Portal hypertension( PH) is one of the main complications of cirrhosis. Transjugular intrahepatic portosystemic shunt( TIPS) is the percutaneous creation of a conduit from the hepatic vein to the portal vein that is used to manage consequences of PH( i. e.,variceal bleeding and refractory ascites) and used as a bridging therapy to liver transplant for decompensated cirrhosis. The following Clinical Practice Guidelines( CPGs) presents profession associational recommendations of the Chinese College of Interventionalists( CCI) on TIPS for PH.The CPGs was written by more than 30 experts in the field of TIPS in China( including interventional radiologists,liver surgeons,hepatologists and gastroenterologist,et al.). The panel of experts,produced these CPGs using evidence from PubMed and Cochrane database searches and combined with relevant expert consensuses and high quality clinical researches in China providing up to date guidance on TIPS for PH with the only purpose of improving clinical practice.

Objective To investigate the role and mechanism of endoplasmic reticulum stress in the formation of sex difference in liver diseases. Methods A retrospective analysis was performed to investigate the sex distribution of 23 043 patients with liver diseases in the outpatient service of hepatology and 1110 patients with liver diseases in Department of Hepatology in Zunyi Medical University in 2018. A mouse model of acute liver injury was established by intraperitoneal injection of carbon tetrachloride to confirm the sex difference of liver injury and investigate the mechanism of action of endoplasmic reticulum stress in the formation of sex difference in liver injury. A one-way 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. The chi-square test was used for comparison of categorical data. Results Among the patients in the outpatient service and the hospitalized patients,the male patients had a significantly higher incidence rate than the female patients,with a male/female ratio of 1. 56∶ 1 in the patients in the outpatient service and 1. 86 ∶ 1 in the hospitalized patients,and there was a significant difference between the two groups of patients( χ2= 7. 517,P = 0. 003). The animal model study showed that compared with the female mice with acute liver injury induced by carbon tetrachloride,the male mice had significantly higher death rate( 50% vs 30%,P < 0. 05),serum levels of alanine aminotransferase( 5767. 8 ± 518. 8 U/L vs 4749. 5 ± 378. 0 U/L,P < 0. 05) and total bilirubin( 6. 20 ± 0. 88 mmol/L vs4. 83 ± 0. 57 mmol/L,P < 0. 05),liver necrotic area( 47. 50% ± 4. 65% vs 38. 80% ± 5. 00%,P = 0. 043),and protein expression of the marker for hepatocyte apoptosis clea-caspase-3( 26. 00 ± 2. 11 vs 18. 40 ± 1. 54,P = 0. 042). Compared with the control mice,the model mice had significant increases in the expression of p-PERK,XBP1 s,P58 IPK,and CHOP in the liver( all P < 0. 05). Compared with the female model mice,the male model mice had significantly higher expression of XBP1 s( 25. 92 ± 2. 11 vs 15. 54 ± 1. 21,P = 0. 033),P58 IPK( 28. 60 ± 2. 43 vs 13. 56 ± 1. 13,P = 0. 026),and CHOP( 27. 15 ± 2. 61 vs 18. 18 ± 1. 81,P = 0. 038) and significantly lower expression of p-PERK( 16. 82 ± 0. 11 vs 22. 84 ± 0. 03,P = 0. 043) in the liver. Immunohistochemistry also showed that the male mice had significantly higher expression of CHOP than the female mice( 1. 00 ± 0. 11 vs 0. 62 ± 0. 03,P = 0. 032). Conclusion The uncoordinated activation of the endoplasmic reticulum stress signaling pathway may be involved in the formation of sex difference in liver diseases.

Objective To investigate the value of indocyanine green( ICG) clearance test in evaluating the short-term prognosis of patients with hepatitis B virus( HBV)-related acute-on-chronic liver failure( HBV-ACLF),to establish a new model for prognostic evaluation based on indocyanine green retention rate at 15 minutes( ICGR15) combined with Model for End-Stage Liver Disease( MELD) score and Child-Turcotte-Pugh( CTP) score,and to provide a basis for establishing an ideal model for the short-term prognosis of HBV-ACLF.Methods A total of 97 patients with HBV-ACLF who were admitted to Department of Infectious Diseases in The Affiliated Hospital of Southwest Medical University from June 2017 to January 2019 were enrolled and related clinical data were collected. According to the primary liver disease,these patients were divided into chronic hepatitis B( CHB) group and liver cirrhosis( LC) group; according to the outcome at 3-month follow-up,they were divided into death group and survival group. ICGR15,biochemical indices,and coagulation markers were measured at the time of confirmed diagnosis,and CTP and MELD scores were calculated. The t-test was used for comparison of normally distribu-ted continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The chi-square test was used for comparison of categorical data between groups,and a Spearman rank correlation analysis was used to investigate the correlation of ICGR15 with each variable. A binary logistic regression analysis was used to establish the combined predictive models of MELD-ICGR15 and CTP-ICGR15 for HBV-ACLF. The area under the receiver operating characteristic( ROC) curve( AUC)was used to compare the accuracy of these models in predicting the short-term prognosis of patients with HBV-ACLF,and the Medcalcdcal method was used for comparison of AUC. The maximum of Youden index( sensitivity + specificity-1) was calculated based on the sensitivity and misjudgment rate corresponding to each point on the ROC curve,and the optimal cut-off value for survival or death of patients with HBV-ACLF was determined. Results There were significant differences between the CHB group and the LC group in CTP score( t =-3. 245,P= 0. 002),albumin( Alb)( t = 2. 210,P = 0. 029),alanine aminotransferase( Z =-2. 572,P = 0. 010),and aspartate aminotransferase( Z=-1. 993,P = 0. 046). Compared with the CHB group,the LC group had significantly higher mortality rate( 37. 5% vs 17. 54%,χ2=4. 893,P = 0. 027) and incidence rate of peritonitis( 90% vs 64. 91%,χ2= 7. 945,P = 0. 005). In the CHB group,there were significant differences in ICGR15,MELD score,CTP score,total bilirubin,Alb,prothrombin time activity,prothrombin time,and international normalized ratio between the patients who died and those who survived( t = 3. 036,3. 878,3. 488,2. 756,-3. 049,-3. 954,2. 713,and 2. 717,all P < 0. 05); in the LC group,there were significant differences in ICGR15,CTP score,and Alb between the patients who died and those who survived( t = 3. 476,2. 79,and-2. 274,all P < 0. 05). Regardless of the presence or absence of LC,ICGR15 was positively correlated with MELD score( r = 0. 483 and 0. 35,both P < 0. 05) and CTP score( r = 0. 35 and 0. 411,both P < 0. 05). Based on the binary logistic regression analysis,the combined predictive models of MELD-ICGR15 and CTP-ICGR15 for HBV-ACLF were established,with an AUC of 0. 820 and 0. 847,respectively. The combined predictive models had a larger AUC than each index alone( ICGR15: 0. 787; MELD score: 0. 754;CTP score: 0. 795),and the CTP-ICGR15 model had the largest AUC. ICGR15 had a high sensitivity and a poor specificity,and the combined predictive models improved the specificity of ICGR15 alone; the CTP-ICGR15 model had a higher specificity than the MELD-ICGR15 model.Conclusion ICGR15 has a high sensitivity in predicting the short-term prognosis of HBV-ACLF,and combined predictive models have a higher accuracy than the models of a single index and can improve the specificity of the prediction based on ICGR15 alone. The combined model of CTP-ICGR15 has a higher predictive value than that of MELD-ICGR15.

Objective To investigate the mechanism of action of Qingre Jiedu Liangxue prescription in the treatment of mice with acute-on-chronic liver failure( ACLF). Methods A total of 36 male C57 BL/6 mice were randomly divided into normal group( n = 6),traditional Chinese medicine( TCM) group( n = 6),Western medicine group( n = 6),and model group( n = 18). All mice except those in the normal group were given intraperitoneal injection of 10% CCl4 three times a week for 8 weeks,and LPS 0. 5 mg/kg and D-gal 400 mg/kg were given after last injection. The mice in the model group were sacrificed at 3,12,and 24 hours after D-gal administration. After 4 weeks of intraperitoneal injection of 10% CCl4,the mice in the TCM group and the Western medicine group were given TCM or Western medicine by gavage for 4 weeks and were sacrificed at 3 hours after D-gal administration. Serum levels of alanine aminotransferase( ALT),aspartate aminotransferase( AST),and inflammatory factors were measured; HE staining and picrosirius red staining were used to observe liver pathological changes; immunofluorescence assay was used to observe F4/80 and CD11 b; immunohistochemistry was used to measure the expression of myeloperoxidase( MPO); Western blot was used to measure the expression of CD44,intercellular adhesion molecule-1( ICAM-1),and high-mobility group box 1( HMGB1). A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the SNK-q test was used for further comparison between two groups. Results Compared with the normal group,the 3-hour model group had significant increases in the serum levels of ALT and AST χ2= 51. 41 and 71. 22,( both P < 0. 001),and comparedwith the 3-hour model group,the TCM group had a significant increase in the serum level of interleukin-17 A( IL-17 A) and significant reductions in tumor necrosis factor-α( TNFα),granulocyte-macrophage colony-stimulating factor( GM-CSF),and interleukin-10( IL-10)( all P < 0. 01),as well as significant reductions in the expression of interleukin-1β( IL-1β),monocyte chemotactic protein 1( MCP-1),and interferon gamma( IFNγ)( all P < 0. 05). Compared with the model group,the Western medicine group had significant reductions in the serum levels of GM-CSF,IFNγ,and interferon beta( all P < 0. 05). HE staining showed that compared with the normal group,the model group had severe hepatocyte injury and significant inflammatory cell infiltration. Liver pathological changes were improved after the administration of TCM and Western medicine. The 3-hour model group had a significant increase in the expression of MPO compared with the normal group( P < 0. 05),and the expression of MPO gradually decreased in the 12-and 24-hour model groups( P<0. 05); the TCM group had a significant reduction in the expression of MPO compared with the 3-hour model group( P < 0. 05). The model group had significant increases in the expression of F4/80 and CD11 b compared with the normal group,and the TCM group had significant increases in the expression of F4/80 and CD11 b compared with the 3-hour model group. The model group had significant increases in the expression of CD44 and ICAM-1 compared with the normal group( both P < 0. 05),and the TCM and Western medicine groups had significant reductions in the expression of HMGB1,CD44,and ICAM-1 compared with the 3-hour model group( all P < 0. 05). Conclusion In mice with ACLF,Qingre Jiedu Liangxue prescription can reduce the serum levels of ALT and AST,improve liver injury,increase IL-17 A,and reduce TNFα,GM-CSF,IL-10,IL-1β,MCP-1,and IFNγ． In addition,Qingre Jiedu Liangxue prescription can reduce the expression of MPO,CD44,ICAM-1,and HMGB1 and increase the expression of F4/80 and CD11 b in liver tissue. It is suggested that Qingre Jiedu Liangxue prescription can improve liver injury by regulating neutrophils and Kupffer cells,and further studies are needed to investigate the specific mechanism.

Objective To investigate the value of red blood cell distribution width( RDW),mean platelet volume( MPV),platelet distribution width( PDW),lymphocyte-monocyte ratio( LMR),platelet-lymphocyte ratio( PLR),and neutrophil-lymphocyte ratio( NLR)in evaluating the deterioration and progression of primary biliary cholangitis( PBC). Methods A retrospective analysis was performed for the clinical data of 80 patients who were diagnosed with PBC in The First Affiliated Hospital of Shihezi University from December 2015 to March 2019,including liver function and RDW,MPV,and PDW in routine blood test,and NLR,LMR,and PLR were calculated. According to related diagnostic criteria,the patients were divided into PBC liver cirrhosis group and PBC hepatitis group. The independent samples t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The chi-square test was used for comparison of categorical data between groups. A binary logistic regression analysis was used to investigate the risk factors for PBC liver cirrhosis. The receiver operating characteristic( ROC) curve was plotted to compare the value of different indices in the diagnosis of PBC liver cirrhosis. Results Compared with the PBC hepatitis group,the PBC liver cirrhosis group had a significant reduction in the serum level of white blood cells( Z =-4. 777,P<0. 001) and a significant reduction in the serum level of alanine aminotransferase( Z =-2. 152,P = 0. 031). Compared with the PBC hepatitis group,the PBC liver cirrhosis group had significant increases in RDW,MPV,and NLR( Z =-3. 180,-2. 963,and-3. 590,all P< 0. 05). The binary logistic regression analysis showed that RDW( odds ratio [OR] = 4. 99,95% confidence interval [CI]: 1. 39-17. 92),MPV( OR = 13. 01,95% CI: 2. 96-57. 07),and NLR( OR = 4. 45,95% CI: 1. 59-12. 40) were independent risk factors for progression to liver cirrhosis in PBC patients,for the diagnosis of which RDW,MPV,and NLR had an area under the ROC curve of 0. 683,0. 667,and 0. 741,respectively,while the combination of these three indices had an area under the ROC curve of 0. 891. Conclusion In-creases in RDW,MPV,and NLR may indicate the progression to liver cirrhosis in PBC patients and thus have a certain value in predicting malignant progression in PBC patients.