Table of Content

30 November 2022, Volume 27 Issue 11

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Liver Cancer

Predictive value of 3 scoring systems on liver injury in patients with primary hepatocellular carcinoma after hepatectomy

ZHANG Xiao-feng, ZHANG Da-li, NIU Xiao-feng, HE xi, FENG Dan-ni, LIU Zhen-wen, WANG Hong-bo

2022, 27(11):  1167-1169. 

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Objective To investigate the predictive value of 3 scoring systems on liver function in patients with hepatocellular carcinoma (HCC) after hepatectomy.Methods A total of 62 patients with HCC treated by hepatectomy in our hospital from October 2020 to March 2021 were enrolled. The clinical data of all the cases were collected. The predictive value of 3 scoring systems on liver function of patients after operation.Results A total of 62 patients were involved in the study. All the patients were Child-Pugh A, the median ICG R15 was 4.5(3.5, 6.8)%. Twenty-six patients were in ALBI grade 1, and 36 patients were in ALBI grade 2. Among 62 patients, 15 (24.19%) were developed posthepatectomy liver failure (PHLF). Multivariate analysis showed that ICG R15 greater than 10% (OR=9.111, 95%CI 1.910-43.465, P=0.006) was a risk factor for PHLF. Compared to the patients with ICG R15 less than 10% ,patients with ICG R15 greater than 10% had higher total bilirubin (TBIL) and international normalized ratio (INR) at day 1, day 3 and especially day 7 (TBIL: 29.7 μmol/L vs 16μmol/L, P=0.042, INR: 1.29 VS 1.20, P=0.032) after operation.Conclusion ICG R15 greater than 10% is a risk factor for PHLF in HCC patients with Child-Pugh A after hepatectomy. ICG R15 scoreing system can stably reflect the dynamic changes of postoperative liver function.

Detection of recurrent markers for hepatocellular carcinoma based on proteomic data

YANG Yong-qin, FENG Gong, HAO Shuai, CHEN Min, LIANG Tian, YAN Hong-lin, HE Na

2022, 27(11):  1170-1174. 

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Objective Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. More than 500000 cases are diagnosed each year. The recurrence of HCC affects the prognosis of patients. Proteomics technology has great potential in searching related biomarkers, and also drives progress on new diagnostic Methods. The purpose of the study was to find new markers of HCC recurrence from the perspective of proteomics.Methods The proteomic data were from the clinical proteomic tumor analysis consortium (CPTAC) database. The data was grouped according to the recurrence of HCC, and differential proteins between the 2 groups were analyzed. Survival analysis, Cox regression and receiver operator characteristic (ROC) curve were used to screen clinically significant proteins. The key proteins were verified in the human protein map database.Results A total of 690 differential proteins were screened in 50 relapse cases and 77 non-relapse cases. Among them, 39 proteins were related to the survival analysis, 18 proteins were independent factors affecting the prognosis of HCC. The area under the ROC curve predicted of 7 proteins (BAHCC1、ESF1、RAP1GAP、RUFY1、SCAMP3、STK3、TMEM230) for the 5-year survival of HCC exceeded 0.7.Conclusion New proteins predicting the recurrence of HCC are screened in the study. The key proteins are not only independent factors, but also have good predictive value for the prognosis of HCC.

Targeting AFP-MHC complex with CAR T cell therapy for liver cancer

WANG Wei, SHA Jun-ping, DING Feng, WANG Xin-ming

2022, 27(11):  1175-1179. 

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Objective To investigate the effect of targeting alpha fetoprotein-major histocompatibility complex (AFP-MHC) with CAR T cell therapy for liver cancer.Methods The human liver cancer cell line HepG2 was purchased from Guangzhou Zhenniao Biotechnology Co.Ltd. Healthy human donor peripheral blood leukocytes were obtained from Pacific Blood Center, and EasySep Human T Cell Isolation Kit was used to separate T cells. The bispecific antibody ET1402L1 was designed as a second-generation CAR containing the CD28/CD3 costimulatory domain. The CAR construct was cloned into a lentiviral vector for the transduction of primary human T cells. Forty male BALB/c nude mice (weight 21-25 g; 4-6 weeks) were raised under the condition without specific pathogens. HepG2 cells were used to construct the xenogeneic liver cancer model. The cells were divided into HepG2 group and AFP-CAR T cell group. The mice were divided into tumor model group and AFP-CAR T targeted therapy group. The cell proliferation was detected by CCK-8 kit. T cell toxicity was evaluated by the cellular LDH release assay. The mRNA expression levels of cytokines tumor necrosis factor-α (TNFα), interferon gamma(IFNγ), interleukin-2 (IL2) and IL10 were detected by PCR. The size of xenograft tumor was measured by calipers. The AFP level of tumor mice was detected by ELISA. The contrast of mouse viscera was measured by clinical iodohyalcohol (GE, Omnipaque 350 mg I/ mL).Results There was no significant difference in cell proliferation between the 2 groups at the first day (P>0.05). The cell proliferation in AFP-CAR T cell group at day 3, 5 and 7 was significant lower than that in the HepG2 group (P<0.05). The cell lysis rate of HepG2 group and AFP-CAR T cell group were 8.24±2.33% and 72.19±8.32%, the difference was statistically significant (P<0.05). TNFα, IFNγ, IL2 and IL10 mRNA expression levels in AFP-CAR T cell group were higher than HepG2 group (TNFα: 1.95 ± 0.17 vs 1.04 ± 0.02; IFNγ: 2.01 ± 0.19 vs 1.13 ± 0.06; IL2: 1.96 ± 0.16 vs 1.07 ± 0.05; IL10: 1.99 ± 0.18 vs 1.03 ± 0.04) (P<0.05). There was no difference in tumor size between the 2 groups on day 0 (P>0.05). On day 10d, 20d, 30d and 40d, the tumor size of THE AFP-CAR T-targeted therapy group was decreased compared with that of the tumor model group (P<0.05). AFP levels of tumor model group and AFP-CAR T-targeted therapy group were 2564.18±265.19 μg/ mL and 837.49±63.22 μg/ml, respectively. Serum AFP level in the AFP-CAR T-targeted therapy group was lower than that in the tumor model group (P<0.05). The tumor size of the AFP-CAR T-targeted therapy group was lower than that of the tumor model group (P<0.05).Conclusion The clinical effect of targeting alpha-fetoprotein (AFP)-MHC complex with CAR T cell therapy for liver cancer is satisfactory.

Expression and prognostic significance of GPC-3 protein in hepatocellular carcinoma

ZHAO Huan-yu, ZHANG Rui-rui, ZHANG Zheng-wei, WU Jian, SUN Su-an

2022, 27(11):  1180-1182. 

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Objective To investigate the expression and clinical significance of glypican-3 (GPC-3) protein in hepatocellular carcinoma (HCC) and to investigate the correlation between the GPC-3 expression and the prognosis of HCC.Methods Ninety-one HCC cases and 32 healthy subjects from January 2014 to April 2015 were collected. The GPC-3 and P53 protein levels of all subjects were detected through immunohistochemical SP indirect method. The correlation and prognostic value between HCC and proteins were analyzed.Results The GPC-3 expressed in 80.2% HCC tissues (73/91) and 6.3% (2/32) normal tissues, the difference was. statistically significant (P<0.001). The positive rate P53 (92.5%) was significantly higher in GPC-3 positive group (P=0.015). The positive expression of GPC-3 was related to the histological differentiation and TNM stages (P=0.010, P=0.011). The survival rate of patients in GPC-3 positive group (9.6%) was much lower than that in GPC-3 negative group (38.9%) (P=0.017).Conclusion GPC-3 is an important biomarker in diagnosing HCC. P53 and GPC-3 pathway may be related to tumorigenesis and progression of HCC. Detection of the GPC-3 expression is important in evaluating the prognosis of HCC.

Liver Fibrosis & Cirrhosis

Nutritional risk is associated with an increase of postoperative infection after endoscopic treatment for esophagogastric variceal bleeding in liver cirrhosis

LOU Jian-jun, ZHANG Fang-fang, HUANG Yan, SANG Yuer

2022, 27(11):  1183-1188. 

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Objective To investigate the incidence rate of the nutritional risk on cirrhosis patients with esophagogastric variceal bleeding (EGVB). To investigate the correlation between nutritional risk and postoperative infection after endoscopic therapy.Methods A total of 163 patients with EGVB who received endoscopic therapy were involved. The nutritional risk was evaluated based the Nutrition Risk Screening Sore (NRS2002). The data including medical history, liver function, blood ammonia levels, Child-Pugh scores, B ultrasound and postoperative infection status were colledcted.Results According to the NRS2002 scores, there were 79 (48.5%) patients with nutritional risk. The level of serum albumin (27.87 ± 3.70) g/L and prealbumin values (0.08 ± 0.02)g/L of patients with nutritional risk were significantly lower (P<0.05) than that without the nutritional risk (35.76 ± 4.32, 0.11 ± 0.03) g/L. The blood ammonia, prothrombin time (PT), international normalized ratio (INR) and Child-Pugh B/C, ascites and postoperative infection proportion were significantly increased in patients with nutritional risk (P<0.05). The incidence of postoperative infection after endoscopic treatment was 19.0% in all patients, 32.9% in patients with nutritional risk, and 6.0% in patients without nutritional risk. Age ≥ 60 (OR:4.610; 95%CI:1.028-20.673; P=0.046), WBC level (OR:1.324; 95%CI:1.036-1.693; P=0.025) and NRS2002 ≥ 3(OR: 11.670; 95%CI: 1.832-74.334; P=0.009) were significant risk factors.Conclusion The patients with nutritional risk are more likely to suffer from postoperative infection after endoscopic treatment. It is neccessary for cirrhosis patients with EGVB to receive nutritional assessment as well as clinical interventions before and after the endoscopic treatment.

Analysis of Viatorr stent in the treatment of cirrhotic portal hypertension with upper gastrointestinal bleeding during TIPS

YANG Mei-rong, CHEN Wei, DENG Jun, SUN Jun-kai, ZHOU Yan, JIANG Jun-lin, LI Shu-shu

2022, 27(11):  1189-1193. 

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Objective To observe the clinical efficacy and safety of Viatorr stent during transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhotic portal hypertension (PHT) with upper gastrointestinal bleeding (UGB).Methods 32 patients with cirrhotic PHT and UGB treated in the hospital from November 2017 to December 2020 were selected as the research subjects, all patients were treated with Viatorr stent during TIPS and followed up in the clinic; the success rate of Viatorr stent implantation of patients was observed. The preoperative and postoperative portal vein pressure indexes [portal vein pressure gradient (PPG), portal vein pressure (PVP), portal vein velocity (PVV)] of patients were compared, changes of blood routine indexes [platelet count (PLT), hemoglobin (Hb), leukocyte count (WBC)], liver and kidney function indexes [alanine aminotransferase (ALT), aspartate aminotransferase (AST), Albumin (Alb), total bilirubin (TBil), serum creatinine (Scr), urea nitrogen (BUN)] and coagulation function indexes [prothrombin time (PT)] were observed before operation, 1 week, 1 month and 6 months after operation. The incidence of adverse events such as rebleeding, hepatic encephalopathy and shunt stenosis of patients within 6 months after operation were counted.Results 32 patients with PHT and UGB were successfully implanted with Viatorr stent, and the success rate was 100% (32/32); 3 days after operation, PVV and PVP were (51.28 ± 10.46) cm/s and (2.17 ± 0.63) mmHg, respectively, higher than those before operation (29.78 ± 7.65) cm/s and (3.32 ± 0.84) mmHg, and PPG was (12.75 ± 4.13) mmHg, lower than that before operation (21.46 ± 6.28) mmHg (P<0.05); from 1 week to 6 months after operation, the levels of PLT, Hb and WBC pf patients were gradually increased than those before operation (P<0.05); 1 week after operation, ALT, AST, TBil and PT of patients were increased and Alb was decreased than those before operation. 1 and 6 months after operation, ALT, AST, TBil and PT were gradually decreased, Alb was gradually increased (P<0.05); at 1 week, 1 month and 6 months after operation, Scr and BUN were significantly decreased than those before operation (P<0.05); during follow-up period, rebleeding occurred in 3 cases, with an incidence of 9.38% (3/32); and hepatic encephalopathy in 5 cases, with an incidence of 15.63% (5/32); shunt stenosis occurred in 6 cases, with an incidence of 18.75% (6/32).Conclusion The use of Viatorr stent in TIPS in the treatment of cirrhotic PHT with UGB can significantly reduce the postoperative portal venous pressure of patients, while the clinical effect is significant, and the risk of postoperative rebleeding, hepatic encephalopathy and shunt stenosis of patients is low.

Effect of direct acting antiviral treatment based on sofosbuvir on the dynamic changes of serum cytokines in chronic hepatitis C patients

YE Fei-xiang, LI Jing, LIU Jing-rui, LIU Pei, DU Yun-fei

2022, 27(11):  1194-1197. 

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Objective To analyze the effect of direct acting antiviral (DAA) treatment based on sofosbuvir on the dynamic changes of cytokines in chronic hepatitis C (CHC) patients.Methods From June 2018 to October 2021, 78 newly diagnosed CHC patients were selected, including 41 males and 37 females, aged (52.3±10.7) years. According to the different stages of HCV infection, they were divided into a chronic hepatitis group and a cirrhosis group. In addition, 50 physical examination subjects in the same time period were selected as control, including 29 males and 21 females, aged (51.2±11.5) years. The dynamic changes of cytokines levels of CHC at different disease stages were compared before and after DAAs treatment.Results Comparing the baseline data of CHC and healthy people, the ALT, AST and TBil of healthy people were 20 (12, 35) U/L, 22 (14, 31) U/L and 10.6 (8.0, 13.6) ?mol/L, respectively, which were significantly lower than those of [59 (37,92) U/L, 47 (40, 82) U/L and 21.8 (14.8, 38.0) μmol/L in CHC patients, respectively, P<0.05]. The levels of IL-6, MCP-4 and VEGF-A in healthy subjects were 170.8 (122.0, 268.9)pg/mL, 60.3 (39.4, 110.5)pg/mL and 8.1 (3.6, 15.9)pg/mL, and in CHC patients were [271.2(184.6, 431.2)pg/mL, 132.4 (96.2, 210.5)pg/mL and 20.8 (12.3, 25.8)pg/mL], respectively, the difference was statistically significant (P<0.05). The levels of IL-7 in healthy persons and patients with CHC were 18.0 (7.2, 25.2)pg/mL and 9.2 (6.2, 14.5)pg/mL, respectively, the difference was statistically significant (P<0.05). After 12 weeks of treatment with DAAs regimen based on sofosbuvir, the sustained virological response (SVR) rate of CHC patients was 93.6% (73/78), including 98.1% (52/53) of chronic hepatitis cases and 84.0% (21/25) of cirrhosis cases, with statistical significance (P<0.05). Comparing the dynamic changes of cytokines before and after treatment, IL-6 expression in CHC before treatment, chronic hepatitis and liver cirrhosis after treatment were 271.2 (184.6, 431.2) pg/mL, 202.6 (146.2, 286.8) pg/mL and 238.1 (158.7, 365.0) pg/mL, respectively, with statistical differences (P<0.05). The levels of IL-7 in CHC before treatment, chronic hepatitis and liver cirrhosis after treatment were 9.2 (6.2, 14.5) pg/mL, 14.5 (12.7, 19.2) pg/mL and 11.6 (10.6, 13.0) pg/mL, respectively, with statistical significance (P<0.05). The MCP-4 levels of CHC before treatment, chronic hepatitis and liver cirrhosis after treatment were 132.4 (96.2, 210.5) pg/mL, 94.0 (68.7, 120.9) pg/mL and 110.2 (98.6, 146.5) pg/mL, respectively, with statistical significance (P<0.05). After treatment, the levels of VEGF-A in chronic hepatitis [25.6 (21.1, 30.7) pg/mL] and liver cirrhosis [27.0 (24.5, 32.6) pg/mL] were significantly higher than those in CHC [20.8 (12.3, 25.8) pg/mL, P<0.05] before treatment.Conclusion IL-6, IL-7, MCP-4 and VEGF-A are involved in the immune response of CHC patients. DAA treatment based on sophorbuvir can significantly affect the serum concentrations of the inflammatory cytokines and improve the inflammatory state of patients.

Drug Induced Liver Injury

Short-term efficacy of dual plasma molecular adsorption combined with glucocorticoid in the treatment of severe acute drug-induced liver injury

DING Peng, ZHONG Hai-feng

2022, 27(11):  1198-1202. 

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Objective To investigate the short-term efficacy of dual plasma molecular adsorption system (DPMAS) combined with glucocorticoids (GCs) in the treatment of severe acute drug-induced liver injury (DILI).Methods A total of 69 DILI patients admitted to Haian Hospital affiliated to Nantong University from January 2019 to march 2021 were randomly divided into observation group (n=31) and control group (n=38) by random number table method. DPMAS combined with GCs or DPMAS alone were used to treat the two groups of patients, respectively. Biochemical indexes, bilirubin rebound, liver reserve function, clinical efficacy and adverse reactions were compared before and after treatment.Results When compared the serum total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), prothrombin total activity (PTA), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and c-reactive protein (CRP) levels between the two groups of patients at 1 week and 2 week after treatment, the differences were statistically significant (P<0.05). Prothrombin time (PT) was lower than that of before treatment, and there was no significant difference within groups (P>0.05). The levels of TBil and DBil in the observation group increased slightly at 4 day and 8 day after treatment, but at the end of treatment, 4 day and 8 day after treatment, the levels in the observation group were significantly lower than those in the control group (P<0.05). The liver reserve function, effective circulating blood volume, model of end-stage liver disease (MELD) score and DPMAS times in the observation group were lower than those in the control group after treatment, the differences were statistically significant (P<0.05). The total effective rate of observation group was significantly higher than control group, and the difference was statistically significant (P<0.05). There were no significant differences in the incidence of acute liver failure and 6-month survival rate between the two groups (P>0.05). The DILI grading of both groups was significantly improved after treatment compared with before treatment, and the improvement degree of observation group was better than that of control group (P<0.05). There was no statistical significance in the incidence of adverse reactions between the two groups (P>0.05).Conclusion DPMAS combined with GCs can significantly improve the clinical symptoms and liver function of patients with severe DILI, and the effect time and improvement degree are higher than those of DPMAS alone.

An experimental study on the evaluation of organophosphorus poisoning-induced acute toxic liver injury in rabbit with ultrasonic tissue elastography

PEI Feng, MA Zhi-ping, GUO Ming-yang, CHEN Ting-ting, HE Shen-yan, TU Jiao, YUAN Ping, QIAN Rong

2022, 27(11):  1203-1205. 

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Objective To investigate the feasibility of ultrasonic real-time tissue elastography (RTE) in evaluating acute toxic liver injury.Methods Fifty healthy rabbits were divided into a control group and a poisoning group. The poisoning group was intraperitoneally injected with organophosphate and the control group was treated with normal saline. Routine ultrasonography, RTE and blood sampling were performed pre-poisoning and at 4 h, 6 h, 8 h, 10 h after organophosphorus exposure. Meanwhile, rabbit liver tissues were taken for pathological examination. The same procedures were performed in the control group.Results At 8 hours and 10 hours after organophosphorus exposure, alanine aminotransferase (ALT) and total bilirubin (TBIL) increased (P<0.05), the levels of ALT were (50.18 ± 19.38) and (76.53 ± 21.31), and the levels of TBil were (10.61 ± 2.79) and (11.09 ± 1.95), respectively. On the contrary, the levels of albumin (Alb) decreased, (36.75 ± 16.11) and (31.92 ± 13.89), respectively (P<0.05). At 6 hours, 8 hours and 10 hours after exposure, the liver elasticity score gradually increased when compared with the control group. At 10 hours after exposure, the elasticity score of the interested region ≥ 3 points. Based on the pathological diagnostic criteria, the sensitivity, specificity and accuracy of RTE in the diagnosis of hepatocyte injury were 95.83 %, 85.71% and 92.11%, respectively.Conclusion Ultrasound elastography may reflect the pathological changes of liver tissue in rabbits with acute organophosphorus poisoning, which include hepatocellular ballooning, steatosis and degeneration and necrosis.

Other Liver Diseases

Muscle loss in elder male residents of the community is associated with the severity of metabolic associated fatty liver disease

ZHANG Shuang, LIU Xiao-hui, WANG Gang, ZHANG Li, WU Jian, ZHANG Jing

2022, 27(11):  1206-1212. 

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Objective To investigate the relationship between metabolic associated fatty liver disease (MAFLD) and muscle loss in elder male residents of the community.Methods A cross-sectional survey was conducted among 232 elderly male residents over 65 years old in a community in Beijing. Demographic data, medical history, physical examination and laboratory examination Results were collected for all subjects. Body composition was detected with body composition tester. Liver fat content and liver elasticity were examined by FibroScan. Muscle loss was defined as the ratio of skeletal muscle mass and weight (ASM%) less than 29.1. The patients were divided into a muscle loss group and a non-muscle loss group, and the differences in metabolic indicators, proportion and severity of MAFLD between the two groups were compared. The differences between the quartiles were compared using Chi-square test, one-way ANOVA analysis, and Kruskal-Wallis test.Results In all patients, age, BMI, body fat percentage, visceral fat area, hypersensitive C-reactive protein and glucose metabolism indexes in muscle loss group [ASM% (27.41±1.17)] were significantly higher than those in non-muscle loss group [ASM% (31.47±1.86)], ALT [24.0 (18.0, 33.0) vs. 20.0 (16.0, 26.0)], liver fat content [(290.4±60.4) vs. (256.4±53.6)], liver stiffness scores [(5.30 (4.20, 6.80) vs. 4.45 (3.80, 5.90)], basal metabolic rate, and HDL-C were lower than those in non-muscle loss group (all P<0.05). Patients in the lower ASM% quartile group had more significant metabolic disturbances and severe hepatic fatty changes than those in the higher ASM% quartile group. 76.9% of patients with MAFLD were in the muscle loss group and 50.3% in the non-muscle loss group (χ²=13.593, P<0.001). BMI, waist circumference, hip circumference, waist-hip ratio, upper arm circumference, body fat percentage, visceral fat area and controlled attenuation parameters (CAP) in patients with MAFLD combined with muscle loss were higher than those in the non-muscle loss group (all P<0.05).Conclusion In elder men, muscle loss is accompanied by more severe metabolic abnormalities and hepatic steatosis, suggesting that attention should be paid for the screening of elderly muscle loss and MAFLD to lay the foundation of timely diagnosis and early intervention.

Protective effect of GO-CoA-Tat on liver injury of mice with non-alcoholic fatty liver disease

ZHANG Shao-ren, HU Jing-xian, ZHOU Hao, JIANG Miao, FAN Xiao-ming

2022, 27(11):  1213-1215. 

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Objective To investigate the protective effect of GO-CoA-Tat, an antagonist of Ghrelin o-acyltransferase, on liver injury of mice with non-alcoholic fatty liver.disease (NAFLD).Methods High fat diet (HFD) induced mice model of fatty liver disease was established. C57BL/6 male mice were feed with HFD for 8 weeks to induce chronic NAFLD. The mice were separately injected with physiological saline or GO-COA-TAT subcutaneously. The experimental groups included a Normal group, an HFD+Saline group and an HFD+GO-CoA-Tat group. Mice weights during feeding period were measured weekly. Microplate detection kits were used for detecting alanine aminotransferase (ALT), aspartame aminotransferase (AST), triglyceride (TG), total cholesterol (TC) and glucose (GLU). The cellular lipid assay kit was used for detecting the concentration of triglyceride in mouse liver. The changes in the levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) mRNA expressions were detected by RT-PCR.Results GO-CoA-Tat significantly reduced the body weight gain of fatty liver mice, and the body weight of the HFD+GO-CoA-Tat group at week 8 (33.125±0.153) was significantly different from that of the HFD+Saline group (37.327±0.296) (P=0.014). There were significant differences in TG and TC (1.237±0.071, 2.403±0.151) in HFD+GO-CoA-Tat group and HFD+Saline group (1.943±0.136, 5.013±0.369) (P=0.038 and 0.029, respectively). The GLU of HFD+GO-CoA-Tat group (4.103±0.184) was significantly different than that of HFD+Saline group (6.370±0.296) (P=0.013). Compared with the HFD+Saline group (101.332±2.052), the liver triglyceride content of mice in HFD+GO-CoA-Tat group was significantly different (75.602±1.487) (P=0.027). There were significant differences in ALT and AST in the HFD+GO-CoA-Tat group (37.862±2.425, 122.932±6.907) and the HFD+Saline group (54.901±5.201, 173.321±13.971) (P=0.035 and 0.026, respectively). There were significant differences in TNF-α and IL-6 between the HFD+GO-CoA-Tat group (1.730±0.040, 1.630±0.040) and the HFD+Saline group (2.740±0.140, 2.980±0.070) (P=0.042 and 0.038, respectively).Conclusion GO-CoA-Tat has protective roles in NAFLD mice.

Clinical and imaging analysis of hepatic tuberculosis

JIANG Jia-qi, CAI Jian-ming, DONG Jing-hui, REN Hong-wei, LIU Chang-chun, GAO Shen, LIU Yuan

2022, 27(11):  1216-1219. 

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Objective To analyze the clinical and imaging features of 20 patients with hepatic tuberculosis (TB).Methods The clinical data and imaging materials of 20 patients with hepatic TB hospitalized in Fifth Medical Center of PLA General Hospital from January 2009 to April 2021 were analyzed retrospectively, the sex, age, main complaints, body temperature, clinical manifestations, laboratory examinations and imaging features were summarized.Results In 20 patients with liver TB, fever, fatigue and abdominal distension were the main symptoms. Laboratory examination showed that all tumor markers were negative in 12 cases, with 7 cases of CA125 increased, 2 cases of CA199 increased, and 1 case of CA153 increased. 14 cases of computed tomography (CT) or magnetic resonance (MR) showed nodules or mass-like lesions, 2 cases showed spot or spot pattern, the focal length was between 0.60 cm to 18.10 cm, 14 cases showed mild circular or uneven enhancement, irregular separation and division-like enhancement was seen in 10 cases, and 13 cases showed delay progressive enhancement. Increased abdominal lymph nodes were seen in 12 patients, and massive recurrent intrahepatic lesion was identified after surgery in 1 patient.Conclusion Hepatic TB is more common in middle-aged and elderly men. Fever, fatigue and abdominal distension were the main complaints. Some patients may havd elevated tumor markers. Most of the imaging findings were single or multiple nodules or patches, enlarged abdominal lymph nodes. Most enhancement scans show circular progressive enhancement, and some of them could have mutual fusion and separation enhancement, and some patients may recur.Imaging examination combined with liver pathological examination was the main diagnosis of hepatic TB.

Clinical manifestations and etiological analysis of 94 neonates with abnormal hepatic enzymes

XUE Yan, LI De-liang, BIE Jing-yang, CHANG Jun-ming, ZHAO Jie, ZHANG Wei-ye, BAO Feng-yuan, ZHU Ping

2022, 27(11):  1220-1222. 

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Objective The clinical data of 94 neonates with abnormal liver enzymes were retrospectively analyzed, and the clinical manifestations and etiology of abnormal liver enzymes were discussed, so as to provide effective information for early diagnosis and treatment of such patients in clinical practice.Methods From January 2019 to September 2021, 94 neonates with abnormal liver enzymes (56 males and 38 females), aged 22 (10, 25) days, were reviewed. Specific manifestations of abnormal liver enzymes included jaundice, hepatomegaly, splenomegaly, ascites and abnormal coagulation function. To analyze the clinical manifestations and causes of abnormal liver enzymes in neonates.Results Among the 94 neonates with abnormal liver enzymes, 32 cases (34.0%) had specific manifestations of liver damage, and some neonates had simultaneous manifestations, including jaundice in 15 cases (16.0%), hepatosplenomegaly in 9 cases (9.6%), jaundice with hepatosplenomegaly in 2 cases (2.1%), hepatomegaly in 2 cases (2.1%) and splenomegaly in 2 cases (2.1%). According to the primary diseases, clinical manifestations and auxiliary examination Results, 52 cases of infectious diseases (55.3%), 16 cases of non-infectious diseases (30.8%) and 26 cases of unknown causes (27.6%) were found. The causes of infectious diseases included viral infection and bacterial infection, among which viral infection included cytomegalovirus in 14 cases (26.9%), respiratory syncytial virus in 7 cases (13.5%) and enterovirus in 6 cases (11.5%). Bacterial infections included septicemia in 16 cases (30.8%), purulent meningitis in 6 cases (11.5%), intracranial infection in 2 cases (3.8%) and appendicitis in 1 case (1.9%). The causes of non-infectious diseases included anatomical abnormalities, trauma and genetic metabolic diseases, among which anatomical abnormalities included biliary atresia in 6 cases (37.5%), biliary stricture in 4 cases (25.0%) and biliary dilatation in 2 cases (12.5%). Trauma included 2 cases (12.5%) of traumatic organ or soft tissue contusion and 1 case (6.2%) of fracture. Metabolic diseases included glycogen storage disease in 1 case (6.2%).Conclusion Infectious diseases are the main cause of abnormal liver enzymes in neonates, and viral infections are common, among which cytomegalovirus is the most common. Anatomical abnormalities are the most common non-infectious diseases, among which biliary atresia is the most common.

Application and exploration of liver indocyanine green fluorescent staining in clinical teaching of liver surgery in standardized training of residents

FU Xiu-tao, ZHANG Xin, HUANG Ao, SHI Ying-hong, DING Zhen-bin

2022, 27(11):  1223-1226. 

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Objective To investigate the effect of liver indocyanine green fluorescent staining technique in the clinical teaching of residents in standardized training of liver surgery.Methods The residents who received standardized training in our department from January 2021 to December 2021 were randomly divided into two groups. The control group of 15 residents was taught by the traditional teachers’ explanation and the hepatectomy surgical training; the experimental group of 15 residents was given the traditional teaching method plus indocyanine green fluorescent staining of liver surgery training. Both groups took theoretical written and oral tests to check the effect of acquiring knowledge of liver anatomy and their satisfaction with teaching Methods.Results Residents in the experimental group had a deeper impression and understanding of the anatomical structure of the liver.Conclusion Indocyanine green fluorescence staining technology can make surgeons more intuitive, accurate and in-depth understanding of liver anatomy.

Application of holmium laser lithotripsy combined with endoscopic retrograde cholangiopancreatography in refractory common bile duct stones

DONG Yao, ZHANG Jing, SHANG Na, WANG Na

2022, 27(11):  1227-1229. 

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Objective To observe the clinical effect of combined holmium laser lithotripsy and endoscopic retrograde cholangiopancreatography in patients with refractory common bile duct stones (CBDS).Methods A total of 85 patients with refractory CBDS who were admitted to the Third Hospital of Shijiazhuang City (June 2019 to May 2021) were selected and divided into study groups (holmium laser lithotripsy + endoscopic retrograde cholangiopancreatography) according to different surgical Methods. treatment, 44 cases) and control group (surgical treatment of choledocholithotomy, 41 cases). The operation-related indicators, stone removal success rate, inflammatory factor levels and complications were compared between the two groups.Results The operation time of the study group [(35.28±10.15) vs (102.57±34.56) min], postoperative bed time [(1.58±0.37) vs (3.86±0.73) d] and hospital stay [(6.41±0.52) vs (11.85) ±2.76)d] were shorter (t=12.361, 18.347, 12.837, all P<0.001). The success rate of stone removal in the study group (97.73% vs 95.12%) was similar (χ²=0.423, P=0.515). The postoperative IL-1β[(6.48±0.81)vs(25.46±4.83)ng/mL], IL-6[(4.73±1.15)vs(13.75±2.86)ng/mL] and TNF-α[(2.56) ±0.46) vs (6.85±0.76) μg/mL] levels were lower (t=25.639, 19.318, 31.729, all P<0.001). The total incidence of complications in the study group (4.55% vs 21.95%) was lower (χ²=5.707, P=0.017).Conclusion The combination of holmium laser lithotripsy and endoscopic retrograde cholangiopancreatography is effective in the treatment of refractory CBDS patients.

Bibliometric analysis of anesthesia for liver transplantation based on Web of Science database

XU Hui-hong, QIU Hai-bo, CHEN Qian-bo, SUN Yu-ming, WANG Li-qin

2022, 27(11):  1230-1234. 

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Objective To understand the research hotspots and trends of anesthesia for liver transplantation between 2012 and 2021 through a bibliometric analysis.Methods The Web of Science (Core Collection) database was used as the statistical source. Literatures on anesthesia for liver transplantation were retrieved from 2012 to 2021. “The number of published articles per year , high-published journals, and high-cited papers” were analyzed by bibliometrics analysis. The VOSviewer software was used to analyze the co-occurrence cluster view and tag view of keywords.Results 469 documents on anesthesia for liver transplantation were included in this study. Statistics about anesthesia for liver transplantation researches changed from year to year a wavy trend within Web of Science lierature database. “TRANSPLANTATION PROCEEDINGS” was the primary source of literature. “Perioperative acute kidney injury” published in “BRITISH JOURNAL OF ANAESTHESIA” was the most cited article. Keywords co-occurrence cluster analysis of anesthesia for liver transplantation research hotspots included “organ protection of anesthetics”, “preoperative evaluation”, “liver transplantation combined with other organ transplantation”, “perioperative organ complications”, “pharmacology for anesthesia” and “perioperative volume management”. Also, “extracorporeal membrane-oxygen”, “thromboelastometry”, “hepatic ischemia”, “pain management”, “perioperative management” were getting more and more attention.Conclusion The current research hotspot on anesthesia for liver transplantation has shifted from basic research to research on the perioperative protection of organ function, which can provide scientific basis for the management of anesthesia for liver transplantation and improving postoperative survival rate.