Nonalcoholic fatty liver disease( NAFLD) is the most common liver disease in China. To provide evidence-based and updated practical recommendations for clinician,this expert recommendations have updated the diagnosis and treatment of NAFLD in five aspects as follows:( 1) the framework of NAFLD treatment centre or clinic;( 2) screening and evaluation: who should be screened,initial evaluation items,non-invasive assessment of steatohepatitis and advanced fibrosis,when to obtain a liver biopsy in patients with NAFLD,and other metabolic disorders and cardiovascular risk assessment;( 3) managements of patient with NAFLD: lifestyle intervention( dietary,exercise and weight loss),drug treating metabolic co-morbidities such as hyperlipidemia,type 2 diabetes mellitus and hypertension,and steatohepatitis and fibrosis;( 4) management of special populations with NAFLD: children,pregnant or lactating women,patients co-existence with alcoholic liver disease,chronic HBV and/or HCV infection,and autoimmune disorders;( 5) monitoring and follow-up. This consensus aims to modify the optimizing management process and guide physicians make correct and reasonable decisions in the diagnosis and treatment for patients with NAFLD.

Radical resection is the only curable treatment for perihilar cholangiocarcinoma. With the continuous renewal of laparoscopic instruments and the continuous improvement of technology,laparoscopic radical resection of perihilar cholangiocarcinoma has been gradually carried out in China,and its feasibility and safety have been recognized by some domestic peers. In order to standardize clinical diagnosis and treatment behavior,ensure patients receive safe and standardized treatment and improve prognosis,so that the operation can be standardized application and development. Based on the principles of treatment of perihilar cholangiocarcinoma and the corresponding technical norms of laparoscopic operation,the Expert Group on Operational Norms of Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma and Editorial Board of Chinese Journal of Surgery have organized relevant domestic expels to formulate expert recommendations for laparoscopic radical resection of perihilar cholangiocarcinoma,so as to facilitate clinical practice and standardized application.

Objective To investigate the effect of Hic-5 gene knockout on NF-κB/p65 expression and liver fibrosis. Methods Ten wild-type male C57 BL/6 mice were randomly divided into wild-type control group( WT-Control group with 5 mice) and wild-type experimental group( WT-CCl4 group with 5 mice),and ten male C57 BL/6 mice with Hic-5 gene knockout were randomly divided into Hic-5 knockout control group( Hic-5 KO-Control group with 5 mice) and Hic-5 knockout experimental group( Hic-5 KO-CCl4 group with5 mice). The serum levels of alanine aminotransferase( ALT) and aspartate aminotransferase( AST) were measured. Picrosirius red staining was used to observe collagen deposition in liver tissue. Immunohistochemistry was used to measure the expression of alpha-smooth muscle actin( α-SMA) and p65 protein,and real-time quantitative PCR was used to measure the mRNA expression of α-SMA,collagen1,and p65 in liver tissue. The primary hepatic stellate cells of mice were isolated and stimulated with different concentrations of TGF-β1,and then real-time quantitative PCR was used to measure the mRNA expression of α-SMA,collagen 1,and p65 in primary hepatic stellate cells. A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups. Results Picrosirius red staining showed that compared with the WT-CCl4 group,the Hic-5 KO-CCl4 group had a significant reduction in collagen fibers in liver tissue( P < 0. 001). Measurement of serum ALT and AST showed that there were significant differences in ALT and AST between the WT-Control group,the WT-CCl4 group,the Hic-5 KO-Control group,and the Hic-5 KO-CCl4 group( F = 22. 85 and 25. 15,both P < 0. 001),and the Hic-5 KO-CCl4 group had significantly lower serum levels of ALT and AST than the WT-CCl4 group( both P < 0. 05). Immunohistochemistry showed that there were significant differences in the expression levels of α-SMA and p65 protein in liver tissue between the WT-Control group,the WT-CCl4 group,the Hic-5 KO-Control group,and the Hic-5 KO-CCl4 group( F = 207. 10 and 98. 16,both P < 0. 001),and the Hic-5 KO-CCl4 group had significantly lower expression of α-SMA and p65 protein in liver tissue than the WT-CCl4 group( both P < 0. 01).The results of real-time quantitative PCR showed that there were significant differences in the relative mR NA expression of α-SMA,collagen 1,and p65 in liver tissue between the WT-Control group,the WT-CCl4 group,the Hic-5 KO-Control group,and the Hic-5 KO-CCl4 group( F = 41. 62,13. 93,and 98. 16,all P < 0. 001),and the Hic-5 KO-CCl4 group had significantly lower relative mR NA expression of α-SMA,collagen 1,and p65 in liver tissue than the WT-CCl4 group( all P < 0. 05). After the primary hepatic stellate cells were stimulated by TGF-β1 at concentrations of 0,5,and 10 ng/ml,there were significant differences in the relative mR NA expression ofα-SMA,collagen 1,and p65 between the WT 0 ng/ml group,the WT 5 ng/ml group,the WT 10 ng/ml group,the KO 0 ng/ml group,the KO 5 ng/ml group,and the KO 10 ng/ml group( F = 53. 9,75. 82,and 52. 41,all P < 0. 001),and the Hic-5 KO group had significantly lower relative mR NA expression of α-SMA,collagen 1,and p65 than the WT group( all P < 0. 01). Conclusion Hic-5 knockout inhibits NF-κB/p65 expression and hepatic stellate cell activation and alleviates CCl4-induced liver fibrosis.

Objective To investigate the clinical features of diabetic patients with bacterial liver abscess and different levels of glycosylated hemoglobin( Hb Alc). Methods A total of 118 adult diabetic patients with bacterial liver abscess who were admitted to our hospital from December 2014 to December 2018 were enrolled,and according to the level of Hb Alc,they were divided into well-controlled group with 32 patients,fairly-controlled group with 31 patients,and poorly-controlled group with 55 patients. The three groups were compared in terms of general data,clinical manifestations,laboratory results,complications,and pathogen test results. A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. Results There were significant differences in mean age and length of hospital stay between the three groups( F = 2. 933 and 3. 310,both P < 0. 05). Compared with the other two groups,the poorly-controlled group had a significantly younger mean age of onset( P = 0. 016) and a significantly longer length of hospital stay( P = 0. 044). Hypertension was the most common underlying disease in diabetic patients with liver abscess,followed by biliary tract diseases and cerebral infarction,and there was a significant difference in cerebral infarction between the three groups( χ2= 6. 135,P =0. 037). Compared with the well-controlled group,the poorly-controlled group had significantly fewer and less typical signs of abdominal tenderness( χ2= 6. 178,P = 0. 046),and compared with the other two groups,the poorly-controlled group tended to have a significant increase in C-reactive protein( χ2= 5. 985,P = 0. 049) and were more likely to develop sepsis( χ2= 6. 247,P = 0. 044). Conclusion For diabetic patients with bacterial liver abscess,the patients with a poorly controlled Hb Alc level often have a young age of onset,a long length of hospital stay,and atypical clinical signs and are likely to develop sepsis,which may lead to insufficient attention in clinical practice,delay diagnosis and treatment,and even endanger life,and therefore,such patients should be taken seriously in clinical practice.