Microcirculation disturbance and ischemia of the pancreas are important pathophysiological changes in the onset of acute pancreatitis,and organ hypoperfusion is a risk factor for poor prognosis. During the first 12 to 24 hours after admission,fluid resuscitation is the most important medical treatment for the early stage of acute pancreatitis,and timely and rational fluid infusion helps to improve prognosis.However,there lacks high- quality clinical evidence for type of fluid,infusion speed,and monitoring methods,and more randomized controlled trials are needed.

In China,hepatitis B virus( HBV) infection remains a great threat to public health. Preventing the mother- to- child transmission( MTCT) of HBV is the main method to reduce the harm and disease burden caused by viral hepatitis in China. Recent studies have demonstrated that antiviral therapy with tenofovir disoproxil fumarate( TDF) during late pregnancy for mothers can further reduce MTCT of HBV. Meanwhile,Chinese Foundation for Hepatitis Prevention and Control launched the Hepatitis B Shield Project on July 25,2015. This project aims to further reduce or even eliminate MTCT of HBV by means of standard management of pregnant women with HBV via a mobile- health application. At present,China has made great achievements in fighting against HBV. We believe that the remarkable findings of such studies and the launch of the Chinese Shield Project will make the Chinese dream- HBV- free generation come true in the near future.

Objective To quantify the medical expenditure per case of patients with hepatitis B virus- related diseases in Qidong,Jiangsu,China,and analyze its composition and related influencing factors. Methods Cluster sampling was used to select consecutive cases in The People's Hospital of Qidong and Qidong Infectious Diseases Hospital. A total of 217 hospitalized patients of HBV related primary liver cancer,234 hospitalized patients with HBV related B cirrhosis,and 136 hospitalized patients with chronic hepatitis B( CHB) were enrolled,and the total inpatient and outpatient costs( medical costs per case) from January 2010 to December 2012 and related clinical data were collected from the hospital records. Expert consultation was performed to investigate the costs per case of patients with acute hepatitis B,HBs Ag asymptomatic carriers,and occult HBV infection. Costs in different years were converted based on the consumer price index for medical and health consumption in 2014. The independent samples t- test was used for comparison of continuous data between groups,an analysis of variance was used for comparison between multiple groups,and the SNK- q test was used for comparison within each group. Multiple linear regression analysis( stepwise regression) was used to investigate the influencing factors for medical costs per case. Results The medical costs per case of patients with HBV related primary liver cancer,patients with HBV related cirrhosis,and CHB patients from 2010 to 2012 were30183 RMB,22066 RMB,and 15703 RMB,respectively,and the inpatient costs were 29058 RMB,21383 RMB,and 15394 RMB,respectively,which accounted for 96. 3%,96. 9%,and 98. 0% of the medical costs per case. Drug costs of these three groups accounted for55. 0%,73. 4%,and 78. 2% of the medical costs per case,respectively. The number of times of hospitalization( F = 89. 1,67. 7,and11. 5,all P < 0. 001),treatment regimen( F = 21. 8,t =- 2. 1,and t =- 3. 7,P < 0. 001,P = 0. 039,and P < 0. 001),and type of medical insurance( t = 3. 1,2. 6,and 2. 7,P = 0. 002,0. 011,and 0. 012) were influencing factors for medical costs per case,while clinical stage was an influencing factor for medical costs per case only in CHB patients( a multivariate analysis for patients mild,moderate,and severe CHB: β = 1. 238,F = 5. 9,P = 0. 021). The medical costs per case for patients with acute hepatitis B were 5950 RMB,and the annual medical costs for HBs Ag asymptomatic carriers and patients with occult HBV infection ranged from 770 RMB to 1540 RMB. Conclusion The medical costs of HBV related is increasing as the illness progresses. Our results will provide baseline information for the following economic evaluation of vaccination or screening interrention.

Objective To investigate the correlation between peripheral CD4+CXCR5+PD- 1+T cells and serum globulin in chronic hepatitis C( CHC) patients and health volunteers,and to clarify the role of the expression of achaete- scute homologue 2( Ascl2),the transcription factor in peripheral follicular helper T( Tfh) cells,in the process of chronic hepatitis C virus( HCV) infection. Methods A total of 46 previously untreated CHC patients who were admitted to Tangdu Hospital,Fourth Military Medical University,from October 2015 to May 2016 were enrolled,and 32 healthy laboratory technicians and persons who underwent physical examination in our hospital were enrolled as healthy control group. Flow cytometry was used to measure the percentage of Tfh cells in CD4+T cells and the change in its subset( CD4+CXCR5+PD- 1+T cells) in peripheral blood,an automatic biochemical analyzer was used to measure the serum globulin level,and real- time PCR was used to measure the mRNA expression of Ascl2 in Tfh cells. The association between the changes in these parameters and HCV infection was analyzed. The independent samples t- test was used for the comparison of continuous data between groups,and the Pearson correlation analysis was also performed. Results In CHC patients,peripheral Tfh cells were positively correlated with B lymphocytes( r = 0. 582 3,P = 0. 011 2),peripheral B lymphocytes were positively correlated with globulin( r = 0. 450 9,P = 0. 031 6),and Tfh cells were positively correlated with globulin( r = 0. 583 5,P = 0. 038 3). CHC patients had significantly higher mRNA expression of Ascl2 in peripheral Tfh cells than the healthy control group( 1. 019 ± 0. 666 vs 6. 437 ± 5. 776,t = 4. 552,P = 0. 001 9). Conclusion Tfh cells may be involved in the production of serum globulin in CHC patients,and the transcription factor Ascl2 may participate in the differentiation and development of Tfh cells in the process of HCV infection.

Objective To investigate the characteristics of the changes in sex hormone levels in female patients with liver cirrhosis. Methods A total of 30 female patients with liver cirrhosis who visited or were hospitalized in Beijing Ditan Hospital,Capital Medical University from September 2014 to June 2015 were enrolled as liver cirrhosis group,and 30 non- cirrhotic female patients who had no chronic liver disease and visited the hospital due to other diseases or underwent physical examination were enrolled as the control group. The serum levels of estradiol( E_2),follicle- stimulating hormone( FSH),luteinizing hormone( LH),prolactin( PRL),progesterone( PRGE),and testosterone( T) were measured in both groups,and the proportion of menopausal women and sex hormone levels were compared between the two groups. The chi- square test was used for comparison of categorical data between groups,and the t- test was used for comparison of continuous data between groups. Results There were 13 menopausal women( 43. 33%) in the control group and 23( 76. 67%) in the liver cirrhosis group,and the liver cirrhosis group had a significantly higher proportion of menopausal women than the control group( χ~2= 6. 944,P = 0. 008). Compared with the control group,the liver cirrhosis group had a significantly lower level of E_2( t = 4. 489,P < 0. 01) and significantly higher levels of FSH and T( t =- 5. 010 and- 4. 082,both P < 0. 01). Conclusion There are differences in the levels of some sex hormones between female patients with liver cirrhosis and healthy women,and female patients with liver cirrhosis have different characteristics of the changes in sex hormone levels from male counterparts,which may be related to the development and progression of chronic liver diseases. This suggests that sex hormone therapy for patients with liver cirrhosis needs further investigation.

Objective To investigate the clinical effect of endoscopic esophageal variceal ligation( EVL) in the treatment of esophageal variceal bleeding( EVB) in patients with liver cirrhosis. Methods A total of 84 liver cirrhosis patients with EVB who were admitted to The Third People's Hospital of Shenzhen,Guangdong Medical University,from December 2010 to July 2013 were divided into ligation group( group A,treated with EVL combined with somatostatin and esomeprazole) and control group( group B,treated with somatostatin and esomeprazole),with 42 patients in each group. The hemostasis rate,rebleeding rate,incidence rate of complications,and mortality rate were observed in both groups,as well as the variceal eradication rate after EVL and risk factors for early rebleeding. The t- test was used for comparison of normally distributed continuous data between two groups,and an analysis of variance was used for comparison between multiple groups; the Mann- Whitney U test was used for comparison of non- normally distributed continuous data between two groups,the Wilcoxon signed- rank sum test was used for comparison within each group,and the Kruskal- Wallis H test was used for comparison between multiple groups. The chi- square test or Fisher's exact test was used for comparison of categorical data between groups. The Kaplan- Meier method was used to calculate survival rates,and the log- rank test was used to compare survival rates between groups. The logistic regression method was used to investigate the influencing factors for dichotomous data. Results There was a significant difference in the hemostasis rate between groups A and B( 97. 62% vs 80. 95%,P = 0. 029). Compared with group B,group A had significantly lower rebleeding rates in 1-2 years( 15. 38% vs 38. 89%,χ~2= 5. 323,P = 0. 021) and 2- 3 years( 15. 38% vs 48. 48%,χ~2= 10. 448,P = 0. 001). A total of 14patients( 33. 33%) in group A and 7 patients( 16. 67%) in group B experienced adverse events,and 4 patients in group A and 9 patients in group B died within 3 years. Group A had significant improvements in the levels of alanine aminotransferase( ALT) and aspartate aminotransferase at 1 week after treatment( Z =- 2. 177 and- 2. 044,P = 0. 029 and 0. 041). Both groups had significant improvements in prothrombin time activity( PTA),prothrombin time( PT),international normalized ratio( INR),and albumin at 1 week after treatment( group A: Z =- 4. 007,t = 3. 866,Z =- 4. 152,t =- 4. 623,all P < 0. 001; group B: t =- 5. 069,Z =- 3. 870,Z =- 3. 909,Z =-5. 245,all P < 0. 001). There was a significant difference in PTA at 1 week after treatment between the two groups( Z =- 3. 902,P <0. 001). In group A,the overall disappearance rate of varices was 85. 71% and the recurrence rate was 14. 29%,and there was a significant correlation between the Child- Pugh score and diameter of the portal vein( F = 3. 319,P = 0. 047). Symptoms on admission,length of hospital stay,Child- Pugh score,spontaneous bacterial peritonitis,diameter of the portal vein,PT,INR,and ALT were risk factors for early rebleeding after ligation( all P < 0. 05). Conclusion EVL is a safe and effective method for the treatment of EVB in patients with liver cirrhosis and causes few complications.

Objective To investigate the correlation between hepatitis B virus( HBV) drug- resistance gene mutations and hepatocellular carcinoma( HCC). Methods The clinical data of treatment- experienced patients,who underwent examination for HBV drug- resistance gene mutations in Beijing Ditan Hospital from January 1 to December 31,2013,and still had detectable HBV DNA after being treated with nucleos( t) ide analogues,were collected. All the patients were followed up,and the development of HCC was considered as the clinical outcome. The correlation between drug- resistance gene mutations and the development of HCC in patients with HBV infection was analyzed.The chi- square test was used for comparison of categorical between groups,the t- test was used for comparison of continuous data between two groups,and the log- rank test was used for comparison of the incidence of HCC between two groups. Results A total of 227 patients were enrolled in this study. According to the results of the detection of HBV drug- resistance gene mutations,103 patients( 103 /227,45. 37%) had no drug- resistance gene mutations and 124( 124 /227,54. 63%) had drug- resistance gene mutations. There were no significant differences between the mutation group and the non- mutation group in HBV DNA load( 5. 19 ± 1. 60 log10 IU / ml vs 5. 44 ± 1. 75log10 IU / ml,t =- 1. 134,P = 0. 258) and the percentage of patients with liver cirrhosis( 24. 19%( 30 /124) vs 16. 50%( 17 /103),χ~2=2. 026,P = 0. 155). The median follow- up was 28 months( range 4- 58 months),and the incidence of HCC was 7. 49%( 17 /227). Among the patients with HBV drug- resistance gene mutations,12( 12 /124,9. 68%) developed HCC,and among those without HBV drug- resistance gene mutations,5( 5 /103,4. 85%) developed HCC. Among the patients who developed HCC,70. 59%( 12 /17) had HBV drug- resistance gene mutations at baseline; among the patients who did not develop HCC,53. 33%( 112 /210) had HBV drug- resistance gene mutations at baseline. Conclusion The patients with poor control of HBV DNA during antiviral therapy have a comparable incidence of HCC to those not treated with antiviral therapy,with a relatively high risk of developing HCC; the treated patients with HBV drug- resistance gene mutations may have a higher risk of HCC than those without such mutations,which needs to be confirmed by the studies with a longer follow- up period and a larger sample size.

Objective To investigate the clinical effect of ginger- partitioned moxibustion at Zusanli and Yongquan points combined with transarterial chemoembolization( TACE) in the treatment of primary liver cancer. Methods A total of 60 patients initially diagnosed with primary liver cancer with stagnation of liver qi and spleen deficiency who were hospitalized in The Affiliated Tumor Hospital of Guangxi Medical University from December 2013 to December 2014 were enrolled and randomly divided into moxibustion group and control group,with 30 patients in each group. The patients in both groups were given TACE and symptomatic / supportive treatment after TACE,including conventional liver- protecting,stomach- protecting,pain- relieving,and antiemetic treatment. The patients in the moxibustion group were given moxibustion since day 1 before TACE. Moxibustion was performed at bilateral Yongquan and Zusanli points once a day( 30 minutes each time) for 8 consecutive days. The patients' quality of life was recorded at 1 day before and 7 days after surgery,and the postoperative adverse events,traditional Chinese medicine( TCM) syndrome score,and EORTC QLQ- C30 results were compared between the two groups.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 the Mann- Whitney U test was used for comparison of ranked data between groups. Results The moxibustion group had a significantly lower proportion of patients who experienced nausea and vomiting after surgery than the control group( Z = 9. 692,P =0. 046). Among the patients in the moxibustion group,7 achieved significant improvements in TCM syndrome and 16 achieved partial improvements in TCM syndrome,resulting in an overall response rate of 77%; among the patients in the control group,5 achieved significant improvements and 9 achieved partial improvements,resulting in an overall response rate of 47%; there was a significant difference in overall response rate between the two groups( χ~2= 7. 198,P = 0. 027). As for the quality of life,the moxibustion group had significantly better improvements in fatigue,anorexia,nausea / vomiting,and general health compared with the control group( t = 2. 722,2. 530,2. 538,and3. 144,P = 0. 011,0. 017,0. 017,and 0. 004). Conclusion Ginger- partitioned moxibustion at bilateral Zusanli and Yongquan points combined with TACE for the treatment of primary liver cancer can alleviate the adverse effects after TACE and improve patients' TCM syndrome and quality of life. This combined therapy reflects the features and advantages of “local and systemic”combined- modality therapy for primary liver cancer.

Objective To investigate the clinical effect and application experience of radiofrequency ablation in the treatment of hepatic hemangioma. Methods A retrospective analysis was performed for the clinical data of 34 patients with hepatic hemangioma who underwent radiofrequency ablation in Beijing You'an Hospital from January 2011 to June 2015. Among these patients,22 underwent ultrasound- guided percutaneous transhepatic radiofrequency ablation( PRFA),10 underwent laparoscopic radiofrequency ablation( LRFA),and 2 underwent open hepatectomy combined with hepatic hemangioma radiofrequency ablation( OHRFA). The intraoperative and postoperative conditions were compared between patients undergoing different methods of radiofrequency ablation. Results All the patients underwent successful radiofrequency ablation. The mean time of operation in PRFA group,LRFA group,and OHRFA group was 75. 45 ± 27. 33 min,97. 90 ±32. 37 min,and 192. 5 min,respectively,and the median hospital stay in these groups was 3 d,3 d,and 10. 5 d,respectively. There were no serious complications during and after surgery. The complete remission rate at 1 month after surgery was 94. 1%( 32 /34). The patients were followed up for 6- 24 months and no recurrence was observed. Conclusion Radiofrequency ablation is a safe and effective procedure for the treatment of hepatic hemangioma. Strict control of surgical indications and selection of proper radiofrequency ablation approach are of great importance.

Objectives To investigate the early risk factors for pyogenic cholangitis in patients with common bile duct stones. Methods The clinical data of patients with common bile duct stones within 3 days after admission,who visited Qinghai Provincial People' s Hospital from January 2013 to June 2015,were collected,including sex,age,C- reactive protein( CRP),alkaline phosphatase( ALP),gamma-glutamyl transferase( GGT),direct bilirubin( DBil),diameter of the common bile duct,diameter of the stones,oxygen partial pressure,and urobilinogen. The patients were divided into bile duct stone group and bile duct stone- pyogenic cholangitis group. The independent samples 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 the binary logistic regression was used for the screening for risk factors. Results There were significant differences in sex,CRP,ALP,GGT,DBil,diameter of the common bile duct,oxygen partial pressure,and urobilinogen between the bile duct stone group and the bile duct stone- pyogenic cholangitis group( all P < 0. 05). The binary logistic regression analysis showed that sex( OR =4. 24,P < 0. 001),CRP ≥3 mg / dl( OR = 2. 39,P = 0. 030),GGT≥224 U / L( OR = 4. 33,P < 0. 001),ALP ≥198 U / L( OR =2. 76,P = 0. 010),DBil > 73 μmol / L( OR = 2. 57,P = 0. 020),diameter of the common bile duct ≥13 mm( OR = 8. 21,P < 0. 001),oxygen partial pressure < 80 mm Hg( OR = 31. 23,P < 0. 001),and urobilinogen ≥2 +( OR = 2. 28,P < 0. 001) were risk factors for pyogenic cholangitis in patients with common bile duct stones. Conclusion The risk factors for pyogenic cholangitis in patients with common bile duct stones can be detected in early stage,which helps with the selection of surgical timing and procedure.

Objective To investigate the influence of laparoscopic cholecystectomy( LC) versus open cholecystectomy( OC) on postoperative systemic infection and immune response in patients with acute cholecystitis complicated by choleperitonitis. Methods A prospective randomized controlled trial was performed for 45 patients who had a definite diagnosis of acute calculous cholecystitis complicated by choleperitonitis in Shanghai Liqun Hospital from January 2014 to June 2016. According to surgical procedures,the patients were randomized into LC group( 23 patients) and OC group( 22 patients). The length of hospital stay,postoperative complications,and deaths were evaluated in both groups. Blood samples were collected from all patients before surgery and at 1,3,and 6 days after surgery to compare the changes in neutrophil count,serum levels of C- reactive protein( CRP) and interleukin- 6( IL- 6),and erythrocyte sedimentation rate( ESR),as well as the incidence of endotoxemia. 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 LC group had a significantly shorter length of hospital stay than the OC group( 5. 4 ± 2. 7 d vs 10. 2 ± 3. 5 d,t =- 5. 46,P < 0. 001). One patient( 4. 3%) in the LC group and 6( 27. 3%) in the OC group experienced peritoneal abscess after surgery,and there was a significant difference in the incidence rate of complications between the two groups( χ2= 4. 77,P = 0. 03). In all patients,the mortality rate was 17. 8%( 8 /45),with 1( 4. 3%) in the LC group and 7( 31. 8%) in the OC group,and there was a significant difference between the two groups( χ2= 5. 16,P = 0. 02). Of all patients in the OC group,4died of peritoneal abscess,1 died of pulmonary embolism,and 1 died of myocardial infarction; of all patients in the LC group,1 died of myocardial infarction. There were no significant differences in inflammatory markers before surgery between the two groups. At 1,3,and 6 days after surgery,the LC group had significantly lower neutrophil count,serum levels of CRP and IL- 6,and ESR( except at 1 day after surgery) than the OC group( all P < 0. 05). Furthermore,the OC group had a significantly higher concentration of endotoxin than the LC group( P < 0. 05),but the level of endotoxin returned to normal at 2 days after surgery in both groups. Conclusion Compared with OC,LC can reduce the probability of endotoxemia,help with the establishment of immunological defense,and reduce the risk of postoperative infection.

Objective To investigate the clinical effect of anatomical hepatectomy in the treatment of intrahepatic bile duct stones. Methods A retrospective analysis was performed for the clinical data of 117 patients with intrahepatic bile duct stones who underwent hepatectomy in The Affiliated Hospital of Zunyi Medical College from July 2013 to December 2015. Among these patients,66 underwent anatomical hepatectomy( anatomical hepatectomy group) and 51 underwent irregular hepatectomy( irregular hepatectomy group). The time of operation,intraoperative blood loss,volume of drainage on the day after surgery,serum levels of aspartate aminotransferase( AST),alanine aminotransferase( ALT),and total bilirubin( TBil),and length of postoperative hospital stay were recorded,as well as the patients' general status,liver function parameters,and abdominal ultrasound,and CT or MRI findings from 2 months to 2 years after discharge,to observe the presence or absence of residual stones or stone recurrence. 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 irregular hepatectomy group,the anatomical hepatectomy group had a significantly longer time of operation( 303. 1 ± 51. 6 min vs 246. 5 ± 36. 2 min,t = 6. 963,P < 0. 01),but it had significantly less intraoperative blood loss( 467. 9 ± 80. 6 ml vs 565. 9 ± 92. 0 ml,t = 6. 026,P < 0. 01),a significantly lower volume of drainage on the day after surgery( 212. 6 ± 54. 9 ml vs 358. 3 ± 69. 4 ml,t = 12. 682,P < 0. 01),a significantly lower incidence rate of complications( 10. 6% vs 25. 5%,χ~2= 4. 497,P = 0. 034),a significantly lower rate of postoperative residual stones( 4. 5% vs15. 7%,χ~2= 4. 192,P = 0. 041),and a significantly shorter length of hospital stay( 13. 4 ± 2. 6 d vs 21. 9 ± 3. 2 d,t = 15. 427,P<0. 01). On day 3 after surgery,the anatomical hepatectomy group had significantly lower serum levels of ALT,AST,and TBil than the irregular hepatectomy group( AST: 62. 7 ± 25. 4 U / L vs 114. 8 ± 37. 0 U / L,t = 9. 024,P < 0. 01; ALT: 91. 3 ± 35. 7 U / L vs 149. 5 ± 53. 3 U / L,t =7. 067,P < 0. 01; TBil: 31. 8 ± 10. 4 μmol / L vs 51. 3 ± 14. 3 μmol / L,t = 8. 531,P < 0. 01). Conclusion Under the premise of preserving the function of the residual liver,anatomical hepatectomy can completely remove the lesions and has the features of low residual stone rate,low recurrence rate and rapid postoperative recovery. It has a better clinical effect than irregular hepatectomy.

Objective To investigate the clinical effect of early bowel- relaxing treatment and drainage in the treatment of severe acute pancreatitis( SAP). Methods A retrospective analysis was performed for the clinical data of 52 patients with SAP who were admitted to Department of Hepatopancreatobiliary Surgery,Zhuzhou Central Hospital,from January 2009 to January 2015,and these patients were divided into conventional treatment group with 22 patients and early bowel- relaxing / drainage group with 30 patients. The incidence of multiple organ dysfunction syndrome and abdominal compartment syndrome within 2 weeks,time to intra- abdominal pressure reduced to below 15 cm H2 O,time to gastrointestinal function recovery,pancreatic infection rate,and mortality rate were compared between the two groups. The independent samples t- test was used for comparison of continuous data between the two groups,and the chi- square test was used for comparison of categorical data. Results Compared with the conventional treatment group,the early bowel- relaxing / drainage group had significant reductions in the incidence rates of multiple organ dysfunction syndrome( 31. 8% vs 10. 0%,χ2= 3. 89,P = 0. 049) and abdominal compartment syndrome( 22. 7% vs 3. 3%,χ2= 4. 68,P = 0. 031) within 2 weeks,pancreatic infection rate( 40. 9% vs 13. 3%,χ2= 5. 15,P= 0. 023),and mortality rate( 22. 7% vs 3. 3%,χ2= 4. 68,P = 0. 031). Compared with the conventional treatment group,the early bowel- relaxing / drainage group had significantly shortened time to intra- abdominal pressure reduced to below 15 cm H2 O,time to bowel sound recovery,and time to the recovery of passing of flatus and defecation( t = 1. 02,6. 67,and 2. 13,all P < 0. 01). Conclusion In the early stage of SAP,bowel- relaxing treatment and drainage can effectively reduce intra- abdominal hypertension,protect vital organ function,alleviate the condition of SAP,reduce the incidence of complications,and thus significantly improve the prognosis of SAP.

Objective To investigate the clinical effect of ulinastatin in preventing pancreatitis after endoscopic retrograde cholangiopancreatography( ERCP). Methods The Cochrane Library,Pub Med,EMBASE,CNKI,VIP,and Wanfang Data were searched for randomized controlled trials( RCTs) on ulinastatin for the prevention of post- ERCP pancreatitis published from 1970 to June 2016. Two researchers selected RCTs,extracted data,and evaluated methodological quality independently,and Rev Man 5. 3 software was used for the meta- analysis. The chi- square test was used for the heterogeneity analysis of RCTs included,and the funnel plots were used to evaluate publication bias. Results A total of six RCTs with 923 patients were included in this analysis. Compared with the placebo,ulinastatin had significantly better effects in preventing post- ERCP pancreatitis( OR = 0. 26,95% CI: 0. 13- 0. 53,P = 0. 000 2),hyperamylasemia( OR = 0. 47,95% CI: 0. 33- 0. 67,P < 0. 001),and abdominal pain( OR = 0. 56,95% CI: 0. 34- 0. 91,P = 0. 020). Compared with gabexate,ulinastatin had similar effects in preventing post- ERCP pancreatitis,hyperamylasemia,and abdominal pain( P = 0. 52,0. 13,and 0. 79);low- dose ulinastatin also had similar effects as gabexate in preventing post- ERCP pancreatitis and hyperamylasemia( P = 0. 49 and0. 25). The funnel plots based on the effect of ulinastatin in preventing post- ERCP pancreatitis were slightly asymmetric,which suggested the presence of publication bias. Conclusion Ulinastatin( ≥15 × 104U) can effectively prevent post- ERCP pancreatitis,hyperlipidemia,and abdominal pain in the general population and it is recommended to start using this drug before surgery.

Objective To investigate the risk factors for pancreatic fistula after pancreaticoduodenectomy( PD),and to provide a reference for the prevention and treatment of pancreatic fistula after PD in clinical treatment. Methods A retrospective analysis was performed for the clinical data of 75 patients who underwent PD in Huadong Hospital,Fudan University from January 2014 to December 2015. The influencing factors for pancreatic fistula were analyzed,and the incidence rate of pancreatic fistula was compared between patients undergoing laparoscopic or open PD. The chi- square test or Fisher's exact test was used for univariate analysis,and the logistic regression model was used for multivariate analysis. Results Of all patients,21( 28%) had pancreatic fistula,among whom 7 had grade A pancreatic fistula,11 had grade B pancreatic fistula,and 3 had grade C pancreatic fistula. The univariate analysis showed that age,presence or absence of pancreatic duct dilatation,and amylase level in drainage fluid on day 1 after surgery were influencing factors for pancreatic fistula after surgery( χ2=6. 868,12. 990,and 4. 383,P = 0. 009,P < 0. 001,and P = 0. 004). The multivariate analysis showed that age ≥65 years( 95% CI:2. 551- 187. 550,P = 0. 005) and absence of pancreatic duct dilatation( 95% CI: 5. 210- 487. 321,P = 0. 001) were risk factors for pancreatic fistula after surgery. An amylase level of ≥5000 IU / L in drainage fluid on day 1 after surgery had a certain predictive value for the development of pancreatic fistula after surgery. There was no significant difference in the incidence rate of pancreatic fistula between patients undergoing laparoscopic or open PD( 18. 8% vs 30. 5%,P > 0. 05). Conclusion As for patients with an age of ≥65 years,absence of pancreatic duct dilatation,and an amylase level of ≥5000 IU / L in drainage fluid on day 1 after surgery,treatment should be given as soon as possible to avoid the development of pancreatic fistula.

Objective To investigate the safety and clinical effect of fast track surgery in pancreaticoduodenectomy,one of the most complex surgeries in general surgery. Methods The Chinese and foreign databases were searched for articles on the application of fast tract surgery in pancreaticoduodenectomy published from January 1994 to April 2016. Two researchers evaluated the quality of the articles which met the inclusion criteria and extracted related data. Stata 12. 0 software was used to analyze the overall incidence rate of complications and the incidence rates of pancreatic leakage and gastrointestinal emptying disorder,and the Begg rank correlation test and Egger linear regression method were used to investigate publication bias. Results The fast track surgery group had a significantly lower overall incidence rate of complications than the conventional group( RR = 0. 748,95% CI: 0. 680- 0. 824,P < 0. 001). There was no significant difference in the incidence rate of pancreatic leakage between the two groups( RR = 0. 894,95% CI: 0. 734- 1. 089,P = 0. 266). The fast track surgery group had a significantly lower incidence rate of gastrointestinal emptying disorder than the conventional group( RR = 0. 520,95% CI: 0. 400- 0.670,P < 0. 001). Conclusion Fast track surgery is safe and effective in pancreaticoduodenectomy,but the application of some measures in fast track surgery still needs more medical evidence.

Objective To investigate the value of preoperative contrast- enhanced ultrasound( CEUS) in evaluating peripancreatic vascular invasion and resectability of pancreatic cancer. Methods A retrospective analysis was performed for the clinical data of 25 patients with pancreatic cancer confirmed by surgical exploration or postoperative pathological examination,who visited Shengjing Hospital of China Medical University from December 2012 to October 2014,and all the patients underwent CEUS before surgery. The relationship between the lesion and the peripancreatic vessels was observed,the degree of invasion was evaluated,and related scores were measured. These results were compared with the results of intraoperative exploration and postoperative pathological results. The rate of peripancreatic vascular invasion,sensitivity and specificity of preoperative CEUS in evaluating the degree of peripancreatic vascular invasion,and sensitivity,specificity,positive predictive value,negative predictive value,overall coincidence rate,and Youden index of CEUS in evaluating the resectability of pancreatic cancer were calculated. Results Preoperative CEUS showed that 42 vessels were invaded,while intraoperative exploration showed41 vessels were invaded. A total of 17 patients were considered resectable by CEUS,while 15 patients were considered resectable by intraoperative exploration. In evaluating the resectability of pancreatic cancer,CEUS had a sensitivity of 93. 3%,a specificity of 70. 0%,an overall coincidence rate of 84. 0%,a false positive rate of 30. 0%,a false negative rate of 6. 7%,a positive predictive value of 82. 4%,a negative predictive value of 87. 5%,and a Youden index of 0. 633. Conclusion Compared with intraoperative exploration,CEUS has higher sensitivity and specificity in evaluating the degree of peripancreatic vascular invasion and higher sensitivity,specificity,and coincidence rate in evaluating the resectability of pancreatic cancer. CEUS can accurately evaluate the degree of peripancreatic vascular invasion and provides a new method for preoperative evaluation of the resectability of pancreatic cancer.

Objective To investigate the expression of neural precursor cell- expressed,developmentally down- regulated 9( NEDD9) in pancreatic cancer tissues and adjacent tissues and its association with the progression and prognosis of pancreatic cancer. Methods A total of 98 patients with pancreatic cancer who were treated in The Third People's Hospital of Wuxi from August 2005 to December 2010 were enrolled,and the samples of pancreatic cancer tissues and adjacent tissues were collected. Immunohistochemistry was used to measure the expression of NEDD9 in pancreatic cancer tissues and adjacent tissues. The chi- square test was used for comparison of categorical data between groups. Results The high expression rate of NEDD9 in pancreatic cancer tissues was significantly higher than that in adjacent tissues( 57. 1% vs 41. 8%,χ2= 4. 592,P = 0. 032). The expression of NEDD9 in pancreatic cancer tissues was significantly associated with TNM stage,degree of tumor differentiation,and lymph node metastasis( χ2= 45. 02,20. 41,and 36. 21,all P < 0. 001) and not associated with sex,age,tumor location,or presence or absence of liver metastasis( all P > 0. 05). Conclusion NEDD9 may play a role in the progression and invasion / metastasis of pancreatic cancer and can be used as a prognostic marker and a therapeutic target for pancreatic cancer.

Objective To investigate the expression of cysteinyl leukotriene receptor- 1( Cys LTR- 1) in pancreatic cancer tissue and its association with clinical features and prognosis. Methods A total of 42 patients with pathologically confirmed pancreatic cancer who were admitted to Central Hospital of Huludao from January to October,2015 were enrolled,and cancer and adjacent tissues were collected. Real-time PCR was used to measure the relative mRNA expression of Cys LTR- 1 in these tissues,and the patients were followed up for 1 year.The t- test was used for comparison of continuous data between groups; an analysis of variance was used for comparison between multiple groups,and the least significant difference t- test was used for comparison between any two groups. The multivariate logistic regression analysis was used to determine influential factors for the prognosis of patients with pancreatic cancer. Results The cancer tissues had significantly higher relative mRNA expression of Cys LTR- 1 than adjacent tissues( 0. 037 1 ± 0. 020 5 vs 0. 016 8 ± 0. 011 4,t = 6. 58,P<0. 001). The relative mRNA expression of Cys LTR- 1 was associated with TNM stage( t = 2. 731,P = 0. 009),degree of tumor differentiation( F = 10. 537,P < 0. 001),and lymph node metastasis( t = 3. 408,P = 0. 002). During the 1- year follow- up,17 patients died and25 survived; the patients who died had significantly higher relative mRNA expression of Cys LTR- 1 than those who survived( 0. 045 6 ±0. 021 7 vs 0. 031 3 ± 0. 019 8,t = 2. 21,P = 0. 03). The logistic regression analysis showed that TNM stage( OR = 6. 92,95% CI: 1. 30-36. 82,P = 0. 02),degree of tumor differentiation( OR = 5. 71,95% CI: 1. 44- 22. 62,P = 0. 01),and lymph node metastasis( OR =9. 62,95% CI: 2. 23- 41. 46,P < 0. 001) were prognostic factors for pancreatic cancer. After adjustment for age,sex,TNM stage,degree of tumor differentiation,tumor location,and lymph node metastasis,the mRNA expression of Cys LTR- 1 was still a prognostic factor for patients with pancreatic cancer( OR = 1. 11,95% CI: 1. 07- 1. 15,P = 0. 03). Conclusion Cys LTR- 1 is involved in the development and progression of pancreatic cancer and can be used as a new molecular marker for prognostic evaluation in patients with pancreatic cancer.

Objective To investigate the clinical effect and safety of Kezhi capsules in the treatment of nonalcoholic steatohepatitis( NASH). Methods A total of 100 patients with NASH who visited The Eighth People's Hospital of Shanghai from November 2013 to December 2015 were enrolled and randomly divided into treatment group and control group,with 50 patients in each group. The patients in the treatment group were treated with Kezhi capsules and those in the control group were treated with polyene phosphatidylcholine capsules. The course of treatment was 24 weeks for each group. The changes in liver function,blood lipid,and liver / spleen CT ratio after treatment were observed in both groups. The two- independent- samples t test was used for comparison of continuous data between groups,and the paired- samples t test was used for comparison of continuous data within each group. The chi- square test was used for comparison of categorical data between groups. Results After treatment,the treatment group and the control group had significant improvements in the levels of aspartate aminotransferase( 49. 2 ± 21. 7 U / L vs 119. 5 ± 44. 2 U / L,t = 10. 0,P < 0. 01; 52. 4 ± 33. 1 U / L vs 115. 2 ± 48. 3 U / L,t = 7. 6,P < 0. 01),alanine aminotransferase( 41. 8 ± 14. 8 U / L vs 92. 8 ± 42. 1 U / L,t = 8. 1,P < 0. 01; 42. 9 ± 16. 6 U / L vs 95. 3 ± 40. 4 U / L,t = 8. 5,P < 0. 01),gamma- glutamyl transpeptidase( 52. 3 ± 23. 7 U / L vs 168. 4 ± 85. 9 U / L,t = 9. 2,P < 0. 01; 54. 8 ± 30. 2 U / L vs177. 6 ± 88. 7 U / L,t = 9. 3,P < 0. 01),triglyceride( TG)( 1. 78 ± 1. 01 mmol / L vs 3. 52 ± 2. 35 mmol / L,t = 4. 8,P < 0. 01; 2. 51 ±1. 08 mmol / L vs 3. 65 ± 2. 43 mmol / L,t = 3. 0,P = 0. 02),total cholesterol( TC)( 3. 81 ± 1. 28 mmol / L vs 6. 13 ± 5. 22 mmol / L,t =3. 0,P = 0. 02; 3. 63 ± 1. 39 mmol / L vs 5. 27 ± 4. 54 mmol / L,t = 2. 6,P = 0. 03),and liver / spleen CT ratio( 0. 94 ± 0. 16 vs 0. 74 ±0. 18,t = 5. 8,P < 0. 01; 0. 89 ± 0. 13 vs 0. 70 ± 0. 20,t = 5. 6,P < 0. 01). There were significant differences in these parameters between the two groups. At the end of treatment,the treatment group had significantly greater reductions in TC and TG levels than the control group( t = 3. 5 and 2. 8,both P < 0. 01). Conclusion Kezhi capsules can effectively improve liver function,reduce blood lipids,and reduce the degree of fatty degeneration of the liver,without significant toxic and side effects.

Objective To investigate the chronological changes in the clinical features of autoimmune liver disease( AILD) at initial diagnosis,presence or absence of complications of liver cirrhosis at initial diagnosis,initial diagnostic methods,and results of liver biopsy,to summarize the chronological changes in the clinical features of AILD at initial diagnosis,and to provide a basis for early screening and standardized management. Methods A retrospective analysis was performed for the clinical data of 514 AILD patients who were initially diagnosed at Department of Gastroenterology,Tianjin Medical University General Hospital,from January 2000 to December 2015. According to the time of diagnosis,they were divided into January 2000 to December 2007 group( 86 patients) and January 2008 to December 2015 group( 428 patients). The patients' age at initial diagnosis,disease features,diagnostic methods,proportion of patients with liver cirrhosis and its complications at initial diagnosis,extrahepatic autoimmune diseases,and pathological features on liver biopsy were compared between the two groups. 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 the corrected chi- square test or Fisher's exact text was used for the categorical data that cannot be analyzed by the chi- square test. Results Among the 514 patients with AILD,326 had autoimmune hepatitis( AIH),106 had primary biliary cholangitis( PBC),62 had PBC- AIH overlap syndrome,2 had primary sclerosing cholangitis,and 18 had Ig G4- associated pancreaticobiliary diseases. With December 31,2007 as the time dividing point,there was a significant difference in the proportion of patients with liver cirrhosis at initial diagnosis between the two groups( 83. 72% vs 29. 91%,χ2= 84. 996,P < 0. 05). Of all patients,204( 39. 69%) were found to have abnormal liver function during physical examination( no symptoms at initial diagnosis),among whom there were 13 male( 6. 4%) and 191 female( 93. 6%) patients; there was an increased proportion of asymptomatic female patients who visited the hospital due to elevation of aminotransferases found by physical examination after 2007( 22. 4% vs 50. 3%,χ2= 16. 525,P < 0. 01). Of all patients,97( 18. 87%) were transferred due to comorbidity with other diseases from related departments( such as Department of Rheumatology & Immunology),among whom 31( 32. 0%) were male and 66( 68. 0%) were female; there was a significant difference in the proportion of female patients transferred from related departments before and after 2007( 25. 4% vs 14. 0%,χ2= 4. 640,P = 0. 031). There was also a significant difference in the proportion of female patients who had gastrointestinal bleeding at initial diagnosis before and after 2007( 31. 3% vs4. 0%,χ2= 51. 184,P < 0. 01). Among the 171 AILD patients who had other extrahepatic autoimmune diseases,59( 34. 5%) had autoimmune thyroid disease. Among the 244 AILD patients who underwent liver biopsy from 2006 to 2015,there was a significant difference in the proportion of patients with hepatic fibrosis / liver cirrhosis between 2006- 2007,2008- 2009,2010- 2011,2012- 2013,and 2014- 2015( χ2= 15. 487,P = 0. 004); there was a significant difference in the proportion of AILD patients with hepatic fibrosis / liver cirrhosis diagnosed by liver biopsy between 2014- 2015 and 2006- 2007( 25. 5% vs 70. 0%,χ2= 6. 728,P = 0. 009). Conclusion In patients with AILD,there is a significant increase in the proportion of patients who visit the hospital initially due to abnormal liver function found by physical examination,but the age at initial diagnosis tends to decrease. The incidence of liver cirrhosis and complications at initial diagnosis is decreasing year by year. It is suggested that in patients with elevation of aminotransferases found by physical examination,standardized immunological examination and early diagnosis should be taken seriously in order to improve their prognosis.

Objective To investigate the clinical features of patients with pure red cell aplasia( PRCA) associated with human parvovirus B19( HPV B19) infection after liver transplantation. Methods The clinical data of 420 patients who underwent liver transplantation in 302 Hospital of PLA from July 2007 to July 2016 and were followed up regularly were collected,and among these patients,five had a progressive reduction in hemoglobin( Hb) level within a short period of time. Bone marrow cytological examination showed erythropoiesis disorders and positive HPV B19 Ig M,and the patients were diagnosed with PRCA after the exclusion of other causes. The patients were given human gamma- globulin,glucocorticoids,and adjustment of immunosuppressants. The patients' clinical manifestations during treatment and the changes in reticulocyte count( RC),Hb,white blood cell count( WBC),platelet count( PLT),and myelogram findings determined by peripheral blood cell analysis were observed,as well as the changes in liver and renal function parameters. Results After the multimodality therapy using human gamma- globulin,glucocorticoids,and red blood cell infusion,the five patients had significant alleviation in the symptoms of weakness,short breath,and dizziness,and the peripheral blood cell analysis showed recovery of Hb and RC,suggesting that anemia was corrected. Conclusion As for patients with PRCA associated with HPV B19 infection,early diagnosis and treatment with human gamma-globulin and glucocorticoids can achieve a good therapeutic effect.

Objective To investigate the changes in lymphocyte subsets and natural killer( NK) cells before splenectomy in patients with primary immune thrombocytopenia( ITP) who have no response to corticosteroid therapy or experience recurrence after drug withdrawal,as well as their association with early ITP recurrence after splenectomy. Methods A total of 32 patients with ITP who were treated with splenectomy in The People's Hospital of Bao'an District from January 2009 to December 2015 and followed up for 3- 60 months were enrolled and divided into early recurrence group( with recurrence within 6 months after splenectomy and platelet count < 30 × 109/ L) and response group( platelet count > 30 × 109/ L after splenectomy,two- fold increase compared with before splenectomy) according to the outcome of splenectomy. Flow cytometry was used to measure the percentages of peripheral blood lymphocyte subsets( CD3+CD4+,CD3+CD8+,CD3+CD4+/ CD3+CD8+,and CD3-CD19+) and CD56+CD16+NK cells before splenectomy. The t- test was used for comparison of continuous data between groups and the chi- square test or Fisher's exact test was used for comparison of categorical data between groups. Results There were 11 patients( 11 /32,34. 4%) in the early recurrence group and 21( 21 /32,65. 6%) in the response group. Compared with the response group,the early recurrence group had a significantly lower percentage of CD3+CD4+( 21. 7% ± 5. 4% vs 32. 6% ± 4.1%,t = 6. 39,P = 0. 015) and a significantly lower CD3+CD4+/ CD3+CD8+ratio( 0. 65 ± 0. 21 vs 1. 29 ± 0. 36,t = 3. 92,P = 0. 003),as well as a significantly higher percentage of 〗CD3+CD8+T cells( 34. 5% ± 5. 9% vs 26. 8% ± 6. 6%,t =- 3. 20,P = 0. 030) before splenectomy. There were no significant differences in CD3-/ CD16+CD56+ratio and the percentage of CD3-CD19+T cells between the two groups( both P > 0. 05). Conclusion ITP patients with a low percentage of CD3+CD4+T cells and a low CD3+CD4+/ CD3+CD8+ratio before splenectomy tend to experience recurrence after surgery,which suggests that abnormal T lymphocyte subsets can be used as one of the reference indices for predicting the clinical outcome of splenectomy in ITP patients.

Objective To investigate a new type of HFE gene mutation in a family with hereditary hemochromatosis( HH). Methods The analysis of HFE gene was performed for one patient with a confirmed diagnosis of HH and five relatives. Blood genomic DNA was extracted and PCR multiplication was performed for the exon and intron splice sequences of related HFE,HJV,HAMP,transferrin receptor 2( TfR2),and SLC40A1 genes. After agarose gel electrophoresis and purification,bi- directional direct sequencing was performed to detect mutation sites. Results The proband had abnormal liver function and increases in serum iron,total iron binding capacity,serum ferritin,and transferrin saturation,as well as T→C homozygous mutation in the fourth base of intron 2 in the intervening sequence of the exon EXON2 of HFE gene( IVs 2 + 4T→C,C / C homozygous,splicing,abnormal). There were no abnormalities in HJV,HAMP,TfR2,and SLC40A1 genes. The proband's son had the same homozygous mutation,three relatives had heterozygous mutations,and one relative had no abnormal mutations. Conclusion Gene detection plays an important role in the diagnosis of hemochromatosis,and IVs 2 + 4T→C mutation may be a new pathogenic mutation for HH in China.

Early diagnosis of hepatocellular carcinoma( HCC) using tumor markers is very important for long- term survival. This article elaborates on the value and high sensitivity and specificity of protein induced by vitamin K absence or antagonist- Ⅱ( PIVKA- Ⅱ) in the early diagnosis,prognostic evaluation,and recurrence prediction of HCC. Its combination with alpha- fetoprotein can significantly increase the early diagnostic rate of HCC. It is pointed out that dynamic measurement of PIVKA- Ⅱ level can assist the correct evaluation of the development,progression,invasion / metastasis,and recurrence of HCC and can be used as an important marker for the prognosis of HCC.

Liver and gastrointestinal tumors greatly threaten human health and have poor therapeutic outcomes and prognosis. Tumor necrosis factor- alpha- induced protein 8- like 2( TIPE2) can negatively regulate innate immunity and adaptive immunity and maintain immune homeostasis. Recent studies have found that TIPE2 can affect various signaling pathways and thus exerts an inhibitory effect on the development and progression of tumors. This article briefly introduces the structure and function of TIPE2 and its regulatory effect on tumor- related signaling pathways such as Ras,Ral,and Rac and downstream molecules,as well as the role of TIPE2 in liver and gastrointestinal tumors,related signaling pathways,and research advances.

Intrahepatic cholangiocarcinoma is an uncommon malignant tumor,and its incidence has been increasing in the recent 30 years.Since patients have no specific clinical manifestations in early stage,the diagnosis of this disease is often very difficult,with a low rate of radical resection in late stage and poor prognosis. Therefore,as for patients with intrahepatic cholangiocarcinoma,early screening and diagnosis is of vital importance. Imaging examination is an important method for the diagnosis of intrahepatic cholangiocarcinoma,and when combined with laboratory markers and pathological examination,it can increase diagnostic rate and reduce the rate of missed diagnosis. It is important in clinical practice to select reasonable methods based on the patient's actual condition.

Endoscopic retrograde cholangiopancreatography( ERCP) has become an important method for the diagnosis and treatment of cholangio- pancreatic duct diseases. Post- ERCP pancreatitis( PEP) is the most common complication and its incidence has increased up to 40% in recent years. The prevention of PEP has always been a hot topic in clinical research. This article reviews the research advances in the pharmacological prevention of PEP and points out that controlled clinical trials with a large sample size are still needed to investigate the effect of preventive drugs,and further studies should focus on optimal medication time,route of administration,and dose. In addition,demographic features of populations from different countries and different age groups should be taken into consideration.

Severe acute pancreatitis( SAP) is a special type of acute pancreatitis,and misdiagnosis and mistreatment can easily cause serious complications,which makes it a tough disease in clinical practice. In recent years,integrated traditional Chinese and Western medicine therapy for SAP has been explored and great progress has been achieved with several new highlights. It has special advantages in clinical treatment. However,conventional methods are still used for the treatment of SAP,and a lack of treatment classification and literature review limits its efficiency and quality in clinical treatment. This article summarizes the effective treatment modalities for SAP from the perspectives of Western medicine and traditional Chinese medicine,in order to provide a reference for the development in the clinical treatment of SAP.