The incidence of intrahepatic bile duct stones as primary cholelithiasis varies in different regions, though it decreases to some extent. Minimally invasive hepatectomy is the correct procedure for treating early intrahepatic bile duct stones. However, there are still many problems concerning the surgical treatment of end- stage liver disease caused by complex intrahepatic bile duct stones. The multidisciplinary mode should be recommended to provide comprehensive treatment, and studies on the prevention, etiology, and pathogenesis of intrahepatic bile duct stones should be strengthened, so as to improve the treatment of intrahepatic bile duct stones.

Nucleos (t) ide analogs (NAs) have been successfully used for treatment of chronic hepatitis B. Hepatitis B virus (HBV) replication is now recognized as the key driver of liver injury and disease progression, so the primary aim of treatment for chronic HBV infection is to maximize sustained suppression of HBV replication to undetectable levels. The long- term treatment has also been shown to achieve substantial histological improvement and regression of liver fibrosis or cirrhosis, and reduction of hepatocellular carcinoma. This paper has reviewed the necessity, clinical benefits, and the management of long- term treatment for chronic hepatitis B.

Objective To analyze the clinical characteristics and prognosis of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) in infants. Methods The clinical data of43 infants with NICCD in our hospital from July2011 to April2014 were collected. The diagnosis was confirmed by tandem mass spectrometry (MS- MS) analysis of blood, gas chromatography- mass spectrometry (GC- MS) analysis of urine, and genetic testing, and an analysis was performed with reference to clinical manifestations and laboratory results. Results Most patients with NICCD developed jaundice early, with a round, fat face, hepatomegaly, and growth retardation. Laboratory examinations showed increased bilirubin, total bile acids, blood lactic acid, alpha- fetoprotein, and procalcitonin in all patients, increased alanine aminotransferase, gamma- glutamyl transpeptidase, and blood ammonia, decreased albumin and blood glucose, and dyslipidemia and coagulation disorders in most patients, and abnormal liver fibrosis markers (20 /24) and low ceruloplasmin (17 /20) in some patients. Abdominal ultrasound showed hepatomegaly in 32 patients. MS- MS analysis of blood samples revealed distinctive elevation of methionine, citrulline, tyrosine, threonine, and a variety of acyl carnitine in most patients. GC- MS analysis of urine samples revealed elevated galactose and galactitol in 20 patients, elevated 4- hydroxyphenyllactic acid and 4- hydroxyphenylpyruvic acid in 10 patients, and no abnormalities in 6patients. Genetic testing revealed 851del4, 1638ins23, and IVS6 + 5G > A mutations, especially 851del4 mutation. After being treated by giving lactose- free diet, strengthening medium- chain fatty acid diet, protecting the liver, and relieving cholestasis, most patients had normalized indices 2 months later, 2 cases had liver cirrhosis, and 7 cases died. Conclusion The clinical manifestations of NICCD vary in children. MS- MS analysis of blood, GC- MS analysis of urine, and genetic testing should be performed early in children with clinically suspected NICCD to provide intervention in time.

Objective To investigate the incidence of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) in neonates with idiopathic neonatal cholestasis (INC) in Nanjing, China, SLC25A13 gene mutations in these neonates, and clinical features. Methods A total of 152 neonates with INC, who were admitted to the Affiliated Nanjing Children's Hospital of Nanjing Medical University from September 2009 to August 2013, underwent gene analysis for detecting SLC25A13 gene mutations. The neonates were divided into NICCD group, who had been diagnosed definitely, and INC group at a ratio of 1∶ 2, considering the age and gender. Several biochemical indices were compared between the two groups. Comparison of continuous data between the two groups was made by Mann- Whitney U test after Bonferroni correction. Results There were 21 confirmed cases of NICCD (21 /152, 13. 82%) among the 152 neonates with INC; five types of SLC25A13 mutations were identified in the 21 neonates with NICCD, including 851_854del (27 /42, 64. 29%) , IVS6 + 5 G→A (7 /42, 16. 67%) , 1638ins23 (5 /42, 11. 90%) , IVS11 + 1 G→A (2 /42, 4. 76%) , and Q259X (1 /42, 2. 38%) . The alanine aminotransferase (ALT) level, aspartate aminotransferase (AST) level, bile acid concentration, albumin level, fasting blood glucose, blood ammonia, and prothrombin time for the NICCD group were 39. 42 ± 23. 40 U /L, 124. 85 ± 92. 65 U /L, 142. 43 ± 24. 34 μmol /L, 30. 66 ± 2. 70 g /L, 2. 79 ±0. 54 mmol /L, 117. 57 ± 27. 88 μmol /L, and 14. 03 ± 2. 79 s, respectively, versus 136. 02 ± 113. 67 U /L, 226. 12 ± 129. 26 U /L, 80. 47 ±31. 53 μmol /L, 36. 87 ± 4. 96 g /L, 3. 14 ± 0. 45 mmol /L, 76. 43 ± 20. 80 μmol /L, and 11. 40 ± 1. 55 s for the INC group. The NICCD group had significantly lower ALT and AST levels than the INC group ( Z =- 5. 02, P = 0. 000; Z =- 3. 66, P = 0. 000) ; the NICCD group had a significantly higher bile acid concentration than the INC group ( Z =- 5. 58, P = 0. 000) ; the NICCD group had significantly lower albumin level and fasting blood glucose than the INC group ( Z =- 4. 52, P = 0. 000; Z =- 2. 56, P = 0. 010) ; the NICCD group had a significantly higher blood ammonia level than the INC group (Z =- 4. 75, P = 0. 000) ; the NICCD group had a significantly longer prothrombin time than the INC group (Z =- 4. 10, P = 0. 000) . Conclusion Citrin deficiency due to SLC25A13 gene mutations is an important cause of INC in Nanjing. The three most common mutations are 851_854del, IVS6 + 5 G > A, and 1638_1660dup23, which account for 92. 86% of the SLC25A13 gene mutations. More attention should be paid to clinical analysis and detection of SLC25A13 gene mutations to confirm the diagnosis of NICCD.

Objective To summarize the clinical application of laparoscopy combined with choledochoscopy for treatment of gallstones with common bile duct stones in primary hospitals. Methods The clinical data of 46 patients who were diagnosed as having gallstones with common bile duct stones and underwent laparoscopy combined with choledochoscopy from March 2010 to December 2013 were analyzed. Results All 46 patients successfully completed the combined minimally invasive procedure, and none was converted to open surgery. The mean operating time was 100 ± 20. 2 min. The mean length of hospital stay was 7. 0 ± 1. 4 days. The mean intraoperative blood loss was 77 ± 21 ml.Forty- one cases had laparoscopic T- tube drainage. Three cases had primary suture of the common bile duct. Two cases had stone extraction by choledochoscopy. No severe postoperative complications such as residual stones and bile leakage were observed. Conclusion The minimally invasive procedure of laparoscopy combined with choledochoscopy for treatment of gallstones and common bile duct stones has multiple advantages, including low risk, fast recovery, and high patient satisfaction. This application could be adopted in primary hospitals.

Objective To investigate the relationship between cholecystectomy and the subsequent occurrence of primary choledocholithiasis and to review the surgical treatment of primary choledocholithiasis. Methods The clinical data of 70 patients with forward common bile duct stones after cholecystectomy who were admitted to our hospital from January 2007 to December 2013 were retrospectively analyzed. Results All 70 patients underwent open surgery for removal of common bile duct stones, which were identified as bile pigment calculi. The postoperative complications included incisional wound infection (8 cases) and lung infection (5 cases) , and no severe complications as biliary leakage or hematobilia were observed. All patients fully recovered at the time of discharge. Eight cases of recurrent common bile duct stones were found and surgeries were performed 2. 5 to 4 years after the recurrence. All patients were cured by choledocholithotomy, common bile duct transection, and Roux- en- Y hepaticojejunostomy. Conclusion Primary choledocholithiasis is an age- related disease, not a long- term complication of cholecystectomy. If no bile duct injury occurs during the cholecystectomy, the incidence rate of primary choledocholithiasis will not be increased. Surgical treatment is required for primary choledocholithiasis. For the cases of choledochectasia with the diameter of common bile duct greater than 2. 5 cm or recurrent choledocholithiasis, the laparotomy with common bile duct transection and Roux- en- Y anastomosis is recommended.

Objective To investigate the value and clinical application of posterior- anterior cystohepatic triangle dissection in laparoscopic cholecystectomy (LC) . Methods The medical records of 250 patients who underwent LC were reviewed. The clinical data, including operating time, amount of bleeding, and surgical complications, were retrospectively analyzed. Results LC was successfully completed in 246 cases. The operating time ranged from 25 min to 120 min, with a mean of 42 min. The amount of bleeding ranged from 5 ml to 80 ml, with a mean of 20 ml. Two cases were converted to open surgery due to gastric carcinoma or cholecystocolonic fistula, and 2 cases underwent laparoscopic common bile duct exploration. There was no report of severe complications in the entire group, such as abdominal hemorrhage, bile leakage, and biliary stricture. Conclusion With proper identification of the anatomical structure, it is safe and feasible to perform LC by dissection of the posterior- anterior cystohepatic triangle, which effectively helps avoid hemorrhage and bile duct injury during operation.

Objective To investigate the advantage and safety of the concept of fast- track surgery (FTS) applied in perioperative patients with biliary calculi and liver cirrhosis. Methods Fifty- two patients undergoing operation for biliary calculi and liver cirrhosis from January2011 to September 2013 were included in this study. These patients were randomly divided into FTS group ( n = 30) and control group (n = 22) . Patients in the FTS group received perioperative care measures guided by FTS concept, while patients in the control group received traditional perioperative management measures. The intraoperative situation of patients, time to postoperative recovery of intestinal function, length of postoperative hospital stay, total medical expenses during hospitalization, and postoperative complications were compared between the two groups. Continuous data and categorical data were compared by t- test and χ2test, respectively. Results As compared with the control group, the FTS group had significantly time to postoperative recovery of intestinal function ( t = 2. 239, P = 0. 045) , a significantly shortened length of postoperative stay (t = 4. 246, P = 0. 038) , and significantly reduced total medical expenses during hospitalization (t = 3. 045, P = 0. 033) . No significant difference in postoperative complications was observed between the two groups (P >0. 05) . Conclusion The concept of FTS can be safely and effectively applied in perioperative patients with biliary calculi and liver cirrhosis, which can accelerate rehabilitation without increasing the risk of surgery.

Objective To explore the clinical characteristics and surgical indications of polypoid lesions of the gallbladder (PLG) . Methods The clinical data of 331 patients with PLG who underwent surgery in Department of General Surgery from August 2008 to December2013 were analyzed retrospectively. Comparison of ratios between two groups was analyzed by chi- square test. Results Among the 331 surgical cases, there were 13 cases with adenomatous polyps (3. 9%) and 318 cases with non- adenomatous polyps (96. 1%) . After comparing the clinical characteristics of the two groups, significant differences were observed in the following parameters: sex (χ2= 6. 2, P =0. 013) , age (≥40 / < 40) (χ2= 3. 90, P = 0. 048) , sizes of polyps (≥10 mm / < 10 mm) (χ2= 77. 4, P < 0. 000 1) , number of lesions (multiple /solitary) (χ2= 6. 2, P = 0. 013) , PLG basal width (≥6 mm / < 6 mm) ( χ2= 111. 8, P < 0. 000 1) , and presence or absence of concomitant calculi (χ2= 7. 5, P = 0. 006) . Conclusion Clinical symptom is considered an indication for surgery. For most of the gallbladder polyps, the risk of malignant transformation is extremely low. Other surgical indications for gallbladder excision include age≥40 years, single polyps measured ≥10 mm in diameter, polyp basal width ≥6 mm, recent rapid polyp growth, and tumor- associated factors such as polyps with calculi.

Objective To investigate the clinical effect of different nutritional therapies on the immune function of patients with malignant obstructive jaundice after percutaneous transhepatic cholangiodrainage (PTCD) . Methods A total of 50 patients with malignant obstructive jaundice who were admitted to our hospital from January 2009 to March 2013 were randomly divided into two groups according to the admission order. The patients in group A (n = 25) received enteral nutritional support after PTCD, and those in group B (n = 25) received total parenteral nutritional support after PTCD. Intra- group and inter- group comparisons were made in terms of jaundice clearance, nutritional indices, and body's immune function on preoperative day 1 and postoperative day 7; comparison between the two groups was made by t test.Results Among the 50 patients who underwent PTCD, 39 (78%) had good drainage, while 11 (22%) did not reach the expectation, of which, 5 (10%) were in group A and 6 (12%) in group B. In both groups, the nutritional indices on postoperative day 7 were significantly higher than those on preoperative day 1 (P < 0. 05) , but no significant difference in these indices was observed between group A and group B on postoperative day 7 (P > 0. 05) . The immune function of patients in both groups was significantly improved following PTCD and nutritional support (P < 0. 05) , but there was no significant difference between the two groups (P > 0. 05) . Although the same scheme of nutritional support was used, there were 11 patients who did not achieve the expected jaundice clearance after PTCD and had limited improvement in immune function compared with those who had complete jaundice clearance (all P < 0. 05) . Conclusion Jaundice clearance is closely related to PTCD in patients with malignant obstructive jaundice, but not markedly associated with the ways of nutritional support.

Objective To profile the types of bacteria in bile culture and study their antibiotic sensitivity pattern in patients with varying degrees of acute cholangitis and to provide data guidance for the prevention and treatment of bacterial infection. Methods The clinical data of230 patients with acute cholangitis who were admitted to our hospital from April 2010 to April 2014 were retrospectively analyzed. Classification of pathogenic bacteria and the antibiotic sensitivity test in bile cultures were performed using VITEK 2 Compact Biomerieux microbiological system. Results Within the 230 patients, 172 tested positive for biliary bacteria, and the positive rate was 74. 78% (172 /230) . There were 237 strains of pathogenic bacteria, including 135 strains of Gram- positive bacteria (56. 96%) , comprised mainly of Enterococcus and Staphylococcus aureus, 96 strains of Gram- negative bacteria (40. 51%) , comprised mainly of Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumonia, and 6 strains of fungi (2. 53%) , comprised mainly of yeast. Significant difference in the positive rate of bacteria was detected between patients with mild and severe cholangitis (χ2= 4. 58, P = 0. 028) . Gram- negative bacteria were the predominant isolates in patients with mild and moderate acute cholangitis, while multiple bacterial infection was more common in patients with severe cholangitis. Biliary bacteria had a higher rate of susceptibility to vancomycin, imipenem, and amikacin compared with other antibiotics.Conclusion Gram- positive bacteria are the predominant pathogens in acute cholangitis. Early detection, immediate intervention, and accurate drug susceptibility test should be implemented at regular intervals to direct effective clinical therapy.

Objective To analyze and study the implication of dynamic changes in plasma CD62 Pamong patients with obstructive jaundice and cholecystolithiasis. Methods A total of 58 patients diagnosed with choledocholithiasis and jaundice were included in the obstructive jaundice group, and 50 patients were in the cholecystolithiasis group. Peripheral venous blood was collected on preoperative day 3, on operative day, and on postoperative days 3, 6, 9, 12, 15, 18, and 21 in two groups, and the concentrations of plasma CD62 Pwere measured by ELISA. Comparison of continuous data between the two groups was made by t test. Results The concentrations of plasma CD62 Pfrom preoperative day 3 to postoperative day 18 were significantly higher in the obstructive jaundice group than in the cholecystolithiasis group ( P <0. 01 across all time points) . In the cholecystolithiasis group, the concentrations of plasma CD62 Psignificantly increased on operative day, and the increase continued and reached the peak on postoperative day 3, then followed by a decrease down to the preoperative level on postoperative day 9. In the obstructive jaundice group, the concentrations of plasma CD62 Preached the peak on postoperative day 9, followed by a gradual decrease down to the preoperative level on postoperative day 18 and to an even lower level (preoperative level of patients with cholecystolithiasis) on postoperative day 21. Conclusion Extrahepatic biliary obstruction may lead to endothelial cell injury and platelet activation, the condition of which is improved with the relief of obstruction. The surgery for obstructive jaundice may lead to much more endothelial cell injury and higher platelet activation than that for cholecystolithiasis.

Objective To investigate the effects of Jinyinlidanling (JYLDL) on gallbladder volume, rate of gallstone formation, and the expression of G protein- coupled bile acid receptor (TGR5) in guinea pigs. Methods Seventy- two female guinea pigs were randomly divided into treatment groups, normal control group, and model group, with 12 ones in each group. Guinea pigs in the treatment groups and model group were subcutaneously injected with lincomycin hydrochloride to build a cholelithiasis model, while the normal control group with the same volume of normal saline. The treatment groups were divided into four groups which were separately given aspirin and low-, medium-and high- dose JYLDL. At one hour after the last administration, the gallbladder of each guinea pig was resected to measure the gallbladder volume and calculate the rate of gallstone formation. HE staining was applied for microscopic observation, and positive cells (with expression of TGR5) were detected by immunohistochemistry. Comparison between multiple groups was made by one- way ANOVA, and comparison between two groups by LSD- t test; comparison of categorical data was made by chi- square test, and the significance level was adjusted when comparison was made between two groups; comparison of ranked data was made by Kruskal Wallis H test. Results The rate of gallstone formation in the model group was significantly higher than that in the control group (P = 0. 00) ; the rate of gallstone formation in the high- dose JYLDL group was lower than those of other groups. Typical inflammatory changes and infiltration of neutrophils were observed in the model group; the high- dose JYLDL group had the mildest inflammatory changes among treatment groups. The gallbladder volume of the model group was significantly bigger than that of the control group (P < 0. 01) , indicating that the cholelithiasis model was successfully established; the gallbladder volume of the high- dose JYLDL group was the smallest and those of the medium- dose JYLDL group and aspirin group were smaller, as compared with the model group ( P < 0. 01) . The expression of TGR5 in the gallbladder mucosa was significantly higher in the model group than in the normal control group (P = 0. 00) , while the high- dose JYLDL group had a significantly lower expression of TGR5 than the model group (P < 0. 01) . Conclusion The expression of TGR5 in the gallbladder mucosa is significantly increased in guinea pigs with cholelithiasis. JYLDL can reduce the positive rate of TGR5 expression in the gallbladder mucosa, the inflammation of the gallbladder, and the formation of gallstones among guinea pigs with cholelithiasis.

Objective To examine the occurrence and possible mechanism of hepatocyte apoptosis in acute biliary tract infection. Methods After adaptive feeding for seven days, 30 male rats were randomly divided into five groups (n = 6 each) , i. e., one control group injected with 0. 2 ml of saline through the common bile duct and four experimental groups injected with an equal volume of Escherichia coli cell suspension to build an acute biliary tract infection model. Animals of the control group were killed 6 h after injection of saline, and those of the four experimental groups were killed respectively at the time points of 6, 12, 24, and 48 h after injection of E. coli. Liver tissue specimens were taken from all the rats to prepare tissue sections. Pathological features were examined by hematoxylin- eosin staining and light microscopy. Hepatocyte apoptosis was examined by cell counting after TUNEL staining and calculation of the apoptotic index. The expression of apoptosis- related proteins (Bcl- 2 and Bax) was measured by immunohistochemistry. Data comparison between groups was performed by analysis of variance, and pairwise comparisons were further conducted using the LSD- t test and Dunnett's T3 test. Results Tissue specimens of the control groups had no significant pathological changes, while those of the experimental groups showed hepatocyte apoptosis.Compared with the control group, the four experimental groups had significantly greater values of apoptotic index (P < 0. 05) . Additionally, the values of apoptotic index in the 24 and 48 h experimental groups significantly increased over time compared with that of the 12 h experimental group (P < 0. 05) . Bax protein expression level significantly differed between the control group and the experimental groups ( P<0. showing="" a="" slight="" increasing="" trend="" over="" time="" in="" the="" latter="" four="" groups="" p="">0. 05) . Bcl- 2 protein expression level had no significant differences between the control group and the 6 or 12 h experimental groups (P > 0. 05) . Over time, however, significant differences were observed in Bcl- 2 expression level between the 12 h experimental group and the 24 or 48 h experimental group (P < 0. 05) . Conclusion Hepatocyte apoptosis occurs within a short time after acute biliary tract infection. It persists in the whole process of the infection, with increased expression of Bax (inducer of apoptosis) and decreased expression of Bcl- 2 (inhibitor of apoptosis) . The changes in the expression of apoptosis- related genes coincide with hepatocyte apoptosis, suggesting that hepatocyte apoptosis may be associated with Bax and Bcl-2 genes.

Objective To investigate the efficacy and safety of entecavir (ETV) combined with adefovir (ADV) in chronic hepatitis B (CHB) patients with high viral load. Methods Eighty CHB patients with high viral load who were admitted to our hospital from December2008 to December 2011 were equally and randomly divided into observation group and control group. The control group was given ETV, while the observation group was treated with ETV combined with ADV. HBV DNA load, HBsAg or HBeAg seroconversion, alanine aminotransferase (ALT) normalization, and adverse reactions before and after 3, 6, 12, and 24 months of treatment were evaluated. Comparison of continuous data between the two groups was made by independent- samples t test, and comparison of categorical data was made by chi- square test. Results Compared with the control group, the observation group had significantly lower HBV DNA load after 6, 12, and 24 months of treatment (3.7 ±0.3 vs3.4 ±0.4 log copies/ml, t =3.339, P<0.05;2.9 ±0.4 vs2.6 ±0.3 log copies/ml, t =5.657, P <0.05;1.6 ±0.7 vs1.2 ±0. 4 log copies /ml, t = 2. 806, P < 0. 05) . The HBV DNA clearance rate and HBeAg clearance rate in observation group were significantly higher than those in control group after 12 months of treatment (87. 5% vs 70. 0%, P < 0. 05; 80. 0% vs 55. 0%, P < 0. 05) and 24 months of treatment (95. 0% vs 77. 5%, P < 0. 05; 90. 0% vs 70. 0%, P < 0. 05) . The observation group had significantly higher HBeAg seroconversion rate and ALT normalization rate than the control group after 24 months of treatment (77. 5% vs 50. 0%, P < 0. 05; 82. 5% vs 55. 0% P <0. .="" during="" the="" there="" was="" no="" significant="" difference="" in="" incidence="" of="" adverse="" reactions="" between="" two="" groups="" p="">0. 05) , but the observation group had a significantly lower viral breakthrough rate than the control group (0 vs 10. 0%, P < 0. 05) . Conclusion For CHB patients with high viral load, ETV combined with ADV has strong antiviral activity, reduces drug resistance and poor response, and shows better long- term clinical efficacy than ETV alone, suggesting that it is a safe and reliable therapy.

Objective To investigate the factors related to negative conversion of HBsAg in patients with acute hepatitis B (AHB) . Methods A total of 106 AHB patients who were admitted to the Department of Infectious Diseases, Zhoukou Central Hospital from February 2007 to February 2013 were recruited. Liver function, five serological markers of HBV infection (HBsAg, HBeAg, anti- HBs, anti- HBe, and anti- HBc) , and HBV- DNA were measured every three months. All patients were followed up for 12 months. The major HBV genotypes (A through D) were determined by type-specific primer nested PCR. Categorical data were expressed as rates and compared with χ2test;continuous data were expressed as mean ± SD and analyzed by t- test. Results When just admitted to our hospital, compared with the patients with negative conversion of HBsAg, AHB patients with HBsAg persisting for more than 6 or 12 months had a significantly lower peak level of alanine aminotransferase (ALT) (718 ± 696 vs 1282 ± 913 U /L, 622 ± 514 vs 1203 ± 924 U /L, P < 0. 05) and a significantly higher level of HBV- DNA (6. 8 ± 1. 4 vs 5. 2 ± 1. 5 log10 copies /ml, 7. 3 ± 1. 6 vs 5. 4 ± 1. 5 log10 copies /ml, P < 0. 05) . The HBsAg clearance rate in patients with HBV genotype A was significantly lower than that in patients with HBV genotype B or D (75. 0% vs 89. 5% or100%, 83. 3% vs 97. 4% or 100%, P < 0. 05) . Conclusion The HBsAg clearance rate in AHB patients may be associated with HBV genotypes, peak level of ALT, and HBV- DNA.

Objective To observe the prognostic impact of portal vein immunochemotherapy in patients after resection of primary hepatocellular carcinoma (HCC) . Methods A retrospective analysis was performed on the clinical data of 48 patients who received portal vein immunochemotherapy after resection of primary HCC (immunochemotherapy group) and 59 patients who did not receive portal vein immunochemotherapy after resection of primary HCC (control group) . Continuous data were analyzed by two- sample t- test; rates were compared withχ2test. Survival analysis was performed by the Kaplan- Meirer method for calculating the mean survival time; the survival differences between the two groups were analyzed with the log- rank test. The prognostic factors in all the 107 patients were analyzed using a multivariate Cox regression model. Results The 1-, 2-, and 3- year disease- free survival (DFS) rates of the immunochemotherapy group and control group were 87. 5% (42 /48) vs 67. 8% (40 /59) (χ2= 5. 739, P = 0. 017) , 52. 1% (25 /48) vs 32. 2% (19 /59) (χ2= 4. 320, P =0. 038) , and 16. 7% (8 /48) vs 10. 2% (6 /59) (χ2= 0. 982, P = 0. 322) , respectively, and the mean survival time of the two groups was32. 4 ± 2. 3 months vs 24. 7 ± 2. 3 months (χ2= 4. 044, P = 0. 044) . Among the cases complicated by portal vein tumor thrombosis, those receiving postoperative portal vein immunochemotherapy had a mean survival time of 12. 4 ± 1. 3 months, versus 4. 8 ± 0. 4 months for those not receiving postoperative portal vein immunochemotherapy (χ2= 15. 535, P < 0. 001) . Cox regression analysis revealed that pathological differentiation, tumor size, liver function grade, and portal vein tumor thrombus were independent prognostic factors for the recurrence in patients after resection of primary HCC. Whether to receive portal vein immunochemotherapy is related to postoperative recurrence time (P < 0. 001) .Conclusion Portal vein immunochemotherapy could improve the DFS rate and survival time in patients after resection of primary HCC.

Objective To investigate the clinical characteristics, etiology, and prognosis of hypoxic hepatitis (HH) . Methods The medical records of 68 patients with HH admitted to our hospital from January 2002 to December 2012 were collected and reviewed. The common causes of HH were analyzed. The patients were divided into groups of survival and death according to the clinical outcomes. The age, sex, and the Sequential Organ Failure Assessment (SOFA) score on admission were compared between groups. The clinical and laboratory data, including bilirubin (Bil) , alkaline ( ALP) , gamma- glutamyl transpeptidase ( GGT) , international normalized ratio ( INR) , lactate dehydrogenase (LDH) , alanine aminotransferase (ALT) , and blood urea nitrogen (BUN) , were monitored, and the peak of each parameter was compared between groups. Normally distributed continuous data were compared between the two groups using Student's t- test, and non- normally distributed continuous data were compared using rank sum test. Results The common causes of HH included heart failure (acute myocardial infarction and congestive heart failure) , respiratory failure, septic shock, heat shock, and severe allergic reactions to bee sting. Sharply increasing levels of serum ALT and AST were observed in all patients. The 28- day in- hospital mortality rate was 33. 8%. Significant differences between two groups were observed in age of admission (P < 0. 001) , SOFA value (P < 0. 001) , and peak levels of Bil (P < 0. 001) , ALP (P <0. 001) , GGT (P = 0. 001) , INR (P < 0. 001) , LDH (P < 0. 001) , ALT (P = 0. 013) , and BUN (P < 0. 001) . The treatments of HH mainly targeted the primary disease, while adjuvant therapies such as nutritional support and liver protection were also needed. Conclusion The prognosis of HH is poor and the mortality rate is high. The major cause of death is cardiogenic shock, followed by septic shock and acute myocardial infarction. Protecting vital organs from injury and preventing infection play important roles in improving the prognosis.

Objective To analyze the diagnostic values of contrast- enhanced ultrasound (CEUS) and time- intensity curve (TIC) for alpha- fetoprotein (AFP) - negative hepatocellular carcinoma ( HCC) , AFP- positive HCC, and hepatic hemangioma. Methods Patients with a confirmed diagnosis from October 2012 to October 2013 were divided into AFP- negative HCC group (24 patients) , APP- positive HCC group (48 patients) , and hepatic hemangioma group (76 patients) . Routine ultrasound, CEUS, and TIC analysis were performed on the three groups. CEUS findings and TIC indices of the three groups were compared using χ2test and independent- samples t test, respectively. Results There were significant differences in the CEUS findings during arterial and parenchymal phases between the AFP- negative HCC group and hemangioma group (χ2= 39. 4, P = 0. 001; χ2= 78. 9, P = 0. 001) , as well as between the AFP- positive HCC group and hemangioma group (χ2= 50. 6, P = 0. 001; χ2= 89. 7, P = 0. 001) , but no significant differences were observed in the CEUS findings during the same two phases between the AFP- negative HCC and AFP- positive HCC group (χ2= 0. 036, P = 0. 85; χ2= 0. 22, P = 0. 643) .The time to peak (TP) , peak intensity, area under the ROC curve (AUC) , and mean transit time (MTT) for the AFP- negative HCC group were 27. 52 ± 4. 11 s, 49. 52% ± 4. 31%, 1527. 20 ± 80. 37% s, and 78. 71 ± 3. 26 s, respectively, versus 28. 28 ± 4. 09 s, 50. 20% ± 4. 37%, 1725. 08 ± 78. 46% s, and 79. 21 ± 3. 32 s, respectively, for the AFP- positive HCC group, as well as 50. 42 ± 5. 32 s, 47. 83% ± 4. 29%, 1613. 44 ± 76. 37% s, and 79. 86 ± 3. 10 s, respectively, for the hemangioma group; there were significant ofifferences in TP among the three groups (F = 568. 63, P = 0. 001) , there were no significant differences in peak intensity, AUC and MTT among the three groups ( F =0. 245, 0. 645, 0. 860, P > 0. 05) . there were significant differences in TP between the AFP- negative HCC group and hemangioma group (P= 0. 001) , as well as between the AFP- positive HCC group and hemangioma group (P =0. 001) , but no significant difference in TP was observed between the AFP- negative HCC group and AFP- positive HCC group. Conclusion AFP- negative HCC ( or AFP- positive HCC) and hepatic hemangioma can be diagnosed differentially by CEUS findings and TP. A combination of the two examinations can improve the diagnostic value for benign and malignant liver lesions and increase the detection rate of AFP- negative HCC.

Objective To summarize the experience in the treatment of severe interstitial pneumonia after liver transplantation. Methods A retrospective analysis was made on the clinical data of 8 cases of severe interstitial pneumonia after liver transplantation who were diagnosed and treated from May 2008 to October 2013. Their processes of treatment and reasons for treatment success were analyzed. Results Eight patients appeared with interstitial pneumonia within 1- 3 months after liver transplantation; their first symptoms were fever, followed by progressive hypoxemia; chest X- ray showed significant interstitial pneumonia. After stopping immunosuppressants, using immunostimulants, strengthening anti- infective therapy, respiratory support, controlling fluid intake, and nutritional support, the clinical symptoms of 8 patients were relieved, the chest radiograph returned to normal, and all patients were cured and discharged. Conclusion Severe interstitial pneumonia is a complication of liver transplantation, with severe illness status and rapid progression. If rescue is not timely, it has high mortality. Early diagnosis and stopping immunosuppressants, using immunostimulants, controlling liquid intake, and nutritional support are important factors to increase the cure rate.