End-stage liver disease (ESLD) is a life threaten clinical syndrome with significantly increasing mortality when patients complicated with infections. For patients with ESLD, infections can induce or aggravate the occurrence of liver decompensation. In turn, infections are among the most common complications under disease progression. There is lacking of working procedures for early diagnosis and appropriate management for patients of ESLD complicated with infections, neither guidelines nor consensus at home and abroad. This consensus assembled up-to-date knowledge and experience across Chinese colleagues, providing principles as well as working procedures for clinicians to diagnose and treat an ESLD patient complicated with infections.

Objective To investigate the efficiency of Fibro Touch noninvasive liver stiffness measurement (LSM) in evaluating liver fibrosis degree in nonalcoholic fatty liver disease (NAFLD) patients with different levels of body mass index (BMI) . Methods A total of 238 NAFLD patients who were admitted to The Affiliated Hospital of Xuzhou Medical University from June 2015 to January 2018 and underwent liver biopsy were enrolled in this study, and according to BMI, they were divided into group A (BMI < 24) , group B (24≤BMI < 28) , and group C (BMI≥28) . Fibro Touch was performed within one week after liver biopsy, and fasting blood samples were collected on the same day. The fibrosis indices were calculated. The efficiency of LSM in evaluating fibrosis degree was analyzed in all groups, and the correlation of LSM with related serological fibrosis indices was analyzed. The receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was used to evaluate the diagnostic value of LSM and serum markers. A one-way analysis of variance and the SNK-q test were used to investigate the differences in related indices between NAFLD patients with varying fibrosis degrees, and the Kruskal-Wallis H test was used for comparison of non-normally distributed data. The Spearman's rank correlation analysis was used to investigate the correlation between LSM and other indices. Results In group A, B, or C, there was a significant difference in LSM between the NAFLD patients with different fibrosis degrees (F = 18. 543, 22. 985, and 5. 904, P < 0. 001, P < 0. 001, and P = 0. 004) . In the NAFLD patients with progressive liver fibrosis, there was a significant difference in LSM between the patients with different levels of BMI (F = 3. 899, P = 0. 026) . LSM was correlated with Hui score, Forns index, fibrosis-4, and NAFLD fibrosis score (r = 0. 459, 0. 388, 0. 427, and 0. 422, all P < 0. 001) . LSM had the highest efficiency in the diagnosis of progressive liver fibrosis in NAFLD patients, with an AUC of 0. 870, a specificity of 86%, and a sensitivity of 70%. Conclusion Fibro Touch has good value in evaluating the liver fibrosis degree of NAFLD patients, and BMI may affect the result of LSM. LSM is well correlated with other diagnostic indices for liver fibrosis and holds promise for clinical application.

Objective To investigate the clinical effect of endoscopic application of tissue adhesive and ligation in the treatment of esophagogastric variceal bleeding in children. Methods A retrospective analysis was performed for the clinical data of 16 children who underwent endoscopic treatment due to esophagogastric variceal bleeding from May 2010 to May 2017. Preoperative conditions and physiological indices and postoperative hemostasis rate, rebleeding rate, complications, and further treatment. Results The mean age of these children was 8. 50± 4. 97 years. Of all children, 5 had esophageal varices alone, among whom 1 had moderate (GII) type and 4 had severe (GIII) type, and11 had esophageal varices complicated by gastric varices, among whom 6 had GOV1 type (1 complicated by GI type, 3 complicated by GII type, and 2 complicated by GIII type) and 5 had GOV2 type (2 complicated by GII type and 3 complicated by GIII type) . There were a total of 50 varicose veins in these 16 children, with a mean number of 4 veins (range 1-5) in each child, and ligation was performed for 70 sites in total, with a mean number of 5 sites (range 0-8) in each child. Tissue adhesive injection was performed for 9 children at a total of15 sites, and 20 ml of tissue adhesive was used in total, with 2. 22 ml for each child and 1. 33 ml for each site. The hemostasis rate immediately after endoscopic therapy was 100%, and the rebleeding rate was 6. 25% (1/16) within 3 months and 12. 5% (2/16) after 3 months.The follow-up time ranged from 3 months to 7 years, and during follow-up, 4 children underwent liver transplantation and 1 underwent endoscopic treatment again due to bleeding. No obvious complications were observed. Conclusion In the treatment of esophagogastric variceal bleeding in children, endoscopic application of tissue adhesive and ligation has a marked hemostatic effect and few complications and provides valuable time for long-term treatment.

Objective To investigate the prevalence of nonalcoholic fatty liver disease (NAFLD) in Haikou, China and the association of NAFLD with metabolic syndrome (MS) and its components. Methods A total of 18771 persons who underwent physical examination in Haikou People's Hospital from September 2016 to August 2017 were enrolled. Body height, body weight, blood pressure, fasting plasma glucose, blood lipids, and liver function parameters were measured, and ultrasound examination was performed for the liver. The prevalence rate of NAFLD was calculated, and the association of NAFLD with MS and its components was analyzed. 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 all18771 persons, 5715 had NAFLD, resulting in a prevalence rate of 30. 45%; the prevalence rate of NAFLD was 41. 74% in men and17. 22% in women. Men aged 45-59 years had the highest prevalence rate of NAFLD, and women aged ≥45 years had the highest prevalence rate. Men had a significantly higher prevalence rate of moderate NAFLD than women (8. 10% vs 1. 19%, χ2= 476. 1, P < 0. 001) .Men with obesity and overweight had a higher prevalence rate of NAFLD, and women with obesity had a higher prevalence rate; in both men and women, there was a significant difference in the prevalence rate of NAFLD between groups with different levels of body mass index (BMI) (χ2= 2111, 1917, all P < 0. 001) . NAFLD patients had significantly higher BMI, blood pressure, fasting plasma glucose, triglyceride, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transpeptidase than non-NAFLD patients (t = 41. 276, 32. 339, 31. 487, 12. 185, 9. 716, 38. 382, 26. 350, 25. 291, and 15. 008, all P < 0. 001) . Conclusion There is a high prevalence rate of NAFLD in people undergoing physical examination in Haikou, and men tend to have a higher prevalence rate than women. NAFLD is closely associated with MS and its components.

Objective To investigate the association between gene polymorphisms of low-density lipoprotein receptor (LDL-R) and nonalcoholic fatty liver disease (NAFLD) and the effect of LDL-R gene polymorphisms on serum lipid levels in the Chinese Han population.Methods A total of 216 NAFLD patients who visited Qingdao Municipal Hospital from October 2015 to July 2017 and 135 healthy subjects were enrolled. PCR and mass spectrometry were used to determine the genotypes of the rs1433099 and rs2738464 loci of LDL-R. The biochemical methods were used to measure the changes in blood lipid levels and liver enzymes. The Hardy-Weinberg (H-W) equilibrium was used to test the group representativeness of samples, and the chi-square test was used to test whether the distribution of genotypes was in accordance with the H-W equilibrium. The direct counting method was used to determine genotype and allele frequencies; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups; the t-test and wilcoxon rank sum test were used for comparison of continuous data between groups; the association of rs1433099 and rs2738464 polymorphisms with the relative risk of NAFLD was expressed as odds ratio (OR) and its 95% confidence interval (CI) , and the binary logistic regression model was used for calculation. Results There was no significant difference between the NAFLD group and the healthy control group in allele and genotype frequencies of LDL-R rs1433099 and rs2738464 (all P > 0. 05) . There were also no significant differences between the two groups in blood lipid levels, liver enzymes, and body mass index (BMI) (all P > 0. 05) . In the NAFLD group, the healthy control group, and all subjects, there were no significant differences in general clinical features, including blood lipid levels, BMI, blood pressure, and liver enzymes, between the subjects carrying rs1433099 T and rs2738464 G and those who did not carry such alleles (all P > 0. 05) . Conclusion The polymorphisms of LDL-R rs1433099 and rs2738464 do not affect blood lipid levels. This study demonstrates for the first time that the polymorphisms of LDL-R rs1433099 and rs2738464 are not associated with the risk of NAFLD in the Chinese Han population.

Objective To investigate the effect of blueberry combined with probiotics on the JAK1/STAT3/BAX signaling pathway regulated by interleukin-22 (IL-22) and their mechanism of action in improving nonalcoholic fatty liver disease (NAFLD) . Methods A total of40 clean Sprague-Dawley rats were divided into normal control group (CG group) , IL-22 siRNA-negative control group (IL-22 SI-NC group) , IL-22 siRNA group (IL-22 SI group) , IL-22 siRNA-negative control + blueberry-probiotics group (IL-22 SI-NC + BPG group) , and IL-22 siRNA + blueberry-probiotics group (IL-22 SI + BPG group) . The rats in the CG group were given 100% normal diet, and the rats in all the other groups were given compound high-fat diet to establish a rat model of fatty liver and were then given the injection of IL-22 siRNA-negative control lentivirus or IL-22 siRNA lentivirus at the abdominal liver area (blind puncture) every other day for 12 weeks in total. The liver was harvested to confirm whether the model was established successfully or not and the effect of siRNA, and then the above groups were given normal diet and blueberry-probiotics solution by gavage. The rats were observed for 8 weeks. One-way analysis of variance was used for comparison between multiple groups; the SNK test (q test) was used for further pairwise comparisons of data with homogeneity of variance, while the Tamhane' s test (q' test) was used for the data with heterogeneity of variance. Results Compared with the IL-22 SI-NC group, the IL-22 SI group had significant increases in alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , total cholesterol (TC) , triglyceride (TG) , and low-density lipoprotein (LDL) (all P < 0. 01) , a significant reduction in high-density lipoprotein (HDL) (P < 0. 01) , significant reductions in the mRNA and protein expression of IL-22, JAK1, and STAT3 (all P < 0. 01) , and a significant increase in the expression of Bcl-2-associated X protein (BAX) (P < 0. 01) . Compared with the IL-22 SI-NC group, the IL-22 SI-NC + BPG group had significant reductions in ALT, AST, TC, TG, and LDL (all P < 0. 01) , a significant increase in HDL (P < 0. 01) , significant increases in the mRNA and protein expression of IL-22, JAK1, and STAT3 (all P <0. 01) , and a significant reduction in BAX (P < 0. 01) . Compared with the IL-22 SI group, the IL-22 SI + BPG group had significant reductions in ALT, AST, TC, TG, and LDL (all P < 0. 05) , a significant increase in HDL (P < 0. 05) , significant increases in the mRNA and protein expression of IL-22, JAK1, and STAT3 (all P < 0. 05) , and a significant reduction in BAX (P < 0. 05) . Conclusion Blueberry combined with probiotics can antagonize hepatocyte fatty degeneration accelerated by IL-22 siRNA to a certain degree and increase the expression of IL-22, indicating that IL-22 may be a key factor for blueberry combined with probiotics in improving NAFLD. It is speculated that blueberry combined with probiotics can enhance the expression of IL-22, activate the JAK1/STAT3 signaling pathway to inhibit the expression of the downstream apoptotic factor BAX, reduce hepatocyte apoptosis, increase cholesterol metabolism, reduce lipid deposition, and thus improve NAFLD. Therefore, it is considered an adjuvant therapeutic regimen for NAFLD.

Objective To investigate the effect of neutrophil-lymphocyte ratio (NLR) on the 28-day prognosis of patients with HBV-associated acute-on-chronic liver failure (HBV-ACLF) . Methods A total of 100 patients with HBV-ACLF who were admitted to The Second Affiliated Hospital of Anhui Medical University from January 2015 to December 2016 were enrolled, and according to their prognosis on day 28, they were divided into death group and survival group. The data on sex, age, laboratory markers, Model for End-Stage Liver Disease (MELD) score, and clinical complications were collected for univariate analysis. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups. The Chi-square test was used for comparison of categorical data between two groups. Binary logistic regression was used for multivariate analysis. Pearson correlation analysis was used to investigate the correlation between MELD score and NLR. The receiver operating characteristic (ROC) curve was used to analyze the value of indices in predicting the prognosis of HBV-ACLF. Results The analysis of 100 patients with HBV-ACLF showed that there were significant differences between the survival group and the death group in age, albumin, alanine transaminase, serum creatinine, white blood cell count, neutrophil count, lymphocyte count, monocyte count, international normalized ratio, total bilirubin, NLR, and MELD score (all P < 0. 05) . The survival group had lower incidence rates of hepatic encephalopathy, hemorrhage, ascites, and infection than the death group, but there were no significant differences between the two groups (all P > 0. 05) . The binary logistic regression analysis showed that NLR and MELD score were independent predictive factors for 28-day mortality in HBV-ACLF patients (P < 0. 001 and P = 0. 022) , and NLR was positively correlated with MELD score (r = 0. 264, P = 0. 008) . The ROC curve analysis showed that NLR had a significantly larger area under the ROC curve than MELD score (0. 889 vs 0.728, P =0.026 7) . Conclusion NLR is an independent predictive factor for the short-term prognosis of HBV-ACLF patients.

Objective To investigate the value of MELD combined with serum sodium concentration (MELD-Na) in predicting the short-term outcome of patients with HBV-related acute-on-chronic liver failure (ACLF) in China. Methods Pub Med, Embase, CNKI, VIP, and Wanfang Data were searched for related articles in English and Chinese published from January 2006 to March 2018. The second version of Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of each article. The presence or absence of threshold effect was examined. According to the presence or absence of heterogeneity, a random effect model or a fixed effect model was used for pooling sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (DOR) . The receiver operating characteristic (ROC) curve was plotted and the area under the ROC curve (AUC) was calculated. The Deek's funnel plot asymmetry test was used to investigate the presence or absence of publication bias. Results A total of eight studies were included, with a total of 1386 patients, among whom there were 1173 (84. 6%) male patients. The mean age of the patients included in these studies ranged from 41. 3 to 46. 9 years. The tests for heterogeneity showed significant heterogeneity between studies and a random effect model was used for pooling. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and DOR were 0. 67 (95% confidence interval [CI]: 0. 59-0. 75) , 0. 77 (95% CI: 0. 63-0. 87) , 2. 89 (95% CI: 1. 84-4. 54) , 0. 43 (95% CI: 0. 35-0. 52) , and 7. 32 (95% CI: 4. 33-12. 40) , respectively. The AUC was 0. 75 (95 CI: 0. 72-0. 79) . The Deek's funnel plot asymmetry test showed no significant publication bias. Conclusion MELD-Na score has a certain value in predicting the short-term outcome of patients with HBV-related ACLF in China.

Objective To investigate the changes in peripheral blood mononuclear cells [CD8+T lymphocytes and natural killer (NK) cells] and levels of perforin and granzyme B in these cells in children with infectious mononucleosis (IM) , as well as their clinical significance in liver injury. Methods A total of 60 children who met the diagnostic criteria for IM were enrolled, and 30 healthy children were enrolled as control group. With the help of cell surface markers and cytokine staining, flow cytometry was performed to analyze CD8+T lymphocytes, NK cells, and the expression of perforin and granzyme B. The t-test was used for comparison of continuous data between groups;a one-way analysis of variance was used for comparison between three groups, and the Dunnett-t test was used for further comparison between two groups. Results Among the 60 children with IM, the incidence rate of liver injury was 50% (30/60) ; 18 (60%) children had an alanine aminotransferase (ALT) level of < 200 IU/L, 10 (33. 3%) had an ALT level of ≥200 IU/L and < 400 IU/L, and 2 (6. 67%) had an ALT level of ≥400 IU/L. All children had normal liver functions after one month of treatment. Compared with the control group, the non-liver injury IM group and the liver injury IM group had significant increases in the expression of perforin and granzyme B in CD8+T lymphocytes (all P < 0. 05) . Compared with the non-liver injury subgroup of IM patients, the liver injury subgroup had a significantly higher percentage of CD8+T lymphocytes and significantly higher expression of perforin and granzyme B in NK cells (all P < 0. 05) . Conclusion There is a high incidence rate of liver injury in children with IM, mainly mild or moderate elevation of aminotransferases, which are self-limiting and can be returned to normal. High levels of perforin and granzyme B in NK cells and a high percentage of CD8+T lymphocytes are the cause of liver injury.

Objective To investigate the mechanism of action of Compound Yindan Decoction on acute intrahepatic cholestasis induced byα-naphthyl isothiocyanate (ANIT) in rats. Methods A total of 108 male Sprague-Dawley rats were randomly divided into normal control group, model group, high-, middle-, and low-dose traditional Chinese medicine (TCM) groups, and positive control group, with 18 rats in each group. According to the time of sampling, each group was divided into 24-hour, 48-hour, and 72-hour subgroups, with 6 rats in each subgroup. The model group, the TCM groups, and the positive control group were given a single dose of 2% ANIT (100 mg/kg/d) by gavage to establish the model, and the normal control group was given an equal volume of salad oil by gavage. At 2 hours after modeling, the high-, middle-, and low-dose TCM groups were given Compound Yindan Decoction 1 ml/100 g body weight once a day by gavage at a dose of 24. 48 g·kg-1·d-1, 12. 24 g·kg-1·d-1, and 6. 12 g·kg-1·d-1; the model group and the normal control group were given an equal volume of normal saline once a day by gavage; the positive control group was given ursodeoxycholic acid (UDCA) solution 1 ml/100 g body weight once a day by gavage at a dose of 67. 5 mg·kg-1·d-1. The rats were sacrificed at 24, 48, or 72 hours after modeling, and RT-q-PCR, Western blot, and immunohistochemistry were used to measure the expression of farnesoid X receptor (FXR) and multidrug resistance-associated protein 3 (MRP3) in liver tissue. A one-way analysis of variance was used for comparison between multiple groups, and LSD-t test was used for further comparison between two groups. Results According to the results of RT-q-PCR, compared with the normal control group at each time phase, the model group had a significant reduction in the mRNA expression of FXR (all P<0. 05) ; compared with the model group at each time phase, all the TCM groups and the UDCA group had a significant increase in the mRNA expression of FXR (all P < 0. 05) ; the high-dose TCM group had significantly higher mRNA expression of FXR than the middle-and low-dose TCM groups at each time phase (all P < 0. 05) . Compared with the normal control group at each time phase, the model group had a significant increase in the mRNA expression of MRP3 (all P < 0. 05) ; compared with the model group at each time phase, the UDCA group and all the TCM groups except the 24-hour low-dose TCM subgroup had a significant increase in the mRNA expression of MRP3 (all P <0. 05) ; the 48-and 72-hour high-dose TCM subgroups had significantly higher mRNA expression of MRP3 than the middle-and low-dose TCM groups (all P < 0. 05) . According to the results of immunohistochemistry, compared with the normal control group at each time phase, the model group had a significant reduction in the protein expression of FXR (all P < 0. 05) ; compared with the model group, the 24-hour high-, middle-, and low-dose TCM subgroups and the UDCA group at each time phase had a significant increase in the protein expression of FXR (all P < 0. 05) ; the high-dose TCM group had significantly higher protein expression of FXR than the middle-and low-dose TCM groups at each time phase (all P < 0. 05) . Compared with the normal control group at each time phase, the model group had a significant increase in the protein expression of MRP3 (all P < 0. 05) ; compared with the model group at each time phase, the UDCA group and all the TCM groups except the 24-hour low-dose TCM subgroup had a significant increase in the protein expression of MRP3 (all P <0. 05) ; the high-dose TCM group had significantly higher protein expression of MRP3 than the low-dose TCM group at each time phase and the 72-hour middle-dose TCM subgroup (all P < 0. 05) . According to the results of Western blot, compared with the normal control group at each time phase, the model group had a significant reduction in the protein expression of FXR (all P < 0. 05) ; compared with the model group at each time phase, the high-, middle-, and low-dose TCM groups and the UDCA group had a significant increase in the protein expression of FXR (all P < 0. 05) ; the high-dose TCM group had significantly higher protein expression of FXR than the middle-and low-dose TCM groups at each time phase (all P < 0. 05) . Compared with the normal control group at each time phase, the model group had a significant increase in the protein expression of MRP3 (all P < 0. 05) ; compared with the model group, the 48-and 72-hour middle-and high-dose TCM subgroups and the UDCA group had a significant increase in the protein expression of MRP3 (all P < 0. 05) ; at 48 and72 hours, the high-dose TCM group had significantly higher protein expression of MRP3 than the middle-and low-dose TCM groups (all P < 0. 05) . Conclusion Compound Yindan Decoction has a therapeutic effect on rats with acute intrahepatic cholestasis induced by ANIT through gavage, possibly by upregulating the mRNA and protein expression of FXR and MRP3.