Under the framework of value-based healthcare, the diagnosis-related group (DRG) payment system has been recognized as a key mechanism for enhancing healthcare quality and efficiency, and it has been widely implemented all over the world. However, its effectiveness mainly depends on the alignment between disease characteristics and payment rules. Severe liver diseases are characterized by high clinical complexity, substantial risks, and intensive resource utilization. The current DRG payment model often fails to capture the true cost structure of such conditions, leading to financial deficits in some medical institutions. It suggests that the optimization of DRG systems should incorporate risk stratification, dynamic adjustment, and additional reimbursement mechanisms for innovative technologies to balance income control with clinical cost burdens from international experience. In China, preliminary reforms have demonstrated a gradual transition from cost containment toward value-based payment approaches. This review is aimed at discussing the current knowledge on the compatibility between DRG payment models and the management of severe liver diseases from a value-based healthcare perspective, to provide theoretical insights and policy recommendations for refining China’s payment system.

Objective The aim of this study was to investigate the protective effect of betaine on liver injury in mice with LPS/D-gal-induced acute liver failure (ALF). Methods 30 C57BL/6J mice were randomly divided into control model, low-dose, medium-doseand high-dose of betaine-intervened groups, and the model of ALF was established by LPS/D-gal intraperitoneal injection. Western blotting was performed to detect hepatic expression of signal transducer and activator of transcription 3 (STAT3), phosphorylated STAT3 (p-STAT3), c-Jun N-terminal kinase (JNK) and phosphorylated JNK (p-JNK). Results LPS/D-gal injection successfully induced liver failure model with significant liver tissue congestion, structural disruption and inflammatory cell infiltration, and the betaine intervention alleviated liver pathological damages; serum ALT and AST levels in the model group were (1924.9±100.0) U/L and (2363.3±80.3) U/L, both significantly higher than in the control group, while they decreased greatly in low-, medium- and high-doses of betaine-intervened groups (P<0.05); betaine intervention increased remarkably the phosphorylation of STAT3 (Tyr705) and decreased the phosphorylation of JNK (Thr183/Tyr185) expression (P<0.05). Conclusion Betaine ameliorates liver injury in mice with ALF, might by inhibiting JNK activation and promoting STAT3 activation.

Objective The aim of this study was to investigate assessment of liver fibrosis by Yang’s modules in combination with serum liver fibrosis markers in patients with chronic hepatitis B (CHB). Methods A total of 116 patients with CHB were encountered in our hospital between March 2022 and March 2025, and all underwent liver biopsies. Serum hyaluronic acid (HA), laminin (LN), N-terminal propeptide of type Ⅲ procollagen (PⅢNP) and type Ⅳ collagen (CⅣ) levels were detected routinely. Yang’s modules was measured by shear wave elastography. Multivariate Logistic regression analysis was used to find impacting factors for liver fibrosis, and receiver operating characteristic (ROC) curve was adopted to evaluate the diagnostic efficacy of liver fibrosis in patients with CHB. Results Of the 116 patients with CHB, liver histopathological examination proved liver fibrosis S0 in 35 cases, S1 in 16 cases [e.g., non-significant liver fibrosis (NSLF) in 51 cases], S2[(significant liver fibrosis(SLF)in 35 cases], S3 [advanced liver fibrosis (AdLF) in 22 cases and S4(liver cirrhosis) in 8 cases; Yang’s modules in patients with liver cirrhosis was (20.6±4.0)kPa,much greater than [(17.2±2.5)kPa,P＜0.05] in patients with AdLF or [(15.6±3.8)kPa,P＜0.05] in those with SLF or [(10.9±2.2)kPa,P＜0.05] in those with NSLF;serum HA, CⅣ and/or PⅢNP levels in patients with SLF or AdLF elevated greatly(P＜0.05);multivariate Logistic regression analysis showed that increases serum liver fibrosis markers and Yang’s modules were impacting factors for SLF in patients with CHB (P＜0.05);ROC analysis demonstrated that the predicting performance for SLF by Yang’s modules in combination with at least two increased serum liver fibrosis markers was satisfactory, with accuracy of 98.8% in patients with CHB. Conclusion Serum liver fibrosis markers could play an auxiliary role to Yang’s modules in predicting liver fibrosis in patients with CHB.

Objective The aim of this study was to investigate tenofovir disoproxil fumarate (TDF) and compound glycyrrhizin combination therapy in patients with chronic hepatitis B (CHB). Methods 94 patients with CHB were enrolled in our hospital between June 2021 and June 2024, and were randomly assigned to receive oral TDF therapy in control (n=47), or receive oral TDF and compound glycyrrhizin combination therapy for 48 weeks. Serum HBV DNA loads were detected by PCR, serum HBeAg and HBsAg levels were assayed by electrochemiluminescence, serum HA, LN, C-IV and PC-III levels were detected by chemiluminescence, and serum IL-6, IL-8 and TNF-α were determined by ELISA. Results By end of 48-week treatment, serum HBV DNA loads became undetectable and HBeAg and HBsAg levels didn’t changed statistically differently in the two groups; serum HA, LN and PC-Ⅲ levels in the combination group were (175.2±21.9)ng/mL, (160.1±20.3)ng/mL and (147.4±18.4)ng/mL, all significantly lower than [(281.3±35.2)ng/mL, (229.4±28.7)ng/mL and (170.1±21.3)ng/mL, respectively, P<0.05] in the control; serum ALT and AST levels were (32.6±2.8)U/L and (28.4±4.1)U/L, both much lower than [(50.3±3.6)U/L and (44.2±4.3)U/L, respectively, P<0.05] in the control; serum IL-6, IL-8 and TNF-α levels were (11.8±1.5)μg/L, (4.3±1.0)μg/L and (20.6±2.6)μg/L, all much lower than [(18.1±2.3)μg/L, (6.0±1.1)μg/L and (38.1±4.8)μg/L, respectively, P<0.05] in the control group. Conclusion TDF in combination with compound glycyrrhizin in treatment of patients with CHB is efficacious, with improvement of serum liver function tests, which might be related to inhibition of liver fibrosis and reduced cytokine reactions.

Objective The aim of this study was to investigate the clinical efficacy of tenofovir amibufenamide (TMF) in combination with diammonium glycyrrhizinate in treatment of patients with chronic hepatitis B (CHB). Methods A total of 112 patients with CHB were enrolled in our hospital, and were randomly assigned to receive oral TMF in 56 cases in the control group or TMF in combination with diammonium glycyrrhizinate in another 56 cases in the observation group for 48 weeks. Serum HBV DNA loads were detected by fluorescence quantitative PCR. Serum and blood parameters were routinely obtained for calculation of fibrosis index based on the 4 factors (FIB-4). Lliver stiffness measurement (LSM) was measured by Fibroscan. Results At presentation, serum HBV DNA loads in the two groups were(7.3±1.2)lg copies/mL and (7.5±1.3)lg copies/mL(P>0.05), by end of 48-week treatment, they were (1.3±0.2)lg copies/mL and (1.3±0.3)lg copies/mL(P>0.05), and serum HBV DNA negative rates in the two groups were both 100.0%(P>0.05); serum ALT and AST in the observation group were (39.6±1.1)U/L and (34.2±14.5)U/L, both significantly lower than [(54.2±5.6)U/L and (43.8±16.3)U/L, respectively, P＜0.05] in the control; the FIB-4 score was (1.8±0.3), much lower than [(2.1±0.4),P＜0.05] in the control, while the LSM[(6.7±1.0)kPa vs. (6.8±1.3)kPa] were not significantly different between the two groups (P>0.05); incidences of adverse effects in the two groups(17.9% vs. 14.3%)was not significantly different (P>0.05). Conclusion The combination of TAF and diammonium glycyrrhizinate in the treatment of patients with CHB is satisfactory, which might improve liver function tests normal.

Objective The aim of this study was to investigate the efficacy of entecavir and Liuwei Wuling tablets, an herbal medicine, in treating patients with chronic hepatitis B (CHB). Methods 79 patients with CHB were encountered in our hospital between May 2021 and May 2024, and were randomly assigned to receive entecavir treatment in 39 cases as a control, or receive combination of entecavir and the herbal medicine in 40 cases for 48 week treatment. Serum hepatitis B viral markers were detected by chemiluminescence, serum HBV DNA loads were detected by real-time fluorescent polymerase chain reaction, serum hyaluronic acid (HA), laminin (LN), type III procollagen (PCIII) and type IV collagen (IV-C) levels were determined by radioimmunoassay, and serum transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were assayed by ELISA. Results By end of 48-week treatment, serum HBV DNA negative rates in the two groups were not significantly different (97.5% vs. 94.9%, P>0.05);serum ALT and AST levels in the combination group were (32.5±5.6)U/L and (30.3±3.9)U/L, both much lower than [(47.6±7.3)U/L and (44.7±5.1)U/L, respectively, P<0.05] in the control; serum HA, LN, PCⅢ and Ⅳ-C levels were (88.9±16.4)ng/mL, (87.8±12.7)ng/mL, (84.8±13.2)ng/mL and (82.7±11.4)ng/mL, all significantly lower than [(121.1±20.4)ng/mL, (115.2±15.3)ng/mL, (106.2±17.7)ng/mL and (102.3±14.3)ng/mL, respectively, P<0.05] in the control group; serum TGF-β1, TNF-α and IL-6 levels were (26.2±5.3)ng/mL, (22.1±4.4)pg/mL and (17.5±3.1)pg/mL, all much lower than [(37.5±7.2)ng/mL, (33.7±6.1)pg/mL and (25.6±5.0)pg/mL, respectively, P<0.05] in the control. Conclusion Entecavir in combination with Liuwei Wuling tablets could help improve liver function tests normal, which might be duo to inhibition of liver fibrosis and inflammatory reactions in patients with CHB.

Objective This study aimed to compare prevention of mother-to-child hepatitis B virus (HBV) transmission by tenofovir alafenamide fumarate (TAF) and tenofovir disoproxil fumarate (TDF) in pregnant HBV carriers. Methods 62 pregnant chronic HBV carriers were encountered in our hospital between May 2022 and May 2024, and were randomly assigned to receive TDF in 31 cases or TAF anti-viral therapy in another 31 cases since gestation 26 to 28 weeks until childbirth. All newborns were inoculated with hepatitis B immune globulin and hepatitis B vaccine. Serum creatinine (sCr) level and 24-hour urinary protein quantification were measured by using a fully automated biochemical analyzer, and the estimated glomerular filtration rate (eGFR) was calculated by using the CKD-EPI formula. Serum HBeAg levels were detected by chemiluminescence, and serum HBV DNA loads were measured by fluorescent quantitative PCR system. Results By end of one year follow-up, the successful blocking of mother-to-child HBV transmission in TAT-treated women was 100.0%, not significantly different as compared to 96.8%(P>0.05) in TDF-treated women; at laboring, serum HBV DNA turned to negative in the two groups, and serum HBeAg levels dint changed greatly (P>0.05); sCr, eGFR and urine protein level in TAF-treated women were (86.1±5.9)μmol/L, (96.6±8.2)mL/(min.1.73m² and (97.5±22.1)mg/24 h, all not significantly different compared to [(88.1±5.7)μmol/L, (94.4±7.9)mL/(min.1.73m² and (99.7±28.2)mg/24 h, P>0.05) in TDF-treated women; incidences of adverse events, such as premature birth, premature rupture of membranes and gestational hypertension in the two groups were not significantly different(P>0.05). Conclusion At present, we recommend both TDF or TAF for prevention of mother-to-child HBV transmission, which warrants further clinical observation.

Objective The aim of this study was to investigate the efficacy of intravenous administration of ganciclovir and glutathione in the treatment of children with cytomegalovirus (CMV)-infected hepatitis. Methods A consecutive 112 children with CMV hepatitis were encountered in our hospital between January 2021 and June 2024, and all children received intravenous administration of ganciclovir and glutathione for 2 to 3 weeks. Serum interleukin-18 (IL-18), interferon-γ(IFN-γ) and tumor necrosis factor-α(TNF-α) levels were assayed by ELISA, and serum CMV DNA loads were determined by PCR. Results Of our series, the children with CMV hepatitis were found mild hepatitis (MH) in 74 cases and severe hepatitis (SH) in 38 cases; after treatment, serum ALT and total serum bilirubin levels in children with SH decreased from (244.7±25.9)U/L and (167.5±22.3)μmol/L to (45.5±11.0)U/L and (31.2±5.8)μmol/L, respectively, and serum biochemical parameters returned to normal in children with MH; serum IL-18 and TNF-α levels in children with SH decreased from (74.8±27.9)pg/L and (41.0±10.2)pg/ml to (42.2±12.3)pg/L and (35.3±7.9)pg/ml(P<0.05), respectively, and they reduced from (56.4±17.4)pg/L and (39.4±6.9)pg/ml to (35.1±10.7)pg/L and (28.7±5.8)pg/ml(P<0.05) in those with MH; serum CMV DNA load returned to negative in (7.5±2.2)d in children with MH, much shorter than [(13.0±5.5)d, P<0.05] in those with SH; all patients but one (2.6%)who died of liver failure with complicated pneumonia with CMV-infected hepatitis recovered in our series. Conclusion Intravenous administration of ganciclovir and glutathione in the treatment of children with CMV-infected hepatitis is efficacious, and the pediatrics should take care of those with SH and deal with any complications in time.

Objective The aim of this study was to summarize clinical feature and prognosis of patients with acute hepatitis E(AHE). Methods Fifty-two patients with AHE were encountered in our hospital between January 2022 and December 2023, and were dealt with conventional liver-protecting measures. Patients with liver failure(LF) were carefully treated by artificial liver supporting system (ALSS) and human blood products. Results Of the 52 patients with AHE, typical AHE was found in 30 cases, and those with hyperbilirubinemia in 17 cases and LF in 5 cases; male percentage, concomitant fatty liver, alcoholic liver disease (ALD) and hospital stay in patients with hyperbilirubinemia were 82.3%, 47.1%, 58.8% and (27.0±6.5)d, all much higher or longer than [63.3%, 10.0%, 13.3% and (15.4±3.0)d, respectively, P<0.05] in those withs AHE; peak total serum bilirubin level (TSB) in patients with hyperbilirubinemia was (195.8±45.6)μmol/L, much higher than [(84.7±23.8)μmol/L, P<0.05] in those with AHE; TSB, albumin and prothrombin time international ratio in patients with LF were(345.2±66.8)μmol/L, (28.9±8.6)g/L and (2.6±0.9); all patients, but two (60.0%)with LF died, got a good prognosis in our series. Conclusion Patients with AHE tends to have hyperbilirubinemia, especially in those with fatty liver or ALD, which might lead to death and needs carefully managed clinically.

Objective The aim of this study was to investigate global disease burden and epidemic trends and non-alcoholic fatty liver disease (NAFLD) over the past three decades in the world. Methods Based on the global burden of disease (GBD) data in 2021,this study retrieve relevant data of NAFLD all over the world. The analysis was conducted by using annual percentage change (APC), estimated annual percentage change (EAPC) and percentage change to assess epidemic trends of NAFLD burden and employed a Joinpoint regression analysis model to quantitatively describe its significant points of change. Pearson correlation coefficient was applied to evaluate geographical disparities in the NAFLD disease burden. Results From 1990 to 2021, the prevalence of NAFLD worldwide increased significantly; the crude number of cases rose from 564.43 million to 1267.87 million, with an increase rate as high as 125%, and the EAPC was 1.4 (95% confidence interval: -1.33-4.2); the Joinpoint regression analysis showed that the NAFLD prevalence particularly significantly increased during the period from 2008 to 2015; the prevalence and incidence of NAFLD had an inverted U-shaped changes as the sociodemographic index (SDI) varied, e.g., with the increase of SDI, the prevalence and incidence of NAFLD showed a trend of rising first and falling thereafter; in terms of risk factors, the research indicated that metabolic factors, such as high fasting blood glucose was the main drivers of NAFLD, and in the past 30 years, the proportion of metabolic factors in the pathogenesis of NAFLD had significantly increased; furthermore, the incidences of liver cirrhosis, non-alcoholic steatohepatitis (NASH), and even primary liver cancer derived from NAFLD increased in most regions around the world. Conclusion Overall, over the past 30 years, the disease burden of NAFLD has significantly increased globally, and its epidemic characteristics show significant heterogeneity at different regions, countries, ages and genders, indicating the necessity of constructing a multi-dimensional and hierarchical precise prevention and control system. This study might provide a key epidemiological evidence for the precise management and intervention strategies of the entity.

Objective The purpose of this study was to investigate prediction of concomitant nonalcoholic fatty liver disease (NAFLD) in patients with type two diabetes mellitus (T2DM) by visceral fat area (VFA) and blood lipid. Methods 52 patients with T2DM and concomitant NAFLD and 48 patients with T2DM were encountered in our hospital between June 2021 and June 2023, VFA was detected by Japanese made special visceral fat detection apparatus, and blood lipid and waist-to-hip ratio (WHR) were routinely determined. Multivariate Logistic regression analysis was applied to find impacting factors for NAFLD coexistence, and area under receiver operating characteristic curve (AUC) was used to verify predicting performance. Results BMI, VFA, WHR, serum triglyceride (TG), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels in patients with T2DM/NAFLD group were(26.4±3.1)kg/m²,(114.8±21.8)cm², (1.0±0.1), (2.9±1.1)mmol/L, (6.6±1.0)mmol/L and (4.2±0.9)mmol/L, all significantly higher than [(23.6±3.6)kg/m², (88.2±19.5)cm², (0.9±0.1), (1.6±0.8)mmol/L, (4.7±0.9)mmol/L and (2.8±0.8)mmol/L, respectively, P＜0.05], while serum high-density lipoprotein cholesterol (HDL-C) level was (0.9±0.5)mmol/L, significantly lower than [(1.2±0.3)mmol/L, P＜0.05] in T2DM group; multivariate Logistic regression analysis showed that BMI, VFA, WHR and serum TG, TC and LDL-C levels were all the independent risk factors for co-existence of NAFLD in patients with T2DM, and serum HDL-C level was the protective factor; ROC analysis demonstrated that combination of VFA, WHR and blood lipid were much superior to any parameter did in predicting co-existence of NAFLD, with sensitivity of 94.2% and specificity of 77.1%. Conclusion Combination of VFA, WHR and blood lipids in predicting concomitant NAFLD in patients with T2DM is efficacious, which might help clinicians make appropriately measures for further intervention.

Objective The aim of this study was to investigate implication of serum retinol binding protein 4 (RBP-4), fibroblast growth factor 21 (FGF21) and nuclear factor kappa B (NF-κB) levels in patients with nonalcoholic fatty liver disease (NAFLD) and concomitant type 2 diabetes mellitus (T2DM). Methods 257 patients with NAFLD, of which NAFLD and T2DM concomitant in 132 cases, were enrolled in our hospital between July 2022 and July 2025, and all underwent Fibrotouch for liver stiffness measurement (LSM). Serum RBP-4, FGF21 and NF-κB levels were assayed by ELISA. Multivariate Logistic regression analysis was applied to find risk factors for liver fibrosis, and receiver operating characteristic (ROC) curve was drawn for evaluating diagnostic efficacy. Results Serum RBP-4, FGF21 and NF-κB levels in patients with NAFLD and T2DM were (15.3±2.7)ng/mL, (314.3±33.6)pg/mL and (4.1±0.5)pg/mL, all significantly higher than [(11.5±1.7)ng/mL, (277.8±31.8)pg/mL and (2.7±0.6)pg/mL, respectively P<0.05] in those with NAFLD; serum total cholesterol, RBP-4, FGF21 and NF-κB levels in 39 patients with moderate/severe liver fibrosis based on LSM were (6.2±1.4)mmol/L, (17.7±2.0)ng/mL, (326.9±35.3)pg/mL and (4.2±0.5)pg/mL, all significantly higher than [(5.7±1.3)mmol/L, (14.3±2.3)ng/mL, (309.0±31.6)pg/mL and (3.8±0.5)pg/mL, respectively, P<0.05] in 93 patients with mild liver fibrosis; multivariate Logistic regression analysis showed that elevated serum RBP-4(OR=1.368), FGF21(OR=1.252) and NF-κB (OR=2.563) levels were all the independent risk factors for liver fibrosis in patients with NAFLD and T2DM (P<0.05); ROC analysis demonstrated that the AUC was 0.910, with sensitivity of 97.4% and specificity of 72.0%, when serum RBP-4 level was combined with serum FGF21 and NF-κB levels in predicting moderate/severe liver fibrosis in patients with NAFLD and T2DM. Conclusion In patients with NAFLD and concomitant T2DM, increased serum RBP-4, FGF21 and NF-κB levels hint moderate-to-severe liver fibrosis existence, which might help clinicians screening liver fibrosis as early as possible.

Objective The aim of this study was to investigate serum visfatin, body composition and urinary albumin to creatinine ratio (ACR) changes in patients with type 2 diabetes mellitus (T2DM) and concomitant nonalcoholic fatty liver disease (NAFLD) and their relationship with the occurrence of macrovascular complications. Methods 237 patients with T2DM, of which including T2DM with concomitant NAFLD in 122 cases, were enrolled in our hospital between January 2022 and January 2025. Serum visfatin level was assayed by ELISA. Abdominal fat, visceral fat and visceral fat area were detected and calculated by body composition analyzer. Microalbuminuria and creatinine levels were routinely determined and ACR was calculated. Binary Logistic regression model was applied to analyze the risk factors of macrovascular disorders in patients with T2DM and NAFLD. Results Blood pressure, body mass index (BMI)and waist circumference (WC) in patients with T2DM and NAFLD were much greater or higher than in patients T2DM(P<0.05); serum visfatin, abdominal fat, visceral fat, visceral fat area and ACR in patients with T2DM and NAFLD were(35.8±8.6)ng/mL, (8.9±2.3)kg, (2.9±0.8)kg, (91.8±20.6)cm² and (29.6±6.8)mg/g, all significantly higher than [(20.7±5.4)ng/mL, (7.1±1.4)kg, (2.2±0.7)kg, (64.5±12.4)cm² and (21.2±5.1)mg/g, respectively, P<0.05] in patients with T2DM; of 122 patients with T2DM and NAFLD, macrovascular disorders was found in 31 cases (25.4%); BMI, WC, serum visfatin, abdominal fat and ACR in patients with macrovascular disorders were all significnalty higher than in those without(P<0.05); binary Logistic regression analysis showed that BMI(OR=3.108), serum visfatin (OR=4.187) and ACR (OR=4.362) were all the independent risk factors for occurrence of macrovascular disorders in patients with T2DM and NAFLD (P＜0.05). Conclusion Condition of patients with T2DM and NAFLD could be complicated by macrovascular disorders, and surveillance of serum visfatin, body composition and ACR might provide a hint for it.

Objective The aim of this study was to analyze the diagnostic performance of liver quantitative parameters, proton density fat fraction (PDFF) obtained by magnetic resonance imaging (MRI) water-lipid separation in predicting liver steatosis in patients with non-alcoholic fatty liver disease (NAFLD). Methods A total of 106 patients with NAFLD and 30 healthy individuals were enrolled in our hospital between May 2022 and May 2025, all underwent MRI fat analysis calculation technique (FACT) to detect PDFF of the liver, and all patients with NAFLD received liver biopsy. The diagnostic efficacy of PDFF was evaluated by receiver operating characteristic (ROC) curves. Results Liver histo-pathological examination found mild liver steatosis in 56 cases, moderate in 33 cases and severe in 17 cases; PDFF in patients with NAFLD was (19.1±2.0)%, much higher than [(6.8±0.7)%, P<0.05] in healthy control; serum triglyceride, total cholesterol, low-density lipoprotein cholesterol levels and PDFF in patients with severe liver steatosis were (5.1±0.6)mmol/L, (6.6±0.8)mmol/L, (3.7±0.5)mmol/L and (24.3±2.6)%, all significantly higher than [(2.1±0.3)mmol/L, (5.5±0.6)mmol/L, (3.1±0.4)mmol/L and (17.0±1.8)%, respectively, P<0.05] in patients with mild or [(4.0±0.4)mmol/L, (6.2±0.7)mmol/L, (3.4±0.4)mmol/L and (20.1±2.1)%, respectively P<0.05] in those with moderate liver steatosis, while serum high-density lipoprotein cholesterol level was (0.8±0.1)mmol/L, significantly lower than [(1.3±0.2)mmol/L, P<0.05] in mild or [(1.0±0.1)mmol/L, P<0.05] in those with moderate liver steatosis; ROC analysis showed that the AUC was 0.865, with Youden index of 0.568, sensitivity of 80.0% and specificity of 76.8%, when PDFF, with cut-off-value of 18.8%, was applied to predict moderate/severe liver steatosis in patients with NAFLD. Conclusion PDFF arose from MRI FACT has a certain diagnostic efficacy for assessing moderate to severe liver steatosis in NAFLD patients.

Objective The aim of this study was to investigate the clinical efficacy of Wuling capsule, a herbal compound, in the treatment of patients with metabolic associated steatohepatitis (MASH). Methods 117 patients with MASH were enrolled in our hospital between January 2018 and December 2023, and were randomly assigned to receive oral polyene phosphatidylcholine capsule in 58 cases in control or receive Wuling capsule and polyene phosphatidylcholine capsule combination in another 59 cases in observation for six months. All patients were carefully supervised with food intake and exercise, and hypolipidemic therapy when necessary. Serum hyaluronic acid (HA), laminin (LN), type Ⅲ procollagen N-terminal peptide (PCⅢ) and type Ⅳ collage (IV-C), and serum interleukin-1β(IL-1β), IL-6, IL-18, IL-37 and tumor necrosis factor-α(TNF-α) levels were detected by ELISA. Results By the end of 6 month treatment, serum alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase levels in the observation group were(39.7±7.2)U/L, (36.3±8.6)U/L and (63.6±5.8)U/L, all significantly lower than [(60.5±8.9)U/L, (56.7±9.2)U/L and (72.5±9.2)U/L, respectively, P<0.05] in the control; serum HA, PCⅢ and Ⅳ-C levels were (166.3±30.8)μg/L, (106.1±34.2)μg/L and (108.2±18.4)μg/L, all much lower than [(189.6±36.3)μg/L, (147.4±36.4)μg/L and (126.5±20.7)μg/L, respectively, P<0.05] in the control; serum IL-1β, IL-6, IL-18 and TNF-α levels were (11.8±2.4)pg/ml, (18.2±3.1)mg/L, (139.2±34.7)pg/ml and (3.6±1.1)ng/L, all much lower than [(16.4±2.7)pg/ml, (27.4±3.3)mg/L, (206.5±52.3)pg/ml and (6.3±1.2)ng/L, respectively, P<0.05] in the control group. Conclusion Wuling capsule has exact efficacy in the treatment of patients with MASH, which effectively improve liver function tests, and relieve liver fibrosis and cytokine reactions.

Objective This paper aimed to summarize gait feature and balance function changes in patients with Wilson disease (WD) and complicated by freezing of gait (FOG). Methods 95 patients with Wilson’s disease, including 14 patients with FOG, were encountered in our hospital between January 2018 and January 2024, the Unified Wilson’s Disease Rating Scale Part Ι was applied to evaluate nervous system functions, and U-shaped electronic walkway was used to assess gait and balance functions. Results Percentages of speech disturbances, tremor, drooling and clumsiness or bradykinesia in patients with FOG were 85.7%, 71.4%, 78.6% and 71.4%, with UWDRS-Ι score of (57.7±3.6), much higher than [(20.3±3.6), P<0.05] in patients with Wilson disease without FOG; reduced left and right step length, stride length and step width were found in patients with FOG(P<0.05), and step frequency, gait cycle and double support time also decreased(P<0.05); the FOG group exhibited significantly greater center of pressure (COP) parameters, e.g., sway velocity, angular sway velocity, medial-lateral angular sway velocity, anterior-posterior angular sway velocity and open-eye/closed-eye sway velocity ratio, while presented a smaller envelope area (P<0.05). Conclusion The abnormal gait and balance impairment in patients with WD and FOG is not uncommon, and the pathogenesis needs further investigation.

Objective The aim of this study was to investigate Chinese Group for the Study of Severe Hepatitis B-acute-on-chronic liver failureⅡ(COSSH-ACLF II) score in combination with liver-to-spleen volume ratio (LSR) in predicting prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods 93 patients with HBV-ACLF were enrolled in our hospital between February 2022 and February 2025, and all were carefully managed with routine comprehensive medical treatment. The patients were followed-up for 90 days and the survival was recorded. The baseline data of patients at admission were collected, including blood, biochemical and coagulation function routine, and upper abdominal CT examination for LSR calculation. Multivariate Logistic regression analysis was used to analyze the related risk factors affecting the prognosis of patients with HBV-ACLF, and receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated to analyze the efficacy of COSSH-ACLF II score and LSR in predicting prognosis of patients with HBV-ACLF. Results 45 patients (48.4%) in our series died of liver failure and 48 patients survived, with 90 d survival rate of 51.6%; COSSH-ACLFⅡ score in dead group was (8.2±0.7) points, significantly greater than (6.8±0.9) points in survival group (P<0.05), and LSR was (1.5±0.9), significantly lower than (3.0±1.2) in survival group (P<0.05); the age, total serum bilirubin, international normalized ratio, model for end-stage liver disease score in dead group were significantly older or higher than those in survival group (P<0.05); multivariate Logistic regression analysis revealed that COSSH-ACLFⅡ score (OR=3.200, 95% CI: 1.458-7.021) was an independent risk factor affecting the prognosis of patients with HBV-ACLF, while the LSR (OR=0.119, 95% CI: 0.027-0.520) was a protective factor (P<0.05); ROC analysis showed that the AUC of COSSH-ACLFⅡ score in combination with LSR was 0.940, with a sensitivity of 86.7% and a specificity of 77.1%, much superior to any parameter did alone (P<0.05). Conclusion Application of COSSH-ACLF II score and LSR is efficacious in predicting prognosis of patients with HBV-ACLF, which warrants further clinical investigation.

Objective The aim of this study was to investigate prevalence and impacting factors of abnormal glucose metabolism in patients with chronic hepatitis B (CHB) and hepatitis B-induced liver cirrhosis (LC). Methods 329 patients with CHB and 258 patients with hepatitis B-induced LC were encountered in our hospital between October 2021 and October 2024, and clinical materials were collected routinely. Binary Logistic regression analysis was adopted to analyze the factors impacting abnormal glucose metabolism in patients with CHB and LC. Results Prevalence of abnormal glucose metabolism in our series was 54.2%, with impaired fasting glucose (IFG) of 3.7%, impaired glucose tolerance (IGT) of 23.2% and diabetes mellitus (DM) of 27.3%; incidence of IFG and IGT in patients with LC were 5.0% and 23.6%, both not significantly different as compared to 2.7% and 22.8% in those with CHB (P>0.05), while incidence of DM was 35.7%, much higher than 20.7%(P<0.05) in patients with CHB; ages, body mass index (BMI), percentages of alcohol abuse, concomitant blood hypertension, hyperlipidemia and LC in 318 patients with abnormal glucose metabolism were(51.2±13.6)yr, (25.8±3.4)kg/m², 40.3%, 25.8%, 21.4% and 64.3%, all significantly greater or higher than [(40.3±9.3)yr, (23.6±3.1)kg/m², 28.3%, 14.9%, 9.7% and 34.2, respectively, P<0.05] in 269 patients with normal glucose metabolism; binary Logistic regression analysis showed that age, alcohol abuse, blood hypertension, hyperlipidemia and LC were all the risk factors impacting glucose metabolism in patients with CHB and LC (P<0.05). Conclusion The incidence of abnormal glucose metabolism in patients with CHB and LC is high, and patients with old age, alcohol abuse, concomitant hypertension, hyperlipidemia and LC are susceptible, which should be carefully screened and managed.

Objective This study aimed to retrospectively evaluate the efficacy and safety of balloon-occluded retrograde transvenous obliteration (BRTO) in patients with hepatitis B-induced liver cirrhosis (LC) complicated by gastric varices (GV). Methods A total of 101 patients with hepatitis B-induced LC and complicated GV were encountered in our hospital between January 2022 and June 2024, and were randomly divided into two groups, underwent BRTO in observation group (n=51) or transjugular intrahepatic portosystemic shunt (TIPS) in control group (n=50). All patients were followed-up for one year after operation. Results By end of three-month of follow-up, eradication rate of GV in the observation group was 84.3% and second BRTO eradicated all GV, while GV disappeared in 5 cases (10.0%, P<0.05) in the control; by end of six-month of follow-up, two patients in the observation and four patients in the control died; by end of one-year of follow-up, three cases in BRTO-treated patients and five cases in TIPS-treated died; after operations, the liver function tests and hypersplenism didn’t improved and the related parameter were not significantly different between the two groups(P>0.05). Conclusion BRTO demonstrates safe and a favorable GV eradication rate in the treatment of patients with hepatitis B-induced LC, which might needs sophisticated procedural skills, and the long-term efficacy on prophylactic GV bleeding is still observed.

Objective The purpose of this study was to investigate risk factors impacting re-bleeding in patients with esophageal and gastric varices bleeding (EGVB) after endoscopic variceal ligation (EVL)treatment. Methods A total of 196 patients with EGVB were admitted to Changsha Central Hospital Affiliated to University of South China between January 2021 and January 2024, and 146 cases were assigned to training set and another 50 cases were assigned to validation set. All patients received EVL, some of them were treated with polidocanol injection in combination, and followed-up for 14 days. Multivariate Logistic regression analysis was applied to find risk factors, and receiver operating characteristic curve (ROC) was drawn to evaluate prediction efficacy. Results Re-bleeding was found in 55 patients (28.1%), of which, 40 cases (27.4%) in training set and 15 cases (30.0%, P>0.05) in validation set, out of our 196 patients with EGVB after treatment; in re-bleeding group, the diameter of esophageal varices (EV) was(1.0±0.2)cm, the number of ligation rings was (12.2±3.8) and the number of ligation times was (2.4±1.2), all significantly greater than [(0.7±0.1)cm, (10.4±3.1) and (2.4±1.2), respectively, P＜0.05] in non-re-bleeding group; multivariate Logistic regression analysis showed that diameter of EV, ligation rings and ligation times were all the independent risk factors for re-bleeding(P＜0.05); the ROC analysis demonstrated that the area under the curve (AUC) was 0.830(95%CI:0.767-0.881), with sensitivity (Se) of 84.2% and specificity (Sp) of 71.3% when the model we established was used to predict in the training set, and the AUC was 0.823(95%CI:0.761-0.875), with Se of 87.8% and Sp of 74.5% in validation set. Conclusion Clinicians should take risk factors for re-bleeding into consideration in clinical practice, and take an appropriate measures to deal with it for improving efficacy of hemostasis.

Objective The aim of this study was to investigate application of T1 relaxation time of liver magnetic resonance imaging (MRI) in detecting portal hypertension (PH) in patients with hepatitis B-induced liver cirrhosis (LC). Methods A total of 115 patients with hepatitis B-induced LC were admitted to our hospital between January 2019 and December 2024, all patients underwent MRI scan for detection of T1 relaxation time, and transjugular puncture for measurement and calculation of hepatic venous pressure gradient (HVPG). Multivariate Logistic regression analysis was conducted to identify influencing factors of portal hypertension in patients with hepatitis B cirrhosis and the receiver operating characteristic (ROC) curve was drawn to analyze predicting efficacy of PH by T1 relaxation time. Results Of the 115 patients with LC, PH was found in 74 cases (64.4%); Child-Pugh score, prothrombin time (PT), liver stiffness measurement (LSM), enhanced liver fibrosis (ELF) score and MRI T1 relaxation time of liver in patients with PH were (10.7±2.7), (13.1±2.3)s, (18.0±3.2)kPa, (15.8±1.8) and (880.3±96.7)ms, all significantly greater or higher than [(7.5±1.9), (11.6±1.8)s, (14.8±1.1)kPa, (12.7±1.4) and (779.4±80.3)ms, respectively, P＜0.05] in cirrhotics without PH; multivariate Logistic regression analysis showed that PT, LSM, ELF and T1 relaxation time were all the independent impacting factors for PH in patients with LC(P＜0.05); ROC analysis demonstrated that the AUC was 0.788(95%CI:0.702-0.858), with sensitivity and specificity of 67.6% and 85.4%(Z=6.848, P＜0.001), when MRI T1 relaxation time equal to 860.0 ms was set as the cut-off-value in predicting PH in patients with LC. Conclusion Measurement of MRI T1 relaxation time of liver might help clinicians predict PH in patients with LC, which warrants further clinical investigation.

Objective The purpose of this study was to investigate prevalence of and risk factors for overt hepatic encephalopathy (OHE) in patients with liver cirrhosis (LC) with portal hypertension (PH) after transjugular intrahepatic portosystemic shunt (TIPS) placement. Methods A total of 118 patients with hepatitis B-induced LC and PH were encountered in our hospital between October 2023 and June 2025, and all underwent TIPS placement routinely. Multivariate Logistic regression analysis was applied to find risk factors for occurrence of OHE. Results The prevalence of OHE was 22.9% after TIPS in our series;percentages of HE history, Child-Pugh class C and sarcopenia in patients with OHE were 25.9%, 81.5% and 66.7%, all significantly higher than 8.8%, 22.0% and 16.5%, and MELD score, INR, blood ammonia and diameter of stents were 16(12,19)points, (1.3±0.2), (78.5±22.6)μmol/L and (10.4±1.2)mm,all significantly higher or greater than [12(10,15)points,(1.2±0.2), (32.9±9.4)μmol/L and (8.9±1.1)mm,P<0.05] in those without OHE, Δportal pressure gradient (ΔPPG) was(10.3±3.6)mmHg, much greater than [(7.5±3.2)mmHg, P<0.05] in those without OHE; multivariate Logistic regression analysis showed that HE history (OR=3.25,P=0.041), Child-Pugh clas C(OR=2.62,P=0.033), MELD score (OR=1.12,P=0.018), serum albumin level (OR=0.92,P=0.031), blood ammonia level (OR=1.28,P=0.004), concomitant sarcopenia (OR=2.15,P=0.048), stent diameter (OR=2.80,P=0.023) and ΔPPG(OR=3.10,P=0.009) were all the independent risk factors for OHE occurrence. Conclusion The occurrence of OHE after TIPS in patients with HBV-induced LC is very common, and appropriate prevention and management might improve patients’quality of life.

Objective The purpose of this pilot study was investigate transit oral avatrombopag therapy as a bridge to partial splenic artery embolization (PSAE) in treatment of patients with liver cirrhosis (LC) and hypersplenism with thrombocytopenia. Methods A total of 116 patients with hepatitis B-induced LC with splenomegaly and thrombocytopenia were encountered in our hospital between January 2022 and January 2024, and were randomly assigned to receive conventional supporting treatment in 58 cases as control, or receive oral avatrombopag therapy for 5 days, then the PSAE was performed in another 58 cases in observation group. Results At presentation, peripheral blood platelet, white blood cell and red blood cell counts in the observation were (46.5±7.6)×10⁹/L, (3.8±0.7)×10⁹/L and (3.2±0.7×10¹²/L), all not significantly different as compared to [(46.9±8.1)×10⁹/L, (3.6±0.6)×10⁹/L and (3.0±0.4)×10¹²/L, P>0.05] in the control, while five days after treatment, the platelet count was (127.8±20.9)×10⁹/L, significantly higher than [(47.1±8.6)×10⁹/L, P<0.05] in the control; the PSAE was successfully completed in the 58 patients in the observation group after platelet counts elevated; three months after PSAE, peripheral blood platelet and white blood cell counts returned to normal, and serum albumin level was(35.0±3.8)g/L, much higher than [(32.0±4.4)g/L, P<0.05] at admission in the observation group; a few patients had gastrointestinal symptoms, dizziness, fatigue and rash during taking avatrombopag and disappeared by discontinuation. Conclusion Transit oral avatrombopag could elevate platelet counts rapidly, which might guarantee interventional operation going smoothly.

Objective The aim of this study was to observe clinical efficacy of human serum albumin in combination with lactulose and ornithine aspartate in treatment of patients with liver cirrhosis (LC) and hepatic encephalopathy (HE). Methods 58 cirrhotics with complicated HE were enrolled in our hospital between January 2022 and April 2025, and were randomly assigned to receive intravenous human albumin 5 g daily in 28 patients in control, or receive intravenous human albumin 10 g daily in 30 patients in observation. All patients were carefully managed by internal treatment for two weeks. Serum interleukin(IL)-6, IL-8 and C-reactive protein (CRP) levels were detected by ELISA, and HE was evaluated by West Haven scoring system. Results By end of two week observation, three patients (10.7%)died in the control, and one died (3.3%, P>0.05)in the observation groups; total serum bilirubin level in 29 survivals in the observation was (38.2±10.6)μmol/L, much lower than [(50.1±12.7)μmol/L, P>0.05],while serum albumin level was (35.1±2.5)g/L, much higher than [(33.5±2.1)g/L, P＜0.05)] in 25 survivals in the control; serumIL-6, IL-8 and CRP levels were (21.2±5.9)pg/mL, (31.4±8.7)pg/mL and(11.5±3.2)mg/L, all significantly lower than [(29.4±6.2)pg/mL, (40.5±10.9)pg/mL and (46.2±4.5)mg/L, respectively, P＜0.05] in the control; proportion of West Haven grade 0 in the observation group was 51.7%, much higher than 28.0%(P＜0.05) in the control group. Conclusion Human serum albumin infusion in dealing with LC patients with HE could improve regaining consciousness, which might be related to increased plasma colloid osmotic pressure and relatively quick liver functioning.

Objective The aim of this study was to summarize clinical feature and prognosis of patients primary biliary cirrhosis (PBC) complicated with esophagogastric variceal bleeding (EVB). Methods A retrospective analysis was conducted on 106 patients with PBC and EVB, including first EVB in 33 cases and re-bleeding in 73 cases, who were admitted to our hospital between April, 2021, and December, 2023. The clinical features, laboratory indicators, complications and prognosis were analyzed. Results The ICU admission rate in the first bleeding group was significantly higher than that in re-bleeding group (12.1% vs. 0.0%, P=0.002), and the incidence of portal vein thrombosis was significantly lower than in re-bleeding group (12.1% vs. 32.9%, P=0.025); no significant differences were observed between the two groups as respect to 6-week mortality (9.1% vs. 8.2%, P =0.881), 6-week re-bleeding rate (12.1% vs. 17.8%, P=0.460), and 1-year mortality (16.2% vs. 17.2%, P=0.897). Conclusion PBC patients with decompensated liver functions might complicate EVB, and re-bleeding is very common, which should be carefully intervened with hemostasis, and even endoscopic therapy.

Objective The aim of this study was to investigate prediction of liver cirrhosis (LC) by shear wave elastography (SWE) and liver fibrosis index in patients with hepatolenticular degeneration (HLD). Methods 52 patients with HLD were encountered in our hospital between December 2022 and December 2024, and all underwent liver biopsies and SWE for Young’s modulus. Aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 index (Fib-4) were calculated. Serum hyaluronic acid (HA), laminin (LN), type III procollagen amino-terminal peptide (PIIINP) and type IV collagen (IV-C) levels were analyzed. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive efficacy. Results APRI and FIB-4 scores in 9 patients with LC were (1.1±0.4) and (2.1±0.3), both significantly greater than [(0.5±0.2) and (1.2±0.2), respectively, P<0.05] in 43 patients with HLD; serum HA level was (313.4±54.7)ng/mL, and Young’s modulus was (14.2±2.1)kPa, both much higher or greater than [(142.2±25.4)ng/mL and (7.9±0.9)kPa, respectively, P<0.05] in those with HLD; ROC analysis showed that the AUC was 0.983(95%CI:0.955-1.000), with sensitivity of 97.4% and specificity of 98.1%, when combination of Young’s modulus with APRI or FIB-4 score and serum HA level in predicting LC in patients with HLD. Conclusion Shear wave elastography with combination of serum fibrosis markers or fibrosis index really have an excellent predictive performance in assessing LC in patients with HLD.

Objective The purpose of this study was to summarize the clinical feature of patients with acute portal vein thrombosis (PVT). Methods 15 patients with acute PVT were admitted to The First Affiliated Hospital, Soochow University between January 2020 and April 2022, the etiology, clinical feature, treatments strategy and outcomes were summarized. Results Of the 15 patients with acute PVT, there were 13 males and 2 females, with an average age of (52.5±15.6) years; the etiology included hepatitis B-induced liver cirrhosis (LC) in 5 cases, alcoholic LC in 1 case, primary biliary cholangitis in 1 case, schistosomiasis-induced cirrhosis in 1 case and cryptogenic Cirrhosis in 2 cases, and non-cirrhotics, including non-cirrhotic portal hypertension in 1 case, hereditary protein C deficiency in 1 case and cryptogenic diseases in 3 cases; anticoagulation treatment was initiated in 14 cases, of which 2 patients received interventional thrombolysis and 1 patient received anticoagulation medicine treatment; 2 patients died of septic shock derived from intestinal ischemic necrosis, 1 patient died of hemorrhagic shock derived from esophageal variceal bleeding, PVT didn’t change in 1 case, thrombolysis and vascular recanalization occurred in 2 cases, and thrombosis shrunk in the remaining patients. Conclusion The etiology vary in patients with acute PVT, without specific clinical manifestations, and early diagnosis and intervention might improve the outcomes.

Objective The aim of this study was to investigate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) for assessing tumor viability (TV) following transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Methods 89 patients with HCC were encountered in our hospital between January 2019 and February 2025, and all underwent TACE treatment. Patients received DCE-MRI for volume transfer constant (K^trans), rate constant (K_ep) and extracellular extravascular volume fraction (V_e), and DWI for apparent diffusion coefficient (ADC) measurements. TV was evaluated bydigital subtraction angiography (DSA) after TACE. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic performance. Results DSA after TACE found 96 active tumor regions, 95 adjacent liver regions and 81 necrotic tumor regions in our series; K^trans and K_ep in active tumor regions were (1.1±0.3)min^-1 and (3.0±1.3)min^-1, both significantly higher than [(0.6±0.2)min^-1 and (1.4±0.4)min^-1, respectively, P<0.05] in adjacent liver regions or [(0.3±0.2)min^-1 and (1.0±0.6)min^-1, respectively, P<0.05] in necrotic tumor regions, while the ADC was (0.9±0.3)×10^-3mm/s², significantly lower than [(1.5±0.5)×10^-3mm/s², P<0.05] in adjacent liver regions or [(1.8±0.6)×10^-3mm/s², P<0.05] in necrotic tumor regions; ROC analysis showed that the AUC was 0.973, with sensitivity of 96.0% and specificity of 96.4%, when K^trans and K_ep were combined with ADC in judging TV after TACE treatment in patients with HCC. Conclusion DCE-MRI quantitative parameters and ADC could effectively assess TV after TACE in patients with HCC, which might help clinicians make further anti-tumor plans.

Objective The aim of this study was to explore the clinical application of spectral CT virtual non-contrast (VNC) in evaluating postoperative efficacy of transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Methods A total of 107 patients with HCC were encountered in our hospital between January 2023 and May 2025, and all underwent TACE treatment. All patients underwent spectral CT scans before and after treatment to obtain true non-contrast (TNC) of lesions and VNC images at arterial phase, portal vein phase, and delayed phase by through post-processing. CT values of lesion by TNC and VNC at three-phases were recorded and compared. Serum alpha-fetoprotein (AFP) levels were detected by full-automatic chemiluminescence immunoanalyzer. Results By end of three-month treatment, Objective remission (OR) judged by mRECIST was found in 62 cases (57.9%)and stable disease or disease progression in 45 cases (42.1%) in our series; after treatment, the TNC, VNC CT value of lesions at arterial phase, portal vein phase, and delayed phase in patients with OR were(32.5±3.0)HU, (35.0±2.5)HU, (34.1±1.9)HU and (33.5±2.0)HU, all significantly lower than [(37.2±4.3)HU, (82.4±7.1)HU, (80.6±9.7)HU and (70.3±9.2)HU, respectively, P＜0.05] in those with non-OR; at presentation, serum AFP levels in the two groups were (749.2±53.1)ng/mL and (747.6±48.5)ng/mL(P>0.05), while after treatment, serum AFP level in OR group was (87.4±8.3)ng/mL, much lower than [(453.2±39.4)ng/mL,P<0.05] in non-OR group. Conclusion VNC could be an alternative tool for TNC to satisfactorily evaluate the curative efficacy of TACE in HCC patients, which might effectively reduce radiation doses, with a good clinical application.

Objective The aim of this study was to explore impact of cancerous Kita-Kyushu lung cancer antigen-1 (KK-LC-1) expression on prognosis of patients with hepatocellular carcinoma (HCC) undergoing target and immunotherapy after hepatectomy. Methods Retrospective analysis of clinical data of 200 patients with HCC was conducted in Second Affiliated Hospital, Xi'an Medical College between November 2019 and January 2022, all patients underwent hepatectomy immediately with oral apatinib and intravenous carilizumab treatment and followed-up for three and half years. Multivariate Logistic regression analysis was applied to identify independent factors affecting patient prognosis and ROC was used to predict efficacy. Results By end of three and a half years of follow-up, 160 patients survived and 40 (20.0%)died, with survival period of 5 to 42 months (mean:37.6±10.1 m); percentages of patients with tumor diameter of greater than 5 cm and with low cancerous KK-LC-1 expression in dead group were 65.0% and 77.5%, both significantly higher than 39.4% and 13.8%(P＜0.05), and serum AFP level was (402.4±41.7)μg/L, significantly higher than [(350.4±34.4) μg/L, P＜0.01] in survival group; multivariate Logistics regression analysis showed that large tumor diameter and high serum AFP levels were independent risk factors for poor prognosis of patients with HCC, while strong cancerous KK-LC-1 expression was the protecting factor for patients with HCC (P＜0.05); the AUCs were 0.628(95%CI=0.557-0.695), 0.829(95%CI=0.769-0.878) and 0.819(95%CI=0.758-0.870), when tumor diameter, serum AFP level and cancerous KK-LC-1 expression were applied to predict prognosis of patients with HCC in this setting. Conclusion Strong cancerous KK-LC-1 expression might benefit patients with HCC receiving target and immunotherapy, and mechanism needs further investigation.

Objective The aim of this study was to investigate the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) time-intensity curve (TIC) parameters and liver imaging reporting and data system (LI-RADS) classification in differentiating diagnosis of liver space-occupying lesions (SOL). Methods 82 patients with liver SOL were encountered in our hospital between January 2020 and December 2024, and the diagnosis was proven by liver histo-pathological examination. All patients underwent CEUS to record TIC parameters, including peak intensity, time to peak, rise time, mean transit time and blood flow perfusion index. Intrahepatic lesions were classified according to LI-RADS criteria, with LR-4a as the cut-off value, e.g., LR-1 to LR-4a were classified as benign, and LR-4b to LR-5 were defined as malignant lesions. Results Of the 82 patients with liver SOL, liver histo-pathological examination found malignant lesions in 43 cases (52.4%), and benign ones in 39 cases (47.6%); peak intensity and mean transit time in malignant lesions were(126.2±15.7)% and (126.8±26.0)s, both significantly lower or faster than [(140.5±18.4)% and (246.6±42.6)s, respectively, P<0.05], while time to peak, rise time and blood flow perfusion index were (21.4±3.9)s, (34.4±6.3)s and (85.2±14.6), all much slower or greater than [(17.3±3.2)s, (30.3±5.6)s and (50.4±7.8), respectively, P<0.05] in benign lesions; false negative false positive rates by LI-RADS diagnosis was 13.9% and 10.2%; the sensitivity and specificity by CEUS quantitative parameters were 95.3%(41/43) and 84.6%(33/39), and they were 86.0%(37/43)and 89.7%(35/39) by LI-RADS. Conclusion Both the quantitative parameters of CEUS TIC and the LI-RADS classification demonstrate satisfactory diagnostic performance in distinguishing benign from malignant liver SOL, which warrants further clinical investigation.

Objective The aim of this study was to investigate differential diagnosis of dysplastic nodule (DN) and small hepatocellular carcinoma (sHCC) under background of liver cirrhosis (LC) by enhanced magnetic resonance imaging (MRI). Methods A total of 104 patients with LC and intrahepatic nodular lesions were encountered in our hospital between July 2022 and July 2025, and all underwent Gd-EOB-DTPA enhancement of 3.0 T MR. The diagnosis was proven by histo-pathological examination. Results The histo-pathological examination diagnosed DN with dimeter of (0.9±0.2)cm in 46 cases and sHCC with diameter of (1.1±0.2)cm in 58 cases in our series; DN lesions presented with high or equal signals on T1WI mostly, and with low signals on T2WI and DWI mostly, while sHCC lesions showed with low or equal signals on T1WI mostly, and with high signals on T2WI and DWI mostly; sHCC lesions demonstrated with enhancement at arterial phase, clearance at portal vein phase, low signals at hepatobiliary phase and "fast-in and fast-out" mode, and their relative apparent diffusion coefficient (ADC)was much lower than ADC lesions; the differential diagnosis by MRI was excellent with sensitivity of 89.7%, the specificity of 91.3% and the accuracy of 90.4%, and the Kappa was 0.81 as compared to histo-pathological diagnosis. Conclusion MRI by Gd-EOB-DTPA enhancement could provide differential diagnosis of DN and sHCC, and the signal intensity and enhancement mode between the two lesions were mostly different.

Objective The aim of this study was to summarize clinical feature and antibiotic application in a series of patients with bacterial liver abscess (BLA). Methods A total of consecutive 90 patients with BLA were encountered in our hospital between May 2020 and May 2025, and all underwent puncture drainage and intravenous antibiotic administration. Bacteria separation, characterization and drug sensitivity tests were routinely performed. Results Male to female ratio in our series was 2.1:1, with mean age range of 60.5±7.4 yr; underlying diabetes accounted for 45.5%, cholelithiasis for 35.6%, hypertension for 32.2%, malignant tumors for 5.6%; white blood cell count was (12.0±1.3)×10⁹/L, serum C-reactive protein level was (69.4±5.1)mg/L, serum procalcitonin level was (2.4±0.2)ng/mL, and serum albumin level was(31.5±9.6)g/L; single abscess accounted for 74.4% and multiple for 25.6%; abscess at right lobe accounted for 77.8%, at left for 11.1% and both for 11.1%; diameter of abscess was (6.8±1.1)cm; prevalence of positive bacteria was 80.0%, with 78 strains of pathogens characterized, of which, Klebsiella pneumoniae positive in 74 cases; 100.0% sensitivity to 9 antibiotics, including cefoperazone/sulbactam; initial empirical treatment with β-lactam/enzyme inhibitor accounted for 32.2% and antimicrobial therapy switched to sensitive medicines based on drug sensitivity tests; after 13 to 25 (17.8±2.5)d treatment, the recovery rate was 94.4%, effective rate was 4.4% and one patient (1.1%)died of multiple organ failure. Conclusion The incidence of BLA is higher in middle-aged and elderly males, and most of them have underlying chronic disease. The common pathogen is Klebsiella pneumoniae, and the outcomes is satisfactory in most cases with appropriate management.

Objective The aim of this study was to observe analgesic efficacy of ultrasound (US)-guided costotransverse block in patients with cholelithiasis undergoing laparoscopic cholecystectomy (LC). Methods A total of 126 patients with gallbladder stones were encountered in our hospital between January 2024 and June 2025, and all underwent LC with general anesthesia. For post-operational analgesia, the patients were randomly assigned to receive paravertebral block (n=62) in control, or receive US-guided costotransverse block (n=62) in observation. Visual analogue scale (VAS) scores in resting and motion states were recorded. Results The extubation time, PACU stay, and recovery time after anesthesia in the observation group were(12.4±1.6)min, (35.7±4.2)min and (10.1±1.9)min, all much shorter than [(15.3±1.7)min, (41.8±6.4)min and (13.6±2.1)min, respectively, P<0.05], and total dosage of intraoperative sufentanil administration and 24-hour total dosage of postoperative opioids were(18.7±2.4)μg and (24.7±3.6)mg, both significantly less than [(25.7±3.5)μg and (38.3±4.2)mg, respectively, P<0.05] in the control group; by 8 hour and 24 hour after operation, resting VAS scores in the observation group were (2.2±0.3) and (2.8±0.2), both much lower than [(2.9±0.3) and (4.1±0.5), P<0.05], and motion VAS scores were (3.8±0.5) and (4.5±0.6), both much lower than [(4.8±0.5) and (5.4±0.6), P<0.05] in the control group; by T1 and T4, heart beats and average blood pressure were much slower or lower than in the control group (P＜0.05). Conclusion US-guided costotransverse block in patients after LC exhibits a satisfactory analgesic efficacy, with minimal impact on cardiovascular hemodynamics.

Objective The aim of this study was to compare analgesia by ultrasound-guided superior quadratus lumborum block (QLB) through arcuate ligament or by QLB through anterior approach in patients with gallbladder stones undergoing laparoscopic cholecystectomy (LC). Methods A total of 109 patients with gallbladder stones were encountered in our hospital between January 2023 and December 2024, and all underwent LC. For post-operational analgesia, patients were randomly assigned to receive trans-arcuate ligament superior QLB group (n=51) or trans-anterior approach QLB group (n=58). Analgesia was completed with 0.25% ropivacaine hydrochloride injection for nerve block. The number of block plane segments was evaluated by acupuncture, and pain under rest and when cough was evaluated by visual analogue scale (VAS). Results The postoperative ambulation time in trans-arcuate ligament superior QLB group was (3.8±0.7)h, much earlier than [(4.6±0.9)h, P＜0.05] in trans-anterior approach QLB group, first pressing PCA pump after surgery and remedial analgesia were (5.4±1.1)h and (0.7±0.4)times, much later or less than (4.8±0.9)h and (1.2±0.6)times,P＜0.05] in trans-anterior approach QLB group; onset of analgesia was (6.7±1.6)min, much earlier than [(8.9±2.5)min,P＜0.05] in trans-anterior approach QLB group,and by 5 min, 10 min and 20 min after block, numbers of blocking plane segments were (4.1±0.9), (7.5±1.7) and (8.6±1.8)seg, all much greater than [(2.6±0.5), (5.3±1.1) and (6.8±1.3)seg, respectively, P＜0.05] in trans-anterior approach QLB group;by 6 h, 12 h and 24 h post-operationally, the resting VAS scores were (1.2±0.3), (1.5±0.4) and (1.7±0.7), all much lower than [(1.6±0.5), (1.9±0.8) and (2.0±0.6), P＜0.05], and VAS scores at cough were (1.6±0.6), (2.3±0.7) and (2.1±0.6), all much lower than [(2.2±0.9), (2.8±1.3) and (2.5±1.1),P＜0.05] in trans-anterior approach QLB group. Conclusion Superior QLB through arcuate ligament under ultrasound guidance in patients undergoing LC could effectively improve postoperative analgesic effect, accelerating recovery and reduce the occurrence of adverse reactions.

Objective The aim of this study was to investigate the perfect timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of patients with acute severe cholecystitis (ASC). Methods 45 patients with ASC were admitted to our hospital between January 2022 and March 2025, and all underwent emergent PTGD for amelioration of acute body inflammatory reaction. For LC, patients were randomly assigned to have the operation within 50 days after PTGD in 20 cases (group A) or 70 days after PTGD in 25 cases (group B). Serum interleukin (IL)-6 and C-reactive protein (CRP) levels were detected by ELISA. Results The operation time of LC, postoperative first exhaust time, intraoperative blood loss and hospital stay after surgery in group B were(81.2±9.5)min, (21.6±4.0)h, (67.3±8.2)mL and (4.4±1.3)d, all significantly shorter or less than [(93.4±10.6)min, (28.7±5.1)h, (87.5±9.3)mL and (6.6±1.7)d, respectively, P＜0.05] in group A; at admission for LC, serum bilirubin, ALT and AST levels in group B were (27.4±3.5)μmol/L, (65.1±7.0)U/L and (54.2±10.7)U/L, all much lower than [(46.7±3.8)μmol/L, (94.5±6.3)U/L and (83.6±10.2)U/L, respectively, P＜0.05] in group A; serum IL-6, CRP levels and white blood cell count in group B were (15.1±5.3)pg/mL, (9.6±2.4)mg/L and (8.9±1.6)×10⁹/L, all significantly lower than [(34.8±4.6)pg/mL, (19.3±2.1)mg/L and (13.6±3.2)×10⁹/L, respectively, P＜0.05] in group A; incidence of adverse effects after LC in group B was 12.0%, much lower than 30.0%(P＜0.05) in group A. Conclusion Timing of LC 2 months after PTGD has more advantages in the treatment of patients with ASC, which could shorten operation time, with less post-operational complications, and might be related to alleviation of body inflammatory reaction.

Objective The aim of this study was to investigate the application of gallbladder reporting and data system (GB-RADS), contrast-enhanced ultrasound (CEUS) and ultrasound micro-flow imaging in the diagnosis of gallbladder polypoid lesion (GPL) properties. Methods 114 patients with GPL were encountered in out hospital between January 2022 and December 2024, and all underwent ultrasound micro-flow imaging and CEUS scan for GB-RADS grading. The patients with GPL received radical or conventional surgical resection. Kappa consistency test was applied to evaluate the diagnostic performance. Results Histo-pathological examination found gallbladder cancer in 16 cases(14.0%) and benign lesions in 98 cases (86.0%), including gallbladder polyps in 72 cases, adenomas in 10 cases and gallbladder adenomyomatosis in 16 cases; the proportion of high enhancement in CEUS, multiple vessels in the lesions and fast in and fast out of enhancement model in the malignant lesions were 81.3%, 93.7% and 87.5%, all significantly higher than 46.9%, 17.3% and 39.8%(P<0.05) in benign lesions; the proportion of ultrasound micro-flow imaging grade 3-4 in malignant lesions was 100.0%, much higher than 60.2% in benign lesions (P<0.05); the proportion of GB-RADS grade 3-5 was 81.3%, much higher than 21.4% in benign lesions (P<0.05); Kappa consistency test showed the sensitivity, specificity and accuracy by CEUS in judging the GPL properties were 81.3%, 83.7% and 83.3%, and by GB-RADS were 81.3%, 78.6% and 78.9%, both much superior to 100.0%, 39.8% and 48.2%, respectively (P<0.05) by ultrasound micro-flow imaging. Conclusion The assessment of GPL property by multiple ultrasonography might be helpful in clinical practice, which warrants further investigation.

Objective The aim of this study was to explore application of MRI multi-sequence scan in the preoperative diagnosis of tumor staging in patients with primary gallbladder cancer. Methods 53 patients with primary gallbladder cancer were encountered in our hospital between March 2022 and March 2025, and all had tumor resection after multi-sequence MR scan. The diagnosis was confirmed by post-operational histo-pathological examination. Results Of the 53 patients with primary gallbladder cancer, the pathological study found tumor stageⅠ in 11 cases, stage Ⅱ in 15 cases and stage Ⅲ in 27 cases, and low differentiation in 21 cases, middle differentiation in 23 cases and high differentiation in 9 cases; the apparent diffusion coefficient (ADC) in stage Ⅲ foci was (1.0±0.1), much lower than [(1.5±0.2), P<0.05] in stage Ⅰ or [(1.2±0.2), P<0.05] in stage Ⅱ, while there were no significant differences among different cell differentiation groups(P>0.05); conventional MRI diagnosed tumor stage Ⅰ, Ⅱ and Ⅲ in 10 cases, 18 cases and 25 cases, while they were 9 cases, 18 cases and 26 cases by multi-sequence MR scan, with the accuracy of 90.6%, much higher than 67.9(P<0.05) by conventional MRI. Conclusion Multi-sequence of MRI scan is beneficial to improve the diagnostic accuracy of the tumor staging in patients with primary gallbladder cancer, which might help surgeons make an appropriate operation plan preoperatively.