Objective This study was undertaken to explore the relationship between enteric neuronal and migrating motor complexes（MMC）in rats with acute liver failure. Methods Wistar rats were given the D-galactosamine hydrochloride（D-Gal）to induce acute liver failure. Then，the MMC was recorded by a multilead physiologival recording system. TUNEL，5-HT and NSE immunohistochemistry were used to detect neuronal apoptosis. Results The duration of jejunal MMC was significantly prolonged in rats with acute liver failure compared with the control（P<0.05）；The duration of phaseⅡ was also significantly prolonged，and multiple clusters of contractions was observed in phaseⅡ；However，the duration of phaseⅢ was significantly shortened（P<0.05）compared with the control group；TUNEL staining showed neuronal apoptosis increased significantly in rats with acute liver failure；The content of NSE and 5-HT positive substances of jujunal in rats with acute liver failure was markedly decreased. Conclusion The prolonged duration of MMC and phaseⅡ and decreased duration of phaseⅢ might results in abnormal gastrointestinal motility，which may be related to enteric neuronal apoptosis.

Objective To investigate the immune response and its mechanism of dendritic cells induced by a polypeptide. Methods Using the method of“Bulk”to harvest many DCs. After subcutaneously immunization for ten days，the mice splenocytes were harvested. CD4+T cells were separated from splenocytes by cell sorting technology. Then，CD4+T cells and DC cells were coincubated for a day. The supernatants were detected by cytometric bead array. Result The CD11c+ expression rate of DC cultured in vitro was more than 80%；Compared with control group，the level of TNF-α secreted by CD4+T cell was lower and the levels of IL-5，IL-2 and IFN-γ were higher in experiment group；the levels of IFN-γ，TNF-α，IL-10 and IL-6 secreted by CD8+T cell were increased in experiment group. Conclusion A large number of DCs from mouse bone marrow in vitro exhibites typical morphology of DC，which might be an experimental material for further study on function，markers and antitumor role of DCs in vitro. The 7 peptide could induce cell-mediated immune response through Th1 cells and CD8+T cells.

Objective To investigate the expression of innate immune-associated molecules in Huh7， HepG2，HepG2.2.15 and L02 hepatocyte lines and the influence of their expression by hepatitis B viral transfection in intro. Methods The total mRNA of the four cultured cells and three transfected cells by HBV replication clone（pAAV-HBV1.2）were extracted and reverse transcripted to cDNA. The expression of the innate immune-associated molecules such as TLRs，NLRs and RLRs were detected by PCR. Results The results showed that all of the four cell lines not only expressed the TLRs such as TLR1，TLR3，TLR4 and TLR9，but also expressed the NLRs such as NOD1，and RLRs such as RIG1. The expression of MDA5 and A20 decreased in transfected HepG2 and Huh7 cells. Conclusion Hepatocytes can express a series of innate immune-associated molecules such as TLRs and RLRs. There are distinct expression in different hepatocyte lines. HBV could influence the expression of the innate immune-associated molecules in hepatocyte lines.

Objective To observe the efficacy of ω-3 unsaturated fatty acid on lipid and glycometabolism， as well as on adipocytokines in rats with NASH. Methods 32 rats were divided into 3 groups（control/NASH/therapy group）. Control group was fed with normal diet，and the other two with high-fat diet. ω-3 unsaturated fatty acid was added to therapy group from 8 weeks to 12 weeks. The weight，FBS，ALT，AST，TC，TG and adipocytokines were measured. Results NASH model was established successfully. The weight，TC，TG and ALT decreased in therapy group，as compared with those in rats with NASH；Therapy group showed lower leptin，resistin and higher adiponectin levels than in NASH group. Conclusion Unsaturated fatty acid may improve lipid and glycometabolism on NASH rats，and it can also regulate the expression of adipocytokines.

Objective The aim of this study was to investigate the clinic significance of liver biopsy in asymptomatic chronic hepatitis B virus carriers. Methods 134 individuals with chronic hepatitis B viral carriers received the liver biopsy. Results Liver biopsies showed hepatic necrosis inflammation and fibrosis in 1.49%（2/134）without any change；Among 105 patients who met the HBV DNA≥105copies/ml（or in HBeAg negative patients was≥104copies/ml），there were 80 cases whose liver inflammation≥G2；Between 100 patients with HBeAg（+）and 34 patients with HBeAg（-），there was no significantly statistical difference in their liver inflammation and fibrosis（P=0.308）；the hepatic necrosis inflammation and fibrosis between group with HBV DNA<107copies/ml and those with HBV DNA≥107copies/ml were statistically different（P=0.007，P=0.001）. Conclusions The liver biopsy should be done in chronic hepatitis B carriers in time.

Objective To investigate the clinical and virological characteristics of acute hepatitis B. Methods 37 patients with acute hepatitis B were studied for clinical outcomes and their serum and liver HBV markers were detected. Results On admission，serum alanine aminotransferase in the 37 patients with acute hepatitis B were 1143.64±698.32 U/L，and total billirubin were 83.99±80.44μmol/L；and the normalization of liver function was achieved at 44.41±15.43d；3（8.1%）became chronic carriers，and they were all treated with nucleoside analogues；HBsAg in the 37 patients disappeared at 55.9±44.3d，and HBV DNA at 39.4±25.2d；The results of liver biopsy showed that HBsAg disappeared in 22.6±10.0d with the HBsAg loss rate of 51.4%，and HBcAg disappeared in 29.8±16.5d with the HBcAg loss rate of 73%. Conclusions Most patients with acute hepatitis B recovers with viral clearance. The HBV load at onset maybe predict the outcome of acute hepatitis B.

Objective To compare the efficacy and safety of telbivudine（LdT）and ADV in the treatment of patients with HBeAg-positive CHB. Methods 175 patients with HBeAg-positive CHB were randomly divided into LdT group（n=85 cases）and ADV group（n=90 cases），and the observation was 48 weeks. Results Compared with the ADV group，the LdT group had a very lower serum HBV DNA levels（P<0.01）and higher HBV DNA negative and ALT normalization rates at week 12，24，36 and 48（P<0.05 or P<0.01）；HBeAg negative or HBeAg/anti-HBe conversion and complete response in the LdT group were higher than those in the ADV group at week 12，24，36（P<0.05 or P<0.01）；2 cases in LdT group and 1 case in ADV group had virological rebound at week 48. Conclusions Telbivudine has a stronger inhibition of HBV replication and has a higher HBeAg negative or HBeAg/anti-HBe conversion rates.

Objective To analyze the HBV biological changes pre- and post-clinical exacerbation in an acute-on-chronic liver failure patient caused by HBV YMDD mutation. Methods Two HBV replication competent clones were constructed which contained 1.3 copies of HBV genome and represented the dominant quasispecies before and after clinical exacerbation. Then，they were transfected into Huh-7 cells，and HBsAg and HBeAg in culture supernant were examinanted by ELISA. HBV transcripts in transfected cells was semi-quantified by reverse transcriptional quantified PCR. At the same time，they were employed by hydrodynamic injection into BALB/c mice to establish HBV acute infected model，and the viremia were checked by real-time quantified PCR. Results A series of mutations were observed in all four open reading frames of HBV besides YVDD mutation in YMDD motif after clinical exacerbation. The levels of HBsAg in the supernant of wild and mutant HBV replication competent clones transfected Huh-7 cells were not significantly different（P＞0.05），while HbeAg secretion stopped（P＜0.01）；The HBV transcripts in transfected cells were unchanged（P＞0.05）；The HBV viremia titer（7.24±0.63 and 6.86±0.62lg copies/ml）were comparable between the two clones（P＞0.05）. Conclusion There is no significant change in biological characteristics between the HBV clones pre-and post-clinical exacerbation caused by YMDD mutation，except for the defect of HBeAg secretion competence. The mutations locates in the non-reverse transcriptase domain may play some important roles in compensating the viral replication competence.

Objective To evaluate the value of model for end-stage liver disease（MELD）scoring system in predicting the prognosis of patients with chronic severe hepatitis B receiving plasma exchange. Methods Total serum bilirubin，international normalized ratio and creatinine were determined pre-treatment and post-treatment in 112 patients with chronic severe hepatitis B who were treated with plasma exchange. The patients were divided into three groups according to MELD score. The mortality rate within three months post-treatment were compared in three groups. Results In 63 cases with MELD score less then 30，19% patients died；in 34 cases with MELD score between 30 and 40，58.8% died；and in 15 cases with MELD score more than 40，none of them survived. The mortality rates among the three groups were significantly different（P<0.05）. Conclusion MELD scoring system is useful in predicting the prognosis of patients with chronic severe hepatitis B treated with plasma exchange.

Objective To investigate the efficacy and safety of telbivudine and lamivudine in treatment of active cirrhosis resulting from chronic hepatitis B. Methods 65 patients with active cirrhosis resulting from hepatitis B were randomly divided into treatment group（30 cases）and control group（35 cases）. The treatment group received telbivudine 600 mg once daily and the control group received lamivudine 100 mg once daily on the basis of routine treatment for 72 weeks. Results Serum HBV DNA levels decreased，liver function improved，and the Child-Pugh scores lowered（P<0.05 or P<0.01）in both groups after the treatment；ALT normalization，HBV DNA and HBeAg loss in treatment group were 83.3%，86.7% and 44.4%，respectively，while they were 68.6%，68.6% and 35.0% in control（P>0.05）. Conclusion Telbivudine can inhibit HBV replication and improve liver function in patients with active cirrhosis resulting from hepatitis B.

Objective To invetstigate the expression and significance of heat shock protein 70（HSP70）， p53 and proliferating cell nuclear antigen（PCNA）in hepatocellular carcinoma（HCC）. Methods HSP70，p53 and PCNA were determined in liver tissues of control，chronic hepatitis B，liver cirrhosis and HCC by immunohistochemistry. Resultes The positive rates of HSP70，p53 and PCNA in HCC were higher than that in non-tumor tissues（x21=27.16，x22=67.6，x23=40.6，P＜0.01）；HSP70 expression increased progressively in liver tissues of control，chronic hepatitis B，liver cirrhosis and HCC；The positive rates of HSP70 and p53 in well-differenciated HCC were lower than that in poorly-differenciated HCC（x21=6.8，P1<0.01，x22=6.1，P2＜0.05）；the expression of PCNA were not associated with histological grades（x2=2.4，P＞0.05）；The expression of HSP70 was closely correlated to that of p53 and PCNA in HCC（x21=41.3，x22=41.4，P＜0.01）. Conclusion Expression of HSP70 is high in HCC. The expressions of HSP70，p53 and PCNA are closely correlated，which may play an important role in hepatocarcinogenesis.

Objective To evaluate the effects of stereotactic conformal therapy（SCT）in the treatment of patients with hepatocellular carcinoma with tumor thrombus in inferior vena cava. Methods 66 hepatocellular carcinoma patients with tumor thrombus in inferior vena cava were reviewed and analyzed by Kaplan-Meier and Cox regression analysis. 36 patients with tumor thrombus in inferior vena cava with hepatocellular carcinoma were treated with stereotactic conformal therapy（body gamma knife），and 30 patients did not receive stereotactic conformal therapy. The planned target volume was encompassed by 50% to 70% isodose line，and tumor dose was 3Gy to 4Gy per fraction，with total dose ranging from 30Gy to 48Gy. Results In 36 patients with stereotactic conformal therapy，12（33.3％）were in complete remission，10（27.8％）in partial remission，13（36.1％）were in no change， and 1（2.8％）showed disease progression. The remission rate of tumor thrombus in inferior vena cava was 61.1％ and one-year survival rate was 27.8% with the median survival of 9.8 months. In the non-SCT-treated 30 patients，one-year survival rate was 11.5% and the median survival was 3.5 months. Cox proportional hazards model analysis showed that the number of tumors and Child-Pugh class were the independent prognostic factor for the survival probability of the patients. Conclusion The stereotactic conformal radiotherapy is an effective method for treatment of tumor thrombus in inferior vena cava in patients with hepatocellular carcinoma.

Objective To study the designing of treatment plan for huge primary liver cancer treated by γ-ray stereotactic radiotherapy. Methods 37 patients with huge primary liver cancer were treated with γ-ray stereotatic radiotherapy（SRT）. Each planning target volume was more than 300 cm3（vptv≥300cm3）. The dose of 3200～3900cGy were delivered to PTVs with the fraction dose of 300～350cGy and 6 consecutive fractions per week. The planning targets were all surrounded by 50％～55％ isodose curve. 14～22 isocenters were needed in each treatment plan in order to cover the PTV by 50％～55％ isodose curve. The index of dose homogeneity of target was 1.60～1.72. There was no normal tissue that couldn’t tolerate the irradiation involved. Results All patients were examined with image of CT or MRI. The total effective rate（CR＋PR），steady disease（SD），progressive disease（PD）was 78.4％，8.1％ and 13.5％，respectively. The main gastrointestinal complications were uncomfortable upper abdomen and poor appetite. Conclusions Qualified treatment plan for huge primary liver cancer treated by γ-ray stereotactic radiotherapy could be designed，but lots of isocenters were needed in the treatment plan and the dose in the target was not homogeneous.

Objective To investigate the fat-suppressed sequences in the diagnosis of liver metastases. Methods A retrospective analysis of MRI data was made in 37 patients with primary tumors and liver metastases. Results 201 metastases were found in this 37 patients with T2WI sequence，while 236 metastases were found by STIR sequence. Conclusions STIR sequence could find easily more liver metastases than T2WI sequence.

Objective To investigate the clinical characteristics in elderly patients with drug-induced liver injury. Methods 85 elderly and 87 non-elderly patients with drug-induced liver injury were retrospectively studied. Results The top three drugs in elderly patients were Chinese herbal medicine（49.4%），antibiotics（32.9%）and antituberculous agents（8.2%）；The cholestasis was found in 40.0% of elderly patients，while only 20.7% in non-elderly patients. Conclusion The Chinese herbal medicine and antibiotics are common agents causing elderly hepatic injury.

Objective To analyze the clinical features of patients with hepatolenticular degeneration.Methods The clinical manifestations，laboratory and other special examination data in 12 patients with hepatolenticular degeneration were retrospectively analyzed． Results The age of the patients in this series was between 11 to 40 year old. Seven patients recovered，two were stable and one died in 1 to 5 year follow-up. Conclusions The early therapy is very important to its prognosis． We suggest that screening examination including Kayser—Fleischer rings and copper metabolism should be done once patients is suspected.

0bjective In order to enhance the understanding on unsafe factors about parenteral nutrition after hepatectomy，we made further improvement on the nursing strategies. Methods The potential safety hazards about the parenteral nutrition were discussed. We paid attention to every step in parenteral nutrition after hepatectomy in patients with HCC and then we proposed precaution according to the problems probably found. Results After secure and efficient treatment and nursing during parenteral nutrition，the patients were recovered rapidly and the hospital stays was shortened. Conclusion A safe，effective and high quality nursing care is the key step for the parenteral nutrition.