis was performed on the clinical data of patients with liver failure who were treated from January 2012 to June 2013 in our hospital. Thirty-three patients in PE group received PE in addition to medical comprehensive treatment, and 30 patients in control group were treated with medical comprehensive treatment. Clinical symptoms, complications, and the changes in biochemical markers of liver function were observed after 2 weeks of treatment, post-treatment outcomes were evaluated by 3-month followed-up, and the influential factors for efficacy were analyzed. Experimental data were expressed as mean ± standard deviation, continuous data were compared by t test, and categorical data were analyzed by chi-square test or Fisher's exact test. Results Symptoms such as fatigue, poor appetite, and abdominal distension were significantly relieved after PE. Post-treatment serum alanine aminotransferase ( ALT) and total bilirubin ( TBil) levels were significantly lower compared with pre-treatment levels ( 390. 48 ± 536. 52 U /L vs 81. 03 ± 47. 58 U /L and 479. 27 ± 130. 01 μmol /L vs244. 64 ± 151. 05 μmol /L, P < 0. 005) , whereas post-treatment levels of albumin ( Alb) and cholesterol ( CHO) and prothrombin activity ( PTA) were significantly higher than those measured before the treatment ( 33.06 ±5.42 g/L vs 35.24 ±3.68 g/L, 2.50 ±1.24 mmol/L vs 3. 59 ± 0. 86 mmol /L, and 34. 16% ± 5. 33% vs 73. 98% ± 27. 23%, P < 0. 005) . No significant differences were identified between pre-and post-treatment levels of ALT, TBil, Alb, CHO, and PTA ( P > 0. 05) . Patients in PE group had a significantly higher improvement rate ( χ2= 8. 276, P < 0. 005) and a significantly lower mortality rate ( χ2= 13. 258, P < 0. 005) compared with the control group. The efficacy of PE was found to be correlated with pre-treatment TBil level, complications, bilirubin enzyme separation, and age ≥40 years ( P <0.05) . TBil and bilirubin enzyme separation were independent risk factors affecting the efficacy of PE ( P <0.05, OR =1.01 and8. 75) . Adverse reactions occurred in 8 cases during PE treatment, and disappeared after symptomatic treatment. Conclusion PE is a safe and effective treatment for liver failure, and holds promise for clinical application. TBil level and bilirubin enzyme separation are independent risk factors affecting the efficacy of PE.

Objective To evaluate the clinical effect of artificial liver support system ( ALSS) on serum high-sensitivity C-reactive protein ( hs-CRP) level and investigate the influence of the change in hs-CRP level on clinical prognosis among patients with hepatic failure.Methods Patients were recruited into three groups: group one included 60 patients who received ALSS due to hepatic failure; group two included 37 patients with hepatic failure without ALSS treatment; and group three included 37 patients with chronic hepatitis B. The serum levels of hs-CRP were measured in groups two and three, and in group one before and after ALSS treatment. Comparison of continuous data between groups was made by t test, and comparison of categorical data was made by chi-square test. Results The levels of hs-CRP in group one before treatment and in groups two and three were 12. 89 ± 9. 39, 12. 22 ± 9. 73, and 2. 83 ± 6. 79, respectively. No significant difference in hs-CRP level between group one and group two was observed ( P > 0. 05) . However, the hs-CRP level in group three was significantly different from those in group one and group two ( P < 0. 001) . The improvement rate in group one after ALSS treatment ( 78.3%) was significantly higher compared with that in group two ( 54.05%) ( χ2= 6. 315, P < 0. 05) . ALSS treatment ( t = 5. 179, P <0. 05) . ALSS treatment was selectively effective in a subgroup of patients and greatly decreased the hs-CRP level in these patients ( t =5. 344, P = 0. 000) , resulting in a significant difference from the patients who were unresponsive to ALSS treatment ( t = 2. 368, P =0. 038) . Conclusion Artificial liver support system can decrease the hs-CRP level in patients with hepatic failure. Serum level of hs-CRP can be used as a clinical indicator of disease progression and predict the clinical outcomes of ALSS in patients with hepatic failure.

Objective To observe the changes in gastric emptying and distribution of cholinergic and nitrergic nerves in the myenteric plexus of the antrum of rats with liver failure. Methods Forty Wistar rats were randomly divided into control group and liver failure model group. The gastric emptying of rats was evaluated using Dextran blue 2000 as an indicator. The cholinergic and nitrergic nerves in the myenteric plexus of the antrum were observed by acetylcholinesterase and NADPH-d histochemical staining and whole-mount preparation of the myenteric plexus and were then quantitatively analyzed. Continuous data were expressed as mean ± SD, and comparison between groups was made by t test. Results Compared with the control group, the liver failure model group had significantly reduced gastric emptying ( 163. 00 ± 25. 68 vs 100. 00 ±18. 93, P < 0. 01) , a significantly reduced number of positive cholinergic neurons ( with significantly thinner fibers) in the myenteric plexus of the antrum ( t = 3. 201, P < 0. 01) , and a significantly increased number of positive nitrergic neurons and fibers ( t = 2. 912, P < 0. 01) . Conclusion For rats with liver failure, declining gastric function is associated with a reduced number of cholinergic nerves and an increased number of nitrergic nerves in the myenteric plexus of the antrum.

Objective To improve the hollow fiber bioreactor of artificial liver. Methods Rat hepatocytes mixed with collagen solution were injected into the external cavity of a hollow fiber reactor to construct a bioreactor of hepatocytes suspended in collagen gel ( group Ⅰ) .Other rat hepatocytes suspended in solution were injected into the external cavity of a hollow fiber reactor with a layer of collagen on the wall of the external cavity to construct a bioreactor of collagen layer and hepatocytes ( group Ⅱ) . For each group, the culture solution circulated through the internal cavity of the hollow fiber bioreactor; the bioreactor was put in a culture box for 9 d, and the culture solution in the internal cavity was exchanged for new one every 24 h; the concentrations of albumin ( Alb) , urea, and lactate dehydrogenase ( LDH) in the culture solution samples were measured to examine the hepatocyte function of the bioreactor. Statistical analysis was performed using SPSS13. 0. Continuous data were expressed as mean ± SD, and comparison between groups was made by paired t test. Results For groups Ⅰand Ⅱ, Alb levels reached peak values on day 3 of culture ( 1. 41 ± 0. 08 g /L and 0. 65 ± 0. 05 g /L) ; from day 3 to 9, group I had a significantly higher Alb level than group Ⅱ ( t > 7. 572, P < 0. 01) . For groups Ⅰ and Ⅱ, urea levels reached peak values on days 3 and 5 of culture ( 1. 73 ± 0. 14 mmol /L and 1. 56 ± 0. 18 mmol /L) ; from days 5 to 9, group I had a significantly higher urea level than group Ⅱ ( t> 8. 418, P < 0. 01) . For groups Ⅰ and Ⅱ, LDH levels reached peak values on day 9 of culture ( 32. 03 ± 9. 13 U /L and 70. 17 ± 25. 28 U / L) ; from days 1 to 9, group I had a significantly lower LDH level than group Ⅱ ( t > 5. 633, P < 0. 01) . Therefore, the bioreactor of hepatocytes suspended in collagen gel ( group Ⅰ) showed a better hepatocyte function and less hepatic enzyme leakage compared with the bioreactor of collagen layer and hepatocytes ( group Ⅱ) . Conclusion Hepatocytes suspended and immobilized in collagen gel might be more suitable for construction of a hollow fiber bioreactor of artificial liver.

Objective To evaluate the efficacy and safety of the combined therapy with entecavir ( ETV) and adefovir dipivoxil ( ADV) in patients with lamivudine ( LAM) -resistant chronic hepatitis B ( CHB) . Methods A total of 45 patients who were diagnosed with LAM-resistant CHB and admitted to the Kunshan People's Hospital from May 2011 to May 2013 were recruited in this study and randomly divided to two groups. The treatment group included 23 CHB patients who received the combined therapy with ETV and ADV. The control group included 22 CHB patients who received the combined therapy with LAM and ADV. The changes in levels of HBV DNA, alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , total bilirubin ( TBil) , albumin ( Alb) , and HBV serum markers before and after 4, 12, 24, and 48 weeks of treatment, as well as the rate of mutations other than that at rtM204 I after 48 weeks of treatment, were measured in both groups. Comparison of continuous data between groups was made by t test, and comparison of categorical data by fourfold table chi-square test. Results The levels of ALT and AST in the treatment group were significantly lower than those in the control group after 4 and 12 weeks of treatment ( t = 3. 124, 5. 271, 4. 476, 5. 125, all P < 0. 01) , as well as 24 and 48 weeks of treatment ( t = 2. 240, 2. 307, 2. 886, 2. 908, all P < 0. 05) . The serum HBV DNA clearance rates in the treatment group after 4, 12, 24, and 48 weeks of treatment were73. 9%, 86. 8%, 95. 7%, and 100%, respectively, all of which were significantly higher than those in the control group ( χ2= 11. 79, 5. 75, 10. 29, 5. 89, respectively, all P < 0. 05) . However, there was no significant difference in the HBeAg seroconversion rate among HBeAg-positive patients between the two groups. No mutations other than that at rtM204 I were found in the treatment group, while four new mutations were detected in the control group ( χ2= 4. 59, P < 0. 05) . Conclusion The combined therapy with ETV and ADV has good therapeutic effect in treating LAM-resistant CHB patients, and the clinical application is highly recommended.

Objective To compare the diagnostic performances of FibroScan ( FS) and B ultrasound for liver fibrosis and assess the relationship between the two methods. Methods The clinical data of 432 patients who were admitted to our institution between October 2012 and February 2014 were retrospectively analyzed. Of them, 305 had chronic hepatitis B virus infection, 96 had chronic hepatitis C virus infection, and 31 had primary biliary cirrhosis. FS values and parameters measured by B ultrasound including the thickness of left and right liver lobes, the diameter of the portal vein, spleen thickness, spleen length, the diameter of the splenic vein, and variables describing vascular morphology of the liver were recorded. Additionally, the incidence rates of ascites, fatty liver disease, gallbladder diseases, and liver cirrhosis were also reviewed. The correlations between FS value and the parameters were explored using the Spearman rank correlation test and multiple linear regression model. Patients were categorized based on FS values; parameters were compared between the groups by use of Kruskal-Wallis H test or Mann-Whitney U test. Results FS value was positively correlated with the thickness of left liver lobe, spleen thickness and length, the diameter of the portal vein, the diameter of the splenic vein, liver surface smoothness, parenchymal echo, vascular morphology, ascites ( presence or absence) , and liver cirrhosis ( presence or absence) ( rs= 0. 249-0. 543, P < 0. 05 for all) . Furthermore, positive correlations were also observed between these parameters and the stage of liver fibrosis as determined based on FS values ( rs= 0. 229-0. 541, P < 0. 05 for all) . Multiple linear regression analysis identified liver surface smoothness, thickness of the left liver lobe, ascites, and diameter of the portal vein as independent predictive factors for FS value ( t = 5. 123, 3. 703, 3. 113, and 2. 985, P <0. 05 for all) . FS values were 9. 573 ± 9. 490 kPa, 16. 339 ± 11. 359 kPa, and 27. 688 ± 18. 676 kPa in the three groups with liver echo enhancement, rough echo, and nodular echo, respectively; differences between the groups were significant ( χ2= 98. 469, P = 0. 000) .Conclusion There are reliable correlations between FS value and parameters measured by B ultrasound. The diagnostic performance of FibroScan for liver fibrosis is more accurate and objective than that of B ultrasound.

Objective To investigate the effects of hepatectomy without hepatic blood flow occlusion ( HBFO) on the liver function and postoperative recovery in patients with primary liver cancer. Methods Eighty patients with primary liver cancer who underwent hepatectomy in our hospital from June 2010 to June 2013 were divided into three groups: first porta hepatis control ( Pringle) group ( n = 24) , hemihepatic vascular control ( HVC) group ( n = 24) , and non-HBFO group ( n = 32) . The operation time, intraoperative blood loss, postoperative liver function, surgical complications, and postoperative length of hospital stay were compared between the three groups. Categorical data were analyzed by chi-square test, and continuous data were analyzed using ANOVA followed by Dunnett-t for multiple comparisons. Results There were no significant differences in the operation time and intraoperative blood loss between the three groups ( F = 2. 45 and 0. 34, P > 0. 05 for both) . The recovery of serum total bilirubin ( TBil) and alanine aminotransferase ( ALT) at 1 and 7 d after operation was significantly better in the non-HBFO group ( 1 d, TBil: 22. 4 ± 9. 4 μmol /L, ALT: 287. 4 ± 165. 7 U /L; 7 d, TBil: 17. 1 ± 6. 6 μmol /L, ALT: 86. 2 ± 54. 5 U /L) than in the Pringle group ( 1 d, TBil: 33. 5 ± 11. 9 μmol /L, ALT: 429. 5 ± 137. 8 U /L; 7 d, TBil: 24. 5 ± 7. 0 μmol /L, ALT: 145. 5 ± 43. 6 U /L) and HVC group ( 1d, TBil: 29. 1 ± 8. 3 μmol /L, ALT: 390. 2 ± 176. 6 U /L; 7d, TBil: 21. 5 ± 7. 5 μmol /L, ALT: 121. 5 ± 56. 8 U /L) ( P<0. 05 for all) . The recovery of serum albumin ( Alb) at 1 d after operation was significantly better in the non-HBFO group ( 29. 3 ± 2. 8 g /L) than in the Pringle group ( 27. 3 ± 3. 3 g /L) ( P < 0. 05) , but it showed no significant difference between the non-HBFO group and HVC group ( 29. 3 ± 2. 8 g /L vs 27. 8 ± 2. 5 g /L, P >0. 05) ; there were no significant differences in the recovery of serum Alb at 7 d after operation between the three groups ( P > 0. 05) . The postoperative length of hospital stay was significantly shorter in the non-HBFO group ( 10. 3 ± 2. 1d) than in the Pringle group ( 12. 7 ± 2. 6 d) and HVC group ( 12. 0 ± 2. 2 d) ( P < 0. 05) . Conclusion Compared with Pringle maneuver and HVC, non-HBFO would not increase the intraoperative blood loss and operation time and leads to milder liver function damage and more rapid postoperative recovery in patients with primary liver cancer undergoing hepatectomy.

Objective To explore the early diagnostic values of serum alpha-fetoprotein ( AFP) , gamma-glutamyltransferase Ⅱ ( GGTⅡ) , and Golgi protein 73 ( GP73) in patients with primary hepatocellular carcinoma ( PHC) . Methods The serum specimens of 100 patients with liver diseases ( 50 cases of hepatitis and liver cirrhosis and 50 cases of PHC) and 50 healthy people were collected in our hospital from February 2013 to February 2014. Electrochemical luminescence technique, specific immuno-membrane adsorption assay, and enzyme-linked immunosorbent assay were used to measure the serum levels of AFP, GGTⅡ, and GP73. Comparison of continuous data between multiple groups was made by analysis of variance, and comparison between two groups was made by q test. The receiver operating characteristic ( ROC) curves of single or combined test results were made, and the areas under the ROC curves ( AUCs) were calculated. The sensitivity, specificity, and AUCs of AFP, GGTⅡ, GP73, and the combined test were analyzed and compared. Results The level of serum GGTⅡ in the PHC group was significantly different compared with those in the other two groups ( F = 16. 224, P < 0. 05) , but there was no significant difference between the normal group and the hepatitis and liver cirrhosis group ( P > 0. 05) . Significant differences in serum levels of AFP and GP73 were observed by paired comparison between the PHC group, hepatitis and liver cirrhosis group, and normal group ( F =193. 128, F = 20. 231, P < 0. 05 for both) . When assayed alone, the specificities of GP73, GGTⅡ, and AFP were 69%, 64% and 51%, respectively, and the sensitivities were 92%, 84%, and 76%, respectively. In combined test, the specificity was 94. 6% and the sensitivity was 98. 8%. Conclusion The GP73 test is the best performer in the single assays. Combined test of serum AFP, GGTⅡ, and GP73 shows a good diagnostic value for PHC with greatly improved specificity and sensitivity.

Objective To investigate the clinical efficacy of puerarin combined with compound ammonium glycyrrhetate S in the treatment of alcoholic hepatitis. Methods A total of 92 patients with alcoholic hepatitis who were admitted to our hospital from February 2011 to February 2014 were recruited in this study and randomly divided into two groups. The control group ( n = 46) was treated with conventional therapy combined with compound ammonium glycyrrhetate S. The test group ( n = 46) was treated with puerarin in addition to the regimen used in the control group. After 20 days of treatment, the levels of total bilirubin ( TBil) , alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , glutamyl transpeptidase ( GGT) , albumin ( Alb) , Glasgow alcoholic hepatitis score ( GAHS) , and abdominal ultrasound were measured and compared with the results before the treatment in both groups. The clinical efficacy and adverse reactions in the two groups were also compared. Results After the treatment, the GAHSs and levels of TBil, ALT, AST, and GGT in the two groups were all significantly lower than those before the treatment ( all P < 0. 05) . In the test group after the treatment, the levels of TBil ( 20. 96 ± 6. 85μmol/L) , ALT ( 33. 72 ±14. 18 U/L) , and AST ( 38. 69 ±6. 38 U/L) were all significantly lower than those in the control group ( all P<0. 05) . The marked response rate, overall response rate, and rate of improvement in abdominal ultrasound in the test group were 63. 04%, 93. 48%, and 44. 44%, respectively, all significantly higher than those in the control group ( all P < 0. 05) . There was no significant difference in adverse reactions between the two groups ( P >0. 05) . Conclusion For patients with alcoholic hepatitis, the combined therapy with puerarin and compound ammonium glycyrrhetate S can improve the treatment outcome and protect the liver function, and it has high safety and holds promise for clinical application.

Objective To evaluate the mental disorders in mice with thioacetamide ( TAA) -induced acute hepatic encephalopathy ( AHE) .Methods Thirty male Kunming mice were equally and randomly divided into two groups ( treatment group and control group) . Mice in the treatment group received an intraperitoneal injection of TAA ( 200 mg·kg-1·d-1for 3 days, up to 600 mg·kg-1) , as compared with the same volume of physiological saline in the control group. Neurological function score, light /dark box, open field, and elevated plus-maze test were used to determine behavioral parameters at 24 h after the model was established. Serum ammonia, aspartate amino transferase ( AST) , alanine aminotransferase ( ALT) , and total bilirubin ( TBil) were measured at 24 h post determination of behavioral parameters. Comparison between two groups was made by independent-samples t test. Results In the light /dark box test, the treatment group had significantly reduced residence time in the light box and number of shuttles between two boxes ( t =-4. 006, P < 0. 01; t =-2. 656, P < 0. 05) ; in the open field test, the treatment group had significantly reduced central distance, central time, and number of vertical movements ( t =-3. 639, P < 0. 05;t =-2. 294, P < 0. 05; t =-2. 282, P < 0. 05) , as well as increased grooming time ( t = 5. 992, P < 0. 01) ; meanwhile, the number of open-arm entries and residence time in the open arm for the treatment group were also reduced in the elevated plus-maze test, as compared with the control group ( t =-3. 584, P < 0. 05; t =-3. 992, P < 0. 05) . However, the total distance in the open field test showed no significant difference between the two groups ( t =-0. 96, P > 0. 05) . Moreover, compared with the control group, the treatment group had significantly higher levels of serum ammonia ( t =-3. 168, P < 0. 05) , ALT ( t = 4. 316, P < 0. 05) , AST ( t =-2. 581, P < 0. 05) , and TBil ( t =-9. 127, P < 0. 01) . Conclusion Mice with AHE induced by an intraperitoneal injection of low-dose TAA have anxiety-related behaviors; the anxiety-related behaviors are not associated with reduced locomotor activities.

Liver failure progresses rapidly, and patients with this disease are usually in a critical condition. The medical treatment of liver failure has unsatisfactory results, leading to a high mortality. How to accurately judge the prognosis of patients with liver failure according to their clinical manifestations and laboratory test results is a very good guide for clinical treatment strategies and donor liver allocation. The prognostic models for liver failure, such as CTP score, MELD and its derivative scoring system, KCH criteria, SOFA score, APACHE scoring system, SMSVH score, Clichy criteria, and ANN, are reviewed. These models are used to guide the development of clinical treatment strategies and screen out patients eligible for liver transplantation. In addition, the prognostic values of these models for liver failure and their differences are evaluated.