The development and progression of chronic hepatitis are closely associated with the immune function of human body, and T cells play an important role in this process. Costimulatory molecules OX40/OX40 L are involved in the activation of T cells. This article reviews the molecular features of OX40/OX40 L, the mechanism of action of OX40/OX40 L in immune regulation, and the association between OX40/OX40 L and chronic liver diseases.

Transjugular intrahepatic portosystemic shunt ( TIPS) has been widely used in the treatment of the complications of portal hypertension, and in recent years, with a deepened understanding of TIPS, covered stents have been further developed and applied in clinical practice, among which a special stent for TIPS, Viatorr covered stent, has become a focus of attention. This article reviews the application and effect of Viatorr stent and points out that Viatorr stent can establish intrahepatic shunt and thus significantly improve shunt patency rate.Meanwhile, it can reduce the risk of repeated intervention and rebleeding without increasing the incidence rate of hepatic encephalopathy and improve patients' quality of life.

Cirrhotic patients often have an increased cardiac load and impaired myocardial systolic and diastolic functions, which further cause abnormal myocardial structure, and such patients may develop the symptoms of heart failure under stress, which is called cirrhotic cardiomyopathy ( CCM) . This disease attracts little attention due to its insidious onset. B-type natriuretic peptide ( BNP) is secreted by cardiomyocytes and can sensitively reflect the change in ventricular function, and it is widely used in the pathogenesis, treatment, and prognosis of cardiovascular diseases. BNP plays an important role in the diagnosis and treatment of respiratory and renal diseases, and meanwhile, recent studies have shown a significant increase in BNP in cirrhotic patients, which is closely associated with the severity of cirrhotic ascites, varices, and liver dysfunction. BNP can also reveal myocardial injury when there are no obvious symptoms of CCM. This article reviews the expression of BNP and its significance in patients with CCM.

Chenodeoxycholic acid ( CDCA) is a primary bile acid and is involved in the digestion, transportation, and absorption of nutriments in the hepatobiliary system. Farnesoid X receptor ( FXR) is a member of the nuclear receptor superfamily. In vivo and in vitro studies have demonstrated that CDCA is the natural ligand for FXR and involved in many cell signaling pathways, and it can inhibit the proliferation and induce the apoptosis of hepatobiliary tumor cells. This article reviews the association between CDCA and hepatobiliary tumor.

Autoimmune hepatitis ( AIH) is an immune-mediated liver parenchymal inflammation with hepatocytes as target cells. Second-line drugs can be used for patients who have suboptimal response or intolerance to the standard treatment of AIH. This article reviews the research advances in second-line drugs for AIH.

Liver failure is one of the most serious complications after liver cancer resection. Hemodynamic changes, bile salt imbalance, and impaired immune function can cause liver failure after liver cancer resection, and related risk factors include patient, liver, and surgical conditions. This article summarizes the causes and influencing factors for liver failure after liver cancer resection and points out that prophylactic measures before surgery, expansion of remnant liver volume, adjustment of hemodynamic imbalance of the liver, and optimization of perioperative treatment help to reduce the incidence rate of liver failure after liver cancer resection and improve the prognosis and long-term survival of such patients.

At present, studies have confirmed the closely relationship between liver diseases and intestinal flora, and regulation of intestinal flora has a certain effect on the progression and therapeutic outcome of liver diseases. With reference to the influencing mechanism of intestinal dysbacteriosis on liver diseases such as alcoholic liver disease, non-alcoholic liver disease, and acute liver injury, this article reviews the research advances in China and foreign countries and summarizes the complications of decompensated liver diseases, such as hepatic encephalopathy and spontaneous bacterial peritonitis, in order to provide new strategies for the treatment of liver diseases in future.

Gallbladder carcinoma ( GBC) is often obscured by some benign diseases in clinical practice and thus unsuspected GBC tends to occur. As for etiology, long-term stimulation by gallstones, gallbladder polyps larger than 1 cm, gallbladder adenoma, and adenomyomatosis of the gallbladder are closely associated with GBC. In the aspect of molecular biology, long non-coding RNA, microRNA, surface growth factor receptor, and some membrane proteins are involved in the development and progression of GBC, which may provide a reference for clinical practice. It is of great importance to perform intraoperative and postoperative surgical management of GBC, which is related to patients' survival. Patients with highly suspected or proven GBC should be converted to open surgery after disease assessment, in order to avoid reoperation. Reoperation should be performed for patients with unsuspected GBC found by postoperative pathological examination, in order to avoid tumor progression and metastasis.

Objective To investigate the value of aspartate aminotransferase-to-platelet ratio index ( APRI) in judging the indication for antiviral therapy [liver inflammation grade ( G) ≥2 or fibrosis stage ( S) ≥2] in patients with chronic HBV infection and alanine aminotransferase ( ALT) < 2 × upper limit of normal ( ULN) . Methods A retrospective analysis was performed for the clinical data of 207 patients with chronic HBV infection and ALT < 2 × ULN who were admitted to Nanyang Central Hospital from January 2015 to June 2017, and according to liver inflammation grade and fibrosis stage, these patients were divided into G < 2 + S < 2 group with 87 patients and G≥2 or S≥2 group with 120 patients. The results of liver biopsy and laboratory examination were recorded, and APRI was calculated. The Spearman correlation analysis was performed to investigate the correlation of APRI with liver inflammation grade and fibrosis stage. The area under the receiver operating characteristic curve ( AUC) was used to investigate the value of ALT, aspartate aminotransferase ( AST) , platelet count ( PLT) , and APRI in judging the indication for antiviral therapy in patients with ALT < 2 × ULN. The t-test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Results APRI was positively correlated with liver inflammation grade and fibrosis stage ( r = 0. 661 and 0. 597, P<0. 001) . Among ALT, AST, PLT, and APRI, APRI had the highest value in judging the indication for antiviral therapy, with AUCs of0. 913 in the G≥2 or S≥2 group, 0. 882 in the G≥2 group, and 0. 881 in the S≥2 group. APRI had an AUC of 0. 913 ( 95% confidence interval: 0. 871-0. 954) in predicting the indication in the G≥2 or S≥2 group at the optimal cut-off value of 0. 5324; when APRI was ≥0. 5324, the patients had marked liver histological changes, i. e., G≥2 or S≥2, which met the indication for antiviral therapy. APRI had a sensitivity of 87. 50%, a specificity of 89. 66%, a positive predictive value of 92. 11%, and a negative predictive value of 83. 87%. Conclusion For patients with chronic HBV infection and ALT < 2 × ULN, APRI has a good value in evaluating liver pathological changes and judging the timing of antiviral therapy and can reduce the frequency of invasive assessment of histological changes via liver biopsy.