2019 No. 5

Advances and challenges in the multidisciplinary diagnosis and treatment of pancreatic cancer

Zhang TaiPing, Qiu JiangDong, Feng MengYu, Zhao YuPei

2019, 35(5): 937-940. DOI: 10.3969/j.issn.1001-5256.2019.05.001

Abstract(1623)

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Abstract:
Pancreatic cancer is a highly malignant tumor in the digestive system and has a low rate of surgical resection and poor prognosis.Since pancreatic cancer has unique biological behaviors, surgical resection alone cannot meet the need of clinical treatment. With the popularization of the concept of multimodality therapy, multidisciplinary collaboration can integrate the superior resources of disciplines and develop standardized and individualized diagnosis and treatment process based on patients' conditions. It can help clinicians to observe the indications for neoadjuvant therapy in patients with pancreatic cancer and develop individualized surgical and adjuvant treatment regimens and has achieved a good effect in the treatment of pancreatic cancer. This article summarizes the advances and challenges in the multidisciplinary diagnosis and treatment of pancreatic cancer, in order to improve the level of multidisciplinary diagnosis and treatment of pancreatic cancer in China and the prognosis of patients with pancreatic cancer.

Application of the digital intelligent diagnosis and treatment technique for pancreatic cancer

Fang ChiHua, Zhang Peng

2019, 35(5): 941-945. DOI: 10.3969/j.issn.1001-5256.2019.05.002

Abstract(1497)

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With the advent of the era of digital intelligent diagnosis and treatment, the clinical application of new techniques plays an important role in improving the diagnosis and treatment of pancreatic cancer. The rapid development of digital intelligent diagnosis and treatment techniques, such as three-dimensional visual simulation, three-dimensional printing, virtual reality, augmented-reality surgical navigation, and radiomics, shows the new directions of the diagnosis and treatment of pancreatic diseases and leads digital pancreatic surgery into the era of digital intelligence. With reference to related articles in China and foreign countries and the authors' experience in the digital intelligent diagnosis and treatment of pancreatic cancer, this article elaborates on the current application of related techniques in the diagnosis and treatment of pancreatic cancer and introduces the application of these techniques in preoperative resectability assessment, individualized surgical planning, and visual-guidance surgery for pancreatic cancer, as well as the perspectives of the digital intelligent diagnosis and treatment techniques in improving clinical diagnostic rate of pancreatic cancer, selecting a reasonable treatment regimen, and improving the effect of surgical treatment.

Current status and perspectives of neoadjuvant therapy for pancreatic cancer

Liang TingBo

2019, 35(5): 946-952. DOI: 10.3969/j.issn.1001-5256.2019.05.003

Abstract(1647)

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Abstract:
The multimodality therapy with surgery as the core has gradually become the standard therapy for pancreatic cancer without distant metastasis. At present, many large-sample retrospective clinical studies have shown the value of neoadjuvant therapy in pancreatic cancer, and many international guidelines have recognized neoadjuvant therapy as a fundamental part of pancreatic cancer treatment. There are many ongoing large-scale, prospective, multi-center clinical trials, and the primary results of several studies have shown that neoadjuvant therapy can increase the radical resection rate of tumor and improve overall survival. However, there are still controversies over the value of neoadjuvant therapy in pancreatic cancer, especially resectable pancreatic cancer. In addition, no consensus has been reached on the selection of neoadjuvant regimen, the duration of neoadjuvant therapy, and neoadjuvant regimen after surgery for pancreatic cancer. It is believed that with the appearance of high-level evidence, neoadjuvant therapy will be widely used in pancreatic cancer.

Current status and perspectives of minimally invasive surgical treatment of pancreatic head carcinoma

Chen RuFu, Zhong ChengRui, Zhou QuanBo

2019, 35(5): 953-957. DOI: 10.3969/j.issn.1001-5256.2019.05.004

Abstract(1549)

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Abstract:
Pancreaticoduodenectomy is the only possible surgical procedure for the cure of pancreatic head carcinoma. With the development of minimally invasive surgery, the minimally invasive surgical treatment of pancreatic head carcinoma has become more mature, and an increasing number of grade A tertiary hospitals have reported the minimally invasive surgery for pancreatic head carcinoma. With reference to related articles and experience of our center for pancreatic surgery, this article elaborates on the current status of minimally invasive surgical treatment of pancreatic head carcinoma and points out the perspectives and development directions of minimally invasive treatment of pancreatic head carcinoma.

Immunotherapy for pancreatic ductal adenocarcinoma: Challenges and opportunities

Ge WeiYu, Wang HongXia

2019, 35(5): 958-963. DOI: 10.3969/j.issn.1001-5256.2019.05.005

Abstract(1664)

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Pancreatic ductal adenocarcinoma ( PDAC) is the most common type of pancreatic cancer, and its micrometastases are commonly seen in clinical practice. Although great progress has been made in immunotherapy for malignancies in recent years, immune checkpoint blockade focusing on programmed cell death protein 1 ( PD-1) /programmed death-ligand 1 ( PD-L1) has changed the clinical diagnosis and treatment of non-small cell lung cancer, melanoma, urothelial carcinoma, and renal carcinoma. However, the clinical effect of immunotherapy in PDAC is limited by the low immunogenicity and unique tumor microenvironment ( TME) of PDAC. With the research advances in PDAC-TME, an in-depth analysis of the highly complex interaction network between immune system, tumor cell, and matrix signal may help to develop a rational combination of immunotherapies for PDAC. By elaborating on the unique immunological features of PDAC-TME, this article reviews the potential treatment opportunities for PDAC and the advances in clinical research.

Application and thinking of the concept of enhance recovery after surgery in pancreatic surgery

Tian XiaoDong, Yang YinMo

2019, 35(5): 964-967. DOI: 10.3969/j.issn.1001-5256.2019.05.006

Abstract(1342)

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Abstract:
In recent years, the concept and clinical path of enhanced recovery after surgery ( ERAS) have been widely accepted and applied in clinical practice in China, and it is gradually used in the field of pancreatic surgery. Objective factors such as complexity of disease, difficulties in pancreatic surgeries, and a high incidence rate of postoperative complications have led to the great difference in the clinical application of ERAS concept across pancreas centers, and the application and implementation of related clinical paths in this field is still late than that in other disciplines. At present, there is still a lack of high-level evidence for the application effect of the ERAS concept in pancreatic surgery, and high-quality clinical trials are needed to confirm its safety and efficacy. This article reviews the feasibility of the implementation of ERAS in pancreatic surgery and other hot topics, so as to provide a reference for the research in this field.

Change in HBsAg quantification after HBV DNA negative conversion in chronic hepatitis B patients treated with nucleos (t) ide analogues

Zhou YouQian, Li Cui, Yin FengMing, Zhang HaiYan, Ren Bin, Yang Wei

2019, 35(5): 977-981. DOI: 10.3969/j.issn.1001-5256.2019.05.009

Abstract(1491)

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Objective To investigate the change in HBsAg quantification after HBV DNA negative conversion in chronic hepatitis B ( CHB) patients treated with nucleos ( t) ide analogues ( NAs) . Methods The CHB patients who were treated with NAs in Department of Infectious Diseases, 922 Hospital of PLA & Xiangnan Hospital Affiliated to Hunan Normal University, from January 2016 to November 2018 were enrolled. HBsAg quantitation and HBV DNA quantitation were measured. The chi-square test was used to investigate the difference in the distribution of HBsAg quantitation after HBV DNA negative conversion over the time of treatment. Results A total of 560 HBsAg quantification results were obtained from 275 patients. After 2, 3, 4, 5, and > 5 years of antiviral treatment, the proportion of patients with HBsAg< 20 IU/ml was 1. 2%, 4. 0%, 3. 7%, 4. 3%, and 9. 4%, respectively ( χ2= 11. 186, P = 0. 025) ; the proportion of patients with HBsAg < 200 IU/ml was 9. 9%, 13. 6%, 17. 1%, 23. 4%, and 30. 2%, respectively ( χ2= 21. 449, P < 0. 001) ; the proportion of patients with HBsAg < 1000 IU/ml was 40. 7%, 38. 8%, 56. 1%, 70. 2%, and 67. 9%, respectively ( χ2= 36. 341, P < 0. 001) ; the proportion of patients with HBsAg < 1500 IU/ml was 59. 3%, 64. 8%, 73. 2%, 76. 6%, and 79. 2%, respectively ( χ2= 27. 123, P < 0. 001) .Within 2 years of treatment, the HBeAg-negative patients had a significantly higher proportion of patients with HBsAg < 1000 IU/ml or <1500 IU/ml than the HBeAg-positive patients ( 45. 3%/64. 5% vs 22. 0%/38. 0%, χ2= 9. 039 and 11. 700, P = 0. 003 and 0. 001) . In the third year of treatment, the HBeAg-negative patients had a significantly higher proportion of patients with HBsAg < 1000 IU/ml or <1500 IU/ml than the HBeAg-positive patients ( 52. 6%/71. 1% vs 28. 6%/42. 9%, χ2= 5. 024 and 7. 617, P = 0. 025 and 0. 006) . Among the 162 patients who had multiple HBsAg quantitation tests, 66 had a gradual reduction in HBsAg quantitation, 47 had a gradual increase, and 49 had fluctuations in HBsAg quantitation, among whom 30 had a reduction in HBsAg quantitation from the first test to the last test and 19 had an increase in HBsAg quantitation. Conclusion After achieving virologic response to NAs, most CHB patients can reach the ideal threshold for combined or sequential interferon therapy by prolonged treatment, and some patients can even reach the ideal threshold for drug withdrawal; however, there are still some patients who may not reach the ideal endpoint even if the treatment is extended.

Influencing factors for liver inflammation grade and fibrosis degree in patients with low-level HBV DNA

Liu Li, Li JunYi, Du YingRong, Huang HongLi, Luo Yu, Li HuiMin, Li WeiKun, Wang Lin, Liu ChunYun

2019, 35(5): 982-986. DOI: 10.3969/j.issn.1001-5256.2019.05.010

Abstract(1607)

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Objective To investigate liver pathological features and related factors in patients with low-level HBV DNA, and to provide a basis for evaluating the conditions of such patients. Methods A total of 137 patients with an HBV DNA level of < 2000 IU/ml and > 20 IU/ml who attended The Third People's Hospital of Kunming from January 2014 to December 2017 were enrolled. Liver pathological examination was performed for all patients. Of all patients, 44 had grade 1 ( G1) liver inflammation, 84 had grade 2 ( G2) liver inflammation, and 9 had grade 3 ( G3) liver inflammation; as for fibrosis stage, 2 had S0 fibrosis, 67 had S1 fibrosis, 56 had S2 fibrosis, 9 had S3 fibrosis, and 3 had S4 fibrosis. The correlation of liver inflammation grade and fibrosis stage with age, sex, duration of HBV infection, blood biochemistry, HBsAg level, and HBV DNA was analyzed. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, the chi-square test was used for comparison of categorical data between groups, and univariate and multivariate one-way non-conditional logistic regression analyses were used to investigate the influencing factors for ≥G2 liver inflammation and ≥S2 fibrosis. Results There were significant differences in HBsAg, platelet count ( PLT) , diameter of the splenic vein, and spleen thickness between the G1, G2, and G3 groups ( H = 7. 135, 7. 458, 7. 588, and 10. 150, all P < 0. 05) , and there were also significant differences in HBsAg, PLT, diameter of the portal vein, diameter of the splenic vein, and spleen thickness between the S0, S1, S2, S3, and S4 groups ( H = 20. 564, 12. 065, 26. 171, 14. 720, and 13. 725, all P < 0. 05) . Of all 137 patients, 44 had no or mild inflammation and necrosis ( < G2 group) and 93 had moderate or severe inflammation and necrosis ( ≥G2 group) ; age, alanine aminotransferase, alkaline phosphatase ( ALP) , white blood cell count, diameter of the splenic vein, and spleen thickness, with statistical significance determined by the univariate logistic regression analysis, were included in the multivariate analysis ( α = 0. 15) , and the results showed that age ( odds ratio [OR]= 1. 045, P < 0. 05) , ALP ( OR = 1. 019, P < 0. 05) , and spleen thickness ( OR = 1. 150, P < 0. 05) were independent risk factors for ≥G2 liver inflammation in the patients with low-level HBV DNA. Of all 137 patients, 69 had no or mild liver fibrosis ( < S2 group) and 68 had moderate or severe liver fibrosis ( ≥S2 group) ; total bilirubin, HBsAg, PLT, and diameter of the portal vein, with statistical significance determined by the univariate logistic regression analysis, were included in the multivariate analysis ( α = 0. 15) , and the results showed that HBsAg ( OR = 2. 065) , PLT ( OR = 0. 988) , and diameter of the portal vein ( OR = 2. 464) were independent risk factors for ≥S2 liver fibrosis in the patients with low-level HBV DNA. Conclusion The majority of patients with low-level HBV DNA have the indication of antiviral therapy. Age, ALP, and spleen thickness are closely associated with liver inflammation grade in patients with low-level HBV DNA, and HBsAg, PLT, and diameter of the portal vein are closely associated with liver fibrosis.

Influence of hepatitis C virus on the expression of lipid metabolism indices

Xu Chu, Zhang PingAn

2019, 35(5): 987-991. DOI: 10.3969/j.issn.1001-5256.2019.05.011

Abstract(1258)

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Objective To investigate the influence of hepatitis C virus ( HCV) on the expression of lipid metabolism indices in vitro and in vivo. Methods A total of 114 samples of patients with HCV infection who were treated in Renmin Hospital of Wuhan University from September 2017 to September 2018 were collected as experimental group, and 96 samples of healthy individuals who underwent physical examination were collected as control group. An automatic biochemical analyzer was used to measure blood lipid parameters, including triglyceride ( TG) , total cholesterol ( TCh) , high-density lipoprotein ( HDL) , low-density lipoprotein ( LDL) , small and low-density lipoprotein ( sdLDL) , lipoprotein ( a) , apolipoprotein A1 ( ApoA1) , and apolipoprotein B ( ApoB) . RT-q PCR was used to measure the mRNA expression of fatty acid synthase ( FASN) , acetyl-CoA carboxylase ( ACACA) , hydroxymethylglutarate mono-acyl CoA reductase ( HMGR) , ApoA1, ApoB, and low-density lipoprotein receptor ( LDLR) in Huh7. 5. 1 cells with or without HCV infection. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. Results Compared with the control group, the experimental group had significantly lower serum levels of TCh ( 2. 98 ± 0. 51 mmol/L vs 4. 24 ± 0. 43 mmol/L, t = 4. 96, P < 0. 05) , HDL ( 0. 87 ± 0. 16 mmol/L vs 1. 24 ± 0. 21 mmol/L, t = 5. 65, P < 0. 05) , LDL ( 1. 75 ± 0. 24 mmol/L vs 2. 64 ± 0. 37 mmol/L, t = 3. 88, P < 0. 05) , ApoA1 ( 0. 94± 0. 18 mmol/L vs 1. 47 ± 0. 26 mmol/L, t = 3. 71, P < 0. 05) , and ApoB ( 0. 67 ± 0. 31 mmol/L vs 0. 98 ± 0. 14 mmol/L, t = 4. 41, P <0. 05) . Huh7. 5. 1 cells with HCV infection had significantly lower mRNA expression of Apo A1 than those without HCV infection ( t =-3. 43, P < 0. 05) , as well as significantly higher mRNA expression of FASN, ACACA, HMGR, ApoB, and LDLR ( t = 5. 40, 4. 93, 3. 34, 6. 88, and 3. 84, all P < 0. 05) . Conclusion HCV infection can upregulate the mRNA levels of enzymes involved in the synthesis of fatty acids and cholesterol and thus affect lipid metabolism in vivo and in vitro.

Resistance-associated variants in the non-structural protein 5B region in patients with hepatitis C virus genotype 1b infection in Guangxi, China

Yang Guang, Su MingHua, Jiang JianNing, Wu FeiFei, Zhou Yi, Zhang HuaiDong, Li LinMan, Jiang MengFeng, Huang JinNi, Liang DanDan

2019, 35(5): 992-995. DOI: 10.3969/j.issn.1001-5256.2019.05.012

Abstract(1434)

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Objective To investigate the incidence rate of resistance-associated variants ( RAVs) in the non-structural protein 5B (NS5B) region in patients with hepatitis C virus ( HCV) genotype 1b ( GT1b) infection in Guangxi, China, as well as its difference between male and female patients. Methods A total of 60 previously untreated patients with HCV GT1b infection who were admitted to The First Affiliated Hospital of Guangxi Medical University from April 2016 to September 2018 were enrolled. Their baseline serum samples were collected. The NS5B region fragments were amplified by nested PCR and gene sequencing was performed, and then the sequencing results were compared with standard strains in GeneBank. The t-test was used for comparison of age, HCV RNA, alanine aminotransferase ( ALT) , and aspartate aminotransferase ( AST) between male and female patients, and the Fisher's exact test was used for comparison of mutation rate of drug-resistance sites. Results Of all 60 patients, 55 obtained the complete sequence information of the NS5B region, and the incidence rate of RAVs in the NS5B region was 96. 3%. C316 ( 94. 5%) , A338 ( 70. 9%) , and T19 ( 74. 5%) were the main mutation sites, and multisite mutations such as C316 + T19 and C316 + T19 + A338 were observed. There was no significant difference in the incidence rate of RAVs between male patients and female patients [95. 8% ( 23/24) vs 96. 8% ( 30/31) , P = 1. 000]. Conclusion Patients with HCV GT1b infection in Guangxi have a high incidence rate of RAVs in the NS5B region, with both single-site and multisite mutations.There is no significant difference in the incidence rate of RAVs between male and female patients.

Feasibility, safety, and clinical effect of establishing a green channel for the treatment of cirrhotic portal hypertension with esophagogastric variceal bleeding

Zhou LinFeng, Wang WanSheng, Zhu XiaoLi, Li WanCi, Tang HaoHuan

2019, 35(5): 996-1001. DOI: 10.3969/j.issn.1001-5256.2019.05.013

Abstract(410)

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Objective To investigate the feasibility, safety, and clinical effect of emergency transjugular intrahepatic portosystemic shunt ( TIPS) combined with esophagogastric variceal embolization ( EGVE) in establishing a green channel for the treatment of cirrhotic portal hypertension with esophagogastric variceal bleeding ( EGVB) . Methods A retrospective analysis was performed for the clinical data of 75 patients who underwent TIPS + EGVE in Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, from April 1, 2015 to December 31, 2017. Among these patients, 49 underwent emergency TIPS + EGVE and 26 underwent elective TIPS +EGVE. Postoperative hemostasis rate, length of hospital stay, rebleeding rate within 1 year after surgery, perioperative and postoperative complications, and mortality rate within 1 year after surgery were observed. The t-test was used for comparison of continuous data between the two groups, the chi-square test was used for comparison of categorical data between the two groups, and the Kaplan-Meier method was used to plot survival curves to compare rebleeding rate. Results All 75 patients underwent a successful surgery, with a hemostasis rate of 100% at 1 week after surgery. There was a significant difference in mean hospital stay between the emergency TIPS + EGVE group and the elective TIPS + EGVE group ( 6. 1 ± 1. 0 days vs 8. 1 ± 2. 1 days, t =-4. 685, P < 0. 001) . Among the patients in the emergency TIPS +EGVE group, 2 patients ( 4. 1%) experienced rebleeding, among whom 1 patient ( 2. 0%) experienced rebleeding and died at 2 months after surgery, and the other patient experienced rebleeding at 13 months after surgery and was cured and discharged after conservative treatment; 12 patients ( 24. 5%) had at least one episode of grade ≥2 hepatic encephalopathy during follow-up. Among the patients in the elective TIPS + EGVE group, 4 patients ( 15. 4%) experienced rebleeding after surgery, among whom 3 ( 11. 5%) died; 5 patients ( 19. 2%) had at least one episode of grade ≥2 hepatic encephalopathy, among whom one patient had three episodes of hepatic encephalopathy within one month after surgery. There were no significant differences between the two groups in cumulative rebleeding rate, mortality rate, and incidence rate of hepatic encephalopathy ( P > 0. 05) . Mean blood ammonia level reached the peak at 1 month after surgery and then gradually decreased. Among the 17 patients with hepatic encephalopathy, 11 ( 64. 7%) experienced hepatic encephalopathy within 1 month after surgery, and 15 ( 88. 2%) experienced such disease within 6 months after surgery. Conclusion Emergency TIPS combined with EGVE is feasible, safe, and effective in establishing a green channel in patients with liver cirrhosis and acute EGVB.

Epidemiological characteristics and prognosis of hepatocellular carcinoma: A single-center observational real-world cohort study of 1302 cases

He YaJing, Zhang ZhiMing, He WeiMeng, Hou JinLin

2019, 35(5): 1002-1007. DOI: 10.3969/j.issn.1001-5256.2019.05.014

Abstract(1539)

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Objective To investigate the epidemiological characteristics and clinical prognosis of hepatocellular carcinoma ( HCC) . Methods 1302 HCC patients who were diagnosed and treated in Hepatology Center, Nanfang Hospital, from January 1, 2011 to October 31, 2017 were enrolled, and their clinical and follow-up data were recorded to analyze epidemiological characteristics, recurrence, and survival. The chi-square test was used for comparison of categorical variables, and the Kaplan-Meier method was used to calculate survival and recurrence rates, log-rank test was used for comparison. Results 1302 patients with a male/female ratio of 8. 50 : 1 and a mean age of52. 46 ± 11. 51 years. Of all 1302 patients, 1163 ( 89. 32%) had HBV infection, with a HBeAg-positive/HBeAg-negative ratio of 1: 3. 05; 32 ( 2. 46%) had HCV infection, and 12 ( 0. 92%) had HBV and HCV infections. Of all patients, 1012 ( 77. 73%) had liver cirrhosis. As for liver function classification, most patients are had Child-Pugh class A-B and albumin-bilirubin grade 1-2 liver disease.As for Barcelona Clinic Liver Cancer ( BCLC) stage, 76 patients ( 5. 84%) had BCLC stage 0, 474 ( 36. 41%) had stage A, 236 ( 18. 13%) had stage B, 504 ( 38. 71%) had stage C, and 12 ( 0. 92%) had stage D HCC. Of all 1302 patients, 261 ( 20. 05%) received radical treatment at baseline, and surgery was the main treatment method; among the remaining 1041 patients ( 79. 95%) , most of them received transarterial chemoembolization. The follow-up time ranged from 0. 27 to 88. 70 months, with a median follow-up time of 13. 33 months.The 5-year median overall survival time of all patients was 21. 53 ± 1. 59 months ( 95% confidence interval [CI]: 18. 411-24. 656) , and there was a significant difference in survival time between the patients with different BCLC stages ( P < 0. 001) . In the patients who received radical treatment, the 5-year median overall survival time was not obtained, and their 5-year median recurrence-free survival time was40. 90 ± 4. 81 months ( 95% CI: 31. 467-50. 333) . Conclusion HCC has the epidemiological characteristics from the aspects of demography, etiology, tumor features, and treatment and prognosis, and there are still problems such as a low rate of identification in the early stage, a low rate of radical treatment, and a short survival time. Strategies for HCC prevention and treatment require further investigation and improvement.

Clinical effect of mesohepatectomy versus hemihepatectomy in treatment of centrally located hepatocellular carcinoma: A Meta-analysis

Yu JiShang, Wu Fan, Tan GuoQian, Wang BaiLin

2019, 35(5): 1008-1013. DOI: 10.3969/j.issn.1001-5256.2019.05.015

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Objective To systematically review the clinical effect of mesohepatectomy versus hemihepatectomy in the treatment of centrally located hepatocellular carcinoma ( HCC) . Methods PubMed, EMBASE, Cochrane Library, CKNI, Wanfang Data, and VIP were searched for comparative studies on mesohepatectomy versus hemihepatectomy in the treatment of centrally located HCC. Related data were extracted, including time of operation, intraoperative blood loss, number of patients with postoperative liver failure, mortality rate in the perioperative period, overall survival rate, and disease-free survival rate, and Review Manager 5. 3 software was used for data analysis.The chi-square test was used to evaluate the heterogeneity between these studies. Odds ratio ( OR) was used for the analysis of binary variables, weighted mean difference ( WMD) was used for the analysis of continuous variables, and 95% confidence interval ( CI) was calculated for these variables. Results A total of 10 retrospective case-control studies which met the inclusion criteria were included, with a total sample size of 1861 patients ( 1054 in the mesohepatectomy group and 807 in the hemihepatectomy group) . The meta-analysis revealed that the mesohepatectomy group had a significantly lower incidence rate of postoperative liver failure than the hemihepatectomy group ( OR =0. 37, 95% CI: 0. 16-0. 87, P = 0. 02) , while there were no significant differences between the two groups in time of operation ( WMD =15. 17, 95% CI:-18. 75 to 49. 05, P = 0. 38) , intraoperative blood loss ( WMD = 100. 96, 95% CI:-15. 29 to 217. 21, P = 0. 09) , mortality rate in the perioperative period ( OR = 0. 55, 95% CI: 0. 26-1. 17, P = 0. 12) , incidence rate of bile leakage after surgery ( OR = 1. 32, 95% CI: 0. 74-2. 38, P = 0. 35) , overall survival rate, and disease-free survival rate. Conclusion Mesohepatectomy can significantly reduce the risk of postoperative liver failure. For patients with centrally located HCC and liver cirrhosis, experienced surgeons may give priority to mesohepatectomy.

Value of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in prognostic evaluation of patients with long-term survival after radiofrequency ablation for hepatocellular carcinoma

Zhang HongHai, Sun Yu, Sheng ShouPeng, Li Cong, Sun Bin, Zhang YingHua, Hu CaiXia, Cui XiongWei, Li XingMing, Zhang YongHong, Zheng JiaSheng

2019, 35(5): 1014-1020. DOI: 10.3969/j.issn.1001-5256.2019.05.016

Abstract(1606)

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Objective To investigate the value of platelet-to-lymphocyte ratio ( PLR) and neutrophil-to-lymphocyte ratio ( NLR) in the prognostic evaluation of hepatocellular carcinoma ( HCC) patients with a survival time of > 5 years after radiofrequency ablation. Methods A total of 135 HCC patients who underwent transcatheter arterial chemoembolization combined with radiofrequency ablation in Beijing YouAn Hospital, Capital Medical University, from June 2006 to February 2012 and had a survival time of > 5 years were enrolled. Baseline laboratory and imaging data were collected, and NLR and PLR were calculated based on routine blood test results. The chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic ( ROC) curve was used to determine the cut-off values of NLR and PLR; the Kaplan-Meier method was used to plot survival curves, and the log-rank test was used to compare survival rates; the indices with statistical differences in the log-rank test were included in the Cox multivariate analysis. Results According to the ROC curve, the cut-off value of NLR was 2. 08 and that of PLR was 96. 82. According to the cut-off values of NLR and PLR before treatment, the patients were divided into low NLR group ( NLR < 2. 08, 60 patients) and high NLR group ( NLR≥2. 08, 75 patients) , as well as low PLR group ( PLR < 96. 82, 78 patients) and high PLR group ( PLR≥96. 82, 57 patients) . There were significant differences between the low NLR group and the high NLR group in alpha-fetoprotein ( AFP) and BCLC stage ( χ2= 15. 125 and 9. 649, both P < 0. 05) , and there were significant differences between the low PLR group and the high PLR group in AFP, cholinesterase ( ChE) , BCLC stage, and tumor size ( χ2= 25. 511, 4. 220, 9. 265, and 16. 403, P < 0. 05) . The low NLR group had a significantly higher survival rate than the high NLR group ( χ2= 31. 302, P < 0. 01) , and the low PLR group had a significantly higher survival rate than the high PLR group ( χ2=92. 905, P < 0. 01) . The Cox multivariate analysis showed that preoperative PLR ( odds ratio [OR] = 9. 634, 95% confidence interval[CI]5. 167-17. 964, P < 0. 001) , ChE ( OR = 0. 404, 95% CI: 0. 236-0. 692, P = 0. 001) , tumor diameter ( OR = 3. 861, 95% CI:1. 760-8. 472, P = 0. 001) , and BCLC stage ( OR = 9. 607, 95% CI: 1. 228-75. 151, P = 0. 031) were independent influencing factors for the survival rate of HCC patients with a long-term survival time ( > 5 years) after radiofrequency ablation. Conclusion PLR is an independent risk factor for survival rate of HCC patients with a long-term survival time after radiofrequency ablation, and the prognosis tend to become worse with the increase in PLR. With reference to tumor conditions, it can be used as an important prognostic indicator for the long-term survival of HCC patients after radiofrequency ablation.

A preliminary analysis of the sex distribution of antibiotic resistance genes in patients with intrahepatic bile duct stones

Yang ChenRui, Li JunJian, Zhang YanZhong

2019, 35(5): 1021-1026. DOI: 10.3969/j.issn.1001-5256.2019.05.017

Abstract(988)

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Objective To investigate the distribution of antibiotic resistance genes ( ARGs) in patients with intrahepatic bile duct stones, and to provide a theoretical basis for rational use of antibiotics in clinical practice. Methods A total of 120 patients with intrahepatic bile duct stones ( 60 male and 60 female patients) in People's Hospital Affrliated to Shanxi Medical Universiry, from October 2017 to Septemper2018 were enrolled. Bacterial genome was extracted from the collected specimens, and PCR was used for detection. The 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. Pearson correlation analysis was used to investigate the correlation of normally distributed continuous data. Results Off all ARGs detected, 16 were detected in male patients, among which the sull gene had the highest detection rate ( 9. 4%) ; in male patients, the detection rates of blaCTX-M, blaTEM, blaSHV, blaampC, amp C-01, amp C/blaDHA, bla-ACC-1, blaCMY, blaGES, cfxA, aac, aacc, aadA1, strB, and tetX were 7. 6%, 6. 9%, 7. 3%, 7. 8%, 6. 2%, 6. 5%, 3. 9%, 5. 5%, 2. 4%, 3. 9%, 5. 6%, 7. 4%, 6. 8%, 4. 2%, and 8. 6%, respectively. Off all ARGs detected, 7 were detected in female patients, among which the sull gene had the highest detection rate ( 24%) ; in female patients, the detection rates of blaTEM, aacc, aadD, aadA1, strB, and tetX were 11. 3%, 10. 8%, 8. 4%, 11. 9%, 23. 9%, and 9. 8%, respectively. The aadD gene was not tested in male patients, and blaCTX-M, blaSHV, blaampC, ampC-01, ampC/blaDHA, bla-ACC-1, blaCMY, blaGES, cfxA, and aac were not detected in female patients.16 S rRNA gene was significantly correlated with beta-lactam ARG and tetracycline ARG ( P < 0. 01) , aminoglycoside ARG and sulfonamide ARG ( P < 0. 05) , tnpA gene was significantly correlated with beta-lactam ARG, tetracycline ARGs and sulfonamide ARG ( P < 0. 05) , and intI gene ( P < 0. 01) . Conclusion There are abundant antibiotic resistance genes in patients with intrahepatic bile duct stones, among which the sull gene has the highest abundance. At the same time, male patients have higher abundance of genes than female patients, and female patients have low abundance of beta-lactam ARGs. Therefore, beta-lactam antibiotics should be the first choice for anti-infective therapy for female patients with intrahepatic bile duct stones, while men should use a higher dose of antibiotics or a combination of several antibiotics.

An analysis of the 100 most influential articles in the field of pancreatic diseases in the world from 1990 to 2017

Peng Li, Peng Yan, Tang XiaoWei, Tang ChuanKang, Chen Xia, Ma YuFan, Pu YinQuan

2019, 35(5): 1027-1031. DOI: 10.3969/j.issn.1001-5256.2019.05.018

Abstract(297)

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Objective To investigate the 100 most cited articles in the field of pancreatic diseases in the world from 1990 to 2017. Methods The Web of Science was used to search for the 100 most cited articles on pancreatic diseases published from January 1, 1990 to September 2, 2017, with pancreatology, pancreatitis, pancreatic, and pancreas as the keywords, and these articles were analyzed from the aspects of the number of times cited, country, publication year, research institute, journal, author, research topic, and type of research. Results The number of times cited of these 100 articles ranged from 233 to 1288. They were published in 42 influential journals; among these articles, 11 were published in Gastroenterology, 8 were published in Annals of Surgery, and 7 were published in Cancer Research. The authors of 50 articles came from the U. S. As for the research topic, there were 30 articles on pancreatic cancer, 29 articles on acute pancreatitis, 9 articles on autoimmune pancreatitis, and 9 articles on chronic pancreatitis. As for the type of research, 61 articles were clinical studies, 19 were basic scientific studies, 10 were reviews, 8 were guidelines and consensus statements, and 2 belonged to other types. Conclusion Our study identifies the most frequently cited articles in recent years and analyzes the research trends in the field of pancreatic diseases, which provide a reference for further research in this field.

Clinical effect of the enhanced recovery after surgery strategy for pancreaticoduodenectomy

Ji Bo, Liu SongYang, Zhang Wei, Wang YingChao, Liu YaHui

2019, 35(5): 1032-1036. DOI: 10.3969/j.issn.1001-5256.2019.05.019

Abstract(1530)

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Objective To investigate the clinical effect and safety of the enhanced recovery after surgery ( ERAS) strategy in the perioperative period of pancreaticoduodenectomy ( PD) . Methods A retrospective analysis was performed for the clinical data of 100 patients who underwent PD in The First Hospital of Jilin University from August 2012 to July 2016. The patients were divided into ERAS group and control group according to the management mode during the perioperative period, with 50 patients in each group. The patients in the control group were given routine management, and those in the ERAS group were given ERAS management. The two groups were compared in terms of mortality rate, incidence rate of complications, time of operation, diet, intestinal function, length of postoperative hospital stay, hospital costs, secondary surgical intervention, and readmission rate. The t-test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. Results Two patients in the control group and one in the ERAS group died after surgery. There were no significant differences in mortality, reoperation, and readmission rates between the two groups ( all P > 0. 05) . Compared with the control group, the ERAS group had a significantly lower incidence rate of complications ( 31. 0% vs 56. 3%, χ2= 5. 84, P = 0. 016) and significantly shorter time to first flatus, time to diet, time to ambulation, and time to removal of drainage tube and other tubes ( all P < 0. 001) . There were significant differences between the ERAS group and the control group in length of hospital stay ( 14. 3 ± 1. 2 d vs 18. 5 ± 1. 8 d, t = 13. 73, P < 0. 001) and total hospital costs [10. 7 ± 1. 4 ten thousand yuan vs 13. 2 ± 4. 1 ten thousand yuan, t = 4. 08, P < 0. 001]. Conclusion The ERAS strategy is safe and effective in the perioperative period of PD and can significantly reduce hospital costs, shorten the length of hospital stay, standardize perioperative management, diminish clinical variability, and thus help patients to achieve enhanced recovery. Therefore, it holds promise for clinical application.

Role and mechanism of the high-mobility group box 1/Toll-like receptor 9 signaling pathway in intestinal mucosal barrier injury in severe acute pancreatitis

Pu MinJing, Zhao HongXian, Bo Chao, Zhou XiangYu, Chen Xia

2019, 35(5): 1037-1040. DOI: 10.3969/j.issn.1001-5256.2019.05.020

Abstract(1248)

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Objective To investigate the role and mechanism of the high-mobility group box 1 ( HMGB1) /Toll-like receptor 9 ( TLR9) signaling pathway in intestinal mucosal barrier injury in mice with severe acute pancreatitis ( SAP) . Methods A total of KM mice were randomly divided into control group and SAP group. The mice in the SAP group were given intraperitoneal injection of cerulein and lipopolysaccharide to establish a model of SAP, and the samples were collected at 12 hours after modeling. HE staining was used to observe the pathological changes of the pancreas; ELISA was used to measure the serum levels of diamine oxidase ( DAO) and endotoxin core antibody ( EndoCAb) ; TUNEL was used to observe the apoptosis of intestinal mucosal cells; Western Blot was used to measure the changes in the protein expression of HMGB1, TLR9, and nuclear factor-kappa B ( NF-κB) in the small intestine. The t-test was used for comparison of normally distributed continuous data between two groups. Results A mouse model of SAP was successfully established. Compared with the control group, the SAP group had significantly higher serum levels of DAO ( 12. 172 ± 1. 356 vs 4. 341 ± 0. 521, t = 16. 613, P < 0. 001) and EndoCAb ( 32. 480 ± 3. 054 vs 13. 281 ± 2. 105, t = 14. 725, P = 0. 025) . Compared with the control group, the SAP group had a significant increase in apoptotic intestinal mucosal cells ( 19. 54 ± 3. 63 vs 6. 25 ± 2. 1, t = 11. 582, P < 0. 05) . Compared with the control group, the SAP group had significantly higher protein expression of HMGB1 ( 0. 590 ± 0. 004 vs 0. 059 ± 0. 035, t = 47. 336, P = 0. 001) , TLR 9 ( 0. 530 ± 0. 043 vs 0. 070 ± 0. 023, t = 30. 565, P = 0. 034) , and NF-κB ( 0. 670 ± 0. 059 vs 0. 170 ± 0. 032, t = 23. 655, P =0. 014) . Conclusion There is an increase in the expression of HMGB1 in the intestine of SAP mice, which may play an important role in intestinal mucosal barrier injury by activating the downstream TLR9 signaling pathway.

Clinical effect of nanoparticle albumin-bound paclitaxel combined with gemcitabine in treatment of advanced pancreatic cancer: A meta-analysis

Wang Yun, Zhang GengYuan, Luo ZhangJiang, Yang HanTeng

2019, 35(5): 1041-1046. DOI: 10.3969/j.issn.1001-5256.2019.05.021

Abstract(2405)

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Objective To investigate the clinical effect of nanoparticle albumin-bound paclitaxel ( nab-paclitaxel) combined with gemcitabine in the treatment of advanced pancreatic cancer, and to provide a basis for making better clinical decisions. Methods CBM, CNKI, Wanfang Data, VIP, PubMed, Embase, Cochrane Library, and Web of Science were searched for Chinese and English articles published up to October 2018, with English keywords of“pancreatic cancer”, “gemcitabine”, “nab-paclitaxel”, and “abraxane”and Chinese keywords of“pancreatic cancer”, “gemcitabine”, and“nanoparticle albumin-bound paclitaxel” ( in Chinese) . Appropriate clinical trials were screened out according to the inclusion and exclusion criteria. Then, the data were extracted and quality assessment was performed. RevMan 5. 3 software was used to perform the meta-analysis. Results A total of 10 clinical trials were included, with a total of2908 patients. There were 1633 patients in the study group ( treated with nab-paclitaxel combined with gemcitabine) and 1275 patients in the control group ( treated with FOLFIRINOX) . The results of the meta-analysis showed that compared with the control group, the study group had significantly lower incidence rates of drug side-effects such as fatigue ( odds ratio [OR]= 0. 61, 95% confidence interval [CI]:0. 46-0. 80, P = 0. 0005) , diarrhea ( OR = 0. 39, 95% CI: 0. 29-0. 54, P < 0. 001) , nausea and vomiting ( OR = 0. 46, 95% CI: 0. 26-0. 84, P = 0. 01) , and grade 3-4 neutropenia ( OR = 0. 61, 95% CI: 0. 43-0. 88, P = 0. 007) , as well as a significantly lower rate of second-line treatment ( OR = 0. 30, 95% CI: 0. 14-0. 63, P = 0. 001) . There were no significant differences between the two groups in disease remission rate ( OR = 0. 82, 95% CI: 0. 45-1. 51, P = 0. 53) , disease control rate ( OR = 0. 97, 95% CI: 0. 48-1. 97, P =0. 93) , 1-year survival rate ( OR = 0. 80, 95% CI: 0. 63-1. 01, P = 0. 06) , and incidence rate of complications after neoadjuvant chemotherapy ( OR = 1. 84, 95% CI: 0. 33-10. 19, P = 0. 49) . Conclusion Nab-paclitaxel combined with gemcitabine can improve the clinical outcome of advanced pancreatic cancer without increasing drug adverse events, and therefore, it has good safety and efficacy in clinical practice.

Clinical and pathological features of solid pseudopapillary neoplasm of the pancreas: An analysis of 14 cases

Bai XiaoMei, Sun RunQin, Chen XiaoLi

2019, 35(5): 1047-1051. DOI: 10.3969/j.issn.1001-5256.2019.05.022

Abstract(1656)

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Objective To investigate the clinical features, pathological features, differential diagnosis, and prognosis of solid pseudopapillary neoplasm ( SPN) of the pancreas. Methods A retrospective analysis was performed for the clinical data of 14 patients with SPN who were treated in our hospital from January 2014 to February 2018, and related articles were reviewed. Results There were 11 female and 3 male patients with an age of onset of 13-77 years ( mean 33. 1 years) . Most of them attended the hospital due to lesions found by physical examination or the presence of upper abdominal pain. Radiological examination revealed space-occupying lesion in the pancreas. The maximum diameter of the tumor ranged from 0. 6 cm to 22 cm. Histological examination showed that most tumors were composed of solid areas and pseudopapillary areas, with a microcystic structure in local lesion. Immunohistochemistry showed positive Vimentin and negative CgA, Glucagon, Gastrin, and Insulin in all patients. Some patients were positive for β-catenin ( 13/14) , CD10 ( 10/14) , CD56 ( 9/14) , Syn ( 8/14) , AA-T ( 11/14) , PR ( 8/14) , CyclinD1 ( 9/14) , CA19-9 ( 3/14) , CK-pan ( 9/14) , CEA ( 1/14) , and P53 ( 1/14) . Ki-67 index was ≤10% in all 14 patients. Conclusion SPN of the pancreas should be diagnosed with reference to clinical data, imaging examination, histological features, and immunohistochemistry. The microcystic structure has a certain value in the diagnosis of SPN.

A case of thrombocytopenia due to entecavir

Jiang ZhengYan, Liu ChengHai, Liu Ping, Mu YongPing

2019, 35(5): 1074-1075. DOI: 10.3969/j.issn.1001-5256.2019.05.028

Abstract(1527)

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Direct-acting antiviral agents for treatment of uremia with hepatitis C: A report of 2 cases

Chen QiJun, Shi Ling, Xiu ZiLi

2019, 35(5): 1076-1078. DOI: 10.3969/j.issn.1001-5256.2019.05.029

Abstract(979)

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Misdiagnosis of pseudomyxoma peritonei as cirrhotic ascites: A case report

Li Na, Li JiaNa, Guo FengChang, Hu YuLin

2019, 35(5): 1079-1080. DOI: 10.3969/j.issn.1001-5256.2019.05.030

Abstract(1032)

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Hepatic angiomyolipoma confirmed during hepatic space-occupying lesion resection navigated by indocyanine green fluorescence imaging: A case report

Huang Tao, He Pan, Fang Cheng, Su Song, Xia XianMing, Li Bo

2019, 35(5): 1081-1083. DOI: 10.3969/j.issn.1001-5256.2019.05.031

Abstract(958)

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Renal clear cell carcinoma with large hepatocellular carcinoma metastasis: A case report

Zhu ZeMin, Xie ZhiQin, Zhao ZhiJian, Li Bin, Li HongXia, Tang CaiXi

2019, 35(5): 1084-1085. DOI: 10.3969/j.issn.1001-5256.2019.05.032

Abstract(1163)

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Fructus Swietenia Macrophylla-induced liver injury: A report of 2 cases

Zhao Xi, Qi Yue, Cai YanJun

2019, 35(5): 1086-1088. DOI: 10.3969/j.issn.1001-5256.2019.05.033

Abstract(1646)

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Histiocytic necrotizing lymphadenitis with abnormally elevated enzymes: A case report

Ji TongTong, Zhao YueTong, Lu HaiYing, Yu YanYan

2019, 35(5): 1089-1091. DOI: 10.3969/j.issn.1001-5256.2019.05.034

Abstract(1125)

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A case of Henöch-Schönlein syndrome with acute pancreatitis

Xi YiQing, Xie Wei

2019, 35(5): 1092-1094. DOI: 10.3969/j.issn.1001-5256.2019.05.035

Abstract(1033)

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Pancreatic liposarcoma: A case report

Li ShuXuan, Wu Hao, Kou Kai, Lu: GuoYue

2019, 35(5): 1095-1097. DOI: 10.3969/j.issn.1001-5256.2019.05.036

Abstract(1066)

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A case of aberrant common hepatic artery in pancreaticoduodenectomy

Zhao JianNan, Fan Ying, Wu ShuoDong

2019, 35(5): 1098-1099. DOI: 10.3969/j.issn.1001-5256.2019.05.037

Abstract(1083)

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Splenic sclerosing angiomatoid nodular transformation: A case report

Wang ShouQian, Yang Yang, Li LiangTao, Guan QingChun, Wang YingChao

2019, 35(5): 1100-1102. DOI: 10.3969/j.issn.1001-5256.2019.05.038

Abstract(1055)

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Mother-to-child vertical transmission of hepatitis B virus and its prevention with tenofovir disoproxil fumarate

Chen YouPeng

2019, 35(5): 1103-1105. DOI: 10.3969/j.issn.1001-5256.2019.05.039

Abstract(1202)

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This article reviews the research advances in mother-to-child vertical transmission of hepatitis B virus ( HBV) , cause of standard immunoprophylaxis failure against HBV, and use of tenofovir disoproxil fumarate ( TDF) during pregnancy to prevent mother-to-child vertical transmission of HBV, in order to provide guidance for future clinical studies. Our purpose is to perform scientific clinical management and completely prevent the mother-to-child transmission of HBV.

Sexual transmission of viral hepatitis

Cao YangWei, Li YongGuo

2019, 35(5): 1106-1108. DOI: 10.3969/j.issn.1001-5256.2019.05.040

Abstract(1000)

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At present, there is still controversy over sexual transmission as one important mode of transmission for viral hepatitis, and many epidemiological investigations have confirmed that the transmission of viral hepatitis is closely associated with sexual contact in high-risk adults. This article elaborates on the current status of epidemiological studies on viral hepatitis A, B, and C and discuss related etiologies and pathogeneses, in order to raise the awareness of sexual transmission of viral hepatitis.

Association between gut microbiota and hepatic encephalopathy in patients with liver cirrhosis

Tang ShiHao, Chen Hui, Han GuoHong

2019, 35(5): 1109-1113. DOI: 10.3969/j.issn.1001-5256.2019.05.041

Abstract(1080)

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Hepatic encephalopathy ( HE) is an important indicator of decompensated cirrhosis and is one of the most common causes of death. With the development of research on gut microbiota in patients with liver cirrhosis in recent years, the role of gut microbiota in the pathogenesis of HE has attracted wide attention. At present, next-generation sequencing has deepened the understanding of the composition and function of gut microbiota among researchers, and HE treatment targeting gut microbiota has achieved remarkable results. The research on gut microbiota helps to further clarify the pathogenesis of HE and may provide more treatment methods for patients with HE.

Current status and future perspectives of the application of medical 3D visualization technology in accurate surgery of liver tumors

Li ShanShan, Zhang Ke, Cheng ShuJie, Yang JiHong, Gao Feng, Li JingHua

2019, 35(5): 1114-1117. DOI: 10.3969/j.issn.1001-5256.2019.05.042

Abstract(1249)

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There is a rapid development of 3D visualization ( 3DV) technology in the medical field nowadays. The 3 DV model of the liver established by original CT and/or MRI imaging data can provide information on the complex structure of the liver in a variety of modes and help surgeons to perform better preoperative evaluation and individualized planning, so as to realize optimal protective liver resection and finally help patients get the best benefits. This article reviews the research advances in 3DV technology and precision surgery for liver tumors.

Advances in the diagnosis and treatment of cystic space-occupying lesions in the liver

Xu XiaoLei, Gao CanCan, Wang ZhiXin, Wang Zhan, ZHOU Ying, Wang HaiJiu, Ye HaiWen, Pang MingQuan, Zhou Hu, Hou YaJun, Guo Bing, Fan HaiNing

2019, 35(5): 1118-1122. DOI: 10.3969/j.issn.1001-5256.2019.05.043

Abstract(1622)

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Cystic lesions of the liver are classified into parasitic and non-parasitic lesions. Parasitic lesions mainly refer to hepatic cystic echinococcosis, and non-parasitic lesions can be further classified into benign, borderline, and malignant lesions. At present, there are still no comprehensive standard treatment of cystic space-occupying lesions in the liver. With reference to related literature in China and foreign countries, this article reviews the etiology, clinical manifestations, and diagnosis and treatment of hepatic cystic diseases, so as to improve the understanding of this disease.

Mechanism of action of protein phosphatase 2A in the promotion and inhibition of hepatocellular carcinoma

Yang ChengLei, Huang Shen, Zhang ZhiMing

2019, 35(5): 1123-1128. DOI: 10.3969/j.issn.1001-5256.2019.05.044

Abstract(992)

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Protein phosphatase 2A ( PP2A) is a major serine/threonine phosphatase involved in many signaling pathways associated with cell growth and proliferation, and it also regulates many cellular processes. With an in-depth exploration of PP2A in the process of cell activity, especially malignant tumors, the association between PP2A and hepatocellular carcinoma ( HCC) has attracted more and more attention in recent years; however, there is still a controversy over whether PP2A can promote or inhibit HCC. This article reviews the research advances in the mechanism of action of PP2A as a tumor factor in the regulation of HCC and target therapy.

Role and mechanism of autophagy in development and progression of hepatocellular carcinoma and regulation of immunotherapy

Wang MuQi, Li YaPing, Liu LaYang, Dang ShuangSuo, Shi JuanJuan, Jia XiaoLi

2019, 35(5): 1129-1134. DOI: 10.3969/j.issn.1001-5256.2019.05.045

Abstract(1216)

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As a basic physiological phenomenon, autophagy plays an important role in maintaining cellular homeostasis and physiological metabolism and can also induce programmed cell death. At present, many studies have shown that autophagy plays an important role in the development, progression, and metastasis of various tumors, which provide new viewpoints for tumor research and treatment. Hepatocellular carcinoma has an extremely complex pathogenesis, and the effect of immunoregulation on the development, metastasis, and invasion of hepatocellular carcinoma has been generally accepted. Recent studies have found that autophagy is involved in tumor immunity, oxidative stress, and maintenance of cellular homeostasis and thus affect the progression of hepatocellular carcinoma. It may also influence the effect of immunotherapy via multiple pathways. This article reviews the role and mechanism of autophagy in the development and progression of hepatocellular carcinoma and the regulation of immunotherapy, in order to understand the significant influence of autophagy on hepatocellular carcinoma and the potential therapeutic value of autophagy.

Current status and perspectives of prognostic markers for liver failure

Liu YeYing, Wang Ting, Dou AiHua, Zheng SuJun, Xu Bin, Liu Mei

2019, 35(5): 1135-1139. DOI: 10.3969/j.issn.1001-5256.2019.05.046

Abstract(937)

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Accurate judgment of conditions and prognosis has important clinical significance in improving survival rate and optimal distribution of liver source in patients with liver failure. This article reviews the current application of prognostic markers for liver failure such as alanine aminotransferase, aspartate aminotransferase, total bilirubin, prothrombin time, prothrombin time activity, and international normalized ratio and summarizes the new markers discovered in recent years, such as inflammatory response-related markers, neutrophil gelatinase-associated lipocalin, immune response-related markers, keratin, intestinal flora, microRNAs, liver failure autoantigen and autoantibody, and hemodynamic disorder. It is pointed out that the prognosis of liver failure is affected by many factors and there is still a lack of more sensitive and effective markers and a standardized prognostic scoring system. The new markers used alone or in combination with traditional markers may help to improve the sensitivity and specificity of prognostic evaluation of liver failure.

Potential value of aquaporin-8 in treatment of liver diseases

Peng Xin, Qing DuXin

2019, 35(5): 1140-1142. DOI: 10.3969/j.issn.1001-5256.2019.05.047

Abstract(941)

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Aquaporins are involved in bile metabolism and cell signal transduction. This article briefly describes the role and mechanism of action of aquaporins in cholestatic liver disease, alcoholic liver disease, hepatic encephalopathy, and liver cancer and points out that aquaporin agonists may be a future direction of treatment of these liver diseases, which provides new ideas for the treatment of liver diseases.

Clinical application of magnetic resonance elastography in noninvasive diagnosis of chronic liver diseases

Wang Han, Wang Yu, Ma Hong

2019, 35(5): 1143-1147. DOI: 10.3969/j.issn.1001-5256.2019.05.048

Abstract(1173)

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Accurate judgment of liver fibrosis stage has great significance in the evaluation of chronic liver diseases. Various noninvasive methods have been used for the evaluation of liver fibrosis in recent years, in order to reduce the application of liver biopsy. This article introduces the importance of magnetic resonance elastography ( MRE) in the evaluation of chronic liver diseases. MRE can not only be used to diagnose liver fibrosis, but also be used to evaluate the degree of portal venous pressure, diagnose nonalcoholic steatohepatitis, and evaluate local lesions in the liver. It is pointed out that MRE may become a better method than serological parameters and other imaging indices for the noninvasive diagnosis of chronic liver diseases.

Stimulator of interferon genes inhibits the development and progression of chronic liver diseases

Zhang Xue, Li Man, Zhang Xin, Sun XueHua, Zhu XiaoJun, Gao YaTing, Gao YueQiu

2019, 35(5): 1148-1152. DOI: 10.3969/j.issn.1001-5256.2019.05.049

Abstract(1177)

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Stimulator of interferon genes ( STING) is an important congenital cytoplasmic cyclic dinucleotide sensor that regulates the internal environment of the liver. It activates IRF3/IRF7 and inhibits the development and progression of chronic liver diseases such as chronic hepatitis B, liver fibrosis, and hepatocellular carcinoma through innate immune response, specific T cell response, and autophagy. This article introduces the distribution, structural characteristics, biological functions, and signaling pathways of STING and its role in the development and progression of chronic liver diseases, in order to elaborate on the role of STING in the intervention of chronic liver diseases and provide new ideas for treatment.

Assessment of endoscopic retrograde cholangiopancreatography combined with intraductal radiofrequency ablation in treatment of malignant biliary obstruction

Wang JianMing, Liang JinYao, Luo ShiQiao

2019, 35(5): 1153-1156. DOI: 10.3969/j.issn.1001-5256.2019.05.050

Abstract(1254)

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Malignant biliary obstruction is often in an advanced stage at the time of diagnosis, and palliative relief of obstruction has become the main treatment option. Biliary stent implantation is currently the most widely used treatment for the relief of biliary obstruction, but stent reobstruction has become a common problem in clinical practice. Endoscopic retrograde cholangiopancreatography ( ERCP) combined with intraductal radiofrequency ablation can solve the problem of direct obstruction in malignant biliary obstruction and improve stent patency rate, survival time, and survival rate, with few complications and a low surgery-related mortality rate, and therefore, it can be used as a safe and feasible palliative treatment method for malignant biliary obstruction.

The role of autophagy in the development and progression of acute pancreatitis

Li ChunYun, Liu RuiXia, Yin ChengHong

2019, 35(5): 1157-1160. DOI: 10.3969/j.issn.1001-5256.2019.05.051

Abstract(1222)

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Acute pancreatitis ( AP) is an exocrine inflammatory disease of the pancreas, the pathophysiological mechanism of AP remains unclear. Autophagy is an important pathway of metabolic degradation in cells, and autophagy impairment is closely associated with the development and progression of many diseases. Recent studies have found that the process of autophagy is abnormal in AP, with impaired fusion of autophagosome and lysosome and a significant reduction in the degradation function of autolysosome. Abnormal activation of pancreatic enzymes and inflammatory response is the key event in the initiation of AP, and abnormal autophagy is closely associated with these two events.The study of the upstream and downstream mechanisms of autophagy dysfunction in AP may help to find new molecular targets and strategies for the treatment of AP.

Current status of the research on nonalcoholic fatty pancreatic disease

Yuan BeiBei, Tan YuE, Liu JingJing, Liu Huan, Liu Jia, Song QingLian, Dai GuangRong

2019, 35(5): 1161-1164. DOI: 10.3969/j.issn.1001-5256.2019.05.052

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Nonalcoholic fatty pancreatic disease ( NAFPD) is defined as pancreatic fat deposition associated with obesity in the absence of significant drinking, and its pathogenesis remains unclear. NAFPD is closely associated with nonalcoholic fatty liver disease ( NAFLD) , type2 diabetes, pancreatitis, pancreatic tumor, and pancreatic fistula after pancreaticoduodenal surgery and can promote the spread of pancreatic cancer cells and result in the early death of patients with pancreatic cancer. The diagnosis and evaluation of NAFPD mainly rely on pathological biopsy and imaging examination, but their clinical application is limited by detection techniques and diagnostic level. Major prevention and treatment methods for NAFPD include a reduction in body weight, bariatric surgery, and pharmacotherapy. Since there are few articles on NAFPD and it is not taken seriously in clinical practice, there are significant differences in the clinical diagnosis and treatment of this disease. Therefore, this article elaborates on the current status of research on NAFPD and the advances in its diagnosis and treatment.

Research advances in exosomes in diagnosis of pancreatic cancer

Zhang Cheng, Meng Di, Zhang BingYe, Ge ChunLin

2019, 35(5): 1165-1167. DOI: 10.3969/j.issn.1001-5256.2019.05.053

Abstract(1557)

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Pancreatic cancer is a digestive system malignancy with high mortality. Exosomes are membranous vesicles with a diameter of 30-200 nm, which are released by various cells into the extracellular matrix. Exosomes can carry various molecules such as RNA, DNA, proteins, and lipids and bind to target cells to mediate the communication between cells and regulate the physiological function of cells. Recent studies have shown that exosomes play an important role in the development and progression of pancreatic cancer and can help with the early diagnosis of pancreatic cancer, and exosomes are expected to become a new biomarker for the diagnosis of pancreatic cancer. This article reviews the research advances in the role of exosomes in the early diagnosis of pancreatic cancer.

An excerpt of ESPEN guideline on clinical nutrition in liver disease (2019)

Xiao HuiJuan, Qi YuMei, Han Tao

2019, 35(5): 968-972. DOI: 10.3969/j.issn.1001-5256.2019.05.007

Abstract(339)

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An excerpt of INASL guidelines on management of hepatitis B virus infection in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids (2018)

Yin JiPeng, Yang JianJiang, Wu DongBo, Tang ShanHong, Ceng WeiZheng

2019, 35(5): 973-976. DOI: 10.3969/j.issn.1001-5256.2019.05.008

Abstract(141)

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Abstract:

Stent dysfunction after transjugular intrahepatic portosystemic shunt: Causes and countermeasures

Yao Xin, Zhou Hao, Tang ShanHong, Xie Min, Huang Shan, Qin JianPing

2019, 35(5): 1052-1056. DOI: 10.3969/j.issn.1001-5256.2019.05.023

Abstract(1587)

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Abstract:
Objective To investigate the causes of dysfunction of COOK bare stent, Wallgraft covered stent, and Fluency covered stent after transjugular intrahepatic portosystemic shunt ( TIPS) and related countermeasures. Methods The clinical data of 54 patients who were found to have stent dysfunction and underwent TIPS correction in our hospital from January 2011 to July 2017 were collected. Balloon dilatation, coaxial stent implantation, or parallel TIPS was selected based on angiography results and portal venous pressure to repair stent dysfunction. The Kruskal-Wallis H test was used to compare in-stent restenosis or occlusion time between the three types of stents, and the paired t-test was used to compare portal vein perfusion ( PVP) before and after correction. Radiological examination was performed to evaluate stent dysfunction, and the cause of in-stent restenosis or occlusion was analyzed. Results TIPS correction was successfully performed for all 54 patients. Stenosis was observed in the hepatic vein, the liver parenchyma, or the portal vein, and there was a high incidence rate within 6-24 months after surgery. The median time to stenosis or occlusion was 17. 0 months for COOK bare stent, 10. 0 months for Wallgraft covered stent, and 17. 0 months for Fluency covered stent. COOK bare stent and Fluency covered stent had a longer time to stenosis or occlusion than Wallgraft covered stent ( P = 0. 013 and 0. 023) , and there was no significant difference in the time to stenosis or occlusion between COOK bare stent and Fluency covered stent ( P = 0. 893) . As for the surgical procedure of TIPS correction, 4 patients underwent balloon dilatation, 39 underwent coaxial stent implantation, and 11 underwent parallel TIPS. There was a significant reduction in portal venous pressure after surgery ( 25. 6 ± 4. 8 cm H2O vs 34. 7 ± 6. 4 cm H2O, P < 0. 001) . Conclusion Wallgraft stent has a significantly shorter time to stent dysfunction after TIPS than COOK bare stent and Fluency covered stent, suggesting that Wallgraft stent is not suitable for the initial establishment of TIPS shunt. Correction procedures should be selected based on actual conditions to repair stent dysfunction and restore shunt patency.

Effect of silibinin on liver aminotransferases in patients with nonalcoholic fatty liver disease: A meta-analysis

Chang Yue, Zhang Wen, Liu QinYu, Zhang Qing, Chen Kai, Li Hai

2019, 35(5): 1057-1060. DOI: 10.3969/j.issn.1001-5256.2019.05.024

Abstract(1571)

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Abstract:
Objective To conduct a meta-analysis of the articles on the effect of silibinin on aminotransferases in patients with nonalcoholic fatty liver disease ( NAFLD) , and to investigate the liver-protecting effect of silibinin in patients with NAFLD. Methods CNKI, Wanfang Data, VIP, SinoMed, PubMed, MEDLINE, Embase, and ScienceDirect were searched for randomized controlled trials ( RCTs) on the treatment of NAFLD patients with silibinin, The articles were screened according to inclusion and exclusion criteria, and then quality assessment and data extraction were performed. RevMan 5. 3 was used to perform the meta-analysis. Results A total of 8 articles with 665 patients were included. After 8 weeks to 3 months of silibinin treatment, there were significant reductions in the serum levels of alanine aminotransferase ( ALT) ( weighted mean difference [WMD]=-11. 60, 95% confidence interval [CI]:-18. 68 to-4. 51, P = 0. 001) and aspartate aminotransferase ( AST) ( WMD =-11. 56, 95% CI:-16. 93 to-6. 18, P < 0. 001) . Conclusion Silibinin can significantly reduce the serum levels of ALT and AST in patients with NAFLD.

Risk factors of nonalcoholic fatty liver disease with a normal visceral adipose tissue area

Huang ZhiPeng, Jiang JianJia, Huang ZiCheng, Guo GuiYuan, Zhou APei, Liu XiaoQiang

2019, 35(5): 1061-1064. DOI: 10.3969/j.issn.1001-5256.2019.05.025

Abstract(1402)

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Abstract:
Objective To investigate the risk factors and insulin resistance ( IR) of nonalcoholic fatty liver disease ( NAFLD) with a normal visceral adipose tissue ( VAT) area. Methods A total of 45 NAFLD persons with a normal VAT area who were admitted to Quanzhou First Hospital Affiliated to Fujian Medical University from June 2017 to May 2018 were enrolled as observation group, and 27 non-NAFLD patients with a normal VAT area were enrolled as control group. VAT area, waist circumference, fasting blood glucose ( FBG) , and fasting insulin ( FINS) were measured for both groups, homeostasis model assessment of insulin resistance ( HOMA-IR) was calculated, and the correlation of IR with the indices including waist circumference was analyzed. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between groups. Pearson correlation analysis and Spearman correlation analysis were used to investigate the correlation of normally and non-normally distributed continuous data. A forward logistic regression analysis was used to identify related risk factors. Results The NAFLD group had a significantly higher level of IR than the control group, and there was a significant difference in HOMA-IR between the two groups ( 2. 66 ( 1. 59-4. 06) vs 1. 84 ( 1. 25-2. 47) , Z = 364. 000, P = 0. 005) . IR was positively correlated with FBG ( r = 0. 412, P = 0. 005) , FINS ( r = 0. 789, P <0. 001) , and TG ( r = 0. 306, P = 0. 041) . IR was negatively correlated with HDL ( r =-9. 398, P = 0. 007) . The multivariate regression analysis showed that waist circumference was an independent risk factor for NAFLD with a normal VAT area ( regression coefficient = 0. 181, odds ratio = 1. 198, 95% confidence interval: 1. 099-1. 306, P < 0. 001) . Conclusion There is a certain degree of IR in NAFLD patients with a normal VAT, and waist circumference is an independent risk for NAFLD with a normal VAT.

Effect of plasma exchange combined with continuous renal replacement therapy on the prognosis of patients with HBV-related acute-on-chronic liver failure and acute kidney injury

Yao YunHai, Gan JianHe, Zhao WeiFeng

2019, 35(5): 1065-1069. DOI: 10.3969/j.issn.1001-5256.2019.05.026

Abstract(1454)

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Abstract:
Objective To investigate the effect of plasma exchange ( PE) combined with continuous renal replacement therapy ( CRRT) on the prognosis of patients with HBV-related acute-on-chronic liver failure ( ACLF) and acute kidney injury ( AKI) . Methods A retrospective analysis was performed for the clinical data of 198 HBV-ACLF-AKI patients who were admitted to The First Affiliated Hospital of Soochow University from August 1, 2013 to August 1, 2017. According to the technique of blood purification, they were divided into pharmacotherapy group ( group A with 68 patients) , PE group ( group B with 56 patients) , and PE + CRRT group ( group C with 74 patients) .Related clinical data on admission were collected, including sex, age, biochemical parameters after blood purification ( total bilirubin, albumin, serum sodium, international normalized ratio, white blood cell count, platelet count, and hematocrit) , common complications, and blood purification method. Creatinine clearance rate ( CCR) , estimated glomerular filtration rate ( eGFR) , and MELD combined with serum sodium concentration ( MELD-Na) were calculated before and after treatment. A one-way analysis of variance was used for comparison of normally distributed continuous data between three groups; the paired t-test was used for comparison within one group before and after treatment, and the two samples t-test was used for comparison between groups. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between three groups; the paired samples Wilcoxon signed rank test was used for comparison within one group before and after treatment, and the Mann-Whitney U test was used for comparison between groups. The chi-square test was used for comparison of categorical data between three groups. The Cox proportional-hazards regression model was used to investigate the influencing factors for survival time and outcome. Results Before treatment, there were significant differences between the three groups in sex, age, blood biochemical parameters, eGFR, CCR, complications, and MELD-Na ( all P > 0. 05) . Groups B and C had significant increases in eGFR and CCR and a significant reduction in MELD-Na after treatment ( group B: Z =-2. 81, Z =-3. 67, t = 6. 07, all P < 0. 05;group C: Z =-5. 81, Z =-4. 05, t =-6. 90, all P < 0. 05) , and there were no significant differences in eGFR, CCR, and MELD-Na between groups B and C after treatment ( all P > 0. 05) . The regression analysis showed that eGFR, CCR, and MELD-Na after blood purification were influencing factors for the survival indices of ACLF-AKI patients ( all P < 0. 05) . The risk of death and cumulative risk gradually increased over the time of hospitalization. Conclusion PE alone or in combination with CRRT can significantly improve the renal function of ACLF-AKI patients, but the combination treatment has no obvious advantages. The improvement in renal function after blood purification directly affects the prognosis of ACLF-AKI patients, and the risk of death and cumulative risk gradually increase over the time of hospitalization.

Value of anti-nuclear antibody and liver pathology in diagnosis of male patients with autoimmune liver diseases

Xiao Qian, Tan ShanZhong, Zhao TianHui, Sun WeiWei, Shen JianJun, Liang ZhongFeng, Jiang ShuLian

2019, 35(5): 1070-1073. DOI: 10.3969/j.issn.1001-5256.2019.05.027

Abstract(1280)

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Abstract:
Objective To investigate the value of anti-nuclear antibody ( ANA) in the diagnosis of male patients with autoimmune liver diseases and the role of liver pathology in the examination of autoimmune liver diseases. Methods A total of 84 male patients with unexplained liver diseases who visited Nanjing Second Hospital from December 2016 to June 2018 were enrolled, and among them, 36 had positive ANA and 48 had negative ANA. The two groups were compared in terms of liver pathology, laboratory examination, and diagnosis. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. The Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups, and the Nemenyi test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. Results Among the 36 male patients in the positive ANA group, 5 had autoimmune hepatitis and 1 had overlap syndrome; among the patients in the negative ANA group, 5 had autoimmune hepatitis and 5 had overlap syndrome. There was no significant difference between the two groups in the proportion of patients with a confirmed diagnosis of autoimmune liver diseases ( 16. 7% vs 20. 8%, χ2= 0. 23, P > 0. 05) . All the patients were divided into autoimmune hepatitis group with 10 patients, overlap syndrome group with 6 patients, drug-induced liver injury group with 17 patients, and other group with 51 patients, and there were significant differences in immunoglobulin G and globulin between groups ( F = 2. 977 and 6. 972, P < 0. 05) . Interface hepatitis was observed in all ten patients with autoimmune hepatitis. Four patients in the positive ANA group and three in the negative ANA group had lymphocyte-plasma cell infiltration. Rosette-like changes of hepatocytes were found in two patients each in the positive ANA group and the negative ANA group. Lymphocyte penetration was observed in two patients and multinucleated giant hepatocytes were seen in one patient. The six patients with overlap syndrome had the pathological manifestation of moderate to severe interface hepatitis or debris-like necrosis and inflammatory infiltration in the portal vein area; among these patients, two had rosette-like changes of hepatocytes, and two had interlobular bile duct injury, lymphocyte infiltration/granuloma formation around the bile duct, and secondary hepatic fibrosis. Conclusion Positive or negative ANA has little significance in the diagnosis of autoimmune liver diseases ( autoimmune hepatitis and overlap syndrome) in ANA-positive male patients with unexplained liver diseases. Liver pathological results should be incorporated into the comprehensive analysis, which may help with the diagnosis of liver diseases.

2019 Vol. 35, No. 5

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2019 Vol. 35, No. 5

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