中文English
ISSN 1001-5256
CN 22-1108/R

2015 No. 12

Display Method:
Editorial
Comprehensive strategy for improving the outcome of liver transplantation in patients with hepatocellular carcinoma
Wang Zheng, Zhou Jian
2015, 31(12): 1937-1940. DOI: 10.3969/j.issn.1001-5256.2015.12.001
Abstract:

As a radical treatment for hepatocellular carcinoma( HCC),liver transplantation( LT) brings new hope for the treatment of HCC,but tumor recurrence and metastasis after LT remain the most important factor that affects the outcome of LT in HCC. The comprehensive strategy,including investigating the biological characteristics of HCC and the relationship between immune status after LT and tumor recurrence,selecting the factors which can accurately predict the prognosis after LT in HCC,screening the cases reasonably and providing effective intervention for patients at a high risk of recurrence,controlling the primary disease actively,and providing individualized treatment for recurrence and metastasis,may further improve the outcome of LT in HCC. In the era of precision medicine,innovative treatments will change the strategies for treatment.

Therapeutic guidelines
The guideline of prevention and treatment for chronic hepatitis B: a 2015 update
Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association
2015, 31(12): 1941-1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002
Abstract(5881) PDF (657KB)(10431)
Abstract:
The guideline of prevention and treatment for hepatitis C: a 2015 update 
Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association
2015, 31(12): 1961-1979. DOI: 10.3969/j.issn.1001-5256.2015.12.003
Abstract(491) PDF (670KB)(2924)
Abstract:
Consensus on the diagnosis and management of primary biliary cirrhosis (cholangitis)(2015)
Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association
2015, 31(12): 1980-1988. DOI: 10.3969/j.issn.1001-5256.2015.12.004
Abstract(5723) PDF (329KB)(3767)
Abstract:
Consensus on the diagnosis and treatment of cholestasis liver diseases(2015)
Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association
2015, 31(12): 1989-1999. DOI: 10.3969/j.issn.1001-5256.2015.12.005
Abstract(421) PDF (416KB)(2387)
Abstract:
EASL clinical practice guidelines (2015): autoimmune hepatitis
Wang QiXia, Jiang Xiang, Lian Min, Zhang Jun, Yan Li, Sun ChunYan, Ma Xiong
2015, 31(12): 2000-2019. DOI: 10.3969/j.issn.1001-5256.2015.12.006
Abstract:
Discussions by experts
Research advances in auxiliary liver transplantation
Zhu ZhiJun, Ceng ZhiGui
2015, 31(12): 2020-2022. DOI: 10.3969/j.issn.1001-5256.2015.12.007
Abstract(2354) PDF (1355KB)(1125)
Abstract:

With the continuous development for half a century,auxiliary liver transplantation and related techniques have become more mature,and the major indications are also expanding. This article reviews the history of auxiliary liver transplantation and introduces its indications,including metabolic liver disease,fulminant hepatic failure,kidney transplantation for highly sensitized patients,and prevention of small- for- size syndrome after hepatectomy; meanwhile,this article summarizes the major surgical methods of auxiliary liver transplantation,as well as related hot issues and difficulties. On the basis of previous experience,cross- auxiliary liver transplantation has been applied to metabolic liver disease creatively,with its unique advantages in the treatment of metabolic liver disease.

Current status of adult living donor liver transplantation
Jiang WenTao, Wang HongHai, Guo QingJun
2015, 31(12): 2023-2026. DOI: 10.3969/j.issn.1001-5256.2015.12.008
Abstract:

With the establishment of reasonable selection criteria and continuous technical refinement,living donor liver transplantation( LDLT) has been widely performed in the world. Right- lobe LDLT has become the conventional procedure performed at many centers. In recent years,due to the considerations of donor safety,other graft types have become important choices for adult- adult LDLT,especially left-lobe LDLT,and good outcome has been achieved. Although the minimally invasive technique has certain technical and safety issues,it will play an important role in donor hepatectomy due to its unique advantages. At present,the research data for patients with hepatocellular carcinoma( HCC) are controversial,but LDLT can be applied in the treatment for these patients. The therapeutic regimens for LDLT should be selected on the basis of the individualized principle and comprehensive analysis of donor safety,surgical risk,and the recipient's survival.

Risk factors for biliary complications after liver transplantation from donation after cardiac death
Lu: GuoYue
2015, 31(12): 2027-2030. DOI: 10.3969/j.issn.1001-5256.2015.12.009
Abstract:

Liver transplantation has become the effective therapeutic method for end- stage liver disease,but the incidence of biliary complications after liver transplantation remains high. With an increasing number of liver transplantation procedures from donation after cardiac death( DCD),it is necessary to investigate the risk factors for biliary complications after liver transplantation from DCD and enhance our understanding of such risk factors in order to reduce biliary complications after liver transplantation from DCD.

Application of immune induction therapy with antibodies in liver transplantation
Yang Yang, Deng YiNan
2015, 31(12): 2031-2034. DOI: 10.3969/j.issn.1001-5256.2015.12.010
Abstract:

Immune induction therapy with antibodies has been widely applied in liver transplantation. This paper introduces common antibodies for immune induction and their application in liver transplantation,and points out that immune induction therapy with antibodies reduces the dosage of hormones and calcineurin inhibitors( cyclosporine and tacrolimus),reduces infections effectively,protects renal function,prevents acute rejection reaction,and finally improves the prognosis of transplant recipients. The effect of immune induction therapy with antibodies on hepatitis and liver cancer still needs further investigation. Key words: liver transplantation; immunity induction; therapy

Application of Kupffer cells in immune tolerance and regulation after liver transplantation
Wu YaKun, Gong JianPing
2015, 31(12): 2035-2038. DOI: 10.3969/j.issn.1001-5256.2015.12.011
Abstract:

With the development of organ transplantation techniques and the improvement of immunotherapies,liver transplantation( LT)has been developing rapidly and has become the most effective method for treating end- stage liver diseases. However,acute and chronic rejection reactions and ischemia- reperfusion injury occurring after LT are still the major influencing factors for successful LT and long- term survival rate. As the largest group of macrophages in human body,Kupffer cells( KCs) can secrete and release various inflammatory cytokines after LT,and thus play an important role in induction of apoptosis and differentiation of T lymphocytes and clearance of apoptotic cells.KCs play the dual role of promoting rejection response and inducing immune tolerance after LT,but the detailed mechanisms remain unclear.Therefore,investigation of the mechanisms of KCs in immune process after transplantation is very important for reducing rejection reaction and inducing immune tolerance after transplantation.

Original articles_Liver transplantation
Clinical efficacy of direct-acting antiviral agents in treatment of patients with hepatitis C recurrence after liver transplantation
Liu HongLing, Zhang Min, Zang Hong, Zhou Xia, Yao Hong, Gao YinJie, Zhou ShuangNan, Liu ZhenWen
2015, 31(12): 2039-2041. DOI: 10.3969/j.issn.1001-5256.2015.12.012
Abstract:

Objective To observe the clinical effect and safety of direct- acting antiviral agents( DAAs) in patients with hepatitis C recurrence after liver transplantation. Methods Fifteen patients who received liver transplantation in 302 Hospital of PLA from December 2014 to May 2015 were selected,and after treatment,the HCV RNA- positive patients were treated with DAAs. The patients with genotype 1b were treated with Harvoni( sofosbuvir 400 mg / d + ledipasvir 90 mg / d) or sofosbuvir 400 mg / d + daclatasvir 60 mg / d,and those with genotype 2a were treated with sofosbuvir 400 mg / d + ribavirin 900 mg / d. The course of treatment was 12 weeks. The changes in clinical symptoms and signs and laboratory markers including routine blood test,liver function,and HCV RNA quantification were observed regularly. Results Among the 15 patients with hepatitis C recurrence after liver transplantation,14 achieved HCV RNA clearance within 1- 4weeks,and the shortest time to clearance was 5 days; one patient had a HCV RNA level of 5. 6 × 10 IU / ml at week 4. At month 12 of treatment,all the patients achieved HCV RNA clearance,and at the end of treatment,all the patients achieved virologic response. At present,14 patients had achieved sustained virologic response for 12 weeks,and the other patients were still in the follow- up stage; at present,3patients had achieved sustained virologic response for 24 weeks,and the other 12 patients were still in the follow- up stage. Side effects of the treatment were mainly headache( 1 case),weakness( 5 cases),and arthralgia( 1 case). Conclusion DAAs can be used in the treatment of patients with hepatitis C recurrence after liver transplantation with minor side effects,tolerance,and definite curative effect. Long-term sustained virologic response requires further observation.

Clinical analysis of hypophosphatemia induced by adefovir dipivoxil in treatment of chronic hepatitis B
Liu JianYong, Pan Fan, Lu: LiZhi, Jiang Yi
2015, 31(12): 2042-2046. DOI: 10.3969/j.issn.1001-5256.2015.12.013
Abstract:

Objective To investigate the association of Model for End- Stage Liver Disease( MELD) score with complications and early survival rate after liver transplantation for benign end- stage liver disease,and to analyze the criteria to select donor livers with fatty liver for patients with different MELD scores. Methods A total of 145 recipients of orthotopic liver transplantation with benign end- stage liver disease in Fuzhou General Hospital of Nanjing Military Command from January 2008 to December 2013 were analyzed retrospectively,and frozen fatty liver biopsy was performed for donor livers in 47 patients before transplantation. The patients were divided into the following three groups according to MELD score: group A with 28 patients( MELD score ≥30,mean MELD score 35. 7 ± 5. 5); group B with 35 patients( 20≤ MELD score<30,mean MELD score 22. 5 ±2. 3); group C with 82 patients( MELD score <20,mean MELD score 11. 0 ±3. 7). The preoperative,intraoperative,and postoperative biochemical parameters,postoperative complications,and survival rate were compared between these groups. The 47 patients receiving frozen biopsy were divided into the following two groups according to MELD score: group a with 9 patients( MELD score ≥30); group b with 38 patients( MELD score < 30). The 1- year survival rates of the recipients of donor livers with mild,moderate,and severe fatty liver were compared between the two groups. Comparison of continuous data between the two groups was made by t test or ANOVA and comparison of categorical date was made by chi- square test or Fisher's exact. Results The 1- month survival rate after transplantation showed no significant difference between groups A,B,and C( 71. 4%,87. 8%,and 86. 6%,respectively; P >0. 05); group A had significantly lower 3- month,6- month,and 1- year survival rates than groups B and C( 64. 3% /64. 3% /64. 3% vs 88. 6% /88. 6% /88. 6% and 87. 8% /86. 6% /86. 6%,all P < 0. 05). Group A had a significantly higher incidence of postoperative complications than groups B and C( 82. 14% vs 42. 86% and 25. 61%,P < 0. 05). As for the patients receiving donor livers with moderate and severe fatty liver,group a had a significantly lower 1- year survival rate than group b( 20. 0% vs 81. 8%; χ2= 5. 111,P = 0. 014). Conclusion The recipients with a high MELD score( ≥30) may experience a large number of postoperative complications and a high mortality rate,and therefore donor livers with moderate and severe fatty liver should be abandoned.

Original articles_Viral hepatitis
Clinical analysis of hypophosphatemia induced by adefovir dipivoxil in treatment of chronic hepatitis B
Yang XiaoYan, Sun ZhangYu, Yuan Xiang, Liang YaLin
2015, 31(12): 2047-2050. DOI: 10.3969/j.issn.1001-5256.2015.12.014
Abstract:

Objective To observe the occurrence of hypophosphatemia induced by adefovir dipivoxil( ADV) for the treatment of chronic hepatitis B and investigate the association between intact fibroblast growth factor 23( i FGF23) and occurrence of hypophosphatemia,and to find a new way for early discovery and prevention of hypophosphatemic osteomalacia. Methods A total of 1050 patients with chronic hepatitis B and hepatitis B cirrhosis who visited the First Affiliated Hospital of Zhengzhou University from December 2008 to December 2014 were analyzed retrospectively and divided into group A and group B according to different medications. The patients in group A( n = 750) received ADV 10 mg / d and liver protection therapy,and those in group B( n = 300) received entecavir( ETV) 500 mg / d and liver protection therapy,with a median treatment time of 76. 652 ± 5. 053 months. The changes in the levels of serum phosphorus,i FGF23,alkaline phosphatase( ALP),and bone mineral density( BMD) during treatment were collected in the patients in both groups. Chi- square test was applied for comparison of categorical data between the two groups,and Spearman' s rank correlation was applied for correlation analysis. Results In these 1050 patients,47 patients experienced a persistent low level of serum phosphorus,consisting of 46 cases in group A( 4 cases were diagnosed with hypophosphatemic osteomalacia) and 1 case in group B,and group A had a significantly higher incidence of hypophosphatemia than group B( 6. 13% vs 0. 33%; χ2= 16. 859,P < 0. 01). Group A also had significantly higher incidence rates of high i FGF23 and ALP levels and reduced BMD than group B( χ2= 17. 727,10. 823,and 13. 578,respectively,all P < 0. 01). The level of serum phosphorus was negatively correlated with that of i FGF23( r =- 0. 906,P < 0. 01),and was positively correlated with BMD( r = 0. 941,P <0. 01). Conclusion Long- term administration of ADV may cause hypophosphatemia,and high expression of i FGF23 may be related to the occurrence of hypophosphatemia. It is recommended that patients who take ADV for a long time be examined regularly for serum phosphorus,i FGF23,ALP,and BMD.

Association between Helicobacter pylori infection and stages of liver pathology in patients with chronic hepatitis B
Wen XiaoFeng, Jiang ZhongSheng, Chen Nian, Ke Liu
2015, 31(12): 2051-2053. DOI: 10.3969/j.issn.1001-5256.2015.12.015
Abstract:

Objective To investigate the association between Helicobacter pylori( Hp) infection and stages of liver pathology in patients with chronic hepatitis B( CHB). Methods Seventy- nine patients who were hospitalized in the People's Hospital of Liuzhou from February 2008 to December 2014 were selected,and liver biopsy was performed for all patients to determine the liver inflammation grade( G) and fibrosis stage( S). Meanwhile,14C urea breath test(14C- UBT) was performed to detect Hp infection. The patients were divided into Hp-positive group and Hp- negative group based on the results of14C- UBT,and liver inflammation grade and fibrosis stage were compared between the two groups. The t- test was applied for comparison of continuous data between the two groups,and χ2test was applied for comparison of categorical data between the two groups. Results There were no differences in liver inflammation grade or fibrosis stage between Hp- positive group and Hp- negative group( t =- 1. 622 and- 1. 263,respectively; both P > 0. 05); there was no difference in the proportion of patients ≥G2 between the two groups( χ2= 1. 58; P > 0. 05); there was no difference in the proportion of patients ≥S2 between the two groups( χ2= 0. 02; P > 0. 05). Conclusion Hp infection may not be associated with liver inflammation grade or fibrosis stage in patients with CHB.

The correlation study of  serum LHB, HBsAg, HBV DNA,  ALT levels and  liver inflammation activity in patients with chronic hepatitis B
Li Yang, Xian JianChun
2015, 31(12): 2054-2056. DOI: 10.3969/j.issn.1001-5256.2015.12.016
Abstract:

Objective To explore the clinical significance of serum hepatitis B virus large surface protein( LHB),HBs Ag,hepatitis B virus( HBV) DNA,and alanine aminotransferase( ALT) levels and their correlation with liver inflammation activity in patients with chronic hepatitis B( CHB). Methods One hundred and two HBe Ag- positive patients with CHB who visited the People's Hospital of Taizhou from January 2011 to December 2014 were enrolled in the study,and were divided into mild inflammation group( G0- 1) and severe inflammation group( G2- 4) according to the grade of liver inflammation activity. Continuous data were expressed as x ± s; the t- test was applied for comparison between two groups,and analysis of variance was applied for comparison between multiple groups. The Spearman rank correlation test was applied to investigate the correlation between LHB,HBs Ag,HBV DNA,and ALT levels and the grade of liver inflammation activity. The area under the receiver operator characteristic( ROC) curve( AUC) was applied to evaluate their diagnostic values. Results The level of LHB tended to increase with the increasing HBV DNA. The AUCs of LHB,HBs Ag,ALT,and HBV DNA for diagnosing severe liver inflammation were 0. 763,0. 756,0. 702,and 0. 581,respectively,and the diagnostic efficiency of LHB,HBs Ag,and ALT reached a moderate level( AUC of the ROC curve 0. 70- 0. 90); the diagnostic values of serum LHB and HBs Ag levels for severe liver inflammation were higher than that of serum ALT level. The optimal cut- off for serum LHB level to diagnose severe inflammation was 24. 6,and the corresponding sensitivity and specificity were 73. 4% and 60. 3%,respectively. Conclusion Serum LHB and HBs Ag levels have certain predictive values for severe liver inflammation in HBe Ag- positive patients with CHB.

Original articles_Liver fibrosis and liver cirrhosis
Application of pericardial devascularization and omental packing combined with gastric noose cerclage in treatment of portal hypertension
Sun HaiFeng, Wu JianJun, Zhu RenFei, Xiao Xu, Chen Jun
2015, 31(12): 2057-2060. DOI: 10.3969/j.issn.1001-5256.2015.12.017
Abstract:

Objective To investigate the application of pericardial devascularization and omental packing combined with gastric noose cerclage in the treatment of portal hypertension. Methods The clinical data of 59 patients who were treated in our hospital and received pericardial devascularization and omental packing combined with gastric noose cerclage from June 2007 to June 2013 were analyzed retrospectively,and the indices such as changes in portal venous pressure,portal vein diameter,and liver function after surgery,postoperative rebleeding rate,and survival rate were observed. Analysis of variance was applied for comparison between multiple groups,and paired t- test was applied for comparison between two groups. Results All the 59 patients received a successful surgery,and the portal venous pressure was significantly decreased after the surgery; after the emergency operation,upper gastrointestinal bleeding was stopped,with no complications such as gastroparesis and pancreatic fistula; there was no death. The postoperative follow- up was performed for 2 ~ 5 years,and 1 case of rebleeding and 1 death occurred. Conclusion Pericardial devascularization and omental packing combined with gastric noose cerclage have the advantages of both devascularization and shunt,and can achieve complete devascularization of the vessels at the lower segment of the esophagus,the cardia,and the gastric fundus,and the submucosal vessels in the gastric wall,with exact hemostasis,few postoperative complications,low rebleeding rate,and simplicity in operation,which is a reasonable,reliable,safe,and effective operation method.

Original articles_Liver neoplasms
Predictive value of preoperative ultrasound examination for factors associated with early postoperative recurrence of hepatocellular carcinoma after surgical resection 
Wang YiBin, Liao JinTang, Xie LuLu, Qi WenJun, Chen LuYang, Li YueYi
2015, 31(12): 2061-2065. DOI: 10.3969/j.issn.1001-5256.2015.12.018
Abstract:

Objective To investigate the risk factors associated with early postoperative recurrence of hepatocellular carcinoma( HCC) after surgical resection,and to discuss the predictive value of preoperative ultrasound examination for early recurrence of HCC after surgical resection. Methods The clinical data of 59 patients who underwent radical resection for HCC in Xiangya Hospital of Central South University from December 2010 to January 2014 were analyzed retrospectively. These patients were divided into early recurrence group( 27 patients)and no early recurrence group( 32 patients) based on whether recurrence occurred within 1 year after resection. The demographic data,laboratory examination data,and diagnostic data for conventional ultrasound and contrast- enhanced ultrasound( CEUS) in HCC patients with HBV who received CEUS before surgery were analyzed to determine their predictive values for early recurrence of HCC. The t- test or Mann-Whitney U test was applied for continuous data,chi- square test or Fisher's exact test was applied for categorical data,and the logistic regression model was applied for multivariate analysis. Results Univariate analysis showed that preoperative serum α- fetoprotein( AFP)level ≥400 ng / ml,maximum tumor diameter ≥5 cm,involvement of major blood vessels,a " fast wash- out" enhancement pattern on CEUS,and uneven distribution of contrast agent were risk factors for early postoperative recurrence( all P < 0. 05). Multivariate analysis showed that preoperative serum AFP level ≥400 ng / ml( OR = 14. 90,95% CI: 1. 44- 154. 39; P = 0. 02),maximum tumor diameter ≥5 cm( OR = 6. 75,95% CI: 1. 07- 42. 50; P = 0. 04),and a “fast wash- out”enhancement pattern on CEUS( OR = 9. 67,95% CI:1. 78- 52. 54; P = 0. 01) were independent risk factors for early postoperative recurrence. The evaluation of sensitivity of each independent risk factor and their combinations to predict early recurrence showed that the sensitivity of a“fast wash- out”enhancement pattern on CEUS did not differ significantly from that of maximum tumor diameter ≥5 cm( P > 0. 05),but it was significantly higher than that of the other indicators( all P < 0. 05). Conclusion The “fast wash- out”enhancement pattern on CEUS is highly sensitive in predicting early recurrence of HCC; therefore,it can be applied as one effective indicator for high- risk population screening,and provide guidance for the development and perfection of perioperative and postoperative long- term comprehensive therapeutic regimens for HCC.

Association between CD4+/CD8+ ratio in peripheral blood before hepatectomy for liver cancer and patient prognosis
Wu ShanShan, Liu HongYu, Chen QiuLian, Du ZhenShuang, Liu ChaoHui
2015, 31(12): 2066-2069. DOI: 10.3969/j.issn.1001-5256.2015.12.019
Abstract:

Objective To investigate the association between CD4~+/ CD8~+ratio in peripheral blood and patient prognosis after hepatectomy for liver cancer. Methods The clinical data of 150 patients who received partial hepatectomy for liver cancer in the 180 Hospital of PLA from October 2008 to November 2011 were analyzed retrospectively. CD4~+/ CD8~+ratio in peripheral venous blood was measured before surgery,and the patients were divided into low- CD4~+/ CD8~+group( CD4~+/ CD8~+ratio ≤1,52 patients) and high- CD4~+/ CD8~+group( CD4~+/ CD8~+ratio > 1,98 patients). Clinical indices were compared between the two groups,and outpatient follow- up and telephone follow- up were applied to record survival rate and tumor recurrence. The chi- square test was applied for comparison between the two groups,and Kaplan- Meier method( log- rank test) was applied for survival analysis. Univariate and multivariate logistic regression analyses were performed for clinical factors to determine the related risk factors for recurrence after hepatectomy for liver cancer. Results The low- CD4 + / CD8 + group had significantly lower 1-,3-,and 5- year survival rates than the high- CD4~+/ CD8~+group( χ2= 36. 473,41. 983,and 55. 214,respectively; all P < 0. 001),and the 5- year survival rate differed significantly between the two groups( χ2= 81. 471;P < 0. 05); the low- CD4~+/ CD8~+group had significantly higher 1-,3-,and 5- year tumor recurrence rates than the high- CD4~+/CD8~+group( χ2= 44. 041,68. 234,and 55. 157,respectively; all P < 0. 05). Univariate analysis showed that CD4~+/ CD8~+ratio,tumor diameter,existence of satellite lesions,hepatitis B virus infection,depth of tumor invasion,microvascular invasion,lymph node metastasis,and degree of tumor differentiation were high risk factors for recurrence after resection of liver cancer. Multivariate analysis showed that CD4~+/CD8~+ratio,tumor diameter,degree of tumor differentiation,lymph node metastasis,and microvascular invasion were independent risk factors for recurrence after resection of liver cancer. Conclusion The patients with a CD4~+/ CD8~+ratio of ≤1 before resection of liver cancer have poor prognosis and high recurrence rates,and CD4~+/ CD8~+ratio has a certain predictive value for prognosis after resection of liver cancer.

Original articles_Biliary diseases
Expression of Toll-like receptor 4 in rat model of nonalcoholic fatty liver disease induced by hyperlipidemia
Zhong HengGao, Mou Lin, Ji GuoZhong, Jiang GuoBin, Yang LiHua, Liu Zheng, Fan ZhiNing
2015, 31(12): 2070-2072. DOI: 10.3969/j.issn.1001-5256.2015.12.020
Abstract:

Objective To investigate the application value of transpancreatic septotomy with pancreatic duct stent or guide wire in difficult endoscopic retrograde cholangiopancreatography( ERCP). Methods A total of 309 patients who underwent difficult ERCP in Medical Center for Digestive Diseases,The Second Affiliated Hospital of Nanjing Medical University from June 2012 to May 2014 were selected; 228 patients among them received placement of pancreatic duct guide wire / plastic stent or conventional precut papillotomy,and achieved successful bile duct cannulation; the other 81 patients received transpancreatic septotomy with placement of guide wire( guide wire group,37 patients)or pancreatic duct stent( stent group,44 patients). The success rate and incidence of complications were compared between these two methods for cannulation. Results Of the 81 patients who underwent transpancreatic septotomy,77 achieved successful bile duct cannulation,and the success rate did not differ significantly between the guide wire group and stent group( 91. 89%( 34 /37) vs 97. 73%( 43 /44); P >0. 05). Seventeen patients experienced complications,with 8 cases of acute pancreatitis,3 cases of hemorrhage,and 1 case of biliary tract infection in the guide wire group,and 3 cases of acute pancreatitis,1 case of hemorrhage,1 case of biliary tract infection in the stent group;compared with the guide wire group,the stent group had a significantly lower incidence of complications( 11. 36% vs 32. 43%; χ2= 3. 75,P < 0. 05) and a significantly lower incidence of acute pancreatitis( 6. 82% vs 21. 62%; χ2= 2. 25,P < 0. 05). Conclusion Transpancreatic septotomy can further improve the success rate of bile duct cannulation with ERCP. The stent group has a higher success rate and a lower incidence of pancreatitis after ERCP than the guide wire group,and thus the application of stent is safer in clinical practice.

Original articles_Others
Expression of Toll-like receptor 4 in rat model of nonalcoholic fatty liver disease induced by hyperlipidemia
Liu Tao, Xu QiuLing, Zhao Yan
2015, 31(12): 2073-2076. DOI: 10.3969/j.issn.1001-5256.2015.12.021
Abstract:

Objective To investigate the expression of Toll- like receptor 4( TLR4) in the rat model of nonalcoholic fatty liver disease( NAFLD). Methods A total of 16 specific pathogen- free Sprague- Dawley rats were divided into normal group and NAFLD group,with8 rats in each group,and in the NAFLD group,a rat model was established by high- fat feed. HE staining was used to detect the pathological changes in the liver,enzyme- linked immunosorbent assay was applied to measure the levels of tumor necrosis factorα( TNFα) and interleukin- 1( IL- 1) in serum,and quantitative real- time PCR and immunohistochemical staining were applied to observe the expression of TLR4 signal in the liver. Comparison of continuous data between the two groups was made by t- test. Results In the NAFLD group,typical formation of lipid droplets and vacuoles was observed in hepatocytes,and mononuclear cell infiltration was observed in some hepatocytes. Compared with the normal group,the NAFLD group had significantly higher levels of serum TNFα and IL- 1( t = 7. 94 and 2. 86,respectively; both P < 0. 05) and significantly higher expression of TLR4,myeloid differentiation factor 88,and TNF receptor- associated factor 6( t = 13. 91,30. 71,and 29. 70,respectively; all P < 0. 05). Conclusion Overexpression of TLR4 signal is observed in the NAFLD rat model,which suggests that it is involved in the process of NAFLD inflammation and hepatic fibrosis.

Regulatory effect of poly I∶C on intrahepatic natural killer cells in mouse model of liver injury induced by carbon tetrachloride
Peng Yuan, Tao YanYan, Huang Kai, Zhao Qiang, Liu ChengHai
2015, 31(12): 2077-2083. DOI: 10.3969/j.issn.1001-5256.2015.12.022
Abstract:

Objective To investigate the effect of polyinosinic- polycytidylic acid( poly I∶ C) on the activation of natural killer cells( NK cells)in the mouse model of liver injury induced by carbon tetrachloride( CCl4). Methods Eighty C57BL/6 mice were randomly divided into normal control group,poly I∶ C control group,model control group,and poly I∶ C group. The mice in model control group and poly I∶ C group were intraperitoneally injected with 10% CCl4( 2 ml·kg-1·2d-1) to establish the model of liver injury,and the mice in normal control group and poly I∶C control group were intraperitoneally injected with the same dose of olive oil. The mice in poly I∶ C control group and poly I: C group were intraperitoneally injected with poly I∶ C( 1 mg·kg-1·2d-1),and the mice in normal control group and model control group were intraperitoneally injected with the same volume of normal saline. After continuous administration for 4 weeks,serum levels of liver function indices and liver inflammatory factors were observed; HE staining was applied to observe liver inflammation grade; flow cytometry was applied to measure NK cells in the liver,as well as the expression of the activating receptor NKG2 D and inhibitory receptor Ly49 A on NK cells. Analysis of variance was applied for comparison between groups,with least significant difference( LSD) test applied for homogeneity of variance and Dunnett's T3 method applied for heterogeneity of variance. Results After administration of poly I∶ C for 1 week and 4 weeks,there was no obvious liver injury in normal mice. With aggravation of CCl4 poisoning,the model control group,compared with the normal control group,had gradually increased serum levels of alanine aminotransferase,aspartate aminotransferase,and total bilirubin( P < 0. 01) and upregulated levels of intrahepatic proinflammatory factors( P < 0. 05); HE staining suggested necrosis of a large number of hepatocytes,a decreased proportion of hepatic NK cells,reduced expression of NKG2 D,and increased expression of Ly49 A in the model control group( P < 0. 05). Poly I∶ C improved the serum levels of liver function indices,reduced the levels of intrahepatic proinflammatory factors,significantly improved liver inflammation,and increased the proportion and number of hepatic NK cells and expression of NKG2D( P < 0. 01). Conclusion Poly I∶ C can protect the liver from acute and chronic liver injury,and its mechanism of action is closely related to activation of NK cells.

Reviews
Application of direct-acting antiviral agents in perioperative period of liver transplantation for patients with hepatitis C
Zhang Jing, Liu XueMin, Liu ZhengWen, Lu: Yi
2015, 31(12): 2084-2087. DOI: 10.3969/j.issn.1001-5256.2015.12.023
Abstract:

For patients with chronic hepatitis C who undergo liver transplantation,recurrence of hepatitis C virus( HCV) infection after liver transplantation has always been a great challenge in the medical field. With our increased understanding of HCV replication cycle,the appearance of direct- acting antiviral agents( DAAs) has brought new hope to patients who have failed interferon therapy. Based on the latest research advances at home and abroad,this article retrospectively introduces the mechanism of action and the development of DAAs,focuses on the clinical application,therapeutic effects,and potential risks of various regimens with DAAs before and after liver transplantation,and systematically reviews the application of DAAs in the perioperative period of liver transplantation for patients with hepatitis C. The results show that DAAs are safe and effective as perioperative antiviral therapies,and a combination of drugs with different targets is recommended as the antiviral therapy in the perioperative period of liver transplantation for patients with chronic hepatitis C.

Research advances in risk factors for primary biliary cirrhosis
Chen BiHua, Zhang Wei, Wu Pei, Huang Ying
2015, 31(12): 2088-2092. DOI: 10.3969/j.issn.1001-5256.2015.12.024
Abstract:

Primary biliary cirrhosis( PBC) is an autoimmune liver disease which progresses slowly,and its pathogenesis remains unclear. A total of 29 papers reporting the risk factors for PBC from different perspectives were obtained through Google Scholar search and screening,consisting of 19 reviews and 10 reports of investigational studies. By summarizing the objects and methods in 10 investigational studies and the conclusions of all the 29 papers,the induction mechanism of risk factors for PBC is clarified,and the control strategy for PBC is put forward. Since the literature included was studies on foreign populations conducted by foreign scholars,the applicability of these findings in China should be further investigated.

Research advances in cavernous transformation of portal vein
Li YongJian, Yan JiQi
2015, 31(12): 2093-2096. DOI: 10.3969/j.issn.1001-5256.2015.12.025
Abstract:

Cavernous transformation of the portal vein( CTPV) is considered a rare condition. However,with the development of radiological technology,an increasing number of patients have been diagnosed with CTPV,thus causing wide attention in clinical practice. This article elaborates on the research advances in CTPV from etiology to treatment,discusses the etiology of portal vein thrombosis and the mechanism by which portal vein thrombosis leads to CTPV,and summarizes the clinical manifestations of CTPV and the main methods of diagnosing this disease. Besides,this article analyses various methods in treating CTPV,and believes that surgical shunts are still the most extensively used method in treating CTPV.

Research progress in hepatic myelopathy
Yang Yang, Yang Long
2015, 31(12): 2097-2099. DOI: 10.3969/j.issn.1001-5256.2015.12.026
Abstract:

Hepatic myelopathy is a rare neurological complication which is caused by various acute or chronic liver diseases. It is clinically characterized by progressive spastic paraplegia of both lower extremities. The pathogenesis of this disease is unclear,and there is a lack of effective treatments as well as poor prognosis for this disease. By reviewing the relevant literature,the pathogenesis,pathological studies,clinical diagnosis criteria,and treatment of the disease are summarized. It is necessary to strengthen the study of pathogenesis of the disease as well as the clinical study of large sample size and long- term follow- up,thus providing reliable evidence for evidence- based medicine.

Role of thymosin β4 in liver diseases
Zhou LengXiao, Han Tao, Xing Jing, Lu Xu
2015, 31(12): 2100-2103. DOI: 10.3969/j.issn.1001-5256.2015.12.027
Abstract:

Thymosin β4 exists in most human tissues and cells,involved in many physiological and pathological processes in the human body,such as anti- inflammation,wound healing,angiogenesis,and tumor metastasis. In recent years,thymosin β4 has been found to play an important role in the development and progression of liver diseases. This article reviews the relationship between thymosin β4 and the development and progression of liver diseases,indicating that further exploration of thymosin β4 would make it a new biomarker in diagnosing and treating liver diseases.

Application of antibody preparation technology based on single B lymphocytes in liver diseases
Lu: XinPing, Wu Jing, Chen JingTao
2015, 31(12): 2104-2109. DOI: 10.3969/j.issn.1001-5256.2015.12.028
Abstract:

Monoclonal antibodies( m Abs) have a high specificity and have been widely used in various diseases,especially in the treatment and study of liver injury induced by viruses. In recent years,human m Abs directly prepared from single B lymphocytes have been getting more and more attention due to high antigenic specificity,low immunogenicity,and good safety and efficiency. With the continuous improvement in monoclonal antibody technology and polymerase chain reaction technology,the antibody preparation technology based on single B lymphocytes has been developed greatly. Although there are rare reports about the m Abs which are derived from single B lymphocytes and applied in liver diseases,the application of such m Abs is promising in the treatment and study of liver diseases. This article reviews the research advances in the development of antibody preparation technology based on single B lymphocytes and the application of the prepared antibodies in liver diseases.

Risk factors for pancreatic fistula after pancreaticoduodenectomy and its prevention and treatment measures 
Xing GuoQuan, Yan TianQing, Jia ZhiShuo, Kang TieLi
2015, 31(12): 2110-2113. DOI: 10.3969/j.issn.1001-5256.2015.12.029
Abstract:

Pancreatic fistula,a common complication after pancreaticoduodenectomy,is a severe condition with a high mortality. Therefore,early diagnosis of this condition and effective prevention and treatment measures are essential. This article reviews the diagnostic criteria for pancreatic fistula,the risk factors for its development,and research advances in the prevention and treatment of pancreatic fistula.