Hepatic encephalopathy is one of the most common complications of liver failure and has a high incidence in hospitalized patients. Most patients with hepatic encephalopathy have varying degrees of malnutrition.In recent years,more and more clinical trials have confirmed that the nutritional support therapy is beneficial to patients with hepatic encephalopathy,and more attention has been paid to nutritional ther-apy.This paper introduces the pathogenesis of malnutrition in hepatic encephalopathy,and reviews the methods for nutrition evaluation and nutritional therapy in patients with hepatic encephalopathy.

Objective To investigate bone health conditions in 1637 aged women. Methods From May 2004 to October 2008, Bone mineral density (BMD) of 1637 women at age of more than 60 years old were measured by Hologic DephiA dual energy X-ray absorptiometry (DXEA) in Huadong hospital affiliated to Fudan University. All data were compared and analyzed among each group which will be divided by every ten years. Those women were divided into groups on 10 years range. BMD of lumbar vertebral and hip bone,fracture incidence and bone turnover marker were compared and analyzed. Results (1) BMD: at age of 3=90, 80 - 89, 70 - 79, 60 - 69, BMD of the lumbar vertebral 2 - 4(L2-4) values were (0. 96 ± 0. 18),(0. 90 ± 0. 20) , (0. 81 ± 0. 16) , (0. 83 ± 0. 14) g/cm2 , respectively. There were significantly increased BMD of lumbar of women at the age of 80 - 89 and ≥90 year-old compared with those of 60 - 69 year-old (P<0. 05). At age of ≥90,80 -89,70-79,60 -69 BMD of femur neck, Total, Torch, Ward's trianger were(0. 60 ±0. 11) , (0. 65 ±0. 11) ,(0. 47 ±0. 09) ,(0. 37 ±0. 09) g/cm2; at age of 80 -89 BMD of FN,Total, Torch, Ward's trianger were(0. 57 ±0. 10) , (0. 68 ±0. 13) , (0. 48 ±0. 11) , (0. 35 ±0. 10) g/cm2;at age of 70-79 BMD of FN, Total, Torch, Ward's trianger were (0.57±0. 10) ,(0. 69 ±0. 12), (0.49± 0. 10) , (0. 36 ± 0. 11) g/cm2; at age of 60 - 69 BMD of FN, Total, Torch, Ward's trianger were (0. 63 ± 0. 10) , (0. 76 ±0. 12) , (0. 54 ±0. 10), (0. 45 ±0. 15) g/cm2; There were significantly decreased in BMD of hip at the age of 70 - 79, 80 - 89,≥90 year-old compared with those of 60 - 69 year-old (P < 0. 05).(2) Fracture incidence: one time fracture incidence at age of 60 - 69,70 - 79,80 - 89, ≥ 90 were 34. 8 % (242/695) ,45. 0% (296/658) ,51. 3% (137/267) ,5/17. There were increasing trend of fracture in aged women. (3) Bone turnover marker of bone Gla protein (BGP) N-mid(N-midBGP) in serum and C-terminal telopeptide of type Ⅰ collagen/Cr (CTX/Cr) in urine values were (17 ±5) μg/L, (106 ±56) μg/mmol at age of more than 90 years ,(17 ±7) (μg/L,(128 ±99)μg/mmol at age of 80-89 years,(21 ± 14) μg/L,(182 ± 173)μg/mmol at age of 70-79 years, (25±13)μg/L, (190 ± 168)μg/mmol at age of 60 - 69 years. There were significant decreased trends of N-midBGP at age of 70 -79,80 -89 compared with that of 60-year (P < 0. 05). There were significant decreased trends of CTX/Cr 80 - 89 compared with that of 60-year (P < 0. 05). Conclusions There were significant decreased bone metabolism in aged women. The risk of hip fracture is significantly increased in aged women. Diagnosis of osteoporosis based on BMD of hip in aged women is more reliable.

Acute-on-chronic liver failure (ACLF), a severe hepatic syndrome, is the most common type of hepatic failure in China, which has no specific treatment until now. Traditional therapies mainly include comprehensive medical treatment, artificial liver support system (ALSS), and liver transplantation. In recent years, several novel approaches including new ALSS, hepatocellular transplantation, stem cell transplantation, colony stimulating factor, and combination therapies have been proposed with the constant development of biotechnologies and cytotechnologies. In the present review, the traditional therapies, as well as the mechanism and characteristics of new approaches to the treatment of ACLF, are summarized. Then, the current application, problems, and advances of these new approaches are also discussed.

Objective: Heart failure (HF) patients are usually associated with liver function impairment, Child-Turcotte-Pugh (CTP) scores can evaluate liver function, but its effect in HF patients has been unclear. We want to study the application of CTP scores in predicting the risk of death for in-hospital HF patients. Methods: A total of 1180 consecutive in-hospital HF patients were enrolled. According to CTP scores evaluated liver function at admission, the patients were divided into 3 groups: CTP grade A group, n=951, CTP grade B group, n=206 and CTP grade C group, n=23. The endpoint of this study was all-cause death. Results: There were 180 patients died at 1 year follow-up period, the in-hospital and 1 year mortalities were increased with the elevated CTP grades accordingly: for in-hospital mortalities in CTP grade A, B and C groups were (0.8%, 11.7% and 56.5%) respectively, P< 0.001; for 1 year mortalities were (9.6%, 34.5% and 78.3%) respectively, P< 0.001. Multivariable Cox regression analyses indicated that the higher CTP grades, the higher risk of in-hospital and 1 year mortalities in HF patients. The area under curve for CTP scores in predicting the in-hospital and 1 year mortalities were 0.88 and 0.74 respectively. Kaplan-Meier survival analysis presented that the patients with improved CTP scores from grade B or C to grade A at discharge had the higher 1 year survival rate than those without improvement, P=0.028.
Conclusion: CTP scores may independently predict the risk of death for in-hospital HF patients, the levels of CTP scores might be used for evaluating the efficacy of in-hospital treatment.

OBJECTIVETo establish the liver-depression and spleen-deficiency syndrome model in rats to screen the optimal extraction method of small compound Yueanjian on the basis of pharmacodynamic and chemical indicators.

METHODThe PMS liver-depression and spleen-deficiency syndrome model were established by the chronic restraint stress method and treatment with Yueanjian extracted by three methods: water-extraction, steam-distillation and alcohol-extraction. Behavioral performances and the contents of estradiol and progestin in serum were determined before and after the administration of the three extracts. The contents of salvianolic acid B in these three extracts were detected by HPLC. The optimal extraction method of Yueanjian was selected according to pharmacodynamic results.

RESULTThe contents of estradiol and progestin in groups treated with steam distillations and alcoholic extraction were higher than the model group. In the open field test, the group treated with steam distillations showed much higher scores than the model group. HPLC showed that the content of salvianolic acid B extracted by steam-distillation was higher than the other two extracts.

CONCLUSIONOn the basis of pharmacodynamic and chemical results, the steam-distillation was proved to be best extraction method of Yueanjian.

Animals ; Benzofurans ; analysis ; Chromatography, High Pressure Liquid ; Distillation ; Drugs, Chinese Herbal ; isolation & purification ; pharmacokinetics ; therapeutic use ; Estradiol ; blood ; Female ; Premenstrual Syndrome ; blood ; drug therapy ; Progestins ; blood ; Rats ; Rats, Wistar

Objective To systematically review the efficacy of different artificial liver support systems in the treatment of acute-on-chronic liver failure (ACLF) using a network Meta-analysis. Methods PubMed, Embase, the Cochrane library, Clinical Trial, CNKI, SinoMed, and Wanfang Data were searched for randomized controlled trials (RCTs) on different artificial liver support systems in the treatment of ACLF. Literature screening, data extraction, and method ological quality assessment were performed according to inclusion and exclusion criteria, and Stata15.1 software and R4.1.0 software were used to perform a network Meta-analysis. Results A total of 14 RCTs were included, with 1141 patients in total. The network meta-analysis showed different intervention methods had no significant difference in reducing mortality rate based on cross comparison (all P > 0.05). The probability ranking diagram showed that plasma exchange (PE) showed the best effect in reducing 30-day mortality rate, followed by extracorporeal liver assist device (ELAD), fractionated plasma separation and adsorption with Prometheus system, molecular adsorbent recirculating system (MARS), Biologic-DT liver dialysis device, and PE+MARS. PE showed the best effect in reducing 90-day mortality rate, followed by Prometheus, ELAD, and MARS. Biologic-DT showed the best effect in improving hepatic encephalopathy, followed by MARS, PE+MARS, and ELAD. Patients undergoing ELAD had the lowest risk of bleeding, and compared with standard medical treatment, Biologic-DT might increase the risk of bleeding [risk ratio=1.9×10 8 , 95% confidence interval: (4.6-6.2)×10 27 ]. Conclusion PE might be the best option for reducing 30- and 90-day mortality rates in ACLF patients. Biologic-DT has a better effect in improving hepatic encephalopathy, but it may increase the risk of bleeding.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.