Hepatorenal syndrome( HRS) is one of the most severe complications of decompensated cirrhosis. Splanchnic arterial vasodilation in patients with advanced liver cirrhosis and the reduction in cardiac output due to cirrhotic cardiomyopathy may trigger the reduction in effective circulating blood volume,the activation of endogenous vasoconstrictor systems,and significant contraction of renal blood vessels;meanwhile,impairment in renal autoregulation of blood flow may finally lead to the reductions in renal blood flow and glomerular filtration rate. Systemic inflammation also plays an important role in the pathogenesis of HRS. The treatment of HRS should start as soon as it is diagnosed. In the past,HRS was considered“functional”renal insufficiency,while at present,it is considered a spectrum of diseases gradually changing from functional renal insufficiency to varying degrees of parenchymal damage. As there are still no suitable animal models of HRS,current investigations of the pathophysiology of HRS and related pharmacological research mainly rely on clinical studies,which brings difficulties in further understanding the natural history and pathophysiology of HRS. This article reviews the recent advances in the basic and clinical research on HRS and related difficulties.

Hepatorenal syndrome( HRS) is one of the common serious complications in patients with end-stage liver disease and has poor prognosis and high mortality,and in-depth studies on its pathogenesis will help to achieve precise prevention and treatment. Although the exact pathogenesis of HRS has not yet been fully elucidated,achievements have been made in the pathogenesis of HRS. The classic mechanism of the hypothesis of visceral vasodilation continues to be enriched and perfected,and new understandings have been gained for the role of systemic inflammation and intestinal bacterial translocation in pathogenesis. In addition,a new concept of cardiorenal syndrome is put forward for the involvement of cardiac dysfunction in HRS,and renal pathology has been questioned and challenged. This article reviews the research advances in the pathogenesis of HRS in recent years and related implications for clinical work.

Hepatorenal syndrome( HRS) is a common complication of decompensated cirrhosis and is traditionally defined as progressive oliguria or anuria,azotemia,dilutional hyponatremia,and hyponatremia,while renal insufficiency without marked organic lesions in the kidney is the typical manifestation of HRS. Recent studies have found that besides the abnormalities in hemodynamics,inflammatory response,oxidative stress,and direct renal tubular toxicity of bile salts are jointly involved in the development and progression of HRS. HRS is not the only renal complication in patients with liver cirrhosis,and it is only a functional form of acute kidney injury( AKI). HRS meeting the criteria for AKI is called HRS-AKI,which is formerly known as HRS-Ⅰ type. For cirrhotic patients with acute kidney disease or chronic kidney disease,if they meet the criteria for HRS,they can be diagnosed with HRS-NAKI,which is formerly known as HRS-Ⅱ type. The most common risk factors for HRS are infection,digestive bleeding,and large-volume paracentesis without transfusion of human serum albumin for volume expansion.

Hepatorenal syndrome is one of the major complications of decompensated cirrhosis secondary to the reduction in effective blood volume,imbalance of endogenous vasoactive substances,and the reduction in renal blood flow,with renal insufficiency as the main manifestation. In clinical practice,hepatorenal syndrome mainly manifests as the reduction in renal blood flow and glomerular filtration rate,with no marked changes in renal histology. The treatment of hepatorenal syndrome should start as soon as it is diagnosed. Current therapeutic modalities include the following:( 1) general supportive therapies for primary diseases and predisposing factors;( 2) pharmacotherapy,including albumin and vasoactive agents;( 3) renal replacement therapy;( 4) molecular adsorbent recirculating system;( 5) transjugular intrahepatic portosystemic shunt;( 6) liver transplantation. Liver transplantation is the optimal regimen for the treatment of hepatorenal syndrome,and the other methods including pharmacotherapy and renal replacement therapy are often used as transitional therapies before liver transplantation. Albumin combined with terlipressin is currently the preferred regimen of pharmacotherapy for hepatorenal syndrome. This article reviews the new concepts and advances in the treatment of hepatorenal syndrome.

Hepatorenal syndrome( HRS) is a serious complication that occurs in patients with decompensated cirrhosis or acute/chronic liver failure. The main pathological features of HRS include marked peripheral vasodilation and strong renal vasoconstriction,with rapid progression,unsatisfactory treatment response,and poor prognosis. Vasoconstrictors are mainly used in the pharmacotherapy for HRS,and at present,terlipressin combined with albumin is the first-line treatment method for HRS. Some drugs with a renal vasodilatory effect also show a potential therapeutic effect. This article reviews the latest research advances in the role and clinical application of vasoactive drugs in the treatment of HRS.

Acute kidney injury( AKI) and hepatorenal syndrome( HRS) are serious complications in patients with end-stage liver disease,with renal injury as the main manifestation. They are interrelated,but also different from each other. There are several types of AKI,i. e.,prerenal AKI,intrarenal or intrinsic AKI,and post-renal AKI,and type 1 HRS is considered a special type of AKI. There are different therapies for different types of AKI. With the improvement in the diagnostic criteria for AKI and chronic kidney disease in recent years,the diagnostic criteria and classification of HRS have also been updated. As for pathogenesis,systemic inflammation caused by intestinal bacterial translocation is attracting more and more attention. HRS was considered functional renal injury in the past,but recent evidence suggests the existence of structural injury. Vasoconstrictor combined with albumin is the main therapeutic drug for HRS. This article reviews the diagnosis and treatment of AKI in end-stage liver disease and the recent advances in the diagnostic criteria,classification,pathology,pathogenesis,and treatment of HRS.

Objective To investigate the changes of Th22 cells,interleukin-22( IL-22),and transcription factor aryl hydrocarbon receptor( AhR) in patients with hepatitis B virus( HBV) infection and their correlation with clinical indices. Methods A total of 11 patients with acute hepatitis B( AHB) and 38 patients with chronic hepatitis B( CHB) who attended Eighth Hospital of Xi'an from March 2018 to March 2019 were enrolled as AHB group and CHB group,respectively,and 16 healthy controls were enrolled as HC group. The patients with CHB received tenofovir disoproxil fumarate( TDF) antiviral therapy. Peripheral blood samples were collected for AHB patients at baseline and 6 months after discharge,and peripheral blood samples were collected for CHB patients at baseline and at months 6 and 12 of treatment;peripheral blood mononuclear cells( PBMCs) and plasma were isolated,then PBMCs were stimulated with phorbol ester + ionomycin or recombinant HBcAg,and flow cytometry was used to measure nonspecific CD3+CD4+IL-22+Th22 cells and HBcAg-specific Th22 cells.ELISA was used to measure the plasma level of IL-22,and quantitative real-time PCR was used to measure the mRNA expression of AhR in PBMCs. The t-test and the paired t-test were used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison of normally distributed continuous data 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. The chi-square test was used for comparison of categorical data between groups. A Spearman correlation analysis was used to investigate correlation. Results The AHB group had a significantly higher percentage of nonspecific Th22 cells than the CHB group( 2. 86% ± 0. 45% vs 1. 39% ± 0. 33%,t = 11. 80,P < 0. 001) and the HC group( 2. 86% ± 0. 45%vs 0. 80% ± 0. 13%,t = 17. 30,P < 0. 001),and the CHB group also had a significantly higher percentage of nonspecific Th22 cells than the HC group( t = 6. 825,P < 0. 001). The AHB group had a significantly higher percentage of HBc Ag-specific Th22 cells than the CHB group( 2. 97% ± 0. 52% vs 1. 22% ± 0. 22%,t = 16. 58,P < 0. 001). The AHB group had a significantly higher plasma level of IL-22 than the CHB group( 130. 7 ± 39. 97 pg/ml vs 66. 59 ± 20. 83 pg/ml,t = 7. 176,P < 0. 001) and the HC group( 130. 7 ± 39. 97 pg/ml vs50. 63 ± 11. 07 pg/ml,t = 7. 662,P < 0. 001),and the CHB group also had a significantly higher plasma level of IL-22 than the HC group( t = 2. 887,P = 0. 006). The AHB group had significantly higher mRNA expression of AhR than the CHB group( 11. 45 ± 3. 03 vs 4. 81 ±1. 25,t = 10. 85,P < 0. 0001) and the HC group( 11. 45 ± 3. 03 vs 1. 10 ± 0. 17,t = 13. 75,P < 0. 001),and the CHB group also had significantly higher mRNA expression of AhR than the HC group( t = 11. 77,P < 0. 001). In both AHB and CHB patients,the percentage of HBc Ag-specific Th22 cells was positively correlated with alanine aminotransferase( ALT) level( r = 0. 638 and 0. 830,P = 0. 035 and0. 002),and the plasma level of IL-22 was also positively correlated with ALT level( r = 0. 552 and 0. 431,P = 0. 001 and 0. 007). The AHB patients were followed up at 6 months after discharge,and there were significant reductions in the percentage of HBc Ag-specific Th22 cells( 2. 79% ± 0. 56%,t = 3. 055,P = 0. 012) and the plasma level of IL-22( 105. 8 ± 25. 23 pg/ml,t = 2. 362,P = 0. 040) from baseline. All CHB patients received TDF antiviral therapy and were followed up at months 6 and 12 of treatment,and there were significant reductions in the percentage of HBc Ag-specific Th22 cells( t = 4. 353 and 3. 927,all P < 0. 001) and the plasma level of IL-22( t =4. 426 and 4. 810,both P < 0. 0001) from baseline to months 6 and 12 of treatment. Conclusion HBc Ag-specific Th22 cells and IL-22 are closely associated with inflammatory response to HBV infection.

Objective To investigate the association between serum interleukin( IL) and liver pathological changes in patients with chronic hepatitis B( CHB). Methods A total of 59 patients with CHB who were treated in Putuo District Central Hospital of Shanghai from February 2018 to February 2019 were enrolled as subjects,and liver biopsy was performed for all patients. According to the degree of liver inflammation,the patients were divided into mild inflammation( G1-G2) group and severe inflammation( G3-G4) group,and according to the degree of liver fibrosis,the patients were divided into mild fibrosis( S0-S2) group and severe fibrosis( S3-S4) group. Serum liver function parameters,blood lipids,interleukin-2( IL-2),interleukin-6( IL-6),interleukin-8( IL-8),and interleukin-10( IL-10)were measured for all patients. The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the Wilcoxon non-parametric 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 groups. A Spearman correlation analysis was also performed.Results The degree of liver fibrosis increased with the increase in liver inflammation( rs= 0. 538,P < 0. 001). Compared with the mild inflammation group,the severe inflammation group had significantly higher serum levels of alanine aminotransferase [95. 00( 45. 00-169. 25) U/L vs 51. 00( 29. 00-88. 00) U/L,Z =-2. 625,P = 0. 009],aspartate aminotransferase [54. 50( 34. 75-84. 50) U/L vs38. 00( 30. 00-49. 00) U/L,Z =-2. 014,P = 0. 044],and gamma-glutamyl transpeptidase [91. 00( 56. 72-192. 25) U/L vs 44. 00( 24. 00-100. 00) U/L,Z =-2. 400,P = 0. 016]. The severe fibrosis group had a significantly higher serum level of high-density lipoprotein than the mild fibrosis group [0. 97( 0. 32-1. 08) mmol/L vs 1. 23( 0. 36-1. 38) mmol/L,Z =-1. 300,P = 0. 008]. The severe inflammation group had a significantly higher serum level of IL-2 receptor than the mild inflammation group [704. 00( 418. 00-1038. 00) U/ml vs 436. 00( 335. 00-555. 00) U/ml,Z =-3. 405,P = 0. 001],and the severe fibrosis group had a significantly higher serum level of IL-2 receptor than the mild fibrosis group [735. 00( 523. 00-890. 50) U/ml vs 447. 00( 351. 50-624. 50) U/ml,Z =-5. 358,P = 0. 001]. Conclusion The degree of liver inflammation is positively correlated with that of liver fibrosis,while the serum level of IL-2 receptor increases with the increase in the degrees of liver inflammation and fibrosis,indicating that IL-2 receptor can reflect the degrees of liver inflammation and fibrosis to some extent.

Objective To investigate the clinical significance of highly sensitive nucleic acid detection in precise antiviral therapy for patients with liver cirrhosis and its association with aminotransferase level. Methods A total of 377 patients with hepatitis B cirrhosis who were hospitalized or attended the outpatient service from May 2013 to April 2019 were enrolled and tested by both domestic HBV DNA detection and highly sensitive Cobas HBV DNA detection. All patients underwent biochemical examination,four blood coagulation tests,routine blood test,and upper abdominal computed tomography or ultrasound. Sensitivity of different HBV DNA detection reagents was compared in liver cirrhosis patients with a low viral load,and the correlation between alanine aminotransferase( ALT) level and viral load was analyzed.The paired t-test was used for comparison of continuous data before and after treatment. The receiver operating characteristic( ROC) curve was used to screen out the optimal predictive values of ALT at different cut-off values of HBV DNA. Results Among the 377 patients with hepatitis B cirrhosis,215 tested positive and 162 tested negative by domestic HBV DNA,and among these 162 patients,104( 64. 2%) tested positive by Cobas HBV DNA detection,with a mean level of 267. 5 ± 42. 3 IU/ml. After 24 weeks of antiviral therapy,the 104 patients with hepatitis B cirrhosis had significant improvements in viral replication level,ALT,and Child-Pugh score for liver function; HBV DNA decreased from 267. 5 ± 32. 2 IU/ml before treatment to 59. 6 ± 7. 7 IU/ml after treatment( t = 3. 486,P = 0. 002),ALT decreased from87. 1 ± 10. 8 U/L before treatment to 36. 5 ± 7. 6 U/L after treatment( t = 3. 235,P = 0. 020),and the Child-Pugh score decreased from6. 5 ± 0. 7 before treatment to 5. 7 ± 0. 5 after treatment( t = 2. 928,P = 0. 041). The ROC curve analysis of ALT in predicting HBV DNA decision point showed that an ALT level of 29 IU/L was the most sensitive cut-off value for predicting HBV DNA < 20 IU/ml,with an area under the ROC curve of 0. 904,a sensitivity of 1. 0,and a specificity of 0. 237. Conclusion Precise detection helps to guarantee the precise clinical treatment of patients with hepatitis B cirrhosis and improve their treatment outcome and prognosis. An ALT level of 29 IU/L is a sensitive indicator for predicting patients with negative Cobas HBV DNA,so as to achieve individualized precise screening and treatment.

Objective To investigate the expression and clinical significance of programmed death-1(PD-1) and T-cell immunoglobulin-and mucin domain-3-containing molecule 3(TIM-3) in hepatocellular carcinoma(HCC).Methods The paraffin blocks of HCC tissue and adjacent tissue(> 1 cm from the tumor margin) were collected from 46 patients with HCC who underwent surgical treatment in No.900 Hospital of The Joint Service and Security Force of The Chinese People's Liberation Army from January 2013 to December 2015.Immunohistochemistry was used to measure the expression of PD-1 and TIM-3,and their association with clinicopathological features and prognosis was analyzed.The Wilcoxon test was used for comparison of paired ranked data,and a Spearman correlation analysis was used to investigate the correlation between ranked data; the Kaplan-Meier method was used for survival analysis,and the log-rank test was used for comparison of survival rates between groups; the Cox regression model was used to perform a multivariate analysis.Results The expression levels of PD-1 and TIM-3 in HCC tissue were higher than those in adjacent tissue(both P<0.05).PD-1 was mainly localized in lymphocytes and TIM-3 was mainly localized in tumor-associated macrophages.The expression of PD-1 was positively correlated with that of TIM-3 in HCC tissue(rs=0.397,P=0.006).The expression level of PD-1 in HCC tissue was associated with tumor size(rs=0.480,P=0.001),portal vein tumor thrombus(rs=0.307,P=0.038),and TNM stage(rs=0.534,P <0.001),and the expression level of TIM-3 was associated with portal vein tumor thrombus(rs=0.301,P=0.042),degree of pathological differentiation(rs=0.356,P=0.015),and TNM stage(rs=0.416,P=0.004).For the patients with HCC,the 1-,3-,and 5-year overall survival rates were89.1%,56.5%,and 34.4%,respectively,and the 1-,3-,and 5-year disease-free survival rates were 52.2%,21.7%,and 10.9%,respectively.The multivariate analysis showed that degree of pathological differentiation(hazard ratio [HR]=4.723,95% confidence interval [CI]:1.618-7.684,P=0.001),tumor size(HR=3.234,95% CI:1.327-7.883,P=0.010),TNM stage(HR=3.254,95% CI:1.076-9.835,P=0.037),and expression level of TIM-3(HR=0.572,95% CI:0.329-0.995,P=0.048) were independent prognostic factors for the overall survival of HCC patients,and degree of pathological differentiation(HR=2.945,95% CI:1.527-5.682,P=0.001) and TNM stage(HR=2.074,95% CI:1.259-9.793,P=0.016) were independent prognostic factors for the disease-free survival of HCC patients.Conclusion High expression levels of both PD-1 and TIM-3 are observed in HCC tissue,and PD-1 and TIM-3 may be involved in the progression and poor prognosis of HCC patients.

Objective To investigate the association of the expression of the NK cell-activating receptor NKG2 D,its ligand major histocompatibility complex class I chain-related gene A( MICA),and related cytokines [interferon-γ( IFN-γ),interleukin-10( IL-10),and interleukin-15( IL-15) ] with intrahepatic inflammation in primary biliary cholangitis( PBC). Methods Liver biopsy specimens were collected from 30 patients with PBC( PBC group),15 patients with chronic hepatitis B( CHB group),and 10 patients with nonalcoholic fatty liver disease( NAFLD group),who were hospitalized in The Second Affiliated Hospital of Kunming Medical University from August 2014 to June 2015. The degree of liver inflammation( G) and fibrosis degree( S) of the liver specimens were determined,and immunohistochemistry was used to measure the expression of NKG2 D,MICA,IFN-γ,IL-10,and IL-15 in liver tissue( the scores were determined based on the number of cells stained and the degree of staining to evaluate the expression of each marker). A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the t-test was used for comparison between two groups; a Spearman correlation analysis was used to investigate correlation. Results In the PBC group,the expression of NKG2 D increased with the degree of inflammation,and the patients with G3-4 inflammation had significantly higher expression than those with G1-2 inflammation( G1 vs G2 vs G3 vs G4: 1. 4 ± 0. 05 vs 1. 56 ± 0. 05 vs 1. 86 ± 0. 11 vs 2. 60 ± 0. 17,F = 150. 8,P < 0. 05); the expression of NKG2 D decreased with fibrosis degree( S3 vs S4: 2. 30 ± 0. 17 vs 1. 56 ± 0. 05,t =-1. 52,P < 0. 05). In the PBC group,there was no significant difference in MICA between G3 and G4( 0. 11 ± 0. 01 vs 0. 20 ± 0. 03,t =-2. 20,P > 0. 05) and between S3 and S4( 0. 12 ±0. 02 vs 0. 18 ± 0. 03,t =-2. 64,P > 0. 05). In the PBC group,there was a significant difference in the expression of IL-15 between the patients with different degrees of inflammation( G1 vs G2 vs G3 vs G4: 0. 70 ± 0. 10 vs 1. 50 ± 0. 10 vs 1. 93 ± 0. 11 vs 2. 60 ± 0. 17,F =251. 3,P < 0. 05),while there was no significant difference between the patients with different fibrosis degrees( S3 vs S4: 2. 00 ± 0. 05 vs2. 40 ± 0. 30,t =-1. 62,P > 0. 05). In the CHB group,there was a significant difference in the expression of IL-15 between the patients with different degrees of inflammation( G1 vs G2 vs G3: 0. 73 ± 0. 15 vs 1. 96 ± 0. 15 vs 2. 50 ± 0. 17,F = 150,P < 0. 05) and between the patients with different fibrosis degrees( S1 vs S2 vs S3: 0. 70 ± 0. 10 vs 21. 96 ± 0. 15 vs 2. 50 ± 0. 17,F = 158. 7,P < 0. 05). In the PBC group,the expression of IL-10 was only observed in the patients with G1 inflammation( 0. 16 ± 0. 01),and in the CHB group,the expression of IL-10 was observed in the patients with G1 and G2 inflammation,with no significant difference( G1 vs G2: 0. 19 ± 0. 01 vs0. 13 ± 0. 01,t =-1. 522,P > 0. 05). In the patients with PBC,the expression of IL-15 in liver tissue was positively correlated with the levels of alkaline phosphatase( ALP) and gamma-glutamyl transpeptidase( GGT)( r = 0. 241 and 0. 407,P = 0. 014 and 0. 045).Conclusion The NK cell-activating receptor NKG2 D affects the degree of intrahepatic inflammation in PBC,and the NKG2 D ligand MICA is expressed in the advanced stage of PBC and can downregulate NKG2 D. The expression of IL-15 increases with the degree of inflammation in PBC and is positively correlated with the levels of ALP and GGT,suggesting that the activation of NK cells and abnormal secretion of cytokines are involved in the development and progression of PBC and IL-15 may be used as an auxiliary index for the diagnosis of PBC.

Objective To investigate the value of Model for End-Stage Liver Disease( MELD) and Child-Turcotte-Pugh( CTP) score in predicting the prognosis of patients with hepatic sinusoidal obstruction syndrome( HSOS) associated with Gynura segetum( Lour.) Merr.Methods A total of 49 patients with HSOS associated with Gynura segetum( Lour.) Merr. who were admitted to Beijing YouAn Hospital,Beijing Ditan Hospital,The Fifth Medical Center of Chinese PLA General Hospital,Tianjin Third Central Hospital,and The First Affiliated Hospital of Xinxiang Medical University from January 2012 to July 2018 were enrolled and followed up for three years,with death as the outcome event. MELD and CTP scores were calculated according to the laboratory examination and clinical data on admission,and according to CTP score,the patients were divided into CTP class A( CTP score 5-6) group( n = 8),CTP class B( CTP score 7-9) group( n = 23),and CTP class C( CTP score ≥10) group( n = 18). The patients were divided into death group( n = 12) and survival group( n = 37) according to the clinical outcome during follow-up. The Mann-Whitney U test was used for comparison of continuous data between groups,and the Kruskal-Wallis H test was used for ranked data. The area under the receiver operator characteristic( ROC) curve( AUC) was used to investigate the ability of CTP and MELD scores in predicting death. The Kaplan-Meier survival curves were used to determine the long-term prognosis of patients with different CTP and MELD scores,and the log-rank test was used for comparison. The ROC curve was used to evaluate the performance of these two scoring systems in predicting death. Results A total of 12 patients died during the 3-year follow-up period. The patients with HSOS had a median MELD score of 13. 443( 8. 792-18. 379),and the death group had a significantly higher MELD score than the survival group [19. 84( 15. 49-25. 41) vs 11. 58( 8. 60-15. 79),Z =-3. 511,P < 0. 001]. The patients with HSOS had a CTP score of 6-12,and of all 49 patients,8( 16. 3%) had CTP class A HSOS,23( 46. 9%) had CTP class B HSOS,and18( 36. 7%) had CTP class C HSOS. The mortality rate of the patients increased significantly with the increase in CTP score( χ2= 16. 078,P < 0. 05). The mortality rates of the patients with CTP class A,B,and C HSOS were 0. 0%,13. 0%,and 50. 0%,respectively( χ2=10. 343,P < 0. 05). The Kaplan-Meier analysis showed that the patients with a MELD score of < 14. 294 4 had a significantly better 3-year prognosis than those with a MELD score of ≥14. 294 4( χ2= 14. 893,P < 0. 001). The higher the CTP score,the poorer the 3-year prognosis of patients( χ2= 11. 083,P < 0. 05). CTP class had an AUC of 0. 780( 95% confidence interval [CI]: 0. 639-0. 922) in predicting the prognosis of HSOS patients,while MELD score had an AUC of 0. 840( 95% CI: 0. 722-0. 958),and there was no significant difference between the two scores( Z = 2. 63,P > 0. 05). Conclusion Both MELD and CTP scores can predict the risk of death in patients with HSOS,with similar performance in predicting the prognosis of patients,and further studies are needed to validate their clinical value.

Objective To investigate the intervention effect of moderate-intensity aerobic exercise on patients with metabolic associated fatty liver disease( MAFLD) and preliminary intervention regimens,and to provide a theoretical basis and new ideas for the effective prevention and treatment of MAFLD. Methods A total of 158 MAFLD patients who underwent physical examination in Health Management Center of Sichuan Provincial People's Hospital from May to August 2019 or who were recruited through the WeChat official account of“Health Management Center of Sichuan Provincial People's Hospital”were enrolled as subjects,and the patients were divided into control group with 52 patients,monthly follow-up group with 54 patients,and weekly follow-up group with 52 groups using a random number table. The patients in the control group were given health education alone on admission,and those in the monthly follow-up group and the weekly follow-up group were received the intervention of moderate-intensity aerobic exercise; in the monthly follow-up group and the weekly follow-up group,a sports bracelet was used to monitor the exercise and follow-up was performed through the WeChat platform at a frequency of once a month and once a week,respectively. The noninvasive liver fibrosis diagnosis system FibroTouch was used to evaluate the degree of fatty liver disease before and after intervention. The three groups were compared in terms of the changes in body mass index( BMI),waist circumference,hepatic fat attenuation index,liver stiffness,blood pressure,aspartate aminotransferase,alanine aminotransferase( ALT),gamma-glutamyl transpeptidase( GGT),fasting plasma glucose( FPG),uric acid( UA),total cholesterol( TG),triglyceride( TG),low-density lipoprotein cholesterol,and high-density lipoprotein cholesterol after 3 months of intervention. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the paired t-test was used for comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups,and the Nemenyi test or Wilcoxon signed rank-sum test was used for comparison between two groups. Results A total of 147 patients completed the trial,with 49 patients in the control group( 3 were lost to follow-up),49 in the monthly follow-up group( 5 were lost to follow-up),and 49 in the weekly follow-up group( 3 were lost to follow-up). With the amount of exercise,which reached the target heart rate,5 times a week for more than 30 minutes each time as the criteria,the rate of reaching the standard was 66. 7% in the monthly follow-up group and 93. 2% in the weekly follow-up group. There were no significant differences in each index between the three groups before intervention( all P > 0. 05). The monthly follow-up group had a significant reduction in waist circumference after intervention( 93. 39 ± 9. 24 cm vs 94. 24 ± 8. 89 cm,t = 2. 590,P < 0. 05). After intervention,the weekly follow-up group had significant reductions in BMI( 26. 46 ± 3. 36 kg/m2 vs 27. 63 ± 3. 46 kg/m2,t =8. 534,P<0. 001),waist circumference( 87. 04 ±8. 84 cm vs 91. 47 ±8. 08 cm,t =6. 854,P <0. 001),hepatic fat attenuation index( 260. 08 ± 31. 07 d B/m vs 287. 88 ± 23. 28 d B/m,t = 8. 521,P < 0. 001),diastolic blood pressure( 76. 78 ±11. 23 mm Hg vs 79. 27 ± 12. 36 mm Hg,t = 2. 106,P = 0. 040),ALT [32( 20-43) U/L vs 43( 28-59) U/L,Z =-3. 973,P <0. 001],GGT [25( 19-40) U/L vs 34( 24-47) U/L,Z =-3. 847,P < 0. 001],TG [1. 48( 1. 20-2. 02) mmol/L vs 2. 04( 1. 63-2. 80) mmol/L,Z =-3. 873,P < 0. 001],UA( 381. 53 ± 71. 89 μmol/L vs 414. 37 ± 81. 27 μmol/L,t = 3. 953,P < 0. 001),and FPG( 5. 05 ± 0. 58 mmol/L vs 5. 21 ± 0. 71 mmol/L,t = 2. 185,P = 0. 034). Conclusion Moderate-intensity aerobic exercise can significantly reduce the serum levels of TG,ALT,and GGT and alleviate the degree of fatty liver disease in MAFLD patients,and weekly follow-up has a better management effect than monthly follow-up. The method of remote management based on sports bracelet and We Chat software is simple and easy,with a high level of acceptance among MAFLD patients.

Objective To investigate the association of liver stiffness measurement( LSM) and serum biochemical parameters with hepatic steatosis,liver inflammation,and liver fibrosis in patients with nonalcoholic steatohepatitis( NASH). Methods A total of 520 patients with NASH who were treated in The Fifth Medical Center of Chinese PLA General Hospital from January 2007 to December 2018 were enrolled,and according to body mass index( BMI) with a cut-off value of 28 kg/m2,the patients were divided into obese group with 151 patients and non-obese group with 369 patients. All patients underwent liver biopsy,and LSM was measured within 3 days before biopsy. Serum biochemical parameters and general clinical data were collected before liver biopsy,and the noninvasive indices aspartate aminotransferase to platelet ratio index( APRI) and fibrosis-4( FIB-4) were calculated. The t-test was used for comparison of normally distributed continuous between groups,the nonparametric Mann-Whitney U test was used for comparison of non-normally distributed continuous between groups; the chi-square test was used for comparison of categorical data between groups. A Spearman rank correlation analysis was also performed. Results Alanine aminotransferase( ALT),aspartate aminotransferase,LSM,controlled attenuation parameter( CAP),spleen length,and APRI gradually increased with the increase in BMI( all P < 0. 05). The Spearman correlation analysis showed that LSM,ALT,BMI,and CAP were positively correlated with the degree of hepatic steatosis( r = 0. 263,0. 327,0. 184,and 0. 452,all P < 0. 05); LSM,ALT,and CAP were positively correlated with the degree of liver inflammation( r = 0. 357,0. 278,and 0. 121,all P < 0. 05); LSM,ALT,BMI,and CAP were positively correlated with the degree of liver fibrosis( r = 0. 500,0. 216,0. 248,and 0. 101,all P < 0. 05); age was negatively correlated with the degree of hepatic steatosis,liver inflammation,and liver fibrosis( r =-0. 344,-0. 129,and-0. 163,all P < 0. 05). Conclusion LSM,CAP,ALT,and age are significantly correlated with the degree of liver inflammation,liver fibrosis,and hepatic steatosis in NASH patients,and therefore,they can be used in noninvasive diagnostic and predictive models to access the severity of liver injury.

Objective To investigate the expression of leptin( LEP) and adiponectin( ADPN) in the serum of patients with nonalcoholic fatty liver disease( NAFLD) and coronary heart disease( CHD) and the association of LEP and ADPN with NAFLD and CHD. Methods A total of 83 patients with NAFLD,86 patients with NAFLD and CHD,and 69 healthy individuals,who attended Qingdao Municipal Hospital from October 2018 to August 2019,were enrolled as NAFLD group,NAFLD + CHD group,and healthy control group,respectively.Clinical data and blood samples were collected; ELISA was used to measure the serum levels of LEP and ADPN,and an automatic biochemical analyzer was used to investigate liver function. An analysis of variance was used for comparison of normally distributed continuous data between three 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 three groups. The chi-square test was used for comparison of categorical data between groups. A logistic regression analysis was used to investigate the association of LEP,ADPN,and other related indices with NAFLD or NAFLD with CHD,and a Pearson correlation analysis was used to investigate the correlation of LEP and ADPN with other indices. Results The NAFLD group had a significantly higher serum level of LEP and a significantly lower serum level of ADPN than the healthy control group( both P < 0. 05); the NAFLD + CHD group had a significantly higher serum level of LEP and a significantly lower serum level of ADPN than the NAFLD group( both P < 0. 05); the NAFLD + CHD group had a significantly higher serum level of LEP and a significantly lower serum level of ADPN than the healthy control group( both P < 0. 05). Body mass index( BMI)( odds ratio [OR]=23. 564,95% confidence interval [CI]: 2. 696-205. 919,P < 0. 05),fasting blood glucose( OR = 5. 559,95% CI: 1. 030-29. 996,P < 0. 05),triglyceride( OR = 7. 740,95% CI: 1. 379-43. 426,P < 0. 05),high-density lipoprotein( OR = 0. 072,95% CI: 0. 019-0. 268,P < 0. 05),LEP( OR = 17. 549,95% CI: 2. 344-131. 357,P < 0. 05),and ADPN( OR = 0. 182,95% CI: 0. 043-0. 760,P < 0. 05) were all associated with the risk of NAFLD,and BMI( OR = 11. 561,95% CI: 4. 828-27. 682,P < 0. 05),LEP( OR =19. 804,95% CI: 2. 476-158. 402,P < 0. 05),and ADPN( OR = 0. 025,95% CI: 0. 005-0. 121,P < 0. 05) were all associated with the risk of CHD. In the NAFLD group,the serum level of ADPN was positively correlated with low-density lipoprotein( r = 0. 251,P =0. 022),and in the NAFLD + CHD group,the serum level of LEP was positively correlated with BMI( r = 0. 241,P = 0. 025). Conclusion Hypoadiponectinemia and hyperleptinemia are not only the risk factors for NAFLD,but they may also increase the risk of CHD in NAFLD patients,and BMI is the basis for the association between the abnormal expression of leptin and the risk of CHD in NAFLD.

Objective To investigate the effect of Quzhi Ruangan decoction on the mRNA and protein expression of organic anion transporting polypeptide 2 B1( OATP2 B1) in the small intestine of rats with nonalcoholic fatty liver disease( NAFLD). Methods After 1 week of adaptive feeding,36 male Sprague-Dawley rats were randomly divided into normal group,model group,simvastatin group,and high-,middle-,and low-dose Quzhi Ruangan decoction groups,with 6 rats in each group. Liver tissue was collected and HE staining was used to observe hepatic steatosis; an automatic biochemical analyzer was used to measure the serum levels of alanine aminotransferase( ALT),aspartate aminotransferase( AST),glucose( GLU),and cholesterol( CHOL); RT-PCR and Western blot were used to measure the mRNA and protein expression of OATP2 B1 in the small intestine of rats. 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 There were significant differences in liver index,GLU,and CHOL between groups( F = 10. 814,12. 298,and 5. 024,all P < 0. 05),and there were also significant differences in the mRNA and protein expression of OATP2 B1 in the small intestine( F = 13. 384 and 73. 025,both P<0. 05). Compared with the normal group,the model group had significant increases in the mRNA and protein expression of OATP2 B1( both P < 0. 05); compared with the model group,the simvastatin group and the high-and middle-dose Quzhi Ruangan groups had a significant reduction in the mRNA expression of OATP2 B1( all P < 0. 05); compared with the simvastatin group,the middle-and low-dose Quzhi Ruangan groups had a significant reduction in the mRNA expression of OATP2 B1( both P < 0. 05). Compared with the normal group,the model group had a significant increase in the protein expression of OATP2 B1( P < 0. 05); compared with the model group,all treatment groups had a significant reduction in the protein expression of OATP2 B1( all P < 0. 001); compared with the simvastatin group,the high-,middle-,and low-dose Quzhi Ruangan groups had a significant reduction in the protein expression of OATP2 B1( all P < 0. 05). Conclusion Quzhi Ruangan decoction may alleviate the pathological changes of NAFLD by reducing the overexpression of OATP2 B1.

Objective To investigate the influencing factors for multidrug-resistant organisms( MDRO) infection in patients with chronic calculous cholecystitis. Methods A retrospective analysis was performed for 654 patients with chronic calculous cholecystitis who underwent cholecystectomy in The Third Affiliated Hospital of Guizhou Medical University from February 2014 to December 2019,and the patients were divided into MDRO infection group with 178 patients and non-MDRO infection group with 476 patients. Related clinical data and medical history were recorded,including age,sex,course of disease,body mass index( BMI),presence or absence of diabetes mellitus/stone incarceration/gallbladder atrophy/bile duct stones/gallbladder polyps/pancreatitis,stone size,attack frequency,number of stones,alanine aminotransferase,duration of antibiotic use,frequency of antibiotic use,combined use of antibiotics,application of cholagogic treatment,blood glucose on admission,glycosylated hemoglobin on admission,aspartate aminotransferase,application of traditional Chinese medicine treatment,and presence or absence of MDRO infection and related strains. 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 was used for comparison of categorical data between two groups; a multivariate logistic regression analysis was used to perform a multivariate analysis. Results The MDRO infection rate was 27. 22% in patients with chronic calculous cholecystitis.There were significant differences between the two groups in course of disease( Z = 3. 503,P < 0. 001),BMI( t = 2. 153,P = 0. 032),diabetes mellitus( χ2= 4. 866,P = 0. 027),stone size( t = 3. 276,P = 0. 001),attack frequency( Z = 2. 574,P = 0. 010),stone incarceration( χ2= 14. 880,P < 0. 001),number of stones( Z = 4. 268,P < 0. 001),gallbladder atrophy( χ2= 14. 855,P < 0. 001),gallbladder polyps( χ2= 14. 234,P < 0. 001),glycosylated hemoglobin on admission( t = 2. 233,P = 0. 026),frequency of antibiotic use( t = 2. 302,P = 0. 022),combined use of antibiotics( Z = 3. 314,P = 0. 001),blood glucose on admission( t = 3. 420,P = 0. 001),duration of antibiotic use( t = 2. 024,P = 0. 044),traditional Chinese medicine treatment( χ2= 7. 529,P = 0. 006),and cholagogic treatment( χ2= 9. 826,P = 0. 002). Incarceration( odds ratio [OR]= 2. 476,95% confidence interval [CI]: 1. 544-3. 972,P < 0. 05),gallbladder atrophy( OR = 3. 548,95% CI: 2. 198-5. 725,P < 0. 05),gallbladder polyps( OR = 3. 198,95% CI: 1. 928-5. 305,P < 0. 05),frequency of antibiotic use( OR = 1. 936,95% CI: 1. 257-2. 981,P < 0. 05),and combined use of antibiotics( OR = 3. 429,95% CI: 2. 049-5. 736,P < 0. 05) were independent risk factors for MDRO infection in patients with chronic calculous cholecystitis,while traditional Chinese medicine treatment( OR = 0. 640,95% CI: 0. 433-0. 945,P < 0. 05) and cholagogic treatment( OR = 0. 548,95% CI: 0. 354-0. 847,P < 0. 05) were independent protective factors against MDRO infection in patients with chronic calculous cholecystitis. Conclusion The risk of MDRO infection in patients with chronic calculous cholecystitis can be reduced by rational use of antibiotics,auxiliary cholagogic and traditional Chinese medicine treatment,reduction in combined and repeated use of antibiotics,early surgical treatment in case of indications such as stone incarceration,and avoidance of gallbladder atrophy and polyps caused by long-term recurrent infection.

Objective To systematically review the efficacy and safety of endoscopic papillary large balloon dilation( EPLBD) versus endoscopic sphincterotomy combined with large balloon dilation( ESBD) in the treatment of large common bile duct stones( ≥10 mm). Methods Pubmed,Embase,Cochrane Library,CNKI,Wanfang Data,and VIP were searched for related articles published up to March 2020.Two reviewers independently performed article screening,data extraction,and quality assessment,and RevMan 5. 3 software was used for statistical analysis. Results A total of 11 studies( 6 randomized controlled trials and 5 non-randomized controlled trials) were included,with 1282 patients in total. The meta-analysis showed that in the 6 randomized controlled trials,there were no significant differences between the EPLBD group and the ESBD group in initial stone clearance rate( odds ratio [OR]= 0. 71,95% confidence interval [CI]: 0. 45-1. 12,P = 0. 14),overall stone clearance rate( OR = 1. 39,95% CI: 0. 65-2. 96,P = 0. 39),rate of use of mechanical lithotripsy( OR =1. 19,95% CI: 0. 75-1. 89,P = 0. 46),and incidence rate of early complications( OR = 1. 10,95% CI: 0. 60-2. 03,P = 0. 75); in the5 non-randomized controlled trials,there were no significant differences between the EPLBD group and the ESBD group in initial stone clearance rate( OR = 0. 64,95% CI: 0. 35-1. 15,P = 0. 13),overall stone clearance rate( OR = 0. 46,95% CI: 0. 19-1. 12,P =0. 09),and incidence rate of early complications( OR = 1. 20,95% CI: 0. 65-2. 21,P = 0. 56),but the EPLBD group had a significantly higher rate of use of mechanical lithotripsy than the ESBD group( OR = 1. 96,95% CI: 1. 26-3. 05,P = 0. 003). Conclusion EPLBD and ESBD have similar efficacy and safety in the treatment of large common bile duct stones,while EPLBD may increase the risk of the use of mechanical lithotripsy. More high-quality randomized controlled trials are needed to confirm this conclusion.

Objective To investigate the effect of longitudinal trajectories of body mass index( BMI) on new-onset gallstone disease.Methods A prospective cohort study was conducted for 44168 employees who underwent physical examination in Kailuan General Hospital in 2006,2008,and 2010,and related data,including BMI,were collected. Physical examination was performed once every two years,and the employees were followed up to observe the onset of gallstone disease. According to the longitudinal trajectories of BMI,the employees were divided into low-stable group with 14888 employees,medium-stable group with 22334 employees,and high-stable group with 6948 employees. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups; 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 gallstone disease in each group,and the log-rank test was used for comparison between groups. The Cox proportional-hazards regression model was used to analyze the influence of longitudinal trajectories of BMI on the onset of gallstone disease. Results the mean follow-up of 5. 41 years,a total of 902 patients with gallstone disease were observed,and the cumulative incidence rates of gallstone disease in the low-stable group,the medium-stable group,and the high-stable group were 4. 80%,5. 25%,and 9. 45%,respectively,with a significant difference between groups based on the log-rank test( χ2= 81. 86,P < 0. 01). After adjustment for confounding factors in the Cox proportional hazards model,compared with the low-stable group,the medium-stable group and the high-stable group had a risk of gallstone disease increased by 1. 55 times( 95% confidence interval[CI]: 1. 31-1. 84) and 2. 29 times( 95% CI: 1. 86-2. 80),respectively. Conclusion The ncreased longitudinal trajectory of BMI is an independent risk factor for the onset of gallstone disease.

Objective To investigate the value of serum cystatin C in the early prediction of acute kidney injury( AKI) in patients with acute pancreatitis( AP). Methods A retrospective analysis was performed for the clinical data of 273 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January 2013 to August 2018,among whom there were 45 patients with AKI( AKI group) and 228 without AKI( non-AKI group). Related indicators were collected from all patients,including sex,age,amylase,lipase,serum creatinine,blood urea nitrogen,serum uric acid,serum cystatin C,triglyceride,high-density lipoprotein cholesterol,hematocrit,C-reactive protein,alanine aminotransferase,serum calcium,and white blood cell count. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. The variables with statistical significance in the univariate analysis were included in the multivariate logistic regression analysis,and the receiver operating characteristic( ROC) curve was used to evaluate the diagnostic efficiency of indicators. A Spearman correlation analysis was used to evaluate the correlation between data. Results There were significant differences between the two groups in age( Z =-2. 746,P = 0. 006),sex( χ2= 4. 080,P = 0. 043),amylase( Z =-5. 040,P < 0. 001),lipase( Z =-4. 399,P < 0. 001),serum creatinine( Z =-10. 241,P < 0. 001),blood urea nitrogen( Z =-8. 295,P < 0. 001),uric acid( Z =-7. 974,P < 0. 001),serum cystatin C( Z =-9. 312,P < 0. 001),and serum calcium( Z =-4. 271,P < 0. 001). The multivariate logistic regression analysis showed that serum cystatin C( odds ratio [OR]= 7. 871,95% confidence interval [CI]: 3. 406-18. 190,P < 0. 001),uric acid( OR =1. 007,95% CI: 1. 003-1. 011,P = 0. 001),and serum calcium( OR = 0. 112,95% CI: 0. 023-0. 540,P = 0. 006) were independent influencing factors for AKI in patients with AP. Serum cystatin C had an area under the ROC curve of 0. 939,a sensitivity of 0. 889,and a specificity of 0. 904 in predicting AKI in patients with AP. The Spearman correlation analysis showed that cystatin C was strongly correlated with creatinine( r = 0. 741,P < 0. 001). Conclusion Serum cystatin C is an important predictive factor for AKI in patients with AP.

Objective To investigate the influence of serum triglyceride( TG) level on the outcome of acute biliary pancreatitis( ABP).Methods A retrospective analysis was performed for 249 ABP patients who were admitted to The Affiliated Hospital of Southwest Medical University from September 2018 to August 2019,and the patients were divided into normal blood lipid group( n = 156) and mild( n = 25),moderate( n = 44),and severe( n = 24) hyperlipidemia groups. The patients' data were collected for analysis. 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 nominal categorical variables between multiple or two groups; the Kruskal-Wallis H test was used for comparison of ordinal categorical variables between multiple groups,and the Mann-Whitney U rank sum test was used for further comparison between two groups. A multivariate logistic regression analysis was used to investigate the influencing factors for organ failure and infectious pancreatic necrosis( IPN),and the receiver operating characteristic( ROC) curve was used to evaluate the value of different indices in predicting severe acute pancreatitis( SAP). Results There were significant differences in age and BISAP between four groups( χ2= 25. 057,10. 430,all P < 0. 05). Compared with the normal blood lipid group,the severe hyperlipidemia group had a significantly higher proportion of patients with IPN or multiple organ failure syndrome( MODS)( both P < 0. 05),and the moderate hyperlipidemia group had a significantly higher proportion of patients with MODS( P < 0. 05),while the severe hyperlipidemia had a significantly higher proportion of patients with systemic inflammation reaction syndrome than the other three groups( all P<0. 05). Compared with the normal blood lipid group,the moderate and severe hyperlipidemia groups had a significant increase in the risk of MODS( moderate hyperlipidemia group: odds ratio [OR]= 3. 500,95% confidence interval [CI]: 1. 193-10. 270,P < 0. 05; severe hyperlipidemia group: OR = 6. 167,95% CI: 1. 921-19. 792,P < 0. 05),and after adjustment,the risk of MODS in the severe hyperlipidemia group was 3. 430 times that in the normal blood lipid group( 95% CI: 1. 198-9. 825,P = 0. 022). The severe hyperlipidemia group had a significant increase in the risk of IPN( OR = 4. 351,95% CI: 1. 719-11. 008,P < 0. 05),and after adjustment,the risk of IPN in the severe hyperlipidemia group was 5. 819 times that in the normal blood lipid group( 95% CI: 1. 489-22. 745,P < 0. 05). Blood lipids had a good value in predicting SAP,with an area under the ROC curve of 0. 626( 95% CI: 0. 530-0. 723,P = 0. 008). Conclusion Compared with the ABP patients with normal TG,ABP patients with elevated TG tend to have a younger age,more complications,and a higher mortality rate,especially those with a TG level of >5. 65 mmol/L,and therefore,antihyperlipidemic treatment for such patients should be taken seriously to improve their survival rate and prognosis.

Objective To investigate the features of patients with recurrence of hypertriglyceridemic acute pancreatitis( HTG-AP) and the influence of metabolic syndrome( MetS) on recurrence through a retrospective analysis. Methods A retrospective analysis was performed for 132 patients with recurrent HTG-AP who were admitted to The Affiliated Hospital of Southwest Medical University from June 2013 to December( recurrence group),and 132 patients with non-recurrent HTG-AP who were treated during the same period of time were enrolled as control group. Related data were collected,including basic information( age,sex,diabetes,hypertension,and body mass index),clinical data( etiology,routine blood test results,and biochemical results),and complications [systemic inflammatory response syndrome( SIRS),acute peripancreatic fluid collection( APFC),acute necrosis collection( ANC),acute respiratory distress syndrome( ARDS),acute renal failure( ARF),multiple organ dysfunction syndrome( MODS),and ICU admission rate]. 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 non-normally distributed continuous data between groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups.A logistic regression analysis was used for comparison of related variables,and the receiver operating characteristic( ROC) curve was used to validate the diagnostic value of variables. Results Compared with the control group,the recurrence group had a significantly higher proportion of patients with MetS,obesity,a high-density lipoprotein cholesterol( HDL-C) level of < 1 mmol/L,or ANC and significantly higher levels of blood glucose and C-reactive protein( CRP) and white blood cell count( WBC)( χ2= 9. 138,χ2= 6. 823,χ2= 13. 251,χ2=9. 587,Z =-2. 255,Z =-2. 202,Z =-4. 674,all P < 0. 05). The 132 patients in the recurrence group were divided into MetS group with 92 patients and non-Met S group with 40 patients,and compared with the non-Met S group,the Met S group had significantly higher WBC and blood glucose and a significantly higher proportion of patients with SIRS,APFC,ANC,or progression to moderate-to-severe AP( MSAP)( t = 2. 434,t = 4. 881,χ2= 4. 513,χ2= 7. 936,χ2= 7. 031,χ2= 7. 150,all P < 0. 05). Met S( odds ratio [OR]= 2. 007,95%confidence interval [CI]: 1. 152-3. 497,P < 0. 05),ANC( OR = 2. 270,95% CI: 1. 185-4. 347,P < 0. 05),and WBC( OR = 1. 135,95% CI: 1. 059-1. 217,P < 0. 05) were independent risk factors for recurrence in HTG-AP patients. The combination of Met S,ANC,and WBC had a relatively high value in predicting the recurrence of HTG-AP,with an area under the ROC curve of 0. 692. In the recurrence group,the levels of triglyceride,blood glucose,and CRP and the proportion of patients with smoking,HDL-C < 1 mmol/L,or obesity in 125 patients( 7 patients were excluded due to incomplete case data) at the time of recurrence were significantly lower than those in 132 patients at initial admission( Z =-3. 270,Z =-3. 546,Z =-4. 382,χ2= 0547,χ2= 8. 259,χ2= 5. 143,all P < 0. 05),with further reductions in the proportion of patients with MSAP,APFC,or ANC( χ2= 4. 086,χ2= 11. 930,χ2= 4. 967,all P < 0. 05).Conclusion Met S aggravates disease severity in patients with recurrent HTG-AP and is an important factor for recurrence. Smoking cessation,weight loss,and oral lipid-lowering drugs can reduce disease severity at the time of readmission.

Since the development of direct-acting antivirals( DAAs) for hepatitis C virus( HCV),more than 95% of the patients with hepatitis C can be cured,but a very small proportion of patients still face treatment failure. There are many reasons for treatment failure,among which HCV genotype and resistance-associated substitutions( RASs) in virus genes show a certain impact. This article mainly introduces the RASs associated with the NS5 B and NS5 A gene fragments in genotype 2/3 HCV,summarizes the distribution of RASs,and compares the difference in the distribution of RASs between previously untreated chronic hepatitis C patients and patients with treatment failure.

Proton pump inhibitor( PPI) is often used for the prevention and treatment of digestive system diseases,and the adverse outcomes caused by the use of PPI are increasingly concerned by scholars. This article elaborates on the association of the complications of liver cirrhosis,such as upper gastrointestinal bleeding,spontaneous bacterial peritonitis,hepatic encephalopathy,hepatocellular carcinoma,and infection,and the change in gut microbiota with the use of PPI,and points out that in clinical practice,it is important to master the medication rules of PPI,understand the risk of complications caused by PPI,and actively improve the complications caused by medication.

Hepatorenal syndrome( HRS) is a common complication of severe liver disease,with severe conditions and poor prognosis,and causes a great burden to both patients' family and society. HRS has a complex pathogenesis,and Western medicine treatment has a limited therapeutic effect; therefore,integrated traditional Chinese and Western medicine therapy is a feasible treatment method with a good clinical effect. This article reviews the advances in the diagnosis and treatment of HRS in both modern and traditional medicine,so as to overcome this challenge as early as possible.

Portal hypertension is a group of clinical syndromes caused by increased pressure of the portal vein system due to various reasons,with liver cirrhosis as the most common cause,but 10%-20% of portal hypertension cases are secondary to various non-cirrhotic diseases,which are collectively referred to as non-cirrhotic portal hypertension( NCPH). NCPH is a group of highly heterogeneous diseases. This article summarizes the clinical features,pathological features,and key diagnosis and treatment points of different types of NCPH,in order to improve the understanding of these diseases among clinicians.

Hepatic vascular tumors originate from endothelial cells. Except hepatic cavernous angioma,hepatic vascular tumors tend to have a low incidence rate and atypical clinical symptoms and imaging findings,which brings great challenges to clinical diagnosis and treatment.This article reviews the classification,clinical diagnosis,intervention measures,and prognosis of hepatic vascular tumors,so as to improve the overall understanding of such diseases.

Due to its deep anatomic location and complex blood supply characteristics,hepatocellular carcinoma originating from the caudate lobe has become the difficulty in surgical resection,and radiofrequency ablation( RFA) is gradually applied to the treatment of hepatocellular carcinoma originating from the caudate lobe with the help of its advantages of precision and minimal invasiveness. This article briefly describes the anatomic characteristics of the caudate lobe,introduces the advances in radiofrequency approach for the caudate lobe,intraoperative guidance,and selection of RFA needle in detail,and summarizes the surgical safety and effectiveness of RFA associated with the caudate lobe through an analysis of the latest articles in recent ten years. It is concluded that RFA is a promising alternative for the treatment of hepatocellular carcinoma originating from the caudate lobe with the advantages of minimal invasiveness,good repeatability,and few complications,and it can also achieve the goal of complete ablation.

In recent years,the prevalence rate of nonalcoholic fatty liver disease( NAFLD) has increased significantly and NAFLD has gradually become one of the common chronic liver diseases in China. Patients with NAFLD-related end-stage or deteriorative liver diseases have become one of the main populations for liver transplantation. The increasing prevalence rate of NAFLD and the severe outcomes of nonalcoholic steatohepatitis( NASH) make it necessary to use effective methods to identify NAFLD. Therefore,this article summarizes the current serological methods for the diagnosis of NAFLD,including steatosis,NASH,and liver fibrosis,and discusses their advantages and disadvantages. Although most of the serum markers have limited clinical value,serum marker models have a good application prospect in the diagnosis of hepatic steatosis,the evaluation of fibrosis degree,and preliminary screening. Since a combination of different serological models can improve the accuracy of diagnosis,multi-angle and multicenter joint diagnosis will be a research hotspot in the future.

Nonalcoholic fatty liver disease( NAFLD) and hypertension are both important components of metabolic syndrome,and there is a strong association between these two diseases. This article analyzes the association between NAFLD and hypertension based on clinical data and describes the common pathogeneses of the two diseases,among which insulin resistance,gut microbiota,renin-angiotensin-aldosterone system play an important role in the pathogenesis of these two diseases. In addition,this article briefly summarizes the application of renin-angiotensin-aldosterone system inhibitors and diuretics in the treatment of NAFLD,which provides a reference for further clarifying the association between these two diseases,understanding the mechanism of interaction between the two diseases,and exploring the treatment methods for NAFLD with hypertension.

With the rapid change in lifestyle in recent years,the prevalence rate of nonalcoholic fatty liver disease( NAFLD) is increasing year by year and it has gradually become one of the major causes of chronic liver diseases. With the development of the bio-psycho-social medical model,the influence of psychological diseases on physical diseases has attracted the attention of scholars. At present,evidence has shown that anxiety,as one of the most common type of mental disorders,may be associated with the development of NAFLD. This article introduces the current status of research on anxiety and NAFLD and their common influencing factors and predicts the possible pathophysiological mechanism of NAFLD caused by anxiety,so as to lay a foundation for further research on the association between anxiety and NAFLD and provide new directions for the treatment of NAFLD.

Nonalcoholic fatty liver disease( NAFLD) is defined as hepatic steatosis without heavy drinking( the amount of alcohol intake is limited within the safe threshold),and the difference between NAFLD and alcoholic liver disease is largely dependent on the amount of alcohol intake. Alcohol intake and NAFLD coexist in a considerable proportion of the population,and this proportion is increasing continuously.There are still controversies over the definition of“safe threshold”and whether moderate drinking within the“safe threshold”has a protective effect against NAFLD,so as to improve the adverse outcome and survival prognosis of chronic liver diseases. This article elaborates on the above ideas,and it is believed that we should pay attention to individualized risk assessment when evaluating the influence of drinking on NAFLD and follow the principle of individualization when judging the benefits and harms of drinking and giving suggestions for drinking.

Nonalcoholic fatty liver disease( NAFLD) has become the most important chronic liver disease in the world,but there is still no approved drug for clinical practice. Due to the heterogeneity of NAFLD itself,although drug therapy is being developed,the response rate seems to remain low. In order to meet the needs of clinical trial design and provide accurate information for drug developers,relevant scholars have proposed to change the name of NAFLD to metabolic associated fatty liver disease This article summarizes the origin of NAFLD heterogeneity and the background of NAFLD renaming,so as to provide new ideas for accelerating the development of new therapies.

With the increasing incidence rate of nonalcoholic fatty liver disease( NAFLD) in Western developed countries and rich regions of China year by year,the treatment methods for NAFLD have been constantly improved and NAFLD has become a research hotspot. As an important physiological structure of the liver,liver sinus endothelial cells( LSECs) play an important role in the development and progression of NAFLD. This article summarizes the mechanism of action of LSECs in the pathogenesis of NAFLD,which included the following aspects:LSEC capillarization occurs in nonalcoholic fatty liver and promotes steatosis; meanwhile,LSECs contribute to oxidative stress in nonalcoholic steatohepatitis( NASH) and is a major effector of liver inflammation in NASH,thus promoting liver fibrosis; in addition,angiogenesis is highly stimulated and promotes NAFLD-related hepatocellular carcinoma in NAFLD. However,the role of LSECs in NASH-associated liver cirrhosis has not been validated,which needs to be further clarified to provide new ideas and directions for treatment.

Alcoholic hepatitis( AH) is a severe alcohol-associated liver disease with a mortality rate as high as 40%. A recent study reveals that the exotoxin( cytolysin)-secreting gut bacterium Enterococcus faecalis is a critical factor for AH,which can be eliminated by bacteriophages,and therefore,the use of bacteriophages for the treatment of AH provide a new treatment option for AH. This article introduces this pioneering study and the knowledge of bacteriophages and cytolysin,so as to provide a theoretical basis for the clinical research on AH.

As lactate is elevated due to lactate metabolic disorder in liver failure,recent studies have shown that blood lactate has a high value in predicting the prognosis of liver failure. With reference to the research findings in recent years,this article introduces the prediction model of LiFe score and reviews the advances in the clinical application of blood lactate level in patients with liver failure in China and foreign countries. It is believed that a high lactate level is an independent risk factor for poor prognosis of liver failure patients,and it is proposed that lactate can be used as an important indicator to evaluate the severity and prognosis of liver failure and further optimize the scoring system for the prognosis of related liver diseases.

Echinococcosis is a common type of parasitic disease in pastoral areas,and hepatic cystic echinococcosis is mainly observed in clinical practice,with surgical resection as the main treatment method. With the continuous development of endoscopic technology and the advantages of little trauma,clear visual field,and rapid postoperative recovery,it has gradually been applied in the treatment of hepatic cystic echinococcosis and has achieved a good treatment effect. Since laparoscopic endocystectomy and subtotal pericystectomy have high incidence rates of residual cavity complications and recurrence in clinical practice,they are not recommended for the treatment of hepatic cystic echinococcosis,and meanwhile,laparoscopic partial hepatectomy and total pericystectomy have the advantages of little trauma,few complications,and good safety in radical resection of lesion. With reference to related articles in China and foreign countries,this article summarizes and elaborates on the indications,precautions,and complications of laparoscopic partial hepatectomy and total pericystectomy,so as to provide a reference for minimally invasive treatment of hepatic cystic echinococcosis.

Bile acids( BAs) are produced in the liver and are the final product of cholesterol catabolism,with a wide range of biological effects. This article reviews the research advances in the synthesis,transport,and metabolism of BAs and the role of BAs in regulating hepatocytes and immunity via enterohepatic circulation,as well as the current research on traditional Chinese medicine in the regulation of BAs,in order to further understand the mechanism of action of BAs in affecting intestinal flora and liver function,expand the knowledge of its regulatory mechanism,explore the mechanism of action of traditional Chinese medicine and related pathways in regulating BAs,and provide new ideas for the prevention and treatment of liver-related systemic diseases by regulating BAs.

Autophagy can regulate liver physiology and balance liver metabolism. Autophagy activation has a double-sided and complex effect on liver injury,and it is regulated by many factors and is associated with many protein pathways. This article summarizes the role of m TOR in the regulation of autophagy,which can inhibit or enhance autophagy through the PI3 K/Akt upstream signaling pathway and participate in the physiological and pathological changes of related liver diseases. Therefore,this article reviews the research advances in the m TOR/PI3 K/Akt autophagy pathway in liver injury,in order to provide new therapeutic targets for related liver diseases.

Due to the need of the diagnosis and minimally invasive treatment of biliary tract diseases,peroral choledochoscopy has recently become an important method for the diagnosis and treatment of biliary tract diseases,which helps to avoid some invasive and unnecessary surgical procedures. This article introduces the clinical advantages of SpyGlassTMDS Direct Visualization System and its indications and possible complications in biliary duct diseases. SpyGlassTMDS provides endoscopic imaging of the biliary tree and can perform biopsy under direct view,and thus it plays an important role in the diagnosis and treatment of biliary tract diseases. In particular,it can improve the diagnostic accuracy of biliary stricture with unknown nature and the surgical success rate and stone clearance rate of complex bile duct stones,with similar incidence rates of complications as conventional endoscopic retrograde cholangiopancreatography. SpyGlassTMDS is a safe and effective procedure and supplements the standard endoscopic diagnosis and treatment.

Insulin resistance is a manifestation of glucose metabolism disorder secondary to pancreatic disease,and previous studies have shown that it is associated with inflammatory factors and tumor progression. This article reviews the mechanism and influence of insulin resistance in chronic pancreatitis and pancreatic cancer and points out that further research on insulin resistance can provide an effective basis for the prevention of chronic pancreatitis and the evaluation of the progression and prognosis of pancreatic cancer.