From 2012 to 2015 the Department of Interventional Radiology of the Affiliated Hospital of Xuzhou Medical University undertook the clinical special research subject” Study on the standardization of interventional diagnosis and treatment of Budd-Chiari syndrome” (No.BL2012021) , a program supported by the Department of Science and Technology of Jiangsu Province.Based on the clinical results of three years research and the scientific summary of the experience from more than 2150 cases accumulated in more than 20 years, the Department of Interventional Radiology of the Affiliated Hospital of Xuzhou Medical University presided over a demonstration meeting about “the standardization of interventional diagnosis and treatment of Budd-Chiari syndrome” on January 14, 2016 in Xuzhou City of Jiangsu Province, China.The scholars from the Expert Committee on Vena Cava Obstruction of Specialized Committee of Endovascology, Chinese Medical Doctor Association, as well as the experts from the related medical fields, including interventional radiology, vascular surgery, pathology and diagnostic imaging, who have been engaged in the study of Budd-Chiari syndrome, attended the meeting, and in the meeting the participants made a full and thorough discussion on the classification and subtypes of Budd-Chiari syndrome.The scholars and experts have unanimously reached a consensus on the subtype definition of Budd-Chiari syndrome:the Budd Chiari syndrome is suggested to be classified into the hepatic vein occlusion subtype, the inferior vena cava occlusion subtype and mixed occlusion subtype, including 10 subtype entities in total.The hepatic vein occlusion subtype includes membranous occlusion of hepatic vein/accessory hepatic vein, segmental occlusion of hepatic vein, extensive occlusion of hepatic vein, and hepatic vein occlusion associated with thrombus formation.The inferior vena cava occlusion subtype includes inferior vena cava membranous occlusion with hole in membrane, inferior vena cava membranous occlusion, segmental occlusion of inferior vena cava, and inferior vena cava occlusion with thrombus formation.The mixed occlusion subtype includes occlusion of hepatic vein and inferior vane cava, and occlusion of hepatic vein and inferior vane cava associated with thrombus formation.

Liver is the most important metabolic organ in the human body.The varying nutrient metabolism and malnutrition (undernutrition) occur in people with chronic liver diseases.Malnutrition and chronic liver damage are reciprocal causation, leading to form a vicious spiral.Whether nutritional support for patients with chronic liver disease (compensated or decompensated cirrhosis, acute on chronic liver failure and chronic liver failure) can play a role in improving the outcome is the focus of our attention.In recent years, there is still lack of large sample, high quality clinical reports in this field.Based on systematic review of major literatures and clinical practice of chronic liver disease in our country, this consensus would provide references for physicians, nurses, dietitians and pharmacists in clinical work related to chronic liver disease.

Objective To investigate the clinical features of patients with hepatitis B virus-related acute-on-chronic liver failure (ACLF) induced by the withdrawal of nucleos (t) ide analogues (NAs) .Methods A retrospective analysis was performed for the clinical data of 865 patients who were admitted to The First Affiliated Hospital of Nanchang University from June 2014 to October 2016 and diagnosed with ACLF.Among these patients, 137 experienced ACLF induced by drug withdrawal (withdrawal group) and 728 experienced ACLF not induced by drug withdrawal (non-withdrawal group) .The type of antiviral drugs, duration of standard antiviral therapy, withdrawal way, time from withdrawal to the development of liver failure, monitoring after withdrawal, underlying liver diseases, and 30-day mortality after progression to ACLF were recorded in detail.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 Of all the 728 patients in the non-withdrawal group, 389 were cured or improved and 339 died or had no response.Of all the 137 patients in the withdrawal group, 69 had chronic viral hepatitis, among whom 40 were cured or improved and 29 died or had no response;68 had liver cirrhosis, among whom 16 were cured or improved and 52 died or had no response;there was a significant difference (χ2=16.81, P<0.001) 6="" 16="" 25="" 32="" 33="" 37="" 47="" 79="" 137="" .of="" all="" the="" patients="" in="" withdrawal="" before="" used="" adefovir="" lamivudine="" combined="" with="" and="" entecavir.of="" when="" they="" developed="" had="" a="" duration="" of="" drug="" 6-12="">12 months.Conclusion Improper withdrawal of NAs can easily induce ACLF.The changes in virologic parameters, liver function parameters, and liver imaging findings should be closely monitored for patients with hepatitis B within 6 months after withdrawal.Underlying liver diseases determine the development and prognosis of ACLF after withdrawal, and long-term standard antiviral therapy is of great importance in patients with liver cirrhosis.

Objective To investigate the incidence rates and features of non-alcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH) , and to provide a theoretical basis for health management and development of intervention and preventive measures in the health management department.Methods Physical examination reports in 2016 were obtained from a large IT company to analyze the incidence rates of NAFL and NASH in different age and sex groups, as well as the correlation with the indices including overweight (or obesity) , triglyceride, fasting blood glucose, blood uric acid, and blood pressure.The chi-square test was used for comparison of rates.Results In all employees, the incidence rates of NAFL and NASH were 4.51% and 17.64%, respectively, and the overall incidence rate of these two diseases was 22.15%.The NAFL-NASH group had significantly higher incidence rates of overweight (or obesity) (91.20% vs 12.68%, χ2=7571.9, P<0.001) , hyperlipidemia (95.06% vs 9.27%, χ2=9373.8, P<0.001) , and hyperuricemia (40.02% vs 10.51%, χ2=1591.90, P<0.001) than the non-NAFL-NASH group.Compared with female employees, male employees had significantly higher incidence rates of NAFL (6.78% vs 1.81%, χ2=190.35, P<0.001) and NASH (25.04% vs 5.06%, χ2=991.90, P<0.001) , as well as significantly higher incidence rates of overweight (or obesity) (40.90% vs 12.97%, χ2=1319.10, P<0.001) , hyperlipidemia (36.00% vs 16.07%, χ2=696.22, P<0.001) , hyperglycemia (2.17% vs 0.64%, χ2=53.82, P<0.01) , hyperuricemia (26.76%vs 1.69%, χ2=1581.10, P<0.001) , and hypertension (6.21% vs 1.22%, χ2=170.94, P<0.001) .Compared with those aged<35 years, the employees aged ≥35 years had significantly higher incidence rates of NAFL (8.13% vs 4.47%, χ2=41.56, P<0.001) and NASH (21.73% vs 16.76%, χ2=24.72, P<0.001) , as well as significantly higher incidence rates of hyperglycemia (2.79% vs1.43%, χ2=17.26, P<0.001) and hypertension (6.33% vs 4.03%, χ2=18.56, P<0.001) while="" there="" were="" no="" significant="" differences="" in="" the="" incidence="" rates="" of="" overweight="" or="" and="" high="" uric="" acid="" between="" these="" two="" groups="" all="" p="">0.05) .Conclusion Although IT employees are young, there is no significant reduction in the incidence rate of nonalcoholic fatty liver disease.The development of NAFL and NASH has the clinical features of overweight (or obesity) , hyperlipidemia, and hyperuricemia, which are commonly seen in male patients.Older employees have higher incidence rates of NAFL, NASH, hyperglycemia, and hypertension than younger employees.

Objective To investigate the application of a modified diagnostic scale in the diagnosis of acute drug-induced liver injury (DILI) .Methods A total of 82 patients with acute DILI who were treated in Beijing You An Hospital, Capital Medical University from January 2011 to December 2015 were enrolled, among whom 52 were enrolled in DILI group and 30 were enrolled in non-DILI group.On the basis of Roussel Uclaf Causality Assessment Method (RUCAM) scale and with reference to Digestive Disease Week Japan scale, three parameters, i.e., “report of liver injury induced by single Chinese materia medica or Chinese patent medicine”, “eosinophil count”, and “drug lymphocyte stimulation test based on Cell Counting Kit-8”, were added to establish a modified diagnostic scale.The RUCAM scale and the modified diagnostic scale were used to evaluate each suspected drug to verify the sensitivity and specificity of this new scale in the diagnosis of DILI.The chi-square test was used for comparison of categorical data between groups.Results There were 75 suspected drugs in the DILI group and 41 suspected drugs in the non-DILI group.Compared with the RUCAM scale, the modified diagnostic scale increased the number of drugs evaluated as “highly probable” and “probable” from 74.7% to 94.7% (χ2=11.554, P=0.001) in the DILI group.In the non-DILI group, only 2 drugs (4.9%) were changed from“possible”to“probable”, and the other drugs were maintained as “possible”, “unlikely”, or“excluded”;the specificity of diagnosis was reduced from 100% to 95.1% (χ2=0.512, P=0.474) .Conclusion Compared with the RUCAM scale, this modified diagnostic scale has an increased sensitivity and a reduced specificity of diagnosis and needs to be further validated in clinical practice.

Objective To investigate the clinical, pathological, and genetic features of erythropoietic protoporphyria, and to enhance the knowledge of liver involvement in this disease.Methods A retrospective analysis was performed for the clinical data of 4 patients with erythropoietic protoporphyria with jaundice as the main manifestation who were hospitalized in Peking Union Medical College Hospital from July 2011 to September 2014, including clinical features, liver pathology, and gene mutations.Results All the children had an acute/subacute onset, with intrahepatic cholestatic jaundice as the main clinical feature.The liver function test showed gamma-glutamyl transpeptidase 425-1152 U/L, alkaline phosphatase 196-356 U/L, total bilirubin 287-485 μmol/L, and direct bilirubin 216-394 μmol/L.All the patients experienced typical skin pain, erythema, and blisters after sunshine in their childhood.Further examinations showed free erythrocyte protoporphyrin 49.8-113.1 μg/g Hb, liver pathological examination showed“Maltese”cross under a polarizing microscope, and mutations at different loci of FECH gene were detected.Conclusion For patients with intrahepatic cholestatic liver disease with typical painful erythema after sunshine, the possibility of erythropoietic protoporphyria should be considered.Skin/liver pathology, erythrocyte protoporphyrin, and FECH gene detection help with the diagnosis of this disease.

Objective To investigate the expression characteristics of peripheral follicular cytotoxic T (Tfc) cells in patients undergoing liver transplantation and their significance in acute rejection.Methods A total of 36 patients who underwent liver transplantation in Liver Transplantation Research Center in 302 Hospital of PLA from December 2015 to February 2017 were enrolled, and among these patients, 11 experienced acute rejection (AR group) and 25 did not experience acute rejection (NAR group) .A confirmed diagnosis of acute rejection was made by pathological diagnosis.Another 20 healthy volunteers in Physical Examination Center were enrolled as controls (HC group) .Flow cytometry was used to investigate the characteristics of Tfc in peripheral blood and its correlation with total B lymphocytes, juvenile B lymphocytes, memory B lymphocytes, plasma cells, and liver function parameters.The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the Mann-Whitney U test was used for further comparison between any two groups;Spearman rank correlation was used for correlation analysis.Results The AR group had a significantly higher frequency of Tfc in peripheral blood than the NAR group (U=60, P=0.008) and the HC group (U=2, P<0.001) , and the NAR group had a significantly higher frequency of Tfc than the HC group (U=40, P<0.001) .The frequency of Tfc was positively correlated with total B lymphocytes and juvenile B lymphocytes (r=0.665 and 0.462, both P<0.001) , negatively correlated with memory B lymphocytes and plasma cells (r=-0.453, P=0.001) , and positively correlated with serum gamma-glutamyl transpeptidase level (r=0.371, P=0.026) .Conclusion There is an increase in the frequency of peripheral Tfc in patients who experience acute rejection after liver transplantation, which is correlated with B lymphocytes and hepatic bile duct injury.Tfc may be involved in acute rejection after liver transplantation.