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Objective To investigate the characteristics of flora microbiota before and after transjugular intrahepatic portosystemic shunt (TIPS) in patients with liver cirrhosis. Methods A total of 18 patients with liver cirrhosis who were hospitalized and underwent TIPS in Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, from July 2018 to July 2019 were enrolled. Fecal samples were collected from 18 patients before surgery, 6 fecal samples were collected at 1 month after surgery, and 9 were collected at 3 months after surgery. The results of liver function and coagulation were collected before and after surgery. Fecal samples were analyzed by the 16S rRNA high-throughput sequencing method, and the DADA2 method recommended by QIIME2 was used in the bioinformatics analysis. The intestinal flora was analyzed in terms of the generated amplified characteristic sequence, and the multiple hypothesis tests of LEfSe, SPSS (Alpha analysis), PERMANOVA (Beta analysis), and Pheatmap were used for analysis. For normally distributed continuous data, intergroup comparison of parameters at different time points was made by a repeated measures analysis of variance. For non-normally distributed continuous data, intergroup comparison of parameters at different time points was made using a generalized estimating equation, and further pairwise comparison was made using the Bonferroni method. Results There were significant differences in total bilirubin and total bile acid between groups before TIPS and during the three periods of time after TIPS (F=8.201 and 39.482, P=0.001 and P＜0.001). At 1 month after surgery, Beta diversity changes were observed in fecal samples (F=2.603, P=0.02), while there was no significant difference in Alpha diversity of the fecal samples between the three periods of time (P＞0.05). At the genus level, portal venous pressure before TIPS was negatively correlated with Bifidobacterium, Collinsella, and Ruminococcus (r=-0.35, -0.38, and -0.34, P=0.04, 0.02, and 0.04) and was positively correlated with Boletus (r=0.41, P=0.015). Other indices were also correlated with different components of the intestinal flora (P＜0.05). Conclusion There is a correlation between clinical indices and intestinal flora before TIPS. The composition of intestinal flora changes after TIPS, with a significant difference at the genus level. [ABSTRACT FROM AUTHOR]

Objective To investigate the independent predictive factors for significant liver histological changes (SLHCs) in patients with HBeAg - positive high - viral - load chronic hepatitis B virus (HBV) infection and a normal alanine aminotransferase (ALT) level. Methods A retrospective analysis was performed on the clinical data of 116 previously untreated patients with HBeAg - positive high - viral -load (HBV DNA≥105 copies/ml) chronic HBV infection and a normal ALT level ( <50 U/L) who were hospitalized in Shanghai Public Health Clinical Center Affiliated to Fudan University from June 2013 to August 2015. The definition of SLHCs was inflammation ≥G2 and// or fibrosis ≥S2. The t - test or Mann - Whitney U rank sum test was used for comparison of continuous data between groups, and the chi -square test was used for comparison of categorical data between groups. Univariate and multivariate regression analyses were used to determine independent predictive factors for SLHCs. Results Of all the 116 patients, 47 (40. 5% ) had SLHCs. The multivariate analysis showed that age ( OR =2. 828 , P < 0. 05 ) , ALT ( OR = 1.011, P <0.05) , and gamma - glutamyl transpeptidase ( GGT) ( OR = 1. 089, P <0. 05) were independent predictors for SLHCs in patients with HBeAg - positive high - viral - load chronic HBV infection and a normal ALT level. The patients aged ≤30 years had a significantly lower incidence rate of SLHCs than those aged > 30 years (21.6% vs 49.4% , X2 = 6. 42, P =0. 015 ) , the patients with ALT ≤30 U/L had a significantly lower incidence rate of SLHCs than those with 30 U/L < ALT≤ 50 U/L (17.6% vs 50.0% ,;X2 = 19. 86, P <0.001), and the patients with GGT ≤40 U/L had a significantly lower incidence rate of SLHCs than those with GGT >40 U/L (28. 8% vs 66. 7% , x2 = 28. 63 , P < 0. 001 ) . Conclusion In patients with HBeAg - positive high -viral - load chronic HBV infection and a normal ALT level, those with an age of > 30 years, ALT > 30 U/L, and GGT > 40 U/L tend to develop SLHCs and need liver biopsy. [ABSTRACT FROM AUTHOR]

Ｏｂjｅｃｔｉｖｅ　Ｔｏ ｉｎｖｅｓｔｉｇａｔｅ ｔｈｅ ｓｉｍｐｌｅ ｓｅｒｕｍ ｍａｒｋｅｒｓ ｆｏｒ ｓｉｇｎｉｆｉｃａｎｔ ｌｉｖｅｒ ｉｎｆｌａｍｍａｔｉｏｎ ｉｎ ｃｈｒｏｎｉｃ ｈｅｐａｔｉｔｉｓ Ｂ （ＣＨＢ）ｐａｔｉｅｎｔｓ ｗｉｔｈ ａｎ ａｌａｎｉｎｅ ａｍｉｎｏｔｒａｎｓｆｅｒａｓｅ （ＡＬＴ）ｌｅｖｅｌ ｏｆ ＜2 ｔｉｍｅｓ ｕｐｐｅｒ ｌｉｍｉｔ ｏｆ ｎｏｒｍａｌ （ＵＬＮ）. Ｍｅｔｈｏｄｓ　Ｔｈｅ ｃｌｉｎｉｃａｌ ｄａｔａ ｏｆ 2７8 ＣＨＢ ｐａｔｉｅｎｔｓ ｗｉｔｈ ＡＬＴ ＜2 × ＵＬＮ （ＵＬＮ ＝40 Ｕ/ Ｌ）ｗｅｒｅ ａｎａｌｙｚｅｄ ｒｅｔｒｏｓｐｅｃｔｉｖｅｌｙ. Ｓｉｇｎｉｆｉｃａｎｔ ｌｉｖｅｒ ｉｎｆｌａｍｍａｔｉｏｎ ｗａｓ ｄｅｆｉｎｅｄ ａｓ ａ ｌｉｖｅｒ ｉｎｆｌａｍｍａｔｏｒｙ ａｃｔｉｖｉｔｙ ｇｒａｄｅ （Ｇ）≥2. Ｔｈｅ ｔ - ｔｅｓｔ ｗａｓ ｕｓｅｄ ｆｏｒ ｃｏｍｐａｒｉｓｏｎ ｏｆ ｎｏｒｍａｌｌｙ ｄｉｓｔｒｉｂｕｔｅｄ ｃｏｎｔｉｎｕｏｕｓ ｄａｔａ ｂｅｔｗｅｅｎ ｇｒｏｕｐｓ，ａｎｄ ｔｈｅ Ｋｒｕｓｋａｌ - Ｗａｌｌｉｓ ｒａｎｋ ｓｕｍ ｔｅｓｔ ｗａｓ ｕｓｅｄ ｆｏｒ ｎｏｎ - ｎｏｒｍａｌｌｙ ｄｉｓｔｒｉｂｕｔｅｄ ｃｏｎｔｉｎｕｏｕｓ ｄａｔａ；ｔｈｅ ｃｈｉ - ｓｑｕａｒｅ ｔｅｓｔ ｗａｓ ｕｓｅｄ ｆｏｒ ｃｏｍｐａｒｉｓｏｎ ｏｆ ｃａｔｅｇｏｒｉｃａｌ ｄａｔａ ｂｅｔｗｅｅｎ ｇｒｏｕｐｓ. Ｍｕｌｔｉｖａｒｉａｔｅ ｌｏｇｉｓｔｉｃ ｒｅｇｒｅｓｓｉｏｎ ａｎａｌｙｓｉｓ ｗａｓ ｕｓｅｄ ｔｏ ｉｄｅｎｔｉｆｙ ｉｎｄｅｐｅｎｄｅｎｔ ｐｒｅｄｉｃｔｏｒｓ ｆｏｒ ｓｉｇｎｉｆｉｃａｎｔ ｌｉｖｅｒ ｉｎｆｌａｍｍａｔｉｏｎ ｉｎ ＣＨＢ ｐａｔｉｅｎｔｓ ｗｉｔｈ ＡＬＴ ＜2 × ＵＬＮ. Ｔｈｅ ｒｅｃｅｉｖｅｒ ｏｐｅｒａｔｉｎｇ ｃｈａｒａｃｔｅｒｉｓｔｉｃ （ＲＯＣ）ｃｕｒｖｅ ｗａｓ ｕｓｅｄ ｔｏ ｅｖａｌｕａｔｅ ｔｈｅ ｄｉａｇｎｏｓｔｉｃ ｖａｌｕｅ ｏｆ ｓｅｒｕｍ ｍａｒｋｅｒｓ ｉｎ ｓｉｇｎｉｆｉｃａｎｔ ｌｉｖｅｒ ｉｎｆｌａｍｍａｔｉｏｎ. Ｒｅｓｕｌｔｓ　Ｏｆ ｔｈｅ 2７8 ＣＨＢ ｐａｔｉｅｎｔｓ ｅｎｒｏｌｌｅｄ，1７５ （62. ９％ ）ｈａｄ ｎｏ ｓｉｇｎｉｆｉｃａｎｔ ｌｉｖｅｒ ｉｎｆｌａｍｍａｔｉｏｎ （Ｇ0 - 1 ｇｒｏｕｐ）ａｎｄ 103 （3７. 1％ ）ｈａｄ ｓｉｇｎｉｆｉｃａｎｔ ｌｉｖｅｒ ｉｎｆｌａｍｍａｔｉｏｎ （Ｇ2 - 4 ｇｒｏｕｐ）. Ｔｈｅｒｅ ｗｅｒｅ ｓｉｇｎｉｆｉｃａｎｔ ｄｉｆｆｅｒｅｎｃｅｓ ｉｎ ＡＬＴ，ａｓｐａｒｔａｔｅ ａｍｉｎｏｔｒａｎｓｆｅｒａｓｅ，ａｌｋａｌｉｎｅ ｐｈｏｓｐｈａｔａｓｅ，ｇａｍｍａ - ｇｌｕｔａｍｙｌ ｔｒａｎｓｐｅｐｔｉｄａｓｅ （ＧＧＴ），ａｌｂｕｍｉｎ，ｇｌｏｂｕｌｉｎ，ｐｒｏｔｈｒｏｍｂｉｎ ｔｉｍｅ （ＰＴ），ｐｌａｔｅｌｅｔ，ａｂｓｏｌｕｔｅ ｎｅｕｔｒｏｐｈｉｌ ｃｏｕｎｔ，ｈｙａｌｕｒｏｎｉｃ ａｃｉｄ （ＨＡ），ｇｌｙｃｏｃｈｏｌｉｃ ａｃｉｄ，ｐｒｅｃｏｌｌａｇｅｎ Ⅲ，ａｎｄ ｃｏｌｌａｇｅｎ ｔｙｐｅ Ⅳ（ⅣＣ）ｂｅｔｗｅｅｎ ｔｈｅ ｔｗｏ ｇｒｏｕｐｓ （ａｌｌ Ｐ ＜0. 0５）. Ｔｈｅ ｍｕｌｔｉｖａｒｉａｔｅ ｒｅｇｒｅｓｓｉｏｎ ａｎａｌｙｓｉｓ ｓｈｏｗｅｄ ｔｈａｔ ＧＧＴ，ＰＴ，ⅣＣ，ａｎｄ ＨＡ ｗｅｒｅ ｉｎｄｅｐｅｎｄｅｎｔ ｐｒｅｄｉｃｔｏｒｓ ｆｏｒ ｓｉｇｎｉｆｉｃａｎｔ ｌｉｖｅｒ ｉｎｆｌａｍｍａｔｉｏｎ ｉｎ ＣＨＢ ｐａｔｉｅｎｔｓ ｗｉｔｈ ＡＬＴ ＜2 × ＵＬＮ （ＯＲ ＝1. 01５，1. 600，1. 1５1，ａｎｄ 1. 014，Ｐ ＝0. 008，0. 021，0. 003，ａｎｄ 0. 018）. Ｔｈｅ ａｒｅａｓ ｕｎｄｅｒ ｔｈｅ ＲＯＣ ｃｕｒｖｅ ｆｏｒ ＧＧＴ，ＰＴ，ＩＶＣ，ａｎｄ ＨＡ ｔｏ ｄｉａｇｎｏｓｅ ｓｉｇｎｉｆｉｃａｎｔ ｌｉｖｅｒ ｉｎｆｌａｍｍａｔｉｏｎ ｗｅｒｅ 0. 804，0. ７22，0. ７0７，ａｎｄ 0. 632，ｒｅｓｐｅｃｔｉｖｅｌｙ. Ｔｈｅ ｃｕｔ - ｏｆｆ ｖａｌｕｅ ｏｆ 48. ５ Ｕ/ Ｌ ｆｏｒ ＧＧＴ ｔｏ ｐｒｅｄｉｃｔ ｓｉｇｎｉｆｉｃａｎｔ ｌｉｖｅｒ ｉｎｆｌａｍｍａｔｉｏｎ ｈａｄ ａ ｓｐｅｃｉｆｉｃｉｔｙ ｏｆ ９0. 3％ ａｎｄ ａ ｎｅｇａｔｉｖｅ ｐｒｅｄｉｃｔｉｖｅ ｖａｌｕｅ ｏｆ ７4. 6％ . Ｃｏｎｃｌｕｓｉｏｎ　ＧＧＴ，ＰＴ，ＩＶＣ，ａｎｄ ＨＡ ａｒｅ ｉｎｄｅｐｅｎｄｅｎｔ ｐｒｅｄｉｃｔｏｒｓ ｆｏｒ ｓｉｇｎｉｆｉｃａｎｔ ｌｉｖｅｒ ｉｎｆｌａｍｍａｔｉｏｎ ｉｎ ＣＨＢ ｐａｔｉｅｎｔｓ ｗｉｔｈ ＡＬＴ ＜2 × ＵＬＮ，ａｍｏｎｇ ｗｈｉｃｈ ＧＧＴ ｈａｓ ｔｈｅ ｈｉｇｈｅｓｔ ｐｒｅｄｉｃｔｉｖｅ ｖａｌｕｅ. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical features of acute hepatitis B (AHB) and acute exacerbation of chronic hepatitis B (CHB) for differential diagnosis. Methods A retrospective analysis was performed on the clinical data of 96 AHB patients and 124 patients with acute exacerbation of CHB, who were admitted to the Public Health Clinical Center Affiliated to Fudan University from June to December, 2014. Comparison of continuous data between the two groups was made by Mann Whitney U test, while comparison of categorical data was made by chi-square test. Results There were no significant differences in the age of onset and sex between the AHB group and the acute exacerbation of CHB group; the incidence was higher in males than in females. Sexual transmission and iatrogenic transmission were the main routes of transmission for AHB, while mother-to-child transmission was the main route of transmission for acute exacerbation of CHB. The sensitivity and specificity of alanine aminotransferase (ALT) level ≥1072 U/L for diagnosing AHB were 78.6% and 79.2%, respectively. The sensitivity and specificity of S/CO ≥13.6 in the anti-HBc-IgM test for diagnosing AHB were 94.5% and 89.3%, respectively. At week 2 after admission, the AHB group showed significantly greater decreases in levels of HBsAg, HBeAg, and hepatitis B virus (HBV) DNA than the acute exacerbation of CHB group (P＜0.05). At week 8 after admission, the AHB group had significantly higher HBsAg clearance rate, anti-HBs seroconversion rate, HBeAg clearance rate, anti-HBe seroconversion rate, and HBV DNA clearance rate than the acute exacerbation of CHB group (P＜0.05). ConclusionIt is helpful for making the differential diagnosis between AHB and acute exacerbation of CHB to know the route of transmission, ALT level, anti-HBc-IgM test result (S/CO value), HBV DNA clearance rate, and the seroconversion rates of HBV markers. [ABSTRACT FROM AUTHOR]

Chronic hepatitis B (CHB) is one of the major causes of liver cirrhosis and hepatocellular carcinoma. Interferon and nucleos(t)ide analogues can control disease progression. However, they cause very low HBsAg clearance or seroconversion rates and relapse in most patients after treatment withdrawal. In recent years, the further understanding of the interaction between hepatitis B virus (HBV) and host gives birth to a large number of novel drugs that hold promise for successful cure of CHB. This paper reviews several novel drugs against HBV in phase I, II, or III clinical trials, and points out that these novel drugs against HBV have preliminarily indicated a bright future. [ABSTRACT FROM AUTHOR]

There are about 150 million people around the world with chronic hepatitis C virus (HCV) infection currently, of whom 20% will ultimately progress to cirrhosis and eventually die of end - stage liver disease and hepatocellular carcinoma. Interferon (IFN) has long been recognized as the cornerstone of the treatment of chronic hepatitis C because of its role in sustained virologic response and prevention of disease progression. However, it has limited efficacy and multiple adverse effects. In recent years, direct - acting antiviral agents (DAAs) have shown good efficacy. This review summarizes the recent advances in IFN - free anti - HCV therapeutic regimens based on DAAs. We believe that, with the emergence of DAAs , IFN - free therapies will develop rapidly and display better prospects. [ABSTRACT FROM AUTHOR]

Non-alcoholic fatty liver disease (NAFLD) affects up to a third of the population in developed countries. Between 10% and 30% of patients with NAFLD have non-alcoholic steatohepatitis (NASH). There are metabolic risk factors common to both NAFLD and cardiovascular disease, so patients with NASH have an increased risk of liver-related and cardiovascular death. This articles reviews the most recent advances in the management of NAFLD in five main areas: lifestyle modification, weight loss treatment, therapy for metabolic syndrome, insulin sensitizer and antioxidant pharmacotherapy, and management of end-stage liver disease. It is pointed out that clinicians need to pay more attention to metabolic syndrome in the diagnosis and treatment of NAFLD. [ABSTRACT FROM AUTHOR]

Splenomegaly is an early sign of cirrhotic portal hypertension. In patients with liver cirrhosis, the resistance of splenic venous reflux increases and portal venous pressure is reversed to the spleen, which causes congestive splenomegaly and hyperplasia of splenic tissue and fibrous tissue. In addition, intestinal antigens enter the systemic circulation via the portal-systemic collateral circulation and stimulates the proliferation of mononuclear macrophages in the spleen after being taken up by the spleen, which further leads to splenomegaly and hypersplenism. On the contrary, abnormal spleen can cause the changes in liver function and portal vein hemodynamics. Therefore, the intervention of the spleen cannot be neglected during the treatment of liver cirrhosis and its complications. This article reviews the influence of abnormal spleen structure and function on liver pathophysiological function in patients with liver cirrhosis. [ABSTRACT FROM AUTHOR]

Objective To investigate the safety and clinical effect of fast track surgery in pancreaticoduodenectomy, one of the most complex surgeries in general surgery. MethodsThe Chinese and foreign databases were searched for articles on the application of fast tract surgery in pancreaticoduodenectomy published from January 1994 to April 2016. Two researchers evaluated the quality of the articles which met the inclusion criteria and extracted related data. Stata 12.0 software was used to analyze the overall incidence rate of complications and the incidence rates of pancreatic leakage and gastrointestinal emptying disorder, and the Begg rank correlation test and Egger linear regression method were used to investigate publication bias. ResultsThe fast track surgery group had a significantly lower overall incidence rate of complications than the conventional group (RR=0.748, 95%CI: 0.680-0.824, P＜0.001). There was no significant difference in the incidence rate of pancreatic leakage between the two groups (RR=0.894, 95%CI:0.734-1.089, P=0.266). The fast track surgery group had a significantly lower incidence rate of gastrointestinal emptying disorder than the conventional group (RR=0.520, 95%CI:0.400-0.670, P＜0.001). ConclusionFast track surgery is safe and effective in pancreaticoduodenectomy, but the application of some measures in fast track surgery still needs more medical evidence. [ABSTRACT FROM AUTHOR]