Early identification and effective treatment of hepatocellular carcinoma plays an important role in improving survival rate.The establishment of simple and effective procedures for early diagnosis, census methods, and effective minimally invasive treatment is an important project in China to improve the diagnosis and treatment level of liver cancer.Contrast-enhanced ultrasound plays an important role in the early diagnosis of liver cancer and radiofrequency ablation treatment.This article describes how contrast-enhanced ultrasound helps with the identification of small hepatocellular carcinoma and degree of tumor differentiation in patients with liver cirrhosis, as well as the differential diagnosis of hyperplasia/canceration and precancerous lesion.It also introduces the important role of contrast-enhanced ultrasound in standard radiofrequency ablation and development of therapeutic regimens and strategies and clarifies that it can be used before, during, and after radiofrequency ablation treatment.

Gene mutation is the molecular basis of the pathogenesis of primary liver cancer, and precise treatment based on gene mutation is an important direction for the treatment of liver cancer in future.This article introduces the current status, complexity, and prospects and future directions of precise treatment for liver cancer from the aspects of complex gene mutations in liver cancer, level of mutation detection, and limitations of clinical trials.It is pointed out that there are many challenges in precise treatment for liver cancer, but precise treatment still has a promising future.

P53 abnormality or mutation is commonly seen in patients with hepatocellular carcinoma (HCC), and therefore, restoration of P53 function has become a research hotspot in the treatment of HCC.This article reviews the association of P53 with Bcl-2 protein family, microRNA, TGFβ, HBV, HCV, and AKT and the role of P53 in regulating cell apoptosis, in order to provide clues for improving the therapeutic outcome of HCC.

Liver cancer is one of the most common malignant tumors in the world, and traditional liver cancer treatment methods have their own limitations.Glypican-3 (GPC3) is a cell-surface heparan sulfate proteoglycan and is involved in the regulation of individual development and cell proliferation and differentiation.It is also a hepatoma-specific carcinoembryonic antigen.The mechanism of action of GPC3 in the development and progression of liver cancer has become a hot research topic.GPC3 not only has a unique value in the diagnosis of liver cancer, but also plays an important role in the treatment of liver cancer.This article also introduces the application of GPC3-derived tumor vaccines, GPC3 antibodies, GPC3 gene therapy, and targeted therapy and brings new ideas for the treatment of liver cancer.

Hepatocellular carcinoma (HCC) has a high fatality rate and most patients are in advanced stage when diagnosed with routine methods.As a molecular imaging method, positron emission tomography/computed tomography (PET/CT) has become more and more important.However, it also has certain limitations, since it always has false-negative results for well-differentiated HCC and small HCC.Therefore, a combination of various tracers can improve the sensitivity and specificity of PET/CT in the diagnosis of HCC.This article reviews the role of PET/CT in the therapeutic effect evaluation, recurrence monitoring, and prognosis of HCC.

Esophageal variceal bleeding is a major complication of liver cancer and a major cause of death in patients with liver cancer.This article summarizes the current status of the treatment of liver cancer complicated by esophageal variceal bleeding, including drugs and endoscopic and interventional treatment, with an emphasis on treatment options for liver cancer complicated by esophageal variceal bleeding.

In the patients with end-stage renal disease (ESRD) with hepatitis B virus (HBV) infection who underwent hemodialysis, the viral load of HBV DNA is relatively low and stable.For this phenomenon, some studies suggest that hemodialysis can reduce the HBV DNA load.The mechanism, which remains unclear, may be as follows: when HBV DNA enters the dialysate through the dialysis membrane, it was adsorbed onto the dialysis membrane;some virus particles were destroyed, and antiviral substances were produced in the course of hemodialysis.At present, there is no consensus on the mechanism responsible for the influence of maintained hemodialysis on the viral load of HBV DNA.This article reviews the factors involved in the influence of maintained hemodialysis on the viral load in ESRD patients with HBV infection and the recent progress.

Nucleos(t)ide analogues (NAs) have been widely used in clinical practice as first-line antiviral drugs.In recent years, many clinical studies have found that some patients cannot reach a satisfactory therapeutic outcome.This article introduces the antiviral indications and follow-up of chronic hepatitis B and summarizes the influence of baseline characteristics, HBV genotype, HBV mutation and drug resistance, patients'' medication compliance, presence or absence of other diseases or viral infection, and serum vitamin D level on the antiviral effect of NAs.It is pointed out that appropriate timing for antiviral therapy, patient education before treatment, regular follow-up during treatment, and timely identification of comorbidities and drug resistance help to improve the antiviral effect of NAs and delay the progression of liver diseases.

Objective To investigate the high-risk factors for cholangitis after endoscopic sphincterotomy (EST), and to provide a reference for clinical prevention and treatment.Methods A total of 196 patients who underwent EST in our hospital from June 2013 to January 2016 were enrolled, among whom 31 experienced cholangitis after EST (infection group) and 165 had no cholangitis (control group).Related factors were analyzed for both groups.The t-test was used for comparison of continuous data between groups;the chi-square test was used for comparison of categorical data between groups, and a multivariate non-conditional logistic regression analysis was performed for variables with statistical significance.Results The univariate analysis showed that there were significant differences between the two groups in the past history of biliary tract surgery [8 (25.81%) vs 10 (6.06%), χ2=12.200, P=0.000 5], number of common bile duct stones (2.8±0.5 vs 2.2±0.6, t=5.234, P=0.000 5), gallstones complicated by cholecystitis [8 (25.81%) vs 13 (7.88%), χ2=6.994, P=0.000 4], intrahepatic bile duct stones [6 (19.35%) vs 8 (4.85%), χ2=8.280, P=0.004 0], time of operation (35.6±5.8 min vs 27.1±6.2 min, t=7.072, P=0.000 4), presence or absence of lithotripsy [10 (32.26%) vs 15 (9.09%), χ2=10.591, P=0.000 1], postoperative pneumobilia [12(60.00%) vs 16 (21.82%), χ2=17.940, P=0.000 2], and duration of the use of antibiotics (3.6±0.7 d vs 4.5±0.8 d, t=5.854, P=0.000 6).The multivariate non-conditional logistic regression analysis showed that past history of biliary tract surgery [OR (95%CI)=1.962 (1.156-3.658), P=0.024], number of common bile duct stones [OR (95%CI)=2.632 (1.366-5.013), P=0.021], intrahepatic bile duct stones [OR (95%CI)=2.976 (1.482-5.536), P=0.024], time of operation [OR (95%CI)=4.859 (2.513-8.622), P=0.006], postoperative pneumobilia [OR (95%CI)=5.326 (2.633-10.524), P=0.005], and duration of the use of antibiotics [OR (95%CI)=0.565 (0.263-0.895), P=0.009] were independent risk factors for cholangitis after EST.Conclusion Positive intervention of related risk factors for cholangitis after EST has important clinical significance in the prevention of cholangitis after EST.

Objective To investigate the short-and long-term efficacy of transarterial chemoembolization (TACE) versus liver resection in the treatment of patients with Barcelona Clinic Liver Cancer (BCLC) stage B multiple hepatocellular carcinoma (HCC).Methods A retrospective analysis was performed for the clinical data of 80 patients with BCLC stage B multiple HCC who were treated from June 2010 to June 2011, and among these patients, 49 underwent liver resection (LR group) and 31 underwent TACE (TACE group).The postoperative complications, changes in liver function parameters, survival time, and 1-, 3-, and 5-year survival rates were compared between the two groups.The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier curve was used for survival analysis, The log-rank test was used for conparison between two groups.Results At 1 week after surgery, the LR group and the TACE group had significant increases in total bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) (LR group: t=3.181, 2.181, and 2.955, P=0.002, 0.032, and 0.004;TACE group: t=3.109, 3.965, and 4.519, P=0.003, P<0.001, and P<0.001), and after surgery, the LR group had significantly lower levels of AST and ALT than the TACE group (t=2.094 and 2.111, P=0.040 and 0.038).Compared with the TACE group, the LR group had significantly higher 1-, 3-, and 5-year survival rates (75.51%/51.02%/40.82% vs 61.29%/22.58%/9.68%, all P<0.05) and significantly longer median survival time (36.3 months vs 26.5 months, P<0.05).The LR group had a significantly lower recurrence rate than the TACE group (30.61% vs 67.74%, χ2=10.576, P=0.001).Conclusion Liver resection has a better effect in the treatment of patients with BCLC stage B multiple HCC than TACE and can improve overall survival and prolong survival time.