中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

2017 No. 10

Display Method:
Editorial
Development of liver diseases in children in China
Huang ZhiHua
2017, 33(10): 1833-1838. DOI: 10.3969/j.issn.1001-5256.2017.10.001
Abstract:

Some achievements have been made in the research on liver diseases in children in China, with the help of several generations of physicians for 60 years. At present, liver biopsy, examination of duodenal fluid and bile, screening for inherited metabolic diseases, and new techniques of genetic diagnosis have been conducted in China. Planned immunization with hepatitis A and B vaccines significantly reduces the incidence rates of hepatitis A and B. Remarkable achievements have been obtained in the research on cytomegalovirus infection, cytomegalovirus hepatitis, nonalcoholic fatty liver disease, autoimmune liver diseases, and drug-induced liver disease. Intensive research on liver diseases in children in China may gradually narrow the gap between China and developed countries in future.

Therapeutic guidelines
The standards of traditional Chinese medicine syndrome differentiation for viral hepatitis
Branch of Hepatobiliary Diseases, Chinese Association of Chinese Medicine
2017, 33(10): 1839-1846. DOI: 10.3969/j.issn.1001-5256.2017.10.002
Abstract:
Guidelines on the management of ascites and complications in cirrhosis
Chinese Society of Hepatology, Chinese Medical Association
2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003
Abstract(3873) PDF (1761KB)(1382)
Abstract:
Expert consensus on standardized clinical application of image-guided thermal ablation of liver tumor
Expert Committee of National Industrial Technology Innovation Strategic Alliance for Minimally Invasive Treatment of Tumor, Expert Guidance Committee for Ablation Therapy, Society of Interventional Physicians, Chinese Medical Doctor Association, Society of Interventional Physicians, Beijing Medical Doctor Association
2017, 33(10): 1864-1869. DOI: 10.3969/j.issn.1001-5256.2017.10.004
Abstract:
Chinese guidelines for clinical diagnosis and treatment of small-for-size syndrome after living donor liver transplantation (2016)
Chinese Society of Organ Transplantation, Chinese Medical Association, Organ Transplantation Branch, Chinese Medical Doctor Association
2017, 33(10): 1870-1875. DOI: 10.3969/j.issn.1001-5256.2017.10.005
Abstract:
Chinese expert consensus on enhanced recovery after hepatectomy (2017)
Study Group of Surgical Operation, Chinese Society of Surgery, Chinese Medical Association, China International Exchange and Promotive Association for Medical and Health Care, Hepatic Surgery Group, Society of Enhanced Recovery After Surgery
2017, 33(10): 1876-1882. DOI: 10.3969/j.issn.1001-5256.2017.10.006
Abstract:
EASL clinical practical guidelines on the management of acute(fulminant) liver failure(2017)
Yang Min, Zhang ShengGuo, Lu MingQin
2017, 33(10): 1883-1887. DOI: 10.3969/j.issn.1001-5256.2017.10.007
Abstract:
An excerpt of EASL Clinical Practice Guidelines: the diagnosis and management of patients with primary biliary cholangitis(2017)
Sun ChunYan, Ma Xiong
2017, 33(10): 1888-1894. DOI: 10.3969/j.issn.1001-5256.2017.10.008
Abstract:
An excerpt of American gastroenterological association institute guideline on the role of elastography in the evaluation of liver fibrosis(2017)
Lin XiaoLing, Deng ChaoWen, Hu GuoXin
2017, 33(10): 1895-1897. DOI: 10.3969/j.issn.1001-5256.2017.10.009
Abstract:
An exerpt of surgical management of pancreatic necrosis: a practice management guideline from the Eastern Association for the Surgery of Trauma in 2017
He Gao, Yang GuiYuan, Yang XiaoJun, Qian ZhuYin
2017, 33(10): 1898-1903. DOI: 10.3969/j.issn.1001-5256.2017.10.010
Abstract:
An excerpt of role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) clinical guideline (2017)
DING Min, LIANG Bing, HE Song
2017, 33(10): 1904-1909. DOI: 10.3969/j.issn.1001-5256.2017.10.011
Abstract:
An excerpt of EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (short version)
Chen Lei, Chen LuZeng
2017, 33(10): 1910-1915. DOI: 10.3969/j.issn.1001-5256.2017.10.012
Abstract:
Discussions by experts
Treatment and follow-up of children with common chronic liver diseases in children
Lu: XinTong, Zhu ZhongSheng, Wang ChaoXia
2017, 33(10): 1916-1921. DOI: 10.3969/j.issn.1001-5256.2017.10.013
Abstract:

Chronic liver diseases in children greatly affect their growth and development and quality of life in future. There are many causes of chronic liver diseases in children, and such causes, diet, and treatment guidance are closely associated with prognosis. This article discusses the guidance and follow-up of common chronic liver diseases in children, such as infantile cholestatic liver disease, chronic hepatitis B, hepatolenticular degeneration, and nonalcoholic fatter liver disease, in order to deepen the understanding of these diseases among patients, raise the awareness of follow-up in medical staff, and improve the cure rate of liver diseases with different causes and children's quality of life.

Association between enterohepatic circulation of bile acid and cholestatic liver disease
Li XiaoFeng, Gong JingYu, Wang JianShe
2017, 33(10): 1922-1927. DOI: 10.3969/j.issn.1001-5256.2017.10.014
Abstract:
The development of cholestatic liver disease is closely associated with the enterohepatic circulation disorder of bile acid. This article elaborates on metabolism of bile acid, enterohepatic circulation-related mechanism of hereditary cholestasis, molecular regulation of related transporters, and association between current therapeutic regimens and enterohepatic circulation, in order to investigate the pathogenesis of cholestatic liver disease and provide a basis for the research on new drugs or therapies.
Perspectives of liver transplantation for infantile cholestatic liver disease
Jiang Chao, Huang HeYu, Lu: GuoYue
2017, 33(10): 1928-1930. DOI: 10.3969/j.issn.1001-5256.2017.10.015
Abstract:
Cholestatic liver disease is a common disease in infancy, and due to its complex etiology and different outcomes, conservative medical treatment and conventional surgery lack therapeutic effect. Liver transplantation has obvious advantages in the treatment of decompensated intrahepatic cholestatic liver disease and biliary atresia. This article summarizes the etiology, clinical manifestations, diagnosis, and treatment of infantile cholestatic liver disease, as well as related perspectives.
Etiology of pediatric acute liver failure
Guo Jing, Sun Mei
2017, 33(10): 1931-1935. DOI: 10.3969/j.issn.1001-5256.2017.10.016
Abstract:
Pediatric acute liver failure ( PALF) is a complex syndrome with rapid progression, and the cause of PALF is age-dependent.This article analyzes the common causes of PALF in clinical practice, including infection factors, inherited metabolic factors, poisoning and drugs, abnormal perfusion, and autoimmune diseases, among which infection factors are the most common cause. With the improvement in diagnosis and treatment techniques, the diagnostic rate of PALF caused by inherited metabolic diseases and autoimmune diseases keeps increasing. Due to the small number of PALF patients, there lacks experience in etiological diagnosis. This article summarizes related reports, in order to provide a reference for screening the causes of PALF.
Long-term treatment and follow-up management of children with hepatolenticular degeneration
Fang Feng
2017, 33(10): 1936-1938. DOI: 10.3969/j.issn.1001-5256.2017.10.017
Abstract:
Hepatolenticular degeneration is the most common autosomal recessive disorder in childhood and is one of the few diseases that can be treated. Early diagnosis and initiation of lifelong low-copper diet and copper removal therapy can help to reduce the risk of disease onset ( for patients who are diagnosed before symptoms appear) , achieve long-term remission, and achieve good quality of life and a similar survival time as healthy people. Therefore, sticking to effective lifelong treatment is critical to improving the prognosis of such patients. With reference to clinical guidelines in China and foreign countries and a focus on actual problems in clinical treatment, this article discusses treatment concepts and their importance, as well as treatment regimens and follow-up management for patients with different clinical types in the stages of disease onset and maintenance treatment and patients who are diagnosed before symptoms appear.
Original articles_Liver fibrosis and liver cirrhosis
Value of Glasgow-Blatchford score in predicting early prognosis of cirrhotic patients with esophagogastric variceal bleeding
Cui Shu, Wang Fang, Lu: HongMin, Wang FengMei
2017, 33(10): 1939-1943. DOI: 10.3969/j.issn.1001-5256.2017.10.018
Abstract:
Objective To investigate the value of Glasgow-Blatchford score ( GBS) , Child-Turcotte-Pugh ( CTP) score, and Model for End-Stage Liver Disease ( MELD) score in predicting the 1-and 6-week prognosis of cirrhotic patients with esophagogastric variceal bleeding via a comparative analysis. Methods A retrospective analysis was performed for the clinical data of 202 cirrhotic patients with esophagogastric variceal bleeding who were hospitalized in Tianjin Third Central Hospital from January 1 to December 31, 2014. According to the endpoint of death at 6 weeks after admission, the patients were divided into 1-week death group ( 10 patients) , 6-week death group ( 23 patients) , and survival group ( 179 patients) . The Glasgow-Blatchford score, MELD score, CTP score, and CTP score and classification were calculated on admission, and these scores were compared between the three groups. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups, and the non-parametric Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The Z test was used for comparison of the area under the receiver operating characteristic curve ( AUC) of these three scoring systems. Results There were significant differences between the 1-week death group and the survival group in the incidence rates of liver cancer with vascular invasion or metastasis ( χ2= 4. 559, P = 0. 033) , hepatic encephalopathy ( χ2= 25. 568, P < 0. 01) , melena ( χ2= 0. 842, P = 0. 04) , and heart failure ( P = 0. 003) , pulse rate ( Z =-2. 943, P = 0. 003) , CTP classification ( χ2= 12. 22, P = 0. 002) , CTP score ( Z =-2. 505, P = 0. 012) , MELD score ( t =-2. 395, P = 0. 018) , and GBS score ( Z =-2. 545, P = 0. 011) . There were significant differences between the 6-week death group and the survival group in the incidence rates of liver cancer ( χ2= 9. 374, P = 0. 002) , liver cancer with vascular invasion or metastasis ( χ2= 14. 766, P < 0. 01) , and hepatic encephalopathy ( χ2= 16. 327, P < 0. 01) , albumin ( Z =-2. 770, P = 0. 006) , bilirubin ( Z =-3. 191, P = 0. 001) , hemoglobin ( Z =-2. 484, P = 0. 013) , blood urea nitrogen ( Z =-2. 407, P = 0. 016) , international normalized ratio ( Z =-2. 304, P = 0. 021) , systolic pressure ( t = 2. 69, P = 0. 008) , pulse rate ( Z =-3. 507, P < 0. 01) , CTP classification ( χ2= 25. 851, P < 0. 01) , CTP score ( Z =-3. 591, P < 0. 01) , MELD score ( t =-4. 121, P < 0. 01) , and GBS score ( Z =-3. 54, P < 0. 01) . GBS score ( AUC = 0. 738, 95% confidence interval [CI]: 0. 67-0. 80) was superior to MELD score ( AUC = 0. 731, 95% CI: 0. 66-0. 79) and CTP score ( AUC = 0. 728, 95% CI:0. 66-0. 79) in predicting the risk of death at 1 week. MELD score ( AUC = 0. 761, 95% CI: 0. 70-0. 89) was superior to CTP score ( AUC = 0. 748, 95% CI: 0. 69-0. 81) and MELD score ( AUC = 0. 726, 95% CI: 0. 66-0. 79) in predicting the risk of death at 6 weeks.There was a significant difference in the AUC for predicting the death rate at 1 week between GBS score and CTP score ( Z = 0. 079, P =0. 037) , while there was no significant difference in the AUC for predicting the death rate at 6 weeks between the three scoring systems ( P> 0. 05) . Conclusion GBS score is superior to MELD score and CTP score in predicting the risk of death at 1 week in cirrhotic patients with esophagogastric variceal bleeding, and MELD and CTP scores are superior to GBS score in predicting the risk of death at 6 weeks.
Original articles_Liver neoplasms
Clinical effect of recombinant adenovirus containing thymidine kinase suicide gene in preventing postoperative recurrence of hepatocellular carcinoma
Meng Jian, Du SongTao, Zhang JingGuang
2017, 33(10): 1944-1948. DOI: 10.3969/j.issn.1001-5256.2017.10.019
Abstract:
Objective To investigate the clinical effect of surgical operation combined with gene therapy in preventing postoperative recurrence of hepatocellular carcinoma ( HCC) . Methods A total of 102 patients with single HCC ( TNM stage 1-2, tumor diameter < 10 cm) who were admitted to Beijing You An Hospital, Capital Medical University, from July 2006 to February 2013 were enrolled, and among these patients, 60 underwent the gene therapy with recombinant adenovirus containing thymidine kinase suicide gene ( ADV-TK) before and after surgery ( gene group) and 42 underwent surgical resection alone ( surgery group) . The patients were followed up regularly after surgery to observe postoperative recurrence. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The log-rank test was used for the analysis of cumulative recurrence rate, and univariate and multivariate Cox regression analyses were used to identify influencing factors for recurrence rate. Results The 1-, 3-, and 5-year recurrence rates of tumor were 13. 8%, 33. 7%, and 47. 7% in the gene group and 18. 5%, 53. 2%, and 69. 2% in the surgery group, and there was a significant difference between the two groups ( χ2= 2. 643, P = 0. 041) . The gene group had a significantly higher proportion of patients with pyrexia after surgery than the surgery group, and there were no significant differences in the incidence rates of other complications and length of hospital stay between the two groups. The multivariate analysis showed that gene therapy was an independent influencing factor for cumulative rumulative recurrence rate ( odds ratio = 2. 752, 95 confidence interval: 1. 164-4. 251, P = 0. 038) . Conclusion Gene therapy combined with surgical resection can effectively reduce postoperative recurrence of tumor, and therefore, it holds promise for clinical application.
Glucose-regulated protein 78 regulates the expression of mitochondrial genesis proteins in HBV-related hepatocellular carcinoma: a clinical analysis
Li YaPing, Wang Yuan, Zhai Song, Jia XiaoLi, Zhang Xin, Pan GuoYing, Yang Ying
2017, 33(10): 1949-1954. DOI: 10.3969/j.issn.1001-5256.2017.10.020
Abstract:
Objective To investigate the expression of glucose-regulated protein 78 ( GRP78) in HBV-related hepatocellular carcinoma ( HBV-HCC) and its association with clinicopathological features, as well as its regulatory effect on mitochondrial genesis proteins in hepatoma cells, and to provide a basis for new strategies for the prevention and treatment of HCC. Methods Tissue samples were collected from54 patients with HBV-HCC, and immunohistochemistry and Western blot were used to measure the expression of GRP78, Lon, TFAM, and cytochrome C oxidase Ⅳ ( COX Ⅳ) . The expression of GRP78 in hepatoma cells was interfered by siRNA, and then the expression of GRP78, Lon, mitochondrial transcription factor A ( TFAM) , and COX Ⅳ was measured. Quantitative real-time PCR was used to measure the level of mitochondrial DNA ( mt DNA) in clinical specimens and HCC cells after GRP78 expression was interfered with. A statistical analysis was performed for clinical and experimental data. The t-test was used for comparison of continuous data between groups, the Fisher's exact test was used for comparison of categorical data between groups, and the Kaplan-Meier method was used for survival analysis. Results Compared with the adjacent tissues, HBV-HCC tissues had significantly higher expression of GRP78 and Lon ( t = 9. 135 and 5. 523, both P < 0. 0001) and significantly lower expression of the mitochondrial genesis proteins TFAM and COX Ⅳ and mt DNA level ( t = 2. 765, 4. 260, and 12. 280, P = 0. 011, < 0. 001, and < 0. 001) . There were significant increases in the expression of the mitochondrial genesis proteins TFAM and COX Ⅳ and mt DNA level after the interference with GRP78 expression in hepatoma cells ( all P < 0. 05) . There were significant differences in the expression of GRP78 between patients with different numbers of tumors, patients with and without portal vein tumor thrombus, and patients with different tumor stages ( P = 0. 016, 0. 003, and 0. 045) . The patients with low GRP78 expression had significantly longer overall survival and recurrence-free survival after surgery than those with high GRP78 expression ( χ2= 5. 006 and4. 995, P = 0. 025 and 0. 026) . Conclusion GRP78 has a potential regulatory effect on mitochondrial genesis and maintenance and has important clinical guiding significance in establishing new strategies for the prevention and treatment of HCC.
Expression of sperm-associated antigen 6 in liver cancer tissue and its clinical significance
GU Junming, CAO Yi, WEI Peng
2017, 33(10): 1955-1960. DOI: 10.3969/j.issn.1001-5256.2017.10.021
Abstract:

ObjectiveTo investigate the expression of sperm-associated antigen 6 (Spag6) in liver cancer tissue and its association with the clinicopathological features and prognosis of liver cancer patients, as well as the effect of Spag6 on the proliferation and migration of HCCLM3 hepatoma cells. MethodsClinical samples were collected from 102 liver cancer patients who were treated in Xiangya Hospital of Central South University from August 2006 to November 2009, and Western blot was used to measure the expression of Spag6 in hepatoma cells, normal liver tissue, tumor tissue, and corresponding adjacent tissue. Immunohistochemistry was used to measure the expression of Spag6 in 102 liver cancer tissue samples, and according to the immunohistochemical scoring criteria, the patients were divided into high Spag6 expression group and low Spag6 expression group.  Lentivirus-mediated RNA interference technique was used to silence Spag6 expression in HCCLM3 cells; Western blot was used to analyze silencing effect, wound-healing assay was used to investigate the effect of Spag6 gene silencing on the migration of HCCLM3 cells, and colony formation assay was performed to observe the effect of Spag6 gene silencing on the proliferation of HCCLM3 cells. The chi-square test was used to investigate the association between Spag6 expression and clinicopathological features of liver cancer patients, and the Kaplan-Meier survival analysis and log-rank test were used to analyze the association between Spag6 expression and the prognosis of liver cancer patients. ResultsHepatoma cells and liver cancer tissue had significantly higher expression of Spag6 than the normal LO2 cells and normal liver tissue. Immunohistochemistry showed that the expression rate of Spag6 was 58.8% (60/102) in liver cancer tissue samples and 12.7% (13/102) in adjacent tissue samples (χ2=47123,P<0.001). According to the results of the chi-square test, Spag6 expression was associated with the number of tumor nodules, presence or absence of capsule, vascular invasion, and Edmondson-Steiner classification (χ2=8.360, 6.761, 4.344, and 7.172, P=0.004, 0.009, 0.037, and 0.007). Further analysis showed that the high Spag6 expression group had significantly lower 1-, 3-, and 5-year survival rates than the low Spag6 expression group (71.5% vs 905%,437% vs 688%, 197% vs 487%, χ2=11.228, P=0.001). Cell assays showed significant reductions in the proliferation and migration of HCCLM3 cells after Spag6 gene silencing (both P<0.01). ConclusionSpag6 is highly expressed in hepatoma cells and liver cancer tissue, and its high expression is associated with poor clinicopathological features and postoperative survival of liver cancer. Spag6 can promote the proliferation and migration of hepatoma cells, suggesting that Spag6 may be involved in the development and progression of liver cancer. Therefore, it can be used as a reference index for predicting the prognosis of liver cancer patients and a potential target for liver cancer treatment. 

Original articles_Biliary diseases
Association of blood lipid levels with the risk of cholecystectomy and postoperative pain
Wang Qiang, Zhang XianYong, Yan XiaoLin
2017, 33(10): 1961-1965. DOI: 10.3969/j.issn.1001-5256.2017.10.022
Abstract:
Objective To investigate whether blood lipid control can delay the progression of asymptomatic gallstones and reduce the risk of cholecystectomy in patients with gallstones and hyperlipidemia, as well as the influence of hyperlipidemia on postoperative pain after cholecystectomy. Methods A total of 153 patients with asymptomatic gallstones and hyperlipidemia who underwent physical examination from February 2013 to February 2015 were enrolled and randomly divided into experimental group with 72 patients and control group with 81 patients. The patients in the experimental group were given blood lipid control via diet, exercise, and drugs, and according to fasting triglyceride ( TG) and total cholesterol ( TC) after 3 months, these patients were further divided into normal blood lipid group with 47 patients and abnormal blood lipid group with 25 patients. All the patients were followed up for 2 years with an interval of 3 months. The surgical indications for laparoscopic cholecystectomy were persistent pain in the gallbladder or more than 3 times of gallbladder discomfort within the past one month. A subgroup analysis was performed based on the number and size of gallstones to evaluate the risk of cholecystectomy. A numerical pain scale was used to assess the improvement in pain during hospitalization and at 3 and 6 months after surgery. The t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between three groups, and the Bonferroni test was used for further comparison between any two groups. The chi-square test was used for comparison of categorical data between groups. Results The normal blood lipid group had a significantly lower rate of cholecystectomy than the abnormal blood lipid group and the control group ( 23. 4% vs 68. 8%/70. 4%, χ2= 27. 72, P < 0. 01) . The patients in the normal blood lipid group had moderate pain during hospitalization, while those in the abnormal blood lipid group and the control group had severe pain, and there was a significant difference in pain score between the normal blood lipid group and the abnormal blood lipid group/control group ( P < 0. 05) . Among the patients with a single gallstone, multiple gallstones, ≥1 cm stones, or < 1 cm stones in the abnormal blood lipid group, 61% ( 11/18) , 86% ( 6/7) , 88% ( 7/8) , and 59% ( 10/17) underwent cholecystectomy, while in the normal blood lipid group, 21% ( 6/29) , 28% ( 5/18) , 35% ( 6/17) , and 17% ( 5/30) underwent cholecystectomy, and there were significant differences in the proportion of patients with different types of gallstones who underwent cholecystectomy between the two groups ( χ2= 7. 86, 6. 87, 6. 12, and 8. 77, all P < 0. 05) . Conclusion In patients with gallstones and hyperlipidemia, effective blood lipid control can significantly delay disease progression and reduce the risk of cholecystectomy for different types of gallstones and may alleviate postoperative pain.
Clinical effect of ultrasound-guided percutaneous abdominocentesis and catheter drainage in treatment of peritoneal effusion caused by bile leakage after hepatobiliary surgery
Gao ZhiLing, Xu Fei, Wu Fan, He Zheng
2017, 33(10): 1966-1968. DOI: 10.3969/j.issn.1001-5256.2017.10.023
Abstract:
Objective To investigate the clinical effect of ultrasound-guided percutaneous abdominocentesis and catheter drainage in the treatment of peritoneal effusion caused by bile leakage after hepatobiliary surgery. Methods A retrospective analysis was performed for the clinical data of 15 patients with peritoneal effusion caused by bile leakage after hepatobiliary surgery who underwent ultrasound-guided percutaneous abdominocentesis and catheter drainage in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2011 to September 2016. Results All the patients underwent ultrasound-guided abdominocentesis and catheter drainage once successfully, and there were no intraoperative or postoperative complications. All the patients were cured and discharged. Conclusion Ultrasound-guided percutaneous abdominocentesis and catheter drainage have a good clinical effect and high safety in the treatment of peritoneal effusion caused by bile leakage after hepatobiliary surgery and thus holds promise for clinical application.
Original articles_Pancreatic diseases
Effect of early controlled fluid resuscitation combined with traditional Chinese medicine treatment on the prognosis of severe acute pancreatitis
Huang Tao, Yao HongYan, Er QiDong, Liu ShuHang, Zhao Kai
2017, 33(10): 1969-1973. DOI: 10.3969/j.issn.1001-5256.2017.10.024
Abstract:
Objective To investigate the effect of early controlled fluid resuscitation combined with traditional Chinese medicine ( TCM) treatment on the prognosis of severe acute pancreatitis ( SAP) . Methods A retrospective analysis was performed for the clinical data of 48 patients with SAP who were treated in our hospital from July 2013 to August 2016, and according to the treatment modality, the patients were divided into early controlled fluid resuscitation-TCM treatment group ( treatment group with 26 patients) and conventional fluid therapy group ( control group with 22 patients) . The two groups were observed in terms of total liquid volume within 72 hours of treatment, urine volume, intra-abdominal pressure ( IAP) , mean arterial pressure ( MAP) , central venous pressure ( CVP) , and changes in heart rate and biochemical parameters, and the incidence of gastrointestinal dysfunction and related complications was evaluated. The continuous data, such as SAP severity score, clinical indices within 72 hours after admission, biochemical parameters before and after treatment, gastrointestinal dysfunction score, and IAP after treatment, were expressed as mean ± SD ( x ± s) , and the t-test was used for comparison of such data.The chi-square test was used for comparison of incidence rates of complications. Results Within 72 hours of treatment, both groups achieved the early treatment requirements for hematocrit ( HCT) , and the treatment group had significantly lower HCT than the control group ( t = 2. 188, P = 0. 034) . Compared with the control group, the treatment group had a significantly lower total liquid volume ( t = 7. 342, P< 0. 001) and a significantly greater improvement in heart rate ( t = 6. 315, P < 0. 001) . After treatment, the treatment group had significantly greater improvements in biochemical parameters including alanine aminotransferase, aspartate aminotransferase, total bilirubin, C-reactive protein, AMY, lipopolysaccharide, blood urea nitrogen, and creatinine compared with the control group ( t = 3. 420, 2. 170, 2. 700, 3. 330, 6. 960, 12. 590, 2. 400, and 2. 740, P = 0. 001, 0. 035, 0. 010, 0. 002, 0, 0, 0. 020, and 0. 009) . Both groups had a significant change in gastrointestinal dysfunction score after treatment ( both P < 0. 05) , and the treatment group had a significantly lower gastrointestinal dysfunction score than the control group ( t = 8. 063, P < 0. 001) . There was a significant difference in IAP after treatment between the two groups ( t = 2. 200, P = 0. 033) . The treatment group had a lower incidence rate of complications ( abdominal compartment syndrome, acute renal failure, acute respiratory distress syndrome, and multiple organ dysfunction syndrome) than the control group ( 15. 38% vs 50%) , and 1 patient in the control group experienced multiple organ dysfunction syndrome. Conclusion In patients with SAP, early controlled fluid resuscitation combined with TCM treatment can significantly improve gastrointestinal dysfunction, reduce the incidence of complications, and improve the prognosis of such patients.
Original articles_Others
Association between cerebral hemodynamic changes and neonatal hyperbilirubinemia
Liu ShuYan
2017, 33(10): 1974-1976. DOI: 10.3969/j.issn.1001-5256.2017.10.025
Abstract:

Objective To investigate the association between cerebral hemodynamic changes and neonatal hyperbilirubinemia. Methods A total of 67 neonates with hyperbilirubinemia who were admitted to our hospital from January 2014 to November 2015 were enrolled as study group, and another 36 normal healthy neonates were enrolled as control group. The two groups were compared in terms of end-diastolic velocity ( Vd) , systolic peak velocity ( Vs) , mean blood flow velocity ( Vm) , resistance index ( RI) , and pulsatility index ( PI) , and the serum level of bilirubin and systemic symptoms were observed after treatment. The t-test was used for comparison of continuous data between groups, and a Pearson correlation analysis was also performed. Results At the time of enrolment and on day 3 of treatment, the control group had significantly lower Vd, Vs, and Vm than the study group ( before treatment: t = 75. 873, 81. 589, 64. 600, 19. 834, 30. 453; day 3 of treatment: t = 39. 476, 55. 729, 35. 274, 6. 069, 9. 382, all P < 0. 001) . The study group had improvements in Vd, Vs, Vm, RI, and PI on day 3 of treatment. On day 5 of treatment, there were no significant differences in hemodynamic parameters between the two groups ( all P > 0. 05) . Serum level of bilirubin was positively correlated with Vd ( r = 0. 387, P < 0. 001) , Vs ( r = 0. 483, P < 0. 001) , and Vm ( r =0. 412, P < 0. 001) and negatively correlated with RI ( r =-0. 492, P < 0. 001) and PI ( r =-0. 497, P < 0. 001) . Conclusion Serum level of bilirubin interacts with cerebral hemodynamics, and cerebral hemodynamic parameters can provide objective evidence for evaluating disease progression and prognosis of neonatal hyperbilirubinemia.

Clinical effect of liver transplantation in the treatment of hepatolenticular degeneration
Mao JiaXi, Zou You, Guo WenYuan
2017, 33(10): 1977-1980. DOI: 10.3969/j.issn.1001-5256.2017.10.026
Abstract:

Objective To investigate the clinical effect of liver transplantation in the treatment of hepatolenticular degeneration ( HLD) and the prognosis of HLD patients. Methods A retrospective analysis was performed for the clinical data of 15 HLD patients who underwent liver transplantation in Changzheng Hospital of Second Military Medical University from June 2003 to January 2017. Friedman test of K related samples test was used for comparison of data between groups, and Wilcoxon one-sample test of 2 related samples test was used for comparison of data between two groups. Results Of all patients, 13 underwent standard orthotopic liver transplantation, and 2 underwent modified piggyback liver transplantation. One patient died of multiple organ failure during the perioperative period and 2 were lost to follow-up at half a year after surgery. Of all patients, one lived for 14 months, one lived for 5 years and 8 months, and the other ten patients were still alive up to now. Six patients suffered from acute rejection reaction ( AR) , among whom four were improved after conventional hormone pulse therapy, one was improved and discharged after antiviral therapy with ganciclovir for cytomegalovirus infection, and the other one patient was improved and discharged after the second liver transplantation at 5 months after surgery due to poor response to hormone pulse therapy and chronic rejection reaction. Ten patients had varying degrees of improvement in positive Kayser-Fleischer ring, and three patients achieved varying degrees of improvement in severe neuropsychiatric symptoms and had a basically normal neuropsychiatric state at half a year to one year after surgery.One patient died in the perioperative period, and the other 14 patients had a significant improvement in liver function at 1 month after surgery, and the level of ceruloplasmin gradually increased to a normal level. Conclusion Orthotopic liver transplantation can effectively improve copper metabolism, liver function, and neuropsychiatric symptoms in HLD patients and increase their quality of life and long-term survival rates.

Interaction between autophagy and lipid metabolism in cell models of nonalcoholic fatty liver disease
Yan Rong, Niu ChunYan, Yu Lu, Tian Yu
2017, 33(10): 1981-1986. DOI: 10.3969/j.issn.1001-5256.2017.10.027
Abstract:

Objective To investigate the interaction between autophagy and lipid metabolism in nonalcoholic fatty liver disease ( NAFLD) .Methods Human hepatocytes ( steatosis) were cultured in vitro to establish a cell model of NAFLD. Rapamycin was used to induce autophagy and 3-methyladenine was used to inhibit autophagy. MTT colorimetry was used to measure cell viability. ELISA was used to measure the levels of triglyceride ( TG) , alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , lactate dehydrogenase ( LDH) , gamma-glutamyl transpeptidase ( GGT) , and albumin ( Alb) . IF method was used to determine the location and distribution of LC3-II. Western blot was used to measure LC3-II/LC3-I ratio. An analysis of variance was used for comparison of continuous data between groups, and the SNK-q test was used for further comparison between two groups. Results Compared with the steatosis group, the induced autophagy group had significant reductions in absorbance and cell viability ( HL-7702 cells: q = 4. 160 and 4. 110, P < 0. 05; SK-HEP-1 cells: q = 4. 407 and 4. 032, P < 0. 05) . Compared with the control group, the steatosis group had significant increases in the levels of TG, ALT, AST, LDH, GGT, and Alb ( HL-7702 cells: q = 5. 316, 3. 730, 4. 013, 6. 967, 6. 192, and 5. 531, P < 0. 05; SK-HEP-1 cells: q = 4. 963, 3. 603, 4. 774, 7. 479, 6. 319, and 5. 193, P < 0. 05) . Compared with the steatosis group, the induced autophagy group had significant reductions in the levels of TG, ALT, AST, LDH, GGT, and Alb ( HL-7702 cells: q = 4. 978, 3. 695, 3. 960, 5. 130, 4. 695, and 3. 192, P < 0. 05; SK-HEP-1 cells: q = 3. 846, 5. 575, 4. 184, 5. 019, 4. 203, 3. 049, P < 0. 05) . The induced autophagy group had the highest percentage of LC3-II-positive HL-7702 cells ( 90. 1%) and LC3-II-positive SK-HEP-1 cells ( 80. 0%) , followed by the steatosis group ( 47. 2% LC3-II-positive HL-7702 cells and 48. 4% LC3-II-positive SK-HEP-1 cells) and the autophagy inhibition group ( 30. 2% LC3-II-positive HL-7702 cells and 45. 5% LC3-II-positive SK-HEP-1 cells) . The induced autophagy group had a significant increase in LC3-II/IC3-I ratio compared with the steatosis group ( HL-7702 cells: q = 6. 786, P < 0. 05;SK-HEP-1 cells: q = 5. 926, P < 0. 05) . Conclusion Upregulation of autophagy can promote the elimination of liver fat, while downregulation of autophagy can promote lipid accumulation.

Brief reports
Postoperative complications after laparoscopic distal pancreatectomy and related risk factors
Zheng Yi, Bai Xia, Xu Xin, Zhou MoWei
2017, 33(10): 1987-1989. DOI: 10.3969/j.issn.1001-5256.2017.10.028
Abstract:
Case reports
Chronic hepatitis B with bile duct hamartomas in the liver: a case report
Zhang QingShan, Zhao SuXian, Ren WeiGuang, Kong Li
2017, 33(10): 1990-1991. DOI: 10.3969/j.issn.1001-5256.2017.10.029
Abstract:
A case of hepatitis B cirrhosis with hepatic amyloidosis
Li Ling, Li XiaoYing, Cui ShiYu, Liu JinXia, Wang JingBo
2017, 33(10): 1992-1993. DOI: 10.3969/j.issn.1001-5256.2017.10.030
Abstract:
Chronic active EBV infection with histiocytic necrotizing lymphadenitis: a case report
Xu JunHui, Lu HaiYing, Yu YanYan
2017, 33(10): 1994-1996. DOI: 10.3969/j.issn.1001-5256.2017.10.031
Abstract:
Reviews
Research advances in predictive indices for antiviral effect in patients with chronic hepatitis B
Bao Teng, Tao Ben, Gao YuFeng
2017, 33(10): 1997-2000. DOI: 10.3969/j.issn.1001-5256.2017.10.032
Abstract:
Optimization of antiviral effect in patients with chronic hepatitis B has always been a hot topic of clinical research. In recent years, more and more studies have focused on the prediction of antiviral effect, including the values of HBs Ag, anti-HBc, covalently closed circular DNA, HBcr Ag, and HBV RNA quantitation in predicting antiviral effect. This article reviews the predictive values of these markers.
Advances in treatment of muscle cramp in liver cirrhosis
Zhao WenShan, You Hong, Zhao XinYan
2017, 33(10): 2001-2003. DOI: 10.3969/j.issn.1001-5256.2017.10.033
Abstract:
Muscle cramp is one of the common symptoms of patients with liver cirrhosis and significantly affects patients' quality of life. In general, the research on liver cirrhosis mainly focuses on the management and prevention of causes or common complications, and there are relatively few studies on the treatment of muscle cramp. Therefore, it is very important to find safe and effective therapeutic regimens. This article describes the pathogenesis and manifestations of muscle cramp in patients with liver cirrhosis, summarizes the therapeutic regimens with clinical value, including new drugs such as baclofen, L-carnitine, and taurine, and further elaborates on the protective effect of taurine against liver fibrosis via its activation of extracellular matrix and hepatic stellate cells, in order to provide new evidence for the treatment of muscle cramp in liver cirrhosis.
The mechanisms and impacts of obesity on the development of liver cancer
Shi PeiCen, Li Wei
2017, 33(10): 2004-2008. DOI: 10.3969/j.issn.1001-5256.2017.10.034
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Obesity has become a severe public health issue. Studies have shown that obesity is closely associated with metabolic disease and the development and progression of various tumors. This article summarizes the obesity-related factors in the development and progression of liver cancer, including adipokines ( such as leptin, insulin like growth factor-1, interleukin-6, tumor necrosis factor-α, and adiponectin) , insulin, insulin resistance, oxidative stress response, intestinal microecological disorders, and regulations of PNPLA3, miRNA, TM6 SF2, and JAZF1 genes. This article reviews the research advances in these mechanisms, in order to provide guidance for the prevention and treatment of liver cancer.
Route of metastasis of primary hepatic carcinoma from the perspective of anatomy
Wu HuiLi, Zheng SuJun, Duan ZhongPing
2017, 33(10): 2009-2015. DOI: 10.3969/j.issn.1001-5256.2017.10.035
Abstract:
Intrahepatic or extrahepatic metastasis of primary hepatic carcinoma ( PHC) often occurs via various routes, which leads to treatment failure or recurrence after treatment. Almost 90% of PHC patients die of metastasis. This article summarizes the common routes of PHC metastasis, including blood channel ( the portal vein and the hepatic vein) , lymphatic channel, biliary tract, direct invasion of adjacent organs, and implantation metastasis, and analyzes the basic features, clinical significance, and future research interests of each route of metastasis. It is pointed out that these routes are closely associated with anatomy.
Application of different scoring systems in evaluating prognosis after transarterial chemoembolization for primary liver cancer
Wang XiaoFang, Zhu LiYing, Lu BaoLing, Zhong LiHua, Cheng Yu, Fan Jian, Yao Hong, Yu Lei
2017, 33(10): 2016-2020. DOI: 10.3969/j.issn.1001-5256.2017.10.036
Abstract:
There are many treatment guidelines for primary liver cancer, among which Barcelona Clinic Liver Cancer ( BCLC) is commonly used as the reference for the treatment of liver cancer in the world; however, only BCLC stage B patients meet the indication for transarterial chemoembolization ( TACE) , which limits the clinical application of TACE. Therefore, several scoring systems for evaluating prognosis after TACE have been developed in recent years and provide an important reference for the treatment of primary liver cancer. This article introduces the application of scoring systems for evaluating prognosis after TACE and points out their advantages/disadvantages and performance, in order to provide a theoretical basis for the treatment of liver cancer.
Research advances in Huai'er granules combined with transarterial chemoembolization in treatment of hepatocellular carcinoma
Dong DeShuo, Liu ZhaoYu
2017, 33(10): 2021-2024. DOI: 10.3969/j.issn.1001-5256.2017.09.10.037
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Hepatocellular carcinoma ( HCC) has an insidious onset and when a confirmed diagnosis is made, most patients lose the chance for surgery and are given transarterial chemoembolization ( TACE) as palliative treatment. However, repeated TACE may lead to overexpression of hypoxia-inducible factor 1α ( HIF-1α) and vascular endothelial growth factor ( VEGF) , liver injury, and reduced immune function and has poor long-term efficacy. The introduction of Huai'er granules may help to change the current status. Studies in China and foreign countries have shown that Huai'er granules exert a remarkable anti-tumor effect by blocking cell cycle, inducing cell apoptosis, inhibiting cell proliferation and invasion, and blocking the hepatitis B-hepatocellular carcinoma pathway. Meanwhile, as an adjuvant drug for HCC, Huai'er granules cover the shortcomings of TACE from multiple aspects and can effectively inhibit the overexpression of HIF-1α and VEGF, improve liver injury and immunity, enhance the effect of chemotherapy drugs, and reverse drug resistance. Many clinical studies have confirmed the remarkable advantages of Huai' er granules combined with TACE, and their synergistic effect helps to enhance anti-tumor effect and improve short-and long-term survival rates.
Research advances in the diagnosis of nonalcoholic fatty liver disease in children
Li Jing, Qi LingLi, Wu Jie
2017, 33(10): 2025-2029. DOI: 10.3969/j.issn.1001-5256.2017.10.038
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Nonalcoholic fatty liver disease ( NAFLD) has become one of the most common chronic liver diseases in children. Since the clinical manifestations of NAFLD lack specificity, the diagnosis of this disease is mainly based on clinical symptoms and auxiliary examinations.Serum liver enzymes, blood lipid levels and homeostasis model assessment of insulin resistance are commonly used in clinical practice, and cytokeratin-18, triglyceride glucose index may become new markers for the diagnosis of NAFLD in children. Imaging examinations such as ultrasound, magnetic resonance imaging and computed tomography have their own limitations in the diagnosis of NAFLD in children, while controlled attenuation parameter and acoustic radiation force impulse may have a high value in future. The scoring systems for NAFLD need to be validated by clinical research. At present, liver biopsy remains the“gold standard”for the diagnosis of NAFLD in children. This article summarizes the latest research advances in NAFLD in children and discusses the diagnostic values of laboratory markers and imaging examinations.
Application of microwave ablation in treatment of solid space-occupying lesions in the liver
Du Lei, Hou LiChao, Zhang LingQiang, Wang HaiJiu, Fan HaiNing
2017, 33(10): 2030-2034. DOI: 10.3969/j.issn.1001-5256.2017.10.039
Abstract:
With the development of science and technology, many therapies for hepatic space-occupying lesions have emerged, such as surgical operation, chemotherapy, intervention, and biological therapy. In recent years, microwave technique for the treatment of hepatic space-occupying lesions has attracted more and more attention because of its small trauma, low expense, marked clinical effect, and few complications. This article reviews the advances in the application of microwave in the treatment of liver cancer, hepatic hemangioma, hepatic alveolar echinococcosis, and other benign hepatic space-occupying lesions.
Association between oxidative stress and pancreatic cancer
Li XiaoCheng, Tu JingKai, Gong JianPing
2017, 33(10): 2035-2038. DOI: 10.3969/j.issn.1001-5256.2017.10.040
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Pancreatic cancer ( PC) is often asymptomatic in the early stage and most patients have progressed to the advance stage at the time of diagnosis. At present, chemotherapy is mainly used in patients with advanced PC, but PC patients have poor response to chemotherapy, which brings great challenges to the treatment of PC. Oxidative stress-induced reactive oxygen species ( ROS) can cause damages in DNA, proteins, and lipids and produce the toxic and mutagenic metabolites that alter the biological behavior of tumor and transform the tumor into a malignant phenotype. Antioxidants have an antitumor effect and provide a basis for the design of anti-oxidative stress drugs for the treatment of PC. This article summarizes the research advances in the molecular pathways associated with oxidative stress and PC, in order to explore new ROS-targeted methods for the treatment of PC.
Conference overviews
Summary of the special meeting of The 17th Congress of Gastroenterology China
Guo XiaoZhong, Qi XingShun
2017, 33(10): 2039-2039. DOI: 10.3969/j.issn.1001-5256.2017.10.041
Abstract: