Objective To study the etiologies,clinical symptoms and signs,and therapeutic options of patients with primary liver cancer （PLC）. Methods The clinical data,laboratory tests,image materials,therapeutic options and prognosis of patients who were first diagnosed with PLC between May,2011 and December,2012 were collected and analyzed retrospectively. Results Five hundred and seventy-seven patients with complete data were included, among whom the ratio of male to female was 512:65;The age ranged from 22 to 90 years,and the average age was（53.1±12.0） years;Among these patients,there were 511 patients （88.56%） who were positive for serum marker（s） of hepatitis B virus （HBV） infection,and 132 （22.9%） with a family history of HBV-related chronic liver diseases;Among 513 patients with HBV serum marker examination,91.0%（467）of patients were HBsAg positive,30.8%（158） HBeAg positive and 60.2%（309）HBeAg negative;Hepatalgia was the most common initial symptom;There were 115 patients （19.93%） who were suitable for surgery at the time of diagnosis,however,only 40.87% （47 cases） of them received hepatectomy indeed. Conclusions PLC is more common in male persons,closely associated with chronic HBV infection in China and lacks of specific clinical manifestations;The proportion of patients receive surgical procedure to total patients who are suitable for surgical therapy is still rather low,and standardized therapy according to the available guidelines should be further promoted in HCC patients in China.

Objective To observe the efficacy of sorafenib in the treatment of advanced primary liver cancer. Methods Nineteen patients with advanced primary liver cancer were treated by sorafenib at a dose of 400mg twice daily until the occurrence of intolerable toxicity or death. Results Partial response was obtained in one（5.3%）,stable disease in 10（52.6%）,and progressed disease in 8（42.1%）,and serum alpha fetoprotein decreased in 42.9%（6/14）of patients three months after the regimen;sixteen patients（84.2%） died,and three survived still taking sorafenib at eight month follow-up; sixteen （84.2%）got hand and foot numb,seven （36.8%）got rash and alopecia,ten had blood hypertension, fifteen （78.9%）had gastrointestinal symptoms,two （10.5%） went arrest of bone marrow,and eight （42.1%）had diarrhea. Conclusion Sorafenib is effective and safe in treatment of patients with advanced primary liver cancer. The quality of life in those patients is stable during the administration of sorafenib.

Objective To evaluate the expression of tissue inhibitor of metalloproteinases-1 （TIMP-1） in livers of patients with chronic hepatitis B（CHB） and to explore the potential relationship between TIMP-1 level and hepatic fibrosis progression. Methods The tissue and serum levels of TIMP-1 were determined by immunohistochemistry and double-antibody sandwich enzyme-linked immunoadsorbent assay,respectively,and their correlation was determined. One hundred and fifty-nine patients with CHB underwent liver biopsy and their liver histological activity index （HAI） and fibrosis （S） were determined. The correlation between the serum TIMP-1 levels and HAI grading and staging was analyzed. Results The expression of TIMP-1 in liver tissues were positively correlated to serum TIMP-1 levels in CHB patients （r=0.9521,P<0.01）;Serum TIMP-1 levels were significant different among patients with different liver fibrosis stages（S₁ to S₄）（P<0.05）,and a positive correlation between serum TIMP-1 level and hepatic fibrosis staging was found（r=0.704,P<0.01）;However,there were no significant differences in serum TIMP-1 levels among patients with different liver inflammatory grades. ConclusionsSerum TIMP-1 level is not affected by liver inflammatory grades and is promising in non-invasive clinical evaluation of liver fibrosis.

Objective To systematically review the efficacy and safety of telbivudine in preventing mother-to-infant transmission of hepatitis B virus in the third trimester of pregnancy. Methods Chinese Biomedical Literature Database,WanFang Database Online,Chinese Scientific Journals Database,CNKI,PubMed,ISI web of knowledge,EMBASE,Cochrane Library and BIOSIS Previews were searched for related articles till September 2013. Two reviewers independently screened these articles according to inclusion and exclusion criterion. Meta-analysis was performed by using software Rvman 5.1. Results Eleven papers were included in this study,with a total of 1241 pregnant women,including 602 cases received telbivudine and 639 cases of control;Meta-analysis showed that, after a 6 to 12 month of follow-up,the seropositive rates for HBsAg and HBV DNA in babies of telbivudine-treated mothers were significantly lower than in babies of non-treated mothers[RR=0.15,95%CI（0.08,0.28）,P<0.00001;RR=0.12,95%CI（0.05,0.32）,P<0.0001,respectively];Maternal HBV DNA levels prior to delivery was significantly lower in telbivudine-treated women than in non-treated women[MD=-3.86,95%CI（-4.55,-3.16）,P<0.00001];The rate of elevation in serum creatine kinase （CK） was significantly higher in telbivudine-treated mothers than in non-treated mothers[MD=-3.86,95%CI（-4.55,-3.16）,P<0.00001];The neonates in telbivudine group were born without deformity and other complications. Conclusion Telbivudine is effective and safe in blocking HBV intrauterine infection.

Objective Hepatitis B virus （HBV） genotypes and pre-core mutations were studied in patients with HBV infection. Methods Viral DNA was extracted from serum samples of 740 patients with hepatitis B and liver cirrhosis from August 2010 to October 2011,and HBV genotypes and pre-core mutations were detected by ABI sequencing instrument. Results Among 740 patients with HBV infection,40（5.41%） were with HBV genotype B,695 （93.92%） were with genotype C,and 5 （0.68%） were with genotype D infection;377 （50.95%） patients carried mutations related to lamivudine,adefovir dipivoxil and entecavir resistance,among whom 195 patients （51.72%） has a definite history of application of nucleos（t）ide analog （NA）. Out of the 195 patients,there were 12 patients with HBV genotype B and 183 with genotype C infection. Also among these patients with definite NA history,118 patients were with CHB,and 77 patients were with liver cirrhosis,and the major resistant mutations were M204V+L180M,M204,M204I+L180M and A181V;Serum HBV DNA load was related to NA resistance（x²=0.496,P<0.001）,but not age,gender,disease severity （CHB or cirrhosis） and ALT levels;Besides,a number of new mutations,e.g. rt64,rt126,rt178,rt129 and so on were found in this series. Conclusions The administration of NA might results in mutation of hepatitis B virus and drug resistance,and the mutations have certain characteristics. Dynamic monitoring of serum HBV DNA load will help early detection of gene mutation and drug resistance.

Objective To study the effects of ozone-enriched autologous blood transfusion on the efficacy and adverse reactions in patients with chronic hepatitis C（CHC）receiving interferon-α and ribavirin therapy. Methods One hundred and five CHC patients were divided into control group and treatment group;The patients in control group （n=52） were treated with subcutaneous injection of peginterferon-α and oral administration of ribavirin,while the patients in treatment group（n=53） were treated with combinational therapy of interferon,and ribavirin,and ozone-enriched autologous blood transfusion （an average of 10 to 16 times）. The regimen lasted for 48 weeks with a 24 week-posttreatment of follow-up. The virologic response rates and adverse reactions were observed. Results The incidence rates of serum high triglycerides levels,hypertension and diabetes in patients of treatment group were 28.3%,28.3% and 28.3%,respectively,significantly higher than those in the control patients（5.8%,7.7% and 7.7%,respectively,P<0.05）;No significant differences as respect to gender,average age,liver function tests,HCV RNA load and percentage of cirrhosis were observed between the two groups;The incidence rates of fever, flu-like symptoms and reduction of hemoglobin in patients of the treatment group（50.9%,35.8% and 34.0%,respectively） were significantly lower than those in the control patients （73.1%,x²=5.5,P<0.01;59.6% x²=5.9,P<0.01 and 55.8%,x²=5.0,P<0.05）;The rates of early virologic response,virologic response at end of treatment and sustained virologic response in patients in the treatment group（83.0%, 83.0% and 74.4%,respectively） were not significantly different from those （88.5%,86.5% and 76.3%,respectively） in the control patients. Conclusions Although some patients having metabolic syndrome,the virologic response rate in patients receiving interferon-α and ozone-enriched autologous blood transfusion is very high,with reduced adverse reactions. Ozone-enriched autologous blood transfusion may be promising in reducing interferon-α-induced adverse reactions.

Objective To investigate the toll-like receptor 2 （TLR2） in livers of mice with murine hepatitis virus-3 （MHV-3）-induced fulminant hepatitis and in peripheral blood mononuclear cell （PBMCs） from patients with mild chronic hepatitis B（CHB）or with HBV-associated acute-on-chronic liver failure （HBV-ACLF）. Methods PBMCs from patients with mild CHB and HBV-ACLF were collected. The TLR2 mRNA in PBMCs were determined by quantitative real-time PCR. Balb/cJ mice were injected intraperitoneally with MHV-3 at dose of 100 pfu to induce fulminant hepatitis. At 0,24,48 and 72 h after injection,the TLR2 mRNA in liver tissues of mice were determined. Results After infection of MHV-3,TLR2 mRNA increased significantly at 48 and 72 h when compared with the baseline at 0 h [（0.39±0.06）% vs.（9.06±1.60）%,P<0.05 and （6.42±2.42）%,P<0.05] and it peaked at 48 h;mRNA levels for TLR2 at 48 and 72 h were positively correlated with the serum ALT and AST（r=0.804,P<0.01;r=0.797,P<0.01,respectively）;mRNA level of TLR2 in PBMCs from patients with HBV-ACLF was significantly higher than patients with mild CHB [（5.92±5.26）% vs.（1.15±1.59）%,P<0.05]. Conclusions TLR2 may take part in the process of liver injury in MHV-3-induced fulminant hepatitis in mice and the pathogenesis of patients with HBV-ACLF.

Objective To investigate the effect of cirrhosis on the development of atherosclerosis in vivo. Methods Normal male New Zealand white rabbits（n=40） were randomly divided into four groups,e.g. control （n=12）,high-fat （n=8）,carbon tetrachloride （CCl₄） （n=12） and combined treatment group （n=14）;Liver cirrhosis was induced by CCl4 injection and atherosclerosis by high fat diet（92% normal rabbit chow with 2% cholesterol and 6% lard） intake;Rabbits were sacrificed at the end of week 10 and serum aminotransferase,lipid,and fasting plasma glucose were examined and morphology changes in ascending aortas and livers were observed. ResultsAtherosclerosis was successfully induced by high-fat diet intake both in high-fat group and in combinational treatment group,while steatohepatitis-related cirrhosis was induced by CCl₄ administration and high fat diet intake in both groups;As compared with in control group,serum ALT and AST in CCl₄ group were increased significantly[（87.42±57.92）IU/L and （137.33±114.54）IU/L vs. （21.33±17.76） U/L and （63.67±29.06） IU/L,P<0.05],and significant liver steatosis,inflammation and fibrosis were also observed in CCl4-treated rabbits,but atherosclerosis were not found in ascending aortas;Serum aminotransferase,lipid and fasting plasma glucose in animals of high lipid diet were significantly higher than those in the controls（P<0.05）,in addition,significant liver steatosis,inflammation and fibrosis,and typical atherosclerosis plaques in ascending aortas were also observed in animals with high-fat diet intake;There were significant differences in serum alanine aminotransferase and intima-to-media （I/M） ratio of ascending aortas,but not in intima-media thickness（IMT）between the high fat group and the combinational treatment group. Conclusions A combination of high fat diet and CCl₄ aggravates liver inflammation but attenuates atherosclerosis induced by high fat diet in rabbits.

Objective To evaluate the clinical implication of peripheral blood dendritic cell （DC） subsets in cirrhotic patients with hepatitis B virus （HBV） infection. Methods Flow cytometry was used to analyze the counts of peripheral blood DC subsets and T lymphocyte subsets in 42 cirrhotic patients with HBV infection,45 patients with chronic hepatitis B and 30 healthy persons. Results The percentages of DC1 and DC2 subsets were （0.2±0.1）% and（0.2±0.04）%,respectively,in cirrhotic patients with chronic HBV infection, and （0.3±0.1）% and （0.2±0.1）%,respectively,in patients with chronic hepatitis B,all were significantly lower than those in health controls [（0.4±0.1）% and （0.3±0.1）%,P<0.01]; The DC2 subset in 13 cirrhotic patients with HBeAg-positive was （5.62±1.28） cells per microliter, significantly lower than that in 29 cirrhotic patients with HBeAg-negtive[（8.75±2.32）cells per microliter,P<0.05];No significant difference was found in DC1 subsets between cirrhotic patients with HBeAg-positive and HBeAg-negative;The CD4⁺ T lymphocyte and CD8⁺ T lymphocyte counts in cirrhotic patients were（588.4±124.2） cells per microliter and （338.5±97.4）cells per microliter,both significantly lower than those in patients with chronic hepatitis B[（686.7±106.5） cells per microliter and （432.1±102.6）cells per microliter,P<0.05];Moreover,CD8⁺ T lymphocytes in patients with cirrhosis and with chronic hepatitis B were both significantly lower than that in health controls[（560.2±105.6） cells per microliter,P<0.05]. Conclusion The decrease in DC1 and DC2 subsets in cirrhotic patients with HBV infection,accompanied with a decrease in CD8⁺ T lymphocytes,might play an important role in the development of cirrhosis after HBV infection.

ObjectiveTo investigate the recurrence factors for esophageal varices after endoscopic eradication therapy of endoscopic sequential variceal ligation plus sclerotherapy（EVLS）. MethodsSixty-one patients with esophageal varices achieved eradication standards after EVLS therapy were followed up for 2 years. The patients were divided into high recurrence risk group （relapse within 24 months） and low recurrence risk group （without recurrence within 24 months） according to the recurrence time,and the biochemical and clinical data of the two groups were collected and analyzed statistically. Results There were 24（39.3%） cases of patients diagnosed with esophageal variceal recurrence within two years,and 37（60.7%）without recurrence. There were significant differences between the two groups as respect to bleeding history,spleen hyperthyroidism,diabetes,moderate/severe ascites, Child-Push scores,serum albumin,platelet counts,prothrombin time and portal vein diameters measured by ultrasound（P<0.05）;Furthermore,non-conditional logistic regression analysis showed that bleeding history,moderate/severe ascites and diabetes history were independent risk factors for esophageal varices recurrence（OR value 9.7,6.5 and 10.8,respectively）. Conclusions Bleeding history,moderate/severe ascites and diabetes history are independent risk factors for esophageal varices recurrence and these patients should be actively followed up and retreated in time.

Objective To assess the clinical value of 64-slice spiral CT portography in prediction of esophageal variceal bleeding （EVB） in cirrhotic patients. MethodsSixty four patients with liver cirrhosis （30 cases with EVB, and 34 without） and 36 normal persons underwent 64-slice spiral CT portography and the diameters of the main portal vein （MPV）,splenic vein （SPV）,left gastric vein （LGV）,intrahepatic left portal vein （IHLPV） and intrahepatic right portal vein（IHRPV） were measured; The ability of these indexes in prediction of EVB were evaluated by the area under the receiver operating characteristic （ROC） curves （AUC）. Results The diameters of MPV,SPV,LGV,IHLPV and IHRPV in cirrhotic patients were （1.68±0.21） cm,（45±0.18） cm,（0.53±0.12） cm,（1.21±0.15） cm and（1.26±0.22） cm,respectively, significantly higher than those in the controls[（1.18±0.14） cm,（0.80±0.09） cm,（0.42±0.07） cm,（0.95±0.07） cm and （0.96±0.11） cm,respectively,P<0.05];The diameters of MPV,SPV,LGV,IHLPV and IHRPV in patients with Child-Pugh class C were（2.01±0.20）cm,（1.57±0.10） cm,（0.59±0.11）cm,（1.36±0.09） cm and（1.45±0.12） cm,respectively,significantly higher than those in patients with Child-Pugh class A[（1.68±0.15）cm,（1.35±0.13）cm,（0.48±0.09）cm,（1.11±0.13）cm and （1.15±0.21）cm,respectively,P<0.05];The diameters of MPV,SPV,LGV and IHLPV in EVB group were（1.78±0.16） cm,（1.54±0.20）cm,（0.62±0.10）cm and（1.28±0.15）cm,respectively,significantly higher than those in patients without EVB[（1.60±0.21）cm,（1.36±0.13）cm,（0.45±0.06）cm and（1.15±0.13）cm,respectively,P<0.05];The diameter of IHRPV showed no difference between patients with EVB （1.29±0.21）cm and without EVB （1.25±0.23）cm;The AUC of LGV was 0.906,and the sensitivity and specificity in prediction of EVB were 93.3% and 58.8%, respectively when LGV was greater than 0.61 cm. Conclusion 64-slice spiral CT portal venography can not only clearly show the collateral vessels of portal hypertension in cirrhotic patients,but also has a certain value in prediction of EVB in clinical practice.

Objective To study the clinical characteristics of patients with Madelung syndrome （MS） in China. Methods We searched China National Knowledge Internet（CNKI）database （1994-2013）,Wanfang database （2000-2013） and VIP Citation database （2002-2013） for articles about MS; Finally,61 articles with 282 cases of MS were included in this study;SPSS17.0 and Excel software were used to analyze the retrieved data. Results In all 282 cases,there were 264 male （93.62%） and 18 female （6.38%） patients,and the male to female ratio was 14.6:1;Among these patients,62 cases from 41 articles had complete case history and clinical data （60 male and 2 female） and the age of patients ranged from 34 to 79 year-old with a average age of （50.04±8.15） year old;In this 62 cases,the course of disease lasted for 3 months and 20 years and the average disease course was （5.62±4.02） years;Forty-one cases （66.13%） had chronic alcoholism; Eighteen cases showed the symptoms of compression of the upper mediastinum,including oppression of the neck, dyspnea,snoring or sleep apnea syndrome;Symmetry or neck-rounded ring-shaped lumps were found in the parotid area,cervical region,and back at physical examination;Fifty-eight （out of 62） cases underwent surgical excision （include plastic surgery）. Conclusion MS is a kind of concealed and slowly progressing benign tumor,mostly affecting middle-aged men with long-term heavy alcohol intake.

Objective To explore the related factors of controlled attenuation parameter （CAP） of liver obtained by FibroScan examination in healthy individuals. Methods The CAP was obtained by FibroScan in208healthy persons, and the main biochemical indexes, gender, age, body mass index （BMI）, waist-hip ratio （WHR）, waist-height ratio were collected at the same time, and the relationship between CAP value, these common indicators was analyzed. Results Multiple linear regression analysis showed that CAP value was significantly correlated with BMI, WHR, age （for BMI, β=0.280, P=0.0002;for WHR, β=0.206, P=0.0059;for age, β=0.192, P=0.0022）;And the regression equation established after multiple linear regression analysis, partial least squares regression were CAP=-137.70+9.40*TG+5.40*BMI+176.34*WHR+1.60*age, the adjusted CAP=-92.11+10.67*TG-10.25*HDL+4.45*BMI+196.25*WHR+1.03*age. Conclusions The range of CAP value is affected by BMI, WHR, and age in the general population, the adjusted regression equation is more better to predict the CAP value of the liver

Hepatitis B virus-associated glomerulonephritis （HBV-GN） is a common clinical secondary renal disease in China, which is mostly seen in children and young adults. It has been more than 30 years since the discovery of the association between hepatitis B virus（HBV） infection and the occurrence of glomerulonephritis. However,controversy still lie in the treatment of HBV-GN since then. We aim to give a brief introduction of research and progress in the treatment of HBV-GN.

Minimal hepatic encephalopathy (MHE) is a common complication of decompensated liver cirrhosis or in patients with various portal-systemic shunt. Due to lack of typical clinical features and biochemical abnormally, MHE can only be diagnosed through psychometric or neurophysiological tests. And its incidence has increased to 30% to 84%. MHE affects daily life of patients, and it may make progress to overt hepatic encephalopathy without intervention. So far, there is no well established method to define its diagnosis as golden standard. This review mainly introduces the diagnostic methods applied at home and abroad.

Nonalcoholic fatty liver disease （NAFLD） is a part of hepatic manifestation of the metabolic syndrome. Its main features are fat deposition in liver and insulin resistance （IR）. Adipokines, a group of polypeptides secreted by adipocyte cells, play an important role in the pathogenesis of NAFLD and IR. In this paper,the focus is emphasized on the roles of adipokines in NAFLD,such as leptin, adiponectin, retinol binding protein 4,fibroblast growth factor 21,chemerin and other emerging factors.

Non-alcoholic fatty liver diseases （NAFLD） has an increasing worldwide prevalence. A ‘two-hit’ mechanism has been accepted,however,its pathogenesis remains to be clarified. Recently,some new findings about gut microbiota in NAFLD have emerged. It might be involved in gut permeability,low-grade inflammation and immune inbalance,and it is believed that it modulates dietary choline metabolism,regulates bile acid metabolism and produces endogenous ethanol. All of these factors are molecular mechanisms by which the microbiota can induce NAFLD or has some roles in the process from NAFLD to overt non-alcoholic steatohepatitis. This review summarizes the main literature findings about the relationships between gut microbiota and NAFLD.