Serum cholinesterase (ChE) is synthesized by hepatic parenchymal cells and is released into blood immediately after synthesis,and therefore,serum ChE can be used as an objective and sensitive indicator of liver function.Serum ChE has been used as an independent factor for the evaluation of liver function for a long time and can reflect the synthetic function of the liver and help to determine the severity of liver diseases.Combined measurement of serum ChE and serum prealbumin,total cholesterol,total bile acid,and prothrombin time has an important value in the diagnosis and treatment of liver diseases.At the same time,serum ChE combined with Child-Turcotte-Pugh score or MELD score can accurately evaluate liver reserve function,which may help with the prognostic evaluation of patients with liver diseases.

As a global disease,hepatitis B still threatens human health.However,the pathogenesis of hepatitis caused by HBV remains unclear.The innate immune system in the liver can detect HBV infection and use every strategy to eliminate the virus.DNA recognition receptors play an important role in this process;they recognize tlBV DNA or pgRNA in cytoplasm or nucleus,activate innate immunity through various signaling pathways to produce inflammatory cytokines and interferon,and finally exert their antiviral effect.This article summarizes the DNA recognition receptors involved in inflammation induced by HBV and HBV clearance,elaborates on their detailed pathways,and discusses the issues regarding the role of DNA recognition receptors in liver innate immunity induced by HBV and related perspectives.

An investigation of the special policies for chronic diseases in medical insurance for urban employees and residents has been conducted in 333 prefecture-level cities in China,and the results showed that 78％ of all cities included chronic hepatitis B (CHB) in medical reimbursement for urban employees and 57％ included CHB in medical reimbursement for urban residents.However,there are still some issues to be resolved,such as inconsistent descriptions of the diagnosis of CHB-related diseases,inconsistent diagnostic criteria,lack of standardization of reimbursement process,infringement of patient privacy,and inadequate dose prescribed for CHB patients in the outpatient service.Therefore,we suggested that the Ministry of Human Resources and Social Security should introduce unified policies to include CHB in medical reimbursement,unify disease name and diagnostic criteria,standardize the reimbursement process for CHB,and increase the prescribed dose.

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Objective To investigate the diagnostic value of real-time shear wave elastography (SWE) technique in evaluating classification of liver fibrosis.Methods PubMed,CNKI,CBM,VIP,and Wanfang Data were searched for Chinese and English articles on SWE for evaluating classification of liver fibrosis published from January 2010 to December 2016,and these articles were screened and evaluated.Meta-disc 1.4 software was used for the meta-analysis of the data in the articles included.Results A total of 11 English articles were included,with 1560 cases in total.In the ≥F2 group,SWE had a pooled sensitivity of 0.85 (95％ confidence interval [CI]:0.82-0.87),a specificity of 0.79 (95 ％ C1:0.76-0.82),and a diagnostic odds ratio (DOR) of 30.81 (95 ％ CI:16.55-57.34).In the ≥ F3 group,SWE had a pooled sensitivity of 0.87 (95 ％ CI:0.84-0.91),a specificity of 0.84 (95 ％ CI:0.82-0.87),and a DOR of 41.45 (95 ％ CI:18.25-94.45).In the F4 group,SWE had a pooled sensitivity of 0.88 (95％ CI:0.83-0.91),a specificity of 0.91 (95％ CI:0.89-0.92),and a DOR of 67.18 (95％ CI:30.03-150.31).The areas under the receiver operating characteristic curve for these three groups were 0.914 7,0.922 3,and 0.952 0,respectively.Conclusion SWE has a high diagnostic value in evaluating the classification of liver fibrosis and can be used to determine liver fibrosis stage in clinical practice.

Malnutrition is a common complication in patients with end-stage liver disease and is associated with patients' clinical prognosis and quality of life,but it has not been taken seriously by clinical physicians.This article elaborates on the pathogenesis of malnutrition in patients with end-stage liver disease and introduces the latest research advances in malnutrition assessment and nutrition support therapy for end-stage liver disease in China and foreign countries.Early nutrition support therapy for patients with end-stage liver disease may help to improve their comprehensive clinical outcome.

The main features of liver failure are extensive necrosis of hepatocytes,rapid disease progression,and poor prognosis,and at present,there are no effective drugs and methods for the treatment of liver failure.This article summarizes four treatment methods for liver failure,i.e.,medical treatment,cell transplantation,liver transplantation,and artificial liver support therapy,and elaborates on the existing treatment methods.The current medical treatment regimen should be optimized;cell transplantation has not been used in clinical practice;liver transplantation is the most effective method,but it is limited by donor liver shortage and high costs;artificial liver can effectively remove toxic substances in human body.Therefore,this article puts forward artificial liver as a transition for liver transplantation;artificial liver can buy time for liver regeneration or liver transplantation and prolong patients' survival time and thus has a promising future.The new treatment modality of bioartificial liver combined with liver transplantation may bring good news to patients with liver failure.

With the increase in patients with liver failure,the artificial liver support system is facing great opportunities and challenges.Although artificial liver has achieved remarkable results in the treatment of patients with liver failure,non-bioartificial liver techniques commonly used in China,mainly plasma exchange,are facing the issue of limited plasma supply.This article focuses on plasma exchange and discusses how to deal with the shortage of plasma in non-bioartificial liver treatment from various aspects,in order to provide a reference for clinical physicians.

There are still controversies over the use of glucocorticoids in the treatment of liver failure,and current guidelines for liver failure recommend that glucocorticoids should be used with great caution.However,some latest studies have shown that the use of glucocorticoid therapy in the early stage of liver failure can bring more benefits to patients.Age,disease progression rate and severity,and complications of liver failure may affect the treatment outcome.Further studies are still needed for the selection of right patients,drugs and dose,and treatment timing.

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