The current situation of pancreatic cancer is that the etiology is not clear and prevention is impossible. The sensitivity and specificity of the auxiliary detection methods are low,and early diagnosis is a worldwide problem. The efficacy of existing treatment methods is not satisfactory,and it is difficult to break through in a short time. The overall 5-year survival rate is only 7. 2%. In the face of the current situation of pancreatic cancer,the solution to the key problems is to strengthen basic research,explore its etiology and pathogenesis,remove the cause,cut off the path of occurrence and development,which is the only correct way to overcome pancreatic cancer. It is an important way to significantly improve the efficacy by developing peripheral blood,urine detection technology with high sensitivity and specificity,imaging diagnosis technology,and improving the early diagnosis rate. However,the research on basic and early diagnostic techniques takes a long time and costs a lot,which makes it difficult to achieve results in a short time. Therefore,the problem to be solved urgently is to develop a personalized treatment plan through standardized MDT,optimized combination of existing diagnosis and treatment methods,so as to achieve the purpose of improving the efficacy. This expert consensus is developed from the first edition,which is based on the diagnosis and treatment status of pancreatic cancer and the dilemma that is difficult to break through in a short time,with reference to the successful diagnosis and treatment experience at home and abroad,combined with the national conditions of our country,after repeated deliberation,discussion and revison by many well-known experts in the domestic industry. This consensus discusses the meaning and purpose,the main tasks,the necessary objective conditions for carrying out,workflows,precautions,relevant clinical and basic research of MDT,multi-center MDT and eMDT mode exploration in detail. Through the formulation and publication of this consensus,we hope that it can help to promote the standardized development of pancreatic cancer MDT and improve the efficacy of pancreatic cancer in China,to summarize successful experience and promote international exchanges,to strengthen personnel training and echelon construction,to formulate relevant policies and promote the development of MDT in the whole country. This consensus is expert consensus on the MDT model developed in China,which is not only applicable to pancreatic cancer,but also can be used as a reference for other tumors.

Objective To investigate the 28-day incidence rate of acute-on-chronic liver failure( ACLF) and the 90-day prognosis of patients with acute deterioration( AD) of hepatitis B virus( HBV)-related liver cirrhosis( LC). Methods A total of 670 patients with AD of HBV-related LC who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from October 2014 to October 2016 were enrolled,and according to total bilirubin( TBil) and prothrombin time activity( PTA),they were divided into group A with 134 patients( 51. 3 μmol/L < TBil < 171. 1 μmol/L and PTA < 40%),group B with 393 patients( 51. 3 μmol/L < TBil < 171. 1 μmol/L and40% ≤PTA < 60%),and group C with 143 patients( TBil > 171. 1 μmol/L and 40% < PTA < 60%). The patients were analyzed in terms of clinical features,28-day incidence rate of ACLF and its influencing factors,and 90-day survival and its influencing factors. Ananalysis 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 or the Fisher's exact test was used for comparison of categorical data between multiple groups. The Kaplan-Meier method was used to calculate cumulative incidence rate,and the log-rank test was used for comparison between groups. Cox regression analysis and logistic regression analysis were used to investigate the influencing factors for the onset of ACLF and 90-day survival. Results There were significant differences between groups A,B,and C in Model for End-Stage Liver Disease score( 20. 2 ± 4. 6 vs 14. 7 ± 3. 6 vs 22. 7 ± 5. 6,F = 211. 118,P < 0. 001) and Child-Pugh score( 10. 6 ± 0. 8 vs 9. 3 ± 1. 2 vs10. 4 ± 1. 2,F = 66. 427,P < 0. 001),and group B had significantly lower scores than groups A and C( all P < 0. 05). Among the 670 patients,69( 10. 3%) developed ACLF within 28 days,with 19 patients( 14. 2%) in group A,17 patients( 4. 3%) in group B,and 33 patients( 23. 1%) in group C. Group B had a significantly lower incidence rate of ACLF than group A( χ2= 15. 937,P < 0. 001) and group C( χ2= 48. 502,P < 0. 001). In group A,aspartate aminotransferase( AST)( risk ratio [RR]= 1. 033,P = 0. 030),bacterial infections( BIs)( RR = 14. 326,P = 0. 001),blood sodium( Na)( RR = 0. 888,P = 0. 019),and alpha-fetoprotein( AFP)( RR = 1. 003,P <0. 001) were independent influencing factors for ACLF; in group B,male sex( RR = 0. 201,P = 0. 035),alanine aminotransferase( RR =0. 996,P = 0. 006),AST( RR = 1. 008,P < 0. 001),gamma-glutamyl transpeptidase( RR = 1. 004,P = 0. 018),PTA( RR = 0. 642,P < 0. 001),TBil( RR = 1. 039,P = 0. 002),BIs( RR = 49. 656,P < 0. 001),and HBV DNA( RR = 2. 206,P < 0. 001) were independent influencing factors for ACLF; in group C,acute variceal bleeding( AVB)( RR = 3. 172,P = 0. 025) and BIs( RR = 2. 946,P =0. 007) were independent influencing factors for ACLF. Of all 670 patients,79( 11. 8%) died within 90 days,with 29 patients( 21. 6%)in group A,15 patients( 3. 8%) in group B,and 35 patients( 24. 5%) in group C,and group B had a significantly lower mortality rate than group A( χ2= 41. 492,P < 0. 001) and group C( χ2= 52. 905,P < 0. 001). In each group,the patients with ACLF had a significantly higher 90-day mortality rate than those without ACLF( group A: χ2= 4. 151,P = 0. 042; group B: P = 0. 022; group C: χ2= 16. 968,P< 0. 001). In group A,creatinine( odds ratio [OR]= 1. 075,P = 0. 007) and Na( OR = 0. 450,P < 0. 001) were independent influencing factors for 90-day survival; in group B,AVB( OR = 1378. 999,P = 0. 026) and Na( OR = 0. 392,P = 0. 018) were independent influencing factors for 90-day survival; in group C,AVB( OR = 31. 699,P = 0. 038),Na( OR = 0. 841,P = 0. 023),and development of ACLF( OR = 14. 258,P = 0. 017) were independent influencing factors for 90-day survival. Conclusion Patients with AD of HBV-related LC can be divided into three clinical types,and the patients with high jaundice type( group C) or low coagulation type( group A) tend to develop ACLF and have poorer prognosis. BIs are the common influencing factor for ACLF in these three types of patients,and blood Na level is the common influencing factor for 90-day prognosis.

Objective To investigate the effect of intraoperative Viatorr stent implantation for shunting of blood flow in the left or right branch of the portal vein on the clinical outcome of patients with cirrhotic portal hypertension undergoing transjugular intrahepatic portosystemic shunt( TIPS). Methods A retrospective analysis was performed for the clinical data of 120 patients with cirrhotic portal hypertension who underwent TIPS in The General Hospital of Western Theater Command from March 2016 to December 2019,and according to the target position of portal vein puncture determined by intraoperative angiography,the patients were divided into left branch group and right branch group.The two groups were compared in terms of the incidence rates of postoperative recurrence and bleeding,stent dysfunction,and hepatic encephalopathy( HE) and survival. The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier curve was used to calculate rebleeding rate,stent patency rate,incidence rate of HE,and survival rate. Results The surgical success rate was 100% for all 120 patients,with a short-term hemostasis rate of100%. Among the 120 patients,52 underwent shunting of the left branch of the portal vein and 68 underwent shunting of the right branch.There was a significant reduction in portal venous pressure after surgery( 9. 98 ± 2. 84 mm Hg vs 24. 72 ± 5. 11 mm Hg,t = 37. 76,P < 0. 01).The cumulative rebleeding rates at 12 and 24 months after surgery were 3. 2% and 11. 0%,respectively,and the cumulative incidence rates of HE at 3,6,12,and 24 months after surgery were 10. 8%,13. 6%,21. 2%,and 24. 5%,respectively. Among the 29 patients who experienced HE,23 had gradeⅠ-ⅡHE and 6 had grade Ⅲ HE. The cumulative incidence rates of stent dysfunction at 12 and 24 months after surgery were 7. 1% and 21. 4%,respectively. The cumulative survival rates at 12 and 24 months after surgery were 92. 0% and 86. 5%,respectively.As for comparison of the left branch group and the right branch group,there were no significant differences in postoperative stent patency rate,rebleeding rate,incidence rate of HE,and survival rate( all P < 0. 05). Conclusion TIPS is a safe and effective method for the treatment of cirrhotic portal hypertension,and intraoperative Viatorr stent implantation,no matter for establishing the shunt of the left or right branch of the portal vein,will not affect the clinical outcome of patients.

Objective To investigate the effect of entecavir( ETV) alone or combined with interferon( IFN) on the risk of hepatocellular carcinoma( HCC) in patients with chronic hepatitis B( CHB). Methods A retrospective analysis was performed for 409 patients with CHB who were admitted to Beijing Ditan Hospital from January 2008 to December 2014,and according to their antiviral therapy,they were divided into ETV + IFN group with 169 patients( IFN treatment for ≥6 months) and ETV group with 240 patients( ETV treatment for ≥12 months). The patients were followed up to June 2019,and the development of HCC was the outcome event. The Mann-Whitney U test was used for comparison of continuous variables between two groups,and the chi-square test was used for comparison of categorical variables between two groups. The propensity score matching( PSM) method was used to eliminate baseline differences between groups,the Kaplan-Meier method and the log-rank test were used to compare the incidence rate of HCC between groups,and the Cox proportional-hazards regression model analysis was used to investigate the risk factors for the development of HCC. Results The median follow-up time in this study was 5. 4 years( IQR: 4. 9-7. 9). There was no significant difference in the cumulative incidence rate of HCC between the two groups before and after PSM( before PSM: 1. 2% vs 2. 8%,χ2= 1. 423,P = 0. 233; after PSM: 1. 7% vs 4. 1%,χ2= 1. 676,P = 0. 195),and the subgroup analysis also showed no significant difference in the cumulative incidence rate of HCC between the two groups in the non-high risk population( 1. 3% vs 1. 5%,χ2= 0. 335,P = 0. 563). The Cox proportional-hazards regression model showed that age was an independent risk factor for HCC( hazard ratio = 1. 107,95% confidence interval: 1. 005-1. 219,P = 0. 038). Conclusion For CHB patients without a high risk of cancer,compared with ETV monotherapy,ETV combined with IFN for at least 6 months does not significantly reduce the risk of HCC.

Objective To investigate the value of ABCR clinical scoring system in guiding repeated transcatheter arterial chemoembolization( TACE) therapy for patients with hepatocellular carcinoma( HCC) and the treatment strategies for patients with an ABCR score of 1-3.Methods The patients with HCC who underwent TACE in The First Affiliated Hospital of Soochow University from January 2008 to December 2017 were enrolled. In order to investigate the effect of repeated TACE in patients with different ABCR scores,229 patients who underwent repeated TACE consecutively( at least twice,without systemic therapy) were enrolled as group A,which was further divided into group A1 with 92 patients( an ABCR score of ≤0),group A2 with 78 patients( an ABCR score of 1-3),and group A3 with 59 patients( an ABCR score of ≥4). In order to investigate the survival time of patients with an ABCR score of 1-3 who received different regimens after first TACE therapy,118 patients with an ABCR score of 1-3 who received TACE for the first time were enrolled as group B,which was further divided into group B1 with 78 patients( treated with TACE after first TACE therapy),group B2 with 21 patients( treated with TACE combined with sorafenib),and group B3 with 19 patients( treated with sorafenib alone). The survival of the above groups of patients were analyzed. The Fisher's exact test was used for comparison of categorical data between groups,the Kaplan-Meier method was used to plot survival curves,and the log-rank test was used for comparison of survival time between groups. Results The median survival time was32. 0 months( 95% confidence interval [CI]: 27. 7-36. 3) in group A1,10. 3 months( 95% CI: 8. 4-12. 2) in group A2,and 4. 6 months( 95% CI: 3. 7-5. 5) in group A3. Group A1 had a better survival time than group A2( χ2= 106. 99,P < 0. 01),and group A2 had a better survival time than group A3( χ2= 49. 66,P < 0. 01). The median survival time was 10. 3 months( 95% CI: 8. 4-12. 2) in group B1,14. 8 months( 95% CI: 7. 8-21. 8) in group B2,and 6. 0 months( 95% CI: 4. 6-7. 4) in group B3,and group B2 had a better survival time than group B1( χ2= 6. 80,P < 0. 01) and group B3( χ2= 29. 89,P < 0. 01). Conclusion The ABCR score has a certain guiding significance for the treatment of HCC patients. Repeated TACE may be considered for patients with an ABCR score of ≤0,while patients with an ABCR score of ≥4 may not benefit from further TACE therapy,and TACE combined with sorafenib might bring maximum benefits to patients with an ABCR score of 1-3.

Objective To investigate the risk factors for tumor recurrence and death after liver transplantation in patients with hepatocellular carcinoma( HCC) and their survival. Methods The patients with HCC who underwent liver transplantation in The Fifth Medical Center of Chinese PLA General Hospital from January 2005 to February 2019 were enrolled,and according to the presence or absence of HCC recurrence after liver transplantation,they were divided into recurrence group and non-recurrence group. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate Cox proportional-hazards regression model analyses were used to determine the risk factors for HCC recurrence and death after liver transplantation. The Kaplan-Meier method was used for survival analysis,and the receiver operating characteristic( ROC) curve was used to investigate the predictive value of death-related risk factors after liver transplantation. Results A total of 391 HCC patients who underwent liver transplantation were enrolled,with a median follow-up time of 2 years,among whom78( 19. 95%) experienced HCC recurrence. Preoperative alpha-fetoprotein( AFP) level > 200 ng/ml( recurrence: hazard ratio [HR]=2. 52,95% confidence interval [CI]: 1. 58-4. 03,P < 0. 001; death: HR = 2. 99,95% CI: 1. 59-5. 62,P < 0. 001],total tumor diameter( recurrence: HR = 1. 20,95% CI: 1. 12-1. 28,P < 0. 001; death: HR = 1. 10,95% CI: 1. 02-1. 17,P = 0. 002),and vascular invasion( recurrence: HR = 1. 15,95% CI: 1. 04-1. 26,P = 0. 016; death: HR = 1. 10,95% CI: 1. 03-1. 18,P = 0. 004) were independent risk factors for tumor recurrence and death after liver transplantation. The 1-,5-,and 10-year overall survival rates after liver transplantation were 94. 8%,84. 2%,and 83. 5%,respectively,and the 1-,5-,and 10-year disease-free survival rates were84. 0%,75. 1%,and 75. 1%,respectively. AFP,involvement of major blood vessels,body mass index,and total tumor diameter had a certain value in predicting the death of HCC patients with recurrence,with an area under the ROC curve of 0. 789( 95% CI: 0. 719-0. 858). Conclusion Tumor biological features before transplantation are the key factors for tumor recurrence after transplantation.

Objective To investigate the value of abnormal prothrombin [protein induced by vitamin K absence or antagonist-Ⅱ( PIVKA-Ⅱ) ]in monitoring the short-term efficacy of transcatheter arterial chemoembolization( TACE) in patients with hepatocellular carcinoma( HCC). Methods A retrospective analysis was performed for the clinical data of 114 patients with HCC who were admitted to Zhongda Hospital Affiliated to Southeast University from January to December,2019,and all patients received conventional TACE alone and had a baseline PIVKA-Ⅱ level of ≥40. 00 m AU/ml. Serological response of PIVKA-Ⅱ was observed before TACE and at 1,3,and 6 months after TACE and was compared with radiological response at the same time point( based on mRECIST guidelines). A Spearman correlation analysis was used to investigate the correlation between serological response and radiological response. The paired chi-square test was used to analyze the consistency between the sensitivity of serological response and that of radiological response. Radiological response was used as the gold standard to investigate the validity and reliability assessment indices of the serological response of PIVKA-Ⅱ． Results The patients enrolled in this study had a PIVKA-Ⅱ level of 7225. 44( 40. 13-30 000. 00) m AU/ml. At 1,3,and 6 months after TACE,104 patients( 91. 2%),94 patients( 90. 3%),and 86 patients( 90. 5%),respectively,had serological response,while 103 patients( 90. 3%),90 patients( 86. 5%),and 82 patients( 86. 3%) had radiological response. The Spearman correlation analysis showed that radiological response was positively correlated with serological response at 1,3,and 6 months after TACE( r = 0. 739,0. 731,and 0. 708,all P < 0. 001). The paired chi-square test showed that serological response and radiological response had a relatively consistent sensitivity in assessment at 1,3,and 6 months after TACE( χ2= 0,1. 5,and 1. 5,P = 1. 000,0. 219,and 0. 219). The validity and reliability assessment indices of serological response maintained at a relatively high level. Conclusion Based on the criteria for radiological response,PIVKA-Ⅱ has a good value in monitoring the short-term efficacy of TACE in patients with HCC.

Objective To investigate the clinical value of indocyanine green retention rate at 15 minutes( ICG-R15),Child-Turcotte-Pugh( CTP) class,and Model for End-Stage Liver Disease( MELD) score in predicting post-transjugular intrahepatic portosystemic shunt( TIPS) hepatic encephalopathy( HE) in liver cancer patients with portal hypertension. Methods A retrospective analysis was performed for the clinical data of 95 liver cancer patients with portal hypertension who underwent TIPS in Department of Interventional Therapy in Beijing Shijitan Hospital from January 2015 to June 2017,and according to the presence or absence of HE after TIPS,they were divided into HE group with 24 patients and non-HE group with 71 patients. ICG-R15,CTP class,and MELD score were determined for all patients before surgery. 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 and the Fisher's exact test were used for comparison of categorical data between two groups. Univariate and multivariate logistic regression analyses were used to investigate the risk factors for HE after TIPS,and the receiver operating characteristic( ROC) curve was used to analyze the value of ICG-R15,CTP class,and MELD score in predicting HE. Results The incidence rate of HE was 25. 2%( 24/95) within 12 months after TIPS. The univariate analysis showed that stent location( P = 0. 021),ICG-R15( P = 0. 005),and CTP class( P = 0. 040) were associated with HE after TIPS. The multivariate analysis showed that stent located in the right portal vein( OR = 3. 373,95% CI: 2. 346 ～ 5. 103,P = 0. 010) and ICG-R15 > 30%( OR = 2. 107,95% CI: 1. 331 ～ 3. 212,P = 0. 036) were independent risk factors for HE after TIPS in liver cancer patients with portal hypertension. The ROC curve analysis showed that ICG-R15,MELD score,and CTP class had an area under the ROC curve of 0. 659,0. 638,and 0. 621,respectively,in predicting HE after TIPS. Conclusion ICG-R15 has a certain clinical value in predicting HE after TIPS in liver cancer patients with portal hypertension.

Objective To investigate the effect of artificial liver support therapy on the short-term( 28-and 90-day) mortality rate of patients with liver failure in the plateau stage through a stratified analysis based on Model for End-Stage Liver Disease( MELD) score.Methods A retrospective analysis was performed for 187 patients with liver failure who were admitted to Nanfang Hospital,Southern Medical University,from January 2015 to April 2019,with 73 patients in the artificial liver group and 114 in the non-artificial liver group. The stratified analysis based on MELD score in the plateau stage was performed to investigate the differences in 28-and 90-day mortality rates,hospital costs and length of hospital stay of surviving patients,and incidence rate of adverse reactions of artificial liver support therapy between the two groups. The t-test was used for comparison of continuous data between the two groups,and the chi-square test or the Fisher's exact test was used for comparison of categorical data between the two groups. Results Compared with the non-artificial liver group,the artificial liver group had a significant reduction in the 28-day mortality rate of the patients with an MELD score of 30-39( 5. 9% vs39. 6%,P < 0. 001) or those with an MELD score of 40( 25. 0% vs 72. 7%,P < 0. 05). Compared with the non-artificial liver group,the artificial liver group had a significant reduction in the 90-day mortality rate of the patients with an MELD score of 30-39( 23. 5% vs62. 3%,P < 0. 001). Artificial liver support therapy did not significantly shorten the mean hospital stay of the surviving patients( P > 0. 05)and had no significant influence on the total hospital costs of the surviving patients within 90 days( P > 0. 05). The incidence rate of adverse reactions related to artificial liver support therapy was 29. 1%,but the symptoms were mild and were relieved after symptomatic treatment.Conclusion Patients with an MELD score of < 30 in the plateau stage tend to have low 28-and 90-day mortality rates,and artificial liver support therapy can be reasonably selected according to the patient's economic conditions and willingness. Artificial liver support therapy is recommended for patients with an MELD score of 30-39 in the plateau stage if there is no obvious contraindication. For patients with an MELD score of 40 in the plateau stage,artificial liver support therapy is recommended within 28 days if there is no obvious contraindication,and liver transplantation is recommended as soon as possible. Artificial liver support therapy has no significant influence on the total hospital costs and mean hospital stay of the surviving patients within 90 days and does not increase the economic burden of patients.

Objective To investigate the clinical features of the two most common types of pyogenic liver abscess in clinical practice,Klebsiella pneumoniae liver abscess( KPLA) and Escherichia coli liver abscess( ECLA),and to provide a reference for early diagnosis and effective treatment. Methods A retrospective analysis was performed for the clinical data of 371 patients with liver abscess who were admitted to The Second Affiliated Hospital of Air Force Medical University from March 2005 to July 2018,among whom 145 patients tested positive for pathogen. KPLA patients and ECLA patients were compared in terms of clinical features,laboratory examination,radiological examination,and prognosis. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. A multivariate logistic regression analysis was used to determine the influencing factors for prognosis. Results Among the 145 patients that tested positive for pathogen,66 tested positive for Klebsiella pneumonia and 42 tested positive for Escherichia coli. Compared with the KPLA patients,the ECLA patients tended to have an older age( t =-2. 25,P = 0. 027),biliary diseases( χ2= 10. 019,P = 0. 002),a history of abdominal surgery( χ2= 27. 481,P < 0. 001),tumor( χ2= 17. 745,P < 0. 001),and a significantly higher proportion of individuals with recurrent liver abscess( χ2=13. 745,P < 0. 001). KPLA was often observed in patients with diabetes( χ2= 17. 505,P < 0. 001). As for laboratory examination,compared with the KPLA patients,the ECLA patients had a significant increase in total bilirubin( U = 880. 000,P = 0. 001) and significant reductions in albumin( t =-2. 625,P = 0. 010) and platelet count( U = 1719. 000,P = 0. 036). Radiological examination showed that there was a higher proportion of patients with multiple liver abscess in ECLA( χ2= 23. 372,P < 0. 001),while KPLA often had an abscess diameter of > 5 cm( χ2= 7. 637,P = 0. 006). As for complications,the ECLA patients were more likely to develop pulmonary infection( χ2=18. 857,P < 0. 001) and emphysema( P = 0. 013). ECLA patients were more likely to have multidrug-resistant organisms,and most patients were treated with antibiotics combined with ultrasound-guided percutaneous drainage in both groups. The multivariate logistic regression analysis showed that Acute Physiology and Chronic Health Evaluation Ⅱ score on admission( odds ratio = 0. 049,95% confidence interval: 0. 026-0. 266,P < 0. 001) was an influencing factor for prognosis. Conclusion ECLA is commonly seen in elderly patients with biliary diseases,with easy recurrence,multiple abscesses on radiological examination,and a high proportion of pulmonary infection and emphysema. There is a high positive rate of extended-spectrum beta-lactamases produced by ECLA,and therefore,antibiotics should be used reasonably in the early stage.

Objective To investigate the clinical effect and safety of second-line drugs in the treatment of adult patients with autoimmune hepatitis( AIH) through a Meta-analysis of related articles. Methods PubMed,EMBASE,Cochrane Library,Web of Science,CNKI,CBM,Wanfang Data,and VIP were searched for the articles on second-line drugs for AIH published up to December 31,2019. The Newcastle-Ottawa Scale( NOS) was used to assess the quality of articles,related data were extracted,and Meta-Analyst software was used to perform the Meta-analysis. Results A total of 22 articles were included,with 636 patients in total. The Meta-analysis showed that mycophenolate mofetil( MMF),tacrolimus( TAC),cyclosporine,and budesonide had a pooled response rate of 56. 1%,76. 0%,62. 7%,and 57. 3%,respectively,and their pooled incidence rates of adverse events were 22. 5%,47. 4%,48. 4%,and 33. 0%,respectively.The patients treated with MMF were divided into groups based on intolerance or no response to the first-line treatment,and a comparative analysis of these groups showed a relative risk of 1. 965( 95% confidence interval: 1. 181-3. 269,I2= 0. 665,P = 0. 014). Conclusion Selection of second-line drugs for adult AIH patients should consider response rate and incidence rate of adverse reactions. Both MMF and tacrolimus are good second-line drugs,and TAC may be a better choice for patients with no response to first-line treatment.

Objective To evaluate the quality of life and treatment of patients with primary biliary cholangitis( PBC) using the PBC-40 scale. Methods The PBC-40 scale was used to perform an investigation of 37 patients who were diagnosed with PBC and received continuous treatment in Department of Gastroenterology,The First Affiliated Hospital of Air Force Medical University,from January 2017 to December 2018. With reference to patients' baseline biochemical parameters and pathological staging,the scores of the six domains of the PBC-40 scale,i. e．,“symptom”,“pruritus”,“weakness”,“cognitive function”,“social function”,and “emotional function”,were analyzed. The two-independent-samples t test was used for comparison of normally distributed continuous data between two groups,and an analysis of variance was used for comparison between multiple groups; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups,and the Kruskal-Wallis H test was used for comparison between multiple groups. The paired-samples Wilcoxon signed rank sum test was used for comparison of pruritus score before and after treatment,and the paired samples t-test was used for comparison of weakness score before and after treatment. A Spearman analysis was used to investigate correlation.Results In the PBC-40 scale,the scores of symptom,pruritus,weakness,cognitive function,social function,and emotional function were 16. 5 ± 4. 3,5. 2 ± 3. 3,26. 4 ± 8. 3,15. 3 ± 5. 1,25. 4 ± 8. 4,and 8. 1 ± 2. 7,respectively. A stratified analysis was performed for the patients aged < 50 years,50-60 years,and > 60 years,and the results showed that there was a significant difference in the score of pruritus between the different age groups( χ2= 8. 290,P = 0. 016). The PBC patients with a body mass index of ≥24 kg/m2 had significantly lower scores of symptom and cognitive function than those with a body mass index of < 24 kg/m2( symptom: Z =-2. 222,P =0. 025; cognitive function: t = 2. 255,P = 0. 030). The patients with positive anticentromere antibody had a significantly higher score of weakness than those with negative anticentromere antibody( t = 3. 453,P = 0. 001). The score of pruritus was positively correlated with alkaline phosphatase( ALP)( R2= 0. 325,P = 0. 049) and gamma-glutamyl transpeptidase( GGT)( R2= 0. 402,P = 0. 014). Conclusion The PBC-40 scale can be used to evaluate the quality of life of Chinese patients with PBC. High levels of ALP and GGT may predict low quality of life.

Objective To investigate the association of peroxisome proliferator-activated receptor gamma coactivator 1 alpha( PPARGC1 A) rs8192678 single nucleotide polymorphism( SNP) with the risk of nonalcoholic fatty liver disease( NAFLD) and the influence of PPARGC1 A rs8192678 SNP on NAFLD-related biochemical parameters. Methods A total of 119 NAFLD patients who attended Qingdao Municipal Hospital Affiliated to Qingdao University from December 2017 to December 2018 were enrolled as NAFLD group,and 213 individuals who underwent physical examination during the same period of time were enrolled as control group. Clinical data and blood samples were collected from all subjects to measure related biochemical parameters and detect PPARGC1 A rs8192678 SNP. The chi-square test was used to determine whether the genotype distribution of samples was in accordance with the Hardy-Weinberg equilibrium. The t-test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. A binary logistic regression analysis was used to investigate the risk factors for NAFLD.Results There were no significant differences in the genotype and allele frequencies of PPARGC1 A rs8192678 between the NAFLD group and the control group( χ2= 0. 011 and 0. 015,P = 0. 918 and 0. 904). The binary logistic regression analysis showed that CT genotype of PPARGC1 A rs8192678 was not a risk factor for NAFLD( odds ratio = 0. 951,95% confidence interval: 0. 368-2. 457,P = 0. 918). In the NAFLD group,the patients carrying CT genotype had a significantly higher level of gamma-glutamyl transpeptidase( GGT) than those carrying CC genotype( Z =-2. 331,P = 0. 020). Conclusion PPARGC1 A rs8192678 SNP does not increase the risk of NAFLD,while NAFLD patients carrying CT genotype tend to have a higher serum level of GGT.

Objective To investigate the effect and significance of cyclooxygenase-2( COX-2) inhibitors on the expression of the Acsl gene family in the ileum of rats with nonalcoholic fatty liver disease( NAFLD). Methods A total of 45 Sprague-Dawley rats were randomly divided into normal control group( 15 rats given normal diet),NAFLD model group( 15 rats given high-fat diet),and nimesulide group( 15 rats given high-fat diet and nimesulide). All rats were sacrificed after 12 weeks of feeding,and then blood samples were collected from the inferior vena cava to measure total cholesterol( TC) and triglyceride( TG). HE staining and oil red O staining were performed for the liver to evaluate the degree of hepatic steatosis in each group,and quantitative real-time PCR was used to measure the mRNA expression of the Acsl family genes in the ileum. An 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 Compared with the normal control group,the NAFLD model group had significant increases in serum TC and TG and marked hepatic steatosis( all P < 0. 05); compared with the NAFLD model group,the nimesulide group had significant reductions in serum TC and TG and degree of hepatic steatosis( all P < 0. 05). Compared with the normal control group,the NAFLD model group had a significant increase in the expression of COX-2 in the ileum( P < 0. 05),and compared with the NAFLD model group,the nimesulide group had a significant reduction in the expression of COX-2 in the ileum( P <0. 05). Compared with the normal control group,the NAFLD model group had significant increases in the mRNA expression of Acsl3 and Acsl5 in the ileum( both P < 0. 05),and compared with the NAFLD model group,the nimesulide group had significant reductions in the mRNA expression of Acsl3 and Acsl5( both P < 0. 05). Conclusion The COX-2 inhibitor nimesulide can regulate the expression of the Acsl gene family in the ileum of rats with NAFLD,suggesting that COX-2 inhibitors may inhibit the progression of NAFLD through the Acsl gene.

Objective To investigate the expression of exosome microRNAs( miRNAs) in bile of hepatic alveolar echinococcosis( HAE)patients with biliary tract invasion and the regulatory mechanism of differentially expressed miRNAs on target genes. Methods Bile samples were collected from 12 HAE patients who attended Qinghai University Affiliated Hospital from August 2017 to October 2018,with 6 patients in observation group( with the manifestation of biliary tract invasion) and 6 in control group( without the manifestation of biliary tract invasion). Ultracentrifugation extraction and Western blot were used to identify the structure of exosomes,the Trizol method was used to extract total RNA in exosomes,and miRNA expression profile microarray was used to identify differentially expressed miRNAs. The pathway enrichment analysis was performed to predict the target genes of biliary tract invasion based on differentially expressed miRNAs. Results A total of 74 differentially expressed miRNAs were identified between the observation group and the control group,among which 9 were upregulated and 65 were downregulated( | Fold Change | > 2). The pathway analysis showed that the target genes were mainly enriched in the pathways for tumorigenesis,phosphatidylinositol signaling system,and PTEN( FDR < 0. 05). The GO annotation and enrichment analysis showed that the target genes were mainly enriched in the biological processes such as positive regulation of gene repression and regulation of cell differentiation( FDR < 0. 05). Conclusion The established expression profile of differentially expressed exosome miRNAs in bile of HAE patients with biliary tract invasion can be used as biomarkers for biliary tract invasion of HAE and preliminarily elaborate on the regulatory mechanism of differentially expressed miRNAs on target genes after HAE invades the biliary tract.

Objective To investigate the clinical features of biliary acute pancreatitis( BAP) and hypertriglyceridemic acute pancreatitis( HTGAP). Methods A total of 378 patients with acute pancreatitis who were admitted to The Affiliated Hospital of Southwest Medical University from September 2018 to August 2019 were enrolled,among whom 229 patients had BAP( BAP group) and 149 had HTGAP( HTGAP group). Clinical features were analyzed for both groups,including age,sex,underlying diseases,laboratory markers,disease severity,local and systemic complications,and outcome measures. The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups,and the Mann-Whitney U test was used for comparison of ordinal categorical data between groups. A logistic regression analysis was used to investigate the independent risk factors for acute liver injury,systemic inflammatory response syndrome,and multiple organ dysfunction syndrome. Results Compared with the BAP group,the HTGAP group had a significantly younger age( t = 7. 192,P < 0. 05),a significantly lower referral rate( χ2= 7. 680,P < 0. 05),and significantly higher constituent ratio of male patients( χ2= 16. 987,P < 0. 05),body mass index( BMI)( t =-4. 171,P < 0. 05),BISAP score( Z =-2. 701,P < 0. 05),rate of high-fat diet( χ2= 6. 702,P < 0. 05),recurrence rate( χ2=6. 702,P < 0. 05),and proportion of patients with diabetes( χ2= 8. 567,P < 0. 05),smoking( χ2= 9. 291,P < 0. 05) or drinking( χ2=11. 934,P < 0. 05). Compared with the HTGAP group,the BAP group had significantly higher amylase( Z =-3. 298,P < 0. 05),alanine aminotransferase( Z =-5. 290,P < 0. 05),aspartate aminotransferase( Z =-6. 247,P < 0. 05),total bilirubin( Z =-3. 626,P <0. 05),direct bilirubin( Z =-8. 803,P < 0. 05),and D-dimer( Z =-3. 511,P < 0. 05) and significantly lower white blood cell count( Z =-3. 344,P < 0. 05),hemoglobin( t =-7. 496,P < 0. 05),and hematocrit( t =-3. 812,P < 0. 05). Compared with the HTGAP group,the BAP group had a significantly higher proportion of patients with pancreatic pseudocyst or acute liver injury( χ2= 11. 131 and19. 089,both P < 0. 05),and compared with the BAP group,the HTGAP group had a significantly higher proportion of patients with systemic inflammatory response syndrome or multiple organ dysfunction syndrome( χ2= 3. 848 and 4. 485,both P < 0. 05). There were also significant differences between the two groups in surgical rate( χ2= 18. 348,P < 0. 05) and length of hospital stay( Z =-2. 002,P < 0. 05).The multivariate logistic regression analysis showed that hypertriglyceridemia( odds ratio [OR] = 0. 347,95% confidence interval [CI]:0. 152-0. 793,P = 0. 012),BMI( OR = 1. 113,95% CI: 1. 031-1. 202,P = 0. 006),and diabetes( OR = 0. 379,95% CI: 0. 160-0. 896,P = 0. 027) were independent influencing factors for acute liver injury; hypertension( OR = 4. 050,95% CI: 1. 820-9. 011,P =0. 001) was an independent influencing factor for systemic inflammatory response syndrome; hypertriglyceridemia( OR = 3. 741,95% CI:1. 170-11. 956,P = 0. 026) was an independent influencing factor for multiple organ dysfunction syndrome. Conclusion Compared with BAP patients,HTGAP patients tend to have a younger age,a higher proportion of male patients,a higher rate of high-fat diet,and a higher BMI. HTGAP patients are more likely to develop systemic inflammatory response syndrome and multiple organ dysfunction syndrome than BAP patients,while BAP patients are more likely to develop pancreatic pseudocyst and acute liver injury.

Liver fibrosis can progress to liver cirrhosis and end-stage liver disease,which may lead to poor prognosis. In addition to pathological angiogenesis and hepatic sinusoid remodeling,hepatic lymphangiogenesis also plays an important role in the progression of liver fibrosis. This article briefly describes lymphatic vessel markers and their expression in the liver,introduces the role of lymphangiogenesis in liver fibrosis,and reviews the role of liver macrophages( Kupffer cells) and lymphatic endothelial cells in lymphangiogenesis. It is pointed out lymphangiogenesis may become a potential target for the intervention of liver fibrosis,which plays an important role in the early treatment and reversal of liver fibrosis and the prevention of liver cirrhosis and end-stage liver disease.

Exosomes,as a type of multivesicular bodies secreted by various cells in human body,exist in many kinds of body fluids in the body. Exosomes have the structure of lipid bilayer membranes to protect the structure and function stability of their contents and they carry a large number of active substances including microRNA( miRNA) and mRNA. Studies have shown that exosomes and their miRNA are closely associated with the development and progression of liver fibrosis and regulate such process by acting on hepatic stellate cells to change their activation,proliferation,apoptosis,and migration. This article elaborates on the biological characteristics of exosome miRNA and its association with liver fibrosis,analyzes its important role in the development and progression,diagnosis and treatment,and prognostic evaluation of liver fibrosis,and points out that exosome miRNA may become a new potential target for the diagnosis,treatment,and prognostic evaluation of liver fibrosis.

Hepatocellular carcinoma( HCC) is one of the most common malignant tumors in the world. At present,the treatment methods for HCC mainly include surgical treatment,local regional treatment,radiotherapy,systematic treatment,and traditional Chinese medicine treatment. This article introduces the indications for surgical treatment,surgical procedures,and the advantages of postoperative adjuvant therapy,analyzes the indications for liver transplantation and its future application in clinical practice,and describes the basic principles,optimal indications,and technical advantages of mature and new ablation techniques at present. It is pointed out that for patients with early-stage HCC,the advantages and shortcomings of each treatment regimen should be fully understood to select a precise treatment regimen.

Comprehensive scoring models are one of the main methods for liver function evaluation and an important part of the treatment strategy for hepatocellular carcinoma. This article summarizes the value and limitations of traditional scoring models( Child-Turcotte-Pugh score and Model for End-Stage Liver Disease score) and new scoring models( albumin-bilirubin score,platelet-albumin-bilirubin score,and albumin-indocyanine green score) in radiofrequency ablation for hepatocellular carcinoma and points out that the new scoring models,especially platelet-albumin-bilirubin score,are advantageous.

In the past decade,the role of the mevalonic acid pathway and its inhibitor statins in preventing tumorigenesis and improving tumor prognosis has attracted wide attention; however,so far,there are still controversies over the role of statins in liver cancer. Previous studies have shown that statins play an important role in cholesterol metabolism,antioxidation,and anti-inflammation,and cholesterol metabolism,oxidative stress,and inflammatory response are important factors to promote the development and progression of liver cancer. However,some recent studies have found that statins have an adverse effect on the treatment of some liver cancer patients. This article elaborates on the role of statins as a“double-edged sword”in the treatment of liver cancer and related molecular mechanisms.

The incidence rate of liver cancer keeps increasing in recent years,and this disease has difficulties in early diagnosis,poor treatment outcome,and poor prognosis. This article describes the research advances in tumor-associated neutrophils involved in the regulation of liver tumor microenvironment and points out that they can be used as a new target for the treatment of liver cancer. Combined with tumor-associated macrophages, regulatory T cells, and various cytokines in liver tumor microenvironment, tumor-associated neutrophils can achieve a systemic anti-tumor effect and thus bring hopes to the treatment of liver cancer.

Intrahepatic cholangiocarcinoma is a highly invasive malignant tumor,and at present,surgical resection is the only effective way for cure. Lymph node metastasis makes it difficult to accurately judge the extent of radical resection,and no international consensus has been reached on the need for routine lymph node dissection and the extent of lymph node dissection. This article summarizes and analyzes the disputes and problems in preventive lymph node dissection for patients without lymph node metastasis before surgery,hoping to provide a reference for radical resection of intrahepatic cholangiocarcinoma.

Nonalcoholic fatty liver disease( NAFLD) is a common chronic liver disease,and its prevalence rate is increasing year by year.Insulin resistance and oxidative stress are the main pathogeneses of NAFLD,and there are still no effective drugs for the treatment of this disease. Insulin resistance is also a main pathogenesis of type 2 diabetes,and people with type 2 diabetes have a higher prevalence rate of NAFLD than those without diabetes. Liraglutide is a human glucagon-like peptide-1 analogue and can improve insulin resistance,and more and more studies have found that liraglutide has a certain therapeutic effect in patients with type 2 diabetes and NAFLD,while related mechanisms have not been fully clarified. This article reviews the therapeutic effect and related mechanisms of liraglutide in the treatment of type 2 diabetes and NAFLD.

Non-bioartificial liver is one of the important means for the treatment of liver failure and has been increasingly recognized in recent years,and meanwhile,it has also been widely used in non-liver failure diseases. This article reviews the application of non-bioartificial liver in the treatment of some non-liver failure diseases,including refractory pruritus caused by cholestasis,“cytokine storm”caused by various viral infections,hyperlipidemia,thyroid storm,and nervous system diseases,so as to provide a reference for clinical practice.

Hepatectomy is a common surgical procedure for hepatic surgeries,and due to its high complexity,the mortality rate after hepatectomy is as high as 30%. As one of the most common postoperative complications,posthepatectomy liver failure( PHLF) directly affects the disease-free survival and overall survival of patients after hepatectomy. Although there are great improvements in liver surgeries in the past ten years,PHLF cannot be avoided due to the condition and liver reserve function of patients before surgery. Although current techniques can significantly reduce the mortality rate of PHLF and bring more opportunities to patients,how to effectively evaluate the risk of PHLF and guide prevention and treatment strategies is still a major concern of liver surgeons. This article reviews the recent research on PHLF,including the definition,risk factors,preoperative evaluation,and prevention and treatment of PHLF,so as to provide a reference for reducing PHLF and performing effective treatment.

Primary biliary cholangitis( PBC) is a multifactorial disease caused by the combined effect of genetic susceptibility and environmental triggers. Among the known risk factors for PBC,environmental factors mainly cause the onset of the disease by disrupting mitochondrial immune tolerance. With the deepening of research,especially the application of genome-wide association study technology,some dangerous genes have been found,such as human leukocyte antigen gene IL and X chromosome monomer. This article reviews the research advances in high-risk factors for PBC.

Primary biliary cholangitis( PBC) is an autoimmune-mediated chronic progressive liver disease and can progress to liver cirrhosis and liver cancer in the late stage. Clinical manifestations and complications of PBC have significant impact on patients' mind and body,leading to the reduction in Health-related Quality of Life( HRQL). At present,HRQL has attracted more and more attention. This article summarizes the HRQL scales commonly used in China and foreign countries to assess HRQL in PBC patients and analyzes the main influencing factors for HRQL in PBC patients,in order to improve the treatment and monitoring of PBC patients in clinical practice.

Liver injury caused by viral and non-viral factors is an important stage of chronic liver disease,and the pathogenesis of liver injury is still a research hotspot. With the deepening of the research on gut microbiota,substantial evidence indicates that gut microbiota participates in the development and progression of liver injury,and it has been confirmed that Akkermansia muciniphila( Akk) has a beneficial effect against liver injury. This article summarizes the role and potential mechanism of Akk in immune-mediated liver injury,alcoholic liver disease,and nonalcoholic fatty liver disease. It is believed that Akk may provide new directions and choices for the prevention and treatment of liver injury.

Prostaglandin E2( PGE2) is a bioactive polyunsaturated fatty acid produced by arachidonic acid,and it is mainly metabolized in the liver and has an important regulatory effect on various liver diseases. Prostaglandin E synthases( PGESs) are important terminal rate-limiting enzymes in the PGE2 synthesis pathway and are involved in the development and progression of liver disease. This article mainly summarizes the role of PGESs in liver injury,hepatitis,and liver cancer in existing studies,hoping to provide a reference for further research on the role of PGESs in liver diseases.

Endoscopic retrograde cholangiopancreatography( ERCP) and its derivative technologies have become the first-line treatment methods for bile duct stones. Most stones can be removed by conventional endoscopic techniques,while the treatment of large common bile duct stones requires a combination with endoscopic lithotripsy. This article summarizes the current research advances in endoscopic mechanical lithotripsy,electrohydraulic lithotripsy/laser lithotripsy,extracorporeal shockwave lithotripsy for bile duct stones in the treatment of large common bile duct stones,so as to provide recommendations and bases for the clinical treatment of large common bile duct stones.

Pancreatic cancer is a digestive system tumor with insidious onset,high malignancy,and difficult diagnosis,and early diagnosis is the key to improving the survival rate and prognosis of patients with pancreatic cancer. This article introduces the research advances in abnormal methylation of cell-free DNA in pancreatic juice and the early diagnosis of pancreatic cancer,and it is believed that the detection of cell-free DNA methylation in pancreatic juice may be an effective method for the early diagnosis of pancreatic cancer.

Although great achievements have been made in the diagnosis and treatment of pancreatic cancer in the past several decades,the5-year survival rate of this disease is still below 10% due to high degree of malignancy,rapid progression,and strong invasion and metastasis. Exosomes are a class of nanoscale membranous vesicles that can be secreted by a variety of cells,and they carry various substances including proteins,lipids,and nucleic acids and participate in various physiological and pathological processes,such as intercellular material transport,information transmission,and development,progression,and metastasis of tumor. Studies have shown that exosomes play an important role in the metastasis of pancreatic cancer and can regulate the metastasis of pancreatic cancer by promoting epithelial-mesenchymal transition and angiogenesis to act on tumor microenvironment,affecting the formation of premetastatic microenvironment,and participating in the formation of immunosuppression microenvironment. This article reviews the research advances in exosomes in the metastasis of pancreatic cancer.