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

2014 No. 8

Display Method:
Editorial
Current status and thinking of diagnosis and treatment of severe acute pancreatitis
Li ZhaoShen, Du YiQi
2014, 30(8): 709-711. DOI: 10.3969/j.issn.1001-5256.2014.08.001
Abstract:
The guidelines for the diagnosis and treatment of acute pancreatitis are the important reference for clinicians in treating acute pancreatitis, especially severe acute pancreatitis (SAP) .However, currently there is much discrepancy on the opinion and practice in China, which affects the treatment outcome and cure rate of this disease.Clinical focuses are described in terms of the diagnostic criteria and treatment for SAP, with the hope of initiating reflection and discussion on the clinical diagnosis and treatment of SAP.
Therapeutic guidelines
Diagnosis and treatment of acute pancreatitis:comparison and interpretation of the main guidelines in China and abroad
Zhang TaiPing, Cao Zhe, Zhao YuPei
2014, 30(8): 712-715. DOI: 10.3969/j.issn.1001-5256.2014.08.002
Abstract:
A review of ISGPS consensus on definition and classification of post- pancreatic surgery complications
Yang GuiYuan, Qian ZhuYin
2014, 30(8): 716-718. DOI: 10.3969/j.issn.1001-5256.2014.08.003
Abstract:
Recommendations on hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases
Zhang Ying, Liu Wei, Zhang FuKui
2014, 30(8): 719-721. DOI: 10.3969/j.issn.1001-5256.2014.08.004
Abstract(3627) PDF (1377KB)(1128)
Abstract:
Discussions by experts
Diagnosis and treatment of drug- induced pancreatitis
Qian JiaMing, Wang ShuJun
2014, 30(8): 722-725. DOI: 10.3969/j.issn.1001-5256.2014.08.005
Abstract:
Drug- induced pancreatitis (DIP) belongs to gastrointestinal drug- induced diseases.With the wide use of drugs, the number of drugs that may induce DIP is increasing.Since there are not specific clinical indicators for detecting DIP or a complete diagnostic and therapeutic process for DIP, its diagnosis is often missed.The epidemiology and pathogenesis of DIP, as well as drugs inducing DIP and their classifications, are reviewed.It is stressed that careful collection of medication history of DIP patients and timely discontinuation of suspected pharmacological agents are the key to diagnosis and treatment of this disease, and the patients should be informed of the related drugs that induce DIP to prevent its recurrence.
Clinical features and treatment of organ failure in severe acute pancreatitis
Cui LiJian, Liu RuiXia, Wang Yan, Yin ChengHong
2014, 30(8): 726-729. DOI: 10.3969/j.issn.1001-5256.2014.08.006
Abstract:
Organ failure is an important factor causing death in patients with severe acute pancreatitis (SAP) .In recent years, thanks to the further study of pathophysiology of SAP and the continuous accumulation of experience and technology, substantial progress has been made in the diagnosis and treatment of SAP complicated by organ failure.The clinical features of SAP complicated by organ failure and the measures to be strengthened in the treatment of SAP are summarized.Currently, it is thought that organ failure tends to appear once SAP occurs, so timely, standardized treatment can shorten the course of disease and significantly reduce mortality.
Role of autophagy in development and progression of acute pancreatitis
Yang ShuLi, Liu Jie, Chen WeiChang
2014, 30(8): 730-733. DOI: 10.3969/j.issn.1001-5256.2014.08.007
Abstract:
Acute pancreatitis is considered an autodigestive disorder in which inappropriate activation of trypsinogen to trypsin within pancreatic acinar cells leads to the development of pancreatitis.Autophagy is an evolutionarily preserved degradation process of cytoplasmic cellular constituents, and it is one of the early pathological processes in acute pancreatitis.Autophagic flux is impaired in acute pancreatitis, which mediates the key pathologic responses of this disease.Impaired autophagy, dysfunction of lysosomes, and dysregulation of autophagy suggest a disorder of the endolysosomal pathway in acute pancreatitis.The role of autophagy in acute pancreatitis is discussed from the aspects of autophagic process, autophagy and activation of trypsinogen, impaired autophagy and acute pancreatitis, and defective autophagy promoting inflammation.
Discussion of difficult problems of early diagnosis of pancreatic cancer
Guo XiaoZhong, Liu Xu
2014, 30(8): 734-736. DOI: 10.3969/j.issn.1001-5256.2014.08.008
Abstract:
Pancreatic cancer is a common malignant neoplasm of the pancreas with an extremely high mortality.Currently, the early diagnosis of pancreatic cancer is still not ideal.Attention should be paid to some clinical warning symptoms, such as unexplained abdominal and back pain, jaundice, and unexpected diabetes.Additionally, the combined use of CA19- 9, CEA, and other tumor markers, the attention to biochemical indicators, the detection of mutation in KAI1 or p53 gene, and the exploration of the value of miRNA in clinical diagnosis are of great significance.On the other hand, ultrasound, CT, MRCP, ERCP, PET- CT, and other imaging methods, as well as effective collection of cytology specimens, should be performed.Thus, there is hope for the early diagnosis of pancreatic cancer.
Research advances in relationship between diabetes and pancreatic cancer
He XiangYi, Yuan YaoZong
2014, 30(8): 737-739. DOI: 10.3969/j.issn.1001-5256.2014.08.009
Abstract:
Pancreatic cancer (PC) is one of common malignant digestive diseases.It is mostly diagnosed at advanced stage, with an extremely poor progression.The relationship between diabetes and PC was shown by numerous epidemiological studies for decades.Retrospective clinical studies and research on molecular mechanisms in recent years have led to a new understanding of the relationship between diabetes, especially new- onset diabetes, and PC, the effect of antidiabetic medication on PC, and the molecular mechanisms underlying the connection between diabetes and PC.It is suggested by recent data that long- standing diabetes is one of the risk factors for PC development, new- onset diabetes may facilitate early diagnosis of PC, diabetes may have an impact on the prognosis of PC, the option of antidiabetic medication may influence the incidence of PC, and exploring the molecular mechanisms underlying the association between diabetes and PC may help to identify the new therapeutic target for PC.
Development of optimal management of upper gastrointestinal bleeding secondary to pancreatic sinistral portal hypertension
Song Yang, Lu Hao, Liu QuanDa
2014, 30(8): 740-742. DOI: 10.3969/j.issn.1001-5256.2014.08.010
Abstract:
The pathogenesis of pancreatic sinistral portal hypertension (PSPH) is quite different from that of cirrhotic portal hypertension, and PSPH is the only curable type of portal hypertension.Gastric variceal bleeding is a less common manifestation of PSPH;however, it probably exacerbates the patient's condition and leads to critical illness, and inappropriate management would result in death.Therefore, it is necessary to develop the optimal management of upper gastrointestinal bleeding in PSPH patients.Splenectomy is considered as a definitive procedure, together with surgical procedures to treat underlying pancreatic diseases.For patients in poor conditions or ineligible for surgery, splenic artery coil embolization is a preferable and effective method to stop bleeding before second- stage operation.The therapeutic decision should be made individually, and the further multi- center study to optimize the management of upper gastrointestinal bleeding from PSPH is warranted.
Original articles_Pancreatic diseases
Clinical effect of endoscopic retrograde cholangiopancreatography in 80 elderly patients with biliary pancreatitis
Liu LianLian, Xu Hui, Wang Hua, Liu Yang, Zou ZeFang, Yang Na
2014, 30(8): 743-745. DOI: 10.3969/j.issn.1001-5256.2014.08.011
Abstract:
Objective To investigate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) treatment in elderly patients with biliary pancreatitis.Methods A retrospective analysis was performed on 80 elderly patients (more than 80 years old) with biliary pancreatitis who were admitted to our center from January 2005 to December 2013.The patients were treated with a combination of ERCP, endoscopic sphincterotomy (EST) , and endoscopic nasal biliary drainage (ENBD) , or treated with plastic biliary stent implantation.Results ERCP treatment was successful in 76 (95%) of the 80 patients, while the other 4 patients were converted to open surgery because of failure to identify the major duodenal papilla endosopically.The mortality rate from ERCP treatment was 2.6% (2 /76) , with the causes of death being septic shock and repeated gastrointestinal bleeding, respectively.The first ERCP + EST + ENBD treatment was successfully performed in 69 of the 76 patients, while the other 7 patients were treated with plastic biliary stent implantation due to unremovable large cast stones.Conclusion ERCP treatment leads to small trauma, quick recovery, and low mortality in elderly patients with biliary pancreatitis, suggesting that it is a safe and effective therapy.
Clinical effect of endoscopic nasobiliary drainage in prevention of post- ERCP pancreatitis in patients with choledocholithiasis
Zhao XiaoWen, Bao JunJun, Hu Cui, Ding Hao, Xu ZhangWei, Liu XiaoChang, Mei Qiao, Xu JianMing
2014, 30(8): 746-748. DOI: 10.3969/j.issn.1001-5256.2014.08.012
Abstract:
Objective To investigate the clinical effect of endoscopic nasobiliary drainage (ENBD) in the prevention of post- endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and hyperamylasemia in patients with choledocholithiasis.Methods A total of 560 patients with choledocholithiasis who underwent ERCP from October 2010 to December 2013 were included in the study.ENBD was performed in 371 patients (test group) , and the other 189 patients were designated as control group.Serum amylase level was measured at 3 and 24 h after ERCP, and the incidence of PEP and hyperamylasemia was determined.Comparison of continuous data between the two groups was made by t test, while comparison of rates was made by chi- square test.Results The incidence rates of PEP and hyperamylasemia in the test group were 8.1% (30 /371) and 13.7% (51 /371) , respectively, significantly lower than those in the control group (13.8%, 26/189;21.2%, 40/189) , (χ2= 4.47, P = 0.034;χ2= 5.06, P = 0.024) .The serum amylase levels at 3 and 24 h after ERCP in the test group were 215.34 ± 304.00 U /L and 199.38 ± 273.32 U /L, respectively, significantly lower those in the control group (283.28 ±261.76 U/L and 257.05 ±199.25 U/L) (t =2.61, P =0.01;t =2.57, P =0.01) .Conclusion ENBD can effectively reduce the incidence of PEP and hyperamylasemia in patients with choledocholithiasis.
Significance of postoperative structural changes in serum N- glycans in pancreatic cancer patients
Jin Yu, Zhan Chao, Zhang YuBao
2014, 30(8): 749-751. DOI: 10.3969/j.issn.1001-5256.2014.08.013
Abstract:
Objective To investigate the structural changes in specific serum N- glycans in pancreatic cancer patients and to identify the specific serum maker of pancreatic cancer.Methods The pancreatic cancer patients who visited the Third Affiliated Hospital of Harbin Medical University from June 2011 to December 2013 were assigned to preoperative serum group (123 cases) and postoperative serum group (78 cases) ;healthy controls whose serum samples were collected in the Physical Examination Center were selected as control serum group (271 cases) .DNA sequencer- aided fluorophore- assisted carbohydrate electrophoresis (DSA- FACE) was used to analyze serum N-glycans and compare them between the three groups.Results The serum N- glycan profiles in pancreatic cancer patients were identified by DSA- FACE.The results indicated that N- glycan peak 8 in preoperative serum group was significantly lower than those in control serum group (t = 2.735, P < 0.05) and postoperative serum group (P < 0.05) , but no significant difference was found between the postoperative serum group and control serum group.Conclusion N- glycan peak 8 can be considered as a serum marker of pancreatic cancer.
Analysis of clinical significance of quantitative expression of VEGF mRNA and uPA mRNA in pancreatic cancer tissue
Xi PengCheng, Shi KaiWang, Zhu Xiang, Yang KunXing, Liu ZiJun, Bian JianMin, Zhao YouCai
2014, 30(8): 752-756. DOI: 10.3969/j.issn.1001-5256.2014.08.014
Abstract:
Objective To investigate the clinical significance of quantitative expression of vascular endothelial growth factor (VEGF) mRNA and urokinase- type plasminogen activator (uPA) mRNA in pancreatic cancer tissue.Methods A retrospective study was conducted on the complete data of 30 patients with a pathological diagnosis of duct adenocarcinoma who were selected from those treated by radical resection of pancreatic head carcinoma from January 2008 to December 2011.Real- time quantitative PCR was used to measure the quantitative expression of VEGF mRNA and uPA mRNA in the pancreatic cancer tissues of the 30 cases and the normal pancreatic tissues of 6 controls, and its relationship with clinicopathological factors was analyzed.Results The quantitative expression of VEGF mRNA and uPA mRNA was correlated with the histological differentiation and perineural invasion of pancreatic cancer.The quantitative expression of VEGF mRNA was significantly higher in patients with lymphatic metastasis than in those without lymphatic metastasis group (t = 20.007, P = 0.000) .The quantitative expression of uPA mRNA was significantly lower in the tumors with a diameter of ≤2 cm than in the tumors with a diameter of > 2 cm (t = 7.539, P = 0.000) .Patients with duodenal invasion had a significantly higher quantitative expression of uPA mRNA than those without duodenal invasion (t =- 2.089, P = 0.037) .The quantitative expression of uPA mRNA in stage III tumor tissues was significantly higher than that of uPA mRNA in stage I and II tumor tissues (t =- 9.450, P = 0.000) .There was a positive correlation between VEGF mRNA expression and uPA mRNA expression (r = 0.334, P = 0.000) .Conclusion The overexpression of VEGF mRNA and uPA mRNA in pancreatic cancer tissue may create an environment that enables the invasion by pancreatic cancer cells.
Original articles_Viral hepatitis
Association between IPS- 1 polymorphisms and PEG- IFN treatment response in patients with HBeAg- positive chronic hepatitis B
Wu HaiQing, Zhao GangDe, Li FengDi, Liu KeHui, Xu YuMin, Lin LanYi, Xie Qing, Wang Hui
2014, 30(8): 757-763. DOI: 10.3969/j.issn.1001-5256.2014.08.015
Abstract:
Objective To investigate whether interferon- β promoter stimulator 1 (IPS- 1) gene polymorphisms could affect the treatment response to peginterferon alpha (PEG- IFN) in patients with HBeAg- positive chronic hepatitis B (CHB) .Methods A total of 212HBeAg- positive CHB patients treated with PEG- IFN monotherapy for 48 weeks were enrolled from the department of infectious diseases of Ruijin hospital in this study from January 2008 to December 2012.We collected peripheral blood from patients and extracted total genomic DNA.Genotype analysis was performed for 10 tag single nucleotide polymorphisms (SNPs) in IPS- 1 gene using the Sequenom MassArray system.Response was defined as cases showing hepatitis B virus (HBV) DNA level < 200 IU /ml, HBeAg seroconversion, and normal aminotransferase (ALT) levels after 48- week PEG- IFN therapy.The chi- square test was conducted to analyze the allele frequency and genotype distribution of IPS- 1 in both the response (R) and non- response (NR) groups.Binary logistic regression modeling was used to analyze the association of SNPs and haplotypes of IPS- 1 with treatment response.Results Of all the 212 patients, 95 (44.8%) were infected with HBV genotype B and 117 (55.2%) with HBV genotype C.There was a total response rate of 34.9% (74 /212) .Significant differences in genotype distributions of four SNPs (rs2326369, rs2464, rs6515831, and rs16989000) were observed between the R and NR groups (P < 0.05) .In multivariate analysis, three SNPs (rs2326369, rs6515831, and rs2464) were found to be independently associated with PEG- IFN efficacy after adjustment for sex, age, HBV genotype, family history, and baseline levels of HBV DNA and ALT: (1) rs2326369 CC genotype was independently associated with NR (OR = 0.51, 95% CI:0.28- 0.92, P = 0.026) ; (2) rs6515831 TT genotype was independently associated with R (OR = 2.08, 95% CI:1.12- 3.86, P = 0.020) ; (3) rs2464 CC genotype was independently associated with R (OR = 2.33, 95% CI:1.24- 4.37, P = 0.009) .Furthermore, two blocks were identified in this study, with block 1formed by rs16989000 and rs6515831 and block 2 formed by rs7272495, rs16989022, and rs2464.In multivariate analysis, haplotype AAC of block 2 was independently associated with R (OR = 2.05, 95% CI:1.09- 3.87, P = 0.026) .Conclusion Our study suggested that genetic variations in IPS- 1 are associated with the treatment response to PEG- IFN in HBeAg- positive CHB patients.For CHB patients treated with PEG- IFN, IPS- 1 genotyping may have a certain predictive value for curative effect.
Original articles_Liver fibrosis and liver cirrhosis
Observation of dietary intervention on nutritional risk in patients with liver cirrhosis
Zhang Min, Hang Lei, Yuan XiaoJie, Yan HongQing
2014, 30(8): 764-767. DOI: 10.3969/j.issn.1001-5256.2014.08.016
Abstract:
Objective To detect nutritional problems in liver cirrhosis patients early through nutritional risk screening, and to provide them with individual dietary intervention for improving their malnutrition and avoiding or reducing diet- related complications.Methods The nutritional risk of liver cirrhosis patients was assessed according to the NRS 2002 standard.A total of 134 patients admitted to our hospital from October 2011 to October 2013 were randomly assigned to intervention group (66 cases) and control group (68 cases) .Their anthropometric parameters, NRS 2002 scores, blood test results, length of hospital stay, and times of hospitalization within six months were recorded and analyzed.A Student's t- test was used to analyze continuous data in normal distribution, and the rank sum test for continuous data in non-normal distribution;the chi- square test was used to analyze categorical data.Results Patients in control group showed significant changes in body mass index (BMI) , lean muscle mass, bone mass, serum total protein, and albumin one week after admission (P < 0.05 for all) .Patients in intervention group showed significant changes in body mass, BMI, body moisture rate, bone mass, hemoglobin, prealbumin, serum albumin, and NRS 2002 score one week after admission (P < 0.05 for all) .There were significant differences between the two groups in hemoglobin, prealbumin, and NRS 2002 score one week after admission and times of hospitalization within six months (P < 0.05 for all) .Conclusions Individual dietary intervention has both short- term effect and long- term effect.Liver cirrhosis patients with nutritional risk need individual dietary intervention.
Original articles_Biliary diseases
Technical difficulties of laparoscopic common bile duct exploration and their countermeasures for patients with history of upper abdominal surgery
Mei Yong, Peng CiJun, Zhu HongJiang, Shu DeJun, Li WeiNan, Li XiongXiong
2014, 30(8): 768-771. DOI: 10.3969/j.issn.1001-5256.2014.08.017
Abstract:
Objective To investigate the technical difficulties of laparoscopic common bile duct exploration (LCBDE) and their countermeasures for patients with a history of upper abdominal surgery.Methods A retrospective analysis was performed on the clinical data of 72 patients with a history of upper abdominal surgery who underwent LCBDE at our hospital from January 2008 to October 2013.The intraoperative difficulties and their countermeasures were summarized and analyzed.Results Intraoperative difficulties occurred in 16 patients;severe adhesions in the abdominal cavity and operation region were found in 9 cases, difficult identification of the common bile duct in 4 cases, and difficult removal of stones in 3 cases.The operative time was 164.36 ± 19.06 min for all patients, 179.31 ± 13.25 min for patients encountering intraoperative difficulties, and 160.09 ± 18.37 min for those not encountering intraoperative difficulties;the operative time was significantly longer in patients encountering intraoperative difficulties than in those not encountering intraoperative difficulties and in all patients (t =-3.898, P =0.000;t =-2.976, P = 0.004) , but the operative time of patients not encountering intraoperative difficulties was not significantly different from that of all patients (t =- 1.278, P = 0.204) .Conclusion For patients with a history of upper abdominal surgery, LCBDE is an operation with high difficulty, high risk, and high technical requirement.In case of intraoperative difficulties, which would prolong the operative time, individualized countermeasures should be taken to ensure successful surgery.
Clinical efficacy of transumbilical single- port laparoscopic cholecystectomy with ultrasonic knife for directly handling cystic artery
Gong JinWei, Xu Jun, Liu ChunFu
2014, 30(8): 772-775. DOI: 10.3969/j.issn.1001-5256.2014.08.018
Abstract:
Objective To investigate the clinical feasibility and value of transumbilical single- port laparoscopic cholecystectomy with intraoperative ultrasonic knife for directly handling the cystic artery.Methods A retrospective analysis was performed on the clinical data of 231 patients who underwent laparoscopic cholecystectomy with intraoperative ultrasonic knife for directly handling the cystic artery in our department from March 2011 to December 2012.According to the required surgical approaches, the patients were divided into transumbilical single- port laparoscopic group (n = 125, group A) and three- port laparoscopic group (n = 106, group B) .The two groups were compared in terms of operative time, intraoperative blood loss, postoperative analgesia, postoperative food intake, length of postoperative hospital stay, and postoperative complications, as well as the performance of the ultrasonic knife in directly handling the cystic artery.Comparison of continuous data between groups was made by t test, while comparison of categorical data was made by chi- square test.Results Group A had a significantly longer mean operative time than group B (20.21 ± 1.86 min vs 18.43 ± 1.37 min, P < 0.05) .There was no significant difference in mean intraoperative blood loss between groups A and B (23.23 ± 6.25 ml vs 22.34 ± 5.49 ml, P > 0.05) .Group A had significantly fewer patients who needed postoperative analgesia than group B (5 vs 21, P < 0.05) .The time to postoperative food intake showed no significant difference between groups A and B (6.56 ± 1.23 h vs 6.67 ± 1.45 h, P > 0.05) .The mean length of postoperative hospital stay was (2.98 ± 0.23) d in group A, versus (3.02 ± 0.18) d in group B (P > 0.05) .No indwelling drainage tube was used after operation in either group.There were no postoperative bleeding, bile duct injury, bile leakage, incisional wound infection, and other complications in the two groups.The ultrasonic knife had reliable hemostatic effect when directly sealing the cystic artery, without causing postoperative secondary bleeding.All patients were followed up for 2- 12 months (mean, 6.5 months) ;they recovered well without incisional hernia, and the umbilical scar was not obvious, with relatively good cosmetic results.Conclusion Transumbilical single- port laparoscopic cholecystectomy has a comparable clinical effect to three- port laparoscopic cholecystectomy, causing little trauma, postoperative pain, and scar, and it is suitable for patients with a high demand for incision appearance.Directly sealing the cystic artery with the ultrasonic knife can reduce bleeding due to careful separation of the cystic artery and shorten the operative time.Therefore, it is a safe, feasible surgical approach and worthy of clinical application.
Role of Rouviere's sulcus as anatomical landmark in laparoscopic cholecystectomy:a report of 750 cases
Wang ShouJun, Wang Yue, Wang QingWen, Li HongXu, Song JinZhi, Hou JunCheng, Tang XueMei
2014, 30(8): 776-778. DOI: 10.3969/j.issn.1001-5256.2014.08.019
Abstract:
Objective To explore the role of Rouviere's sulcus as the anatomical landmark for the cystic duct in laparoscopic cholecystectomy.Methods The clinical data of 750 patients who underwent laparoscopic cholecystectomy operated by one beginner from October 2012 to March 2014 in the Affiliated Santai Hospital of North Sichuan Medical College were analyzed.The frequency of appearance of Rouviere's sulcus was recorded during operation, and the Rouviere's sulcus was used as the anatomical landmark for the cystic duct in laparoscopic cholecystectomy.Results Of the 750 patients, 705 had Rouviere's sulcus.There was no mortality during operation.Bile duct injury occurred in one case (0.13%) , whose Rouviere's sulcus was not seen during operation.Among the first 300 cases, the three- hole method was used in35 cases, and 30 cases (10%) were converted to open surgery.Among the succeeding 450 cases, the three- hole method was used in 387 cases, and 15 cases (3.3%) were converted to open surgery.Conclusion Rouviere's sulcus is an important anatomical landmark for the cystic duct.Its identification before Calot's triangle dissection may help in preventing the bile duct injury in laparoscopic cholecystectomy for beginners.It has great clinical significance and should be applied widely.
Original articles_Hepatopancreatobiliary tumor
CT and pathological features of primary hepatic angiosarcoma
Xing YaoYao, Xia CongYang
2014, 30(8): 779-781. DOI: 10.3969/j.issn.1001-5256.2014.08.020
Abstract:

Objective To present the computed tomography (CT) findings and associated pathological features of eight cases of primary hepatic angiosarcoma (PHA) .Methods All cases were confirmed by pathology.After a CT scan of the upper abdomen, all cases of PHA underwent enhanced scans in the arterial phase, portal venous phase, and delayed phase to observe the CT manifestations.The surgical specimens were subjected to conventional hematoxylin- eosin staining and immunohistochemistry and observed under a microscope.Results Of all patients, 5 cases were massive type, 2 cases were mixed type, and 1 case was multiple nodule type.CT scans revealed inhomogeneous low- density lesions, with necrosis of even lower density in the central part.In 4 cases of massive type, scattered high- density small pieces were observed in low- density areas;in one case of mixed type, high- density nodules were observed on the edge of mass.There were 7 cases of peripheral nodular irregular enhancement in the arterial phase, including 1 case with flocculent central enhancement and another with no enhancement.Lesions remained enhanced in the portal venous and delayed phases, but 1 case had no enhancement.Five in 9 lesions had sharp edges in the arterial and portal venous phases, with“sharpen rim perpendicular to pleura”signs at the boundaries with the surrounding normal liver tissue.The outer edges of 7 lesions were found to have“pseudocapsules”in the portal venous phase.Conclusion CT scans showed a large hypodense lesion with irregular necrotic areas or scattered hemorrhage in PHA patients, whist enhanced scans showed a progressive filling and necrotic area in the central part.There could be“sharpen rim perpendicular to pleura”and“pseudocapsule”signs at the edge.It might be helpful to improve the diagnosis through the above characteristic features.

Original articles_Others
Therapeutic effect of terlipressin combined with albumin in 24 patients with hepatorenal syndrome
Chen Si, Sun ZhangYu, Zhang ZhiHao, Wang YingYing
2014, 30(8): 782-784. DOI: 10.3969/j.issn.1001-5256.2014.08.021
Abstract:

Objective To observe the therapeutic effect of terlipressin combined with albumin in management of patients with hepatorenal syndrome.Methods A retrospective study enrolling 46 patients with hepatorenal syndrome from May 2011 to August 2013 was conducted, in which 22 patients were allocated to control group, and 24 patients to treatment group.In addition to conventional treatment, albumin was used in control group, and the patients in treatment group were treated with terlipressin plus albumin.Clinical symptoms, urine volume, serum creatinine, urea nitrogen, ascites, and prognosis were observed in the study.The Student's t test was used for comparison between the two groups, and the chi- square test was used for comparison of rates.Results The treatment group showed significant improvements in clinical symptoms, while the control group did not.In treatment group, urine volume (ml /24 h) increased from (758.5 ± 284.9) to (2277.1 ±704.8) (P<0.01) ;serum creatinine level (μmol/L) dropped from (234.2 ±87.2) to (126.8 ±62.2) (P <0.01) ;urea nitrogen level (mmol /L) dropped from (18.1 ± 6.4) to (10.3 ± 4.5) (P < 0.01) ;body weight (kg) dropped from (68.1 ± 3.9) to (64.6± 3.9) (P < 0.01) ;abdominal circumference (cm) dropped from (95.0 ± 5.1) to (90.8 ± 4.9) (P < 0.01) .However, the control group showed no significant changes in urine volume, serum creatinine, urea nitrogen, body weight, and abdominal circumference after treatment (P >0.05) .There were significant differences in these indices between the two groups after treatment (P < 0.05) .Significant differences in remission rate and survival rate were observed between the control group and treatment group (P < 0.05) .Conclusion A combination of terlipressin and albumin has favorable therapeutic effect on hepatorenal syndrome and improves the prognosis of patients with hepatorenal syndrome.

Diagnostic values of GP73, AFP- L3, AFP, and AFU for liver diseases
Ding Yan, Li Dan, Wang NianYue, Geng QuanLin
2014, 30(8): 785-789. DOI: 10.3969/j.issn.1001-5256.2014.08.022
Abstract:

Objective To compare the levels of Golgi glycoprotein 73 (GP73) , alpha- fetoprotein heterogeneity 3 (AFP- L3) , alpha-fetoprotein (AFP) , and α- L- fucosidase (AFU) between patients with different liver diseases and the diagnostic value of any or a combination of these makers for liver cancer.Methods The 272 patients with liver cancer, 203 patients with liver cirrhosis, and 248 patients with chronic hepatitis admitted to our hospital from January to December, 2013, as well as 210 healthy individuals, were included in the study.Serum levels of GP73, AFP- L3, AFP, and AFU were determined.Comparison of non- normally distributed data was made by Kruskal- Wallis H test, and multiple comparisons were made by Mann- Whitney U test.Comparison of rates was made by chi- square test.P < 0.05 was considered significantly different.Receiver operating characteristic (ROC) curves were drawn with healthy individuals and patients with chronic hepatitis or liver cirrhosis as controls, and Logistic fitting and ROC analysis were used to evaluate the diagnostic values of these markers.Results The GP73 level of liver cirrhosis group (177.0 (116.0, 247.0) ng /ml) was significantly higher than those of liver cancer group (141.0 (83.3, 218.8) ng /ml) and chronic hepatitis group (151.0 (83.0, 235.3) ng /ml) (U = 22 116.5 and 21 052.0, P<0.05 for both) .The AFP- L3 and AFP levels of liver cancer group (11.3 (4.3, 21.2) % and 78.4 (7.1, 2455.8) ng /ml) were significantly higher than those of liver cirrhosis group (6.0 (4.0, 8.0) % and 10.0 (3.8, 49.5) ng /ml) and chronic hepatitis group (7.0 (5.0, 9.0) % and 18.8 (4.4, 79.6) ng /ml) (U = 16009.0 /16083.5 and 22456.5 /22346.5, P < 0.05 for all) .According to the ROC curves drawn using healthy individuals as a control, the areas under the ROC curve (AUCs) for GP73, AFP- L3, AFP, and AFU were 0.827, 0.817, 0.901, and 0.680, respectively;GP73, AFP- L3, and AFP had a higher diagnostic accuracy for liver cancer than AFU.According to the ROC curves drawn using non- liver cancer patients as a control, the AUCs for the four markers were 0.573, 0.734, 0.753, and 0.552, respectively;AFP- L3 and AFP had some diagnostic accuracy for liver cancer, and their cut- off values were 8.55% (56.6%, 84.9%) and 49.88 ng /ml (57.7%, 80.9%) , respectively, when the sensitivity and specificity reached the peak values.Conclusion Increased GP73 is related to hepatic impairment and chronic fibrosis, and it has a better sensitivity for the diagnosis of liver diseases.AFP- L3 and AFP have good specificity for the diagnosis of liver cancer, and a combination of the two markers can increase the diagnostic sensitivity for liver cancer to 62.1%.

Protective role and immunoregulatory effect of CXCR3 in hepatic ischemia- reperfusion injury
Gao Jun, Chen Gong, Lu: Long
2014, 30(8): 790-794. DOI: 10.3969/j.issn.1001-5256.2014.08.023
Abstract:

Objective To investigate the role and action mechanism of chemokine (C- X- C motif) receptor 3 (CXCR3) in hepatic ischemia- reperfusion injury (IRI) .Methods Forty- eight mice were divided into operation group and sham- operation group.The operation group was treated to establish a mouse model of IRI.Liver tissues were obtained at 3, 6, 12, and 24 h after IRI, with 6 mice at each time point.The expression of chemokine (C- X- C motif) ligand 9- 11 (CXCL9- 11) and their receptor CXCR3 were measured by real- time PCR and Western blot.The effect of CXCR3 was blocked by its specific antagonist C6.Hepatic injury was estimated based on the activity of hepatic transaminase and morphological indices.The distribution of subsets of infiltrating T cells was analyzed by flow cytometry.All data were expressed as mean ± standard deviation.Comparison between groups was made by one- way analysis of variance.Results Compared with the sham- operation group, the operation group had significantly upregulated expression of CXCL9- 11 and CXCR3 at all time points after IRI (P < 0.05) .Blocking CXCR3 significantly protected liver function and morphology (P < 0.05) .Antagonist C6 significantly reduced Th1 cell infiltration (P < 0.01) , but significantly increased Treg infiltration (P < 0.01) .Conclusion CXCR3 is an ideal therapeutic target in IRI treatment due to its relationship with immunoregulation.

Brief reports
Bacterial liver abscess:a clinical analysis of 123 cases
Yu ZeYuan, Zhao RongRong, Jiao ZuoYi
2014, 30(8): 795-797. DOI: 10.3969/j.issn.1001-5256.2014.08.024
Abstract:
Case reports
One case of autoimmune pancreatitis
Li WanYu, Qi Yue, Wu Na, Shi Yu, Cai YanJun
2014, 30(8): 798-800. DOI: 10.3969/j.issn.1001-5256.2014.08.025
Abstract:
Gastrointestinal bleeding caused by pancreatic abscess and gastric fistula:a report of one case
Shang ZhenNing, Yuan QiuXia, Zhu LiNing
2014, 30(8): 801-802. DOI: 10.3969/j.issn.1001-5256.2014.08.026
Abstract:
HBV infection with Budd- Chiari syndrome:a report of one case
Wu Qiong, Liu Na, Xu GuangHua
2014, 30(8): 803-804. DOI: 10.3969/j.issn.1001-5256.2014.08.027
Abstract:
One case of hepatic amyloidosis
Zhu JuanJuan, Liu Qin, Mu Mao, Chen Jia, Wang NiuNiu, Li JunLi
2014, 30(8): 805-806. DOI: 10.3969/j.issn.1001-5256.2014.08.028
Abstract:
Acute- on- chronic liver failure with brain abscess and pulmonary abscess caused by Sphingomonas paucimobilis:a report of one case
Sun Han, Xia Lin, Yin Fang, Zhou XinMin
2014, 30(8): 807-808. DOI: 10.3969/j.issn.1001-5256.2014.08.029
Abstract:
Bile duct hamartoma misdiagnosed as multiple liver cysts:a report of one case
Wang SuNa, Liang ZhiJun, Kang Wen, Jia ZhanSheng, Bai XueFan, Xie YuMei, Hao ChunQiu
2014, 30(8): 809-810. DOI: 10.3969/j.issn.1001-5256.2014.03.030
Abstract:
One case of vanishing bile duct syndrome
Ma LinYuan, Chen Qian, Hua Rui, Pan Yu
2014, 30(8): 811-812. DOI: 10.3969/j.issn.1001-5256.2014.08.031
Abstract:
Academic contention
Several opinions on EASL recommendations on treatment of hepatitis C (April 2014)
Dai MingJia, Yan XueBing
2014, 30(8): 813-814. DOI: 10.3969/j.issn.1001-5256.2014.08.032
Abstract:
Reviews
Pathogenetic mechanism of microcirculatory disturbance and treatment advances in acute pancreatitis
Hou Fei, Liu RuiXia, Yin ChengHong
2014, 30(8): 815-818. DOI: 10.3969/j.issn.1001-5256.2014.08.033
Abstract:
In recent years, there has been increasing evidence that microcirculatory disturbance, including vasoconstriction, shunting, inadequate perfusion, increased blood viscosity, and coagulation, is closely associated with the pathogenesis of acute pancreatitis (AP) .These processes may be exacerbated by ischaemia- reperfusion injury and the generation of oxygen radicals.The anatomical features of pancreatic microcirculation, the pathophysiological mechanism of pancreatic microcirculation disturbance and related inflammatory mediators, and progress in the treatment of microcirculatory disturbance in AP are reviewed.It is suggested that the pancreatic and systemic microcirculation may play a key role in the development and progression of AP.
Significance and progress in detection of HBV cccDNA in peripheral blood mononuclear cells
Cai ShaoPing, Liu Ze, Xu DongPing
2014, 30(8): 819-821. DOI: 10.3969/j.issn.1001-5256.2014.08.034
Abstract:
Hepatitis B virus (HBV) covalently closed circular DNA (cccDNA) is an intermediate replicative episome which is stable and not easy to eliminate.cccDNA serves as the template for HBV replication and plays an important role in persistence of HBV infection in hepatocytes, and it is also a biomarker of HBV activity.Studies suggested that HBV has extrahepatic infectivity and cccDNA could be detected in peripheral blood mononuclear cells (PBMC) .The predictive values of HBV cccDNA in PBMC for HBV recurrence after liver transplantation and antiviral therapy and mother- to- child transmission of HBV in patients with hepatitis B, as well as the possible mechanism of cccDNA involved in extrahepatic HBV infection, are summarized.Therefore, the detection of HBV cccDNA is of great significance for the study and treatment of HBV.
Progress in emergency management of esophageal variceal bleeding
Liu GuoFang, Xiang XiaoXing
2014, 30(8): 822-824. DOI: 10.3969/j.issn.1001-5256.2014.08.035
Abstract:
Esophageal variceal bleeding is a severe complication of cirrhotic portal hypertension and the main cause of mortality in patients.Studies revealed no significant differences in emergency hemostasis rate, fatality rate, and rebleeding rate between patients receiving endoscopic treatment and vasoactive agents.The advances in emergency management of esophageal variceal bleeding, including endoscopic band ligation, sclerotherapy, and use of vasoactive agents, are reviewed, with emphasis on emergency endoscopic treatment and drug therapy for esophageal variceal bleeding.
The role of intestinal endotoxemia in liver failure and its complications
Gao FangYuan, Wang XianBo
2014, 30(8): 825-828. DOI: 10.3969/j.issn.1001-5256.2014.08.036
Abstract:
Recent studies have found that endotoxin not only activates immune response, exacerbates liver injury, and induces liver failure, but also plays an important role in the development of hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, and other fatal complications.The recent progress in research on the pathogenesis of intestinal endotoxemia (IETM) and its impact on the development and progression of liver failure is reviewed and summarized.It is suggested that seeking effective methods to prevent and control IETM holds promise as the key to treating severe liver disease and liver failure successfully.
Research advances in sorafenib combined with orthotopic liver transplantation, radiofrequency ablation, and transarterial chemoembolization in treatment of hepatocellular carcinoma
Zhang MingJuan, Liu Jia, Xiang XiaoXing, Wang Su
2014, 30(8): 829-832. DOI: 10.3969/j.issn.1001-5256.2014.08.037
Abstract:
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide, and traditional surgery and chemotherapy provide limited benefit.Sorafenib, a multikinase inhibitor, was proved effective for advanced HCC in phase III clinical trial, which was a breakthrough in the treatment of HCC.In recent years, the studies on sorafenib combined with other therapies in the treatment of HCC have been conducted around the world, and inspiring results have been seen.The research advances in sorafenib combined with orthotopic liver transplantation, radiofrequency ablation, and transarterial chemoembolization in the treatment of HCC are summarized.It is thought that sorafenib combined with other anticancer therapies is expected to become a new approach of targeted therapy of HCC.
Studies on PPAR α and γ participating in progression of liver fibrosis by regulating ACSL1
Xin Xuan, Yan HongZhu, Li WeiQing, Yu HongYu
2014, 30(8): 833-835. DOI: 10.3969/j.issn.1001-5256.2014.08.038
Abstract:
During the development and procession of liver fibrosis, peroxisome proliferator- activated receptor (PPAR) α and γ are in charge of the regulation of lipid metabolism, fatty acid metabolism, anti- liver fibrosis, etc., and are closely related to fat metabolism- related enzymes.As a key enzyme in fat metabolism, acyl- CoA synthetase long- chain family member 1 (ACSL1) is involved in lipid synthesis and catabolism and then causes lipid deposition and inflammation in the liver, so it directly or indirectly promotes hepatic fibrosis.The biological functions and roles of PPAR α and γ and ACSL1 are reviewed;the action mechanisms of PPAR α and γ in the transcriptional regulation of ACSL1 are briefly described;the regulatory effects of PPAR α and γ on ACSL1 and their effects on the progression of hepatic fibrosis are analyzed from the aspects of liver lipid metabolism and hepatic stellate cell activation.It is pointed out that in the liver PPAR α andγ are directly or indirectly involved in the progression of hepatic fibrosis by regulating ACSL1.
Application of metabolomics in research on biomarkers for hepatocellular carcinoma
Wang JianGang, Li HuaCheng, Fei XinYing
2014, 30(8): 836-838. DOI: 10.3969/j.issn.1001-5256.2014.08.039
Abstract:
As a novel research tool, metabolomics technology can reveal the differences in metabolic profiles during the development and progression of hepatocellular carcinoma (HCC) , so it has been widely applied for research on HCC biomarkers.The significance of metabolomics in the diagnosis of HCC is briefly described, and the metabolomics research aiming at the discovery of HCC biomarkers, including animal experiments and clinical studies of metabolites in the serum, urine, and liver tissue, is reviewed.It is pointed out that analyzing and monitoring metabolites in the development and progression of HCC is of great significance for individualized treatment.