2016 No. 6

Control of patients' condition and prevention of complications in patients with decompensated liver cirrhosis

Zhong Sheng, Song XinYue, Niu JunQi

2016, 32(6): 1033-1035. DOI: 10.3969/j.issn.1001-5256.2016.06.002

Abstract(2579)

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Abstract:
Liver cirrhosis is a common digestive disease in China with serious consequences in clinical practice.There are many causes of liver cirrhosis,and in clinical practice,liver cirrhosis is classified into compensated and decompensated liver cirrhosis.Prevention and control of the progression of liver cirrhosis to decompensated liver cirrhosis is of great significance for patients in the early stage of liver cirrhosis.This article reviews the major aspects in the prevention of decompensated liver cirrhosis.

Advances in staging and treatment of hepatitis B cirrhosis

Sun YaMeng, You Hong

2016, 32(6): 1036-1039. DOI: 10.3969/j.issn.1001-5256.2016.06.003

Abstract(2990)

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Liver cirrhosis is an important stage of the progression of chronic hepatitis B,and it is of great significance to clarify the severity of liver cirrhosis in evaluating prognosis.At present,the clinical staging based on the complications of liver cirrhosis is widely used,but pathological staging still needs to be refined.In the aspect of treatment,liver disease associations updated the guidelines for the diagnosis and treatment of chronic hepatitis B in 2015,and the antiviral therapy for hepatitis B cirrhosis has become more active.As for the prognosis,effective antiviral treatment realizes the reversion of early cirrhosis and reduces the incidence of liver- related complications,but the mechanism of reversion awaits further investigation.

Research advances in treatment of cirrhotic ascites

Chen Yu, Zhou Li

2016, 32(6): 1069-1074. DOI: 10.3969/j.issn.1001-5256.2016.06.009

Abstract(2523)

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Ascites is the most common complication of liver cirrhosis,and prevention and control of the development and progression of ascites are the key to improving the prognosis of patients with liver cirrhosis.This article summarizes the new advances in the treatment of ascites,including the update on first- line therapeutic methods such as etiological treatment,limited intake of sodium,and diuretic treatment,and investigates the treatment of intractable ascites.

Current research on liver cirrhosis with portal vein thrombosis

Xiong JingPing, Zhang YueXin

2016, 32(6): 1075-1078. DOI: 10.3969/j.issn.1001-5256.2016.06.010

Abstract(2148)

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Abstract:
Liver cirrhosis is a common cause of portal vein thrombosis(PVT),and the patients with liver cirrhosis complicated by PVT tend to experience complications such as intractable ascites,upper gastrointestinal bleeding,and intestinal necrosis,which may lead to serious consequences and threaten the patient's life.This article briefly overviews PVT and discusses the reasons and mechanisms of the development of PVT during liver cirrhosis,as well as the diagnosis and treatment of PVT and related controversial issues.

Research advances in computed tomography and magnetic resonance imaging findings of cirrhotic portal hypertension

Yan FuHua

2016, 32(6): 1079-1082. DOI: 10.3969/j.issn.1001-5256.2016.06.011

Abstract(2748)

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Abstract:
Portal hypertension is the most common complication of liver cirrhosis.Noninvasive radiological examinations have important values in evaluating liver parenchyma,collateral circulation,and esophagogastric variceal bleeding in liver cirrhosis.Computed tomography(CT) and magnetic resonance imaging(MRI) can reflect the changes in liver morphology,the density and signals of liver parenchyma,and hemodynamics and have important values in disease diagnosis and prognostic evaluation.CT and functional MRI,such as perfusion- weighted imaging,MR elastography,and MR diffusion- weighted imaging,can provide quantitative information and can be applied in the diagnosis of hepatic fibrosis and early- stage liver cirrhosis in clinical practice.CT angiography and MR angiography,especially unenhanced MR angiography,can show the condition of the branches of portal vein,which helps to evaluate the risk of esophagogastric variceal bleeding and detect the markers for early warning.A combination of CT and MRI and evaluation of their potential in clinical application can give full play to the role of radiological examinations in the diagnosis,evaluation,and prognostic analysis of cirrhotic portal hypertension.

Coagulation disorders in patients with liver cirrhosis

Ning HuiBin, Shang Jia

2016, 32(6): 1083-1085. DOI: 10.3969/j.issn.1001-5256.2016.06.012

Abstract(2308)

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Abstract:
Liver cirrhosis is a necessary stage of various types of liver diseases progressing into end- stage liver diseases.The changes in coagulation function are still a hot topic in research.The tendency to bleeding and thrombosis is a difficult issue in clinical diagnosis and treatment.This article reviews the mechanism of coagulation in liver cirrhosis,investigates the characteristics of bleeding and thrombosis,and points out that the evaluation of coagulation status in patients with liver cirrhosis is still a difficult issue in clinical diagnosis and treatment.An early evaluation of coagulation status in such patients may help to improve their long- term survival rate.

Pathological features of liver fibrosis/cirrhosis caused by different factors

Zhou GuangDe, Zhao JingMin

2016, 32(6): 1086-1091. DOI: 10.3969/j.issn.1001-5256.2016.06.013

Abstract(2238)

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Abstract:
Liver fibrosis / cirrhosis is a pathological process which involves increased deposition of extracellular matrix in liver tissues and changes in liver tissue structure induced by the persistent action of various factors causing liver injury.This article introduces the features of liver fibrosis / cirrhosis caused by different factors.Identifying the etiology and evaluating the degree of liver fibrosis / cirrhosis with reference to their histological characteristics are of great importance for clinical diagnosis and treatment.

Selection of the diagnostic and therapeutic methods for minimal hepatic encephalopathy

Yan Ming

2016, 32(6): 1092-1099. DOI: 10.3969/j.issn.1001-5256.2016.06.014

Abstract(2250)

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Currently,since there is still no “gold standard”for the diagnosis of minimal hepatic encephalopathy(MHE),a “quick and simple”diagnosis cannot be made,and a diagnosis needs a comprehensive evaluation.Some new detection techniques,such as imaging examination,have shown their advantages and may become new directions for the research and development of diagnostic methods in the future.The treatment of MHE should focus on eliminating precipitating factors,regulating diets,and preventing and blocking the increase in blood ammonia.Moreover,the communication and guidance between doctors and patients on diet regulation are necessary and important.

Current status of malnutrition and its association with prognosis in hospitalized patients with decompensated liver cirrhosis

Zhang HuiKai, Meng XiangLin, Li HaiLei, Xu YuLing, Luo HongWei

2016, 32(6): 1100-1103. DOI: 10.3969/j.issn.1001-5256.2016.06.015

Abstract(2423)

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Objective To investigate the current status of malnutrition and its association with prognosis in hospitalized patients with decompensated liver cirrhosis.Methods A total of 101 patients with decompensated liver cirrhosis who were treated in our department from January 2013 to December 2014 were enrolled,and according to the Nutritional Risk Screening 2002,they were divided into malnutrition risk group and non- malnutrition risk group.Serum nutritional indices,anthropometric parameters,body composition,and the incidence rates of complications and fatality within 6 months were compared between the two groups.The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups.Results Compared with the non-malnutrition risk group,the malnutrition risk group had significantly lower serum levels of albumin,total cholesterol,triglyceride,and hemoglobin,body mass index,arm muscle circumference,triceps skinfold thickness,and grip strength(t = 12.562,5.967,4.024,14.775,4.607,7.182,7.424,and 2.256,all P < 0.05).Compared with the non- malnutrition risk group,the malnutrition risk group had significantly lower intracellular water,total body water(TBW),protein,fat,and skeletal muscle content(t = 2.920,6.152,1.713,2.444,and1.693,all P < 0.05),as well as a significantly higher extracellular water / TBW ratio(t = 1.998,P < 0.05).Compared with the non-malnutrition risk group,the malnutrition risk group had significantly higher incidence rates of gastrointestinal bleeding,hepatic encephalopathy,portal vein thrombosis,and electrolyte disturbance and fatality(χ2= 6.410,4.436,3.978,4.316,and 7.285,all P < 0.05).Conclusion Patients with decompensated liver cirrhosis and malnutrition have significantly increased incidence rates of complications and fatality,and it is necessary to enhance nutrition screening in the early stage of liver cirrhosis.

Effect of antiviral therapy on long-term prognosis of patients with decompensated hepatitis B cirrhosis

Yang HanZe

2016, 32(6): 1104-1107. DOI: 10.3969/j.issn.1001-5256.2016.06.016

Abstract(2344)

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Abstract:
Objective To investigate the effect of antiviral therapy on the long- term prognosis of patients with decompensated hepatitis B cirrhosis.Methods A total of 132 patients with decompensated hepatitis B cirrhosis who were hospitalized in The People's Hospital of Lezhi County 3 times or more from May 2009 to May 2012 were enrolled in the study.According to the therapies,the patients were divided into control group(51 patients) and observation group(81 patients).All the patients were followed up for 5 years via outpatient service and by telephone.Child- Pugh score and Model for End- Stage Liver Disease(MELD) score were obtained from all patients,and the reduction in HBV DNA,HBV DNA clearance,and liver function parameters were observed.Clinical outcomes were compared at the end of follow- up between the two groups.The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups.Results The observation group had significantly lower incidence rate of liver cancer,rate of liver transplantation,and mortality rate than the control group(χ2= 4.32,4.33,and 4.71,all P < 0.001).After treatment,the observation group showed a significant reduction in HBV DNA level(t = 20.60,P < 0.001) and had a significantly lower HBV DNA level than the control group(t = 16.40,P < 0.05).After treatment,the observation group had a significantly higher cumulative clearance rate of HBV DNA than the control group(88.89% vs 6.67%,P < 0.05).After treatment,the observation group had a significantly higher serum albumin level and significantly lower levels of total bilirubin(TBil) and alanine aminotransferase(ALT) than the control group(t = 6.77,16.60,and 11.67,all P < 0.001),and both groups showed significant reductions in TBil and ALT after treatment(observation group:t = 25.18 and 23.33,both P < 0.001;control group:t = 6.15 and 7.20,both P < 0.001).The observation group showed a significant increase in serum albumin level after treatment(t = 10.08,P < 0.001).After treatment,the observation group had significantly lower Child- Pugh score and MELD score than the control group(t = 2.27 and 2.24,both P < 0.05),both groups showed significant reductions in Child- Pugh score and MELD score(observation group:t = 9.18 and 8.17,P < 0.001 and P = 0.03;control group:t = 2.93 and 3.12,P = 0.01 and0.04).Conclusion Long- term antiviral therapy can improve the long- term prognosis of patients with decompensated hepatitis B cirrhosis and increase the 5- year survival rate.

Therapeutic effects of entecavir and adefovir dipivoxil in hepatitis B cirrhosis patients with hepatogenous diabetes:a comparative analysis

Li Na, Cui WeiLi, Qiao Bing, Gou Wei

2016, 32(6): 1108-1111. DOI: 10.3969/j.issn.1001-5256.2016.06.017

Abstract(2191)

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Abstract:
Objective To investigate the therapeutic effect of entecavir or adefovir dipivoxil as the antiviral therapy for hepatitis B cirrhosis patients with hepatogenous diabetes.Methods A total of 80 hepatitis B cirrhosis patients with hepatogenous diabetes who visited Qingdao Hospital of Infectious Diseases were enrolled,and according to the antiviral drug they chose,they were divided into group A and group B,with 40 patients in each group.The patients in group A were treated with oral administration of entecavir 0.5 mg qd,and those in group B were treated with oral administration of adefovir dipivoxil 10 mg qd.The antiviral therapy lasted for 48 weeks.The patients in both groups were given diabetic diets and insulin to control blood glucose,as well as liver- protecting and transaminase- lowering treatments.The changes in biochemical parameters,viral response,diabetes control,and the improvement in liver stiffness after treatment were observed in both groups.The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups.Results The viral response showed a significant difference between group A(85%,34 /40) and group B(65%,26 / 40)(χ2= 4.27,P < 0.05).Compared with group B,group A showed significant improvements in biochemical parameters(P < 0.05).After 48 weeks of treatment,group A had significantly lower levels of blood glucose and glycosylated hemoglobin than group B(blood glucose:7.53 ± 1.13 mmol / L vs 8.34 ± 1.12 mmol / L,t = 3.220,P < 0.05;glycosylated hemoglobin:7.23% ± 0.64% vs 7.79% ±0.84%,t = 3.354;P < 0.05).After the treatment,liver stiffness showed a significant difference between group A and group B(16.86 ±5.67 k Pa vs 19.47 ± 5.32 k Pa,t = 2.123,P < 0.05).Conclusion Compared with adefovir dipivoxil,entecavir can improve glycogen metabolism and blood glucose regulation through improving liver function and promoting hepatocyte repair,and finally achieve a better blood glucose control.

Hepatic myelopathy after transjugular intrahepatic portosystemic shunt:natural course,survival analysis,and treatment

Ren ShuYao, Chen Hui, Lu: Yong, Wang ZhengYu, Niu Jing, Yin ZhanXin, He ChuangYe, Guo WenGang, Han GuoHong

2016, 32(6): 1112-1117. DOI: 10.3969/j.issn.1001-5256.2016.06.018

Abstract(355)

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Objective To investigate the features of hepatic myelopathy(HM) after transjugular intrahepatic portosystemic shunt(TIPS).Methods A retrospective analysis was performed for a consecutive cohort of patients with cirrhotic portal hypertension who were successfully treated with TIPS in Department of Liver Disease and Digestive Interventional Radiology in Xijing Hospital of Digestive Diseases,Fourth Military Medical University,from 2005 to 2014 and then developed HM.Routine follow- up was performed for all patients at 1,3,and 6months after TIPS and every half a year subsequently.The time to disease progression was used to summarize the natural course of HM,the comparison of continuous data was made by independent samples t- test,the comparison of categorical date was made by chi- square test.The Kaplan- Meier method was used for survival analysis,and the Cox proportional hazards regression model was used to determine prognostic factors.Relief of symptoms in the lower limbs was analyzed to investigate the therapeutic effect.Results The time to HM progression from grade 1 to grades 2,3,and 4 was 4.0 months(range,1- 36 months),8.5 months(range,1- 44 months),and 18.8 months(range,5.4- 48.6 months),respectively.In HM patients,the 1-,3-,and 5- year cumulative survival rates were 84.19%,51.86%,and 45.21%,respectively.Age of HM onset(HR = 1.034,95% CI:1.003- 1.065) and recurrent ascites(HR = 3.869,95% Cl:1.623- 9.225) were independent prognostic factors in patients with HM.The patients who underwent liver transplantation had a significantly higher proportion of patients with relief of symptoms than those who did not undergo liver transplantation(χ2= 13.5,P = 0.003),while the effects of stent flow limitation and occlusion showed no significant differences(P > 0.05).Conclusion The course of HM consists of rapid progression stage and plateau stage,and HM patients after TIPS show good survival.At present,liver transplantation is an effective method to treat HM.

Influence of antiviral therapy with telbivudine on serum soluble complement receptor type 1 in patients with chronic hepatitis B or liver cirrhosis

Wang Fang, Quan ZuoHua, Yang XingKun, Kou JunFeng, Yun ShengHao, Cai GuoFang, Zhou XinRen

2016, 32(6): 1118-1120. DOI: 10.3969/j.issn.1001-5256.2016.06.019

Abstract(1895)

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Objective To investigate the changes in serum soluble complement receptor type 1(s CR1) at 3 and 6 months after antiviral therapy with telbivudine in patients with chronic hepatitis B(CHB) or liver cirrhosis and the influence of telbivudine on serum s CR1 level.Methods A total of 57 patients with HBe Ag- positive CHB or liver cirrhosis were enrolled and given the antiviral therapy with telbivudine.Venous blood was collected before treatment and at 3 and 6 months after treatment,and enzyme- linked immunosorbent assay was used to measure serum s CR1 level.The paired t- test was used for comparison within one group.Results At 3 and 6 months after the antiviral treatment with telbivudine,the serum s CR1 level changed significantly compared with corresponding baseline values(t = 4.864 and 6.238,both P < 0.05).The patients with CHB or liver cirrhosis showed significant changes in the serum s CR1 level at 3 and 6 months after treatment compared with corresponding baseline values(t = 3.425,5.468,4.047,7.378 all P < 0.05).The patients with CHB had a lower serum s CR1 level at baseline and at 3 and 6 months after treatment than those with liver cirrhosis,but the serum s CR1 level at each time point showed no significant differences between the two groups(all P > 0.05).Conclusion In patients with HBe Ag- positive CHB or liver cirrhosis,serum s CR1 level is reduced significantly after antiviral therapy with telbivudine.

Changes in natural killer cell frequency,function,and receptor expression in peripheral blood of patients with hepatitis B cirrhosis

Zhang AiMin, Liu FangFang, Yang Xiao, Li WenGang, Han Ping, Duan XueZhang

2016, 32(6): 1121-1124. DOI: 10.3969/j.issn.1001-5256.2016.06.020

Abstract(1969)

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Objective To investigate the changes in natural killer(NK) cell frequency,function,and receptor expression in the peripheral blood of patients with hepatitis B cirrhosis.Methods A total of 34 patients with hepatitis B cirrhosis who were admitted to 302 Hospital of PLA from June 2013 to December 2014 were enrolled as the cirrhosis group,and 30 healthy blood donors were enrolled as the healthy control group.Flow cytometry was used to measure NK cell frequency and the expression of CD158 a,CD158b,NKG2 D,NKP30,NKP44,and NKP46 receptors in peripheral blood.Interleukin- 12(IL- 12) was used to stimulate peripheral blood mononucleated cells,and flow cytometry was used to measure the ability of NK cells to secrete interferon- γ(IFNγ) and tumor necrosis factor- α(TNFα) and analyze the killing efficiency of NK cells for K562 cells.NK cell frequency,receptor expression,and function were compared between the two groups.The t- test was used for comparison of normally distributed data between groups,and the Mann- Whitney U rank sum test was used for comparison of abnormally distributed data between groups.Results Compared with the healthy control group,the cirrhosis group had a significantly lower CD56 dimNK cell frequency(Z =- 2.309,P < 0.05) and a significantly higher CD56 brightNK cell frequency(Z = 2.395,P < 0.05).The cirrhosis group had significantly higher expression rates of NKP44 and NKP46(the activating receptors of CD56 dimNK cells) than the healthy control group(Z = 2.834 and 3.404,both P < 0.05).The cirrhosis group also had significantly higher expression rates of NKP30,NKP44,and NKP46(the receptors of CD56 brightNK cells) than the healthy control group(Z = 3.518,4.003,and 4.480,all P <0.05).After IL- 12 stimulation,compared with the healthy control group,the cirrhosis group had significantly lower expression rates of TNFα in CD56 dimNK cells and IFNγ in CD56 brightNK cells(Z =- 3.510 and- 4.301,both P < 0.05).With effector- target ratios of 3∶ 1,10∶ 1,and 30∶ 1,the cirrhosis group had significantly lower proportions of K562 cells killed by NK cells than the healthy control group(Z =- 2.355,- 2.523,and- 2.523,all P < 0.05).Conclusion The patients with liver cirrhosis experience a reduced NK cell function,which may be related to reduced frequency of CD56 dimNK cells and secretion of cytokines,but may not be related to receptor expression.

Simple serum markers for significant liver inflammation in chronic hepatitis B patients with an alanine aminotransferase level lower than 2 times upper limit of normal

Li Qiang, Huang YuXian, Chen Liang

2016, 32(6): 1125-1129. DOI: 10.3969/j.issn.1001-5256.2016.06.021

Abstract(2291)

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Objective To investigate the simple serum markers for significant liver inflammation in chronic hepatitis B(CHB) patients with an alanine aminotransferase(ALT) level of < 2 times upper limit of normal(ULN).Methods The clinical data of 278 CHB patients with ALT < 2 × ULN(ULN = 40 U / L) were analyzed retrospectively.Significant liver inflammation was defined as a liver inflammatory activity grade(G) ≥2.The t- test was used for comparison of normally distributed continuous data between groups,and the Kruskal- Wallis rank sum test was used for non- normally distributed continuous data;the chi- square test was used for comparison of categorical data between groups.Multivariate logistic regression analysis was used to identify independent predictors for significant liver inflammation in CHB patients with ALT < 2 × ULN.The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of serum markers in significant liver inflammation.Results Of the 278 CHB patients enrolled,175(62.9%) had no significant liver inflammation(G0- 1group) and 103(37.1%) had significant liver inflammation(G2- 4 group).There were significant differences in ALT,aspartate aminotransferase,alkaline phosphatase,gamma- glutamyl transpeptidase(GGT),albumin,globulin,prothrombin time(PT),platelet,absolute neutrophil count,hyaluronic acid(HA),glycocholic acid,precollagen Ⅲ,and collagen type Ⅳ(ⅣC) between the two groups(all P< 0.05).The multivariate regression analysis showed that GGT,PT,ⅣC,and HA were independent predictors for significant liver inflammation in CHB patients with ALT < 2 × ULN(OR = 1.015,1.600,1.151,and 1.014,P = 0.008,0.021,0.003,and 0.018).The areas under the ROC curve for GGT,PT,IVC,and HA to diagnose significant liver inflammation were 0.804,0.722,0.707,and 0.632,respectively.The cut- off value of 48.5 U / L for GGT to predict significant liver inflammation had a specificity of 90.3% and a negative predictive value of 74.6%.Conclusion GGT,PT,IVC,and HA are independent predictors for significant liver inflammation in CHB patients with ALT < 2 × ULN,among which GGT has the highest predictive value.

Molecular mechanism in the pathogenesis of mild chronic hepatitis B based on microRNA regulation

Zhang ChuanTao, Gu HaiYing, Huang Qun, Liu YeFang, Wang DeLi, Zheng ZhengLong, Hu Rong, Qiao WeiJuan

2016, 32(6): 1130-1134. DOI: 10.3969/j.issn.1001-5256.2016.06.022

Abstract(1684)

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Objective To investigate the molecular mechanism in the pathogenesis of mild chronic hepatitis B from the perspective of microRNA(miRNA) regulation.Methods A total of 16 patients who visited the outpatient service of Chengdu Hospital of Infectious Diseases from July 2013 to February 2014 were enrolled and divided into mild chronic hepatitis B group and normal group.The Agilent Human miRNA 8 × 60 k microarray chips were used to detect the expression profile of miRNA in plasma and obtain the profile of miRNAs expressed differentially between the two groups.The miRNA bioinformatics analysis software was used to predict target genes,and GO functional enrichment analysis and pathway analysis were performed for these target genes.An analysis of variance was used for comparison between multiple groups,and the t-test was used for comparison between two groups.Results A total of 54 miRNAs were differentially expressed between the two groups(all P < 0.05),and among them,30 were upregulated,and 24 were downregulated.The functions of these miRNAs included cell proliferation,positive / negative transcription regulation,positive / negative regulation of biosynthesis,protein localization,the Wnt receptor signaling pathway,positive / negative regulation of gene expression,the enzyme- linked receptor protein signaling pathway,and phosphorylation of protein amino acids.Pathway analysis revealed that miRNAs were mainly involved in the Wnt signaling pathway,Notch signal transduction pathway,Hedgehog signaling pathway,p53 signaling pathway,and B cell receptor signaling pathways,etc.Conclusion The pathogenesis of mild chronic hepatitis B is regulated by specific miRNAs and involves various life processes and pathways.

Effect of stereotactic body radiotherapy versus intensity-modulated radiotherapy in primary liver cancer patients with secondary malignant tumor of vertebra

Sun Jing, Po JunJie, Fan YuZe, He WeiPing, Li Huan, Sun YingZhe, Wang Hui, Duan XueZhang

2016, 32(6): 1135-1138. DOI: 10.3969/j.issn.1001-5256.2016.06.023

Abstract(2193)

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Objective To investigate the effect of stereotactic body radiotherapy(SBRT) versus intensity- modulated radiotherapy(IMRT)in primary liver cancer(PLC) patients with secondary malignant tumor of vertebra.Methods A total of 49 PLC patients with secondary metastatic tumor of vertebra,who were treated in our hospital from December 2011 to January 2014,were enrolled and divided into group A(20 patients treated with SBRT) and group B(29 patients treated with IMRT).The prescribed dose was 35 Gy in 5 fractions in group A and35 Gy in 10 fractions in group B.The time to pain relief,imaging findings,and survival analysis were used to evaluate pain- relieving effect,the condition of lesions,and survival time.The t- test was used to compare continuous data between groups,and the chi- square test was used to compare categorical data between groups.The K- M method was used to plot survival curves for both groups,and the log-rank test was used for survival difference analysis.Results The proportion of patients who achieved complete or partial remission and stable disease shown by radiological examination after radiotherapy showed no significant difference between group A and group B(P = 0.873).The pain relief rate also showed no significant difference between group A and group B(P = 0.908).The time of pain relief showed a significant difference between group A and group B(t =- 3.353,P < 0.01).The overall survival showed no significant difference between the two groups(P = 0.346).Conclusion Radiotherapy has a definite therapeutic effect in PLC patients with secondary malignant tumor of vertebra.SBRT and IMRT have similar pain- relieving effects.However,with the same prescribed dose,SBRT has a short time to pain relief and does not lead to serious intolerable acute or late toxic and side effects in surrounding fast- response tissues.

Predictive value of neutrophil-lymphocyte ratio and its dynamic change in patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Wang WenJun, Zhao Yan, Xia DongDong, Wang EnXin, Liu Lei, Han GuoHong

2016, 32(6): 1139-1144. DOI: 10.3969/j.issn.1001-5256.2016.06.024

Abstract(2352)

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Objective To investigate the predictive value of neutrophil- lymphocyte ratio(NLR) and its dynamic change in patients with hepatocellular carcinoma(HCC) undergoing transarterial chemoembolization(TACE).Methods The patients who were diagnosed with HCC and treated with TACE in Xijing Hospital of Digestive Disease of Fourth Military Medical University from January 2010 to December2014 were enrolled.The factors including NLR were recorded at baseline and 3 days and 1 month after TACE.The receiver operating characteristic(ROC) curve was used to determine the cut- off value of NLR.The t- test was used for comparison of continuous data between groups,the chi- square test was used for comparison of categorical data between groups,the Kaplan- Meier method was used to calculate survival rates,and univariate and multivariate Cox regression analyses were used for prognostic analysis.Results A total of 427 patients were enrolled.The median value of baseline NLR was 2.4;at 3 days after surgery,NLR increased and the median value reached 6.2;at 1month after surgery,NLR decreased to the baseline level.The cut- off values at baseline,3 days after surgery,and 1 month after surgery were 2.5,9.7,and 2.5,respectively.At baseline,3 days after surgery,and 1 month after surgery,the median survival time showed significant differences between the low- NLR group and the high- NLR group(χ2= 10.529,8.388,and 6.679,all P < 0.05).The multivariate Cox regression analysis showed that the baseline NLR > 2.5 was the independent predictor for survival difference in HCC patients.In the group with low NLR at baseline and 3 days after surgery,the group with high NLR at baseline or 3 days after surgery,and the group with high NLR at baseline and 3 days after surgery,the median survival time was 28.0,21.0,and 10.1 months,respectively,and showed a significant difference between groups(χ2= 19.846,P < 0.001).In the group with low NLR at baseline and 1 month after surgery,the group with high NLR at baseline or 1 month after surgery,and the group with high NLR at baseline and 1 month after surgery,the median survival time was 29.4,21.0,and 15.4 months,respectively,and showed a significant difference between groups(χ2= 11.424,P = 0.003).Conclusion Baseline NLR and its dynamic change can be used to predict the prognosis in HCC patients receiving TACE.

Clinical application of laparoscopy combined with choledochoscopy and duodenoscopy in treatment of gallstones complicated by intra-and extrahepatic bile duct stones

Wen ZhiQiang, Song Yue, Zhang YaoMing, Xu JiWei, Zhang CaiYun

2016, 32(6): 1145-1148. DOI: 10.3969/j.issn.1001-5256.2016.06.025

Abstract(2017)

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Objective To summarize the experience in laparoscopy combined with choledochoscopy and duodenoscopy in the treatment of gallstones complicated by intra- and extrahepatic bile duct stones,and to investigate its therapeutic effect.Methods A total of 413 patients with gallstones complicated by intra- and extrahepatic bile duct stones who visited Meizhou People' s Hospital from March 2010 to March 2015 were enrolled,and according to the patients' individual conditions,they were given laparoscopy combined with choledochoscopy and / or duodenoscopy.Results A total of 31 patients underwent laparoscopic cholecystectomy(LC) + laparoscopic transcystic common bile duct exploration(LTCBDE),and the success rate was 29.0%(9 /31);101 patients underwent LC + LTCBDE + T tube drainage,and the success rate was 93.1%(94 /101);96 patients underwent LC + laparoscopic common bile duct exploration(LCBDE) + choledochoscopic cholecystolithotomy + primary suture,and the success rate was 97.9%(94 /96);61 patients underwent LC + LCBDE + partial hepatectomy,and the success rate was 91.8%(56 /61);155 patients underwent endoscopic sphincterotomy(EST) + LC or LC + EST,and the success rate was 93.5%(145 /155);10 patients underwent laparoscopy + duodenoscopy + choledochoscopy(at the same time),and the success rate was 90%(9 /10).Nineteen patients were converted to open surgery,and the overall success rate was 95.4%(394 /413).All the patients were cured,and there were no serious complications or deaths.Conclusion Laparoscopy combined with duodenoscopy and choledochoscopy is feasible,safe,and reliable in the treatment of gallstones complicated by intra- and extrahepatic bile duct stones.

Clinical effect of primary duct closure and T-tube drainage after laparoscopic common bile duct exploration:a comparative analysis

Zhang HaiWen, Zhou JianPeng, Wei Feng, Wang GuangYi

2016, 32(6): 1149-1151. DOI: 10.3969/j.issn.1001-5256.2016.06.026

Abstract(1984)

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Abstract:
Objective To investigate the effect of primary duct closure and T- tube drainage after laparoscopic common bile duct exploration,as well as the criteria for clinical application of primary duct closure.Methods A retrospective analysis was performed for the clinical data of patients with common bile duct stones who were treated in The First Hospital of Jilin University from July 2014 to July 2015,and 51 patients who met the inclusion criteria were enrolled.Among these patients,26 underwent primary closure of the common bile duct and 25 underwent T- tube drainage.The change in total bilirubin after surgery,time to recovery of gastrointestinal function,volume of peritoneal drainage at 1 day after surgery,time of removal of peritoneal drainage tube,complications,length of postoperative hospital stay,and total hospital fee were analyzed and compared between the two groups.The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups.Results The length of postoperative hospital stay and total hospital fee showed significant differences between the two groups(t =- 7.067,P < 0.001;t =- 3.126,P = 0.003).One patient in each group experienced a complication and was cured after treatment.Conclusion On the basis of strict control of surgical indications,the primary closure of common bile duct after laparoscopic common bile duct exploration has the advantages of a short length of hospital stay,low hospital fee,and high quality of life,and is safe and feasible.Therefore,it holds promise for clinical application.

Endoscopic retrograde cholangiopancreatography after Billroth-Ⅱ gastrectomy and its safety

Lei Ting, Nie ZhanGuo, Re HeMan, Liu Ping, You Yun, Jiang LiLi, Zhang Xin

2016, 32(6): 1152-1154. DOI: 10.3969/j.issn.1001-5256.2016.06.027

Abstract(2067)

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Abstract:
Objective To investigate the safety of endoscopic retrograde cholangiopancreatography(ERCP) after Billroth- Ⅱ gastrectomy.Methods A total of 43 patients who were admitted to our hospital and underwent Billroth-Ⅱ gastrectomy from June 2012 to June 2015 were enrolled and underwent ERCP.Results Of all 43 patients undergoing ERCP,39(90.7%) received successful intubation,2(4.7%) received failed intubation,and 2(4.7%) experienced the complication of digestive tract perforation.Among the 39 patients who underwent ERCP,31(79.5%) were diagnosed with common bile duct stones(3 underwent sphincterotomy and 28 underwent endoscopic papillary balloon dilation to remove stones),6(15.4%) were diagnosed with benign stenosis at the end of bile duct(4 underwent papillary balloon dilation alone and 2 underwent biliary plastic stent implantation),and 1 patient each(2.6%) was diagnosed with ampullary tumor and hepatic portal metastasis of gastric cancer and received implantation of metal and plastic stents,respectively.One patient(2.6%) experienced acute pancreatitis after surgery.Conclusion ERCP is safe and effective in patients after Billroth-Ⅱgastrectomy and holds promise for clinical application.

Ye ChuanTao, Zhao JieRu, Zheng XuYang, Bian PeiYu, Jia ZhanSheng

2016, 32(6): 1165-1166. DOI: 10.3969/j.issn.1001-5256.2016.06.030

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Yi ZhengHui, Chang YingBin

2016, 32(6): 1167-1168. DOI: 10.3969/j.issn.1001-5256.2016.06.031

Abstract(1867)

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Wei HuaFang, Zhou ZhangYu

2016, 32(6): 1169-1170. DOI: 10.3969/j.issn.1001-5256.2016.06.032

Abstract(2008)

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Yang YiLiang, Cui YuanYuan, Hu Yue, Kong WenLi, Peng ShanShan, Pan Yu

2016, 32(6): 1171-1172. DOI: 10.3969/j.issn.1001-5256.2016.06.033

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A case of tuberculous hepatic abscess secondary to pulmonary tuberculosis

Guo XiangLing, Qi LiNa, Yang Kun, Sun Li, Gao RunPing

2016, 32(6): 1173-1174. DOI: 10.3969/j.issn.1001-5256.2016.06.034

Abstract(1983)

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Kang XinDi, Sun Ying, Wen XiaoYu, Niu JunQi, Jin QingLong

2016, 32(6): 1175-1176. DOI: 10.3969/j.issn.1001-5256.2016.06.035

Abstract(2086)

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Wang CaiMing, Fu ZhaoLiang, Liang ZongChao, Yuan Heng

2016, 32(6): 1177-1178. DOI: 10.3969/j.issn.1001-5256.2016.06.036

Abstract(2029)

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Chen JiaCheng, Chen XiaoJing, Xiao XiaoLan, Luo HaiMei, Zhou KaiLun

2016, 32(6): 1179-1180. DOI: 10.3969/j.issn.1001-5256.2016.06.037

Abstract(2010)

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Zhuo HaiYan, Lin Chun, Pan Chen

2016, 32(6): 1181-1182. DOI: 10.3969/j.issn.1001-5256.2016.06.038

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New advances in drug therapies for liver fibrosis

Ma ZhenZeng, Lu LunGen

2016, 32(6): 1183-1187. DOI: 10.3969/j.issn.1001-5256.2016.06.039

Abstract(3220)

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The morbidity and mortality of liver fibrosis induced by a variety of causes remain high around the world and tend to increase year by year.At present,there are no effective radical treatments for liver fibrosis except liver transplantation,and the serious complications of liver fibrosis greatly threaten patients' health and cause a heavy medical burden.Therefore,effective drugs are needed to fight against liver fibrosis.In recent years,great achievements have been made in the research and development of anti- fibrotic drugs and the treatment of liver fibrosis.This article reviews the research advances in drugs and traditional Chinese medicines which act on the different targets of liver fibrosis,inhibit the activation and proliferation of hepatic stellate cells,enhance the activity of matrix metalloproteinase and inhibit the activity of tissue inhibitor of metalloproteinase(TIMP),inhibit inflammatory response,and regulate immune response,as well as the combination of nanoparticles and anti- fibrotic drugs and gene therapy for liver fibrosis.

Research advances in diagnosis and treatment of spontaneous bacterial peritonitis

Song YuanYuan, Jiang YuYong

2016, 32(6): 1188-1191. DOI: 10.3969/j.issn.1001-5256.2016.06.040

Abstract(2554)

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Spontaneous bacterial peritonitis(SBP) is a common complication of cirrhotic ascites,and has a high incidence rate,rapid progression,and a high fatality rate.At present,there are no uniform diagnostic criteria for SBP at home and abroad.Some patients do not have the typical clinical symptoms of SBP,and therefore,missed diagnosis might occur in such patients and the patient's condition might be delayed.This article reviews the advances in the diagnosis,pathogenesis,and treatment of SBP,in order to provide a reference to clinical physicians,increase the diagnostic rate of SBP,reduce clinical fatality rate,and improve patients' prognosis.

Research advances in the role of aquaporins in liver fibrosis and liver cirrhosis

Zhang Qiang, Zhao XiangXuan, Sun Wei, Ci DanWangJiu, Guo QiYong

2016, 32(6): 1192-1195. DOI: 10.3969/j.issn.1001-5256.2016.06.041

Abstract(2004)

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Liver fibrosis is the final outcome of various chronic liver diseases,and various cells,cytokines,and miRNAs are involved in the development and progression of liver fibrosis and liver cirrhosis.Hepatic fibrosis and pathologic angiogenesis are interdependent processes and promote each other,but the physiopathological mechanism of arterial capillary proliferation in liver fibrosis remains unknown.Aquaporins not only transport water molecules,but also promote angiogenesis.This article briefly introduces the expression of aquaporins in the hepatobiliary system and their physiological and biochemical characteristics and summarizes the role of aquaporins in the progression of liver fibrosis and liver cirrhosis,in order to provide new thoughts and guidance for aquaporins as the target in the treatment of liver fibrosis and liver cirrhosis.

Advances in basic research on mesenchymal stem cells and its clinical application in liver cirrhosis

Zhang LiTing

2016, 32(6): 1196-1198. DOI: 10.3969/j.issn.1001-5256.2016.06.042

Abstract(2373)

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Adult mesenchymal stem cells(MSCs) have the features of high plasticity and low immunogenicity,and hold promise for wide clinical application.This article reviews the basic research on MSCs in bone marrow and umbilical cord blood and their clinical application in liver diseases to lay a theoretical foundation and provide support for their clinical application in liver cirrhosis,and to provide more technical measures for the treatment of end- stage liver disease.However,the safety and efficacy in clinical application still need further studies.

Direction and progress in research and development of anti-HBV drugs

Leng XueJun, Zhang Ying, Shen JiaoChun, Yan XueBing

2016, 32(6): 1199-1203. DOI: 10.3969/j.issn.1001-5256.2016.06.043

Abstract(221)

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Chronic hepatitis B(CHB) is considered as the most important risk factor for public health around the world,as well as the main reason for potential diseases to develop into liver cirrhosis and hepatocellular carcinoma.However up to now,there are few methods for the treatment of this lethal viral infection with poor therapeutic effects.At present,we have realized the necessity to develop new drugs.This article reviews the drugs currently available in market or under clinical trials,introduces several drugs with a promising future in each category of anti- HBV drugs,and points out the developmental direction of multi- effect combination of anti- HBV drugs in future,in order to provide the latest advances in HBV treatment for researchers working on HBV and experts engaged in healthcare.

Association between dynamic changes in HBsAg and progression of chronic hepatitis B

Wang Wei, Rong Jun, Li LiHua, Niu HongYao, Gao HengBo, Zheng HuanWei

2016, 32(6): 1204-1206. DOI: 10.3969/j.issn.1001-5256.2016.06.044

Abstract(2130)

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With the application of HBs Ag quantification in clinical practice,recent studies have found that HBs Ag level can not only reflect the transcriptional activity of double- stranded covalently closed circular DNA,but also predict the risk of disease progression and response to antiviral therapy in patients with chronic HBV infection.This article reviews the changes in HBs Ag level in the natural course of HBV infection and points out the changes in HBs Ag level can provide new ideas to the treatment of chronic hepatitis B.

Research advances in blocking mother-to-child transmission of hepatitis B virus and hepatitis C virus

Zhou LengXiao, Han Tao

2016, 32(6): 1207-1211. DOI: 10.3969/j.issn.1001-5256.2016.06.045

Abstract(1445)

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Mother- to- child transmission is one of the important routes of hepatitis B virus(HBV) and hepatitis C virus(HCV) infections in China.As for the neonates whose mothers are infected with HBV,a combined injection of hepatitis B vaccine and immunoglobulin is used for vaccination,and about 10% of these neonates may experience a failure.However,as for the neonates whose mothers are infected with HCV,there are no methods for blocking mother- to- child transmission of HCV.This article introduces the development of mother- to-child transmission of HBV and HCV and related mechanisms and influencing factors,as well as the latest advances in methods for blocking,and points out that with further investigations and findings in the field of hepatitis viruses,it may be possible to block mother- to- child transmission of hepatitis viruses.

Basic research and therapeutic strategies for multinodular hepatocellular carcinoma

Yang ZhenYu, Du XiLin, Yang Tao, Tan Kai, He XiaoJun, Chen An

2016, 32(6): 1212-1215. DOI: 10.3969/j.issn.1001-5256.2016.06.046

Abstract(1513)

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In recent years,with the development of in- depth basic and clinical research on hepatocellular carcinoma(HCC),the heterogeneity,biological characteristics,molecular subtyping,and individualized treatment of HCC have gradually become the basic guiding principles for the clinical treatment of HCC in the modern era.Multinodular HCC is a form of gross specimens of HCC,and new achievements have been made in the molecular origin and guidelines for clinical typing of HCC,which guide the diagnosis and treatment of HCC.However,new controversies have also appeared.This article reviews the advances in basic and clinical research on multinodular HCC,hoping to provide a reference for clinical prevention and treatment of HCC and contribute to patients' survival benefit.

Current status of research on transcatheter arterial chemoembolization in treatment of colorectal cancer liver metastasis

Jian QianHong, Zheng FangRong, Yan Xiong

2016, 32(6): 1216-1219. DOI: 10.3969/j.issn.1001-5256.2016.06.047

Abstract(1692)

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It is widely acknowledged that the liver is the most common organ for colorectal cancer metastasis,and radical resection is thought to be the only therapeutic method to cure colorectal cancer liver metastasis(CRLM).Unfortunately,only about 20% of all patients are eligible for surgical resection.In patients who cannot be treated with surgery,transcatheter arterial chemoembolization(TACE) has been widely used as the preferred therapeutic method by scholars at home and abroad.This article introduces the application basis,indications,contraindications,therapeutic effect,chemotherapeutic agents,and embolic agents of TACE in the treatment of CRLM,and points out that TACE is a palliative treatment regimen with a clear therapeutic effect,minimal invasion,and few side effects and can be used as the preferred therapeutic regimen for patients with unresectable CRLM.

Immunological characteristics of tumor antigen specific T cells and their possible mechanisms in hepatocellular carcinoma

Hou YuLi, Zhang YongHong, Zhao Yan

2016, 32(6): 1220-1224. DOI: 10.3969/j.issn.1001-5256.2016.06.048

Abstract(1368)

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Hepatocellular carcinoma(HCC) is a major health problem around the world and its morbidity is increasing year by year.HCC has a low rate of early diagnosis and advanced HCC has a low survival rate.Therefore,the diagnosis and treatment of HCC has attracted great attention,and tumor specific T cell immunity plays an important role in it.This article describes the immunological characteristics of seven HCC- associated antigen specific T cells,i.e.,alpha fetal protein,phosphatidylinositol proteoglycan- 3,NY- ESO- 1,SSX- 2,melanoma antigen gene A,telomerase reverse transcriptase,and HCC- associated antigen- 519 / target protein xklp- 2,and analyzes the possible mechanisms which affect antigen specific T cell immunity from the aspects of regulatory T cells,myeloid- derived suppressor cells,antigen presenting and processing,inhibitory receptors,and CD4+T cells.

Research advances in mechanisms and intervention of hepatic ischemia-reperfusion injury

Wang QingQing, Zhao Xin, Chen YuChao, Dou Jian

2016, 32(6): 1225-1229. DOI: 10.3969/j.issn.1001-5256.2016.06.049

Abstract(1799)

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Hepatic ischemia- reperfusion injury(HIRI) is a process caused by the combined effect of various factors,and to some extent,it limits the development of liver surgery.In- depth studies on mechanisms of HIRI and the development of reasonable therapeutic strategies have positive effects on the prognosis of patients.This article introduces the pathogenesis of HIRI,including calcium overload,Kupffer cells,microcirculation disturbance,production of reactive oxygen species,complement,non- coding RNA,and various cytokines,and the combined effect of these factors induces the necrosis and apoptosis of hepatocytes.In addition,as a second mode of cell death,autophagy is also involved in HIRI.Due to the complex mechanism of HIRI and many factors involved,intervention should be given from various aspects.This article points out that with the development of intervention such as ischemic pretreatment,mild hypothermia and hydrogen,the new therapeutic methods are expected to bring new thoughts to the clinical intervention of HIRI.

Role of follicular helper T cells in development and progression of liver diseases

Ji LongShan, Sun XueHua, Zhou ZhenHua, Zhang Xin, Gao YaTing, Gao YueQiu, Li Man

2016, 32(6): 1230-1234. DOI: 10.3969/j.issn.1001-5256.2016.06.050

Abstract(1570)

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Follicular helper T cell(TFH) is a new CD4+T lymphocyte subset which helps B lymphocytes to produce antibodies and is closely related to the development and progression of liver diseases.This article reviews the detection and differentiation of TFH and related functional molecules,the mechanism of action of TFH in helping B lymphocytes to produce antibodies through producing interleukin- 21,as well as the role of TFH in liver diseases such as chronic hepatitis B,chronic hepatitis C,autoimmune hepatitis,primary biliary cirrhosis,hepatic failure,and liver transplantation,and points out that TFH may become the new target cell in the treatment of liver diseases.

Expert consensus on enhanced recovery after hepatobiliary & pancreatic surgery(2015 edition)

Chinese Research Hospital Association, Society for Hepatopancreatobiliary Surgery

2016, 32(6): 1040-1045. DOI: 10.3969/j.issn.1001-5256.2016.06.004

Abstract(541)

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Wang Ran, Qi XingShun, Guo XiaoZhong

2016, 32(6): 1046-1051. DOI: 10.3969/j.issn.1001-5256.2016.06.005

Abstract(177)

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Peng Ying, Qi XingShun, Guo XiaoZhong

2016, 32(6): 1052-1053. DOI: 10.3969/j.issn.1001-5256.2016.06.006

Abstract(174)

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Xia JunXia, Yang QianTing, Liao MingFeng, Zhou BoPing, Yuan Jing

2016, 32(6): 1054-1059. DOI: 10.3969/j.issn.1001-5256.2016.06.007

Abstract(164)

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Shen JiaoChun, Leng XueJun, Zhang Ying, Yan XueBing

2016, 32(6): 1060-1068. DOI: 10.3969/j.issn.1001-5256.2016.06.008

Abstract(2833)

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Association between non-high-density lipoprotein cholesterol and nonalcoholic fatty liver disease in postmenopausal Uyghur women in Xinjiang,China

Mai LaMuGuLi, 加那尔古丽·夏坎, Cai Wen, Yao Hua

2016, 32(6): 1155-1159. DOI: 10.3969/j.issn.1001-5256.2016.06.028

Abstract(2251)

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Objective To investigate the association between non- high- density lipoprotein cholesterol(non- HDL- C) and nonalcoholic fatty liver disease(NAFLD) in postmenopausal Uyghur women in Xinjiang,China.Methods A total of 1271 postmenopausal Uyghur women who underwent physical examination in the physical examination centers of hospitals in the First Affiliated Hospital of Urumqi and the First People's Hospital of Kashgar,Xinjiang,were enrolled as study subjects,and according to the presence or absence of NAFLD,they were divided into NAFLD group(682 women) and control group(589 women).Demographic data were recorded in detail,and the hepatic enzyme parameters,parameters for glucose and lipid metabolism,and parameters including uric acid and non- HDL- C were measured.The t- test was used for comparison of continuous data between groups,the chi- square test was used for comparison of categorical data between groups,and non- conditional logistic regression analysis was used to determine the risk factors for NAFLD in postmenopausal women.Results Compared with the control group,the NAFLD group had significantly higher uric acid,fasting blood glucose,triglyceride(TG),glycosylated hemoglobin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),waist circumference,hip circumference,body mass index,waist- hip ratio,and non- HDL- C level(all P < 0.05),and a significantly lower HDL- C and adiponection level(all P < 0.05).Compared with the group with a non- HDL- C level of ≥3.58 mmol / L,the group with a non- HDL- C level of < 3.58 mmol / L had significantly lower levels of blood glucose,total cholesterol,TG,AST,ALT,and low- density lipoprotein cholesterol.The multivariate logistic regression analysis showed that non- HDL- C,serum uric acid,and BMI were risk factors for NAFLD in postmenopausal women.Conclusion Non- HDL- C,along with central obesity,hypertriglyceridemia,and hyperuricemia,is a major risk factor for NAFLD in postmenopausal women.

Clinical effect of ultrasound-guided injection of lauromacrogol versus anhydrous ethanol as sclerotherapy for simple hepatic cyst:a therapeutic effect analysis and comparative study

Dong JinBin, Shi YiHai, Fang WeiBing

2016, 32(6): 1160-1164. DOI: 10.3969/j.issn.1001-5256.2016.06.029

Abstract(388)

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Objective To investigate the clinical effect of ultrasound- guided injection of lauromacrogol versus anhydrous ethanol as the sclerotherapy for simple hepatic cyst,as well as the incidence rates of adverse events and changes in liver function and the results of routine blood test after surgery,and to evaluate the advantages and disadvantages of these two sclerosing agents in the treatment of simple hepatic cyst.Methods A total of 62 patients with simple hepatic cyst who were treated in Department of Gastroenterology,Shanghai Pudong New Area Gongli Hospital were enrolled and randomly divided into observation group(lauromacrogol group) and control group(anhydrous ethanol group).The patients in these two groups were given ultrasound- guided injection of lauromacrogol and anhydrous ethanol,respectively.The incidence rates of intraoperative and postoperative adverse events,cure rate,changes in the serum levels of serum total bilirubin(TBil),alanine aminotransferase(ALT),aspartate aminotransferase(AST),cholinesterase(CHE),and alkaline phosphatase(ALP),and changes in the results of routine blood test within 24 hours after surgery were compared between the two groups.The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups.Results Compared with the control group,the observation group had significantly lower incidence rates of adverse events and a significantly lower blood alcohol concentration(both P < 0.05).The cure rate(1 and 6 months after surgery) and the changes in the results of routine blood test within 24 hours after surgery showed no significant differences between the two groups(both P > 0.05).At 1 week after surgery,the serum levels of ALT and AST showed significant differences between the observation group and the control group for single hepatic cyst(t =- 3.680 and- 5.571,P = 0.001 and < 0.001),while the serum levels of ALT and AST showed significant differences between the observation group and the control group for multiple hepatic cysts(t =- 2.156 and- 4.626,P = 0.040 and < 0.001).Conclusion Ultrasound- guided injection of lauromacrogol or anhydrous ethanol as the sclerotherapy for simple hepatic cyst is safe and effective,with mild injury and a relatively high clinical cure rate.However,compared with anhydrous ethanol,lauromacrogol causes significantly fewer adverse events and milder adverse effects on liver function.As for patients with multiple hepatic cysts and poor hepatic functional reserve,lauromacrogol has obvious superiority and can be used as the first- line sclerosing agent.

2016 No. 6

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2016 No. 6

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