Objective To compare and study the value of multiple antigens dot immunogold filtration assay (DIGFA ) and ima-ging diagnosis for rapid diagnosis of two kinds of echinococcosises .Methods 167 cases of hydatid patients diagnosied by pathologi-cal examination were divided into the DIGFA group for diagnosis of DIGFA and the control group for imaging diagnosis .Results The diagnosis rate of cystic echinococcosis (CE) in the DIGFA group was 74 .60% and control group was 90 .48% (P<0 .01);the diagnosis of alveolar echinococcosis(AE) in the DIGFA group was 92 .68% and the control group was 73 .17% (P<0 .05);when the cystica<5 cm ,the diagnosis rate of AE and CE in the DIGFA group was 91 .67% and 61 .11% (P<0 .05) ,when the cystica 5- <10 cm ,the detection rate of AE and CE in the DIGFA group was 94 .12% and 71 .43% (P<0 .05) .When the cystica≥10 cm ,<5 cm or between 5 - < 10 cm ,the detection rate of CE in DIGFA group was 94 .12% ,61 .11% ,71 .43 ,respectively (P<0 .05);The totle detection rates of the AE and CE in DIGFA group were 92 .68% and 74 .60% (P<0 .05) .Conclusion Imaging di-agnosis for the CE was higher and the DIGFA diagnosis for the AE was higher and the DIGFA also had clinical significance espe-cially applicated to the early diagnosis of AE .With the help of the imaging diagnosis ,the DIGFA could diagnose two kinds of echi-nococcosises correctly and it provided the benefits of specificity and sensitivity and performed easily .

Objective To study the safety and efficacy of ultrasound-guided puncture combined with surgical resection for liquefied cavitary hepatic alveolar echinococcosis (HAE).Methods A retrospective study was conducted on 17 patients who had liquefied cavitary HAE and were treated at the Affiliated Hospital of Qinghai University from January 2014 to August 2016.Ten patients were treated with ultrasound-guided puncture combined with surgical resection (the case group),and 7 patients were treated with resection (the control group).The basic characteristics,operation time,blood loss during operation,preoperative and postoperative laboratory tests and complications were compared between the 2 groups.Results There were no significant differences between the 2 groups in basic characteristics,such as age,gender,and lesion diameter (P ＞ 0.05).The operation time and blood loss during operation showed significant differences between the 2 groups,(308.0 ± 23.0) min (389.0 ± 95.7) min and (1 360.0 ± 182.9) ml vs.(1 607.1 ± 205.0) ml,respectively (all P ＜ 0.05).The prothrombin time (PT) after day 3 of operation and alanine aminotransferase level after day 5 of operation showed significant differences between the 2 groups,(13.8 ±0.9) s vs.(15.5 ±1.7) s and (81.9 ±20.9) U/L vs.(108.1 ±29.5) U/L,respectively (all P ＜ 0.05).There was no significant difference in postoperative complications between the 2 groups.Conclusions Ultrasound-guided puncture combined with surgical resection shortened the operation time,reduced blood loss and avoided serious complications after surgery.This treatment is efficacious and safe for liquefied cavitary HAE.

Objective To investigate the expression of osteopontin (OPN)and matrix metalloproteinase-2(MMP-2)in hepatic alveolar echinococcosis(HAE) ,and explore the role of OPN and MMP-2 in the invasion and metastasis of HAE infection .Methods Expression of OPN and MMP-2 in HAE tissues from 69 patients within12 nomral liver tissues .HAE were detected using SP im-munohistochemical technique ,the correlation between OPN and MMP-2 expression and clinieopahtologic features was analyzed .Re-sults OPN and MMP-2 mainly distributed in the cyst wall about granuloma inflammatory cells of HAE and and the peripheral por-tion of stromal cell and liver cells ,the positive expression rate in HAE focus and normal liver tissue at the juncti-on of the invasive margin the most obvious .The results showed that the positive rates of OPN and MMP-2 in HAE tissue were 72 .5% (50/69)and 59 .4% (41/69) ,respectively ,and in normal liver tissue were 16 .7% (2/12) and 8 .3% (1/12) ,respectively .The positive rates of OPN and MMP-2 in HAE were significantly higher than those in normal liver tissue(P<0 .01) .The positive rates of OPN and P21 in HAE tissues with metastasis were 86 .8% (33/38)and 76 .3% (29/38) ,respectively ,which were significantly higher than those without metastasis of OPN and MMP-2 positive expression rate of 54 .8% (17/31) and 38 .7% (12/31) ,(P<0 .01) .The positive expression of OPN and MMP-2 were not related to the size of tumor bulk ,HBsAg ,gender ,age and nation of tumor .Rank correlated analysis showed that OPN and MMP-2 were positive correlated(r=0 .36 ,P<0 .01) .Conclusion OPN and MMP-2 mainly distrib-utes in the cyst wall about granuloma inflammatory cells of HAE and and the peripheral portion of liver cells ,the positive expres-sion rate in HAE and normal liver tissue at the junction of the invasive margin the most obvious ,which might be invasion and me-tastasis of HAE .

Objective:To investigate the prognostic value of preoperative red blood cell distribution width (RDW) for hepatocellular carcinoma (HCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 1 025 HCC patients who were admitted to three medical centers (586 in the First Affiliated Hospital of Xi'an Jiaotong University, 248 in the Second Affiliated Hospital of Xi'an Jiaotong University and 191 in the Qinghai University Affiliated Hospital) between April 2002 and August 2017 were collected. There were 809 males and 216 females, aged (54±11)years, with a range from 16 to 83 years. The average coefficient of variation of RDW (RDW-CV) of 1 025 patients was 14.3%. Of 1 025 patients, 347 cases had high RDW of RDW-CV >14.3%, and 678 had low RDW of RDW-CV ≤14.3%. Observation indicators: (1) clinico-pathological data of HCC patients; (2) influencing factors for prognosis of HCC patients; (3) follow-up and survival. (4) stratified analysis of independent influencing factors. Follow-up was performed by outpatient examination, telephone interview or internet interview to detect postoperative survival of patients up to October 2017. Measurment data with normal distribution were represented as Mean±SD, and measurment data with skewed distribution were described as M (range). Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. The Graphpad Prism 7.0 was used to draw survival curves, and Log-rank test was used for survival analysis. Univariate and multivariate analyses were performed using the COX proportional hazard model. Results:(1) Clinicopathological data of HCC patients: cases with age ≤70 years or >70 years, cases without cirhhosis or with cirhhosis , cases of Child-Pugh grade A or Child-Pugh grade B or C, cases with the level of alpha fetoprotein (AFP) ≤200 μg/L or >200 μg/L, cases with single tumor or multiple tumors were 313, 34, 152, 186, 161, 53, 158, 143, 186, 109 for high RDW patients, versus 641, 37, 359, 310, 415, 48, 367, 227, 547, 131 for low RDW patients, respectively, showing significant differences in above indicators between the two groups ( χ2=6.709, 6.787, 23.906, 7.114, 34.375, P<0.05). (2) Influencing factors for prognosis of HCC patients: results of univariate analysis showed that age, Child-Pugh grade, AFP, RDW-CV, tumor diameter, the number of tumors were related factors for prognosis of patients ( hazard ratio=1.388, 1.432, 1.534, 1.455, 2.813, 1.505, 95% confidence interval as 1.004-1.920, 1.086-1.887, 1.263-1.864, 1.211-1.748, 2.293-3.450, 1.173-1.932, P<0.05 ). Results of multivariate analysis showed that age, RDW-CV, tumor diameter and the number of tumors were independent factors for prognosis of patients ( hazard ratio=1.020, 1.340, 2.427, 1.438, 95% confidence interval as 1.007-1.032, 1.027-1.749, 1.801-3.272, 1.057-1.956, P<0.05). (3) Follow-up and survival: 1 025 patients were followed up for 1-124 months, with a median follow-up time of 25 months. The median survival time was 23 months for high RDW patients, versus 44 months for low RDW patients, showing a significant difference in the overall survival between the two groups ( χ2=11.640, P<0.05). (4) Stratified analysis of independent influencing factors: the results of stratified analysis of 3 independent influencing factors including age, tumor diameter and the number of tumors showed that in the 954 patients with age ≤70 years, the median survival time was 25 months for high RDW patients, versus 48 months for low RDW patients, showing a significant difference in the overall survival between the two groups ( χ2=14.030, P<0.05). In the 71 patients with age >70 years, the median survival time was 11 months for high RDW patients, versus 29 months for low RDW patients, showing no significant difference in the overall survival between the two groups ( χ2=0.933, P>0.05). In the 459 patients with tumor diameter ≤5 cm, the median survival time was 44 months for high RDW patients, versus 76 months for low RDW patients, showing a significant difference in the overall survival between the two groups ( χ2=8.660, P<0.05). In the 487 patients with tumor diameter >5 cm, the median survival time was 14 months for high RDW patients, versus 18 months for low RDW patients, showing no significant difference in the overall survival between the two groups ( χ2=2.950, P>0.05). In the 733 patients with single tumor, the median survival time was 20 months for high RDW patients, versus 48 months for low RDW patients, showing a significant difference in the overall survival between the two groups ( χ2=13.530, P<0.05). In the 240 patients with multiple tumors, the median survival time was 15 months for high RDW patients, versus 20 months for low RDW patients, showing a significant difference in the overall survival between the two groups ( χ2=6.820, P<0.05). Conclusions:Preoperative RDW can be used as a predictive index for prognosis of HCC patients, and patients with high RDW have poorer prognosis. RDW have better predictive value in patients with age ≤70 years or tumor diameter ≤5 cm.

ObjectiveTo investigate new biomarkers for hepatic alveolar echinococcosis by screening out differentially expressed microRNAs (miRNAs) in the tissues and plasma of patients with hepatic alveolar echinococcosis, since hepatic alveolar echinococcosis is caused by the infection of multilocular hydatid cyst. MethodsPatients with hepatic alveolar echinococcosis diagnosed in Qinghai University Affilrated Hospital from June 2016 to May 2018 were in cluded. Two marginal tissue samples and three adjacent normal tissue samples were collected from patients with hepatic alveolar echinococcosis, and plasma samples were collected from three patients with hepatic alveolar echinococcosis and three healthy controls. Agilent Human miRNA microarray was used to obtain the miRNA expression profile in tissue and plasma, and differentially expressed miRNAs were screened out based on fold change (FC＞1.2) and P value (P＜0.05). Plasma miRNAs and tissue miRNAs associated with liver diseases were selected based on target gene prediction of differentially expressed miRNAs and literature reports, and quantitative real-time PCR (qRT-PCR) was used for validation. The t-test was used for comparison of continuous data between two groups. A spearman analysis was used to investigate correlcction. ResultsThere was a significant difference in microRNA expression profile between the patients with hepatic alveolar echinococcosis and the health individuals, and qRT-PCR found that three miRNAs (hsa-miR-4644, hsa-miR-136-5p, hsa-miR-483-3p) were significantly differentially expressed in patients with hepatic alveolar echinococcosis (P＜0.05), among which hsa-miR-4644 and hsa-miR-483-3p were significantly upregulated (P＜0.05) and hsa-miR-136-5p was significantly downregulated (P＜0.05) in patients with hepatic alveolar echinococcosis. Target gene prediction was performed for miRNAs based on TargetScan, PITA, and microRNAorg databases, and the intersection of the target genes predicted by these three databases showed that 137 genes were targeted with miRNAs. The differentially expressed miRNA hsa-miR-483-3p was involved in the target regulation of the genes (IL17A, IL5, CD40LG, TAP2, and TNF) associated with immune response and liver diseases. Gene ontology and Kyoto Encyclopedia of Genes and Genome analyses showed that the target genes of hsa-miR-483-3p played an important role in the primary immunodeficiency signaling pathway, the IL-17 signaling pathway, and the TNF signaling pathway. ConclusionHepatic alveolar echinococcosis has a unique microRNA expression profile, among which hsa-miR-483-3p can be used as a new biomarker for hepatic alveolar echinococcosis, and the target genes regulated by this miRNA are mainly involved in the primary immunodeficiency signaling pathway, the IL-17 signaling pathway, and the TNF signaling pathway. However, further studies are needed to verify the regulatory relationship between these miRNAs and hepatic alveolar echinococcosis.

Autoimmune pancreatitis (AIP) is an autoimmune-mediated abnormal chronic inflammatory disorder and is often misdiagnosed as pancreatic neoplastic lesions. With in-depth studies of this disease in recent years, it has been taken seriously by hepatobiliary physicians and surgeons. This article summarizes the clinical features, diagnostic criteria, and treatment methods for autoimmune pancreatitis at the present stage, so as to provide clinicians with diagnosis and treatment experience to reduce clinical misdiagnosis.

ObjectiveTo investigate the expression of exosome microRNAs (miRNAs) in bile of hepatic alveolar echinococcosis (HAE) patients with biliary tract invasion and the regulatory mechanism of differentially expressed miRNAs on target genes. MethodsBile samples were collected from 12 HAE patients who attended Qinghai University Affiliated Hospital from August 2017 to October 2018, with 6 patients in observation group (with the manifestation of biliary tract invasion) and 6 in control group (without the manifestation of biliary tract invasion). Ultracentrifugation extraction and Western blot were used to identify the structure of exosomes, the Trizol method was used to extract total RNA in exosomes, and miRNA expression profile microarray was used to identify differentially expressed miRNAs. The pathway enrichment analysis was performed to predict the target genes of biliary tract invasion based on differentially expressed miRNAs. ResultsA total of 74 differentially expressed miRNAs were identified between the observation group and the control group, among which 9 were upregulated and 65 were downregulated (｜Fold Change｜＞2). The pathway analysis showed that the target genes were mainly enriched in the pathways for tumorigenesis, phosphatidylinositol signaling system, and PTEN (FDR＜0.05). The GO annotation and enrichment analysis showed that the target genes were mainly enriched in the biological processes such as positive regulation of gene repression and regulation of cell differentiation (FDR＜0.05). ConclusionThe established expression profile of differentially expressed exosome miRNAs in bile of HAE patients with biliary tract invasion can be used as biomarkers for biliary tract invasion of HAE and preliminarily elaborate on the regulatory mechanism of differentially expressed miRNAs on target genes after HAE invades the biliary tract.

Immune checkpoint inhibitors (ICIs) therapy has shown broad prospects in the treatment of malignant tumors and infectious diseases, but problems encountered during application drive researchers to explore potential immune checkpoints. This article summarizes the research advances in the role of the new immune checkpoint lymphocyte activation gene-3 (LAG-3) in liver-related diseases, aiming to provide a reference for subsequent research. LAG-3 is expected to become the classic target of next-generation ICIs therapy and play a key role in immunotherapy for liver-related diseases.

Objective To explore the risk factors,prevention and treatments for liver failure after hepatectomy for hepatic alveolar echinococcosis.Methods Clinical data of 117 patients with hepatic alveolar echinococcosis admitted to the Affiliated Hospital of Qinghai University from August 2016 to August 2017 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among 117 patients,47 cases were male and 70 female,aged (36±13) years on average.According to whether liver failure occurred after operation,the patients were divided into liver failure group (n=28) and non-liver failure group (n=89).The risk factors of liver failure after hepatectomy were analyzed by univariate and multivariate logistic regression.Results The incidence of postoperative liver failure was 24％ (28/117) and its mortality was 21％ (6/28).21 patients were classified as Child-Pugh grade A,4 grade B and 3 grade C.Multivariate logistic regression analysis showed that Child-Pugh grading,complicated with primary liver diseases,AST,operation time,intraoperative blood loss and intraoperative blood transfusion were the independent factors affecting the occurrence of liver failure (OR=0.089,7.412,1.010,7.926,5.961,11.341;P＜0.05).Conclusions The risk of liver failure after hepatectomy is high in patients with hepatic alveolar echinococcosis.Child-Pugh liver function grading,complicated with primary liver diseases,AST,operation time,intraoperative blood loss and intraoperative blood transfusion are the independent factors for liver failure.Preoperative comprehensive assessment of liver function reserve,shortening the operation time,managing intraoperative bleeding and timely diagnosis and treatment after operation are important measures to prevent the postoperative liver failure.