Objective To investigate the effect of Xiaozhang plaster in the treatment of cirrhotic ascites and its influence on the renin-angiotensin-aldosterone system. Methods A total of 220 patients with cirrhotic ascites who were hospitalized in Department of Gastroenterology in Shanghai Baoshan Integrated Traditional Chinese and Western Medical Hospital from March 2015 to March 2016 were enrolled and divided into routine treatment group with 60 patients, Xiaozhang plaster group with 60 patients, and terlipressin group with 100 patients. The patients in the routine treatment group received the routine treatment of cirrhotic ascites with a limitation of the dose of diuretics, those in the Xiaozhang plaster group were treated with Xiaozhang plaster in addition to the routine treatment, and those in the terlipressin group were treated with terlipressin in addition to the routine treatment. The three groups were observed in terms of related outcome measures ( depth of ascites, 24-hour urine volume, abdominal circumference, body weight, and Child-Pugh score) , symptoms and signs ( abdominal distension, diet, passage of gas by anus, and defecation) , hepatic and renal function, electrolytes, routine blood test results, coagulation function, portal vein diameter, glomerular filtration rate, and vasoactive substances [plasma renin activity ( PRA) , angiotensin Ⅱ ( AngⅡ) , and aldosterone ( ALD) ]. An analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for comparison within each group. Results There were significant differences between the three groups in depth of ascites, urine volume, abdominal circumference, Child-Pugh score, AngⅡ level, and ALD level on days 14 and 28 of treatment ( day14: F = 6. 566, 16. 236, 10. 856, 5. 727, 41. 860, and 20. 845, all P < 0. 05; day 28: F = 169. 311, 67. 686, 13. 521, 39. 721, 159. 256, and 80. 400, all P < 0. 05) . There were significant differences between the three groups in body weight and PRA level on day 28 of treatment ( F = 5. 068 and 0. 012, both P < 0. 05) . There were also significant differences between the three groups in the scores of abdominal distension, passage of gas by anus, and defecation on days 7, 14, and 28 of treatment ( day 7: F = 38. 311, 33. 405, and 33. 996, all P < 0. 05; day 14: F = 64. 414, 39. 481, and 52. 455, all P < 0. 05; day 28: F = 57. 596, 23. 041, and 47. 576, all P < 0. 05) . Conclusion Both Xiaozhang plaster and terlipressin can reduce ascites volume in patients with cirrhotic ascites, but they may have different action characteristics. Xiaozhang plaster is superior to terlipressin in the treatment of cirrhotic ascites and can significantly improve clinical symptoms, possibly by reducing the levels of PRA, AngⅡ, and ALD.

Objective To investigate the predictive factors for third-generation cephalosporin-resistant spontaneous bacterial peritonitis ( SBP) . Methods A retrospective analysis was performed for the clinical data of 206 patients with liver cirrhosis who were hospitalized in the Ninth Hospital of Nanchang from January 2010 to December 2018, and all patients had SBP with positive bacteria based on ascites culture. According to drug susceptibility results, the patients were divided into third-generation cephalosporin-resistant SBP group ( 101 patients with third-generation cephalosporin-resistant pathogenic bacteria in ascites) and control group ( 105 patients with pathogenic bacteria sensitive to third-generation cephalosporin) . Electronic medical records were reviewed to collect related information. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of data with skewed distribution between groups. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. A dichotomous logistic regression analysis was used for multivariate analysis, and the Forward: LR method was used for the screening of independent variables. Results There was a significant difference in the composition of pathogenic bacteria between the two groups ( P <0. 001) . The univariate analysis showed that a history of broad-spectrum antibiotic exposure in the past three months ( χ2= 12. 351, P <0. 001) , non-first-time onset of SBP ( χ2= 14. 427, P < 0. 001) , blood creatinine ( χ2=-2. 537, P = 0. 011) , and blood bicarbonate ( χ2=-4. 592, P < 0. 001) were candidate predictive factors with statistical significance between the two groups, and further multivariate analysis showed that a history of broad-spectrum antibiotic exposure in the past three months ( odds ratio [OR]= 2. 376, 95% confidence interval [CI]: 1. 009-5. 598, P = 0. 048) , non-first-time onset of SBP ( OR = 2. 841, 95% CI: 1. 133-7. 122, P = 0. 026) , and blood bicarbonate ( OR = 0. 892, 95% CI: 0. 818-0. 973, P = 0. 010) had an independent predictive value for third-generation cephalosporin-resistant SBP. Conclusion A history of broad-spectrum antibiotic exposure in the past three months, non-first-time onset of SBP, and a low level of blood bicarbonate are independent predictive factors for third-generation cephalosporin-resistant SBP, and third-generation cephalosporins should be used with caution in SBP patients with these features.

Objective To investigate the influence of dyslipidemia and number of items conforming to the diagnostic criteria for dyslipidemia on new-onset acute pancreatitis ( AP) . Methods A prospective cohort study was performed for 99 695 on-the-job or retired workers of Kailuan Group who underwent the first physical examination from 2006 to 2007. According to the number of items conforming to the diagnostic criteria for dyslipidemia in the first physical examination, they were divided into G0 group with 69 465 workers who did not meet the diagnostic criteria for dyslipidemia, G1 group with 23 921 workers who met one item of the diagnostic criteria for dyslipidemia, G2 group with5791 workers who met two items of the diagnostic criteria for dyslipidemia, G3 group with 500 workers who met three items of the diagnostic criteria for dyslipidemia, and G4 group with 18 workers who met four items of the diagnostic criteria for dyslipidemia. New-onset AP cases were collected once every year during follow-up, and a multivariate Cox proportional hazards regression model analysis was used to analyze the influence of dyslipidemia on new-onset AP cases. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to calculate the cumulative incidence rate of AP in each group, and the log-rank test was used for comparison of cumulative incidence rate between groups. Results The total follow-up time of all 99 695 workers was 782 395 person-years, and since no new-onset AP cases were observed in G4 group, G4 group was combined with G3 group for analysis. The incidence rates of AP in G0, G1, G2, and G3 groups were 1. 61, 2. 05, 2. 59, and 7. 72 per thousand person-years, respectively, and the cumulative incidence rates of AP in these four groups were 1. 76‰, 2. 40‰, 3. 12‰, and 8. 39‰, respectively. The log-rank test showed a significant difference in cumulative incidence rate between groups ( χ2= 15. 18, P = 0. 004 3) . After adjustment for the other risk factors, the Cox model showed that the hazard ratio ( 95%confidence interval) for AP was 1. 23 ( 0. 88-1. 73) in G1 group, 1. 58 ( 1. 09-2. 10) in G2 group, and 4. 90 ( 1. 81-13. 37) in G3 group. Conclusion Dyslipidemia is a risk factor for new-onset AP, and the risk of AP increases with the increase in the number of items conforming to the diagnostic criteria for dyslipidemia.

Objective To systematically review the clinical effect of glucocorticoids used alone or in combination with pentoxifylline in patients with severe alcoholic liver disease. Methods PubMed, Embase, Chinese Scientific Journal Full-Text Database, CBM, China Scientific Journal Database, and Chinese Medical Association Digital Journal Database were searched for related articles published up to November 2018, and related journals and collected papers from conferences were searched manually. The clinical effect of glucocorticoids versus placebo, glucocorticoids versus pentoxifylline, and glucocorticoids combined with glucocorticoids versus glucocorticoids alone was analyzed.The effect of glucocorticoids and pentoxifylline used alone or in combination on 28-day survival rate and hepatorenal syndrome in patients with severe alcoholic liver disease was assessed. Odds ratio ( OR) and 95% confidence interval ( CI) were used to evaluate outcome indicators. RevMan 5. 3 software was used for data analysis. Results A total of 22 studies were included, with 1956 patients in total. The glucocorticoid group had a significantly lower 28-day mortality rate than the control group ( 25. 12% vs 30. 67%, OR = 0. 71, 95% CI: 0. 55-0. 93, P = 0. 01) . Subgroup analysis showed that there was a significant difference in 28-day mortality rate between the glucocorticoid group and the pentoxifylline group ( OR = 0. 68, 95% CI: 0. 48-0. 97, P = 0. 03) , while there was no significant difference between the glucocorticoid + pentoxifylline group and the glucocorticoid group ( OR = 0. 92, 95% CI: 0. 66-1. 29, P = 0. 64) . Compared with the glucocorticoid group, the glucocorticoid + pentoxifylline group had a significantly lower incidence rate of hepatorenal syndrome ( 3. 94% vs8. 03%, OR = 0. 45, 95% CI: 0. 24-0. 83, P = 0. 01) . Funnel plots showed no publication bias. Conclusion Glucocorticoids combined with pentoxifylline can reduce the incidence rate of hepatorenal syndrome in patients with severe alcoholic liver disease.

Objective To investigate the interaction between Helicobacter pylori infection and polymorphisms of PPAR-γ2 gene Pro12 Ala and GPx-1 gene Pro198 Leu and its association with nonalcoholic fatty liver disease ( NAFLD) . Methods A total of 750 patients with nonalcoholic fatty liver ( NAFL) , 750 patients with nonalcoholic steatohepatitis ( NASH) , and 750 patients with nonalcoholic fatty hepatic cirrhosis ( NAFHC) who were treated or hospitalized in The First Affiliated Hospital of Xinxiang Medical University from March 2011 to July2015 were enrolled, and 750 individuals who underwent physical examination were enrolled as control group. Peripheral blood leukocytes were collected for each group, and PCR-RFLP was used to detect the polymorphisms of Pro12 Ala and Pro198 Leu. The14 C-urea breath test was used to measure disintegration per minute ( DPM) of Helicobacter pylori binding to14 C, in order to evaluate the degree of Helicobacter pylori infection. A face-to-face questionnaire survey was performed for each subject. The t-test was used for comparison of continuous data between two groups, the chi-square test was used for comparison of categorical data between groups. The multivariate logistic regression model was used for data analysis. The adjusted odds ratio ( OR) and 95% confidence interval of Pro12 Ala polymorphism, Pro198 Leu polymorphism, and Helicobacter pylori infection for the risk of NAFLD were calculated, and the interaction between Helicobacter pylori infection and polymorphism of PPAR-γ2 gene Pro12 Ala and GPx-1 gene Pro198 Leu was analyzed. Results The patients with the genotypes of Pro12 Ala ( PA) , Pro12 Ala ( AA) , Pro198 Leu ( PL) , and Pro198 Leu ( LL) had a significant increase in the risk of NAFLD ( OR = 5. 732 4, 5. 973 2, 6. 360 5, and 6. 165 7, all P < 0. 01) . The combined analysis of the polymorphisms showed positive interactions between Pro12 Ala ( PA) and Pro198 Leu ( PL) , between Pro12 Ala ( PA) and Pro198 Leu ( LL) , between Pro12 Ala ( AA) and Pro198 Leu ( PL) , and between Pro12 Ala ( AA) and Pro198 Leu ( LL) ( all γ > 1) . The Helicobacter pylori infection patients with 100≤DPM < 500 or DPM≥500 had a significant increase in the risk of NAFLD ( 100≤DPM < 500: ORNAFL= 2. 064 1, ORNASH= 4. 448 5, ORNAFHC= 10. 969 5;DPM≥500: ORNAFL= 3. 130 5, ORNASH= 8. 024 6, ORNAFHC= 21. 461 4) , and the patients with DPM≥500 had a significantly higher risk of NAFLD than those with 100 ≤ DPM < 500 ( P < 0. 01) . There were positive interactions between Helicobacter pylori infection and Pro12 Ala ( PA) , Pro12 Ala ( AA) , Pro198 Leu ( PL) , and Pro198 Leu ( LL) ( all γ > 1) . Conclusion The carriers of Pro12 Ala ( PA) , Pro12 Ala ( AA) , Pro198 Leu ( PL) , and Pro198 Leu ( LL) genotypes may have a high risk of NAFLD, and the interaction between these genotypes and Helicobacter pylori infection promotes the development and progression of NAFLD. Therefore, effective prevention measures including Helicobacter pylori eradication and gene expression regulation should be adopted to prevent NAFLD.

Objective To perform dynamic measurement of urinary insulin-like growth factor-binding protein 7 ( IFGBP7) and tissue inhibitor of metalloproteinases-2 ( TIMP-2) in patients with HBV-related acute-on-chronic liver failure ( HBV-ACLF) , and to investigate the value of combined measurement of urinary IFGBP7 and TIMP-2 in early prediction of acute kidney injury ( AKI) associated with HBV-ACLF. Methods A total of 61 patients with HBV-ACLF who were admitted to the First Affiliated Hospital of Nanchang University from September 2015 to January 2016 were enrolled, and according to the presence or absence of AKI, they were divided into AKI group with 15 patients and non-AKI group with 46 patients. A total of 21 hospitalized patients with chronic hepatitis B were enrolled as control group. Urine samples were collected at 8∶ 00 and 20∶ 00 every day since the day of admission. For the AKI group, the urine samples collected within 5 days before a confirmed diagnosis of AKI was made were used for analysis, and for the non-AKI group and the control group, the urine samples collected within 5 consecutive days during the same period of time were used for analysis. ELISA was used to measure the levels of IFGBP7 and TIMP-2 in urine, and serum creatinine ( SCr) and estimated glomerular filtration rate ( eGFR) were recorded during the same period of time. The Kruskal-Wallis rank sum test was used for comparison of continuous data between multiple groups; and pairwise compared was made by Wilcoxon test; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups; the receiver operating characteristic ( ROC) curve and the area under the ROC curve ( AUC) were used to evaluate the efficiency of combined measurement of IFGBP7 and TIMP-2 in the diagnosis of AKI. Results For HBV-ACLF patients, the levels of IFGBP7 and TIMP-2 gradually increased from 48 hours before the diagnosis of AKI to the time of diagnosis, and there were significant differences in the levels of IFGBP7 and TIMP-2 between the control group/the non-AKI group and the AKI group at 48 hours to 12 hours before the diagnosis of AKI to the time of diagnosis ( all P < 0. 05) . With the aggravation of disease conditions in the AKI group, at 36 hours before the diagnosis of AKI and at the time of diagnosis, SCr was significantly higher, eGFR was significantly lower than those at baseline ( both P < 0. 05) . The increases in the levels of IFGBP7 and TIMP-2 at 36 hours before the diagnosis of AKI had a high sensitivity in predicting AKI, with an AUC of 0. 896 ( 95% confidence interval: 0. 789-0. 960, P = 0. 043) and a stronger ability of AKI prediction than SCr and eGFR. Conclusion The increases in urinary TIMP-2 and IGFBP-7 can accurately predict AKI in patients with HBV-ACLF.

Objective To investigate the effect of recombinant human granulocyte colony-stimulating factor ( rhG-CSF) on acute liver failure ( ALF) induced by D-galactosamine ( D-GalN) in rats. Methods A total of 105 male Sprague-Dawley rats were randomly divided into healthy control group, liver failure model group, and rhG-CSF group, with 35 rats in each group. A rat model of ALF was established by intraperitoneal injection of D-GalN ( 1400 mg/kg) . Alanine aminotransferase ( ALT) level in the liver, total bilirubin ( TBil) , peripheral blood leukocyte count, and liver pathological changes were observed at 12, 24, 48, 72, and 120 hours after modeling, and survival rate was observed at 120 hours after modeling. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the LST-t test was used for further comparison between two groups. Results Compared with the liver failure model group, the rhG-CSF group had a significantly higher degree of hepatocyte degeneration and necrosis at all time points except 120 hours after modeling, and compared with the liver failure model group at 120 hours after modeling, the rhG-CSF group had better recovery of lobular structure on HE staining. Compared with the liver failure model group, the rhG-CSF group had a tendency of increase in the percentage of cells with positive tumor necrosis factor-α at the five time points after modeling. Compared with the liver failure model group, the rhG-CSF group had significantly higher levels of ALT and TBil at all five time points. Both groups had a significant change in ALT level at 24 hours after modeling ( P < 0. 05) , as well as a significant change in TBil at 24, 48, and 120 hours after modeling ( P < 0. 05) . The rhG-CSF group had a significantly higher peripheral blood leukocyte count than the liver failure model group at all five time points ( all P<0. 120="" .="" there="" was="" no="" significant="" difference="" in="" survival="" rate="" at="" hours="" after="" modeling="" between="" the="" two="" groups="" p="">0. 05) . Conclusion Application of rhG-CSF during the stage of acute inflammatory reaction of ALF may aggravate liver inflammatory response.

Objective To investigate the effect of probiotics intervention on rats with acute-on-chronic liver failure ( ACLF) and related mechanism. Methods A total of 44 male Sprague-Dawley rats were randomly divided into six groups using a random number table, i. e., control group 1 ( C1 group with 6 rats without any intervention) , model group 1 ( M1 group with 8 rats treated with intraperitoneally injected40% CCl4 oil solution for 10 weeks, followed by phosphate-buffered saline by gavage since week 7 and D-galactosamine acute attack at the end of week 10) , probiotics intervention group 1 ( Y1 group with 8 rats treated with the same modeling method as the M1 group, and probiotics solution was given by gavage) , control group 2 ( C2 group with 6 rats without any intervention) , model group 2 ( M2 group with 8 rats treated with intraperitoneally injected 40% CCl4 oil solution, followed by D-galactosamine acute attack at the end of week 10 and phosphate-buffered saline by gavage at 48 hours after attack, and they were sacrificed at the end of week 12) , and probiotics intervention group 2 ( Y2 group with 8 rats treated with the same modeling method as the M2 group, and probiotics solution was given by gavage) . Body weight, liver function, and liver histopathology were observed before and after intervention. ELISA was used to measure the levels of endotoxin and endocrine immunoglobulin A ( s IgA) in plasma, Western Blot was used to measure the content of the intestinal tight junction protein Occludin, RT-PCR was used to measure the mRNA expression of Occludin and ZO-1, and a selective medium was used to measure the changes in related indices including intestinal flora. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the SNK-q test was used for further comparison between two groups. Results There were significant differences in body weight, liver index, alanine aminotransferase, aspartate aminotransferase, total bilirubin, plasma endotoxin, s IgA, and mRNA expression of Occludin and ZO-1 between the C1, M1, and Y1 groups ( F = 27. 65, 8. 96, 61. 37, 18. 27, 21. 00, 87. 01, 67. 10, 101. 50, and105. 40, all P < 0. 05) , as well as between the C2, M2, and Y2 groups ( F = 14. 04, 12. 85, 14. 02, 11. 39, 35. 80, 19. 14, 15. 37, 25. 02, and 126. 00, all P < 0. 05) . There was no significant difference in the protein expression of Occludin between the C1, M1, and Y1 groups ( F = 16. 40, P < 0. 05) . There were significant differences in the content of Lactobacillus, Bifidobacterium, Enterococcus, and Enterobacter between the C1, M1, and Y1 groups ( F = 77. 95, 66. 61, 25. 63, and 33. 29, all P < 0. 05) , as well as between the C2, M2, and Y2 groups ( F = 21. 50, 22. 62, 6. 71, and 17. 74, all P < 0. 05) . Conclusion Intestinal flora disturbance and intestinal barrier dysfunction are observed in rats with ACLF, and probiotics intervention can remodel the structure of intestinal flora, maintain intestinal barrier function, and promote liver repair.

Objective To investigate the value of Gd-EOB-DTPA-enhanced MRI in the assessment of liver function in dogs with acute liver failure ( ALF) . Methods A total of 16 healthy adult male Beagle dogs were randomly divided into ALF group and blank control group, with 8 dogs in each group. The dogs in the ALF group were given injection of 30% acetaminophen via the saphenous vein of the forelimb and abdominal subcutaneous injection of 40% carbon tetrachloride at a dose of 0. 5 ml/kg, and 12 hours later, 30% acetaminophen and 40% carbon tetrachloride were injected at half of the first dose. Gd-EOB-DTPA-enhanced MRI scan was performed after 24 hours, and after injection of the contrast agent Gd-EOB-DTPA ( 0. 15 ml/kg body weight) , the signal values of high-, medium-, and low-signal regions were measured during plain scan and at 20 and 26 minutes of MRI scan. Liver puncture was performed in different signal regions. Gd-EOB-DTPA-enhanced MRI was performed for the control group, and liver puncture was performed in the corresponding regions. HE staining and electron microscopy were used for tissue examination, and the two groups were compared in terms of signal values and the results of HE staining and electron microscopy. The independent samples t-test was used for comparison of continuous data at each time point between the two groups, and an analysis of variance with repeated measures was used for comparison at different time points within groups; a one-way analysis of variance was used for comparison of signal values at each time point within groups. Results The ALF group had high, medium, and low signals in different time periods after Gd-EOB-DTPA-enhanced MRI scan, and HE staining and electron microscopy showed varying degrees of hepatocyte injury in the high-, medium-, and low-signal regions. The ALF group had significant differences in the levels of alanine aminotransferase, aspartate aminotransferase, and total bilirubin at 0, 6, 12, and 24 hours ( F = 54. 909, 148. 238, and 11. 778, all P < 0. 01) . In the ALF group and the control group, the high-, medium-, and low-signal values showed significant changes during plain scan and at 20 and 26 minutes of MRI scan ( ALF group: F = 232. 69, 65. 39, and 24. 91, all P < 0. 01; control group: F = 800. 43, 817. 35, and 795. 71, all P < 0. 01) . In the ALF group, there were significant differences in the high-, medium-, and low-signal values during plain scan and at 20 and 26 minutes of MRI scan ( F = 3. 914, 24. 343, and 22. 424, all P < 0. 05) . There were significant differences between the two groups in the medium-and low-signal values at 20 minutes of MRI scan ( t =-7. 813 and-7. 492, both P < 0. 001) and the high-, medium-, and low-signal values at 26 minutes of MRI scan ( t =-3. 075, -4. 785, and-6. 326, P =0. 008, P < 0. 001, and P < 0. 001) . The reduction in corresponding signals was associated with the degree of hepatocyte injury. Conclusion Gd-EOB-DTPA-enhanced MRI scan is feasible for the assessment of liver function in ALF dogs, and it can also predict the degree of liver pathological damage.

Liver fibrosis and end-stage liver cirrhosis are often accompanied by liver hypoxia. As a key transcription factor for regulating the body's response to hypoxia, hypoxia-inducible factor 1α ( HIF-1α) plays an important role in the activation of hepatic stellate cells and the development and progression of liver fibrosis. In addition, downregulation of HIF-1α expression can alleviate liver fibrosis and thus HIF-1α is expected to become a new target for the treatment of liver fibrosis. This article reviews the association between HIF-1α and liver fibrosis-related signaling pathways and genes and further discusses the potential of HIF-1α as a new therapeutic target for liver fibrosis.

Primary biliary cholangitis ( PBC) is one of common autoimmune liver diseases, and its pathogenesis remains unclear. This article summarizes the role of microRNA in the pathogenesis, diagnosis, and outcome evaluation of PBC and points out that microRNA may be involved in the development and progression of PBC and may thus be used as a potential biomarker for diagnosis and outcome evaluation.