Liver failure is a complex process involving many factors. The molecular therapy targeting the cytokines and receptors associated with liver failure has become the research hotspots in recent years. Immunotherapy for liver failure includes promoting the regeneration of hepatocytes and immunoregulation by thymosin,and the combination of immunomodulatory therapy with traditional therapy is widely applied in clinical treatment. Research on the animal model of liver failure suggested that importing ARC protein or hepatocyte nuclear factor 4 protected hepatocytes and promoted the recovery of their function. Block therapy against liver failure-related molecules( fibrinogen-like protein 2,apoptosis-related molecules,transforming growth factor β,osteopontin,nuclear factor-κB,and Toll-like receptors,etc.) successfully cured the animal model of liver failure. The research on molecular therapy offers a new way for treatment of liver failure,but it is still in the stage of laboratory research at present and lacks clinical data.

Liver failure is a threat to human health. The survival of patients has been increased with the improvement in both diagnosis and treatment. Several major advances in the diagnosis and treatment of liver failure have been made in recent years,as follows: the EASL-defined diagnostic criteria for acute-on-chronic liver failure have been validated in the Eastern population,defining more accurately those who need liver transplantation; the diagnostic criteria for acute kidney injury in patients with liver dysfunction have been updated,and the new criteria are able to discover patients with kidney injury earlier; the neurohumoral regulation mechanism and factors predicting the efficacy of vasoactive agents in hepatorenal syndrome have been gradually determined; the concepts of use of granulocyte-colony stimulating factor and β-receptor blocker in liver failure are undergoing fundamental changes.

Liver failure is a clinical critical illness,and its complications have various clinical manifestations,often resulting in local or systemic invasive fungal disease( IFD). The damage of other organs may occur secondary to IFD in liver failure patients,thus worsening liver injury. This will ultimately lead to multiple organ failure with extremely high fatality,so it is very difficult to manage. To investigate the causes,symptoms,diagnosis,treatment,prognosis,and prevention of IFD in liver failure,this article reviews the consensus and controversy over IFD in liver failure in recent years and describes the significance and prospect of its research,with the purpose of improving the clinical diagnosis and treatment of IFD in liver failure.

Acute-on-chronic liver failure( ACLF) is the most complicated form of liver failure among various types of liver failure. There are certain differences in the conception,etiology,and pathogenesis of ACLF between different regions. In recent years,ACLF has attracted attention of hepatologists all over the world,and some important progress has been made,which contributes to academic communication on ACLF,an early consensus on the diagnosis and treatment of ACLF,and eventually an increased survival rate in patients. This paper reviews the differences in conception between the Eastern and Western parts of the world,pathogenesis,treatment,and prognostic judgment of ACLF.

Liver failure is a common clinical syndrome of serious liver disease with high fatality. Artificial liver support system is one of the effective methods in the treatment of liver failure,which is widely used by clinicians as a common treatment method for liver failure. This article reviews the principle and classification of artificial liver support system and summarizes the latest progress in the study and treatment of non-bioartificial liver support system in recent years. The research hotspots of bioartificial liver are also reviewed. Finally,the prospect of Li's artificial liver support system is discussed.

Liver failure is a common pathophysiological process of various hepatic diseases developing into the end stage. Because of its intricate pathogenesis and lack of specific and impactful treatment,the incidence and mortality of hepatic failure remains high and life-threatening. Currently,the principle of therapy for liver failure includes eliminating the causes,medical treatment,and preventing complications.Various artificial liver support systems( ALSSs),such as non-bioartificial liver,bioartificial liver,and hybrid artificial liver,which can remove circulating toxins,provide essential substances,and improve the internal environment,act as a partial substitute of the liver and has been widely used as an important therapy for acute or chronic liver failure. Although substantial progress has been made in the clinical studies of ALSS,there are still many problems to be dealt with. This article reviews the clinical efficacy of ALSS,as well as current clinical application,existing problems,and research advances.

Bacterial infection is a common complication in patients with liver cirrhosis,and acute-on-chronic liver failure due to bacterial infection has become a serious clinical problem. There are still many problems in the research on the pathogenesis and management of bacterial infection in liver cirrhosis,such as insidious onset,difficult early diagnosis,and increased multi-drug resistant bacteria. This article reviews the research progress in the causes and management of bacterial infection in liver cirrhosis. More effective strategies for the prevention,early diagnosis,and reasonable treatment of bacterial infection in liver cirrhosis should be developed to reduce the mortality of severe patients.

Objective To investigate the predictive values of four scoring systems,the Model for End-Stage Liver Disease( MELD),the MELD with incorporation of serum sodium( MELD-Na),the integrated MELD( i MELD),and the MELD to serum sodium ratio( MESO),in the short-term prognosis of patients with hepatitis B-associated acute-on-chronic liver failure( ACLF) after artificial liver support therapy. Methods A total of 221 patients with hepatitis B-associated ACLF who were hospitalized from October 2007 to February 2013 were enrolled as subjects and divided into survival group( n = 139) and death group( n = 82). The levels of total bilirubin( TBil),serum creatinine( Cr),international normalized ratio( INR),serum sodium( Na+),and the scores of MELD,MELD-Na,i MELD,and MESO were determined and compared between the two groups. Comparison of continuous data between two groups was made by the Mann-Whitney U test or t test; comparison between multiple groups was made by the Kruskal-Wallis H test; comparison of categorical data was made by χ2test; comparison of area under the receiver operating characteristic curve was made by normal Z test. Results The age,TBil level,INR,and the scores of MELD,MELD-Na,i MELD,and MESO were significantly higher in the death group than in the survival group,while the serum level of Na+was significantly lower in the death group than in the survival group( P < 0. 001). Patients with end-stage liver failure had significantly higher scores than those with early-stage or intermediate-stage liver failure( P < 0. 001),while patients with intermediate-stage liver failure had significantly higher scores than those with early-stage liver failure( P < 0. 001). The mortality rate increased with increasing scores of MELD,MELD-Na,i MELD,and MESO. The optimal cut-off scores of MELD,MELD-Na,i MELD,and MESO were 37. 989,41. 291,55. 406,and 2. 693,respectively. There were no significant differences between any two scoring systems( P > 0. 05). Conclusion All four scoring systems can well predict the short-term clinical prognosis in patients with hepatitis B-associated ACLF after artificial liver support therapy combined with comprehensive medical treatment. The i MELD scoring system is slightly superior to the other three scoring systems.However,the application of these scoring systems still needs to be closely associated with actual clinical situations.

Objective To learn the clinical characteristics of concurrent acute-on-chronic liver failure( ACLF) and hepatorenal syndrome( HRS),and to investigate the predictive factors for HRS in patients with ACLF. Methods A total of 806 patients with ACLF who were admitted to our hospital from January 2012 to May 2014 were selected and divided into two groups according to the incidence of concurrent HRS. Clinical indices and laboratory test results were analyzed in the two groups,and the multivariate logistic regression analysis was used to figure out independent indices for the prediction of HRS in patients with ACLF. A prediction model was established and the receiver operating characteristic curve was drawn to evaluate the accuracy of the prediction model. Comparison of continuous data between the two groups was made by t test,and comparison of categorical data between the two groups was made by χ2test. Results In all patients with ACLF,229 had HRS and 577 had no HRS. The univariate logistic regression analysis showed that hepatic encephalopathy,peritonitis,infection,age,cystatin C( Cys-C),serum creatinine( SCr),blood urea nitrogen,albumin,prealbumin,total bilirubin,direct bilirubin,total cholesterol,K+,Na+,phosphorus,Ca2 +,prothrombin time,prothrombin activity,international normalized ratio,and hematocrit were significant predictive factors for HRS. The multivariate logistic regression analysis showed that concurrent peritonitis,Cys-C,SCr,and HCO3-were independent predictive factors for HRS in patients with ACLF( OR = 3. 155,P < 0. 01; OR = 30. 773,P < 0. 01; OR = 1. 062,P < 0. 01; OR = 0. 915,P < 0. 05). The model was proved of great value in prediction. Conclusion Concurrent peritonitis,Cys-C,SCr,and HCO3-are effective predictive factors for HRS in patients with ACLF.

Objective To explore the methods for prevention and treatment of endotoxemia and multiple organ failure in patients with severe hepatitis. Methods A total of 61 patients with severe hepatitis and toxic enteroparalysis were randomly assigned to three groups. The first group was treated with plasmapheresis,the second group with plasmapheresis and colon dialysis,and the third group with plasmapheresis,colon dialysis,and oral probiotics. Analyses were performed on the clinical symptoms and physical signs,hepatic function,endotoxin level,and clinical outcome in each group. Comparison of continuous data between groups was performed by analysis of variance,and further pairwise comparison by SNK test; comparison of categorical data between two groups was performed by chi-square test. Results The liver function improved in all groups after treatment. The endotoxin level was significantly lower in the third group than in the other two groups( P <0. 05). The symptom improvement rates in the three groups were 35. 3%,64. 7%,and 81. 5%,respectively; the recurrence rates were83. 3%,72. 7%,and 36. 4%,respectively; the clinical remission rates were 5. 9%,17. 6%,and 48. 1%,respectively,and the third group had a significantly higher rate than the first group( χ2= 8. 59,P < 0. 05). Conclusion A combination of plasmapheresis,colon dialysis,and oral probiotics can effectively improve the prognosis of patients with severe hepatitis and toxic enteroparalysis,and can help prevent and treat multiple organ failure in such patients.

Objective To study the clinical features and liver pathology in chronic hepatitis B( HBV)-infected patients with normal liver function,and to explore the influencing factors. Methods A total of 316 chronic HBV-infected patients with normal liver function who were admitted to our hospital from August 2008 to August 2012 were enrolled as subjects. Hepatic tissue was collected by ultrasound-guided biopsy and analyzed by hematoxylin-eosin staining,Masson staining,and anti-HBs Ag and anti-HBc Ag immunohistochemistry staining.The Knodell inflammatory score and Ishak fibrosis score were evaluated,and their relationships with age,gender,HBe Ag,alanine aminotransferase( ALT) level,serum HBV DNA replication,and hepatic expression of HBs Ag and HBc Ag were analyzed. Comparisons of continuous data between two groups and between multiple groups were performed by t test and one-way analysis of variance,respectively. The further pairwise comparison was performed by SNK-q test. Comparison of categorical data was performed by χ2test. Results In all the chronic HBV-infected patients with normal liver function,there were 260( 82. 3%) patients with at least moderate inflammation and necrosis,256( 81. 0%) patients with at least moderate fibrosis,13( 4. 1%) patients with severe inflammation and necrosis,and 26( 8. 2%)patients with severe fibrosis( cirrhosis). The average age,Knodell score,and Ishak score were significantly higher in the female patients than in the male patients( t = 3. 526,P < 0. 05; t = 6. 65,P < 0. 05; t = 5. 77,P < 0. 05). The chronic HBV-infected patients older than30 years of age had significantly higher Knodell and Ishak scores than those younger than 30 years of age( both P < 0. 05). Moreover,the degree of liver injury was significantly higher in the infected patients with an ALT level of( 0. 5-1) × upper limit of normal( ULN) than in those with an ALT level of( 0-0. 49) × ULN( P < 0. 05). Patients with undetectable HBV DNA replication had a significantly lower degree of liver injury than those with detectable HBV DNA replication( P < 0. 05). However,there was no significant correlation between liver injury and hepatic expression of HBs Ag and HBc Ag( both P > 0. 05). Conclusion Liver biopsy should be considered for the chronic HBV-infected patients with detectable viral load and sustainable normal ALT,particularly those older than 40 years of age.

Objective To study the causes and influential factors for relapse after drug withdrawal in patients with chronic hepatitis C( CHC). Methods One hundred and one cases of CHC,including 36 males and 65 females,who were outpatients or inpatients in our hospital,were enrolled as subjects. Twenty-six patients had compensated cirrhosis,and seventy-five had chronic hepatitis. Their age ranged from 19 to 71 years. All patients had no treatment history. Routine blood indices,biochemical parameters,autoantibodies,thyroid function,hepatitis C viral load( HCV RNA),and hepatitis C virus( HCV) genotypes were evaluated before treatment. Liver function,routine blood indices,and HCV RNA load were evaluated at weeks 4,12,24,and the end of treatment,as well as 12,24,48,72,and 96 weeks after treatment. The follow-up time after drug withdrawal was 96 weeks. All patients were divided into relapse group and sustained response group,according to whether HCV RNA was detected or not. Patients in the relapse group were further divided into two groups: relapse within 24 weeks and relapse after achieving sustained virological response( SVR). The effects of baseline levels,4-week virological response rates,biochemical response rates,and treatment regimen on relapse were assessed. Between-group comparison of categorical data was performed by χ2test,and between-group comparison of continuous data was performed by t test. Results In all patients,71 patients( 70. 3%) had rapid virological response( RVR),90 patients( 89. 1%) had early virological response,and 9 patients( 8. 9%) had no response or restored HCV RNA during treatment. Among 92 patients( 91. 1%) with end-of-treatment virological response( ETVR),28patients( 30. 4%) had genotype 1b,while 64 patients( 69. 6%) had non-1 genotypes. Among 92 patients with ETVR,60 patients( 65. 2%) received the standard treatment,while 32 patients( 34. 8%) received the non-standard treatment. During a 2-year follow-up of 92 patients with ETVR after drug withdrawal,30 patients( 32. 6%) had relapse after drug withdrawal,including 13 patients( 43. 3%)who had relapse within 24 weeks after drug withdrawal,and 17 patients( 56. 7% of patients with relapse; 21. 5% of patients with SVR;18. 5% of patients with ETVR) who had relapse after achieving SVR. There were significant differences in age,HCV RNA load,cirrhosis,4-week alanine aminotransferase( ALT) normalization rate,RVR rate,and non-standard treatment rate between the relapse group and the non-relapse group( t = 2. 624,P < 0. 05,χ2= 15. 199,P < 0. 05; χ2= 4. 469,P < 0. 05; χ2= 7. 352,P < 0. 05; χ2= 7. 453,P <0. 05; χ2= 19. 950,P < 0. 05). The genotype and gender were not influencing factors for relapse. There were significant differences in HCV RNA load,cirrhosis,and standard treatment rate between patients with short-term relapse and relapse after achieving SVR( P < 0. 05).Conclusion The causes for relapse after drug withdrawal in patients with CHC involve age,viral load,cirrhosis,ALT normalization rate,RVR rate,and non-standard treatment. The high viral load and non-standard treatment are the main causes for short-term relapse.

Objective To study the relationship between Helicobacter pylori( H. pylori) infection and common lethal factors for hepatitis B virus-related cirrhosis( HBC). Methods A total of 235 patients with HBC who were admitted to our hospitals from October 2008 to October 2014 were retrospectively analyzed. The infection rate of H. pylori in those patients was calculated. In the 155 patients with esophagogastric varices and 97 patients with portal hypertensive gastropathy( PHG),the infection rate of H. pylori was compared between those with different degrees of esophagogastric varices or PHG. In the 32 patients whose blood ammonia was determined,the level of blood ammonia was compared between H. pylori-positive and-negative groups. Between-group comparison of continuous data was performed by t test and analysis of variance,and between-group comparison of categorical data was performed by χ2test. Results The infection rate of H. pylori in the 235 patients with HBC was 80. 85%( 190 /235). In the 155 patients with esophagogastric varices,who had tortuous serpentine uplift or bead-like changes of esophageal varices and tumor-like changes( with or without gastric erosion) of gastric varices visible under endoscopy,there was significant difference in infection rate of H. pylori between patients with mild,moderate,and severe varices( 50. 55%( 46 /91) vs 43. 59%( 17 /39) vs 76%( 19 /25),χ2= 6. 913,P < 0. 05). In the 97 patients with PHG,who had snake skin-like changes,cherry red spots,scarlet rash,and erosion bleeding of gastric mucosa visible under endoscopy,there was significant difference in infection rate of H. pylori between patients with mild and severe PHG( 43. 33%( 26 /60) vs 67. 57%( 25 /37),χ2= 5. 391,P < 0. 05). In patients whose blood ammonia was determined,patients in H. pylori-positive group had a significantly higher average concentration of blood ammonia than those in H. pylori-negative group( 62. 76 ± 13. 43 vs 47. 20 ± 12. 51 μmol / L,t = 3. 39,P < 0. 01). Conclusion The infection rate of H. pylori is high in patients with HBC. The H. pylori infection is likely to increase the severity of esophagogastric varices and PHG,as well as the blood ammonia level,which further increases the risk of upper gastrointestinal bleeding and hepatic encephalopathy that are the main lethal factors for HBC.

Objective To investigate the effects of Monsel's solution on bleeding in endoscopic sclerotherapy for esophageal varices. Methods One hundred and sixteen patients with cirrhosis and esophageal variceal bleeding who were admitted to our hospital from February 2013 to February 2015 were enrolled as subjects. All patients received endoscopic sclerotherapy. Forty-six patients had hemorrhage after removal of needles,and they were treated with topical spraying of 15% Monsel's solution. The instant and long-term hemostatic effects were evaluated. Results After spraying of 15% Monsel' s solution,the immediate formation of coagulum and no bleeding were found in the bleeding spots of 46 patients undergoing bleeding in endoscopic sclerotherapy. At one week after surgery,the blood pressure,pulse,fecal occult blood,and routine blood indices were evaluated,and no signs of active bleeding were found. Conclusion The response rate of topical spraying of Monsel's solution is 100%. Moreover,with a convenient preparation,few adverse reactions,and low economic burden on patients,the simple method is the best choice in the treatment of bleeding in sclerotherapy.

Objective To investigate the immunological improvement effects of different doses of ursodeoxycholic acid( UDCA) on patients with different stages of primary biliary cirrhosis( PBC) and enhance the understanding of the roles of the immune system in the disease,and to provide evidence for the standardized clinical treatment of PBC. Methods One hundred and eighty patients with PBC who were admitted to our hospital from March 2012 to Janurary 2014 were enrolled and equally divided into three classes according to the stage of PBC: early stage,cirrhotic stage,and poor biochemical response stage. Patients in each class were equally divided into three groups according to the dose of UDCA: 8-10,13-15,and 20-25 mg·kg-1·d-1. The general information,clinical symptoms,biochemical indices,and changes in T lymphocyte subsets and cytokines in peripheral blood after the treatment with different doses of UDCA were analyzed. Comparison of continuous data was performed by t test,and comparison of categorical data was performed by χ2test. Results In patients with early-stage PBC who were treated with 13-15 mg·kg-1·d-1UDCA,the percentage of CD3+CD4+T cells,CD4+/ CD8+ratio,and expression of interferon-gamma were significantly reduced after treatment( 54. 8% ± 11. 6% vs 34. 7% ± 7. 7 %,t = 6. 5,P < 0. 05; 2. 3 ± 1. 0 vs 1. 6 ± 0. 6,t = 2. 7,P < 0.05; 33. 0 ± 12. 3 vs 23. 7 ± 7. 2 ng / L,t = 2. 9,P < 0. 05),while the secretion of interleukin-4 was significantly increased after treatment( 29.0 ± 4. 6 vs 38. 5 ± 7. 1 ng / L,t = 5. 0,P < 0. 05). Conclusion The UDCA with a dose of 13-15 mg·kg-1·d-1can substantially improve the immune status in patients with early-stage PBC. The application of UDCA should be standardized in order to achieve the desired response.

Objective To analyze the expression levels of γ-glutamyl transpeptidase( GGT) and alpha-fetoprotein( AFP) and their correlation in patients with hepatocellular carcinoma( HCC) and to evaluate their diagnostic values for HCC. Methods A total of 160 patients consisting of 84 cases of HCC and 76 cases of liver cirrhosis,who were examined in the department of clinical laboratory,Yulin Xingyuan hospital,from December 2011 to December 2014,were selected in this study. The difference and correlation of AFP and GGT expression levels in the two groups were analyzed. The diagnostic cut-off values were determined based on sensitivity,specificity,Youden's index,receiver operating characteristic( ROC) curve,and area under the ROC curve. Comparison between two groups was made by independent-samples t test or Mann-Whitney U test. The correlation between AFP and GGT was determined by Spearman rank correlation analysis. Results The AFP and GGT expression levels in the HCC group were significantly higher than those in the cirrhosis group( Z =-8. 993,P <0. 05; Z =-7. 647,P < 0. 05). The expression levels of AFP and GGT in both groups were positively correlated( rs= 0. 531,P < 0. 05;rs= 0. 416,P < 0. 05). There was also a positive correlation between the AFP and GGT expression levels for all the subjects( rs= 0. 701,P < 0. 05). The diagnostic accuracy of AFP and GGT for HCC was moderate. The maximum Youden's index was 0. 519 for AFP when its cut-off value was 100 ng / ml and the maximum Youden's index was up to 0. 494 for GGT when its cut-off value reached 150 U / L. A combination of AFP and GGT could increase the sensitivity and decrease the specificity in the diagnosis of HCC,but no significant change in the Youden's index for AFP was observed. Conclusion There is a significant positive correlation between the expression levels of GGT and AFP,but the combined measurement of AFP and GGT does not improve the accuracy of HCC diagnosis.

Objective To explore the prognostic factors for patients treated by radical resection of the liver metastases from colorectal cancer and to analyze the significance of these factors. Methods The clinical and pathological data concerning 182 patients with liver metastases from colorectal cancer,who were admitted to our hospital from January 2003 to March 2008,were retrospectively analyzed,and the relationship between clinicopathological factors and treatment outcome was analyzed. The survival rate was calculated by the Kaplan-Meier method;univariate prognostic analysis was performed using the log-rank test; multivariate prognostic analysis was performed using the Cox proportional hazards model. Results Follow-up visits were carried out in all patients,with a follow-up period ranging from 9 to 60 months. The1-,3-,and 5-year survival rates were 82. 96%,59. 73%,and 40. 11%,respectively. Univariate analysis revealed that the number,size,and distribution of metastatic tumors,preoperative serum carcino-embryonic antigen( CEA) concentration,complications,and postoperative auxiliary therapy were prognostic factors for patients treated by radical resection of the liver metastases from colorectal cancer( χ2=4. 598、4. 653、5. 327、4. 768、5. 502、4. 546,all P < 0. 05). Multivariate analysis confirmed that the number of liver metastases,preoperative serum CEA concentration,and postoperative complications were regarded as independent predictors of survival( Wald = 5. 155,5. 905,and 8. 343,P < 0. 05). Conclusion The number of liver metastases,preoperative serum CEA concentration,and postoperative complications are independent predictors of survival. Expanding indications for surgical resection and active postoperative auxiliary therapy are crucial to increase the survival rate after radical resection of liver metastases from colorectal carcinoma.

Objective To study the changes in biological characteristics of a liver cancer cell line PLC / RAF /5 after repeated exposure to a chemotherapy drug,5-fluorouraci( 5-FU),and to investigate the relationship between drug-resistant liver cancer cells and liver cancer stem cells. Methods A low concentration of 5-FU( 1 μg / ml) was used to treat the human liver cancer cell line PLC / RAF /5 repeatedly to establish the PLC / RAF /5 /5-FU cell line. Morphological differences between the two types of cells were observed. The inhibitory effects of different concentrations of 5-FU( 0,0. 25,0. 5,1,1. 5,and 2 μg / ml) on the proliferation of the two types of cells were determined using the CCK-8 assay. Apoptosis of the two types of cells after exposure to different concentrations of 5-FU( 0. 5,1,and 2 μg / ml) for 48 h was analyzed using flow cytometry. The proportions of side population cells in both types of cells were measured using flow cytometry. The colony-forming ability was compared between the two types of cells by the plate colony-forming assay. The expression of Bax,Bcl-2,ABCG2,and Fox M1 proteins in both types of cells was examined by Western blot. Between-group comparison was performed by t test. Results The PLC / RAF /5 /5-FU cell line was successfully established using the chemotherapy drug 5-FU. Compared with the PLC / RAF /5cells,the PLC / RAF /5 /5-FU cells had a larger volume,fewer protrusions,a changed shape of a long shuttle,and enhanced refractivity.Moreover,compared with the parent cells,the PLC / RAF /5 /5-FU cells had a significantly lower sensitivity to the inhibitory effect of 5-FU on proliferation,a significantly lower proportion of cells at the G0 / G1 phase of the cell cycle,significantly higher proportions of cells at the S and G2 / M phases,significantly higher resistance to apoptosis,a significantly higher proportion of side population cells,and significantly enhanced proliferation( P < 0. 05). According to the results of Western blot assay,the expression of Bcl-2,Fox M1,and ABCG2 proteins in the PLC / RAF /5 /5-FU cells was significantly increased( P < 0. 01),while the expression of Bax protein in the PLC / RAF /5 cells was significantly increased( P < 0. 01). Conclusion Liver cancer stem cells are probably responsible for drug resistance of the PLC / RAF /5-FU cell line. Exposure to a low concentration of 5-FU( 1 μg / ml) can enrich liver cancer stem cell-like cells.

Objective To systematically evaluate the clinical efficacy of somatostatin and its analogues combined with proton pump inhibitor in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography( ERCP) by an evidence-based medicine approach.Methods Articles were searched manually or by computer,and were enrolled using methods recommended by the Cochrane Reviewer' s Handbook. The meta-analysis was performed using Rev Man 5. 2 software. Results Five randomized controlled trials were finally enrolled,which involved 1092 patients,including 538 patients in the control group and 554 patients in the experimental group. According to the results of the meta-analysis,patients who received somatostatin and its analogues combined with proton pump inhibitor had lower short-term and long-term serum amylase levels after surgery than patients in the control group( MD =-198. 44,95% CI:-305. 83 ~-91. 05;MD =-103. 48,95% CI:-157. 53 ~-49. 42). Patients who received somatostatin and its analogues combined with proton pump inhibitor also had lower incidence rates of hyperamylasemia and pancreatitis after ERCP than patients in the control group( OR = 0. 29,95% CI: 0. 17 ~0. 51; OR = 0. 24,95% CI: 0. 13 ~ 0. 46). Conclusion Somatostatin and its analogues combined with proton pump inhibitor are effective in reduction of the serum amylase level and prevention of the incidence of pancreatitis after ERCP.

Objective To determine the Golgi protein-73( GP73) level and platelet( PLT) count in the peripheral blood of patients with hepatitis B virus( HBV)-related liver diseases and to investigate their values in diagnosing different stages of HBV-related liver diseases.Methods Peripheral blood samples were collected from 215 patients treated in Beijing Youan Hospital,including 36 patients with chronic hepatitis B( CHB),32 patients with liver cirrhosis( LC),and 147 patients with hepatocellular carcinoma( HCC). The level of GP73 was measured by ELISA and the PLT count was determined using the Automatic Hematology Analyzer. Comparison of continuous variables was performed using one-way ANOVA,and comparison of categorical variables using chi-square test. The correlation between different variables was assessed by liner regression analysis. Results GP73 level( ng / ml) and PLT count( × 109/ L) displayed similar changes between patients with CHB,LC,pro-early HCC,early HCC,progressive HCC,and advanced HCC. The GP73 level and PLT count were significantly lower in patients with pro-early HCC( 80. 5 ± 49. 8; 84. 4 ± 40. 0) than in those with CHB( 135. 5 ± 95. 8; 174. 4 ± 49. 9),progressive HCC( 133. 8 ± 71. 1; 122. 0 ± 70. 50),and advanced HCC( 192. 2 ± 98. 1; 176. 2 ± 86. 3)( all P < 0. 01). Conclusion GP73 level and PLT count change in patients with different stages of HBV-related diseases. The dynamic monitoring of GP73 level and PLT count is useful in the early diagnosis of HCC and the prognostic judgment of HCC patients.

Objective To investigate the main clinical characteristics of patients with autoimmune hepatitis( AIH). Methods An analysis was performed on the data of 194 AIH patients who visited Guanggu Branch of Hubei Provincial Hospital of Traditional Chinese Medicine from December 2010 to December 2014 and 197 healthy blood donors who served as control group. Autoantibodies,biochemical indicators,and liver biopsy were evaluated for AIH patients. The type of AIH patients was determined according to the results of test of autoantibodies and a statistical analysis was conducted for age,sex,biochemical markers,and pathological manifestations of all the AIH patients,Comparison of continuous data between groups was made by analysis of variance and comparison of categorical data between groups was made by chi-square test. Results The female / male ratio was 154 ∶ 40 among the 194 AIH patients. The morbidity achieved a peak value among the patients aged 40-60 years. The proportion of the patients older than 40 years were 76. 80%( 149 /194). According to the results of test of autoantibodies,the numbers of type-Ⅰ,-Ⅱ,and-Ⅲ AIH patients were 163,5,and 26,respectively,the female / male ratios were131∶ 32,4∶ 1,and 19∶ 7,respectively,and the mean ages were 59. 26 ± 10. 24,16. 54 ± 8. 21,and 63. 38 ± 12. 92 years,respectively.There were significant differences in alanine aminotransferase,aspartate aminotransferase,gamma-glutamyltransferase,and immunoglobulin G between type-Ⅰ AIH patients and type-Ⅱ and-Ⅲ AIH patients( all P < 0. 05),and immunoglobulin A significantly differed between type-Ⅱ AIH patients and type-Ⅰ and-Ⅲ AIH patients( P < 0. 05). Pathological manifestations of AIH showed interface hepatitis,infiltration of lymphocytes and plasma cells,and rosette-like changes. Conclusion AIH patients are mostly female aged 40-60 years. The peak age of onset ranges from 40 to 60 years. Biochemical indicators have various degrees of increase among type-Ⅰ,-Ⅱ,and-Ⅲ AIH patients. The main pathological manifestation is interface hepatitis.

Objective To study the effect of high altitude( HA) of 4300 m on the hepatic gluconeogenesis in rats and its underlying mechanism. Methods Thirty-six healthy adult male Sprague-Dawley( SD) rats were randomly assigned to group H1( HA exposure for 1 day,n = 6),group H3( HA exposure for 3 days,n = 6),group H7( HA exposure for 7 days,n = 6),group H15( HA exposure for 15 days,n= 6),group H30( HA exposure for 30 days,n = 6),and group C( no HA exposure,n = 6). After the treatment,the mRNA and protein levels of glucose-6-phosphatase( G6Pase),and forkhead box transcription factor O1( Fox O1) in the hepatic tissues were determined by RT-PCR and Western blot,respectively. The content of hepatic glycogen was determined by spectrophotometry,and the blood glucose level was measured using an automatic biochemical analyzer. The one-way analysis of variance( ANOVA) was used to analyze the differences between groups,and the Tukey test was further used to compare the differences between two groups. Results Compared with those in group C,the levels of G6 Pase and glycogen in the hepatic tissues of rats increased significantly in groups H1,H3,and H7( P < 0. 05),and the expression level of Fox O1 decreased significantly in groups H3,H7,H15,and H30( P < 0. 01). No significant differences in the concentration of blood glucose were observed between the HA-treated groups. Conclusion Increased hepatic gluconeogenesis and glycogen synthesis in the early phase of HA exposure may be one of the important mechanisms of HA acclimatization. Fox O1 and AMPK are involved in the regulation of hepatic gluconeogenesis. The increased content of hepatic glycogen is associated with the decreased activity of AMPK.

Acute-on-chronic liver failure( ACLF),a severe hepatic syndrome,is the most common type of hepatic failure in China,which has no specific treatment until now. Traditional therapies mainly include comprehensive medical treatment,artificial liver support system( ALSS),and liver transplantation. In recent years,several novel approaches including new ALSS,hepatocellular transplantation,stem cell transplantation,colony stimulating factor,and combination therapies have been proposed with the constant development of biotechnologies and cytotechnologies. In the present review,the traditional therapies,as well as the mechanism and characteristics of new approaches to the treatment of ACLF,are summarized. Then,the current application,problems,and advances of these new approaches are also discussed.

Acute-on-chronic liver failure( ACLF) is a severe liver disease with high mortality in China. Early diagnosis could reduce complications and improve the survival rate. In the present review,the definition,etiology,and pathogenesis related to inflammatory response,reactive oxygen species,and metabolism are reviewed. Also,the new approaches to the treatment of ACLF and prognostic factors are summarized. Generally,the development of ACLF is considered to be life-threatening for patients. Therefore,a universal definition of ACLF should be proposed,which would provide good guidance and standard for the clinical diagnosis and treatment of ACLF in China. In addition,the risk factors for ACLF in patients with chronic liver diseases need to be determined by prospective studies.

Liver diseases are common in China. When the diseases progress to the end stage,liver transplantation has been considered as the most effective means of treatment. Whereas,due to the causes such as lack of donors,the treatment of acute-on-chronic liver failure has been restricted. While stem cells,especially the mesenchymal stem cells,can improve liver damage to a certain extent and have been adopted in clinical treatment. After years of studies,the mechanism of treatment has not been thoroughly clarified; due to the insufficient long-term clinical efficacy,there is also controversy on the clinical application. This article reviews related literature at home and abroad in recent years to discuss the mechanism related to the treatment of acute-on-chronic liver failure with mesenchymal stem cells and indicate the optimal clinical protocol.

A high proportion of the causes of liver failure remain unknown. This paper reviews the progress in the epidemiology,etiology,treatment,and prognosis of liver failure of unknown etiology. The possible causes of liver failure of unknown etiology may include occult hepatitis B virus infection,herpesvirus infection,transfusion-transmitted virus infection,hepatitis G virus infection,human parvovirus Bl9 infection,autoimmune and hepatitis. Aciclovir can be considered in the empirical treatment for patients with liver failure of unknown etiology.The mortality in patients with liver failure of unknown etiology is high. The research on the etiology and treatments should be strengthened.

Current antiviral treatment strategy for chronic hepatitis B( CHB) includes pegylated interferon( PEG-IFN) and nucleos( t) ide analogues( NAs). Whether combination therapy with PEG-IFN and NAs improve therapeutic efficacy has become the key question regarding the antiviral therapy for CHB. This article reviews the recent progress in combination therapy for the management of CHB. The results indicate that the efficacy of simultaneous combination of PEG-IFN and NAs is not superior to that of PEG-IFN monotherapy in terms of HBe Ag seroconversion and response after drug withdrawal. Sequential combination or switching therapy in PEG-IFN-or NAs-treated patients,as well as combination with immune cell therapy,is a promising treatment strategy.

Chronic infection with hepatitis B virus( HBV) often leads to the development of liver cirrhosis and liver cancer,creating immense sociological,clinical,and economic burdens worldwide. Although current anti-HBV drugs can control the disease progression,they often fail to eliminate the virus because of the presence of covalently closed circular DNA( ccc DNA) in the hepatocyte nucleus. We review the research advances in therapeutic strategies against ccc DNA from the aspects of interfering with ccc DNA synthesis,promoting ccc DNA degradation,and silencing ccc DNA. Targeting ccc DNA is a promising approach that may lead to a cure of chronic HBV infection.

Hepatitis B virus( HBV) infection is the main cause of liver fibrosis,cirrhosis,and hepatocellular carcinoma,and it is also a major health problem around the world. How to establish an efficient,reliable,and standardized animal model of chronic HBV infection is essential to the study of the pathogenesis and prevention strategies for HBV infection. This review summarizes the general research and new advances in using tree shrews as the model of HBV infection. We believe that tree shrews,as lower primates,will provide a vital platform and have a huge potential for building a proper animal model in the future,and could become the essential animal model for simulating the process of HBV infection in humans.

Spontaneous portosystemic shunt( SPSS) has not yet drawn enough attention. The incidence of SPSS in cirrhotic patients is 38%-40%,and 46%-70% of cirrhotic patients with refractory encephalopathy show SPSS. Embolization of SPSS may be a safe and effective method for the treatment of refractory encephalopathy in patients with cirrhosis. The critical role of transjugular intrahepatic portosystemic shunt( TIPS) in the prevention and treatment of the complications of portal hypertension has been demonstrated. To further reduce portal pressure and prevent gastroesophageal variceal rebleeding,TIPS is essential for the treatment of cirrhotic patients with SPSS. Meanwhile,TIPS with SPSS embolization may reduce the post-TIPS complications,and the patients may benefit more from TIPS. Prospective randomized controlled trials are warranted to further confirm these findings.

Liver fibrosis is the common pathological consequence of all chronic liver diseases with various etiologies. The mechanism of liver fibrosis is associated with the activation and proliferation of hepatic stellate cells( HSCs). The interaction between immune cells and HSCs can regulate the production of extracellular matrix( ECM) and lead to the excessive deposition of ECM and subsequent liver fibrosis and cirrhosis. This article reviews the current understanding of the effects and action mechanisms of immune cells in the development of liver fibrosis and summarizes the regulatory functions of the innate and adaptive immune systems in liver fibrosis. Further study of the interactions between immune cells,cytokines,and HSCs and the regulatory mechanisms of the immune system will provide novel opportunity for the treatment of liver fibrosis.

Recent studies have found that endoplasmic reticulum stress( ERS) is a common feature of the pathogenesis of organ fibrosis.However,the functional alteration of ERS and its potential role in the process of liver fibrosis is still unclear. This review summarizes the potential function of ERS and ERS-mediated apoptosis in liver fibrosis,suggesting that ERS is a cellular self-protection mechanism,but excessive ERS could cause irreversible cell damage and even induce apoptosis. However,the mechanism of ERS-mediated apoptosis involved in liver fibrosis has not been well understood and merits further exploration. With the further thorough research on the association between liver diseases and ERS,the treatments for liver diseases will be more apposite in the future.

In the past,liver cirrhosis was thought to be irreversible. However,theoretically,the process of liver cirrhosis could be slowed down by inhibiting extracellular matrix( ECM) production and by promoting its degradation. Wnt signaling pathway has been involved in many physiological and pathological processes and some studies have confirmed that abnormal activation of Wnt signaling pathway could cause activation of hepatic stellate cells,and then further induce ECM formation and prompt cirrhosis progression. We believe that new clinical therapeutic direction would emerge after in-depth exploration of the mechanism of Wnt signaling pathway involved in liver cirrhosis progression.

Abnormal liver function is biochemical and pathological changes in the liver caused by damages from pathogens,which can be found in viral hepatitis,fatty liver,alcoholic liver diseases,autoimmune liver diseases,and some non-liver diseases. Due to the diversity in etiology,it is difficult to make a diagnosis for a few cases. This paper summarizes the changes in biochemical indices of the liver due to various liver diseases,and the value of a combination of different indices in the diagnosis of hepatobiliary diseases. This paper concludes that biochemical examination of the liver not only provides hints for the etiological diagnosis of abnormal liver function,but also evaluates the severity of the disease. Moreover,the etiological diagnosis of abnormal liver function also depends on the collection of a detailed history of disease,physical examination,serology,imaging,and liver biopsy.

The hepatic nodular lesions in the progression of various chronic liver diseases are hot topics all the time. There is a close relationship between hepatic nodular lesions and hepatocellular carcinoma( HCC),and the former is the precancerous lesions of the latter. This paper summarizes the pathological features and imaging findings of hepatic nodular lesions,as well as the transition from hepatic nodular lesions to HCC. It is believed that early diagnosis and timely intervention are necessary.

Liver resection is the main method of treatment of hepatic space-occupying lesion,and pleural effusion is one of the common complications. With the technological development in recent years,this paper analyzes the pleural effusion after liver resection from the aspects of hypoproteinemia,diaphragm defects,inflammatory response,portopulmonary shunt,and hepatitis B immune complex deposition,summarizes the causes of pleural effusion after liver resection and its preventive measures,and explores the effective ways to reduce the incidence of pleural effusion after liver resection,with the purpose of providing guidance for future clinical practice.

The renin-angiotensin system( RAS) is a classical circulating enzyme pathway that plays an important role in regulation of pancreatic function. In recent years,with deepening understanding of RAS,researchers found that RAS not only includes the classical ACE-Ang II-AT1 axis,but also includes the new ACE2-Ang( 1-7)-Mas axis. Extensive studies have confirmed that the ACE2-Ang( 1-7)-Mas axis can antagonize the effect of the ACE-Ang II-AT1 axis. This paper reviews the composition and function of both axes of the RAS in the local pancreas,and also presents the comparison between the two axes.