Objective The aim of this study was to evaluate the effect,safety and feasibility of percutaneous and open-approach microwave ablation to treat multiple liver metastases. Methods A 59-yr-old man with colon cancer and multiple hepatic metastases was admitted to our department of surgery in November 2013. There was one lesion（0.9 cm×0.8 cm） near heart,which was defined as dangerous for microwave ablation and subjected to open-approach microwave ablation,and there were two lesions （1.4 cm×0.9 cm and 3.0 cm×2.8 cm） ablated by percutaneous microwave ablation. Results There were no serious postoperative complications and the three lesions completely disappeared three months after the treatment. Conclusions Percutaneous combined with open-approach microwave ablation is effective,feasible and safe procedure in the treatment of multiple hepatic metastases.

Objective To determine the effect of recombinant adenovirus p53 （rAd-p53） therapy in combination with transcatheter hepatic arterial themoembolization（TACE） for patients with primary liver cancer （PLC）. Methods A total of 72 patients with advanced PLC were enrolled in this study from Jan. 2008 to Dec. 2014. Patients were divided into TACE group （mitomycin 8 mg,epirubicin 5 mg/m²,oxaliplatin 30 mg/m²,n=36） and p53 treatment group （rAd-p53,mitomycin 8 mg,epirubicin 5mg/m²,oxaliplatin 30 mg/m²,n=36）. The procedure was repeated once every 28 days for 4 times as a course. The therapeutic effects were evaluated according to the clinical symptoms,CT scans and liver functions. Results In TACE group,the total effective rate（CR+PR） was 50% including no complete response （CR） and partial response（PR） of 50%,stable disease （SD） was 5.6%,and progressive disease（PD） was 44.4%;In p53 treatment group,the total effective rate was 69.4%,including CR of 5.6%,PR of 63.8%,SD of 5.6%,and PD of 25%;The Karnofsky performance score in p53 treatment group was improved better than in TACE group（P<0.05）;The adverse effects in rAd-p53-treated patients was transient and self-limited fever. Conclusion The rAd-p53 therapy in combination with TACE is effective for patients with advanced PLC.

Objective To explore the efficacy and mechanism of perfusion embolization combined with microwave in patients with primary liver cancer. Methods 120 cases with primary liver cancer were recruited. Patients in the control group （n=60） were treated with conventional perfusion embolism,and patients in the treatment group（n=60） were given perfusion embolism combined with microwave for four cycles. Treatment efficacy,liver function,immune cell counts and complication were observed. Results The effective rate of treatment group and control group were 80.0% and 50.0% respectively. The complications which occurred in both groups during the treatment included nausea,vomiting,pain,fever and hypohepatia,however,the complication incidence of the treatment group was significantly lower than that of the control group（P<0.05）. In terms of immune cells count, NK cell proportion of patients in the treatment group and control group were （17.99±6.44）% and （18.09±6.30）% respectively,and there was difference in CD4⁺CD25⁺ Treg cell proportion between patients of the treatment group （4.44±2.11）% and control group （7.30±3.09）%,P<0.05. AST and ALT of patients in the treatment group and the control group were also significantly different [AST （41.99±16.44） vs （78.09±16.30） U/L;ALT （40.44±12.11） vs （76.30±13.09） U/L,P<0.05 for both]. Conclusion Perfusion embolization combined with microwave therapy leads to improved anti-tumor effect,better recovery in liver function,and reduced complications in patients with primary liver cancer,which is associated with lower activity of regulatory T cells.

Objective To observe the clinical efficacy of selective transcatheter chemoembolization （TACE） with biologic microsphere and lipiodol in the treatment of patients with primary liver cancer （PLC）. Methods 82 patients with PLC in Daping hospital from January 2010 to December 2012 were included in this study and were divided into two groups. 42 patients received selective transcatheter chemoembolization with lipiodol,and 40 received selective transcatheter chemoembolization with both biologic microsphere and lipiodol. Each patient got chemoembolization at least four times. The follow-up assessment was conducted 1 month later as well as 3 months,6 months,1 year and 2 years later after the first treatment to follow-up the decreased volume and number of tumor masses,serum AFP levels,the remission rates and survival. Results The remission rate of 57.44% in patients treated with both biologic microsphere and lipiodol was obviously higher than that treated with lipiodol（TACE）（5.23%,P<0.05） 3 months after the first operation. The serum level of AFP in the combined group got much lower（296.7±96.3）ng/ml than in the TACE group[（346.9±118.3）ng/ml,P<0.05] 6 months later. We found that the diameters of tumors were much smaller（3.36±1.37） cm in the combined group than in the TACE group[（4.98±1.87）cm,P<0.05] 12 months later. And the survival rate in the combined group was much higher（15.0%） than that in the TACE group[（2.3%）,P<0.05] 24 months later. Conclusions Compared with patients treated with chemoembolization and lipiodol,patients receiving chemoembolization with both biologic microsphere and lipiodol get increased remission of tumor masses,as well as decreased serum AFP levels. Selective transcatheter chemoembolization with biologic microsphere and lipiodol is effective and safe in treatment of advanced liver cancer.

Objective To investigate the efficacy of high-powered microwave ablation （MWA） in treating patients with small and large hepatocellular carcinoma （HCC） and to clarify the safety and the risk factors of recurrence after percutaneous MWA. Methods A total of 45 patients with hepatitis B virus （HBV） associated HCC,who had not received any treatment before percutaneous MWA,were enrolled in this study. All patients received MWA by using high power[（80-100 W） and （2450±10 ） MHz] through percutaneous approach. The procedure was carried out for a total of 60 lesions with the diameter of 3 to 8 cm. The patients were divided into two groups,e.g. 46 in small tumor group （3-5 cm） and 14 in big tumor group （5-8 cm）. The local tumor ablation rates between the two groups were compared. The recurrence, complications and the therapeutic efficacy were recorded. The contrast enhanced ultrasound and the contrast enhanced CT or MRI was performed one month after microwave ablation.The factors related to HCC recurrence were analyzed by using univariate analysis and multivariate analysis. Result The complete ablation rates for the first ablation in the small tumor group was significantly higher than in the big tumor group （82.6% vs. 64.3%,P=0.037）,and the complete ablation rates for the second ablation were 100.0% in the small tumor group and 85.7% in the big tumor group（P>0.05）;After the MWA,no skin burn or death occurred;Ten（22.2%） of 45 patients developed recurrence after ablation and the one-year and two-year survival rates were 95.6% （43/45） and 86.7（39/45）;Univariate analysis showed that a positive correlation existed between the lesion’s number,proximity to a major bile duct,pre-ablation serum α-fetoprotein（AFP） levels,serum HBV DNA positive and early recurrence and multivariate analysis identified HBV DNA（P=0.031） and proximity to a major bile duct（P=0.039） as the independent prognosis factors causing postoperative HCC recurrence. Conclusion The complete ablation rate of high-powered percutaneous MWA in the small tumor group is higher than in the big tumor group and high-powered percutaneous MWA appears to be a safe and effective treatment with fewer complications for patients with HCC. HBV DNA and proximity to risk area are the independent prognosis factors causing postoperative HCC recurrence.

Objective To analyze the short and long-term effects of three-dimensional conformal radiation therapy （3D-CRT） combined with TACE versus TACE alone for treatment of patients with hepatocellular carcinoma with portal vein tumor thrombus（PVTT）. Methods Retrieval was performed according to the principles of systemic assessment,then we conducted a meta-analysis to compare 3-DCRT combined with TACE versus TACE alone for treatment of patients with hepatocellular carcinoma with PVTT. Results A total of 8 randomized controlled trials were included,and 463 cases receiving 3-DCRT combined with TACE and 386 receiving TACE alone were recruited. Compared with in TACE alone,the 3D-CRT combined with TACE treatment had advantages in tumour therapeutic response [OR 2.871,95%CI（1.426,5.783）,P<0.05],control rate [OR 2.871,95%CI（1.426,5.783）,P<0.05],1-year survival [OR 2.993,95%CI（1.713,5.230）,P<0.05] and 2-year survival [OR 3.054,95%CI（1.170,7.973）,P<0.05]. Conclusion 3D-CRT combined with TACE is better than TACE alone in treatment of patients with hepatocellular carcinoma with PVTT,which warrants further study.

Objective To investigate the clinical effect of adefovir dipivoxil （ADV） combined with Compound Biejia Ruangan tablets in the treatment of patients with chronic hepatitis B （CHB）. Methods 80 patients with CHB were randomly divided into control （n=40） and treatment group （n=40）. Patients in control group were given ADV, while patients in treatment group were given ADV combined with Compound Biejia Ruangan tablets for 6 months. Clinical symptoms and signs, liver function, hepatic fibrosis indicators,abdominal ultrasonographic indicators such as portal vein diameter, splenic vein diameter as well as thickness of spleen,and serum HBV DNA levels, HBeAg seroconversion after the treatment were recorded. Results At the end of the treatment,ALT,AST,ALB and TBil in patients of control group were （57.84±16.11） U/L,（51.55±18.46） U/L,（33.43±4.76） g/L and （25.74±4.85） μmol/L respectively,and those in patients of treatment group were（38.47±13.43） U/L,（35.74±15.17） U/L,（26.25±4.57） g/L and（15.27±3.36） μmol/L respectively;The HA,LN,PC-Ⅲ and Ⅳ-C in patients of control group were（168.53±86.21） μg/L,（121.45±38.56） μg/L,（131.61±34.49） μg/L and （123.53±31.67） μg/L respectively,and those in patients of treatment group were（87.57±42.53） μg/L,（62.74±21.87） μg/L,（88.74±28.32） μg/L and（67.63±16.67） μg/L respectively;The portal vein diameters,splenic vein diameters and thickness of spleen in patients of control group were （1.42±0.20） cm,（0.78±0.09） cm and （4.65±0.43） cm respectively,and those in patients of treatment group were（1.31±0.21） cm,（0.74±0.07） cm and （4.24±0.38） cm respectively;Above-mentioned indicators in treatment group had more remarkable decreased compared with patients in control group（P<0.05）;The levels of serum HBV DNA after the treatment in patients of control group decreased from（6.12±1.66） log10 copies/ml to （3.57±1.21） log10 copies/ml,and in patients of treatment group decreased from （5.93±1.84） log10 copies/ml to （3.43±1.17） log10 copies/ml,showing there was no significant difference in HBV DNA levels after the treatment between the two groups. Conclusion ADV combined with Compound Biejia Ruangan tablets has a satisfactory clinical outcome in patients with CHB.

Objective To investigate the effect of compound embryonic bovine liver extract in patients with hepatitis B related liver cirrhosis. Methods One hundred and twenty patients with hepatitis B induced liver cirrhosis were randomly divided into two groups,with 80 in treatment group receiving compound embryonic bovine liver extract tablets at the base of basic liver-protecting treatment and 40 in control group receiving the basic liver-protecting treatment only for 3 months. Liver function tests,liver stiffness measurement（LSM） by Fibrotouch,and portal vein diameters,spleen thickness and splenic vein width before and after treatment were compared in both groups. Results At the end of 3-month treatment,serum TBIL,ALT,and LSM values in patients in treatment group were（33.0±2.07） μmol/L,（36.40±5.86） U/L,（10.78±1.15） Kpa, respectively, significantly decreased as compared with those in the controls[（48.62±4.24） μmol/L,（52.60±7.3） U/L,（15.26±2.17） Kpa,respectively, P<0.05 for all];serum ALB levels in patients in treatment group increased significantly compared with that in controls[（35.0±1.58） g/L vs. （31±1.58） g/L,P<0.05];portal vein diameters,spleen thickness and splenic vein widths remarkably decreased compared with those in patients in the control group [（1.26±0.08） cm vs. （1.36±0.05） cm,（3.97±0.04） cm vs. （4.20±0.10） cm,（0.87±0.02） cm vs. （0.92±0.02） cm,P<0.05 for all]. Conclusions Compound embryonic bovine liver extract can significantly improve the liver function and inhibit liver fibrosis in patients with hepatitis B induced liver cirrhosis.

Objective To investigate the awareness of antiviral treatment in patients with hepatitis B virus （HBV）-related liver cirrhosis and the content of chronic hepatitis B prevention and treatment guidelines（2010, China）in gastroenterologist from tertiary hospitals in Chengdu. Methods Questionnaire based on newly published chronic hepatitis B prevention and treatment guidelines were designed and a total of 224 gastroenterologists in 20 tertiary general hospitals in Chengdu completed the questionnaires on the principle of volunteer,anonymity and independence. The questionnaires were collected by special investigators from our team. Results 208（92.9%） respondents acquired the treatment-related acknowledge mainly by reading the updated guidelines. The necessity and course of anti-HBV regimen were well known,with 220 respondents（98.2%） knowing the antiviral treatment necessary to patients with HBV-related cirrhosis,but 203（90.63%） unaware of the course of treatment. However,the respondents were relatively poor understanding of the antiviral indications,treatment process and follow-up. Only 40（17.9%） respondents gave the correct answer of antiviral indications in HBeAg-positive patients in compensated stage;35（15.6%） gave the correct answer of antiviral indications in HBeAg-negative patients in compensated stage; 87（38.8%） gave the correct answer of antiviral indications in patients with decompensated HBV-related cirrhosis; only 28（12.5%） knew the requirement of follow-up in patients with stable condition after treatment. According to the survey of this study,adefovir dipivoxil,one of nucleoside analogues,was best known, by 193（86.2%） respondents,and 161（71.9%） respondents believed that the costs of the medicine was the major factor determining the choice of antiviral medication. Conclusion Gastroenterologists in tertiary general hospitals in Chengdu have a good understanding of the purpose and necessity of antiviral treatment in patients with HBV-related liver cirrhosis,but have a relatively poor acknowledge about the antiviral indications, choices of antiviral agents, and requirements of follow-up.

Objective To investigate the inhibitory effect of salidroside on cytochrome P4502E1 （CYP2E1） protein expression in primary-cultured rat hepatocytes with steatosis. Methods The hepatocytes of SD rats were separated and primary-cultured for 48 h. Hepatocytes were then exposed to 0.25 mmol/L palmitic acid incubation for 24 h in the presence or absence of 150 μg/ml salidroside. ALT,AST and malonaldehyde （MDA） in the culture supernatants and triglyceride （TG） contents in the hepatocytes were tested. Lipid accumulation was estimated by oil red-O staining. CYP2E1 protein expression in the hepatocytes was examined by Western blot. Results When compared to palmitic acid group,salidroside decreased ALT[（13.5±1.2） U/L vs.（11.3±1.0） U/L,P<0.05],AST [（5.9±0.7） U/L vs. （3.7±0.5） U/L,P<0.05],MDA[（4.2±0.9） nmol/ml vs. （1.7±0.2） nmol/ml,P<0.01] in the supernatants and TG content in the hepatocytes [（268.3±25.8） μg/mg protein vs. （105.7±16.8） μg/mg protein,P<0.01] induced by palmitic acid;Salidroside attenuated severe accumulation of fat drops in the hepatocytes, and suppressed CYP2E1 protein expression up-regulation in hepatocytes with steatosis. Conclusions Salidroside prevents hepatocyte steatosis via suppression of CYP2E.

Objective To study the effect of total flavonoids of astragalus （TFA） on expression of fatty acid translocase and cyclooxygenase 2 in rats with DMN-induced liver cirrhosis. Methods Fifty-three male SD rats were allocated randomly into control group （n=10） and model group （n=43）. Rats in model group were given DMN by intraperitoneal injection for 4 weeks. At the 3rd experimental week,the model rats were randomly divided into model group （n=14） and TFA treatment groups （n=14,at dose of 15 mg.kg^-1 and n=15,at dose of 30 mg.kg^-1）. At the end of 4 week experiment,the rats were sacrificed,and liver samples were collected. Sirus red staining was performed in liver tissues. Total RNA of liver tissues were isolated with TRizol reagents,and real time PCR was adopted to determine fatty acid translocase and cyclooxygenase 2 mRNA and their protein expression by PCR and Western blot. Results Collagen staining in model group increased markedly,and staining in treatment groups decreased markedly;the fatty acid translocase mRNA in model group was （0.098±0.08） and its protein was （1.05±0.076）,while in small dosage group were（0.58±0.04） and（0.67±0.021）,respectively,and in large dosage group were （0.45±0.07） and [（0.31±0.072）,respectively,both P<0.05];the cyclooxygenase 2 mRNA in model group was （0.78±0.044） and its protein was （1.48±0.13）,while in small dosage group were （0.52±0.010） and （1.24±0.11）,respectively,and in large dosage group were （0.28±0.049） and [（0.68±0.09）,respectively, both P<0.01]. Conclusion The anti-fibrotic effect of TFA might be associated with the inhibition of fatty acid translocase and cyclooxygenase 2 in rats with DMN-induced liver cirrhosis.

Objective To investigate extracellular histones changes in concanavalin A （ConA）-induced acute liver injury in mice as well as the intervening potential on targeted histones. Methods Acute liver injury was induced by ConA injection via tail vein at a dose of 35 mg·kg^-1 body weight in C57BL/6 mice. The animals in intervention group were treated with specific anti-histone neutralizing antibody. The survival rates, hepatic function index and related cytokines in different groups were analyzed. Results In model group, plasma ALT levels at the time point of 3 h,9 h,16 h and 24 h after ConA treatment remarkably increased compared with those in control group [（106.5±25.5） IU/L,（769.1±138.2） IU/L,（1340.2±205.9） IU/L and（1304.7±300.7） IU/L vs. （35.5±3.165） IU/L,P<0.01 for all];the plasma extracellular histones in model group at 3 h,9 h,16 h and 24 h increased considerably in a time-dependent manner as compared with those in control group[（1.199±0.1087）,（2.467±0.197）,（2.655±0.2295）,（2.631±0.3014） vs. （0.206±0.024）,P<0.01 for all];Histology revealed degeneration and necrosis in a great amount of hepatocytes in model group,however,survival rate and liver damage were improved following administration of anti-histone neutralizing antibody;Serum IL-6 and TNF-α levels in intervention group were lower than those in model group[（16.98±3.67） pg/ml vs.（238.10±48.56） pg/ml,（3.25±0.67） pg/ml vs. （16.52±2.43） pg/ml,P<0.05 for both]. Conclusions Extracellular histones are important inflammatory mediators involved in the pathogenesis of acute liver injury induced by ConA,and intervention targeting extracellular histones shows promising potential in the relief of hepatic inflammatory reaction.

Objective To assess the feasibility and safety of repairing bile duct defect with intraluminal stent. Methods Thirty local rabbits were randomly divided into group A and B, with 15 in each. The common bile duct resection of 0.5 cm was underwent in group A and of 1.0 cm in group B. The self-made simple biliary stents were inserted to restore the continuity of the injured bile ducts. The liver function,postoperative survival, liver,bile duct and newborn bile duct were determined. The animals in two groups after 1,3,6 months were sacrificed. Results The operation in the two groups were successfully completed and no postoperative jaundice occurred. In group A,1 rabbit died because of bile leakage,and in group B,1 animal died because of stress gastrointestinal ulcer. The serum ALT levels was （56.36±6.35）IU/L,and 1,3 and 6 months after operation,they were[（59.63±5.02）IU/L,（54.63±8.26）IU/L,（59.85±7.43）IU/L,respectively,P>0.05];AST was （54.13±7.63）IU/L,and 1,3 and 6 months after, they were[（57.42±8.31）IU/L,（55.42±5.21）IU/L,（53.62±5.61）IU/L,respectively,P>0.05];ALP was （207.35±63.47）IU/L,and 1,3 and 6 months after,they were [（218.42±73.23）IU/L,（195.31±46.73）IU/L,（189.31±37.64）IU/L,respectively,P>0.05];TBIL was（0.15±0.08）μmol/L and 1,3 and 6 months after,they were[（0.17±0.04）μmol/L,（0.14±0.05）μmol/L,（0.16±0.07）μmol/L,respectively,P>0.05]. In group B,serum ALT level was（60.26±3.65）IU/L,and 1,3 and 6 months after,they were[（69.21±5.13）IU/L,（63.79±8.35）IU/L,（59.97±6.47）IU/L,respectively,P>0.05];AST was（51.33±6.43）IU/L and 1,3 and 6 months after, they were [（55.43±7. 26）IU/L,（61.62±5.73）IU/L,（52.32±5.31）IU/L,respectively,P>0.05];ALP was （217.25±53.72）IU/L,and 1,3 and 6 months after,they were [（228.62±71.32）IU/L,（200.35±46.83）IU/L,（209.83±36.41）IU/L,respectively,P>0.05];TBIL was（0.14±0.05）μmol/L,and 1,3 and 6 months after,they were[（0.16±0.04）μmol/L,（0.12±0.02）μmol/L,（0.13±0.06）μmol/L,respectively,P>0.05]. The liver pathology showed no significant change after operation;The new bile duct tissues had no edema three months postoperation. Conclusion The bile ducts have an vigilant regeneration to restore its defects and the repairment of bile duct defects by intraluminal stent is a safe,feasible,and simple technique.

Objective To explore the clinical features and pathological changes in patients with drug-induced liver injury（DILI） in recent years. Methods Data of 441 patients with DILI from January 2010 to May 2014,including the medication courses,clinical manifestations, lab results,pathological findings and disease courses, were retrospectively analyzed. Results The numbers of patients with traditional Chinese medicine（TCM）-induced liver injury and western medicine-induced liver injury were 176 （39.91%） and 210 （47.62%）,respectively;All patients were divided into three clinical types:e.g. 178（40.36%） with hepatocyte DILI,132（29.93%） with cholestatic DILI and 131（29.71%） with mixed DILI;No significant difference was found in histological changes and laboratory indexes between TCM-and western medicine-induced liver injuries（P>0.05）;However,TCM-induced patients had a lower incidences of erythra than in patients receiving western medicine（1.1% vs. 5.2%,P<0.05）,but had a higher incidences of splenomegaly（78.4% vs. 46.2%,P<0.05）;In addition,it took longer to develop liver injuries for TCM-induced patients（P<0.05）;The recovery rate of all the DILI patients in this series was 94.56%. Conclusion A variety of medicines is closely involved in reducing DILI in clinical practice,which warrants further studies.

Adefovir dipivoxil（ADV）,an oral nucleotide analogue,remains as one of the major antiviral agents in the treatment of chronic hepatitis B（CHB） in China. However,long-term therapy with ADV may lead to hepatitis B virus（HBV） drug-resistant mutations. The signature mutations associated with ADV resistance are rtA181V and rtN236T. The newly-identified ADV primary resistant mutations are rtA181S,rtE218G and rtN236V. In addition,some other mutations including rtA181T,rtV214A, rtQ215H/P/S,rtL217R/P,rtI233V,and rtN238T/D/H remain contradictory,and these mutations need to be further identified.

Acute-on-chronic liver failure （ACLF） refers to an acute decompensated liver function in patients with chronic liver diseases and the most common cause of ACLF in China is HBV infection. Activation of cytotoxic T lymphocytes and increased cytokines can cause immunopathogenetic injuries in liver tissues. This article mainly reviewed the immunopathogenesis progress of HBV related ACLF.

Portal vein thrombosis （PVT） is more common in cirrhotic patients than in normal people, which may have adverse effect on prognosis of patients with liver cirrhosis.Virchow’s triad（hypercoagulability,vascular endothelial injury and reduced blood flow velocity） is a classic theory about thrombosis. Hypersplenism and liver dysfunction cause the change of clotting factors,and intrahepatic vascular compress by liver fibrosis,sclerotherapy,abdominal surgery,infection as well as endotoxemia may injure the endothelial cells;Portal hypertension or prophylactic medicine may block the blood flow. All of the above factors can be the risk factors of PVT. This review mainly describes the risk factors of PVT in cirrhotic patients from the view of Virchow’s triad and hopes to provide theoretical basis for the formulation of prediction method,prevention and treatment of PVT.

Statins（3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors） are widely prescribed to reduce serum cholesterol levels,which is associated with a reduced risk of hepatocellular carcinoma（HCC）. Statins have effects in inhibiting tumor cell proliferation,inducing tumor cell apoptosis and differentiation,resistance to blood vessel formation,reducing the invasive tumor cells,affecting the cell cycle,blocking small G protein isoprene,signal transduction and so on. However,the underlying mechanism remains unclear,it mainly includes the following two ways:rely on and do not rely on HMG CoA reductase pathway. In this article,the anti-cancer effect and the mechanism of statins will be reviewed.

Vascular inteventional therapy has played an important role in patients with unresectable primary liver cancer（PLC）,while the effect of vascular interventional therapy is closely related to the choice of embolic materials. We reviewed the characteristics and the clinical application of common embolic materials used in vascular inteventional therapy.