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

2019 Vol. 35, No. 12

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Editorial
History and development of biliary surgery
Dou KeFeng, Li Xiao
2019, 35(12): 2617-2621. DOI: 10.3969/j.issn.1001-5256.2019.12.001
Abstract:
Biliary surgery is the main branch of general surgery,which plays an important role in the field of surgery. The pathological and clinical manifestations of biliary diseases are very complex,so biliary surgery is still the most challenging surgery in the digestive system.With the development of minimally invasive technology and endoscopic technology,biliary surgery is undergoing a profound theoretical and technological innovation,and these studies will form an important foundation for the sustainable development of biliary surgery in the 21 st century and should be paid more attention.
Discussions by experts
Advances in the diagnosis and treatment of severe acute cholangitis
Wang RongFeng, Lu: Yi, Zhang XiaoGang
2019, 35(12): 2622-2626. DOI: 10.3969/j.issn.1001-5256.2019.12.002
Abstract:
Severe acute cholangitis,also called acute obstructive suppurative cholangitis( AOSC),has acute onset and rapid progression and is the primary cause of death in patients with benign biliary tract diseases,especially in elderly patients,and it is often complicated by multiple system organ failure. This disease has diversified symptoms and signs,which leads to the inconsistency in diagnostic grading and prognosis criteria. With the development of minimally invasive surgery and endoscopic techniques,the diagnosis and treatment of severe acute cholangitis has been constantly improved. Therefore,judgment and selection of the optimal surgical timing,individualized biliary drainage,and comprehensive,standardized,and timely anti-infective therapy based on prognostic factors have great importance in the treatment of severe acute cholangitis.
Surgical management of bile duct injury
Ren Bin
2019, 35(12): 2627-2631. DOI: 10.3969/j.issn.1001-5256.2019.12.003
Abstract:
Cholecystectomy is the most common cause of iatrogenic bile duct injury. The causes,classification and diagnosis of bile duct injury were analyzed. According to the different opportunity of bile duct injury,different treatment strategies and infection control were adopted. The selection of definitive repair of bile duct injury,especially the key points of Roux-Y cholangiojejunostomy,was described in detail. In addition,under the condition of strict indication,it can be combined with hepatectomy or even liver transplantation.
Advance and controversy of hilar cholangiocarcinoma
Li XiangCheng, Feng QinChao
2019, 35(12): 2632-2637. DOI: 10.3969/j.issn.1001-5256.2019.12.004
Abstract:
Hilar cholangiocarcinoma is one of the most difficult malignant tumors in the biliary system. The best chance of treatment often absent on account of the portal vein and liver lobe are invaded. Although the efficacy of hilar cholangiocarcinoma improved with the development of diagnosis and surgical techniques in recent years,accurate definition,preoperative diagnosis and assessment,operation approach and scope,perioperative management,and the application of liver transplantation still have many disputes. This article aims to reports the advance and controversy in diagnosis and treatment of Hilar cholangiocarcinoma.
Research advances in the clinical diagnosis of intrahepatic cholangiocarcinoma
Chen ZhiSheng, Tang ChenWei, Tang ChaoHui, Tong HuanJun, Jin ZhiWei
2019, 35(12): 2638-2643. DOI: 10.3969/j.issn.1001-5256.2019.12.005
Abstract:
Intrahepatic cholangiocarcinoma( ICC) is a malignant liver tumor derived from the epithelial cells of the second-or higher-order branch of the bile duct,with the features of insidious early symptoms,high degree of malignancy,rapid disease progression,lymph node metastasis,intrahepatic metastasis,and vascular invasion,and such patients tend to have poor prognosis. Early diagnosis can improve the radical resection rate and prognosis of ICC. At present,the preoperative diagnosis of ICC mainly relies on imaging technology,laboratory examination,and pathological examination. In addition,some new diagnostic methods have also been used in the diagnosis of ICC in recent years,but histopathological examination remains the only method for the diagnosis of ICC. This article reviews the latest research advances in the diagnosis of ICC.
Liver transplantation for the treatment of intrahepatic cholangiocarcinoma: Controversies and perspectives
Zhang HongTao, Tao KaiShan
2019, 35(12): 2644-2647. DOI: 10.3969/j.issn.1001-5256.2019.12.006
Abstract:
Liver transplantation is the only effective method for the treatment of end-stage liver disease,but there are still controversies over its application in the treatment of intrahepatic cholangiocarcinoma( ICC). ICC has a high degree of malignancy,occult symptoms,and a lack of specific clinical manifestations in the early stage. Most patients are in the advanced stage at the time of diagnosis and lose the opportunity for surgical resection,and thus they tend to have poor prognosis. With the research advances in liver transplantation for the treatment of ICC,development of standardized criteria for patient selection and combination with neoadjuvant therapy and adjuvant therapy may become a promising method for the treatment of locally advanced ICC.
Guidelines
Guidelines for safe use of Polygoni Multiflori Radixl
Branch of Hepatobiliary Diseases, China Association of Chinese, Branch of Chinese Patent Medicine, China Association of Chinese Medicine, Professional Committee of Clinical Chinese Pharmacy , Chinese Pharmaceutical Association, , et al
2019, 35(12): 2687-2693. DOI: 10.3969/j.issn.1001-5256.2019.12.009
Abstract:
CCI clinical practice guidelines: Management of TIPS for portal hypertension (2019 edition)
The Chinese College of Interventionalists
2019, 35(12): 2694-2699. DOI: 10.3969/j.issn.1001-5256.2019.12.010
Abstract(1120) PDF (309KB)(1044)
Abstract:

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

Original articles_Liver fibrosis and liver cirrhosis
Value of platelet count and gallbladder wall thickness in predicting esophageal varices in patients with liver cirrhosis
Duan ZhiHui, Zhou ShengYun, Li ZengKui, Zhai DongCai, Zhou KeRou, Sun XiaoFang, Wang YanHong, Wu YiJuan, Li SuRong, Wang JiTao
2019, 35(12): 2716-2720. DOI: 10.3969/j.issn.1001-5256.2019.12.015
Abstract:
Objective To investigate the value of platelet count( PLT) and gallbladder wall thickness( GBWT) in predicting esophageal varices( EV) in patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical data of 100 patients who were diagnosed with hepatitis B cirrhosis in Xingtai People's Hospital from January 2018 to January 2019,and according to the results of gastroscopy as the gold standard for EV,these patients were divided into non-EV group with 50 patients and EV group with 50 patients. All patients underwent abdominal ultrasound( including GBWT,portal vein diameter,and spleen length),gastroscopy,and serological examination. The independent samples t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. A multivariate logistic regression analysis was used to screen out the noninvasive indices for predicting EV in liver cirrhosis. The receiver operating characteristic( ROC) curve was used to compare the diagnostic efficiency of a single index and combined indices. Results Compared with the non-EV group,the EV group had significantly higher GBWT,portal vein diameter,and spleen length( Z =-6. 251 and-2. 611,t =-3. 657,all P < 0. 01) and significantly lower PLT,PGR,and PLT-to-spleen length ratio( Z =-5. 403,-7. 018,and-6. 015,all P < 0. 001). At the optimal cut-off value of 0. 44 cm,GBWT had an area under the ROC curve( AUC) of 0. 861( 95% confidence interval: 0. 784-0. 938),a sensitivity of 0. 76,a specificity of 0. 86,a positive predictive value of 0. 86,and a negative predictive value of 0. 78 in the diagnosis of EV in hepatitis B cirrhosis. In the diagnosis of EV,PGR had an AUC of 0. 907,a sensitivity of 0. 90,a specificity of 0. 82,a positive predictive value of 0. 91,and a negative predictive value of 0. 84; in the diagnosis of high-risk EV,PGR had an AUC of 0. 823,a sensitivity of0. 68,a specificity of 0. 88,a positive predictive value of 0. 89,and a negative predictive value of 0. 86. With the criteria of GBWT < 0. 47 cm and PLT≥83 × 109/L,46% of all patients( 46/100) had no need for gastroscopy at the moment. Conclusion GBWT is expected to become a new index for predicting EV. Hepatitis B cirrhosis patients with GBWT < 0. 47 cm and PLT≥83 × 109/L have a low probability ofEV,and thus it is recommended to postpone gastroscopy. The combination of these two noninvasive indices can provide a simple preliminary screening tool for clinicians to rule out esophageal varices in cirrhosis.
Original articles_Liver neoplasms
mRNA expression and significance of tumor necrosis factor-alpha-induced protein 8-like 2 and forkhead box P3 in peripheral blood mononuclear cells in patients with primary liver cancer
Kong Li, Zhang YuZhuo, Jin Meng, Wang ShanShan, Du JingHua, Zhang YuGuo, Wang RongQi, Ren WeiGuang, Nan YueMin
2019, 35(12): 2721-2724. DOI: 10.3969/j.issn.1001-5256.2019.12.016
Abstract:
Objective To investigate the mRNA expression of tumor necrosis factor-alpha-induced protein 8-like 2( TIPE2) and forkhead box P3( Foxp3) of CD4+CD25+regulatory T cells( Tregs) in peripheral blood mononuclear cells( PBMCs) and their correlation in patients with primary liver cancer. Methods A total of 55 patients with primary liver cancer who visited the outpatient service or were hospitalized in Third Hospital of Hebei Medical University from January 2014 to December 2016 were enrolled as primary liver cancer group,and 35 healthy volunteers were enrolled as control group. The mRNA expression of TIPE2 and Foxp3 in PBMCs was measured,and their correlation with serum biochemical parameters for the liver,alpha-fetoprotein( AFP),blood leukocytes,and tumor size and number was analyzed. The t-test was used for comparison of continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between two groups,and the Pearson correlation analysis was used to investigate correlation. Results There were significant differences between the two groups in alanine aminotransferase( ALT),aspartate aminotransferase( AST),AST/ALT ratio,total bilirubin,white blood cell count,and AFP( all P < 0. 05). Compared with the control group,the primary liver cancer group had significantly lower mRNA expression of TIPE2( 0. 396 ± 0. 174 vs 1. 045 ± 0. 330,t = 12. 187,P < 0. 01) and significantly higher mRNA expression of Foxp3( 4. 498 ± 1. 672 vs 1. 922 ±1. 297,t = 7. 746,P < 0. 01). The mRNA expression of TIPE2 was negatively correlated with serum levels of ALT and AST,AST/ALT ratio,and AFP level( r =-0. 752,-0. 833,-0. 992,and-0. 848,all P < 0. 05),while the mRNA expression of Foxp3 was positively correlated with serum levels of ALT and AST,AST/ALT ratio,and AFP level( r = 0. 449,0. 536,0. 843,and 0. 640,all P < 0. 05). ThemRNA expression of TIPE2 was negatively correlated with that of Foxp3( r =-0. 821,P < 0. 01). Conclusion Liver cancer patients have downregulated mRNA expression of TIPE2 and upregulated mRNA expression of Foxp3,which is correlated with the degree of hepatocellular injury and AFP level. The TIPE2 gene may be involved in the pathogenesis of liver cancer by negative regulation of Treg-mediated immune response.
Value of spleen stiffness and spleen volume in predicting posthepatectomy liver failure in patients with hepatocellular carcinoma
Chen Hao, Ma JunYong, Qian LiQiang, Yin GuoWen
2019, 35(12): 2725-2729. DOI: 10.3969/j.issn.1001-5256.2019.12.017
Abstract:
Objective To investigate the value of spleen stiffness( SS) and spleen volume( SV) in predicting posthepatectomy liver failure( PHLF) in patients with hepatocellular carcinoma( HCC). Methods Related clinical data were collected from the patients with HCC who underwent hepatectomy in Suzhou Ninth People's Hospital and The Third Affiliated Hospital of Second Military Medical University from May2014 to February 2019. SS,liver stiffness( LS),SV,residual remnant liver volume( FRLV),and inflammation markers were measured for all patients before surgery. The independent samples t-test was used for comparison of continuous data between two groups; a Pearson correlation analysis was used to investigate the correlation of SS with LS and SV; univariate and multivariate logistic regression analyses were used to identify the influencing factors for the development of PHLF. The receiver operating characteristic( ROC) curve was used to evaluate the clinical value of SS,SV/FRLV,and hepatic inflow occlusion( HIO),and the area under the ROC curve( AUC),sensitivity,and specificity were calculated. Results A total of 148 patients with HCC were enrolled,among whom 21( 14. 2%) developed PHLF. Postoperative pathology revealed liver cirrhosis in 73 patients( 49. 3%). There were significant differences in SV,LS,and SS between the patients with liver cirrhosis and those without liver cirrhosis( t = 13. 610,6. 952,and 20. 580,all P < 0. 001). The correlation analysis showed that SS was positively correlated with LS and SV( r = 0. 650 and 0. 453,P = 0. 002 and 0. 005). The univariate analysis showed that tumor diameter,liver cirrhosis,neutrophil/lymphocyte ratio,LS,SS,SV/FRLV,time of operation,blood transfusion,and HIO duration were associated with the development of PHLF( all P < 0. 05),and the multivariate logistic regression analysis showed that SV/FRLV( hazard ratio[HR]= 26. 564,95% confidence interval [CI]: 1. 611-422. 541,P < 0. 001),SS( HR = 1. 018,95% CI: 1. 014-1. 154,P =0. 008),and HIO duration( HR = 1. 045,95% CI: 1. 012-1. 084,P = 0. 002) were independent risk factors for PHLF. The ROC curve analysis showed that SV/FRLV had an AUC of 0. 867( 95% CI: 0. 755-0. 926,P < 0. 001),a sensitivity of 0. 783,and a specificity of0. 919 in predicting PHLF; SS had an AUC of 0. 856( 95% CI: 0. 715-0. 984,P < 0. 001),a sensitivity of 0. 673,and a specificity of0. 862 in predicting PHLF; HIO had an AUC of 0. 694( 95% CI: 0. 542-0. 862,P = 0. 003),a sensitivity of 0. 696,and a specificity of0. 741 in predicting PHLC. Conclusion SS and SV/FRLV can help to predict the development of PHLF in patients with HCC.
Expression of protein phosphatase 2A catalytic subunit in hepatoma cells after acute and chronic injury induced by hydrogen peroxide and aflatoxin B1 and its influence on hepatoma cells
Yang ChengLei, Huang Shen, Mo LaiMing, Tang Shen, Li XiYi, Zhang ZhiMing
2019, 35(12): 2730-2735. DOI: 10.3969/j.issn.1001-5256.2019.12.018
Abstract:
Objective To investigate the expression of protein phosphatase 2 A catalytic subunit in hepatoma cells after acute and chronic injury induced by hydrogen peroxide and aflatoxin B1. Methods Hepatoma cells( HepG2/Huh-7 cells) were treated with different concentrations of hydrogen peroxide( 0,50,100,200,400,and 800 μmol/L) for 2,4,6,and 8 hours or aflatoxin B1( 0,1. 25,2. 5,5,10,20,and 40 μmol/L) for 24 and 48 hours. An inverted microscope was used to observe cell morphology,resazurin assay was used to measure the activity of hepatoma cells,and Western blot was used to measure the expression of demethylated PP2 Ac( dem-PP2 Ac) and total PP2 Ac protein. The independent samples t-test was used for comparison between two groups,a one-way analysis of variance was used for comparison between multiple groups,and the two-way analysis of variance was used for factorial design data. Results HepG2/Huh-7 cells were sensitive to hydrogen peroxide and aflatoxin B1,and with the increases in the concentration of hydrogen peroxide and AFB1 concentration or the prolonged incubation time,there were changes in cell morphology and a reduction in the number of cells. At 2,4,6,and 8 hours of the treatment with hydrogen peroxide at a concentration of 100 μmol/L or above,the activity of HepG2/Huh-7 cells gradually decreased with the increase in the concentration of hydrogen peroxide,and the one-way analysis of variance showed a significant difference between suchcells and the control group( all P < 0. 05). The two-way analysis of variance showed no significant difference in IC50 between the two cell lines during these four periods of time( P > 0. 05). At 24 and 48 hours of the treatment with aflatoxin B1 at a concentration of 2. 5 μmol/L or above,the activity of HepG2/Huh-7 cells gradually decreased with the increase in the concentration of aflatoxin B1,and the one-way analysis of variance showed a significant difference between such cells and the control group( all P < 0. 05). The two-way analysis of variance showed no significant difference in IC50 between the two cell lines during these two periods of time( P > 0. 05). After HepG 2 cells were induced by 200 μmol/L hydrogen peroxide for 2 hours,this group of cells had significantly higher expression levels of total PP2 Ac protein and dem-PP2 Ac than the control group( t =-5. 553 and-2. 990,P = 0. 005 and 0. 040); after Huh-7 cells were induced by 400 μmol/L hydrogen peroxide for 2 hours,this group of cells had significantly higher expression levels of total PP2 Ac protein and dem-PP2 Ac than the control group( t = 0. 073 and-5. 149,P = 0. 002 and 0. 007). After HepG 2 cells were induced by 10 μmol/L aflatoxin B1 for 2 hours,this group of cells had significantly higher expression levels of total PP2 Ac protein and dem-PP2 Ac than the control group( t =-4. 561 and-5. 788,P = 0. 010 and 0. 004); after Huh-7 cells were induced by 20 μmol/L aflatoxin B1 for 2 hours,this group of cells had significantly higher expression levels of total PP2 Ac protein and dem-PP2 Ac than the control group( t =-5. 120 and-6. 144,P = 0. 007 and 0. 004).Conclusion Morphological changes,a reduction in cell activity,and increases in the expression of total PP2 Ac and dem-PP2 Ac are observed after acute and chronic injury of hepatoma cells induced by hydrogen peroxide and aflatoxin B1.
Changes in the expression of 17-β-hydroxysteroid dehydrogenase 13 and mitofusin 2 in liver cancer tissue and a bioinformatics analysis
Ceng ChaiMing, Yan MaoLin, Shi YiHai, Guo TaiLin, Mei AiNong, Chen JianKang, Xu GuiPing, He XiaoHong
2019, 35(12): 2736-2740. DOI: 10.3969/j.issn.1001-5256.2019.12.019
Abstract:
Objective To investigate the change in the expression of 17-β-hydroxysteroid dehydrogenase 13( HSD17 B13) and mitofusin2( MFN2) in hepatocellular carcinoma( HCC) tissue and its clinical significance,and to analyze target genes by bioinformatics methods.Methods Fifteen HCC patients who received surgical treatment in Fujian Provincial Hospital from September 2017 to March 2018 were enrolled. HCC and adjacent tissues were collected after surgery. Real-time PCR and Western blot were used to measure the change in the expression of HSD17 B13 and MFN2 in HCC and adjacent tissues,and the clinical significance of such change was analyzed. The single cell sequencing database,the GTEx database,and The Cancer Genome Atlas database were used to analyze the expression of HSD17 B13 and MFN2 in HCC tissue and different stages of HCC,as well as its correlation with overall survival of liver cancer. The correlation between the expression of HSD17 B13 and MFN2 was also analyzed. For normally distributed continuous data,the t test was used for comparison between two groups,and an analysis of variance was used for comparison between multiple groups; for non-normally distributed continuous data,the Mann-Whitney U test was used for comparison between two groups,and the Kruskal-Wallis H test was used for comparison between multiple groups. The log-rank test was used to investigate the influence of variables on survival rate,and the Kaplan-Meier method was used for plotting the survival curve. A Pearson correlation analysis was used to investigate the relationship between the two variables. Results Real-time PCR and Western blot showed that compared with the adjacent tissue,the HCC tissue had significantly downregulated expression of HSD17 B13 and MFN2( PCR: t =-2. 467 and-3. 933,P = 0. 020 and 0. 001; Western blot: t =-5. 357 and-5. 771,P = 0. 006 and0. 026). The bioinformatics analysis showed significantly downregulated expression of HSD17 B13 in HCC tissue( P < 0. 05),and the expression of HSD17 B13 decreased with the increase in the stage of HCC( F = 3. 220,P = 0. 023); low expression of HSD17 B13 was associated with poor survival( risk ratio = 0. 630,P = 0. 011); in HCC tissue,the expression of MFN2 was positively correlated with that of HSD17 B13( r = 0. 190,P < 0. 001). Conclusion There is downregulated expression of MFN2 and HSD17 B13 in liver cancer,and MFN2 and HSD17 B13 may be potential tumor suppressor genes with clinical relevance. They may be involved in biological behaviors in the development and progression of liver cancer and may become useful molecular markers for liver cancer screening,clinical classification,and prognosis evaluation and effective targets for the treatment of liver cancer.
Original articles_Biliary diseases
Clinical effect of endoscopic ultrasonography in the diagnosis and evaluation of common bile duct stones
Cui YuFang, Bao JunJun, Song YuLin, Zhang Lei, Mei Qiao
2019, 35(12): 2741-2743. DOI: 10.3969/j.issn.1001-5256.2019.12.020
Abstract:
Objective To investigate the value of endoscopic ultrasonography( EUS) in the diagnosis of common bile duct stones. Methods A total of 98 patients who attended The First Affiliated Hospital of Anhui Medical University from June 2017 to May 2019 and were suspected of common bile duct stones were enrolled. All patients underwent EUS and magnetic resonance cholangiopancreatography( MRCP) during hospitalization. The results of open/laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy were the gold standard for diagnosis. The results of EUS alone,MRCP alone,and EUS combined with MRCP( positive results of EUS or MRCP were considered positive,and negative results of both EUS and MRCP were considered negative) were compared with the gold standard,and the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of the three methods were calculated. The chi-square test was used for comparison of the above indices. Results Of all 98 patients,92 had positive EUS results,among whom 5 had false positive results; 6 had negative EUS results,among whom 3 had false negative results. Of all 98 patients,69 had positive MRCP results,among whom 2 had false positive results; 29 had negative MRCP results,among whom 23 had false negative results. Of all 98 patients,94 had positive MRCP/EUS results,among whom 5 had false positive results; 4 had negative MRCP/EUS results,among whom 1 had false negative results. The EUS group had a significantly higher sensitivity than the MRCP group( 96. 67%vs 74. 44%,χ2= 17. 982,P < 0. 05),while there was no significant difference in sensitivity between the EUS group and the combined group( 96. 67% vs 98. 89%,χ2= 1. 023,P = 0. 312). There were 52 patients who were suspected of biliary microlithiasis( ≤0. 5 cm),among whom 51 had positive EUS results,including 3 patients with false positive results; 1 had false negative EUS results; among these 52 patients,36 had positive MRCP results,including 1 patient with false positive results; 16 had negative MRCP results,including 14 patients with false negative results; all 52 patients had positive results of EUS combined with MRCP,among whom 3 had false positive results. The EUS group had a significantly higher diagnostic sensitivity than the MRCP group( 97. 96% vs 71. 43%,χ2= 13. 303,P < 0. 05),while there was no significant difference between the EUS group and the combined group( 97. 96% vs 100%,P = 1. 0). Conclusion EUS has great advantages in the diagnosis of common bile duct stones,especially biliary microlithiasis. EUS has a high diagnostic value and can thus be used as the preferred examination before invasive operation.
Clinical value of ultra-thin electronic flexible endoscopy combined with intraluminal ultrasound in assisting percutaneous transhepatic biliary stricture biopsy
Jiao DeChao, Lei QinYu, Han XinWei, Li ZongMing, Bi YongHua, Zhang QuanHui
2019, 35(12): 2744-2747. DOI: 10.3969/j.issn.1001-5256.2019.12.021
Abstract:
Objective To investigate the clinical value of Olympus ultra-thin electronic flexible endoscope BF-XP290 combined with the intraluminal ultrasound system in assisting percutaneous transhepatic biliary stricture biopsy. Methods From July to September,2018,12 patients with biliary obstruction underwent endoscopic observation and intraluminal ultrasound of stricture using Olympus ultra-thin electronic flexible endoscope BF-XP290 system combined with luminal ultrasound system in the first Affiliated Hospital of Zhengzhou University,and meanwhile,clamp biopsy was conducted for the lesion through the sheath tube under fluoroscopy. Endoscopic observation,ultrasound image,success rate of endoscopic operation,success rate of biopsy,time of operation,and complications were recorded. The t-test was used for comparison of continuous data between groups. Results All the 12 patients underwent endoscopy and intraluminal ultrasound under intravenous anesthesia,and satisfactory tissue samples were collected. The success rates of operation and biopsy were 100%,and the mean time of operation was 27. 8 minutes. Biliary stricture and tumor-like neoplasms were observed in 10 patients( 83. 3%),and biliary stricture and mucosal bulge were observed in 2 patients; the location of lesions was consistent with the location of obstruction on preoperative imaging. Intraluminal ultrasound showed localized mucosal bulge in 6 patients,even thickening and narrowing of the lumen in 2 patients,and invasion of the outer wall in 9 patients. Clamp biopsy suggested bile duct adenocarcinoma( well-differentiated adenocarcinoma in 7 patients,moderately differentiated adenocarcinoma in 2 patients,and poorly differentiated adenocarcinoma in 1 patient). Two patients( 16. 7%) were found to have biliary stricture with calculus; intraluminal ultrasound showed even thickening of the lumen with an intact outer wall,and biliary clamp biopsy confirmed fibrous connective tissue hyperplasia. There was a small amount of bleeding in the bile duct after operation in all patients( 100%),and no complications such as bile duct perforation,pancreatitis,and massive bleeding were observed.There were significant changes in total bilirubin,direct bilirubin,alanine aminotransferase,and aspartate aminotransferase after operation( t = 4. 38,5. 34,6. 21,and 5. 76,all P < 0. 01). Conclusion The ultra-thin electronic flexible endoscope BF-XP290 combined withthe intraluminal ultrasound system can provide direct-view and wall information of the bile duct with stricture and reduce the incidence rate of complications while ensuring the success rate and positive rate of intra-biliary clamp biopsy,and therefore,it holds promise for clinical application.
Clinicopathological features and prognosis of periampullary carcinomas in the pre-jaundice stage
Peng XiaoQian, Liu Lu, Jiao XiaoXiao, Zhou Lin
2019, 35(12): 2748-2753. DOI: 10.3969/j.issn.1001-5256.2019.12.022
Abstract:
Objective To investigate the clinicopathological features and prognostic factors of periampullary carcinomas( PACs) in the pre-jaundice stage. Methods A retrospective analysis was performed for the clinical data of 518 patients with PACs who were admitted from January 2012 to December 2017,and according to jaundice symptom and serum total bilirubin on admission,they were divided into pre-jaundice group with 125 patients and jaundice group with 393 patients. The two groups were compared in terms of clinical data,pathological features,and 5-year survival rate,and prognostic factors were 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 two groups. The Kaplan-Meier method was used to calculate survival rates and plot survival curves. The log-rank test was used for univariate analysis,and the Cox proportional-hazards regression model was used for multivariate analysis. Results Compared with the jaundice group,the pre-jaundice group had a significantly higher proportion of patients with the manifestation of abdominal distension and pain,a significantly longer duration of abdominal distension and pain,and significant increases in red blood cell count,albumin,and prealbumin( χ2= 14. 786,Z =-6. 023,t =-2. 247,-4. 688,and-3. 873,all P < 0. 05),as well as significantly lower alanine aminotransferase,aspartate aminotransferase,gamma-glutamyl transpeptidase,and alkaline phosphatase( Z =-75. 647,-55. 567,-52. 583,and-61. 501,all P < 0. 05). The detection rates of space-occupying lesions by ultrasound,computed tomography,magnetic resonance imaging/magnetic resonance cholangiopancreatography,and endoscopic retrograde cholangiopancreatography were 45. 0%,77. 7%,79. 2%,and 100%,respectively. As for pathology,compared with the jaundice group,the pre-jaundice group had a significantly longer mean tumor diameter,a significant difference in the proportion of patients with different primary sites,and significantly lower T stage and positive rate of pancreatic invasion( Z =-3. 063,χ2=10. 641,3. 991,and 4. 708,all P < 0. 05). The pre-jaundice group had a significantly higher 5-year survival rate than the jaundicegroup( χ2= 4. 582,P < 0. 05). The multivariate analysis showed that intravascular tumor thrombus,degree of tumor differentiation,and adjuvant chemotherapy were independent influencing factors for the prognosis of PACs. Conclusion PACs patients in the pre-jaundice stage has better clinicopathological features and long-term( ≥5 years) survival rate than those with jaundice,and therefore,early identification,diagnosis,and treatment can improve the survival rate of patients with PACs.
Original articles_Others
Role and mechanism of action of endoplasmic reticulum stress in the formation of sex difference in liver diseases
Wang Jie, He YiHuai, Chen Huan, Long Jun, Xiao Xue
2019, 35(12): 2754-2758. DOI: 10.3969/j.issn.1001-5256.2019.12.023
Abstract:

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

Value of indocyanine green clearance test in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure
Dou HongLian, He HongYan, Xiao CiJun, Wang Bo, Li Ye, Sheng YunJian, Deng CunLiang
2019, 35(12): 2759-2764. DOI: 10.3969/j.issn.1001-5256.2019.12.024
Abstract:

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

Clinical effect of Qingre Jiedu Liangxue prescription in treatment of mice with acute-on-chronic liver failure and related mechanism
Wang KaiXia, Zheng Chao, Zhang JingHao, Zhu XiaoJun, Wang Xuan, Kong XiaoNi, Gao YueQiu, Sun XueHua
2019, 35(12): 2765-2771. DOI: 10.3969/j.issn.1001-5256.2019.12.025
Abstract:

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

Value of red blood cell distribution width,mean platelet volume,and neutrophil-lymphocyte ratio in the evaluation of primary biliary cholangitis
Yang Liu, Chen XiangJin, Li BianLi, Peng Ying, Xu LiHong
2019, 35(12): 2772-2775. DOI: 10.3969/j.issn.1001-5256.2019.12.026
Abstract:

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

Case reports
A case of hepatic neuroendocrine tumor with hepatic sinusoidal obstruction syndrome
Chen DongKui, Xu Yang
2019, 35(12): 2776-2777. DOI: 10.3969/j.issn.1001-5256.2019.12.027
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Hepatic sinusoidal obstruction syndrome induced by Chinese herb Emilia sonchifolia(L.) DC: A case report
Chen RuanQin, Zhuo HaiYan, Li XiaoLou, Chen Li
2019, 35(12): 2778-2779. DOI: 10.3969/j.issn.1001-5256.2019.12.028
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Liver injury induced by Dioscorea bulbifera,Swietenia macrophylla seeds,and Periploca forrestii: A report of 3 cases
Qi ChuanWang, Xian JianChun
2019, 35(12): 2780-2782. DOI: 10.3969/j.issn.1001-5256.2019.12.029
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Reviews
Role of hepatitis B virus-induced myeloid-derived suppressor cell subsets in chronic HBV infection
Wu ZhiHui, Yang MiaoMiao, Tu ZhengKun
2019, 35(12): 2783-2787. DOI: 10.3969/j.issn.1001-5256.2019.12.030
Abstract:
Hepatitis B virus( HBV) is a member of hepadnavirus,and HBV infection may not cause direct hepatocyte lesions. Host immune response determines whether the virus can be eliminated and is a major cause of HBV-related liver diseases. Myeloid-derived suppressor cells( MDSCs) are a group of non-lymphoid immune suppressor cells originating from bone marrow and can regulate innate and adaptive immune responses under different pathological conditions. Studies have shown that chronic hepatitis B patients have a significantly higher number of MDSCs in peripheral blood than the healthy population. This article introduces the role of HBV-induced MDSC subsets in persistent HBV infection and liver pathological mechanism.
Biological characteristics of high-mobility group box-1 and its role in the development,progression,and treatment of hepatitis B virus-related liver diseases
Yao ChuanXia, Wang MaoRong
2019, 35(12): 2788-2792. DOI: 10.3969/j.issn.1001-5256.2019.12.031
Abstract:
High-mobility group box-1( HMGB1) is a member of the high-mobility group proteins and is present in eukaryotic cells.HMGB1 is not only a nuclear protein but also a pro-inflammatory factor,and the increase in HMGB1 level in the body indicates cell destruction and inflammatory response. Hepatitis B virus( HBV) infection is a major cause of chronic hepatitis B,liver cirrhosis,and hepatocellular carcinoma in the world. In recent years,the role of HMGB1 in HBV-related liver diseases has attracted more and more attention,especially the important role of HMGB1 in the progression of liver inflammation and liver cancer. This article reviews the recent research advances in the role of HMGB1 in the development,progression,and treatment of HBV-related liver diseases.
Role of monocyte chemoattractant protein 1 and its receptor in the progression of liver fibrosis
Guo YueCheng, Lu LunGen
2019, 35(12): 2793-2795. DOI: 10.3969/j.issn.1001-5256.2019.12.032
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Liver fibrosis is a common reversible pathological change in chronic liver injury and may progress to liver cirrhosis,liver failure,and portal hypertension. In recent years,several studies have shown a significant change in chemokine profiles in patients with liver fibrosis,which is closely associated with the progression of liver fibrosis. Monocyte chemoattractant protein 1( MCP-1) belongs to the family of CC chemokines and can induce the activation,recruitment,and migration of inflammatory cells during liver fibrosis. MCP-1 may be involved in the activation of hepatic stellate cells,the development of insulin resistance,and the progression to hepatocellular carcinoma. This article mainly reviews the potential role of MCP-1 and CC chemokine receptor in the progression of liver fibrosis and related therapies.
Noninvasive assessment of cirrhotic portal hypertension
Mu XueChun, Wang Yu, Ma Hong
2019, 35(12): 2796-2799. DOI: 10.3969/j.issn.1001-5256.2019.12.033
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Hepatic venous pressure gradient( HVPG) is the gold standard for the degree of cirrhotic portal hypertension and has limited use in clinical application,and therefore,there is an urgent need for noninvasive assessment methods for portal hypertension. This article introduces various serological,imaging,and elastography methods and combined diagnostic models and elaborates on the current research results and the advantages and disadvantages of each method. It is pointed out that in future,noninvasive diagnostic techniques may play a greater role in screening,monitoring,and risk stratification of patients with cirrhotic portal hypertension.
Role and mechanism of berberine in treatment of hepatocellular carcinoma
Xu XiaoYang, Wang YuLu, Ping Jian, Zhao ZhangQing
2019, 35(12): 2800-2804. DOI: 10.3969/j.issn.1001-5256.2019.12.034
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A large number of studies have shown that berberine exerts an anti-tumor effect mainly by inhibiting cancer cell proliferation,inducing cancer cell death,inhibiting cancer cell metastasis and invasion,regulating the expression of endogenous oncogenes and tumor suppressor genes,affecting the activity of cancer-related enzymes,exerting an anti-oxidative stress effect,correcting abnormal glucose metabolism,and inhibiting the activity of nuclear factor-kappa B and its pathways. In vivo and in vitro studies have shown than berberine has a marked clinical effect in the treatment of hepatocellular carcinoma with various pharmacological actions and molecular regulatory mechanisms. This article reviews the role and mechanism of berberine,an active component of traditional Chinese medicines including Coptis chinensis,in the treatment of hepatocellular carcinoma and thus reveals the clinical effect of berberine in the treatment of hepatocellular carcinoma. In future,new dosage forms should be developed to improve its bioavailability and form effective therapeutic regimens for clinical application.
Current status of associating liver partition and portal vein ligation for staged hepatectomy in treatment of liver metastasis of colorectal cancer
Liao Yang, Li ShengWei
2019, 35(12): 2805-2808. DOI: 10.3969/j.issn.1001-5256.2019.12.035
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At present,radical resection remains the best treatment strategy for liver metastasis of colorectal cancer,and patients with large or multiple tumors often face the problem of insufficient residual liver volume after hepatectomy,which may lead to serious complications including liver failure after surgery. Associating liver partition and portal vein ligation for staged hepatectomy( ALPPS) is a novel two-step hepatectomy that allows rapid proliferation of the residual liver after primary surgery and can improve the resectability of liver tumors and reduce the risk of postoperative liver failure. Although ALPPS can achieve R0 resection or tumors and prolong patients' survival time,there are still controversies over its application due to high incidence rates of complications and mortality rate. With reference to related studies in China and foreign countries,this article reviews the current application status and clinical value of ALPPS in liver metastasis of colorectal cancer.
Role of hepatocyte mitophagy in the pathogenesis of nonalcoholic fatty liver disease
Zhou ZhenHua, Wang LingTai, Gao YueQiu
2019, 35(12): 2809-2811. DOI: 10.3969/j.issn.1001-5256.2019.12.036
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Nonalcoholic fatty liver disease has become the most important chronic liver disease in China and the leading cause of abnormal liver biochemical parameters in physical examination. Mitophagy can degrade the mitochondria with impaired function and misfolded protein in the liver to regulate cell death and help to maintain stable lipid metabolism in the liver. The binding of adiponectin secreted by adipose tissue to adiponectin receptor 2 can increase the secretion of autophagy agonists in Kupffer cells,induce hepatocyte mitophagy,promote lipid metabolism,and thus reduce liver inflammation,which provides new thoughts for the research and development of drugs with a marked clinical effect and a clear mechanism of action in the treatment of nonalcoholic fatty liver disease.
Research advances in sodium-glucose co-transporter 2 inhibitor in treatment of type 2 diabetes mellitus with nonalcoholic fatty liver disease
Xue MiaoMiao, Li XuePing, Li Ya, Yan NaNa, Xu GangZhu, Song Mei
2019, 35(12): 2812-2816. DOI: 10.3969/j.issn.1001-5256.2019.12.037
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Nonalcoholic fatty liver disease( NAFLD) is a common complication of type 2 diabetes mellitus( T2 DM) and can progress to liver cirrhosis and even hepatocellular carcinoma,but there are still no effective pharmacotherapies for NAFLD at present. Sodium-glucose co-transporter 2 inhibitor( SGLT-2 i) is a newly approved oral hypoglycemic agent and can effectively reduce blood glucose. Meanwhile,SGLT-2 i can improve NAFLD by improving lipid accumulation and insulin resistance,exerting anti-inflammatory and anti-oxidative stress effects,reducing liver fibrosis degree,and delaying the progression to hepatocellular carcinoma. SGLT-2 i also helps with the prevention of NAFLD by reducing the toxicity of high glucose,body weight,and blood uric acid and improving liver dysfunction. This article reviews the current status of T2 DM with NAFLD,the mechanism of action of SGLT-2 i,the effect of SGLT-2 i in preventing T2 DM with NAFLD,and the safety of SGLT-2 i.
Research advances in antioxidants in the progression of alcoholic liver disease
Chen HaiZhen, Huang Jing
2019, 35(12): 2817-2819. DOI: 10.3969/j.issn.1001-5256.2019.12.038
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Alcoholic liver disease( ALD) is a series of chronic non-infectious liver diseases caused by long-term heavy alcohol consumption. Reactive oxygen species( ROS) is produced during alcohol metabolism,and if it is not eliminated completely,it may cause oxidative stress,which will further lead to inflammatory response of Kupffer cells and lipid peroxidation and thus accelerate the progression of alcoholic hepatitis and fibrosis. The human body can generate a variety of enzymes or antioxidants to eliminate ROS and its by-products and resist oxidative stress. This article reviews several enzymes or antioxidants involved in antioxidant activity in ALD.
Clinical evaluation and prognosis prediction of drug-induced liver injury
Xing Lu, Wang Yu, Tao YanYan, Liu ChengHai
2019, 35(12): 2820-2823. DOI: 10.3969/j.issn.1001-5256.2019.12.039
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Drug-induced liver injury( DILI) is commonly seen in clinical practice and may bring serious harm to health. It is an important reason for the failure of liver disease treatment and new drug research and development. The clinical diagnosis of DILI remains a difficult issue in the world,and therefore,exploration of related risk signs and initiation of clinical evaluation and prognosis prediction are of great significance for the prevention,diagnosis,and treatment of DILI.
Research advances in hepatic encephalopathy after transjugular intrahepatic portosystemic shunt
Wang Zhong, Liu FuQuan
2019, 35(12): 2824-2827. DOI: 10.3969/j.issn.1001-5256.2019.12.040
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Transjugular intrahepatic portosystemic shunt( TIPS) has become an effective method for the treatment of portal hypertension.Although the use of polytetrafluoroethylene covered stents enhances shunt patency,hepatic encephalopathy remains a significant issue after TIPS. This article reviews the epidemiology,pathogenesis,pathogenic factors,and treatment of post-TIPS hepatic encephalopathy,so as to improve the understanding and awareness of this issue.
Effect of endoplasmic reticulum stress and autophagy on hepatocyte apoptosis
Gong Jing, Jie XinKe
2019, 35(12): 2828-2832. DOI: 10.3969/j.issn.1001-5256.2019.12.041
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Endoplasmic reticulum stress and autophagy are two two-edged swords. On the one hand,in case of intracellular environment disturbance,unfolded protein response reduces protein synthesis,promotes protein degradation,and increases protein folding to restore intracellular homeostasis through three signaling pathways,while excessive stress activates a series of signaling molecules to induce apoptosis; on the other hand,autophagy is a protective pathway for self-degradation in human body and can absorb and decompose damaged or harmful macromolecular substances in cells through autophagic vacuole-lysosome complex and promote cell metabolism,while excessive autophagy also causes apoptosis. Endoplasmic reticulum stress and autophagy play important roles in the process of hepatocyte apoptosis. Therefore,these two molecular mechanisms may serve as targets for future drug research and provide therapeutic and diagnostic strategies for hepatocellular diseases.
Endoscopic therapy for acute suppurative cholangitis with common bile duct stones
Tian Wen, Zhou ZhongYin
2019, 35(12): 2833-2836. DOI: 10.3969/j.issn.1001-5256.2019.12.042
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Acute suppurative cholangitis( ASC) is an acute infectious disease of the biliary tract caused by bacterial infection and biliary obstruction. Common bile duct stone is the most common cause of biliary obstruction. Due to the characteristics of rapid onset,rapid progress,various complications,and high mortality of ASC,it has attracted more and more attention in clinical practice. The treatment of ASC includes anti-infective therapy and relief of obstruction,and early relief of obstruction is the key to successful treatment. Endoscopic therapy has long been regarded as the first choice for the relief of obstruction,and with the development of medical technology,various new endoscopic techniques are gradually applied in the treatment of ASC and have thus become the new choices for surgeons and patients. With reference to the advantages and disadvantages of different treatment techniques,this article reviews the endoscopic therapies for ASC caused by common bile duct stones.
Immunotherapy for biliary tract cancer: Current status and perspectives
Luo Kui, Sun Hang, Wu ChuanXin
2019, 35(12): 2837-2840. DOI: 10.3969/j.issn.1001-5256.2019.12.043
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Biliary tract cancer( BTC) is rare in clinical practice and is difficult to diagnose in the early stage,and conventional treatment methods have unsatisfactory clinical effects. As a new research hotspot at present,immunotherapy has been proven to have a promising future in the treatment of a variety of cancers. At present,various immunotherapies,including immunological checkpoint inhibitors,adoptive immune cell therapy,and tumor vaccine therapy,have been applied in the clinical trials of BTC. This article briefly describes the current status and perspectives of immunotherapy in the treatment of BTC.
Conference overviews
Minutes of annual meeting of APALD Tianjin alliance (2019)
Zhang Qing, Li Hai
2019, 35(12): 2841-2842. DOI: 10.3969/j.issn.1001-5256.2019.12.044
Abstract: