With the improvement in health economics and wide application of vaccines,the incidence of viral hepatitis decreases dramatically; however,the proportion of non- infectious liver diseases,such as nonalcoholic fatty liver disease,hereditary liver disease,and autoimmune hepatitis,climbs up rapidly. This paper summarizes the development and current situation of the subspecialties of pediatric liver diseases. In recent years,the clinical and basic research on domestic pediatric liver diseases has made some progress through the application of new techniques,such as liver biopsy,bile acid spectrum analysis,screening for inherited metabolic diseases,and genetic diagnosis. However,Chinese pediatricians are confronting new challenges from growing knowledge on liver diseases,expanding disease spectrum,and increasing demand for liver transplant. However,there is an urgent need to enhance the development of the subspecialty of pediatric hepatology in China,because most Chinese pediatricians have little knowledge of liver diseases,and there is a severe shortage of specialized medical staff for pediatric liver diseases.

For children with chronic hepatitis B( CHB),the antiviral therapy should be started in the immune active phase. There are two categories of antiviral drugs used for CHB: interferons( IFNs) and nucleos( t) ide analogues( NAs). In this paper,the current status of antiviral therapy of CHB in children is reviewed. It is pointed out that IFNs are the drug of first choice in antiviral therapy for children with CHB,and the individualized treatment and management of adverse events need to be considered. Some NAs can be given to those special children who cannot accept IFNs. However,there is a high risk of relapse after drug withdrawal. And the subsequent treatment will be seriously affected once the drug resistance is developed. It needs further investigation to improve the efficacy of antiviral therapy and reduce the adverse events and the drug resistance in the future.

In recent years,the incidence of idiosyncratic drug- induced liver injury( IDILI) has been increasing,posing a threat to human health. This article reviews the incidence,pathogenesis,and the principles of clinical diagnosis and treatment of IDILI. Because there is limited literature on IDILI in children,so this article simply describes the experience in the diagnosis and treatment of IDILI in children. It is considered that to reduce the incidence of IDILI in children,drug indications should be strictly followed,and molecular test and accurate medical treatment should be promoted.

Cholestatic hepatopathy is one of the most common diseases in infants including the newborn and it is one of the most significant reasons for infantile death and disability. There are a large number of causes and a large variance in prognosis of this disease. This paper introduces approaches to the diagnosis of biliary atresia and cholestatic hepatopathy and presents a synopsis of therapies for cholestatic hepatopathy in infants nowadays. This paper points out that in future,cooperation across disciplines should be enhanced; new technologies should be developed; academic communication should be held regularly; the early diagnosis and personalized medication of cholestatic hepatopathy in infants should be improved.

Intestinal microecology is an important and complex biological system essential to human health. Intestinal microecology and the liver are closely related in anatomical structure and function. Infantile cholestatic liver disease lead to abnormal bile secretion,abnormal excretion,and reduced bile release into the intestinal tract. As a result,the intestinal mucosa barrier is damaged and intestinal microecology changes; at the same time,pathogenic bacteria and endotoxin translocation cause liver injury and aggravate cholestasis. Therefore,a close relationship of intestinal microecology with infantile cholestatic liver disease can be found. In this article,the relationship of intestinal microecology with the development and progression of infantile cholestatic liver disease is illustrated and it is concluded that probiotics should be given as a supplement when infantile cholestatic liver disease occurs,because it promotes bile secretion,blocks intestinal inflammatory reactions,and improves prognosis of the disease. It is recommended to provide microecological agents routinely as a method to prevent and treat infantile cholestatic liver disease.

Biliary atresia is an important reason for neonatal jaundice,and it is also the primary cause of liver transplantation in children.Porto- jejunal anastomosis( Kasai procedure) is an effective method for treating biliary atresia. In this article,the complications after Kasai procedure and long- term outcome were introduced. It is emphasized that the Kasai procedure is the first choice for biliary atresia patients.In addition,this article analyzes the possible influencing factors for surgical outcome,describes the possible problems regarding the long-term survival of autologous liver after the operation for biliary atresia,and proposes the need for more attention to the comprehensive treatment after Kasai procedure and before liver transplantation.

Elevation of aminotransferase could be seen in children with various diseases. Early diagnosis and etiological treatment could improve the prognosis of some diseases and reduce liver injury,so early diagnosis plays a crucial role for treatment. In this paper,diagnosis and differential diagnosis of the diseases which have the elevation of aminotransferase in children are briefly induced in order to improve pediatricians' understanding of elevated aminotransferase in children.

Objective To analyze the correlation between malnutrition and prognosis in Uyghur pediatric patients with hepatitis A in Hetian of Xinjiang Uyghur Autonomous Region,China. Methods The clinical data of 342 children with hepatitis A admitted to the Infectious Disease Hospital of Hetian from January 2014 to May 2015 were retrospectively analyzed and the patients were divided into malnutrition group with 136 patients and normal nutrition group with 206 patients according to the Z- scores. The data of complete blood count,liver function test,biochemical indices,blood lipids,blood coagulation,and hospitalization days and costs were compared between the two groups. Comparison of categorical data between the two groups was made by chi- square test and comparison of continuous data between the two groups was made by t test. Results Compared with the normal nutrition group,the malnutrition group had significantly lower values of breastfeeding rate,hemoglobin,mean corpuscular volume,mean corpuscular hemoglobin,mean corpuscular hemoglobin concentration,serum iron,serum ferritin,glucose,serum albumin,and plasma thromboplastin antecedent but higher values of alanine transaminase,total bilirubin,total bile acid,cholesterol,and hospitalization days and costs( P < 0. 05). Conclusion Compared with the normal nutrition pediatric patients with hepatitis A,the malnutrition pediatric patients with hepatitis A have more severe iron deficiency anemia,hepatic damage,and abnormal metabolism of carbohydrates and fatty acids,so their recovery time is longer and the hospitalization costs are higher. To effectively protect Uygur children,hepatitis A vaccination in due course and the children's growth and development monitoring are recommended.

Objective To study the blocking effects of different concentrations of hepatitis B vaccine( Hep B) combined with hepatitis B immune globulin( HBIG) on mother- to- infant transmission of hepatitis B virus( HBV) and the influencing factors for mother- to- infant transmission of HBV. Methods A total of 785 pregnant women with hepatitis B and their infants who received interruption of mother- to-infant transmission of HBV in our hospital from July 2012 to February 2015 were enrolled as subjects. According to the results of prenatal examination of serum HBV markers in pregnant women,blocking regimens with different doses were made for infants born to HBs Ag- positive /HBe Ag- negative and HBs Ag- positive / HBe Ag- positive mothers,who received 10 μg and 20 μg Hep B,respectively,combined with 100 IU HBIG by injection within 2 hours after birth,and were vaccinated with Hep B again at 1 and 6 months after birth. A long- term follow-up was performed in pregnant women and infants,and the venous blood of infants was collected at 7 and 12 months after birth for evaluation of serum HBV markers. Results In the 785 infants,none of the infants born to the 529 HBs Ag- positive / HBe Ag- negative mothers were infected,suggesting a blocking rate of 100%,while 14 out of 256 infants born to HBs Ag- positive / HBe Ag- positive mothers were infected,yielding a blocking rate of 94. 53%. The positive HBe Ag and a HBV DNA level higher than 108 IU / ml were significantly correlated with blocking failure( P < 0. 001),while other factors including childbirth and feeding methods were not found correlated with blocking failure in this study. The investigation of intervention for compliance revealed that infants who were not given timely or full- dose injection for the first vaccination were more likely to be infected. Further logistic regression analysis showed that the incidence of mother- to- infant transmission of HBV was higher in infants born to mothers with a HBV DNA level higher than 108 IU / ml,infants who were not given timely or full- dose injection for the first vaccination,and male infants. Conclusion Combination vaccination can effectively increase the blocking rate of mother- to- infant transmission of HBV in infants born to HBs Ag- positive mothers. The infection status of mother,viral load,and first vaccination are key factors for blocking mother- to- infant transmission of HBV.

Objective To investigate the clinical characteristics and outcomes of drug- induced liver injury( DILI) in children,and to improve the understanding of DILI in children. Methods One hundred and eighty- four children with DILI who were under 16 years and hospitalized in our hospital from January 2004 to January 2014 were enrolled as subjects,and their clinical and pathological data were retrospectively analyzed. Results DILI might occur at any age in children,even at the infant stage,and the youngest patient was only 2 months old.There were 143 patients( 77. 7%) with clinical symptoms,including loss of appetite,jaundice,and yellow urine. The drugs causing DILI included traditional Chinese medicine( 28. 3%),antibiotics( 24. 5%),and anti- inflammatory drugs( 19. 6%). The pathological characteristics of DILI in children included eosinophils- based inflammatory cell infiltration( 78. 7%),mixed hepatic steatosis( 73. 5%),and cholangiolar cholestasis( 38. 7%). Four patients( 2. 2%) developed autoimmune hepatitis; twenty- nine patients( 15. 8%) had liver failure,and three of them died of liver failure. After treatment,177 patients( 96. 2%) recovered normal liver function and were discharged.Conclusion DILI may occur at any age in children,and a majority of drugs causing DILI are traditional Chinese medicine,antibiotics,and anti- inflammatory drugs. The pathological examination of liver provides an important basis for the diagnosis of DILI in children. In spite of the benign prognosis in most patients,the incidence of liver failure still needs to be taken into account,and regular follow- up is necessary.

Objective To provide a scientific basis for the prevention and early intervention of obesity and nonalcoholic fatty liver disease( NAFLD) in adolescents. Methods Anthropometric measurements,liver function test,and abdominal ultrasonography were performed in adolescents who received physical examination in our hospital from March to April,2012. Between- group comparison of continuous data was made by t test,and between- group comparison of categorical data was made by χ2test. The further multivariate analysis was performed by logistic regression analysis. Results A total of 4141 adolescents,including 2061 girls and 2080 boys,were enrolled in the study with an average age of 18. 62 ± 0. 66 years. Boys had significantly higher overweight and obesity rates than girls( χ2= 49. 5,P < 0. 01; χ2= 20. 4,P< 0. 01). The overall incidence of NAFLD in subjects was 8. 1%( 335 /4141),while the incidence of NAFLD in boys was significantly higher than that in girls( 13. 4% vs 2. 8%,χ2= 156. 4,P < 0. 01). The detection rate of NAFLD was the highest in obese subjects,followed by subjects with high body mass index( BMI) and subjects with normal BMI. Moreover,obese boys had a significantly higher detection rate of NAFLD than obese girls( 71. 6% vs 29. 0%,χ2= 56. 5,P < 0. 01). Among both boys and girls,BMI,body mass,alanine aminotransferase level,and aspartate aminotransferase level were significantly higher in the NAFLD group than in the non- NAFLD group( all P< 0. 05). Logistic regression analysis revealed that body mass and BMI were likely to be independent risk factors for NAFLD. Conclusion The prevalence of obesity and NAFLD in adolescents in Xi'an is not optimistic. For obese adolescents,healthy lifestyle,body mass control,and BMI reduction are important approaches for prevention of NAFLD.

Objective To investigate the significances of clinical diagnostic approaches to biliary atresia( BA) and intrahepatic cholestasis( IHC) in children,and to improve clinicians' understanding of BA and reduce the rates of missed diagnosis and false diagnosis. Methods A total of 133 children diagnosed with cholestasis with persistent jaundice admitted to our department from July 2011 to June 2014 were divided into IHC group with 111 patients and BA group with 22 patients. The general clinical trial data were reviewed and analysed and the significances of clinical manifestations,laboratory examination,and imaging features for differential diagnosis of BA and IHC were evaluated. Comparison of continuous data between the two groups was made by t test and comparison of categorical data between the two groups was made by chi- square test. When the sample characteristics for chi- square test were not suitable,the comparison was made by Fisher's test.Results Significant differences in clinical manifestations of kaolin stools and enlarged and hardened liver and spleen were observed between the two groups( P < 0. 01). Total bilirubin( TB),direct bilirubin( DB),gamma GGT( γ- GT),alanine aminotransferase( ALT),and aspartate aminotransferase( AST) levels in BA group were significantly higher than those in IHC group( P < 0. 01). The specificity,positive predictive value,and positive likelihood ratio of γ- GT were the highest among them,while TB had the highest sensitivity,the highest negative predictive value,and the lowest negative likelihood ratio. The sensitivity and negative predictive value of TB,DB,and γ- GT in the parallel experiment reached 100%. The specificity and positive predictive value of them in the serial experiment were 98% and 88. 9%,respectively. There were significant differences in the hepatic portal fibrous mass and gallbladder hypokinesia detected with ultrasonography of the liver,gallbladder,and spleen and in magnetic resonance cholangiopancreatography( MRCP) features between the two groups( P <0. 01). The specificity and positive predictive values of them in serial experiment reached 100%. Conclusion Kaolin stools,enlarged and hardened liver and spleen,TB,DB,γ- GT,ultrasonography,and MRCP of the liver and gallbladder are important indices to distinguish between BA and IHC and a combined analysis of them can improve the diagnostic accuracy.

Objective To investigate the value of tandem mass spectrometry( MS / MS) in the etiological diagnosis of cholestasis in infants.Methods A total of 153 infants with cholestasis who visited the Department of Pediatrics,Shengjing Hospital,China Medical University,from January 2013 to March 2015 were studied. All of them underwent blood and urine examinations by MS / MS. The patients' medical history and physical examination characteristics were recorded. Clinical examination results in biochemistry,etiology,and imageology were analyzed. Blood test and urine test were carried out by high- performance liquid chromatography- tandem mass spectrometry( HPLC- MS /MS) and gas chromatography- mass spectrometry( GC- MS),respectively. For the patients with abnormal blood or urine MS / MS results,potential pathogenic genes were determined. Comparison of continuous data was made by non- parametric Mann- Whitney U test and comparison of categorical data was made by chi- square test. Results Among the 153 infants with cholestasis,19( 12. 4%) had abnormal blood or urine MS / MS results. According to clinical data and gene analysis,15 infants among them were diagnosed with neonatal intrahepatic cholestasis caused by citrin deficiency,2 infants with tyrosinemia,1 infant with methioninemia,and another 1 infant with propionic acidemia. Compared with the normal MS / MS group of infants,the abnormal MS / MS group had significantly longer jaundice duration( Z =-2. 227,P < 0. 05) and significantly higher levels of alkaline phosphatase,gamma- glutamyl transferase,and total bile acids( 830. 0 vs523. 0 U / L,Z =- 3. 185,P < 0. 05; 215. 0 vs 160. 0 U / L,Z =- 2. 130,P < 0. 05; 174. 8 vs 125. 7 μmol / L,Z =- 2. 351,P < 0. 05). Significant differences were also found in prothrombin time and activated partial thromboplastin time( Z =- 4. 300,P < 0. 001; Z =- 3. 526,P <0. 001).Cytomegalovirus was detected in 58. 8%( 90 /153) of all patients and in 78. 9%( 15 /19) of patients with abnormal MS / MS results. Conclusions Given the non- specificity of clinical manifestations and biochemical examinations for infantile cholestasis of different causes,MS / MS can be used as the first choice of early screening method and plays an important role in the etiological diagnosis of cholestasis in infants,especially in the identification of cholestasis caused by genetic and metabolic disorders.

Objective To observe the clinical efficacy of artificial extracorporeal liver support therapy in the treatment of pediatric acute liver failure( PALF) and to analyze the associated prognostic factors. Methods The clinical records of 23 patients with PALF treated from January 2012 to February 2015 in the Pediatric Intensive Care Unit of the First Hospital of Jilin University were analyzed retrospectively. After three- month follow- up,15 patients survived( survival group,n = 15),while 8 patients died( death group,n = 8). The changes in biomarkers of liver function and coagulation function after treatment were evaluated within groups. At the same time,the above parameters and Model for End- Stage Liver Disease( MELD) score before treatment were compared between the two groups. The efficacy of artificial extracorporeal liver support therapy was analyzed,and the prognostic factors were reviewed. The t test was applied in the comparison of continuous data. Results In the survival group,the levels of serum alanine aminotransferase( ALT),total bilirubin( TBil),ammonia,and lactic acid were significantly reduced after treatment( t = 8. 812,6. 243,8. 431,and 6. 721,respectively; all P < 0. 01). However,in the death group,only ALT level was significantly reduced after treatment( t = 2. 532,P < 0. 05). Compared with the levels before treatment,the levels of prothrombin time( PT),prothrombin time activity( PTA),and international normalized ratio( INR) were significantly improved after treatment( t = 6. 256,- 2. 738,and 6. 711,respectively; all P < 0. 05). Before treatment,compared with the survival group,patients in the death group presented significantly lower level of ALT( t = 6. 283,P < 0. 01),significantly higher level of TBil( t =- 3. 938,P = 0. 001),significantly longer PT( t =- 2. 394,P = 0. 026),and significantly higher MELD score( t =- 6. 239,P < 0. 01). Conclusion Artificial extracorporeal liver support therapy is an effective way of treating PALF. Once patients with high ALT level,short PT,and high MELD score have been diagnosed with PALF,artificial extracorporeal liver support therapy should be applied as soon as possible to improve the survival rate. Bile enzyme separation,prothrombin time,and MELD score could assist in determining the prognosis of PALF.

Objective To explore the influencing factors for chronic hepatitis C( CHC) with thyroid dysfunction( TD) in untreated Chinese patients and provide evidence for clinical individualized treatment. Methods One thousand and twelve untreated CHC patients were collected nationwide in China. Thyroid function and associated influencing factors( region,age,gender,and hepatitis C virus( HCV) RNA replication level) in the patients were investigated. The relationships between the influencing factors and CHC with TD were analyzed. Between- group comparison of categorical data was performed by χ2test and Fisher' s exact test. Results There were geographical differences between different types of CHC with TD. Across different regions,the incidence of TD was highest in north and northwest China,i. e.,28. 3%and 26. 5%,respectively. Subclinical hypothyroidism was the most common type of TD,accounting for 58. 8% of the total TD cases. Middle- aged patients were most common among the cases of CHC with TD( 44. 0%),who had a significantly higher incidence of hypothyroidism than other age groups( χ2= 10. 10、6. 17,P = 0. 001、0. 013). Females with CHC had a significantly higher incidence of TD than male patients( 58. 9% vs. 41. 1%,χ2= 13. 1,P = 0. 00). Although a high HCV RNA replication level was most common in Chinese patients with CHC,this factor had little influence on TD. Conclusion In China,CHC with TD is influenced by geographic distribution,gender,and age,but less associated with HCV RNA replication level.

Objective To preliminarily investigate the relationship between the chronic hepatitis C virus( HCV) genotypes,2a and 1b,and thyroid hormone levels and autoantibodies. Methods In patients who were admitted to our hospital and diagnosed with chronic hepatitis C from October 2013 to December 2014,reverse transcription- polymerase chain reaction was performed to determine the HCV genotype. A total of 196 patients with HCV genotype 2a or 1b were enrolled as subjects. The levels of thyroid hormone and thyroid autoantibodies were determined by chemiluminescence immunoassay,and the relationship between the HCV genotype and thyroid function was analyzed. Between- group comparison of continuous data was performed by t test,and the risk factors were evaluated by logistic regression analysis. Results In the 196 patients with hepatitis C,57. 7%( n = 113) were infected with HCV- 2a,and 42. 3%( n = 83) were infected with HCV- 1b.There were no significant differences in levels of thyroid hormone and thyroid autoantibodies between patients with HCV- 2a and HCV- 1b( P > 0. 05). In the 92 patients who were treated with interferon,there were no significant differences in levels of thyroid hormone and thyroid autoantibodies between patients with HCV- 2a and HCV- 1b( P > 0. 05). Logistic regression analysis showed that the genotype classification was not a risk factor for abnormal thyroid autoantibodies( OR = 2. 012,P > 0. 05). Conclusion There is no intrinsic link between chronic HCV genotype classification and thyroid function. The genotype classification has no substantial effect on thyroid function.

Objective To assess the accuracy of indirect enzyme- linked immunosorbent assay( ELISA) for hepatitis C virus( HCV) antibody as a routine test in the blood center,discuss how to optimize the reporting process for HCV antibody,and protect donors' enthusiasm and precious blood resources. Methods A total of 116 samples were screened by two indirect anti- HCV ELISA kits available from Shanghai Kehua( reagent A) and Beijing Wantai( reagent B),respectively. Samples that yielded positive results or gray- zone results were further validated using a confirmation reagent to establish definitive results and compare confirmed positive results and the results with the two reagents for indirect ELISA. Differences in the ELISA results of the 116 samples between the two anti- HCV reagents were compared using the paired chi- square test and the agreement between the results with the two reagents were compared using the Kappa test. Results There were significant differences in the test results between the two reagents used for indirect ELISA( P = 0. 04),but the two reagents varied greatly from each other. The false positive rates of samples strongly or weakly positive with both reagents were 0 and 35. 7%,respectively;the false positive rates of samples positive with either reagent or samples with gray- zone results were 94. 3% and 100% for reagent A and84. 2% and 88. 9% for reagent B. Conclusion Reagents used for indirect ELISA have high false positive rates and poor specificity and considerable differences exist between homemade indirect reagents. The existing HCV reporting process should be modified. Weakly positive specimens should be further validated by a confirmatory test to protect blood donors' enthusiasm.

Objective To explore the serological characteristics of viral hepatitis patients with positive anti- mitochondrial antibody( AMA)- M2 and its clinical implications. Methods Serum was collected from viral hepatitis patients who were admitted to Beijing You'an Hospital,Capital Medical University,from January 2011 to December 2013. Serum AMA- M2 was measured by ELISA. A total of 102 viral hepatitis patients with positive AMA- M2 were screened out,including 53 patients with chronic hepatitis B( CHB),27 patients with chronic hepatitis C( CHC),5 patients with hepatitis E( HE),9 patients with CHB accompanied by primary biliary cirrhosis( PBC),and 7 patients with CHC accompanied by PBC. We also collected serum from 60 PBC patients as controls. Patients were grouped by the clinical diagnosis and analyzed retrospectively considering their serological characteristics. Comparison of continuous data was made by one- way ANOVA. Results Level of serum AMA- M2 was low and medium in the CHB,CHC,and HE groups and was significantly lower than those of the PBC group and CHB / PBC and CHC / PBC groups( all P < 0. 0001). Serum ALT and AST in the HE group were significantly higher than that in the PBC group( P < 0. 01). Serum gamma- glutamyl transpeptidase( GGT) levels in the CHB and CHC groups were significantly lower than that in the PBC group( both P < 0. 001),but did not show significant difference when compared with the CHB / PBC or CHC / PBC group( P > 0. 05). Serum alkaline phosphatase( ALP) and Ig M in the CHB group were significantly lower than those in the PBC group( P< 0. 000 1). Serum ALP and Ig M in the CHC group were significantly lower than those in the PBC group and CHC / PBC group( all P <0. 05). Serum Ig M in the HE group was significantly lower that that in the PBC group( P < 0. 01). Serum C3 level in the CHB group was significantly lower than those in the PBC group and CHB / PBC group( both P < 0. 05). Conclusion AMA- M2 is not restricted to PBC patients alone,and medium or low level of AMA- M2 can be seen in patients with viral hepatitis,which is not an autoimmune disease. Other serological markers such as ALP,GGT,Ig M,and C3 are helpful in diagnosing and differentiating PBC.

Objective To analyze the efficacy of endoscopic histoacryl injection in the treatment of gastric variceal bleeding caused by regional portal hypertension. Methods The endoscopic features and efficacy of endoscopic histoacryl injection were examined and compared in two groups of patients admitted to our hospital from June 2012 to December 2012. One of the groups included 6 patients with gastric variceal bleeding caused by regional portal hypertension and the other group included 6 patients with gastric variceal bleeding caused by hepatitis B cirrhosis- related portal hypertension. Between- group comparison of categorical data was made by Fisher' s test. Results In patients with regional portal hypertension,five of them had severe isolated gastric varices( IGV) and one had severe IGV with mild esophageal varices. All six patients with hepatitis B cirrhosis- related portal hypertension had severe IGV and the endoscopic features were similar to those of patients with regional portal hypertension. Significant differences were observed between the group with regional portal hypertension and the group with hepatitis B cirrhosis related portal hypertension in short- term response rate( 1 /6 vs 6 /6,P = 0. 015) and long- term response rate( 0 /6 vs 5 /6,P = 0. 015). Conclusion The gastric varices caused by regional portal hypertension has a fast progression rate and a high bleeding risk. The efficacy of endoscopic histoacryl injection in patients with this type of gastric varices is poor.

Objective To explore the efficacy of terlipressin therapy for refractory ascites in cirrhosis and type- 2 hepatorenal syndrome( HRS- 2). Methods Forty patients with refractory ascites in cirrhosis and HRS- 2 who were admitted to our hospital from June 2009 to June 2014 were randomly divided into treatment group( n = 23) and control group( n = 17). The control group was given comprehensive medical treatment including liver protection therapy,anti- infection therapy,and nutritional support,and the treatment group was treated with terlipressin in addition to the treatment for the control group. The body weight,abdomen circumference,urine volume and urinary sodium output within 24 hours,liver and kidney function,and adverse reactions in both groups were evaluated before and after treatment. Between- group comparison of continuous data was performed by t test,and between- group comparison of categorical data was performed byχ2test. Results In the treatment group,the urine volume and urinary sodium output within 24 hours were significantly increased after treatment( 270. 0 ± 120. 0 vs 1200. 0 ± 490. 0 ml,P < 0. 05; 20. 6 ± 10. 5 vs 62. 5 ± 16. 5 mmol,P < 0. 05),while the body weight and abdomen circumference were significantly reduced after treatment( 58. 5 ± 5. 3 vs 53. 6 ± 4. 8 kg,P < 0. 05; 97. 6 ± 7. 5 vs 90. 5 ± 6. 8 cm,P <0. 05). The serum levels of alanine aminotransferase,total bilirubin,blood urea nitrogen,and creatinine in the treatment group were significantly lower after treatment( P < 0. 05),while the serum level of Alb in the treatment group was significantly higher after treatment( P <0. 05). All the above indices were significantly superior in the treatment group than in the control group( P < 0. 05). The overall response rate in the treatment group was significantly higher than that in the control group( 82. 6% vs 52. 9%,P < 0. 05). There were no severe adverse reactions in both groups. Conclusion On the basis of comprehensive medical treatment,terlipressin achieves good efficacy in the treatment of refractory ascites in cirrhosis and HRS- 2 with few adverse reactions.

Objective To assess the clinical efficacy of percutaneous transhepatic cholecystostomy in elderly patients with severe calculous cholecystitis. Methods The clinical data of 60 elderly patients with severe calculous cholecystitis were analyzed. All of the patients were divided into observation group and control group,with 30 cases in each group. In the observation group,the patients were treated with percutaneous transhepatic cholecystostomy combined with laparoscopic cholecystectomy; in the control group,the patients were treated by laparoscopic cholecystectomy alone. After treatment,the operative situation,time to improvement in clinical symptoms,and incidence of complications were compared. Comparison of continuous data between the two groups was made by t test,while comparison of categorical data was made by chi- square test. Results In the observation and control groups,the operative time,intraoperative blood loss,correction time of shock,recovery time of body temperature,recovery time of leukocytes,and recovery time of coagulation function were 23. 06 ± 3. 61 min vs68. 58 ± 11. 54 min,3. 09 ± 0. 31 ml vs 55. 90 ± 13. 73 ml,1. 12 ± 0. 13 d vs 2. 32 ± 0. 53 d,1. 60 ± 0. 22 d vs 2. 74 ± 0. 83 d,2. 08 ±0. 49 d vs 4. 32 ± 0. 94 d,and 1. 61 ± 0. 31 d vs 2. 95 ± 0. 52 d,respectively; the data were significantly different between the two groups( P < 0. 05). Furthermore,the patients from observation group displayed lower incidence rates of multiple organ failure and biliary fistula( P < 0. 05). However,there were no significant differences in the incidence of enterobrosis,pneumothorax,and liver injury( P > 0. 05).Conclusion For elderly patients with severe calculous cholecystitis,percutaneous transhepatic cholecystostomy can significantly improve the operative situation,shorten the time to improvement in clinical symptoms,and reduce the incidence of postoperative biliary fistula and multiple organ failure,and it is a reliable and safe therapy.

Objective To explore the clinical efficacy of endoscopic biliary metallic stent drainage( EBMSD) in the treatment of malignant obstructive jaundice( MOJ). Methods A total of 48 patients with MOJ who underwent EBMSD in the General Hospital of Beijing Military Command from January 2012 to April 2014 were included in the study. Liver function parameters,including alanine aminotransferase( ALT),aspartate aminotransferase( AST),alkaline phosphatase( ALP),total bilirubin( TBil),direct bilirubin( DBil),and glutamyl transpeptidase( GGT),were compared before and after treatment. Comparison of continuous data was made by t test. Results Placement of the stent was successfully performed in 44( 91. 67%) of the 48 patients; single- stent drainage was performed in 34 cases,and double-stent drainage in 10 cases. The patients had significantly reduced levels of TBil,DBil,ALT,AST,ALP,and GGT after EBMSD( all P <0. 01); the patients treated by double- stent drainage had significantly more improvements in these liver function indices than those treated by single- stent drainage( all P < 0. 01). Thirty- eight cases were successfully followed up after operation,and the 3- and 6- month survival rates of these patients were 94. 25% and 73. 39%,respectively. Conclusion EBMSD has remarkable efficacy in the treatment of MOJ. This operation can effectively relieve jaundice and improve quality of life in MOJ patients,and double- stent drainage is superior to single- stent drainage.

Objective To investigate the expression and significance of Bax,cyclooxygenase- 2( COX2),and inhibitor of differentiation 1( ID1) in gallbladder adenocarcinoma tissues. Methods A total of 70 patients confirmed with gallbladder adenocarcinoma by pathological examination in the Department of Pathology,The First Hospital of Lanzhou University,from 2000 to 2013 were collected. Besides,20 cases of high- grade intraepithelial neoplasia,30 cases of low- grade intraepithelial neoplasia,and 20 cases of cholecystitis were selected as controls. The protein expression of Bax,COX2,and ID1 in the four groups was determined using the immunohistochemical SP method. Meanwhile,chi- square test was conducted on the data using fourfold table exact test,the correlations between Bax,COX2,and ID1 were determined by Spearman correlation analysis,and survival data were subjected to Kapan- Meier survival analysis. Results The high- grade intraepithelial neoplasia group,low- grade intraepithelial neoplasia group,and cholecystitis group showed significantly different expression of Bax compared with the gallbladder adenocarcinoma group( all P < 0. 05); the low- grade intraepithelial neoplasia group and cholecystitis group showed significantly different expression of COX2 and ID1 compared with the gallbladder adenocarcinoma group( all P < 0. 05); the high- grade intraepithelial neoplasia group showed significantly different expression of COX2 and ID1 compared with low- grade intraepithelial neoplasia group and cholecystitis group( all P < 0. 05). Survival analysis showed that patients with positive Bax had a significantly higher survival rate than those with positive COX2 and ID1( both P < 0. 05). COX2 was positively correlated with ID1( r = 0. 329,P < 0. 05).Conclusion Bax,COX2,and ID1 may play a role in the development of gallbladder adenocarcinoma,and joint detection of Bax,COX2,and ID1 is of great significance for the prognosis of gallbladder adenocarcinoma.

Objective To analyze the clinical characteristics of drug- induced liver injury( DILI) accompanied by autoimmune phenomena and to provide evidence for clinical practice. Methods An analysis was performed on the clinical data of 51 patients who were admitted to Beijing You'an Hospital from 2011 to 2013 and diagnosed with DILI. The participants were divided into anti- nuclear antibody( ANA)-positive group and ANA- negative group and,according to the simple scoring system for autoimmune hepatitis( AIH),divided into low-score( sore: 1- 4) group and high- score( score≥5) group,respectively. Comparison was made for laboratory parameters [alanine aminotransferase( ALT),aspartate aminotransferase( AST),total bilirubin( TBil),albumin( Alb),alkaline phosphatase( ALP),gamma-glutamyl transpeptidase( GGT),prothrombin time( PT),immunoglobulin M( Ig M),immunoglobulin A( Ig A),immunoglobulin G( Ig G) ],length of hospital stay,and recurrence. Comparison of normally distributed continuous data between groups was performed by t test,comparison of non- normally distributed continuous data between groups was made by rank- sum test,and comparison of categorical data between groups was conducted by chi- square test. Results Among the 51 patients,34 cases were positive for ANA,and 17 cases were negative for ANA; 17 cases were in the high- score group,and 34 cases were in the low- score group. There were no significant differences in ALT,TBil,Alb,ALP,GGT,PT,and Ig M between the two groups for both grouping criteria( all P > 0. 05). AST and Ig G differed significantly between the two groups for both grouping criteria( all P < 0. 05). The Ig G level and recurrence rate in the high- score group( 3. 87 ± 1. 73 g / L and 10 /17) were significantly higher than those in the low- score group( 2. 75 ± 1. 38 g / L and 8 /34)( both P < 0. 05). Conclusion The clinical manifestations are similar between patients with DILI alone and those with DILI accompanied by autoimmune phenomena. The simple scoring system for AIH is worthy of clinical application in DILI accompanied by autoimmune phenomena.

Objective To summarize the imaging characteristics of solitary necrotic nodule of the liver( SNNL) on contrast- enhanced ultrasonography( CEUS) and to investigate the role CEUS plays in the diagnosis and differential diagnosis of SNNL. Methods Twenty- five lesions of 23 cases diagnosed with SNNL by CEUS were retrospectively analyzed for findings of ultrasonography and contrast enhancement.Results Five patients were confirmed with SNNL by pathological examination of surgically resected liver tissue; necrotic nodule was confirmed in 18 patients by ultrasonographic follow- up or other imaging methods( contrast- enhanced computed tomography or contrast- enhanced magnetic resonance imaging). In 12 of the 25 SNNL lesions,no contrast agent enhancement was observed in all phases; 13 lesions showed thin- ring enhancement around the lesions on the arterial phase images and iso- enhancement with the liver on the portal and delayed phase images without enhancement inside the lesions in all phases. Conclusion The typical imaging of SNNL on CEUS is no enhancement of the whole lesion in all phases or thin- ring enhancement around the lesion with no enhancement inside the lesion in all phases,which is helpful for the differentiation from other space- occupying lesions of the liver.

Objective To investigate the effect of plasma exchange with non- bioartificial liver support system on serum manganese levels in patients with hepatic encephalopathy and its clinical significance. Methods A total of 22 inpatients with hepatic encephalopathy who were admitted to our hospital from October 2007 to July 2011 were treated with plasma exchange,and were divided into improvement group and aggravation group based on prognosis. The serum manganese level was dynamically determined using graphite furnace atomic absorption spectrophotometry,and the changes in manganese levels after treatment and relief or worsening of disease were analyzed. Comparison between the two groups was made using t test. Results After treatment,the 22 patients all showed significantly reduced manganese levels( 22. 6 ± 6. 9μg /L vs 36. 4 ± 10. 6 μg /L,t = 4. 789,P = 0. 000). After treatment,8 cases improved and 14 cases aggravated,and the improvement group showed a significantly lower manganese level than the aggravation group( 18. 9 ± 6. 3 μg / L vs 39. 2 ± 9. 8 μg / L,t = 4. 816,P =0. 000). Conclusion Non- bioartificial liver support system can reduce serum manganese levels in patients with hepatic encephalopathy,and the serum manganese level may influence the disease progression.

Objective To summarize the survival outcomes of 34 cases of liver transplantation,and analyze the influencing factors for the long- term survival outcomes after liver transplantation. Methods Thirty- four patients who underwent liver transplantation in our hospital from September 2002 to August 2014 were retrospectively analyzed. The survival rates were estimated by the Kaplan- Meier method,and the complications and causes of death were analyzed. Results The 1-,3-,and 5- year overall survival( OS) rates were 82. 8%,64. 4%,and 50. 9%,respectively. There were no significant differences in the 1-,3-,and 5- year OS rates between Child- Pugh class A and B / C patients( P = 0. 756; P = 0. 486; P = 0. 261). There were significant differences in the 1-,3-,and 5- year OS rates between patients undergoing deceased donor liver transplantation and live donor liver transplantation( P = 0. 01; P = 0. 006; P = 0. 006). Conclusion Elective liver transplantation can achieve a good clinical outcome. Recurrent liver cancer,biliary anastomotic strictures,and immunosuppressive side effects are the influencing factors for the long- term survival outcomes after liver transplantation in this study.

Objective To perform preoperative planning,virtual resection,and risk assessment for patients to be treated by hepatectomy using the liver hepatic image analysis system( IQQA- Liver) and to evaluate the effect and feasibility of three- dimensional( 3D) image reconstruction in assisting liver surgery planning. Methods A retrospective analysis was performed on 32 patients who underwent 3D imaging-assisted preoperative planning from July 2012 to July 2014. The full / residual liver volume was calculated; intrahepatic duct reconstruction was performed; the scheme and extent of surgical removal were simulated. The efficacy of reconstruction and the feasibility of surgical plan were evaluated. Results Surgery was completed according to the 3D imaging- assisted preoperative plan in 29( 90. 63%) of the 32 patients. After operation,biliary fistula occurred in 1 case,pleural effusion in 3 cases,and ascites in 3 cases. All patients were discharged safely with a mean hospital stay of 13 ± 4 d. Conclusion The 3D image reconstruction of the liver contributes to individualized operation and improves the certainty of surgery though intuitive understanding of the location of the tumor and its anatomic relationship with surrounding vessels and bile ducts or virtual liver surgery.

Since age at hepatitis B virus( HBV) infection is a major risk factor associated with the chronicity of HBV,it is of great importance to evaluate the effect of immunoprophylaxis as early as possible in the mother- to- child transmission. This review focuses on HBV serologic and virologic markers in evaluating the effect of immunoprophylaxis in infants born to mother with positive HBV surface antigen( HBs Ag) and indicates that HBs Ag > 250 IU/ml,HBV DNA > 105 IU / ml at birth,HBV e antigen( HBe Ag) being continuously positive for one month,and HBVs antibody( anti- HBs) being negative( < 10 m IU / ml) at one month of age are good indicators of chronic HBV infection in infants. Additionally,several recent studies reported that some babies born to HBs Ag- positive mothers could have occult HBV infection( positive HBV DNA) despite their HBs Ag negativity after vaccination. Thus,in addition to the HBV serologic markers,HBV DNA should be detected when evaluating the effect of immunoprophylaxis in infants born to mother with positive HBs Ag,if conditions allow.

Congenital biliary atresia is considered a neonatal rare disease with multiple causes and phenotypes,whose pathogenesis remains unclear. At present,the etiological study of congenital biliary atresia mainly focuses on viral infection,immune disorder,and dysplasia.This paper summarizes the main etiological hypotheses about congenital biliary atresia nowadays and the connections between them. The research progress provides valuable clues and evidence for the etiology and control of this disease.

It has been confirmed that the body's response to hepatitis C virus( HCV) is not only associated with virus,but also associated with some cytokines and their gene polymorphisms. In this paper,the current research on some cytokines associated with HCV and their gene polymorphisms is reviewed. And it is shown that interleukin- 28 B is closely associated with the course and prognosis of chronic hepatitis C( CHC). Therefore,it is of great significance for the clinical diagnosis and treatment of CHC to investigate host cytokines and their gene polymorphisms.

It has been found in recent years that adipose tissue is not only the organ for storing energy,but can also secrete many adipokines including leptin,adiponectin,and resistin. Leptin and adiponectin play important roles in the formation and treatment of non- alcoholic fatty liver disease( NAFLD) due to their important biological functions,which bring a new direction for the clinical treatment of this disease.This article briefly describes the biological functions of leptin and adiponectin and their relationship with NAFLD. It is pointed out that leptin and adiponectin play essential roles in the treatment of NAFLD and may become novel therapeutic targets.

It is vital for reducing the occurrence of complications,such as liver cirrhosis and hepatic carcinoma,to early diagnose liver fibrosis in chronic hepatitis B and intervene in time with antiviral therapy. Although liver biopsy is the " golden standard" for the diagnosis of fibrosis,it has certain disadvantages,such as complicated operation,invasion,and occurrence of complications. Therefore,non- invasive diagnosis models have gained more and more attention clinically. In this review,we summarizes the non- invasive diagnosis models for chronic hepatitis B that have been established throughout the world. It is noticed that there are a number of models being studied and each model has a diagnostic value,to some degree,but a lack of consensus exists. The development of more efficient models that can replace liver biopsy still needs further research to assess liver fibrosis in chronic hepatitis B and guide antiviral therapy.

Liver cirrhosis is the final outcome of various chronic liver diseases. In recent years,along with the rapid development of molecular biology and cell biological engineering technology,liver regeneration based on stem cell transplantation technique has become a new research hotspot for treatment of acute and chronic hepatic failure. Here we review basic and clinical studies on different types of stem cells for the treatment of liver cirrhosis and optimal choices of the stem cell type used for transplantation based on specificity of patients' particular status. A large number of experimental studies reveal that the technology of stem cell for the treatment of liver cirrhosis has gradually become mature with a broad prospect of application in the field of liver regeneration. This technology that holds enormous potential for treatment will bring hopes to the patients with end- stage liver cirrhosis.

Primary biliary cirrhosis( PBC) is an autoimmune liver disease characterized by chronic and progressive cholestasis,which has a tendency to develop cirrhosis. The pathogenesis of PBC is complicated and still unclear. This paper reviews the latest research progress in immunological mechanisms and therapies for PBC in recent years,which focuses on the relationship between the development of PBC and autoantibodies,immune cells,and important cytokines. The review indicates that immunological factors play a key role in pathogenesis of PBC,and further research on immunological mechanisms might be quite important for the identification of pathogenesis and clinical treatment of PBC.