As a digestive organ, the liver has the functions of metabolism, synthesis, and detoxification. It is also an immune organ and plays an important role in maintaining anti-infection, autoimmune stability, and anti-tumor. In particular, the liver has unique immunological advantages. Its immune cells can maintain the liver's immune homeostasis and participate in immunoregulation. A variety of immunotherapy is used in clinical trials for the treatment of difficult and critical liver diseases. This review mainly summarizes the recent clinical trials of immunotherapy in chronic hepatitis B, cirrhosis, hepatocellular carcinoma, and autoimmune liver disease.

ObjectiveTo investigate the association between baseline blood ammonia (BLA) and 90-day prognosis in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (HBV-ACLF). MethodsA retrospective analysis was performed for the clinical data of 789 patients with HBV-ACLF who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January 2013 to December 2016, and the association between baseline BLA and 90-day prognosis was analyzed. The Cox regression risk model was used for multivariate analysis. The Kaplan-Meier survival curve was used to analyze the 90-day survival rate of patients with different levels of baseline BLA, and the log-rank test was used for comparison. ResultsThe Cox multivariate regression analysis showed that BLA was independently and positively correlated with the risk of 90-day death in HBV-ACLF patients (Model 2: hazard ratio = 1.007, 95% confidence interval: 1.005-1.010, P＜0.00001). The log-rank test indicated that in the patients without hepatic encephalopathy (HE), the BLAhigh group had the highest 90-day cumulative mortality rate, followed by the BLAmid group and the BLAlow group (P=0002 3); among the patients with HE, the BLAhigh group had a significantly higher 90-day cumulative mortality rate than the other two groups (P=0.012), while there was no significant difference in 90-day cumulative mortality rate between these two groups (P=0.18). ConclusionBaseline BLA is independently and positively correlated with the risk of 90-day death in HBV-ACLF patients, and it may have a certain clinical value in treatment and prognostic evaluation.

Objective To assess survival rates and major complications of extremely preterm infants( EPI) discharged from the hospital,in order to provide some evidence for the treatment of such cases in the future. Methods A retrospective study Was performed by revieWing the clinical data of 299 infants at gestational age(GA)﹤28 Weeks Who Were admitted at the Neonatal Intensive Care Unit( NICU)of Tianjin Central Hospital of Gynecology Obstetrics from January 1st 2011 to December 31st,2017. The survival rates and major morbidities of EPI according to different GA Were compared by trend Chi－squaΥe and t test. Results A total of 299 cases of EPI Were included in the study,With a mean GA of 26. 5 Weeks(22 +3 －27 +6 Weeks)and mean birth Weight of 958. 5 g(360－1 550 g). From 2011 to 2017, the number of hospitalized EPI increased gradually( from 21 cases in 2011 to 79 cases in 2017),especially in EPI of loWer GA(GA﹤25 Weeks)Which increased from 4 cases in 2011－2014 to 26 cases in 2015－2017. The rates of sur﹣vival infants With GA﹤28 Weeks Were 78. 6%(235／299 cases),including 18. 2%(2／11 cases)at GA≤23 Weeks, 52. 6%(10／19 cases)at 24 Weeks,75. 8%(25／33 cases)at 25 Weeks,78. 5%(62／79 cases)at 26 Weeks and 86. 6%(136／157 cases)at 27 Weeks,respectively,Which shoWed that survival rates increased With the groWth of GA( χ2 ﹦31. 3,P﹦0. 000). Major morbidities among the survival infants Were severe retinopathy of prematurity(ROP,stageⅢor above according to international classification and received treatment)[16. 2%(38／235 cases)],bronchopulmonary dysplasia(BPD,supplemental oxygen use at a postmenstrual age of 36 Weeks)[15. 3%(36／235 cases)],late－onset sepsis(LOS)[24. 7%(58／235 cases)],intraventricular hemorrhage(IVH),grade 3 or 4)or periventricular leukoma﹣lacia(PVL)[9. 4%(22／235 cases)],necrotizing enterocolitis(NEC),stage≥Ⅱof Bell,criteria)[3. 0%(7／235 cases)],and decreased With increased gestational age(χ2 ﹦18. 450,19. 773,15. 024,all P﹦0. 000). Rates of ROP, BPD and LOS in EPI With GA﹤25 Weeks Were 41. 7%(5／12 cases),58. 3%(7／12 cases)and 66. 7%(8／12 cases), respectively,Which Were much higher than those of EPI With GA 25－28 Weeks[14. 8%(33／223 cases),13. 0%(29／223 cases),22. 4%(50／223 cases)](all P﹤0. 05). Conclusions From 2011 to 2017,the number of hospitalized EPI increased gradually and the rate of survival rose With every 1－Week increase in GA,While major morbidities Were reduced accordingly. EPI of GA﹤25 Weeks had a greater risk of mortality and major morbidities.

Objective To evaluate and compare the effectiveness of propofol-remifentanil closed-loop and open-loop anesthesia in gynecological laparoscopic operation under bispectral index (BIS) monitoring.Methods Forty female patients undergoing elective gynecological laparoscopic operation were recruited and randomly divided into closed-loop (group Ⅰ) and open-loop (group Ⅱ) groups.During anesthesia maintenance,the closed-loop group was administered with a BIS-feedback system to regulate the target effect-site concentration;whereas,the open-loop group was administered the target effect-site concentration according BIS value manually.The variation of non-invasive mean arterial pressure (MAP),heart rate (HR),SpO2,BIS,extubation time,consumption of propofol and remifentanil,Ramsay index,and subjective comfort grade were recorded at the selected time points.Results The extubation time in group Ⅰ was shorter than in group Ⅱ.The total dosage of propofol administered in group Ⅰ was less than that in group Ⅱ,but there was no significant difference in the total consumption of remifentanil.HR in group Ⅰ was steadier than in group Ⅱ.However,the MAP and Ramsay index were similar in both the groups.The subjective comfort grade in group Ⅰ was higher than in group Ⅱ.Conclusion The use of propofol-remifentanil closed-loop system by BIS-feedback anesthesia is safer,more controllable,with higher degree of satisfaction and sparing side-effects,we therefore recommend it during gynecological laparoscopic operations.

Objective To investigate the effects of human milk fortifier(HMF)addition at different time points on the growth,development and the incidence of complications in very low birth weight(VLBW)infants.Methods A total of 93 VLBW infants admitted into Neonatal Intensive Care Unit of Tianjin Central Hospital of Obste-trics and Gynecology from January to September 2015 with more than 80％of total milk intake during hospitalization,excluding those who had severe asphyxia or abandoned treatment and died,were collected.The included cases were divided into 2 groups by using completely randomized grouping method,early fortification group(n=48)and delayed fortification group(n=45)adding HMF with the enteral intake of 50 mL/(kg·d)and 100 mL/(kg·d),respectively.The outcomes included growth development and the incidence of complications during hospitalization.Then,t test and chi-square test of independent samples were used for statistical analysis.Results There was significant difference in the weight growth rate between the 2 groups,and the growth rate of early fortification group and delayed fortification group were(15.4±2.4)g/(kg·d)and(13.6±2.3)g/(kg·d),respectively(t=3.043,P=0.004).There was no significant difference in height growth rate,head circumference growth rate,weight at 34 weeks postmenstrual age,time of recovering birth weight and parenteral nutrition,hospitalization duration,body weight,body length,head circumference at discharge and the incidence of extrauterine growth retardation between the 2 groups(all P>0.05).There was no statistical difference in incidence of feeding intolerance,necrotizing enterocolitis,nosocomial infection,retinopathy of prematurity,bronchopulmonary dysplasia between the 2 groups(all P>0.05).Conclusions HMF with enteral intake of 50 mL/(kg·d)contributes to weight gain rate in VLBW infants during hospitalization,but not to the increase in the incidence of complications.

Objective To study the risk factors for postoperative nausea and vomiting (PONV) in gynecological patients administered prophylactic antiemetics.Methods A total of 1 000 gynecological surgical cases were reviewed.Data on patient characteristics,anesthesia,surgeries,and 1st postoperative day nausea and vomiting were collected and analyzed statistically.Results Multivariate logistic regression analysis included a history of motion sickness,the use of an analgesic pump,the duration of anesthesia,and the use of neostigmine.The odds ratios (ORs),in decreasing order,were that of a history of motion sickness [OR =1.953,95％ confidence interval (CI):1.404-2.716],the use of neostigmine (OR =1.831,95％ CI:1.203-2.786),the use of an analgesic pump (OR =1.472,95％ CI:1.017-2.129),and the duration of anesthesia (OR =1.256,95％ CI:1.058-1.492).The predictive model was described by the following equation:P=1/(1+e(1623-0.669X1-0.386X2-0.228X3+0.605X4)).Tne predictive accuracy of this model for the incidence of PONV in gynecological patients was 70.6％,and the area under the receiver operating characteristic curve for the predictive result was 0.642.Conclusion The independent risk factors for PONV in gynecological patients administered prophylactic antiemetics are a history of motion sickness,the use of neostigmine,the use of an analgesic pump,and the duration of anesthesia,in decreasing order of significance.

Objective To explore the relationship between umbilical cord blood brain-derived neurotrophic factor (BDNF) and neonatal neurobehavioral development in lead exposure infants. Methods All infants and their mother were randomly selected during 2011 to 2012, subjects were selected according to the umbilical cord blood lead concentrations, which contcentration of lead was higher than 0.48&mu;mol/L were taken into high lead exposure group, about 60 subjects included. Comparing to the high lead exposure group, according to gender, weight, pregnant week, length and head circumferenece, the level of cord blood lead concentration under 0.48&mu;mol/L were taken into control group, 60 cases included. Lead content was determined by graphite furnace atomic absorption spectrometry. Neonatal behavioral neurological assessment (NBNA) was used to determine the development of neonatal neuronal behavior. The content of BDNF was detected by ELISA. Comparing the BDNF and the NBNA score between two groups, and linear correlation was given on analysis the correlation between lead concentration in cord blood and BDNF, BDNF and the NBNA score. Results Lead content in high exposure group was(0.613± 0.139)&mu;mol/L,and higher than(0.336±0.142)&mu;mol/L in low exposure group(t=3.21,P<0.001). NBNA summary score (36.35±1.86), active muscle tension score (6.90±0.27) and general assessment score (5.93± 0.32) in high exposure group were lower than those(38.13 ± 0.96, 7.79 ± 0.35, 6.00 ± 0.00)in low exposure group(t values were 8.21, 10.23, 2.32,respectively,P values were <0.001,<0.001 and 0.037). BDNF content in high exposure group which was(3.538±1.203)ng/ml was higher than low exposure group(2.464± 0.918)ng/ml (t=7.60,P<0.001). The correlation analysis found that the cord blood BDNF content was negatively correlated with NBNA summary score, passive muscle tension and active muscle tone score(r was-0. 27,-0.29,-0.30, respectively ,P values were <0.001, respectively). Conclusion Prenatal lead exposure results poor neonatal neurobehavioral development and cord blood BDNF was negatively correlated with neonatal neurodevelopment, may serve as a useful biomarker.

Objective To explore the relationship between umbilical cord blood brain-derived neurotrophic factor (BDNF) and neonatal neurobehavioral development in lead exposure infants. Methods All infants and their mother were randomly selected during 2011 to 2012, subjects were selected according to the umbilical cord blood lead concentrations, which contcentration of lead was higher than 0.48&mu;mol/L were taken into high lead exposure group, about 60 subjects included. Comparing to the high lead exposure group, according to gender, weight, pregnant week, length and head circumferenece, the level of cord blood lead concentration under 0.48&mu;mol/L were taken into control group, 60 cases included. Lead content was determined by graphite furnace atomic absorption spectrometry. Neonatal behavioral neurological assessment (NBNA) was used to determine the development of neonatal neuronal behavior. The content of BDNF was detected by ELISA. Comparing the BDNF and the NBNA score between two groups, and linear correlation was given on analysis the correlation between lead concentration in cord blood and BDNF, BDNF and the NBNA score. Results Lead content in high exposure group was(0.613± 0.139)&mu;mol/L,and higher than(0.336±0.142)&mu;mol/L in low exposure group(t=3.21,P<0.001). NBNA summary score (36.35±1.86), active muscle tension score (6.90±0.27) and general assessment score (5.93± 0.32) in high exposure group were lower than those(38.13 ± 0.96, 7.79 ± 0.35, 6.00 ± 0.00)in low exposure group(t values were 8.21, 10.23, 2.32,respectively,P values were <0.001,<0.001 and 0.037). BDNF content in high exposure group which was(3.538±1.203)ng/ml was higher than low exposure group(2.464± 0.918)ng/ml (t=7.60,P<0.001). The correlation analysis found that the cord blood BDNF content was negatively correlated with NBNA summary score, passive muscle tension and active muscle tone score(r was-0. 27,-0.29,-0.30, respectively ,P values were <0.001, respectively). Conclusion Prenatal lead exposure results poor neonatal neurobehavioral development and cord blood BDNF was negatively correlated with neonatal neurodevelopment, may serve as a useful biomarker.

Objective To understand the whole situation of neonatal resuscitation in high risk deliveries.Methods Totally,3 420 neonates born from high risk pregnant mothers in Tianjin Central Obstetrics and Gynecology Hospital from September 2013 to November 2014 were recruited and divided into four groups according the needs of resuscitation,including no resuscitation group (Group A),initial resuscitation group (Group B),initial resuscitation plus bag-and-mask or T-piece ventilation (positive pressure ventilation group,Group C),tracheal intubation and/or external chest compression and/or epinephrine administation (tracheal intubation group,Group D).Variance analysis,Chi-square test and Logistic regression analysis were applied to compare the differences of clinical conditions among these groups and to analyze risk factors of tracheal intubation requirement for extensive resuscitation.Results Among the 3 420 newborns,2 360(69.0％) were assigned to Group A,565 (16.5％) to Group B,408 (11.9％) to Group C and 87 (2.5％) to Group D.Statistical differences were shown in the gestational age [(35.5 ± 4.1),(33.0 ± 4.3) and (32.1 ± 4.8) weeks],birth weight [(2 593.8 ± 663.6),(2 063.3 ± 973.9) and (1 839.0 ± 977.9) g],and the incidence of multiple births [66(11.7％),65(15.9％) and 23(26.4％)],abruptio placentae [15(2.7％),35(8.6％) and 9(10.3％)],umbilical cord prolapse [0(0.0％),2(0.5％),and 10(11.5％)],abnormal fetal heart rate in labor [28(5.0％),45(11.0％) and 46(52.9％)],prolonged labor [36(6.4％),35(8.6％),and 20(23.0％)],meconium stained liquor [32(5.7％),0(0.0％),and 8(9.2％)],and congenital anomaly [8(1.4％),12(2.9％) and 7(8.0％)] among Group B,C and D (F or x2=233.188,105.050,14.535,19.934,91.434,149.366,26.525,28.602 and 13.765,all P ≤ 0.05).Multiple regression analysis revealed that gestational age ≤ 28 weeks (OR=1.290,95％ CI:1.167-1.425),abnormal fetal heart rate in labor (OR=1.350,95％CI:1.184-6.862) and meconium stained liquor (OR=1.397,95％CI:1.051-6.825) were independent risk factors for endotracheal intubation requirement (all P ≤ 0.05).Conclusions More newborns born from high risk mothers may need resuscitation,especially for those in small gestational age,with abnormal fetal heart rate during labor and meconium-stained liquor,thus close monitoring and management are necessary.