Liver cancer is one of the most common cancers in China. The major risk factors are chronic infections of hepatitis B virus ( HBV) , hepatitis C virus ( HCV) , high exposure to aflatoxins. In addition, exposure to cyanotoxins and some preventable health behaviors are also recognized to contribute to liver cancer development. To relieve the disease burden, primary prevention of etiological interventions is an important strategy. Based on the liver cancer epidemiology in China and the effective evidences and results from the etiological interventions conduced in Chinese population domestically, the following strategies are recommended in the“Strategies of primary prevention of liver cancer: Expert Consensus ( 2018) ”to promote the effective prevention of liver cancer in general population. Immunization with HBV vaccines, including the immune programs to neonates, infants and children born to mothers with different status of HBV infection. Antiviral therapies to the patients with chronic hepatitis B or hepatitis C. Avoiding or reducing the exposure to aflatoxins as well as the cyanotoxins.Changing harmful life style, including quitting smoking and limiting alcohol etc.

Imaging-guided multimode tumor ablation therapy system for malignant hepatic tumors is a therapeutic technique, the performance of which is guided by medical imaging technology, and in the process of alternate conversion between cryoablation and thermal ablation, through accurate control of lesion area temperature and quantitative planning of ablation process, the in situ tumor cells and their circulatory system are thoroughly destroyed, and the active tumor antigens are simultaneously released at a maximum extent, thereby controlling the recurrence and metastasis of malignant hepatic tumors. In order to standardize the operative technique of multimode ablation therapy for malignant hepatic tumors, to enable hospitals at different levels have the ability to carry out the implementation of this therapy and to ensure medical safety and clinical efficacy, the Society of Interventional Therapy of China Anti-cancer Association and the Solid Tumor Theranostics Committee of Shanghai Anti-cancer Association have together organized domestic experts of multiple disciplines, who have been involved in the field of oncotherapy, to make a professional and serious discussion on the subject of“imaging-guided multimode tumor ablation therapy system for malignant hepatic tumors”, focusing on its indications, contraindications and techniques, and the final expert consensus is presented here.

Pancreatic cancer ranks the fifth leading cause of cancer-related death, while the incidence has increased in the recent years.Although available diagnosis and treatment have failed to significantly improve patients' outcome, some advances have been made along with the understanding of the new concepts from oncology over the past several years. Pancreatic Cancer Committee of Chinese Anti-Cancer Association worked out this latest edition of“The Clinical Practice Guidelines for Pancreatic Cancer ( version 2018) ”based on current situation to standardize and improve the diagnosis and treatment of pancreatic cancer in China. This guideline shows algorithms for the diagnosis involving classification and staging, the systematic treatment including surgical resection, systemic chemotherapy and radiation therapy, and the whole-course management model for patients with pancreatic cancer. Different from previous consensus, this guideline contains the discussions and recommendations of 19 hot-issues in the clinical practice for pancreatic cancer in a question-oriented form, such as selection of biopsy and specimen sites, clinical diagnostic criteria for pancreatic cancer, assessment of resectable pancreatic cancer, indications and methods of preoperative biliary drainage, application of laparoscopic surgery, effect of expanding resection on patients' outcomes, dissection of group 16 th lymph node in standard pancreaticoduodenectomy, prognostic value of serum tumor markers, and neoadjuvant therapy in patients with resectable pancreatic cancer, etc. This guideline aims to raise a better comprehensive understanding of the diagnosis and treatment of pancreatic cancer for specialists, and further improving and standardizing the clinical practice in different medical institutions.

Objective To investigate the clinical features and treatment outcome of children with autoimmune hepatitis ( AIH) . Methods A retrospective analysis was performed for the clinical data, liver pathology, treatment outcome, and follow-up data of 10 children with AIH who were treated in Beijing YouAn Hospital, Capital Medical University, from December 2008 to December 2017. Results The children were aged 3-16 years ( median 10 years) , and girls accounted for 70%. Of all patients, 5 had type 1 AIH, and 5 had type 2 AIH; 3 ( 30%) had an acute onset, 2 ( 20%) had a subacute onset, and 5 ( 50%) had a chronic onset. Elevation of aminotransferases was found in 8 children ( 80%) , and elevations of bilirubin, gamma-glutamyl transpeptidase, and immunoglobulin G were found in 7 children ( 70%) , 7 children ( 70%) , and 6 children ( 60%) , respectively. Among the 7 children who underwent liver biopsy, 3 had grade ≥3 liver inflammation, 4 had stage ≥3 liver fibrosis, 5 had interface hepatitis, 5 had plasma cell infiltration, 4 had rosette-like annulation of hepatocytes, and 7 had lymphocyte infiltration. One child died, and one was lost to follow-up; among the other 8 children, 6 had good response, 1 experienced recurrence, and one had poor response. 4 patients with type 2 AIH were treated with glucocorticoids combined with azathioprine, the disease was effectively controlled. Conclusion Children with AIH have diverse clinical manifestations, and some children have serious conditions. Most patients with type 2 AIH need the treatment of glucocorticoids combined with azathioprine.

Objective To investigate the association between MOBAT7 rs641738 polymorphism and the development of NAFLD in the Chinese Han population in Qingdao, China, and to provide a theoretical basis for the prevention and treatment of NAFLD and its complication.Methods A total of 113 NAFLD patients who were treated in Qingdao Municipal Hospital and 74 healthy controls were enrolled in this study. Blood samples were collected, DNA was extracted, and PCR and time-of-flight mass spectrometry were used to determine the genotype of MBOAT7 rs641738. The chi-square test was used to determine whether the distribution of genotypes met the Hardy-Weinberg equilibrium, in order to assess the group representativeness of samples. Clinical data and biochemical results including liver function were collected.The chi-square test was used for comparison of sex and genotype and allele frequencies between the two groups. The independent samples t-test and Wilcoxon rank sum test were used for comparison of continuous data between the two groups. The relative risk of NAFLD associated with gene polymorphisms was expressed as odds ratio ( OR) and 95% confidence interval ( CI) , and the non-conditional logistic regression model was used to calculate OR and 95% CI. Results There was no significant difference in the distribution of CC, CT, and TT genotypes of MBOAT7 rs641738 between the NAFLD group and the control group ( χ2= 0. 157, P = 0. 692) , and there was also no significant difference in the distribution of C and T alleles between the two groups ( χ2= 0. 365, P = 0. 546) . The non-conditional logistic regression analysis showed that the carriers with CC + CT genotypes of MBOAT7 rs641738 had a similar risk of NAFLD as those with CC genotype ( OR = 0. 923, 95% CI: 0. 685-1. 245, P = 0. 692) ; there was also no significant difference after adjustment for sex, age, and body mass index ( corrected OR = 0. 893, 95% CI: 0. 652-1. 223, P = 0. 481) . In the NAFLD group, the carriers with CC + CT genotypes had significantly lower levels of total cholesterol and low-density lipoprotein than those with CC genotype ( t =-2. 348 and-2. 113, P = 0. 021 and0. 037) , and there were no significant differences in the other indices ( all P > 0. 05) . Conclusion There is no significant association between MBOAT7 rs641738 polymorphism and the risk of NAFLD in the Chinese Han population in Qingdao.

Objective To establish a cell model of nonalcoholic fatty liver disease ( NAFLD) by inducing HepG2 cells with oleic acid ( OA) in vitro, and to investigate the effect of salvianolic acid B ( Sal B) on oxidative stress in NAFLD cells and its possible mechanisms via the intervention of NAFLD cells with Sal B. Methods HepG2 cells were divided into control group, model group ( treated with OA) , and intervention group ( treated with OA + Sal B) . The CCK8 method was used to plot the standard cell growth curve, and the optimal drug intervention concentration and intervention time were determined for OA. Oil red O staining was used to observe intracellular lipid accumulation.The levels of alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , triglyceride ( TG) , and total cholesterol ( TC) were measured. A fluorescence microscope was used to measure the content of reactive oxygen species ( ROS) in cells. The TBA method was used to measure the content of malondialdehyde ( MDA) in cells. RT-qPCR and Western blot were used to measure the mRNA and protein expression of SOD2 and SIRT3. After SIRT3 was upregualted with SIRT3 overexpression plasmid, Sal B intervention was performed. Western blot was used to screen out the optimal ratio of transfection reagent to plasmid, and the change in relative expression of SIRT3 and SOD2 was measured. A one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. Results The optimal concentration of OA for modeling was 1 mmol/L. The model group had higher levels of ALT and AST in cell culture supernatant than the control group, and the intervention group had lower levels of ALT and AST than the model group; there were significant differences between the three groups ( F = 1240. 075 and 471. 989, both P < 0. 05) . The model group had higher levels of TG and TC in cells than the control group, and the intervention group had lower levels of TG and TC than the model group; there were significant differences between the three groups ( F = 97. 530 and 39. 824, both P < 0. 01) . The model group had a higher MDA level than the control group, and the intervention group had a significantly lower MDA level than the model group; there was a significant difference between the three groups ( F = 336. 67, P < 0. 01) . There were significant differences in the mRNA expression of SIRT3 and SOD2 between the three groups ( F = 119. 35 and 32. 005, both P < 0. 01) ; the model group had significantly lower mRNA expression of SIRT3 and SOD2 than the control group ( P < 0. 05) , and the intervention group had significantly higher mRNA expression of SIRT3 and SOD2 than the model group ( P < 0. 05) . There were significant differences in the protein expression of SIRT3 and SOD2 between the three groups ( F = 67. 093 and 70. 314, both P < 0. 01) ; the model group had significantly lower protein expression of SIRT3 and SOD2 than the control group ( P < 0. 01) , and the intervention group had significantly higher protein expression of SIRT3 and SOD2 than the model group ( P < 0. 01) . The Western blot showed significant differences in the protein expression of SIRT3 and SOD2 between the empty plasmid+ Sal B group, plasmid group, empty plasmid group, and plasmid + Sal B group ( F = 287. 2 and 179. 8, both P < 0. 01) ; the empty plasmid + Sal B group and plasmid group had significantly higher protein expression of SIRT3 and SOD2 than the empty plasmid group ( P < 0. 05) , and the plasmid + Sal B group had significantly higher protein expression of SIRT3 and SOD2 than the plasmid group ( P < 0. 05) . Conclusion Sal B can reduce lipid accumulation and oxidative stress response in NAFLD cells and thus exert a protective effect on NAFLD cells.

Objective To investigate the risk factors for variceal rebleeding after esophagogastric devascularization and splenectomy in patients with portal hypertension. Methods A retrospective analysis was performed for the clinical data of 244 patients with portal hypertension who were admitted to Beijing YouAn Hospital from April 2010 to September 2015 and underwent esophagogastric devascularization and splenectomy. According to the presence or absence of variceal rebleeding, these patients were divided into non-rebleeding group and rebleeding group. Preoperative, intraoperative, and postoperative clinical data were compared between the two groups. The t-test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed data between groups; the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed for statistically significant variables identified by the univariate analysis. Results Of all 244 patients, 38 ( 15. 6%) experienced variceal rebleeding. The univariate analysis showed that there were significant differences between the two groups in the history of variceal bleeding, preoperative ascites, total bilirubin after surgery, portal venous pressure after devascularization, portal venous pressure before and after splenectomy, and preoperative international normalized ratio ( χ2= 5. 530、4. 120, t = 3. 591、4. 098、2. 516、2. 622、4. 278, P = 0. 016, 0. 026, 0. 008, 0. 002, 0. 022, 0. 012, and 0. 003) . The multivariate logistic regression analysis showed that variceal rebleeding after esophagogastric devascularization and splenectomy was associated with the history of variceal bleeding ( 95% CI:1. 113-13. 704, P = 0. 033) , preoperative ascites ( 95% CI: 1. 257-5. 437, P = 0. 010) , and portal venous pressure after devascularization ( 95% CI: 1. 022-1. 172, P = 0. 010) . Conclusion History of variceal bleeding, preoperative ascites, and portal venous pressure after devascularization are independent risk factors for variceal rebleeding after esophagogastric devascularization and splenectomy.

Objective To investigate the clinical and laboratory features of hemophagocytic lymphohistiocytosis ( HLH) with abnormal liver function as the initial manifestation, and to increase the awareness of this disease. Methods A retrospective analysis was performed for the clinical data of 11 patients who attended the hospital due to abnormal liver function from November 2011 to October 2017 and were diagnosed with HLH, including their medical history, etiology, clinical manifestation, laboratory examination results, and prognosis. Results Of all11 patients, 9 ( 81. 8%) had infection as the etiology of HLH, and as for clinical manifestation, 11 ( 100%) had pyrexia and 9 ( 81. 8%) had splenomegaly. Laboratory examination showed varying degrees of abnormal liver function in all patients, among whom 10 ( 90. 9%) had elevated alanine aminotransferase, 11 ( 100%) had elevated aspartate aminotransferase, 10 ( 90. 9%) had an increase in total bilirubin, 9 ( 81. 8%) had a reduction in albumin, 10 ( 90. 9%) had a reduction in cholinesterase, 9 ( 81. 8%) had an increase in gamma-glutamyl transpeptidase, 10 ( 90. 9%) had an increase in alkaline phosphatase, and 5 ( 83. 3%) had an increase in lactate dehydrogenase. Elevated ferritin in the early course of the disease had the highest sensitivity ( 11/11, 100%) in the diagnosis of this disease, followed by triglyceride >3 mmol/L ( 6/7, 85. 7%) . In the early course of the disease, the positive rates of peripheral cytopenia of two or more lineages and reduced fibrinogen were 54. 5% and 45. 4%, respectively. Dynamic monitoring showed that all patients experienced peripheral cytopenia of two or more lineages. Hemophagocytosis was observed in all patients. NK cell activity and soluble CD25 ( s CD25) level were measured for 7 patients, and they all had a reduction in NK cell activity and an increase in s CD25 level. Conclusion Some diagnostic indices of HLH have a low positive rate in the early course of the disease. For patients with unexplained abnormal liver function and persistent fever, HLH cannot be excluded even if no significant peripheral cytopenia is observed in the early stage. The change in blood cells should be monitored, and laboratory examination including ferritin and blood lipids should be performed as early as possible to assist early diagnosis and treatment.