The common causes of non-cirrhotic sinusoidal hypertension were intrahepatic diseases that involves sinusoidal or perisinusoidal space, with sinusoidal obstruction syndrome being a common etiology, which was mainly caused by chemotherapy or radiotherapy prior to hematopoietic stem cell transplantation and pyrrolizidine alkaloid herbal therapy;defibrotide was the only approved drug for this disease. The other causes included nodular regenerative hyperplasia, which were mainly diagnosed by liver pathophysiology;treatment remains largely tar geted at the individual sequalae of portal hypertension and respective potential causes.

Objective To investigate the effect of initial esophageal variceal sclerotherapy (EVS) on liver function and blood biochemistry in patients with liver cirrhosis and the risk factors for early rebleeding after initial EVS.Methods A retrospective analysis was performed for the clinical data of 120 cirrhotic patients with esophageal variceal bleeding who were hospitalized in Beijing YouAn Hospital, Capital Medical University, from January 2016 to December 2017 and received initial EVS.The patients were divided into groups according to the ChildPugh class, and liver function and blood biochemistry were compared between groups before and after treatment to evaluate the effect of EVS on the above indices.Early rebleeding after surgery was defined as bleeding within 14 days after surgery.The patients were divided into bleeding group and non-bleeding group according to the presence or absence of early rebleeding, and a logistic regression analysis was performed to investigate the main risk factors for early rebleeding.The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups.The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups.ResultsAfter treatment, Child-Pugh class A/B patients had significant changes in total bilirubin (Z=-3.975 and-3.670, both P<0.001) , direct bilirubin (Z=-3.455 and-3.086, P=0.001 and 0.002) , and white blood cell count (Z=-2.811 and-3.683, P=0.005 and P<0.001) .Early rebleeding rate after EVS was 10% (12/120) .The logistic regression analysis showed that the amount of ascites (odds ratio[OR]=2.92, P=0.047) and presence of portal vein thrombosis (OR=4.94, P=0.018) were independent risk factors for early rebleeding after EVS.Conclusion EVS does not have a significant impact on liver function, and bacterial infection should be taken seriously during treatment.The amount of ascites should be reduced before surgery, in order to reduce the incidence rate of early rebleeding after EVS.For patients with portal vein thrombosis, the risk of treatment should be evaluated and an appropriate treatment regimen should be selected based on patient's conditions.

Objective To investigate the clinical effect of transcatheter arterial chemoembolization (TACE) combined with local thermal ablation in the treatment of large hepatocellular carcinoma (HCC) .Methods A retrospective analysis was performed for the clinical data of134 patients with large HCC who underwent TACE combined with local thermal ablation in our center from January 2010 to September 2016.In all patients, 75 underwent TACE combined with microwave ablation and 59 underwent TACE combined with radiofrequency ablation.The effect of ablation (complete ablation and partial ablation) was evaluated, and follow-up was performed to observe the recurrence of intrahepatic tumor in patients with complete ablation.The chi-square test and logistic regression analysis were used to evaluate the influencing factors for the effect of ablation, and the Kaplan-Meier survival analysis and the Cox proportional hazards model were used to analyze recurrence-free survival and related influencing factors.Results Of all patients, 88 achieved complete ablation and 46 patients achieved partial ablation, resulting in a complete ablation rate of 65.7%.The logistic regression analysis showed that presence of portal vein tumor thrombus (odds ratio[OR]=5.051, P=0.017) , incomplete tumor capsule (OR=4.199, P=0.007) , and dangerous location of tumor (OR=4.967, P=0.001) were independent risk factors for the effect of ablation.The patients with complete ablation had a median recurrencefree survival of 17.41±2.73 months and the 1-, 3-, and 5-year recurrence-free survival rates were 61.4%, 23.3%, and 17.7%, respectively;the multivariate analysis showed that multiple tumors (OR=1.708, P=0.041) was an independent risk factor.There were no significant differences between TACE combined with microwave ablation and TACE combined with radiofrequency ablation in the effect of ablation (χ2=2.431, P=0.119) and tumor recurrence (χ2=3.292, P=0.070) .ConclusionPresence of portal vein tumor thrombus, tumor capsule integrity, and tumor location are important influencing factors for the effect of ablation in patients with large HCC.For patients with complete ablation, the number of tumors can be used to assess the risk of intrahepatic tumor recurrence.

Objective To investigate the value of alpha-fetoprotein (AFP) combined with des-γ-carboxy-prothrombin (DCP) in predicting the therapeutic effect of transarterial chemoembolization (TACE) .Methods A retrospective analysis was performed for the clinical data of 85 patients with hepatocellular carcinoma (HCC) who underwent TACE in The First Affiliated Hospital of Soochow University from October 2016 to March 2018.The serum levels of AFP and DCP were measured before TACE and after two consecutive sessions of TACE, and modified RECIST (mRECIST) was used to evaluate the therapeutic effect of TACE.The changes in AFP and DCP were compared with imaging findings based on mRECIST.The two-independent-samples t test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups.The chi-square test was used for comparison of categorical data between two groups, and the Mann-Whitney U test was used for comparison of ranked data between two groups.A Spearman correlation analysis was used to investigate the correlation of mRECIST category with AFP and DCP.The receiver operating characteristic (ROC) curve was used to investigate the value of each index in the diagnosis of remission.Results According to the mRECIST criteria, 38 patients achieved remission (remission group) and 31 did not achieve remission (non-remission group) .After treatment, the remission group had significantly lower AFP and DCP than the non-remission group (Z=-3.366 and-4.065, both P<0.05) .There were significant differences between the remission group and the non-remission group inΔAFP, ΔDCP, ΔAFP%, andΔDCP% (Z=-4.837, -5.597, -4.210, and-5.851, all P<0.001) .The mRECIST category was negatively correlated withΔAFP andΔDCP (rs=-0.552 and-0.593, both P<0.001) .In the diagnosis of remission, ΔAFP%had an area under the ROC curve (AUC) of 0.796, whileΔDCP%had an AUC of 0.912 andΔAFP%combined withΔDCP%had an AUC of0.921, suggesting thatΔAFP%combined withΔDCP%had the highest diagnostic value.Conclusion Changes in serum DCP and AFP after TACE can be used to evaluate the outcome of HCC after TACE.

Objective To investigate the surgical outcome and survival of patients with spontaneous rupture and bleeding of hepatocellular carcinoma after hepatectomy.Methods A total of 68 patients with spontaneous rupture and bleeding of hepatocellular carcinoma who were admitted to Rizhao Municipal Hospital of Traditional Chinese Medicine from January 2008 to June 2016 and underwent hepatectomy were enrolled, and their perioperative conditions, postoperative survival, and risk factors were analyzed.The Kaplan-Meier method was used to calculate cumulative survival rate;the log-rank test was used for the univariate analysis of prognostic factors, and the Cox regression model was used for the multivariate analysis of the risk factors with statistical significance identified by the univariate analysis.Results Of all patients, 3 died after surgery, resulting in a perioperative mortality rate of 4.41%;among the other 65 patients, 14 (21.54%) experienced serious complications after surgery.A total of 61 patients were followed up, and the follow-up rate was 93.85%.The median overall survival time was 14.0 months and the 1-, 3-, and 5-year cumulative overall survival rates were 52.5%, 28.6%, and 11.8%, respectively.The median disease-free survival time was 10.9 months and the 1-, 3-, and 5-year cumulative disease-free survival rates were47.5%, 21.2%, and 10.6%, respectively.The univariate analysis showed that overall postoperative survival time was associated with Child-Pugh class, alpha-fetoprotein level, tumor size, number of tumors, vascular invasion, and serious complications after surgery (χ2=4.201, 5.291, 5.926, 6.327, 5.062, and 5.028, all P<0.05) .The Cox multivariate analysis showed that a tumor diameter of≥10 cm (relative risk[RR]=3.688, 95%confidence interval[CI]:1.211-11.227, P=0.034) , multiple tumors (RR=4.158, 95%CI:1.092-15.827, P=0.027) , vascular invasion (RR=0.206, 95%CI:0.078-0.540, P=0.034) , serious complications after surgery (RR=0.283, 95%CI:0.086-0.929, P=0.025) were independent risk factors for overall postoperative survival time.ConclusionPatients with spontaneous rupture and bleeding of hepatocellular carcinoma have high perioperative mortality rate and incidence rate of complications after hepatectomy, with poor overall survival after surgery.The patients with large tumors, multiple tumors, vascular invasion,

Objective To investigate the expression features and clinical significance of the microRNA-888 (miRNA-888) gene family members in hepatocellular carcinoma (HCC) .Methods A total of 72 patients with pathologically confirmed HCC who were treated in The First Affiliated Hospital of Hunan University of Chinese Medicine from January 2012 to December 2017 were enrolled, and 72 liver tissue samples collected from healthy volunteers were enrolled as normal control group.Quantitative real-time PCR and in situ hybridization were used to measure the expression of miRNA-888 family members (miRNA-888, miRNA-891a, miRNA-891b, miRNA-892a, and miRNA-892b) in HCC tissue, and the association of the expression of miRNA-888, miRNA-891b, and miRNA-892a with the clinicopathological features of HCC was analyzed.The t-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.ResultsHCC tissue had significantly higher expression of miRNA-888, miRNA-891b, and miRNA-892a than normal liver tissue (miRNA-888:2.53±0.75 vs 0.46±0.08, t=14.02, P<0.001;miRNA-891b:2.26±0.38 vs 1.19±0.21, t=7.75, P<0.001;miRNA-892a:5.44±1.01 vs 1.06±0.30, t=35.27, P<0.001) .According to the results of in situ hybridization, the miRNAs of miRNA-888, miRNA-891b, and miRNA-892a were mainly located in the cell nucleus of HCC tissue, and there were significant differences in the expression of these miRNAs between HCC tissue and normal tissue (miRNA-888:3.91±0.92 vs 1.21±0.42, t=22.65, P<0.001;miRNA-891b:2.92±0.76 vs 0.83±0.21, t=22.92, P<0.001;miRNA-892a:3.81±0.99 vs 1.30±0.32, t=20.47, P<0.001) .There were significant differences in the expression of miRNA-888 and miRNA-891b between the patients with different histological grades and clinical stages (χ2=6.25, 4.44, 4.76, and 6.05, all P<0.05) , and there was a significantly higher expression of miRNA-892a in stage III/IV tumors (χ2=8.50, P<0.001) .Conclusion There are significant increases in the expression of miRNA-888, miRNA-891b, and miRNA-892a in HCC tissue, and such increases are closely associated with the malignancy of HCC.

Objective To investigate the expression and clinical significance of long non-coding RNA (lncRNA) exocyst complex component 7 (EXOC7) in hepatocellular carcinoma (HCC) .MethodsA total of 79 pairs of HCC tissue samples and adjacent tissue samples were collected from the patients who underwent HCC surgery from January 2010 to January 2014.Real-time PCR was used to measure the expression of lncRNA EXOC7 in HCC tissue and adjacent tissue, and its association with pathological features and prognosis was analyzed.The t-test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.The Kaplan-Meier method was used for the analysis of survival and recurrence curves after surgery, and the Cox regression model was used for the analysis of survival and recurrence data.ResultsThe expression of lncRNA EXOC7 in HCC tissue was significantly higher than that in adjacent tissue (6.211±0.637 vs 2.924±0.415, t=4.106, P<0.01) .The expression of lncRNA EXOC7 was associated with tumor size (χ2=5.157, P=0.023) , presence or absence of portal vein tumor thrombus (χ2=4.049, P=0.044) , presence or absence of organ metastasis (χ2=4.345, P=0.037) , and TNM stage (χ2=6.479, P=0.011) .The high lncRNA EXOC7 expression group had significantly shorter disease-free survival and overall survival than the low lncRNA EXOC7expression group (χ2=8.215, P<0.001;χ2=6.091, P=0.001) .The Cox multivariate regression analysis showed that lncRNA EXOC7expression, tumor size, portal vein tumor thrombus, organ metastasis, and TNM stage were independent factors for the prognosis of HCC (all P<0.05) .Conclusion LncRNA EXOC7 is involved in the regulation of the development and progression of HCC and may become a new reference index for the prognosis of HCC.

Objective To investigate whether endoscopic ultrasonography (EUS) combined with magnetic resonance cholangiopancreatography (MRCP) can improve the diagnostic efficiency of such combination in the diagnosis of patients suspected of common bile duct stones.Methods A retrospectively analysis was performed for the clinical data of 78 patients who visited Shengjing Hospital of China Medical University from January 2014 to June 2016 and were diagnosed with suspected common bile duct stones.All patients underwent EUS and MRCP during the same period of hospitalization.The patients were divided into EUS group, MRCP group, and combined diagnosis group according to the imaging examination.Laparoscopic common bile duct exploration, laparoscopic common bile duct exploration, endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy, and no symptom of abdominal pain within 6 months after discharge were used as the gold standard.The results of the three groups were compared with the gold standard to calculate the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index of the imaging findings in three groups.The parallel test was used for combined diagnosis;positive results of EUS or MRCP were considered positive, and negative results of EUS and MRCP were considered negative.The chi-square test was used for comparison of the above indices.Results EUS found positive results in 22 patients, among whom20 had true positive results and 2 had false positive results, and negative results in 56 patients, among whom 53 had true negative results and3 had false negative results.MRCP found positive results in 22 patients, among whom 15 had true positive results and 7 had false positive results, and negative results in 56 patients, among whom 48 had true negative results and 8 had false negative results.EUS combined with MRCP found positive results in 29 patients, among whom 22 had true positive results and 7 had false positive results, and negative results in49 patients, among whom 48 had true negative results and 1 had false negative results.The EUS group had a significantly higher diagnostic accuracy than the MRCP group (93.6%vs 80.8%, χ2=5.735, P=0.017) .There were no significant differences between the combined diagnosis group and the EUS group in sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (P>0.05) .The combined diagnosis group had significantly higher sensitivity and negative predictive value than the MRCP group (sensitivity:95.7%vs 65.2%, χ2=6.769, P=0.009;negative predictive value:98.0%vs 85.7%, χ2=5.000, P=0.025) .Conclusion EUS and MRCP have their own advantages and disadvantages in the diagnosis of suspected common bile duct stones and can be used as the preferred choice for disease diagnosis.EUS has a higher overall accuracy than MRCP, and in patients who plan to undergo laparoscopic cholecystectomy due to gallstones, EUS is more reliable and it is recommended to perform EUS to exclude common bile duct stones.Compared with MRCP alone, EUS combined with MRCP can improve sensitivity and negative predictive value;when MRCP yields negative results which are not consistent with other clinical manifestations, EUS should be performed to confirm the presence of suspected common bile duct stones.

Objective To investigate the clinical effect and surgical experience of percutaneous transhepatic cholangial drainage (PTCD) combined with biliary stenting in patients with different types of malignant obstructive jaundice (MOJ) .Methods A retrospective analysis was performed for the early clinical outcomes of 185 patients with MOJ who were admitted to Beijing Air Force General Hospital from July2013 to July 2018 and underwent PTCD combined with biliary stenting.Major observation indices included location and type of obstruction, related hematological parameters before surgery and at 3-5 and 6-10 days after surgery, including total bilirubin (TBil) , direct bilirubin (DBil) , alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase, and stent implantation.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 three groups;the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between three groups.The chi-square test was used for comparison of categorical data between groups.Results Of all 185 patients, 102 had low-level obstruction, 75 had high-level obstruction, 4had complete biliary obstruction, and 4 had anastomotic obstruction.All patients underwent PTCD+biliary stenting successfully, and catheter drainage was performed with a technical success rate of 100%.A total of 233 stents were implanted for 185 patients, and all patients had reduced jaundice, increased appetite, and improved liver function after surgery, among whom 146 had marked response and 39 had response.The patients with low-level obstruction had a significantly better surgical outcome than those with high-level obstruction (χ2=10.866, P=0.001) .There was no significant difference in bilirubin between the patients with type I high-level obstruction who underwent single-stent drainage and those who underwent double-stent drainage before and after surgery (P>0.05) .The patients with typeⅡ/Ⅲ/Ⅳhigh-level obstruction who underwent double-stent drainage had a significantly better outcome than those underwent single-stent drainage (χ2=6.412, P=0.011) , as well as significantly lower levels of TBil and DBil at 6-10 days after stent drainage (t=2.62 and2.06, P<0.05) .ConclusionPTCD combined with biliary stenting can improve liver function, appetite, and quality of life in patients with MOJ, and patients with low-level obstruction have significantly better outcomes than those with high-level obstruction.Double-stent drainage is recommended for patients with typeⅡ/Ⅲ/Ⅳhigh-level obstruction.Biliary stenting also has a good clinical effect in patients with complete biliary obstruction and anastomotic obstruction, and biliary and duodenal stenting can be performed for patients with biliary obstruction combined with duodenal obstruction.

Objective To investigate the preventive and treatment measures for acute pancreatitis in pregnancy (APIP) , and to improve the awareness of this disease.Methods A total of 65 patients with APIP who were admitted to The Affiliated Hospital of Southwest Medical U-niversity from January 2013 to December 2017 were enrolled as subjects.Among these patients, 32 had mild acute pancreatitis (MAP) , 21had moderate-severe acute pancreatitis (MSAP) , and 12 had severe acute pancreatitis (SAP) .The three groups were compared in terms of laboratory results, maternal age, pregnancy complications, body mass index (BMI) , etiology, pregnancy, and maternal and fetal outcomes.An analysis of variance was used for comparison of normally distributed continuous data with homogeneity of variance between multiple groups, and the least significant difference t-test was used for further comparison between two groups;the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Dunn-Bonferroni test was used for further comparison between two groups.The chi-square test was used for comparison of categorical data between groups.Results Of all patients, 36 (55.38%) had a blood amylase level three times higher than normal, and 41 (63.08%) had a serum lipase level three times higher than normal.The SAP group had significantly higher high-sensitivity C-reactive protein, triglyceride, and blood glucose and a significantly lower blood calcium level than the MAP and MSAP groups (all P<0.05) .All 65 patients underwent abdominal color Doppler ultrasound, among whom 51 (78.46%) had a correct diagnosis;28 patients underwent computed tomography and all of them had a correct diagnosis (100%) .The patients with gestational diabetes mellitus tended to develop MSAP and SAP (χ2=7.809, P=0.020) .The MSAP and SAP groups had a significantly higher BMI than the MAP group (P<0.05) .Of all patients, 26 (40.00%) had hyperlipidemia as the etiology of APIP, among whom 50.00%developed MSAP and 34.62%developed SAP (χ2=20.520, P<0.001) .With the increase in the severity of APIP, the rate of intrauterine death increased, and the 5-minute Apgar score of neonates decreased (χ2=25.381 and 14.821, both P<0.05) .ConclusionHyperlipidemia is the main cause of APIP and a major influencing factor for prognosis.The monitoring of blood lipids and BMI should be strengthened in pregnant women, in order to reduce the incidence rate and severity of APIP.

Objective To investigate the clinical outcome of patients with acute-on-chronic liver failure (ACLF) and bacterial infection on admission after 72 hours of anti-infective therapy and related influencing factors.Methods An electronic database was used to select267 patients with ACLF and bacterial infection on admission who were admitted to the fifth Medical center of Chinese PLA General Hospital from January 2014 to March 2016, and their clinical features were analyzed.According to the outcome after 72 hours of anti-infective therapy, these patients were divided into effective group and ineffective group.The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups.The chi-square test was used for comparison of categorical data between two groups.A logistic regression analysis was used to identify the risk factors for outcome after 72 hours of anti-infective therapy and establish a predictive model, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of the new model.Results Hepatitis B virus infection observed in 161 patients and alcoholic liver disease observed in 60 patients were the most common causes, and 29 patients experienced septic shock.There were 312 case-times of bacterial infection, with ascites (199 patients) and the lung (77 patients) as the most common infection sites.A total of 49 strains were cultured, among which Escherichia coli (16 strains) and Klebsiella pneumoniae (13 strains) were the most common strains.A total of 20 patients also had fungal infection.Of all patients, 156 (58.4%) had response to anti-infective therapy.Compared with the ineffective group, the effective group had significantly lower incidence rates of acute kidney injury, hepatic encephalopathy, and septic shock, pulmonary infection rate, fungal infection rate, white blood cell count, neutrophil count, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, serum creatinine, international normalized ratio (INR) , and Model for EndStage Liver Disease (MELD) score (all P<0.05) and significantly higher ascites infection rate and prothrombin time activity (both P<0.05) .Compared with the ineffective group, the effective group had significantly lower 30-day mortality rate (15.2%vs 77.5%, χ2=97.942, P<0.001) and 90-day mortality rate (35.2%vs 91.7%, χ2=71.977, P<0.001) .The multivariate logistic regression analysis showed that baseline INR and the presence of septic shock were the risk factors for the outcome of anti-infective therapy.The new predictive model was logistic (p) =-5.907+2.260×septic shock (yes=1, no=0) +1.603×INR.At the cut-off value of-2.3, this model had an area under the ROC curve of 0.746, with a sensitivity of 62.2%, and a specificity of 78.2%.This new model had a higher diagnostic value than MELD score (Delong test, Z=2.402, P=0.016) .Conclusion INR and septic shock were independent influencing factors for predicting the therapeutic outcome of patients with ACLF and bacterial infection after 72 hours of anti-infective therapy.

Objective To investigate the migration of bone marrow stem cells (BMSCs) to the liver and liver repair in mice with acute liver injury treated with BMSC transplantation through four approaches.Methods Male BALB/c mice were divided into groups A, B, C, D, E, and F, with 10 mice in each group.Groups A, B, C, and D were treated by transplantation, group E was used as the donor of BMSCs, and group F was used as the model of acute liver injury.CCL4/2-AFF was used to establish the model of acute liver injury.Mouse BMSCs were isolated, labeled with the red fluorescent dye PKH26, and then transplanted into the mice with acute liver injury through the portal vein (group A) , the tail vein (group B) , the abdominal cavity (group C) , and the spleen (group D) .The mice were sacrificed 2 weeks later.Serum levels of alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , and albumin (Alb) were measured.The pathology of liver tissue was observed to evaluate the migration of BMSCs to the liver and the degree of liver repair.The mice in group F were sacrificed on day 8 to measure the levels of ALT, AST, and Alb.The t test was used for comparison of continuous data between two groups, and one-way analysis of variance was used for comparison of continuous data between multiple groups.Results In groups A, B, C, and D, transplanted BMSCs migrated to the liver under a microscope, and newly formed hepatocytes were observed on pathological images.There were significant differences in the levels of ALT, AST, and Alb between groups A, B, C, and D and group F (ALT:t=2.372, 2.473, 2.354, and 2.383, all P<0.05;AST:t=2.534, 2.423, 2.437, and 2.643, all P<0.05;Alb:t=2.336, 2.243, 2.373, and 2.352, all P<0.05) .Conclusion BMSCs can promote repair of the liver in mice with acute liver injury, and the degree of liver repair is not related to the transplantation approach.

Objective To investigate the effect of erythropoietin (EPO) on the mRNA expression of apoptosis genes bcl-2 and bax in rats with fatty liver disease after hepatic ischemia-reperfusion injury.Methods A total of 100 male adult Sprague-Dawley rats were fed with high-fat diet for 12 weeks.After the model was established, the rats with fatty liver disease were randomly divided into sham-operation (SHAM) group, ischemia/reperfusion (IR) group, IR+low-dose EPO group (EPO-1 group) , IR+middle-dose EPO group (EPO-2 group) , and IR+high-dose EPO group (EPO-3 group) .The IR model was established by completely blocking the blood flow in the middle and left lobes of the liver to induce ischemia in 70%of the liver, with an ischemia time of 80 minutes.The rats were sacrificed at 1, 3, and 6 hours of reperfusion after 80 minutes of ischemia, and RT-PCR was used to measure the mRNA expression of bcl-2 and bax in liver tissue.A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference test was used for further comparison between two groups.Results Compared with the IR group, the EPO-1, EPO-2, and EPO-3 groups had a significant increase in the mRNA expression of bcl-2 and a significant reduction in the mRNA expression of bax at each time point (all P<0.05) .The SHAM group and the EPO groups had a significantly higher bcl/bax mRNA ratio than the IR group at each time point (all P<0.05) .Conclusion EPO exerts a protective effect against hepatic ischemia-reperfusion injury in rats with fatty liver disease, possibly by promoting the mRNA expression of bcl-2 and inhibiting the mRNA expression of bax.High-dose EPO has a better effect than middle-and low-dose EPO.

Liver cirrhosis is common in clinical practice and is the common clinical outcome of various chronic liver diseases including chronic hepatitis C virus (HCV) infection.Before the development of direct-acting antiviral agents (DAAs) , anti-HCV therapy based on pegylated interferon (PEG-IFN.) and ribavirin (RBV) has a poor clinical effect due to the presence of liver cirrhosis, and decompensated liver cirrhosis itself is an absolute contraindication for PEG-IFN treatment.DAAs have gradually become the first-line drug for HCV infection, and many studies have shown that DAAs have good clinical effects and tolerability in the treatment of cirrhotic patients with HCV infection.On the one hand, DAAs have better clinical effect and safety than PEG-IFN/RBV in patients with compensated liver cirrhosis;on the other hand, patients with decompensated liver cirrhosis are tolerant to DAAs, and although they have a lower proportion of patients with sustained virologic response than normal patients, they can still benefit from DAAs from many aspects.This article reviews the latest research advances in DAAs in patients with HCV-related liver cirrhosis, in order to provide a reference for clinical diagnosis and treatment.

Hepatitis B cirrhosis is a chronic progressive disease caused by hepatitis B virus (HBV) infection and has various complications such as upper gastrointestinal bleeding, hepatic encephalopathy, and hepatorenal syndrome, and it may progress to liver cancer and even cause death in severe cases.In addition, HBV infection is also a high risk factor for renal injury, and patients with HBV infection had a higher incidence rate of renal injury than those without HBV infection.Renal injury does great harm to patients with hepatitis B cirrhosis, and some patients even have renal failure, with poor prognosis and high mortality.In recent years, hepatitis B cirrhosis with renal injury has become a research hotspot.This article briefly describes the research advances in the indices for hepatitis B cirrhosis with renal injury, compares the influence of different nucleotide analogues on renal function during antiviral therapy, and summarizes how to adjust the medication for patients with renal injury.It is pointed out that early identification and reasonable evaluation of renal function in patients has important clinical significance.

Liver fibrosis is a common pathological process in the progression of various chronic liver diseases to liver cirrhosis and liver cancer, and liver biopsy with the highest accuracy in diagnosis cannot be used as a routine examination due to several drawbacks.This article introduces several serological and imaging methods used in clinical practice and analyzes their advantages/disadvantages and the current status of research.It is believed that thanks to the efforts of experts and scholars, noninvasive diagnostic methods have become more and more important and may replace liver biopsy and become an effective method for the diagnosis of liver fibrosis in the near future.

Transjugular intrahepatic portosystemic shunt (TIPS) is an important method for the treatment of cirrhotic portal hypertension;however, its clinical application is limited by postoperative complications such as liver failure and hepatic encephalopathy.This article summarizes and analyzes the research advances in the clinical value of serological markers, clinical indices, and scoring systems in prognostic evaluation of TIPS.Indices can be selected or comprehensive evaluation can be performed based on clinical situations, in order to improve patients’postoperative survival rate.

Overgrowth of intestinal bacteria, change in intestinal flora, translocation between bacteria and their products, and bile acid metabolism are the important pathways for the development and progression of liver diseases.Hepatocytes are persistently exposed to intestinal metabolites and various antigens and antibodies via the portal vein system, and the constituents or metabolites of some intestinal bacteria can activate the autoimmune mechanism targeting hepatocytes through several mechanisms, including molecular mimicry.Therefore, intestinal flora plays an important role in the development/progression and treatment of autoimmune liver diseases, including autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis.This article reviews the related research advances in recent years.

Hepatic sinusoidal obstruction syndrome (HSOS) is a sinusoidal or small venous fibrous occlusive disease characterized by small hepatic vessel damage, especially sinusoidal endothelial cell injury.Exposure to certain exogenous toxins is the main cause of the disease.Based on etiology, HSOS is mainly classified into pyrrolidine alkaloid-related HSOS, hematopoietic stem cell transplantation-related HSOS, and HSOS of unknown etiology.This article summarizes the types of HSOS and reviews the research advances in clinical manifestations, pathogenesis, diagnosis, and treatment of HSOS.

Patients with severe liver diseases are prone to nosocomial infection due to serious liver dysfunction, low immune function, and reduced stress ability to infection, and such infections further aggravate patients’conditions and directly affect their clinical outcome.This article reviews the clinical features of nosocomial infection in patients with severe liver diseases and related risk factors.

Hepatectomy has more complex surgical procedure and process than general surgeries.Although postoperative mortality of hepatectomy has been reduced significantly in this century, the incidence rate of postoperative complications remains at a high level.At present, there are fewer studies on risk factors and prediction systems for posthepatectomy complications.This article introduces the definition of posthepatectomy complications, analyzes the risk factors and prediction systems for bile leakage, liver failure, postoperative hemorrhage, and Clavien-Dindo complication pointed out in recent studies, and summarizes the common risk factors for posthepatectomy complications, i.e., thrombocytopenia, non-anatomic liver resection, extensive liver tissue resection, and a low serum level of albumin.We hope to raise the awareness of these common risk factors among surgeons, reduce the incidence rate of postoperative complications, and improve the degree of satisfaction with surgical treatment.

The clinical application of digestive endoscopic technique in the field of pancreaticobiliary diseases profoundly affects or even overturns many traditional thoughts.From endoscopic sphincterotomy and endoscopic biliary drainage to endoscopic ultrasonography-guided drainage and debridement of infectious pancreatic necrosis, and pancreatic pseudocyst drainage at present, digestive endoscopic technique helps to achieve revolutionary changes in disease diagnosis and treatment, especially during the past two or three years.In order to help clinicians in the field of pancreaticobiliary diseases quickly understand the latest research advances in digestive endoscopy and related advanced techniques, this article elaborates on the latest research advances in digestive endoscopy in the field of pancreaticobiliary diseases.