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

2019 Vol. 35, No. 10

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Editorial
The development history of new biomarkers for hepatitis B virus infection
Tang Hong
2019, 35(10): 2137-2139. DOI: 10.3969/j.issn.1001-5256.2019.10.001
Abstract:
The objective of antiviral therapy for chronic hepatitis B is to maximize the long-term inhibition of hepatitis B virus(HBV) replication,reduce hepatocyte inflammation and liver fibrosis,and delay and reduce liver failure,decompensated cirrhosis,hepatocellular carcinoma,and other complications. In addition to serum HBV DNA which has been used for a long time,new biomarkers such as intrahepatic HBV cccDNA,serum HBcrAg,serum HBV RNA,serum HBsAg,and serum anti-HBc are commonly used in recent years to evaluate antiviral response in clinical practice,and their clinical value has attracted more and more attention. Such biomarkers have important clinical significance in monitoring and evaluating antiviral response and predicting the risk of viral rebound after drug withdrawal and the risk of hepatocellular carcinoma.
Discussions by experts
Clinical application of covalently closed circular DNA detection techniques
Zhang Yu, Zhao JingMin
2019, 35(10): 2140-2144. DOI: 10.3969/j.issn.1001-5256.2019.10.002
Abstract:
Covalently closed circular DNA(cccDNA) is the original template for hepatitis B virus(HBV) replication and is the basis of persistent HBV infection. Only when HBV cccDNA is completely eliminated can HBV be eradicated. Therefore,the detection of HBV cccDNA plays an important role in evaluating the antiviral outcome of chronic hepatitis B,assessing HBV clearance,clarifying occult HBV infection,studying the pathogenesis of hepatitis B,and developing new drugs,and HBV cccDNA detection techniques with high sensitivity and specificity are the basis for clinical application. With reference to related reports in literature and our own research work,this article reviews the development and clinical application of HBV cccDNA detection methods in recent years.
Application value of serum HBV RNA in clinical management of chronic hepatitis B
Liao Hao, Wang Jie, Lu FengMin
2019, 35(10): 2145-2149. DOI: 10.3969/j.issn.1001-5256.2019.10.003
Abstract:
Viral hepatitis,liver cirrhosis,and hepatocellular carcinoma caused by hepatitis B virus(HBV) infection still threaten the health of people in China. Efficient antiviral therapy can significantly prevent the progression of liver diseases and reduce the incidence rate of end-stage liver disease,but it is very difficult to achieve clinical cure by current drugs,and nucleos(t) ide analogues may require long-term medication. New serological markers can be used for further optimization of antiviral regimens,among which serum HBV RNA is transcribed from covalently closed circular DNA(cccDNA) and is mainly derived from pregenomic RNA and its splice variants with no or partial reverse transcription. This article summarizes the sources and existing forms of serum HBV RNA,the influencing factors for serum HBV RNA level,the correlation between serum HBV RNA and other serum virological markers,and the correlation between serum HBV RNA and cccDNA in liver tissue,as well as the clinical significance of serum HBV RNA in monitoring antiviral efficacy and predicting the risk of viral rebound after drug withdrawal.
Serum HBsAg quantification in clinical diagnosis and treatment of chronic hepatitis B
Yu DeMin, Zhang XinXin
2019, 35(10): 2150-2155. DOI: 10.3969/j.issn.1001-5256.2019.10.004
Abstract:
HBsAg is one of the oldest diagnostic markers for HBV infection,and serum HBsAg level is associated with HBV cccDNA level in hepatocytes,HBV replication capability,and host immune response. In recent years,with the development of serum HBsAg quantification and the concept of functional cure,HBsAg quantification has been taken more and more seriously in the clinical diagnosis and treatment of HBV infection. This article analyzes the role of serum HBsAg quantification from the aspects of natural disease course of chronic hepatitis B,prediction of response to antiviral therapy,and prediction of drug withdrawal.
Clinical significance and application of quantification of hepatitis B core antibody
Yin XueRu, She GeXin, Hou JinLin, Fan Rong
2019, 35(10): 2156-2158. DOI: 10.3969/j.issn.1001-5256.2019.10.005
Abstract:
Hepatitis B virus(HBV) infection is a global public health problem. Hepatitis B core antibody(anti-HBc) is one of the serum immunological markers in human body after HBV infection. Previous studies have shown that the low serum level of anti-HBc in HBeAg-positive mothers are associated with immunoprophylaxis failure in infants. In addition,anti-HBc is an important biomarker associated with liver inflammatory activity and therapeutic outcome and can be used to evaluate liver inflammation and predict the efficacy of antiviral therapy and sustained response after drug withdrawal. Anti-HBc quantification provides a new direction for individualized treatment of hepatitis B patients.
Hepatitis B virus core-related antigen:A promising new serum marker for hepatitis B virus
Chen EnQiang, Tang Hong
2019, 35(10): 2159-2162. DOI: 10.3969/j.issn.1001-5256.2019.10.006
Abstract:
Hepatitis B virus core-related antigen(HBcrAg) is a new serum biomarker for hepatitis B virus(HBV) and is composed of several antigens encoded by the pre-C/C region gene of HBV,including HBcAg,HBeAg,and P22 cr precursor protein. There is a poor correlation between HBcrAg and HBsAg and they cannot replace each other. Serum HBcrAg level can reflect the content and transcriptional activity of cccDNA in hepatocytes of patients with chronic hepatitis B,as well as the transcriptional activity of integrated HBV DNA. In addition,HBcrAg can be used to evaluate the antiviral effect of nucleos(t) ide analogues and pegylated interferon-and predict recurrence risk after withdrawal of nucleos(t) ide analogues and the development risk and recurrence of hepatocellular carcinoma after surgery. Therefore,serum HBcrAg is a promising new serum marker for HBV.
Guidelines
Consensus on the diagnosis and therapy of hepatic fibrosis(2019)
Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association
2019, 35(10): 2163-2172. DOI: 10.3969/j.issn.1001-5256.2019.10.007
Abstract(1762) PDF (416KB)(1248)
Abstract:
Diagnosis and treatment standard for hepatitis C virus infection after organ transplantation(2019 edition)
Chinese Society of Organ Transplantation, Chinese Medical Association
2019, 35(10): 2173-2175. DOI: 10.3969/j.issn.1001-5256.2019.10.008
Abstract:
In order to further standardize the diagnosis and treatment of hepatitis C virus(HCV) infection after solid organ transplantation(SOT),Chinese Society of Organ Transplantation,Chinese Medical Association,organizes the experts in organ transplantation and infectious diseases to formulate this standard from the aspects of epidemiology and the diagnosis,prevention,and treatment of HCV infection after SOT,so as to standardize and optimize the diagnosis and treatment of HCV infection among the medical staff involved in organ transplantation.
Minimally-invasive and multidisciplinary comprehensive diagnosis and treatment for HCC: 2018 Guangzhou consensus
Asia-Pacific Association of Image-Guided Therapy of Oncology, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-Cancer Association, Asian Conference on Tumor Ablation 2017
2019, 35(10): 2176-2184. DOI: 10.3969/j.issn.1001-5256.2019.10.009
Abstract:

In China,the vast majority of hepatocellular carcinoma(HCC) is the result of long-term development of hepatitis B and cirrhosis. Pathologically,HCC is characterized by rich blood supply and multicenter origin,with early invasion of small branches of portal vein and intrahepatic metastasis. Therefore,HCC is not only a local organ but also a systemic disease at the beginning of its occurrence. For this reason,in clinical treatment of HCC a comprehensive treatment scheme should be adopted,including local treatment(such as surgical resection,radiofrequency ablation,microwave ablation,chemical ablation and cryoablation et al),organ-level therapy(such as transcatheter arterial infusion chemotherapy and transcatheter arterial chemoembolization),and systemic therapy(such as immunotherapy,antiviral therapy and molecular targeted therapy et al). This consensus sets forth the minimally-invasive and multidisciplinary comprehensive diagnosis and treatment of HCC,focusing on the following eight aspects:(1) hepatic arteriography,hepatic arteriography CT(CTHA),arterioportal angiography CT(CTAP),lipiodol CT(Lp-CT),TACE-CT,which are helpful in finding the lesion and making precise staging;(2)TACE/ablation should be used as the first choice of treatment for early stage or small HCC;(3) infiltrating HCC should be regarded as an independent type;(4) minimally-invasive comprehensive treatment of metastatic lymph nodes;(5) multi-level subdivision of M-staging used for guiding individual treatment and predicting prognosis;(6) HCC with severe hepatic decompensation is a candidate criterion for liver transplantation;(7) promotion of bio-immunotherapy,traditional Chinese medicine therapy,antiviral therapy and social psychotherapy,which should be run through all stages of treatment;(8) implementation of multicenter randomized controlled trials of minimally-invasive therapy and surgery for early and middle stage HCC is recommended.

An excerpt of 2019 WSES guidelines for the management of severe acute pancreatitis
Qin HuiYuan, Kong ZiHao, Yang GuiYuan
2019, 35(10): 2185-2190. DOI: 10.3969/j.issn.1001-5256.2019.10.010
Abstract:
An excerpt of AGA clinical practice update: Coagulation in cirrhosis (2019)
Hong Cen, Han JuQiang, Qi XingShun
2019, 35(10): 2191-2191. DOI: 10.3969/j.issn.1001-5256.2019.10.011
Abstract:
An excerpt of Perioperative hemostatic management in the cirrhotic patient: A position paper on behalf of the Liver Intensive Care Group of Europe (LICAGE) (2019)
He YangLan, Wang YaDong, Qi XingShun
2019, 35(10): 2192-2193. DOI: 10.3969/j.issn.1001-5256.2019.10.012
Abstract:
Original articles_Viral hepatitis
Influencing factors for compliance with antiviral therapy with nucleos(t) ide analogues in patients with chronic hepatitis B
Wu XiaoFeng, Li YuFang, Zhang Chi, Zhang LiLi, Ma Ying
2019, 35(10): 2194-2199. DOI: 10.3969/j.issn.1001-5256.2019.10.013
Abstract:
Objective To investigate the current status of compliance with antiviral therapy with nucleos(t) ide analogues(NAs) among chronic hepatitis B(CHB) patients treated in General Hospital of Ningxia Medical University. Methods The CHB patients who received antiviral therapy with NAs at the outpatient and inpatient services of Department of Infectious Diseases,General Hospital of Ningxia Medical University,from May to December,2017 were enrolled. A questionnaire survey was performed for demographics,family history of CHB,detailed doctor's advice,daily routines,physical exercise,compliance,awareness of the knowledge about hepatitis B,health belief,and social support,and the influence of various factors on compliance with NAs treatment was analyzed. The Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups,and the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was used to investigate the influencing factors for compliance with antiviral therapy with NAs among CHB patients. Results A total of 612 questionnaires were distributed,among which 600 were collected,with a questionnaire recovery rate of 98% and a valid rate of 100%. Among the 600 CHB patients,334(55. 67%) had good compliance with the antiviral therapy with NAs and 266(44. 33%) had poor compliance. Among the 266 CHB patients with poor compliance,56(21. 05%) did not follow the doctor's advice and took other drugs,206(77. 44%) sometimes forgot medication,187(70. 30%) sometimes did not pay attention to medication(time,dose,and frequency),135(50. 75%) reduced or stopped drugs after symptoms were improved,and 100(37. 59%) stopped the drugs due to symptom aggravation or appearance of other symptoms. The univariate analysis showed that 13 indices were the influencing factors for compliance with NAs treatment among CHB patients(all P < 0. 05). Amultivariate analysis was performed for these 13 indices and the results showed that race(odds ratio [OR]= 0. 218,95% confidence interval [CI]: 0. 076-0. 996,P = 0. 007),mode of medical payment(OR = 0. 772,95% CI: 0. 445-0. 919,P < 0. 001),physical exercise(OR = 2. 55,95% CI: 1. 472-6. 545,P = 0. 020),level of social support(OR = 0. 836,95% CI: 0. 649-0. 947,P < 0. 001),awareness of the outcome of incompliance(OR = 0. 577,95% CI: 0. 393-0. 886,P < 0. 001),and self-efficacy(OR = 0. 094,95% CI:0. 074-0. 328,P < 0. 001) were independent influencing factors for compliance with NAs treatment among CHB patients. Conclusion Compliance with antiviral therapy among CHB patients is closely associated with the mode of medical payment,psychological state,and self-management ability. Related measures,such as improvement of patients' ability to pay medical expenses,education on disease risk for patients,and reduction of social discrimination,can help to improve treatment compliance.
Influence of sofosbuvir-based antiviral therapy on the expression profile of cytokines and chemokines in patients with chronic hepatitis C
Gao Yi, Liang ZhiJun, Fu Jian
2019, 35(10): 2200-2204. DOI: 10.3969/j.issn.1001-5256.2019.10.014
Abstract:
Objective To investigate the influence of sofosbuvir-based antiviral therapy on the expression profile of cytokines and chemokines in patients with chronic hepatitis C. Methods A total of 37 previously untreated patients with chronic hepatitis C who visited Department of Infectious Diseases in Hainan Provincial People's Hospital from August 2018 to January 2019 were enrolled. The patients with HCV genotypes 1 b,3,and 6 were given oral sofosbuvir and velpatasvir tablets,while those with HCV genotype 2 a were given oral sofosbuvir combined with ribavirin. A total of 15 healthy individuals were enrolled as healthy controls. Multiple cytokine assay kits were used to measure the serum levels of 36 cytokines and chemokines. The expression profile of cytokines and chemokines at baseline were compared between chronic hepatitis C patients and healthy controls,and the changes in the expression of cytokines and chemokines were analyzed for chronic hepatitis C patients at 12 weeks of treatment. The t-test was used for comparison of normally distributed continuous data between the two groups,and a one-way analysis of variance was used for comparison between multiple groups,the Pearson correlation analysis was used to investigate correlation; the Mann-Whitney U rank sum 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 Spearman correlation analysis was used to investigate correlation. Results Compared with the healthy control group,the chronic hepatitis C group had significantly higher levels of interleukin-6(IL-6),interferon-inducible protein 10(IP-10),monocyte chemotactic protein-4(MCP-4),macrophage inflammatory protein-3α(MIP-3α),and vascular endothelial growth factor-A(VEGF-A)(Z = 2. 020,2. 368,2. 752,1. 976,and 2. 110,P= 0. 019,0. 049,0. 003,0. 024,and 0. 002) and a significantly lower level of interleukin-7(IL-7)(Z = 2. 778,P = 0. 048). There were no significant differences in the remaining 30 cytokines and chemokines between the healthy controls and the chronic hepatitis C patients(all P > 0. 05). The levels of cytokines and chemokines were not correlated with HCV RNA or alanine aminotransferase(all P > 0. 05). After 12 weeks of sofosbuvir-based antiviral therapy,there were significant reductions in the serum levels of IL-6,IP-10,MCP-4,and MIP-3α(all P < 0. 05),while there were no significant changes in IL-7 and VEGF-A after treatment(both P > 0. 05). Conclusion IL-6,IP-10,MCP-4,MIP-3α,and VEGF-A might be involved in HCV-mediated inflammatory response,and sofosbuvir-based antiviral therapy can effectively reduce the expression of IL-6,IP-10,MCP-4,and MIP-3α and inhibit liver inflammation.
Original articles_Liver fibrosis and liver cirrhosis
Influencing factors for hepatic venous pressure gradient in patients with cirrhotic portal hypertension
Zhou Hao, Yao Xin, Tang ShanHong, Feng ZhiSong, He PingPing, Yin QinQin, Li YunMing, Qin JianPing
2019, 35(10): 2205-2209. DOI: 10.3969/j.issn.1001-5256.2019.10.015
Abstract:
Objective To investigate the influencing factors for hepatic venous pressure gradient(HVPG) in patients with cirrhotic portal hypertension undergoing transjugular intrahepatic portosystemic shunt(TIPS). Methods A total of 158 patients with cirrhotic portal hypertension who underwent TIPS in The General Hospital of Western Theater Command of the Chinese PLA from January 2015 to December 2018 were enrolled. Wedged hepatic venous pressure(WHVP),free hepatic venous pressure(FHVP),and portal venous pressure(PVP) were measured during TIPS,and HVPG and portal venous pressure gradient(PVPG) were calculated. The t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups. The Pearson correlation coefficient was used to analyze the correlation between HVPG and PVPG,and a multivariate linear stepwise regression analysis was used to investigate the independent risk factors for HVPG. Results HVPG was positively correlated with PVPG(r = 0. 796,P < 0. 001). The one-way analysis of variance showed that age and etiology were influencing factors for HVPG(F = 19. 900 and 10. 287,both P < 0. 001). The multivariate linear stepwise regression analysis showed that age and etiology were independent influencing factors for HVPG(t = 7. 870 and-2. 178,both P < 0. 001). Conclusion Age and etiology are independent influencing factors for HVPG in patients with cirrhotic portal hypertension,and the patients aged ≥60 years or the patients with hepatitis C virus-related cirrhosis tend to have higher HVPG.
TCM syndrome characteristics of portal vein thrombosis in patients with liver cirrhosis and related risk factors
Lyu Jing, Dong SiSi, Gu HongTu, Zhao ZhangQing, Liu ChengHai
2019, 35(10): 2210-2213. DOI: 10.3969/j.issn.1001-5256.2019.10.016
Abstract:

Objective To investigate the traditional Chinese medicine(TCM) syndrome characteristics of portal vein thrombosis(PVT) in patients with liver cirrhosis and related risk factors. Methods A total of 62 patients with liver cirrhosis and PVT who were hospitalized in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2015 to March 2019 were enrolled as PVT group,and 66 liver cirrhosis patients without PVT were enrolled as non-PVT group. Related clinical data were compared between the two groups. The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between groups,the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups,and the unconditional multivariate logistic regression was used for multivariate analysis. Results The univariate analysis showed that there were significant differences between the PVT group and the non-PVT group in the etiology of liver cirrhosis(χ2= 12. 902,P = 0. 036),alanine aminotransferase(Z =-2. 571,P =0. 010),aspartate aminotransferase(Z =-2. 801,P = 0. 005),cholinesterase(t =-2. 579,P = 0. 011),fibrinogen degradation product(Z=-4. 410,P < 0. 001),D-dimer(Z =-4. 888,P < 0. 001),percentage of neutrophils(Z =-3. 124,P = 0. 002),internal diameter of the main portal vein(t = 2. 572,P = 0. 012),blood flow velocity of the portal vein(t =-2. 441,P = 0. 016),diameter of the splenic vein(t = 3. 175,P = 0. 002),spleen thickness(t = 4. 575,P < 0. 001),spleen length(Z =-4. 028,P < 0. 001),and volume of peritoneal effusion(t = 2. 273,P = 0. 025). The logistic regression analysis showed that D-dimer(odds ratio [OR]= 2. 078,95% confidence interval [CI]: 1. 293-3. 339,P = 0. 003) and spleen length(OR = 1. 964,95% CI: 1. 228-3. 142,P = 0. 005) were independent risk factors for PVT in patients with liver cirrhosis. Fatigue(100%),splenomegaly(74. 19%),abdominal distension(46. 77%),severe esophagogastric varices(48. 29%),history of variceal bleeding(40. 32%),light-reddish tongue(43. 55%),and stringy/thready pulse(96. 77%) were the main characteristics of patients with liver cirrhosis and PVT,which were consistent with the manifestations of Qi deficiency and blood stasis syndrome. Conclusion An increase in D-dimer level and a long spleen length are independent risk factors for PVT in patients with liver cirrhosis,and the syndrome characteristics of such patients are consistent with the manifestations of Qi deficiency and blood stasis syndrome.

Original articles_Liver neoplasms
Value of contrast-enhanced computed tomography and magnetic resonance imaging in diagnosis of residual or recurrent lesion after transcatheter arterial chemoembolization in hepatocellular carcinoma:A Meta-analysis
Li Dong, Luo TianYang, Ran YaWei
2019, 35(10): 2214-2219. DOI: 10.3969/j.issn.1001-5256.2019.10.017
Abstract:
Objective To systematically evaluate the value of contrast-enhanced computed tomography(CECT) and contrast-enhanced magnetic resonance imaging(CEMRI) in the diagnosis of residual or recurrent lesion after transcatheter arterial chemoembolization(TACE)in hepatocellular carcinoma(HCC). Methods Pub Med,Embase,Cochrane Library,Web of Science,CNKI,and Wanfang Data were searched for studies on CECT and/or CEMRI in the diagnosis of residual or recurrent lesion after TACE published up to April 2019. After two reviewers independently performed literature screening,data extraction,and assessment of the risk of bias using the QUADAS-2 tool,Stata 12. 0 and Rev Man 5. 3 were used to analyze pooled sensitivity,specificity,and area under the receiver operator characteristic curve(AUC). Results A total of 13 studies on CECT and 13 studies on CEMRI in the diagnosis of residual or recurrent HCC lesion after TACE were included,with 934 lesions from 748 patients and 847 lesions from 557 patients,respectively. High heterogeneity was observed in the 13 studies on CECT in the diagnosis of residual or recurrent HCC lesion after TACE(P = 0. 001,Q = 12. 56,I2= 84. 08%),while no significant heterogeneity was observed in the 13 studies on CEMRI(P = 0. 473,Q = 0. 11,I2= 0). In the diagnosis of residual or recurrent HCC lesion after TACE,CECT had a sensitivity of 72%(95% confidence interval [CI]: 66%-78%),a specificity of 99%(95% CI: 93%-100%),and an AUC of 0. 87(95% CI: 0. 83-0. 89),and CEMRI had a sensitivity of 88%(95% CI: 82%-93%),a specificity of 96%(95% CI: 91%-98%),and an AUC of 0. 98(95% CI: 0. 96-0. 99). CECT had a significantly lower sensitivity than CEMRI in the diagnosis of residual or recurrent HCC lesion after TACE(Z = 2. 12,P = 0. 03). Conclusion In comparison with CECT,CEMRI has an extremely higher diagnostic efficiency in the diagnosis of residual or recurrent HCC lesion after TACE and is thus an effective method for diagnosis.
Clinical effect of microwave ablation combined with transcatheter arterial chemoembolization in treatment of primary hepatocellular carcinoma with portal vein tumor thrombus and related influencing factors
Zhou ChuanLi, Tian ShiChao, Chen XiaoLi, Huang Jin, Zhang XianPing, Zhang XueYan, Xu YaJi
2019, 35(10): 2220-2224. DOI: 10.3969/j.issn.1001-5256.2019.10.018
Abstract:
Objective To investigate the clinical effect of microwave ablation(MWA) combined with transcatheter arterial chemoembolization(TACE) in the treatment of primary hepatocellular carcinoma(PHC) with portal vein tumor thrombus(PVTT) and related influencing factors. Methods A total of 92 patients with PHC and PVTT who were admitted to Chengdu Seventh People's Hospital from January 2016 to March 2018 were enrolled,among whom 47 patients treated with MWA combined with TACE were enrolled as combined treatment group and 45 treated with TACE alone were enrolled as control group. The two groups were compared in terms of short-term outcome,survival,incidence rates of adverse reactions and complications,and rates of complete response(CR),partial response(PR),stable disease(SD),and progressive disease(PD),as well as response rate(RR) at 3 months after surgery(RR = CR + PR). 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 Kaplan-Meier method was used for survival analysis,the log-rank test was used for univariate analysis of possible factors,and a Cox stepwise regression analysis was used for multivariate analysis. Results At 3 months after the treatment ended,there was a significant difference in RR between the combined treatment group and the control group(42. 2% vs 11. 9%,χ2= 8. 679,P < 0. 05). The adverse reactions such as pyrexia,nausea and vomiting,and liver area pain were observed in both groups. The combined treatment group had 1-,2-,and 3-year cumulative survival rates of 44. 7%,23. 4%,and 6. 4%,respectively,and the control group had 1-,2-,and 3-year cumulative survival rates of 22. 5%,8. 9%,and 0,respectively. The combined treatment group had a significantly longer median survival time than thecontrol group(10. 9 months vs 5. 1 months,χ2= 5. 749,P < 0. 05). Preoperative alpha-fetoprotein,number of tumors,tumor size,type of PVTT,Barcelona Clinic Liver Cancer(BCLC) stage,and Child-Pugh class were associated with the survival of the patients with PHC and PVTT(χ2= 9. 356,7. 641,11. 352,9. 764,8. 236,and 17. 392,all P < 0. 05). The multivariate analysis showed that tumor size(hazard ratio[HR]= 1. 997,95% confidence interval [CI]: 1. 608-3. 145,P < 0. 05),type of PVTT(HR = 1. 584,95% CI: 1. 306-2. 757,P< 0. 05),BCLC stage(HR = 1. 690,95% CI: 1. 035-2. 683,P < 0. 05) were independent influencing factors for survival. Conclusion MWA combined with TACE has good safety and efficacy in the treatment of patients with PHC and PVTT. Tumor size,type of PVTT,BCLC stage are the main influencing factors for prognosis.
Establishment and verification of a nomogram for predicting patient prognosis after hepatectomy for hepatocellular carcinoma
Zang YouYa, Long PeiYun, Han ZhiWei, Wang Huan, Ruan JingSheng, Huang Shan, Wu GuoBin, Chen Chuang
2019, 35(10): 2225-2230. DOI: 10.3969/j.issn.1001-5256.2019.10.019
Abstract:
Expression and clinical significance of ZNF580 mRNA in hepatocellular carcinoma: An analysis based on The Cancer Genome Atlas database
Mao Jun, Li RenLi, Li Hai, Xia ShiHai, Zhang WenCheng, Xiang XiaoHui
2019, 35(10): 2231-2235. DOI: 10.3969/j.issn.1001-5256.2019.10.020
Abstract:

Objective To establish and validate a nomogram for overall survival(OS) of patients after hepatectomy for hepatocellular carcinoma(HCC). Methods A retrospective analysis was performed for the clinical data of 1013 patients who underwent hepatectomy for HCC in The Affiliated Tumor Hospital of Guangxi Medical University from February 2004 to October 2013. These patients were randomly divided into training cohort with 710 patients and validation cohort with 303 patients. For the training cohort,the Cox proportional hazards model was used to determine independent risk factors and a nomogram was established to predict 1-,3-,and 5-year survival rates. The performance of this nomogram was evaluated by internal verification within the training cohort and external verification of the validation cohort,as well as C-index,receiver operating characteristic(ROC) curve,and calibration curve. The independent samples t-test was used for comparison of continuous variables between groups,and the chi-square test or the Fisher's exact test was used for comparison of categorical variables between groups. The Cox proportional hazards model was used for univariate and multivariate analyses. Results The 1-,3-,and 5-year OS rates in the training cohort were 0. 72,0. 48,and 0. 34,respectively,and those in the validation cohort were 0. 66,0. 45,0. 32,respectively. The univariate and multivariate analyses showed that age,number of tumors,tumor diameter,tumor capsule,vascular invasion,microsatellite lesion,aspartate aminotransferase(AST),and alpha-fetoprotein(AFP) were the influencing factors for OS in patients after hepatectomy for HCC(all P < 0. 05),and such factors were used to establish a nomogram model. In the training cohort,the C-index for predicting OS was 0. 748(95% confidence interval [CI]: 0. 712-0. 784); the calibration curve of 1-,3-,and 5-year survival rates showed that the predicted value of the nomogram was in good consistency with the actual values observed; this nomogram model had an area under the ROC curve of 0. 81(95% CI: 0. 76-0. 87),0. 82(95% CI: 0. 77-0. 88),and 0. 79(95% CI: 0. 71-0. 88),respectively,in predicting the 1-,3-,and 5-year survival rates. In the validation cohort,the C-index was 0. 712(95% CI: 0. 685-0. 739); the calibration curve of 1-,3-,and 5-year survival rates showed that the predicted value of the nomogram was in good consistency with the actual values observed; this nomogram model had an area under the ROC curve of 0. 75(95% CI: 0. 71-0. 79),0. 77(95%CI: 0. 73-0. 81),and 0. 74(95% CI: 0. 68-0. 80),respectively,in predicting the 1-,3-,and 5-year survival rates. Conclusion The nomogram established in this study can effectively predict OS in patients after hepatectomy for HCC.

Original articles_Biliary diseases
Value of serum carbohydrate antigeng 19-9 combined with procalcitonin in the diagnosis of acute cholangitis secondary to common bile duct stones
Wu Di, Lu ZhongYi, Tang ZhongLing, He XueYan, Wang Jun
2019, 35(10): 2236-2239. DOI: 10.3969/j.issn.1001-5256.2019.10.021
Abstract:
Objective To investigate the value of serum carbohydrate antigen 19-9(CA19-9) combined with procalcitonin(PCT) in the diagnosis of acute cholangitis secondary to common bile duct stones. Methods A retrospective analysis was performed for the clinical data of764 patients with common bile duct stones who were admitted to The Third Affiliated Hospital of Zunyi Medical University from June 2012 to June 2018,and according to the presence or absence of acute cholangitis,they were divided into cholangitis group with 173 patients and non-cholangitis group with 591 patients. 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. Receiver operating characteristic(ROC) curves were plotted for statistically different indices to calculate the cut-off value,sensitivity,and specificity of each index. Results Compared with the non-cholangitis group,the cholangitis group had significantly higher levels of C-reactive protein(CRP)(78. 24 ± 8. 02 mg/L vs 30. 14 ± 4. 25 mg/L,t =3. 730,P = 0. 038),PCT(2. 25 ± 0. 21 ng/ml vs 0. 21 ± 0. 06 ng/ml,t = 9. 297,P < 0. 001),and CA19-9(87. 52 ± 7. 95 kU/L vs24. 15 ± 3. 87 kU/L,t = 26. 35,P < 0. 001). Serum PCT had an area under the ROC curve(AUC) of 0. 907,a sensitivity of 82. 4%,and a specificity of 86. 1%,serum CA19-9 had an AUC of 0. 825,a sensitivity of 85. 2%,and a specificity of 80. 5%,and serum CRP had an AUC of 0. 643,a sensitivity of 69. 2%,and a specificity of 54. 3%; CRP had no diagnostic value due to an AUC of < 0. 7. Serum PCT combined with CA19-9 had a sensitivity of 97. 11%,a specificity of 98. 65%,a false negative rate of 2. 89%,and a false positive rate of1. 35%. Conclusion Both serum CA19-9 and PCT have an important value in predicting acute cholangitis secondary to common bile duct stones,and combined measurement of serum CA19-9 and PCT has significant increases in specificity and sensitivity and can thus be used as a predictive indicator for acute cholangitis.
Original articles_Pancreatic diseases
Clinical and prognostic features of children with acute pancreatitis:A retrospective analysis of 105 cases
Zhong Rui, Xu Huan, Peng Yan, Yan YongFeng, Jiang Xin, Wang Min, Fu WenGuang, Tang XiaoWei
2019, 35(10): 2240-2245. DOI: 10.3969/j.issn.1001-5256.2019.10.022
Abstract:
Objective To investigate the etiology and clinical features of acute pancreatitis(AP) in children. Methods A total of 105 children with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January 2013 to December 2018 were enrolled,and according to the severity of AP,they were divided into mild acute pancreatitis(MAP) group with 77 children,moderate-severe acute pancreatitis(MSAP) group with 25 children,and severe acute pancreatitis(SAP) group with 3 children,and a comparative analysis was performed for the MAP group and the MSAP group. According to age,the children were divided into young age group with 36 children aged 2-9 years and old age group with 69 children aged 10-17 years,and according to the presence or absence of recurrence,they were divided into recurrence group with 17 children and non-recurrence group with 88 children; a comparative analysis was also performed. A total of 105 adults with incipient AP were randomly selected from databases and were enrolled as control group,and the groups were compared in terms of general data,etiology,laboratory markers,disease severity,complications,and treatment outcome. The t-test was used for comparison of normally distributed continuous data between groups,and the corrected t-test was used in case of heterogeneity of variance; the Mann-Whitney U test was used for comparison of non-normally distributed data and ranked data between groups; the chi-square test was used for comparison of categorical data between groups; the trend chi-square test was used for unidirectional ordered categorical variables,and a Goodman-Kruskal Gamma analysis was used for bidirectional ordered categorical variables; the Kaplan-Meier method and the log-rank test were used for the comparison of cumulative risk. Results As for etiology,among the 105 children with AP,31(29. 5%) had idiopathic AP,27(25. 7%) had biliary AP,20(19. 0%) had trauma,11(10. 5%) had hyperlipidemic AP,10(9. 5%) had viral infection,and 6(5. 7%) had drug-induced AP,and there was a significant difference in the constituent ratio of etiology between the pediatric patients and the adult patients(χ2= 99. 282,P < 0. 001). Compared with the adult patients,the pediatric patients had significantly lower severity(Z =-2. 325,P < 0. 02) and proportion of individuals with pancreatic necrosis(3. 8% vs 12. 4%,χ2=5. 184,P < 0. 023). Compared with the MSAP group at 24 hours after admission,the MAP group had significantly lower C-reactive protein,blood lipase,white blood cell count,and blood glucose(Z =-6. 406,-3. 096,and-2. 762,t = 3. 298,all P < 0. 05) and a significantly higher blood calcium level(t = 3. 43,P = 0. 001). During follow-up,17 children(16. 2%) developed AP again,and the recurrence rate increased with an increase in disease severity(χ2= 6. 503,P = 0. 011). Recurrent AP was often observed in girls(82. 4%)(χ2= 12. 241,P < 0. 001),and the children with first-onset AP and pancreatic necrosis had a higher recurrence rate(χ2= 6. 572,P =0. 01). Hyperlipidemia was the most common cause of acute recurrent pancreatitis(ARP) in children(χ2= 5. 533,P = 0. 019),and hyperlipidemic AP had the highest risk of recurrence over time,while viral and drug-induced AP had the lowest risk of recurrence(P =0. 028). Conclusion Idiopathic and biliary AP are the main causes of AP in children,and compared with adults,children tend to have milder disease conditions and a better prognosis. Female sex and first-onset AP with pancreatic necrosis and hyperlipidemia are high-risk factors for ARP.
Value of contrast-enhanced endoscopic ultrasonography in the differential diagnosis of mass-type chronic pancreatitis and pancreatic cancer:A Meta-analysis
Wang Le, Liu LiXin, Guo XiaoHong
2019, 35(10): 2246-2251. DOI: 10.3969/j.issn.1001-5256.2019.10.023
Abstract:
Objective To systematically evaluate the value of contrast-enhanced endoscopic ultrasonography(CE-EUS) in the differential diagnosis of mass-type chronic pancreatitis and pancreatic cancer. Methods CNKI,Wanfang Data,CBM,PubMed,Embase,and the Cochrane Library were searched for Chinese and English articles on the value of CE-EUC in the differential diagnosis of mass-type chronic pancreatitis and pancreatic cancer published up to December 31,2018. Secondary screening,scoring,and data extraction were performed,and then Meta-Disc1. 4 and stata12. 0 software were used for meta-analysis. Results A total of 20 articles with 1888 patients were included in this study. The meta-analysis showed that in the differential diagnosis of mass-type chronic pancreatitis and pancreatic cancer,CE-EUS had a pooled sensitivity of 86%(95% confidence interval [CI]: 83%-89%),a specificity of 93%(95% CI: 92%-95%),a positive likelihood ratio of 12. 01(95% CI: 9. 72-14. 85),a negative likelihood ratio of 0. 16(95% CI: 0. 10-0. 26),a diagnostic odds ratio of 76. 12(95% CI: 54. 50-106. 31),and an area under the summary receiver operating characteristic curve of 0. 965 5. No sources of heterogeneity were found in the threshold effect test,the meta-regression analysis,and the sensitivity analysis. After the four articles causing heterogeneity were excluded,the heterogeneity of all included articles was reduced to an acceptable range,and there were no significant changes in the results of the meta-analysis. Conclusion CE-EUS has a good value in the differential diagnosis of mass-type chronic pancreatitis and pancreatic cancer,and its application in clinical practice can improve the diagnostic rate of pancreatic cancer.
Original articles_Others
Effect of the liver-regulating and spleen-strengthening method on the expression of Toll-like receptor 4 and occludin in the intestinal mucosa of rats with nonalcoholic fatty liver disease
Chen RuiLin, Shen QingYan, Niu KeMin, Yang ZhongTing, Yin XiuWen, Li Xue, Zhou Tao, Chen Jing, Wei BeiHai
2019, 35(10): 2252-2256. DOI: 10.3969/j.issn.1001-5256.2019.10.024
Abstract:

Objective To investigate the effect of the liver-regulating and spleen-strengthening method on the expression of Toll-like receptor 4(TLR4) and occludin in the intestinal mucosal barrier of rats with nonalcoholic fatty liver disease(NAFLD) induced by high-fat and high-sugar diet. Methods A total of 50 male Sprague-Dawley rats were randomly divided into normal group,model group,liver-regulating and spleen-strengthening group,liver-regulating group,and spleen-strengthening group. A rat model of nonalcoholic steatohepatitis was established by high-fat and high-sugar diet for four weeks. The five groups were observed in terms of the degree of hepatic steatosis,the change in liver function,and the expression of the tight junction protein occludin in the intestinal mucosa and TLR4 in the intestinal epithelium. A one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups. Results Compared with the normal group,the model group showed hepatic steatosis and had significant increases in the serum levels of alanine aminotransferase(ALT) and aspartate aminotransferase(AST)(P<0. 05),as well as a reduction in the expression of the tight junction protein occludin in intestinal epithelial cells and an increase in the expression of TLR4 in the intestinal epithelium. Compared with the model group,the three treatment groups had a significant reduction in the degree of steatosis,a significant increase in the expression of occludin,and a significant reduction in the expression of TLR4 in the intestinal epithelium. Among the three treatment groups,the liver-regulating and spleen-strengthening group had the lowest degree of steatosis and significantly greater reductions in the serum levels of ALT and AST than the model group(P < 0. 05),as well as significantly greater changes in the expression of occludin and TLR4. Conclusion The liver-regulating and spleen-strengthening method can improve intestinal mucosal barrier function by increasing the expression of the tight junction protein occludin in intestinal epithelial cells and reducing the expressionof TLR4 in the intestine,with a better clinical effect than the liver-regulating method or the spleen-strengthening method alone.

Effect on JNK1 gene silencing on the expression of high-molecular-weight adiponectin in mice with nonalcoholic fatty liver disease
Zhao XiaoFang, Tang YouMing, Xu XinJie, Tang YanFang, Liu XuDong, Lu: Ping, Zhao ZhuangZhi
2019, 35(10): 2257-2260. DOI: 10.3969/j.issn.1001-5256.2019.10.025
Abstract:

Objective To investigate the effect of JNK1 gene silencing on the expression of high-molecular-weight adiponectin and related pathway molecules in adipose tissue of mice with nonalcoholic fatty liver disease(NAFLD). Methods A total of 20 C57 BL/6 mice were randomly divided into normal group,model control group,NAFLD group treated with shRNA-JNK1 lentivirus(JNK1 + NAF group),and NAFLD group treated with unrelated-sequence shRNA lentivirus(unrelated sequence + NAF group),with 5 mice in each group. Normal diet and high-fat diet were given for 3 months,and a mouse model of NAFLD was successfully established. The mice with NAFLD were given tail vein injection of shRNA-JNK1 lentivirus with the optimal interfering effect and unrelated-sequence shRNA lentivirus. After 5 days of feeding based on diet and lentivirus injection,HE staining was used to observe the pathological changes of liver tissue. ELISA was used to measure the serum level of high-molecular-weight adiponectin. Western blot was used to measure the expression of AMP-activated protein kinase(AMPK),phosphorylated AMPK(p-AMPK),high-molecular-weight adiponectin,and disulfide-bond-A oxidoreductase-like protein(DsbA-L) in epididymal fat pad. A one-way analysis of variance was used for comparison of continuous data between groups,and the least significant difference t-test was used for further comparison between two groups. Results HE staining showed that compared with the model control group,the JNK1 + NAF group had significant reductions in lipid droplet vacuoles,edema,and inflammation. The JNK1 + NAF group had a significantly lower liver steatosis score than the model control group and the unrelated sequence + NAF group(2. 267 ± 0. 704 vs 3. 800 ± 0. 414/3. 667 ± 0. 617,both P < 0. 05). ELISA showed that the JNK1 + NAF group had a significantly higher serum level of high-molecular-weight adiponectin than the model control group(294. 71 ± 102. 30 ng/ml vs 124. 06 ± 70. 58 ng/ml,P<0. 001). Western Blot showed that the JNK1 + NAF group had significantly higher expression levels of AMPK,p-AMPK,DsbA-L,andhigh-molecular-weight adiponectin than the model control group and the unrelated sequence + NAF group(all P < 0. 05). Conclusion JNK1 gene silencing can promote the expression of Dsb A-L and high-molecular-weight adiponectin in NAFLD mice,activate the AMPK pathway to regulate adiponectin multimerization,and thus improve fat deposition in NAFLD.

Effect of rapamycin on the expression of autophagy-related proteins Unc-51 like autophagy activating kinase 1 and microtubule-associated protein 1 light chain 3 in hepatic ischemia-reperfusion injury and its significance
Yang LongCan, Zhang XuYang, Pan NingBo, Yu Xi, Li JiWei, Zhang Ying
2019, 35(10): 2261-2265. DOI: 10.3969/j.issn.1001-5256.2019.10.026
Abstract:

Objective To investigate the effect of rapamycin on the expression of the autophagy-related proteins Unc-51 like autophagy activating kinase 1(ULK1) and microtubule-associated protein 1 light chain 3(LC3) in hepatic ischemia-reperfusion injury and its significance. Methods A total of 30 rats were divided into experimental group,control group,and sham-operation group,with 10 rats in each group,and a rat model of hepatic ischemia-reperfusion injury was established. Samples were collected at 24 and 72 hours after surgery,and serum levels of alanine aminotransferase(ALT) and aspartate aminotransferase(AST),liver pathology,and mRNA and protein expression of ULK1 and LC3 were measured. 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 There were increases in the serum levels of ALT and AST and liver pathological structural damage at 24 hours after surgery(F = 1531. 83 and 1799. 97,P < 0. 05),and compared with the control group,the experimental group had significant reductions in the serum levels of ALT(354. 58 ± 28. 40 U/L vs 556. 15 ± 19. 32 U/L,P < 0. 05) and AST(384. 37 ± 8. 98 U/L vs 575. 96 ± 30. 21 U/L,P < 0. 05) and alleviation of liver pathological structural damage. At 72 hours after surgery,the experimental group had significantly lower serum levels of ALT and AST than the control group(ALT: 271. 81 ±8. 63 U/L vs 466. 33 ± 30. 00 U/L,P < 0. 05; AST: 358. 92 ± 13. 20 U/L vs 497. 05 ± 40. 14 U/L,P < 0. 05). Both the experimental group and the control group had significant reductions in the serum levels of ALT and AST from 24 to 72 hours after surgery(ALT: t = 8. 87、7. 92,AST: t = 5. 04、5. 34,both P < 0. 05). At 24 hours after surgery,the experimental group and the control group had significant increases in the mRNA and protein expression of ULK1 and LC3 compared with the sham-operation group(all P < 0. 05),and compared with the control group,the rapamycin intervention group had significant increases in the mRNA and protein expression of ULK1 and LC3(ULK1 mRNA: 13. 23 ± 6. 58 vs 4. 91 ± 1. 64,P < 0. 05; LC3 mRNA: 7. 82 ± 1. 65 vs 3. 70 ± 1. 10,P < 0. 05; ULK1 protein: 1. 62 ± 0. 19 vs 1. 17± 0. 33,P < 0. 05; LC3 protein: 1. 62 ± 0. 19 vs 0. 84 ± 0. 10,P < 0. 05). Compared with the control group at 72 hours after surgery,the rapamycin intervention group had significant increases in the mRNA and protein expression of ULK1 and LC3(ULK1 mRNA: 10. 58 ± 3. 31 vs 4. 83 ± 2. 66,P < 0. 05; LC3 mRNA: 6. 42 ± 1. 13 vs 2. 71 ± 0. 81,P < 0. 05; ULK1 protein: 1. 29 ± 0. 24 vs 0. 90 ± 0. 29,P < 0. 05;LC3 protein: 1. 40 ± 0. 73 vs 0. 64 ± 0. 08,P < 0. 05). There were significant reductions in the serum levels of ALT and AST from 24 to 72 hours after hepatic ischemia-reperfusion injury,with alleviation of liver pathological structural damage and reductions in the mRNA and protein expression of ULK1 and LC3(all P < 0. 05). Conclusion There are increases in the expression of ULK1 and LC3 after hepatic ischemia-reperfusion injury,and rapamycin may exert a protective effect on liver function by upregulating autophagy during liver ischemia-reperfusion injury.

Efficacy and safety of norepinephrine combined with albumin versus terlipressin combined with albumin in treatment of type 1 hepatorenal syndrome:A Meta-analysis
Tan YanXin, Long FuLi, Mao DeWen, Zhang JianLing, Ma YuZhen, Yan LianJie
2019, 35(10): 2266-2271. DOI: 10.3969/j.issn.1001-5256.2019.10.027
Abstract:

Objective To systematically review the efficacy and safety of norepinephrine combined with albumin versus terlipressin combined with albumin in the treatment of type 1 hepatorenal syndrome(HRS1). Methods Pub Med,EMBASE,Medline,Cochrane Library,CNKI,Wanfang Data,and VIP were searched for comparative studies on norepinephrine combined with albumin versus terlipressin combined with albumin in the treatment of HRS1. Quality assessment was performed for articles. Related indicators were extracted,including hepatorenal syndrome(HRS) reversal rate,mortality rate,incidence of adverse events,mean arterial pressure,and renal function,and Review Manager 5. 3 was used for data analysis. The chi-square test was used to determine the heterogeneity between studies. Odds ratio(OR) was used for the analysis of dichotomous variables,weighted mean difference(WMD) was used for the analysis of continuous variables,and 95% confidence interval(CI) was calculated for these two types of variables. Results A total of 6 randomized controlled trials which met the inclusion criteria were included,with a total sample size of 298 patients(149 patients in the norepinephrine + albumin group and 149 in the terlipressin + albumin group). The meta-analysis showed that there were no significant differences between the two groups in HRS reversal rate(OR = 0. 95,95% CI: 0. 6-1. 49,P = 0. 81),mortality rate(OR = 0. 84,95% CI: 0. 51-1. 41,P = 0. 51),incidence rate of adverse events(OR =0. 42,95% CI: 0. 16-1. 07,P = 0. 07),mean arterial pressure(standardized mean difference = 0. 05,95% CI:-0. 92 to 1. 03,P = 0. 92),and renal function. Conclusion Norepinephrine combined with albumin has similar efficacy and safety as terlipressin combined with albumin in the treatment of HRS1,and terlipressin can be replaced by norepinephrine in clinical practice when necessary.

A bioinformatics analysis of differentially expressed genes in Huh7 cells with low expression of Mindin
Zhang Xin, Wang MuQi, Wang WenJun, Li YaPing, Shi JuanJuan, Li Mei, Jia XiaoLi, Dang ShuangSuo
2019, 35(10): 2272-2277. DOI: 10.3969/j.issn.1001-5256.2019.10.028
Abstract:

Objective To perform a transcriptomic study of Huh7 cells with low expression of Mindin,and to investigate the biological effects of Mindin. Methods The Mindin interference sequence was designed,synthesized,and introduced into Huh7 cells via the lentiviral vector GV248. Real-time quantitative PCR was used to measure the inhibitory effect on Mindin transcription level. Huh7 cells with low expression of Mindin were obtained and a transcriptomic study was performed for such cells and their control cells. Bioinformatics was used to analyze abnormally expressed genes,and pathway analysis was used to investigate the possible biological functions involving Mindin. The t-test was used for comparison of continuous data between groups. Results Compared with the control cells,Huh7 cells transfected with the lentivirus containing interference sequence had a knockdown efficiency of Mindin mRNA of 63. 8%(P = 0. 003). Huh7 cells with stable low expression of Mindin had a significantly higher cell migration rate than the control cells(3. 511 ± 0. 538 vs 1. 701 ± 0. 765,t =-3. 355,P = 0. 03). Compared with the control cells,Huh7 cells with low expression of Mindin had 2888 upregulated genes and 2516 downregulated genes. Gene ontology analysis and pathway analysis were performed for 895 differentially expressed genes with | log2 FC | > 2. 0 and P<0. 05. The pathway analysis showed that the top 10 biological functions involving Mindin were tumor signaling pathway,chemokine signaling pathway,systemic lupus erythematosus,glycerophospholipid metabolism,neuroactive ligand-receptor interaction,hypertrophic cardiomyopathy,glycerolipid metabolism,MAPK signaling pathway,complement and coagulation cascades,and basal cell carcinoma. Conclusion Huh7 cells with low expression of Mindin are successfully constructed. Mindin has wide biological functions including tumors,chemokines,and lipid metabolism.

Efficacy and safety of different surgical procedures in treatment of primary splenic hydatid cysts
Talaiti·Tuergan, Zhang RuiQing, Shao YingMei, Ran Bo, Jiang TieMin, Tuerganaili·Aji
2019, 35(10): 2278-2280. DOI: 10.3969/j.issn.1001-5256.2019.10.029
Abstract:

Objective To investigate the safety and efficacy of splenectomy versus spleen-preservation surgery(endocystectomy or subtotal pericystectomy) in the treatment of primary splenic hydatid cysts,and to determine the optimal surgical procedure for this disease. Methods A retrospective analysis was performed for the clinical and pathological data of 29 patients with primary splenic hydatid cysts who were admitted to The First Affiliated Hospital of Xinjiang Medical University from April 2002 to June 2017 and underwent surgical treatment. According to the surgical procedure,the patients were divided into group A(splenectomy) and group B(endocystectomy or subtotal pericystectomy).The two groups were compared in terms of time of operation,intraoperative blood loss,time to first flatus after surgery,catheter indwelling time after surgery,length of postoperative hospital stay,hospital costs,residual complications,and recurrence. The t-test was used for comparison of continuous data between the two groups,and the chi-square test was used for comparison of categorical data between the two groups. Results Compared with group B,group A had a significantly longer time of operation(167. 50 ± 41. 85 min vs 125. 84 ± 28. 88 min,t = 3. 41,P = 0. 002) and a significantly higher intraoperative blood loss(189. 00 ± 50. 65 ml vs 113. 16 ± 59. 73 ml,t = 3. 15,P =0. 004). Group A had significantly longer catheter indwelling time after surgery and length of postoperative hospital stay than group B(catheter indwelling time: 5. 00 ± 2. 36 d vs 3. 16 ± 1. 34 d,t = 2. 70,P = 0. 012; length of postoperative hospital stay: 7. 90 ± 1. 91 d vs 5. 47 ±1. 61 d,t = 3. 42,P = 0. 004). There were no significant differences between the two groups in time to first flatus after surgery,hospital costs,and incidence rate of residual cavity effusion(all P > 0. 05). Conclusion Spleen-preserving surgery(endocystectomy and subtotal pericystectomy) is safer and more effective than splenectomy in the treatment of primary splenic hydatid cysts.

Clinical effect of robotic versus laparoscopic splenectomy in treatment of nontraumatic splenic diseases:A Meta-analysis
Lai Li, Peng FangYi, Su Song, Fang Cheng, Zhang MengYu, He Kai, Li Bo, He Pan, Xia XianMing
2019, 35(10): 2281-2285. DOI: 10.3969/j.issn.1001-5256.2019.10.030
Abstract:

Objective To investigate the clinical effect and safety of robotic versus laparoscopic splenectomy in the treatment of nontraumatic splenic diseases. Methods According to the inclusion and exclusion criteria,PubMed,Web of Science,Embase,Cochrane Library,CBM,CNKI,Wanfang Data,and VIP were systematically searched for Chinese and English articles on the comparison of robotic splenectomy and laparoscopic splenectomy in the treatment of nontraumatic splenic diseases published up to March 2019. After quality assessment was performed for the articles included,RevMan 5. 0 provided by Cochrane Library was used for analysis. Mean difference(MD) and rate difference(RD) were used as the effect indicators for continuous variables and binary variables,and pooled value and 95% confidence interval(CI) were calculated. Results A total of 7 studies with 374 patients were included,with 160 patients in the robotic splenectomy group and214 in the laparoscopic splenectomy group. The results of the meta-analysis showed that compared with laparoscopic splenectomy,robotic splenectomy had significantly lower intraoperative blood loss(MD =-127. 14,95% CI:-199. 87 to 54. 42,P < 0. 01),rate of conversion to laparotomy(RD =-0. 06,95% CI:-0. 11 to 0. 01,P = 0. 02),and rate of postoperative complications(RD =-0. 10,95% CI:-0.20 to 0. 01,P = 0. 04). There were no significant differences in time of operation and length of hospital stay between the two surgical procedures(both P > 0. 05). Conclusion Based on current evidence,robotic splenectomy has better clinical effect and safety than laparoscopic splenectomy in some aspects in the treatment of nontraumatic splenic diseases,and more multicenter large-sample randomized controlled trials are needed in the future for verification.

Brief reports
Diagnosis and treatment of intrahepatic biliary papillary mucinous cystadenoma:A report of 6 cases
Chen JiaJun, Zhang HaiYang, Cao XueDong, Qu Yan, Luo YunQuan
2019, 35(10): 2286-2288. DOI: 10.3969/j.issn.1001-5256.2019.10.031
Abstract:
Case reports
A case of recurrent fever and lumbago in hepatic cirrhosis complicated by spontaneous bacterial peritonitis
Xue ShuWen, Zhao QianShu, Li XiaoKe, Yang QianQian, Zhou Qi, Guo XiaoLin, Ji HuiFan
2019, 35(10): 2289-2291. DOI: 10.3969/j.issn.1001-5256.2019.10.032
Abstract:
Autoimmune hepatitis with subacute liver failure as the initial manifestation:A case report
Lu LingLing, Zhang Hui, Geng AiWen, Xiao Li, Xian JianChun, Qi ChuanWang
2019, 35(10): 2292-2294. DOI: 10.3969/j.issn.1001-5256.2019.10.033
Abstract:
Diagnosis and treatment of adult Alagille syndrome:A case report
Ping DaBing, Liu HongLiang, Hu XuDong, Yuan JiLi, Liu ChengHai
2019, 35(10): 2295-2297. DOI: 10.3969/j.issn.1001-5256.2019.10.034
Abstract:
Pancreatic panniculitis:A case report
Chen Hao, Qian BaoLin, Wang AnKang, Yang DaYin, Jiang Yu, Ye MingXin, Li Qiu, He YuanMin, Fu WenGuang
2019, 35(10): 2298-2299. DOI: 10.3969/j.issn.1001-5256.2019.10.035
Abstract:
A case of giant paraganglioma of the pancreas
Xu HongJi, Li XinXin, Liu Kai
2019, 35(10): 2300-2301. DOI: 10.3969/j.issn.1001-5256.2019.10.036
Abstract:
Reviews
Research advances in anti-hepatitis B virus drugs
Cai MengZhi, Qin Gang
2019, 35(10): 2302-2307. DOI: 10.3969/j.issn.1001-5256.2019.10.037
Abstract:
Hepatitis B virus(HBV) infection has always been a great threat to public health,and about 2 billion people in the world have the history of HBV infection. Chronic HBV infection can lead to chronic hepatitis,liver cirrhosis,and even hepatocellular carcinoma. At present,nucleoside analogues(NAs) and interferons(IFNs) have been approved for the treatment of chronic hepatitis B in China. Long-term use of NAs has good safety and tolerability and can effectively inhibit viral replication and reduce the risk of liver-related complications,but there are still the issues such as long and uncertain course of treatment,risk of drug resistance,and recurrence after drug withdrawal. IFNs have severe side effects with limited seroconversion and cure rate. Therefore,the research and development of new antiviral drugs with different targets of HBV is of vital importance for the treatment of chronic HBV infection. This article summarizes the research advances in anti-HBV drugs with different targets,so as to provide a reference for clinical and research work.
Application of terlipressin in the treatment of esophagogastric variceal bleeding in liver cirrhosis
Li XiaoLu, Li Lei
2019, 35(10): 2308-2311. DOI: 10.3969/j.issn.1001-5256.2019.10.038
Abstract:
Esophagogastric variceal bleeding(EVB) is a common fatal complication secondary to cirrhotic portal hypertension. Terlipressin can shrink visceral blood vessels,reduce portal pressure,and increase renal perfusion and is mainly used in the treatment of EVB. This article summarizes the mechanism of action and clinical effect of terlipressin in the treatment of EVB in liver cirrhosis and points out that if conditions permit,terlipressin combined with endoscopic variceal ligation should be the preferred treatment method for EVB.
Research advances in interventional treatment of cirrhotic portal hypertension
Zhang Xue, Xu Ying, Zou SongLong, Wu JieFang, Meng ShuHui
2019, 35(10): 2312-2315. DOI: 10.3969/j.issn.1001-5256.2019.10.039
Abstract:
Portal hypertension is one of the main clinical manifestations of decompensated cirrhosis. A series of complications due to cirrhotic portal hypertension,such as esophagogastric variceal bleeding,hypersplenism,and intractable ascites,greatly threaten human health.Since the application of the radiological interventional technique in the treatment of portal hypertension in the 1970 s,this technique has gradually become mature over the past few decades,and more improvements and new techniques have been applied in clinical practice,with an increasing number of evidence for its efficacy and safety. This article summarizes related articles in China and foreign countries and reviews the clinical application of interventional techniques in patients with cirrhotic portal hypertension,in order to guide the treatment of patients with cirrhotic portal hypertension.
Role and mechanism of ferroptosis in treatment of liver cancer with sorafenib
Chen Xiang, Wen DiGuang, You Yu, Gong JianPing
2019, 35(10): 2316-2319. DOI: 10.3969/j.issn.1001-5256.2019.10.040
Abstract:
Patients with advanced liver cancer have poor basic conditions and poor prognosis due to limited treatment options. Sorafenib is the first-line drug approved by FDA for the treatment of advanced liver cancer,and it has multi-kinase inhibitory activity and can improve the survival time of patients with liver cancer. Recent studies have shown that sorafenib is also an inducer of ferroptosis and its toxicity on hepatoma cells partly depends on the induction of ferroptosis of tumor cells. The enhancement of sorafenib-induced ferroptosis can improve the therapeutic effect of sorafenib on liver cancer. At the same time,ferroptosis also plays an important role in the drug-resistance mechanism of sorafenib,and some key proteins involved in the pathways of ferroptosis can also be used to indicate the efficacy of sorafenib and the prognosis of liver cancer. This article reviews the latest research advances in the role of ferroptos in the treatment of liver cancer with sorafenib.
Value of Sal-like 4 in the diagnosis and treatment of primary liver cancer
Shao YueMing, Zhang Yu, Yin Xin, Wen XiaoYu
2019, 35(10): 2320-2323. DOI: 10.3969/j.issn.1001-5256.2019.10.041
Abstract:
Sal-like 4(SALL4) is a transcription factor that helps to maintain self-renewal and pluripotency of stem cells. This gene is expressed in the human fetal liver,but is silent in the healthy adult liver. It has been reported that SALL4 has a diagnostic value in a variety of solid tumors. These characteristics make SALL4 a possible tumor biomarker for liver cancer. This article reviews the recent advances in the role of SALL4 in the development,progression,metastasis,and other biological processes of primary liver cancer,as well as its role in predicting the prognosis of primary liver cancer. We believe that with further studies,SALL4 and related microRNAs may become new markers for the diagnosis,treatment,and prognostic evaluation of primary liver cancer.
Association between nonalcoholic fatty liver disease and dietary inflammation index and its practical significance
Guo Yan, Huang Li, Yang GuoChao, Liu Shan, Du LinNa, Wang MinJuan
2019, 35(10): 2324-2326. DOI: 10.3969/j.issn.1001-5256.2019.10.042
Abstract:
In recent years,the incidence rate of nonalcoholic fatty liver disease(NAFLD) keeps increasing,and the age of onset gradually becomes younger. Unhealthy lifestyle,including bad dietary choices,is one of the major causes of NAFLD. However,there are still no clear treatment regimens for NAFLD,and lifestyle intervention with the aim of weight loss is still the most mature method for the treatment of NAFLD. Studies have shown that chronic inflammatory response runs through the whole process of the development and progression of NAFLD,and diet plays an important role in the development and regulation of inflammatory cascade. Dietary inflammation index(DII) is an effective tool for assessing inflammatory potential in individual dietary structure,and since its development,it has been continuously improved and is now widely used in the clinical research on many diseases. This article discusses the association between NAFLD and DII,in order to achieve primary prevention of NAFLD from dietary structure and reduce the incidence rate of NAFLD.
Role of circadian clock genes in the development and progression of nonalcoholic fatty liver disease
Ai Yan, Yang XiaoQian, Pan XiaoLi, Ye Jin
2019, 35(10): 2327-2330. DOI: 10.3969/j.issn.1001-5256.2019.10.043
Abstract:
Circadian clock is an inherent biological rhythm of organism which forms in the long process of evolution to adapt to the changes in light and temperature due to day-night alternation. Circadian clock in humans is accurately regulated by various circadian clock genes at the molecular level and are hierarchically regulated by the central clock and the peripheral clock at the anatomical level. Recent studies have found that circadian clock genes can participate in intracellular lipid metabolism by regulating downstream clock-controlled genes,and the disorder of circadian clock genes can result in abnormal lipid metabolism,oxidative stress,insulin resistance,and abnormal secretion of glucocorticoids and inflammatory factors,which are closely associated with the pathogenesis of nonalcoholic fatty liver disease(NAFLD). The disorder of circadian clock genes can also increase the susceptibility to fatty liver disease and thus acts as a bridge that connects circadian clock genes and NAFLD. The pathogenesis of NAFLD remains unclear at present,and therefore,this article summarizes the recent studies on the association between circadian clock genes and NAFLD,so as to provide a theoretical basis for further clarifying the pathogenesis of NAFLD.
Advances in the clinical treatment of autoimmune hepatitis
Jin Chao, Pan JieLu, Yu Xiao, Zhang HaiYan, Xing LianJun
2019, 35(10): 2331-2334. DOI: 10.3969/j.issn.1001-5256.2019.10.044
Abstract:
Autoimmune hepatitis(AIH) is an autoimmune-mediated chronic progressive liver inflammatory disease with unknown pathogenesis. The main purpose of AIH treatment at present is to relieve symptoms,improve liver function and pathological abnormalities,and slow down the progression to liver fibrosis. Easy recurrence and a large difference in prognosis bring difficulties to the treatment of this disease. In recent years,AIH treatment methods mainly include standard immunosuppressive therapy,substitutive therapy or second-line therapy for ineffective standard therapy,traditional Chinese medicine treatment with reduced side effects,and liver transplantation rescue therapy for end-stage AIH or severe fulminant AIH. This article reviews the above treatment methods for AIH,in order to provide a reference for clinical application.
Research advances in the pathogenesis of autoimmune hepatitis
Cao YiNan, Zhou GuiQin, Wang XianBo, Li Bin, Feng Ying, Hu ChaoQun
2019, 35(10): 2335-2338. DOI: 10.3969/j.issn.1001-5256.2019.10.045
Abstract:
Autoimmune hepatitis(AIH) is a progressive chronic inflammatory liver disease with unknown etiology. At present,genetic susceptibility and environmental factors are universally recognized as the etiological factors for AIH. With the deepening of research in recent years,other etiological factors,such as immune cells,immune factors,liver transplantation,and drugs,have attracted more and more attention. This article briefly describes related research findings in the past five years.
Role of autoimmune ecological factors in the pathogenesis of autoimmune hepatitis
Chen Jie, Huang ChunYang, Dan Jing, Liu YanMin
2019, 35(10): 2339-2341. DOI: 10.3969/j.issn.1001-5256.2019.10.046
Abstract:
Autoimmune hepatitis(AIH) is a chronic liver inflammatory disease with unknown etiology,and at present,both genetic and environmental factors are thought to be involved in the pathogenesis of AIH. Environmental exposure has an important impact on the development of AIH. Autoimmune ecology is the study of the interactions between individuals and their environment,the development of imbalance between individuals and environment,and the mechanism of such imbalance in promoting the development of autoimmune disease. This article reviews the research advances in the role of autoimmune ecology in the pathogenesis of AIH.
Advances in research and application of liver organoids
Wang Li, Qiu YiLing, Wang JianShe
2019, 35(10): 2342-2345. DOI: 10.3969/j.issn.1001-5256.2019.10.047
Abstract:
Liver diseases significantly affect human health. Classic research models cannot maintain hepatocyte polarity for a long time and have a different genetic background from normal human hepatocytes,which limits the research on the physiological functions of hepatocytes and the mechanisms of related diseases. The latest liver organoid technology can obtain liver organoids with partial liver structure by reprogrammed induced pluripotent stem cells or in vitro culture of liver biopsy tissue and maintain long-term proliferation and genetic stability,and therefore,it is expected to become a powerful tool for disease modelling,drug screening,and cell therapy. This article mainly reviews the research and application of liver organoids in recent years.
Role of NLRP3 inflammasome in the development and progression of liver diseases
Ye QianLing, Mao DeWen, Wang MingGang, Wang Na
2019, 35(10): 2346-2350. DOI: 10.3969/j.issn.1001-5256.2019.10.048
Abstract:
Immune cascade due to inflammasome has become a research hotspot in recent years,and the role of NLRP3 inflammasome in the development and progression of liver diseases has attracted more and more attention. This article analyzes the action characteristics and regulatory mechanism of NLRP3 inflammasome in liver diseases,such as viral hepatitis,liver fibrosis,nonalcoholic fatty liver disease,liver failure,and liver cancer,and establishes targeted therapy based on NLRP3 inflammasome to regulate immune response triggered by inflammasome,in order to provide new ideas for the prevention and treatment of liver diseases.
Research advances in the role and mechanism of peroxisome proliferator-activated receptor alpha in liver diseases
Zhang Dan, Ma LanQing
2019, 35(10): 2351-2354. DOI: 10.3969/j.issn.1001-5256.2019.10.049
Abstract(2016) PDF (238KB)(481)
Abstract:
Peroxisome proliferator-activated receptor alpha(PPARα) is a member of the nuclear receptor superfamily and plays a central regulatory role in lipid metabolism. Recent studies have found that PPARα agonists play a key role in the prevention and treatment of nonalcoholic fatty liver disease,which has also been reported in other liver diseases. This article reviews the role and mechanism of PPARα in nonalcoholic fatty liver disease,alcoholic liver disease,viral hepatitis,cholestatic liver disease,drug-induced liver injury,and hepatocellular carcinoma,so as to provide a reference for the research on the new application of conventional drugs associated with PPARα.
Research advances in the mechanism of action of intestinal microecology in intrahepatic cholestasis
Huang Qian, Zhang HaiBo, Li JingTao, Wei HaiLiang, Yan ShuGuang, Hui Yi, Chang ZhanJie
2019, 35(10): 2355-2359. DOI: 10.3969/j.issn.1001-5256.2019.10.050
Abstract:
Intrahepatic cholestasis(IHC) is a dysfunction of bile production,secretion,and excretion caused by various factors including genetics,immunity,inflammation,stones,and tumors,and therefore,the bile is not normally discharged into the duodenum and reversely flows into blood,which causes a series of clinical diseases with organic damage,metabolic disorders,and dysfunction. In recent years,with the deepening of clinical and basic research,intestinal microecology is found to play an important role in the development and progression of liver diseases. This article reviews the mechanism of action of intestinal microecology and inflammatory factors in intrahepatic cholestasis and explores the research advances in the role of probiotics in regulating intestinal flora stability and improving intestinal microenvironment,so as to provide a basis for clinical treatment,scientific research,and drug research and development.
Development and enlightenment of intelligentized diagnostic and therapeutic mode for hepatobiliary tumors
Wang XiaoYun, Li LinFeng, Guo Quan, Ceng YiLan, Li HaiYang, Du YingRong, Chen Gang, Liang YueDong, Lu YinYing
2019, 35(10): 2360-2364. DOI: 10.3969/j.issn.1001-5256.2019.10.051
Abstract:
Clinical decision support system(CDSS) and multidisciplinary team(MDT) are important measures to improve the efficiency and quality of healthcare service. This article reviews and analyzes the current status of the development of CDSS and MDT in China and foreign countries and summarizes their features and shortcomings,and with the background of the new era of“medical big data resources”and“big data technology”,this article looks into the future of developing an intelligentized diagnostic and therapeutic mode(a combination of CDSS and MDT) for hepatobiliary tumors suitable for the national conditions of China.
Role of adenosine monophosphate-activated protein kinase in acute pancreatitis
Huang Lei, Zhao XianLin, Wang MingHao, Wang XiaoXiang
2019, 35(10): 2365-2368. DOI: 10.3969/j.issn.1001-5256.2019.10.052
Abstract:
Adenosine monophosphate-activated protein kinase(AMPK) is a critical enzyme for energy and metabolic regulation and can effectively maintain the homeostasis of energy and metabolism in cells and the body,and thus it plays an important role in both health and diseases. Current studies have shown that AMPK can regulate inflammatory response in the body through various cytokines and signaling pathways such as nuclear factor-kappa B(NF-κB),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6) and has become a potential therapeutic target for a variety of inflammatory diseases. In acute pancreatitis,abnormal activation of trypsin can cause the injury and necrosis of tissue cells,release various inflammatory factors including NF-κB,TNF-α,and IL-6,and induce systemic inflammatory response,leading to organ injury or acute inflammatory disease. Recent studies indicate that the activation of AMPK can alleviate the inflammatory damage of acute pancreatitis. Therefore,AMPK and its signaling pathway may become potential therapeutic targets for acute pancreatitis.