Objective Liver injury is common in many chronic liver disease, and liver disease has a systemic impact, and vice versa. Diagnosis and treatment of patients with liver disease should not only consider the liver disease itself, but also need to clarify patho-physiological mechanisms by which the interaction occur between various systemic diseases and inflammatory liver injury. Therefore, the dealing with liver injury often require multidisciplinary discussions and joint decision-making. One of the important aspects of liver disease treatment is to protect and maintain the stability of liver functions, and how to carry out anti-inflammatory and liver protection involves etiology and liver injuries for appropriate treatment strategies. Bicyclol is a chemical agent independently developed in China and has a widespread administration to treat patients with inflammatory liver injury. Bicyclol has a good preventive and therapeutic efficacy on inflammatory liver injury caused by various etiologies documented in literature, and has been registered and listed in nine countries along the Belt and Road. We have organized domestic experts from relevant disciplines all over the country to summarize multidisciplinary clinical application of bicyclol in the prevention and treatment of inflammatory liver injury abide on liver disease diagnosis and treatment guidelines/consensus/clinical pathways and evidence-based medicine, combined with clinical practice in China. The aim of this consensus is to improve the reasonable and standardized clinical application of bicyclol in the treatment of patients with inflammatory liver injury.

Objective This experiment aimed at exploring the mechanism ofprotective role of puerarin on ketoconazole-induced liver injury in rats. Method 48 male SD rats were randomly divided into control, model, low-dose and high-dose of puerarin-intervened groups (n=12 in each).Model was established by oral ketoconazole gavage, and intervention was carried out by oral ketoconazole and low-dose and large-dose of puerarin gavage simultaneously. Hepatic tissue aromatic hydrocarbon receptors (AHR), cytochrome P450 1A1(CYP1A1), and CYP2E1 mRNA levelswere assayed by RT-PCR, and hepatic expression of AHR protein was detected immunohistochemically. Results The model of liver injury was successfully established as proved enzymologically and histopathologically, and the intervention of puerarin greatly improved liver injury; hepatic tissue GSH level in low-dose puerarin-intervened group was (148.2±9.5)μM, much higher than [(77.0±9.1)μM,P<0.05], while GSSG level was (84.7±9.3)μM, much lower than [(131.4±13.4)μM, P<0.05] in the model, and in large-dose of puerarin intervention group, the changes were even more obviously; relative hepatic loads of AHR, CYP1A1 and CYP2E1 mRNA in low-dose of puerarin intervention were (28.4±3.3), (23.7±1.8)and (9.0±1.5), all significantly lower than [(51.7±7.8),(36.2±4.7) and (14.0±1.5), respectively, P<0.05] in the model, and the changes were even more obvious in large-dose of puerarin intervention; AHR expression in liver tissues with puerarin intervention was obviously weaker as compared in the model. Conclusion Puerarin could ameliorate ketoconazole-induced liver injury in rats, which might be related to inhibition of oxidative stress pathway mediated by AHR.

Objective This experiment was conducted to explore effect of liraglutide (Lira) on steatosis in HepG2 cells in vitro. Methods The HepG2 cells were divided into five groups, cell steatosis model were induced by 0.25 mmol/L palmitic acid (PA) incubation, and then intervened by silent information regulator 1(Sirt1) inhibitor, Lira or Sirt1 and Lira combination. Oil red O was stained for lipid droplets, and nicotinamide adenine dinucleotide oxidation/reduced state ratio (NAD⁺/NADH), ALT, AST and triglyceride (TG) contents were determined. Liver kinase B1 (LKB1), free fatty acid (FFA), acetyl-CoA carboxylase (ACC) and adiposetriglyceride lipase (ATGL) mRNA loads were detected by RT-qPCR, and p-adenosine monophosphate-activated protein kinase (AMPK)/sterol regulatory element binding protein 1c(SREBP1c) and p-Sirt1 expression were detected by Western blot. Results Intrahepatocellular lipid droplets were clearly observed in PA-intervened HepG2 cells, which were even more severe in PA/Sirt1-intervened cells, while the lipid droplets obviously reduced in PA/Lira- and PA/Sirt1/Lira-intervened cells, suggesting the model establishment successful and protective effect of Lira; FFA and ACC mRNA loads in PA-intervened cells increased greatly compared to that in control cells (P<0.01), LKB1 and ATGL mRNA loads in PA/Lira-treated cells increased greatly compared to that in PA-treated cells (P<0.001), while FFA and ACC mRNA loads decreased greatly as compared to that in PA-treated cells (P<0.01); LKB1 and ATGL mRNA loads in PA/Sirt1/Lira-treated cells were much higher (P<0.01), while FFA mRNA loads was much lower than in PA/Sirt1-treated cells (P<0.05); p-AMPK and p-Sirt1 protein expression in PA-intervened cells were down-regulated, while SREBP1c expression was up-regulated as compared to that in control cells; p-AMPK expression in PA/Lira-treated cells was up-regulated, while SREBP1c expression was down-regulated compared to that in PA-treated cells; p-AMPK expression in PA/Sirt1/Lira-treated cells was up-regulated compared to that in PA/Sirt1-treated cells. Conclusion Lira could attenuate intracellular fat accumulation in HepG2 cells in vitro, which might be ascribed to direct up-regulation of SIRT1/AMPK signaling pathway or to partially activation of LKB1 leading to increased expression of AMPK protein and inhibition of SREBP1c expression.

Objective The aim of this study was to investigate antiviral efficacy of peginterferon alpha (Peg-IFN-α) and entecavir (ETV) combination in treatment of patients with serum HBeAg-positive chronic hepatitis B (CHB). Methods A total of 279 patients with serum HBeAg-positive CHB were enrolled in this study between January 2019 and January 2022, and were randomly divided into three groups, with 93 cases in each group. Oral entecavir, subcutaneous injection of Peg-IFN-α, or combination of entecavir and Peg-IFN-α were given, and antiviral regimen lasted for 48 weeks. Serum biochemical, serological and virological responses were routinely assessed. Results By end of 48 week treatment, serum HBeAg negative rate and seroconversion rate in combination group were32.3% and 21.5%, in Peg-IFN-α group were 22.6% and 15.1%, while in entecavir group, no serum HBeAg negative and no serum HBeAg conversion; also in combination group, 3.2% of patients had serum HBsAg negative and 2.2% of them had serum HBsAg seroconversion; serum HBsAg and HBeAg levels in combination group were (1.9±0.3)lg s/co and (0.5±0.1)lg s/co, in Peg-IFN-α group were (2.2±0.2)lg s/co and (0.6±0.1)lg s/co, both significantly lower than [(3.6±0.2)lg s/co and (1.3±0.2)lg s/co, P＜0.05] in entecavir group, while serum HBV DNA loads in combination and entecavir groups were much lower than in Peg-IFN-α group (P＜0.05); serum ALT and AST levels in combination group were (30.9±4.5)U/L and (28.4±5.3)U/L, in entecavir group were (31.5±3.6)U/L and (32.3±4.7)U/L, both significantly lower than [(48.1±4.2)U/L and (42.7±5.0)U/L, respectively, P＜0.05] in Peg-IFN-α-treated group. Conclusion Combination of entecavir and Peg-IFN-α in treatment of patients with serum HBeAg-positive CHB could gain satisfactory serum HBeAg negative and seroconversion rates, and in dominant population might obtain functional cure.

Objective The aim of this study was to investigate the risk factors of low-level viremia (LLV) and rescue switch treatment to tenofovir alafenamide fumarate (TAF) in entecavir(ETV)-treated patients with chronic hepatitis B(CHB). Methods A total of 158 patients with CHB were enrolled in our hospital between January 2020 and December 2022, and all were already had treated with ETV for at least 48 weeks. The patients who obtained complete virological response (CVR) continued the ETV treatment, and those with LLV were switched to TAF treatment. The patients in the two groups were observed for 48 weeks. Serum HBV DNA loads were detected by hypersensitive PCR detection system, serum HBeAg and HBsAg quantification were detected by full-automatic chemiluminescence immunoanalyzer. The risk factors of LLV in CHB patients undergoing ETV treatment were analyzed by multivariate Logistic regression analysis. Results Out of the 158 patients with CHB enrolled in this study, the LLV was found in 55 cases(34.8%)and the CVR in 103 cases (65.2%); the body mass index, family hepatitis B history, concomitant liver cirrhosis, baseline serum HBV DNA loads, serum HBeAg positive and serum HBsAg levels were correlated to the occurrence of LLV(P＜0.05), and the multivariate Logistic regression analysis showed that the baseline serum HBV DNA loads (OR:2.793, 95%CI:1.579-4.940), serum HBeAg positive (OR:2.337,95%CI:1.455-3.756) and serum HBsAg high levels (OR:1.931, 95%CI:1.338-2.786) were the independent risk factors for LLV occurrence in ETV-treated patients with CHB (P＜0.05); at the end of 48-week of TAF treatment, the CVR was obtained in 36 cases (65.5%) in 55 patients with LLV, and serum ALT level, HBV DNA load and HBsAg level in 55 patients with LLV were still significantly higher than those with CVR [37.2(19.1,57.0)U/L, (0.9±0.4)lg IU/ml and (3.9±0.6)lg IU/ml vs. 33.5(17.6, 39.2)U/L, (0.7±0.3)lg IU/ml and (3.1±0.5)lg IU/ml, respectively, P＜0.05]. Conclusion The high baseline serum HBV DNA loads, HBeAg positive and high HBsAg quantification might be the risk factors for LLV occurrence in ETV-treated patients with CHB and the rescue TAF treatment could get CVR in most of them, which warrants further clinical investigation.

Objective This clinical trial was conducted to investigate efficacy and safety of sofebuvir and redipavir combination in the treatment of patients with chronic hepatitis C (CHC). Methods Forty-eight patients with CHC were enrolled in our hospital between February 2017 and March 2023, and were randomly divided into observation (n=24) and control group (n=24), receiving sofebuvir and redipavir combination for 12 weeks or peginterferon-α and ribavirin combination for 24 weeks, respectively. Rapid virological response (RVR), end of treatment (EOT) virological response (ETVR) and sustained virological response (SVR) were recorded. Results The clinical materials including HCV genotypes at baseline in the two groups were comparable (P>0.05); RVR, ETVR and SVR in the DAA-treated patients were 75.0%, 95.8% and 95.8%, all much higher than 58.3%, 70.8% and 66.7% (P<0.05) in peginterferon-α-treated patients; by end of antiviral treatment, platelet and white blood cell counts in DAA-treated patients were (201.5±22.3)×10⁹/L and (6.5±1.4)×10⁹/L, both significantly higher than [(137.6±15.0)×10⁹/L and (3.7±1.3)×10⁹/L, P<0.05], while serum ALT level was (36.2±4.3)U/L, much lower than [(60.8±5.4)U/L, P<0.05] in peginterferon-α-treated patients; during antiviral treatment, adverse events rates, such as fever occurred in 83.3%, granulocytopenia in 62.5% and thrombocytopenia in 41.7% in peginterferon-α-treated patients. Conclusion Sofebuvir and redipavir combination therapy in treatment of patients with CHC has a satisfactory efficacy and relatively less adverse events, which warrants widespread clinical application.

Objective The aim of this study was to observe the antiviral efficacy and serum interferon-γ (IFN-γ) and interleukin-10 (IL)-10) level changes in patients with chronic hepatitis C (CHC) with genotype 1b infection. Methods 58 patients with CHC and genotype 1b infection were recruited in our hospital between May 2020 and February 2023, and the antiviral regimen by sorfosbuvir/daratavir was given in 30 patients in the observation group and by peginterferon α-2a and ribavirin combination was given in 28 patients in the control. The treatment lasted for 24 weeks in the two groups. Serum IFN-γ and IL-10 levels were measured by ELISA. Results At the end of the antiviral treatment, the white blood cell count, platelet count and hemoglobin concentration in the observation group were(5.5±1.2)×10⁹/L, (116.2±19.5)×10⁹/L and (121.5±19.7)g/L, all significantly higher than [(4.6±1.1)×10⁹/L, (94.0±18.5)×10⁹/L and (104.7±16.8)g/L, respectively, P<0.05] in the control; serum ALT and AST levels in the observation group were(36.0±5.0)U/L and (38.2±5.5)U/L, both significantly lower than [(47.5±5.8)U/L and (51.9±6.3) U/L, P<0.05] in the control; serum CRP and IL-10 levels in the observation group were (13.4±1.8) ng/L and (36.5±14.6)pg/mL, both significantly lower than [(16.7±2.2)ng/L and (64.0±28.2)pg/mL, P<0.05], while serum IFN-γ level was (19.2±2.0) pg/mL, significantly higher than [(10.4±2.2)pg/mL, P<0.05] in the control; the rapid virological response, early virological response, end-of-treatment response and sustained virological response in the observation group were 73.3%, 90.0%, 100.0% and 96.7%, all significantly higher than 42.8%, 53.6%, 71.4% and 60.7%(P<0.05) in the control group; at the end of four-week treatment, serum IFN-γ level in 46 responders was (23.5±4.7)pg/mL, much higher than [(8.5±1.7)pg/mL, P<0.05], while serum IL-10 level was (29.0±13.2)pg/mL, much lower than [(84.5±30.1)pg/mL, P<0.05] in twelve non-responders. Conclusion The application of sorfosbuvir and daratavir in the treatment of patients with genotype 1b CHC has a good efficacy, which might be be related to the inhibition of viral replication and the successful induction of antiviral immunization.

Objective The aim of this study was to investigate the antiviral efficacy of danoprevir and ravidasvir in the treatment of patients with chronic hepatitis C (CHC). Methods 84 patients with CHC were enrolled in our hospital between January 2021 and January 2023, and were divided into control and observation group, with 42 cases in each group, receiving pegylated interferon-α2b and ribavirin combination, or danoprevir and ravidasvir combination antiviral therapy for 12 w. All patients were followed-up for 24 weeks after discontinuation of the regimen. Serum HCV RNA load was measured by using fully automated viral load analysis system, and the rapidvirological response (RVR), end-treatment virological response (ETVR) and sustained virological responseat 12 weeks (SVR12) were recorded. Serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-10 levelswere assayed by ELISA. Results TheRVR, ETVR and SVR12 in the observation group were 64.2%, 100.0% and 100.0%, all significantly higher than 42.8%, 69.0% and 54.8%(P<0.05)in the control; 24 weeks after discontinuation of the antiviral treatment, six patients (14.2%) in the control, but no patients (0.0%) in the observation relapsed(P<0.05); serum alanine aminotransferase and aspartate aminotransferase levels in the observation group were(32.5±8.4)U/L and (33.8±8.6)U/L, both significantly lower than [(54.2±8.7)U/L and (53.5±7.1)U/L, respectively, P<0.05] in the control; the while blood cell count, platelet count and hemoglobin concentration in the observation were (5.6±0.7)×10⁹/L, (108.1±18.9)×10⁹/L and (113.7±16.2)g/L, all significantly higher than [(3.5±0.6)×10⁹/L,(82.5±16.7)×10⁹/L and (96.8±13.9)g/L, respectively, P<0.05] in the control; serum TNF-α, IL-6 and IL-10 levels were (5.4±0.4)ng/L, (15.6±3.7)ng/L and (64.3±12.7)ng/L, all much lower than [(9.0±0.5)ng/L, (22.9±4.0)ng/L and (125.4±24.3)ng/L, respectively, P<0.05] in the control; during the antiviral treatment period, the incidence of untoward effects in the observation group was much lower than in the control (14.2% vs. 33.3%,P<0.05). Conclusion The combination of danoprevir and ravidasvir in the treatment of patients with CHC could quickly clear the viremia, has a promising antiviral efficacy, and warrants further clinical investigation.

Objective The aim of this study was to explore the clinical implication of serum triglyceride-glucose index (TyG), visceral/subcutaneous fat area ratio (VSR) and cardiac metabolic index (CMI) in elderly patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). Methods A total of 98 elderly patients with NAFLD and concomitant T2DM and another 98 elderly patients with NAFLD were enrolled in our hospital between January 2021 and December 2022, and routine biochemical parameters were determined for calculation of TyG and CMI. The VSR was obtained from calculation of body fat detected by special apparatus. The multivariate Logistic regression analysis was applied for risk factor finding. Results The fasting blood glucose, glycosylated hemoglobin, the HOMA-IR and serum triglyceride level in NAFLD patients with T2DM were(9.3±0.7)mmol/L, (9.1±1.6)%, (5.7±0.8) and (3.7±0.5)mmol/L, all significantly higher than [(5.8±0.5)mmol/L, (6.1±1.2)%, (3.9±0.4) and (1.9±0.3)mmol/L, respectively, P<0.05], while serum high-density lipoprotein cholesterol level was (1.2±0.2)mmol/L, significantly lower than [(1.5±0.4)mmol/L, P<0.05] in patients with NAFLD; the TyG, VSR and CMI were (10.8±1.5)%, (0.9±0.2)% and (1.2±0.3)%, all much higher than [(8.7±0.4)%, (0.3±0.1)% and (0.6±0.2)%, respectively, P＜0.05] in patients with NAFLD; the multivariate Logistic regression analysis showed that the TyG(OR=3.124, 95%CI:1.101-8.862), the VSR(OR=2.601, 95%CI:1.035-6.535) and CMI(OR=2.832,95%CI: 1.061-7.561) elevation were all the independent risk factors for T2DM in elderly patients with NAFLD (P＜0.05); the TyG, VSR and CMI in 37 patients with severe NAFLD and concomitant 2DM were (12.4±1.9)%, (1.2±0.3)% and (1.7±0.4)%, all much higher than [(9.7±0.6)%,(0.7±0.1)% and (0.9±0.2)%, respectively, P＜0.05] in 61 patients with mild to moderate NAFLD and T2DM. Conclusion The detection and calculation of relatively simple TyG, VSR and CMI might be help for screening T2DM in elderly patients with NAFLD, and needs further investigation.

Objective The purpose of this study was to explore the diagnostic performance of FibroScan, magnetic resonance imaging proton density fat-fraction (MRI-PDFF) and FibroScan-AST(FAST)score in judging patients with high risk non-alcoholic steatohepatitis (NASH) from those with non-alcoholic fatty liver diseases (NAFLD). Mthods A total of 107 patients with NAFLD were encountered in our hospital between June 2017 and December 2021, and all patients underwent liver biopsies. FibroScan, MRI-PDFF and serological detection were completed and three non-invasive models of FAST, FIB-4 and APRI were calculated. Univariate and multivariate Logistic regression analysis was used to screen out factors impacting high-risk NASH. The diagnostic performance of relevant parameters and three non-invasive models to identify high risk NASH was analyzed by ROC curve. Result Of 107 patients with NAFLD, the histo-pathological examination showed high risk NASH in 13 cases (12.1%), and simple alcoholic fatty liver and non-high risk NASH in 94 cases (87.9%); liver stiffness measurement (LSM) by Fibroscan, FAST score and aspartate aminotransferase/platelets (APRI) in patients with high risk NASH were significantly higher than in those with non-high risk NASH (P＜0.05);multivariate Logistic regression analysis showed that only the LSM was the independent risk factor impacting high risk NASH(P＜0.05);ROC analysis demonstrated that the LSM, FAST and APRI could identify high risk NASH(P＜0.05), with AUCs of 0.795, 0.713 and 0.682, and the LSM got the optimal diagnostic efficacy, with sensitivity (Se) and specificity (Sp) of 92.3%and 54.3% based on exclusion cut-off-value, and with Se and Sp of 53.8%and 90.4% based on inclusion cut-off-value. Conclusion The simultaneous increased LSM in patients with NAFLD hints existence of NASH, which might help clinicians make appropriate measures to tackle it.

Objective The aim of this study was to investigate prediction of nonalcoholic steatohepatitis (NASH) by ultrasonic attenuation coefficient (UAC) or controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) combination in patients with nonalcoholic fatty liver diseases (NAFLD). Methods 87 patients with NAFLD were recruited in our hospital between June 2020 and June 2023, and all underwent liver biopsies and ultrasonography for UAC detection or Fibrotouch for CAP and LSM detection. Receiver operating characteristic (ROC) was applied to predict existence of NASH. Results Histopathological examination showed simple fatty liver(SFL) in 61 cases and NASH in 26 cases; the UAC, CAP and LSM in patients with NASH were (0.9±0.1)dB/cm·MHz, (327.4±30.6)dB/mand (11.6±1.6)kPa, all significantly greater than [(0.6±0.1)dB/cm·MHz, (266.3±21.5)dB/m and (6.7±0.4)kPa, respectively, P＜0.05] in patients with SFL; the area under ROC (AUC) was 0.9, with sensitivity (Se) of 84.0% and specificity (Sp) of 87.6%, when CAP of 315.2 dB/m and LSM of 10.3 kPa were combined as cut-off-value (COV) in predicting existence of NASH, much superior to that by UAC (COV was 0.9 dB/cm·MHz, AUC was 0.8, Se was 80.0% and Sp was 72.4%, P<0.05). Conclusion Combination of CAP and LSM in predicting occurrence of NASH in patients with NAFLD has a satisfactory diagnostic performance, which might help to screen in clinical practice.

Objective The aim of this study was to explore bile acid (BA) composition changes and their impact of response to immunosuppressant or ursodeoxycholic acid (UCDA) therapy in patients with autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC). Methods 28 patients with AIH and 55 patients with PBC were encountered in our hospital between January 2020 and January 2023, and they received prednisone or UDCA therapy. Serum free BAs, including cholic acid (CA), deoxycholic acid (DCA), chenodeoxycholic acid (CDCA), ursodeoxycholic acid (UDCA) and lithocholic acid (LCA), lycine-binding BAs(G-BAs), including glycocholic acid (GCA), glycodeoxycholic acid (GDCA), glycodeoxycholic acid (GCDCA) and glycodeoxycholic acid (GUDCA), and taurocholate-binding bile acid (T-BAs), including taurine cholic acid (TCA), taurine deoxycholic acid (TDCA), taurine deoxycholic acid (TCDCA) and taurine lithocholic acid (TLCA) levels were detected by liquid chromatography tandem mass spectrometry. Results By end of six month treatment, complete response to therapy in patients with AIH was found in 20 cases (71.4%) and in patients with PBC was found in 42 cases (76.4%); serum CA, CDCA, UDCA and LCA levels in AIH responders were (1.6±0.5)ng/ml, (2.6±0.4)ng/ml, (2.0±0.3)ng/ml and (0.7±0.4)ng/ml, all significantly lower than [(2.4±0.7)ng/ml, (2.9±0.4)ng/ml, (2.4±1.0)ng/ml and (0.9±0.7)ng/ml, respectively, P<0.05], serum GCA, GDCA, GCDCA and GUDCA levels were (1.3±0.5)ng/ml, (2.6±0.3)ng/ml, (2.9±0.3)ng/ml and (1.6±0.5)ng/ml, all significantly lower than [(3.0±1.0)ng/ml, (3.2±0.6)ng/ml, (3.8±0.8)ng/ml and (2.6±1.2)ng/ml, respectively, P<0.05], and serum TCA, TDCA, TCDCA and TLCA levels were (0.5±0.1)ng/ml, (2.6±0.2)ng/ml, (2.5±0.3)ng/ml and (0.1±0.0)ng/ml, all significantly lower than [(2.1±1.2)ng/ml, (3.3±0.6)ng/ml, (2.7±0.4)ng/ml and (0.4±0.1)ng/ml, respectively, P<0.05] in non-responders; serum CA, CDCA, UDCA and LCA levels in PBC responders were(1.7±0.4)ng/ml, (2.7±0.4)ng/ml, (2.1±0.4)ng/ml and (0.8±0.4)ng/ml, all significantly lower than [(2.3±0.9)ng/ml, (3.0±0.4)ng/ml, (2.5±0.7)ng/ml and (1.3±0.7)ng/ml, respectively, P<0.05], serum GCA, GDCA, GCDCA and GUDCA levels were (1.4±0.7)ng/ml, (2.6±0.4)ng/ml, (3.0±0.5)ng/ml and (2.0±0.9)ng/ml, all significantly lower than [(2.9±0.9)ng/ml, (3.2±0.5)ng/ml, (3.8±0.7)ng/ml and (3.0±1.1)ng/ml, respectively, P<0.05], and serum TCA, TDCA, TCDCA and TLCA levels were (0.5±0.2)ng/ml, (2.7±0.3)ng/ml, (2.5±0.4)ng/ml and (0.2±0.1)ng/ml, all significantly lower than [(2.1±0.9)ng/ml, (3.2±0.5)ng/ml, (2.8±0.4)ng/ml and (0.5±0.2)ng/ml, respectively, P<0.05] in non-responders. Conclusion There are significant differences in serum bile acid levels between patients with PBC and with AIH, and serum BAs changes might be involved in pathogenesis of autoimmune liver diseases, and have some influence on outcomes of the diseases.

Objective This study was conducted to explore the clinical implications of serum leptin level, and peripheral blood regulatory T cells (Tregs) and helper T 17 (Th17) cells in patients with autoimmune hepatitis (AIH). Methods 69 patients with AIH were enrolled in our hospital between March 2018 and March 2023, and all underwent liver biopsies and received standardized prednisone and azathioprine combination therapy. Serum cytokine levels were assayed by ELISA, and the percentages of peripheral blood Tregs and Th17 cells were detected by FCM. Results Serum leptin, IL-17, IL-22 and TNF-α, and percentage of blood Th17/CD4⁺ cells and the Th17/Tregs cell ratio in 22 patients with severe AIH were (335.6±84.2)ng/mL, (18.5±4.1)pg/mL, (48.7±11.4)pg/mL, (5.6±0.9)ng/mL, (3.3±1.2)% and (20.1±3.0), all significantly higher than [(66.9±13.8)ng/mL,(6.9±2.5)pg/mL, (13.8±3.3)pg/mL, (1.1±0.4)ng/mL, (2.5±0.3)% and (12.4±1.5), respectively, P<0.05], while blood platelet count, serum IL-10 level and percentage of blood Tregs/CD4⁺ cells were (129.8±29.4)×10⁹/L, (2.3±0.7)pg/mL and (1.6±0.4)%, all much lower than [(174.2±35.6)×10⁹/L, (4.8±0.9)pg/mL and (2.0±0.8)%, P<0.05]in 47 patients with mild/moderate AIH; the histo-pathological examination showed G1-2 histological activity in 42 cases and G3-4 in 27 cases; serum leptin, IL-17, IL-22 and TNF-α levels, percentage of blood Th17/CD4⁺ cell and the Th17/Tregs cell ratio in patients with G3-4 were significantly higher than, while the platelet count, percentage of Tregs/CD4⁺ cells and serum IL-10 level were much lower than in those with G1-2(P<0.05); all patients in our series obtained complete response (CR) after immunosuppression therapy, and the CR occurred less than three months in 35 cases, three to six months in 23 cases and longer than six months in 11 cases; the patients with increased serum leptin levels, percentages of blood Tregs/CD4⁺ and Th17/CD4⁺ cells, and the Th17/Tregs cell ration cost longer period for CR (P＜0.05). Conclusion The surveillance of serum leptin levels and peripheral blood Tregs and Th17 cells might predict the efficacy of immunosuppression therapy, which needs further clinical verification.

Objective The aim of this study was to investigate changes of peripheral blood neutrophil-to-lymphocyte ratio (NLR) and neutrophil CD64 (nCD64) index in patients with autoimmune hepatitis (AIH). Methods 39 patients with AIH and 42 healthy individuals were enrolled in our hospital between May 2020 and May 2023, and all patien ts with AIHunderwent liver biopsy and received prednisone and azathioprine combination therapy. NLR was calculated based on results of blood cytometry, and nCD64 index was detected by FCM. Serum biochemical index and immunoglobulin G (IgG) levels were routinely detected. Results Serum alanine aminotransferase, aspartate aminotransferase, IgG and peripheral blood NLR and nCD64 index in patients with AIH were (176.0±30.2)U/L,(141.4±31.8)U/L, (19.7±2.8)g/L, (2.2±0.6)and (3.1±0.9), all significantly higher than [(22.8±5.8)U/L,(27.6±6.3)U/L,(10.4±1.8)g/L, (1.4±0.2)and (0.6±0.1), respectively, P<0.05] in healthy persons; histo-pathological examination showed mild, moderate and severe disease in 10 cases, 17 cases and 12 cases, G1/G2 in 28 cases and G3/G4 in 11 cases, and F0 in 6 cases, F1/F2 in 22 cases and F3/F4 in 11 cases, finding serum and blood parameters in patients with severe injuries were much higher than in those with relatively mild liver injuries (P<0.05); at end of six month treatment, complete biochemical response (CBR) was obtained in 32 cases(82.1%), and incomplete in 7 cases (17.9%), with NLR and nCD64 in patients with incomplete response of (1.7±0.4)and (2.1±0.6), much higher than [(1.4±0.3) and (1.5±0.5), respectively, P<0.05] in those with CBR. Conclusion Peripheral bloodNLR and nCD64 index in patients with active AIH elevate, which might be applied to assess disease severity and response to standard immunosuppressive therapy.

Objective The clinical feature and biochemical response to immunosuppressive therapy were compared between patients with primary biliary cholangitis (PBC) and PBC-autoimmune hepatitis (AIH)overlap syndrome (OS). Methods 64 patients with PBC and 27 patients with PBC-AIH OS were encountered in our hospital between May 2017 and February 2023, and all undergone liver biopsies. The patients in the two groups were treated by ursodeoxycholic acid (UDCA) or UDCA and prednisone combination, and response were assessed by one year. Results Serum AST, globulin and IgG levels in patients with PBC-AIH OS were 103.5(74.5, 213.3)U/L, 34.2±7.3g/L and 19.1±8.1g/L, all significantly higher than [71.0(32.0, 119.0)U/L,30.2±6.2g/L and 14.7±5.3g/L, respectively, P<0.05] in patients with PBC; histo-patholocially, hepatic activity index, fibrosis staging, interfacial inflammation, fusion necrosis and portal inflammation in patients with PBC-AIH OS were much more severe than in those with PBC(P<0.05); by one year, complete, partial and non-biochemical response were 56.3%, 26.7% and 17.2% in 64 patients with PBC, while they were 44.4%, 37.0% and 18.5% in 27 patients with PBC-AIH OS. Conclusion PBC and PBC-AIH OS predominantly involve in middle-aged and elderly women, and there is little discrepancy in clinical manifestations and characteristic serum autoimmune antibodies between the two groups, while the intrahepatic histo-pathologic damage were obviously severe in patients with PBC-AIH OS, with relatively poor response rate to immunosuppressive therapy, which warrants close surveillance in clinical practice.

Objective The aim of this study was to investigate the predictive performance of transient elastography (TE)and other common non-invasive diagnostic models in predicting histological fibrosis staging in patients with primary biliary cholangitis (PBC). Methods This study enrolled 117 patients with PBC in Beijing You’an Hospital, affiliated to Capital Medical University between January 2019 and August 2023, and all patients underwent liver biopsy and liver stiffness measurement (LSM). The aspartate aminotransferase/platelet ratio (APRI), fibrosis index based on the four factors (FIB-4), gamma-glutamyl transferase to platelet ratio (GPR), Sheth index, King's score, Gotebörg university cirrhosis index (GUCI) score,albumin-bilirubin (ALBI) score, total bile acid - red cell volume distribution width (TR) score were calculated. The ROC curve analysis was conducted to evaluate the predictive efficacy of each index. Results Out of the 117 patients with PBC, the histo-pathological examination showed stage I in 17 cases, stage II in 59 cases, stage III in 34 cases and stage IV in 7 cases; the AUC was 0.875(0.776-0.974) by APRI in predicting the stage II and the above disease, with the sensitivity(Se), specificity(Sp), positive predictive value (PPV) and negative predictive value (NPV) of 75.8%, 87.5%, 76.5% and 87.0%, and the other relatively promising index was the GUCI score, with the AUC of 0.871(0.766-0.976), and Se, Sp, PPV and NPV of 88.7%, 75.0%, 65.6% and 92.4%, respectively. Conclusion The APRI is a simple and inexpensive non-invasive index with a good diagnostic efficacy in predicting stage II or above PBC patients, which needs further clinical investigation.

Objective This study was conducted to investigate the therapeutic efficacy of prednisone and azathioprine combination in the treatment of patients with autoimmune hepatitis (AIH). Methods There were 52 consecutive patients with AIH recruited in our hospital between January 2020 and January 2023, and they were randomly divided into observation (n=26) and control (n=26). All the patients in the two groups took prednisone and azathioprine combination therapy, the dose of prednisone in the control group was tapered relatively rapidly, while in the combination group was slowly week by week. Serum IgG, IgA and IgM levels were detected by ELISA, and peripheral blood lymphocyte subsets were determined by FCM. Results At the end of six-month treatment, serum ALT and AST levels in the observation group were (32.4±7.5)U/L and (31.9±5.2)U/L, both significantly lower than [(46.8±10.1)U/L and (43.6±7.7)U/L, respectively, P<0.05] in the control; serum IgA, IgM and IgG levels were (3.4±0.6)g/L, (3.5±0.8)g/L and (15.3±2.1)g/L, all much lower than [(4.1±0.5)g/L, (4.1±0.6)g/L and (19.8±6.7)g/L, P<0.05] in the control group; the percentages of peripheral blood T lymphocytes, B lymphocytes, inhibitory/cytotoxic T lymphocytes and the ratio of CD4⁺/CD8⁺ cells were(0.7±0.2)%, (12.1±3.5)%, (24.1±3.4)% and (1.2±0.2), all significantly lower thn [(0.9±0.2)%, (16.4±5.1)%, (28.4±3.1)% and (1.4±0.3), respectively, P<0.05] in the control; the incidence of untoward effects in the observation group was 50.0%, much higher than 7.7%(P<0.05) in the control group. Conclusion The regimen of prednisone and azathioprine combination in treatment of patients with AIH has definite clinical efficacy, while the way of dose tapering needs further investigation.

Objective This study was to investigate clinical features of rheumatoid arthritis (RA) patients with complicated drug-induced liver injury (DILI) after administration of herbal medicine, tripterygium wilfordii preparation trerament. Methods Sixty patients with RA and DILI were encountered in our hospital between January 2019 and October 2023, all had received treatment regimen containing tripterygium wilfordii preparation, and DILI was diagnosed by the Roussel Uclaf Causality Assessment Method (RUCAM). Results Of the 60 patients with RA and DILI, older than 46 years accounted for 75.0%, and longer than 4 months of tripterygium wilfordii preparation administration accounted for 40.0%; percentage of greater than five points of RUCAM score accounted for 88.3%, hepatocyte injury type accounted for 66.7%, and 1/2 grade of liver injuries accounted for 50.0%; the regimen for RA treatment included tripterygium wilfordii preparation(group A),tripterygium wilfordii preparation and steroids (group B),tripterygium wilfordii preparation and nonsteroidal anti-inflammatory agents (group C) and tripterygium wilfordii preparation, steroids and nonsteroidal anti-inflammatory agent combination (group D) in 10 cases, 12 cases, 30 cases and 8 cases, blood biochemical parameters in group D were significantly higher than those in other three groups (P<0.05); 26 patients (43.3%) recovered, 30 patients (50.0%)improved, and 4 (6.7%)discharged without liver function test normal after (23.4±7.0)day liver-protecting treatment. Conclusion Patients with rheumatoid arthritis are susceptible to liver injury after treatment of regimens containing tripterygium wilfordii preparation, the liver injuries might be even severe when too many drug combination administered, and fortunately, the prognosis is good.

Objective The aim of this study was to evaluate the existence of esophageal varices (EV) by two-dimensional shear wave elastography (2D-SWE) technology, fibrosis-4 factor index (FIB-4) and serum vascular endothelial growth factor (VEGF) levels in patients with hepatitis B-induced liver cirrhosis(LC). Methods 117 patients with hepatitis B-induced LC were enrolled in our hospital between June 2020 and June 2023, and they all underwent routine gastroscopy to determine the occurrence of EV. The liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) were detected by 2D SWE technology. The FIB-4 was calculated based on blood biochemical results and demographic data. Serum VEGF level was assayed by ELISA. The receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) were calculated to evaluate the diagnostic efficacy of each parameter on EV happening in patients with hepatitis B-induced LC. Results The gastroscopy found EV in 42 cases (35.9%) and no EV in 75 cases (64.1%) in our 117 patients with LC; the LSM, SSM, FIB-4 score and serum VEGF level in patients with EV were (19.4±5.4)kPa, (42.5±9.5)kPa, (4.7±1.6) and (168.6±50.4)pg/mL, all significantly higher than [(14.2±4.7)kPa, (30.9±8.6)kPa,(2.6±0.9) and (130.9±39.3)pg/mL, respectively, P<0.05] in patients without EV; the ROC analysis showed that the AUC was 0.954, with the sensitivity and specificity of 92.0% and 85.7%, respectively, when the LSM, SSM,FIB-4 and serum VEGF level were combined to predict the occurrence of EV (the cut-off-value were 16.0 kPa, 38.8 kPa, 3.7 and 142.9 pg/mL, respectively), much superior to any parameter alone (P<0.05). Conclusion The application of 2D-SWE technology to detect LSM and SSM and their combination of FIB-4 score and serum VEGF level could predict the occurrence of EV in patients with hepatitis B-induced LC, which needs further clinical verification.

Objective The aim of this study was to investigate the clinical efficacy of endoscopic variceal ligation (EVL) with lauromacrogol and snake venom hemocoagulase injection in treating patients with hepatitis B liver cirrhosis (LC) complicated by esophagogastric variceal bleeding (EVB). Methods 98 patients with LC and EVB were enrolled in our hospital between January 2021 and January 2023, and we assigned them to underwent EVL in control, or to underwent EVL with lauromacrogol and snake venom hemocoagulase injection in observation group. All patients were followed-up for 6 months. Portal vein pressure (PVP), portal vein diameter (PVD), portal vein velocity (PVV) and portal vein flow (PVF) were measured by color Doppler ultrasonography. Serum gastrin (GAS), glucagon (GLC) and motilin (MTL) levels were detected by ELISA. Results The 7-day mortality were 16.3% and 18.4%(P>0.05) in the observation and control group, and successful hemostasis in the observation was 65.3%, much higher than 53.1%(P<0.05) in the control; after treatment, PVP, PVV and PVF in the observation were (21.4±2.7)mmHg, (17.9±2.4)cm/s and (552.1±138.4)mL/min, all significantly lower than [(24.5±2.8)mmHg, (21.9±2.2)cm/s and (735.2±159.7)mL/min, respectively, P<0.05] in the control; serum GLC and MTL levels were (45.6±7.6)ng/L and (214.6±19.7)ng/L, both significantly lower than [(56.3±8.4)ng/L and (248.2±22.3)ng/L, respectively, P<0.05] in the control group; incidence of adverse effect, such as retrosternal pain in the observation was 24.4%, much higher than 2.5%, while rebleeding was 4.9%, much lower than 25.0%(P<0.05) in the control group. Conclusion The efficacy of EVL with Lauromacrogol and snake venom hemocoagulase injection in the treatment of LC with EVB is promising, with low rebleeding rate, and warrants further investigation.

Objective This study was conducted to investigate clinical efficacy of esophageal variceal ligation (EVL) with auxiliary oral thrombin and intravenous octreotide administration in the treatment of cirrhotics with esophageal and gastric variceal bleeding (EGVB). Method 120 patients with liver cirrhosis (LC) complicated with EGVB were admitted to our hospital between June 2021 and June 2023, and among them, 60 patients in observation received EVL with auxiliary oral thrombin powder and intranenous octreotide administration, and another 60 patients in control received EVL and octreotide infusion. Medical treatment continued for 1 week, and all patients in the two groups were followed-up for three months. Wedged hepatic vein pressure (WHVP) and free hepatic vein pressure (FHVP) were measured by through jugular vein approach for calculation of hepatic vein pressure gradient (HVPG). Result At end of one week treatment, two and eight patients in the observation and control died, with successful hemostasis of 96.7% in the observation group, much higher than 86.7%(P＜0.05) in the control; among survivals, early and delayed rebleeding and disappearance of varies in the observation were 22.4%, 17.2% and 69.0%, all not significantly different compared to 16.7%, 13.3% and 73.1% (P>0.05) in the control; after treatment, HVPG in the observation was (19.1±2.6)mmHg, not significantly different compared to (19.0±3.0)mmHg in the control (P>0.05); at admission and after treatment, there were no significant differences as respect to hepatic and renal function tests in the two groups (P>0.05). Conclusion The EVL with auxiliary treatment of oral thrombin powder and intranenous octreotide maintenance in the treatment of patients with EGVB has a good efficacy, with ascertainable hemostatic effect and prevention of rebleeding.

Objective The aim of this study was to investigate intestinal barrier function index changes in patients with compensated hepatitis B liver cirrhosis (LC) and high serum viral loads undergoing tenofovir alafenamide fumarate (TAF) or entecavir (ETV) therapy. Methods 64 patients with compensated hepatitis B-induced LC and high serum viral loads (HBVDNAswere 1equal to or greater than×10⁶ IU/mL) were enrolled in our hospital between January 2020 and January 2023, and we randomly assigned them to receive TAF (observation, n=32) or to ETV (control, n=32) therapy. The regimen continued and antiviral efficacy was assessed by end of 12 months. Urine lactulose/mannitol (L/M) ratio was detected by high performance liquid chromatography. Serum D-lactic acid was measured by colorimetry, serum diamine oxidase (DAO) by ultraviolet colorimetry, and serum endotoxin and interleukin-7 (IL-7) levels was assayed by EIISA. Serum procalcitonin (PCT) level was determined by chemiluminescence immunoassay, and heparin-binding protein (HBP) level was detected by immunofluorescence quantitative method. Results By end of 12-month antiviral treatment, complete virological and biochemical responses were obtained in the two groups, and there were no significant differences as respect to serum bilirubin, ALT and AST levels in the two groups (P>0.05); serum DAO, D-lactic acid, endotoxin and urine L/M ratio in the observation group were (2.8±0.6)U/mL, (7.9±1.8)μg/mL, (0.5±0.1)EU/mL and (7.3±1.6)%, all not significantly different compared to [(3.0±0.5)U/mL, (7.8±2.2)μg/mL,(0.6±0.1)EU/mL and (8.1±1.9)%, respectively, P>0.05] in the control; serum PCT, HBP and IL-7 levels were (0.01±0.00)μg/L, (43.1±3.7)ng/mL and (768.9±20.3)pg/mL, also not significantly different as compared to [(0.02±0.01)μg/L,(47.6±3.2)ng/mL and (743.4±21.5)pg/mL, respectively, P>0.05] in the control groups. Conclusion Both TAF or ETV has a satisfactory antiviral efficacy in treatment of patients with compensated hepatitis B-induced LC, without intestinal barrier function damage.

Objective The purpose of this study was to investigate anti-fibrotic efficacy of tenofovir disoproxil fumarate (TAF) and Fufang Biejia Ruangan tablet, an herbal Compound, in the treatment of patients with hepatitis B-induced liver cirrhosis (LC). Methods 116 patients with hepatitis B-induce LC were encountered in our hospital between June 2021 and June 2023, and we randomly assigned them to receive TAF (control, n=58) or TAF and herbal Compound combination (observation, n=58) for treatment of six months. Serum HBV DNA loads, and HBsAg and HBeAg levels were routinely assayed. Serumhyaluronic acid (HA), laminin (LN), procollagen type III (PIIIP) and collagen type IV (CIV) levels were detected by radioimmunoassay, and portal vein diameter (PVD), splenic vein diameter (SVD), splenic thickness (ST) and splenic length (SL) were detected by ultrasonography. Results By end of six month treatment, serum ALT level in the observation group were (43.1±6.2)U/L, much lower than [(62.6±7.8)U/L, P＜0.05]in the control, and there were no significant differences as respect to total serum bilirubin, serum albumin and INR (P>0.05)between the two groups; serum HBV DNA returned to negative, and serum HBsAg and HBeAg levels didn’t change in all patients in the two groups; serum HA,PIIIP and CIV levels in the observation were (82.2±10.3)ng/L, (94.8±11.5)ng/mL and (61.3±7.5)ng/mL, all significantly lower than [(123.1±11.9)ng/L, (132.1±13.8)ng/mLand (89.7±9.1)ng/mL, respectively, P＜0.05] in the control; SWE was (11.2±2.0)kPa, much lower than [(14.1±2.5)kPa, P＜0.05] in the control, and there were no significant differences respect to portal vein diameters and splenic vein diameters (P>0.05) between the two groups. Conclusion Administration of tenofovir disoproxil fumarate and Compound Fufang Biejia Ruangan tablets combination in the treatment of patients with hepatitis B-induced LC could improve liver function tests normal and have anti-fibrotic efficacy, which needs long-term investigation.

Objective This clinical trial was conducted to investigate serum thrombopoietin (TPO) level and blood platelet count changes in patients with hepatitis C-induced liver cirrhosis (LC) receiving direct-acting antiviral agent (DAA) treatment. Method 69 patients with chronic hepatitis C (CHC), 23 patients with hepatitis C-induced LC and 68 patients with hepatitis C-induced LC and complicated thrombocytopenia (TP)were enrolled in this study between February 2019 and June 2022, and all were treated with sophobuvir/vipatavir for 12 weeks. After discontinuation of the regimen, all patients were followed-up for 24 weeks. Serum TPO levels were assayed by ELISA. Results The white blood cell count, platelet count and serum albumin level in patients with LC and TP were (5.0±1.3)×10⁹/L, (67.2±13.5)×10⁹/L and (32.9±1.4)g/L, all significantly lower than [(8.2±1.0)×10⁹/L, (182.8±32.7)×10⁹/L and (39.7±1.8)g/L, respectively, P<0.05] in patients with CHC or [(7.5±1.2)×10⁹/L, (145.5±27.6)×10⁹/L and (35.7±1.5)g/L, respectively P<0.05] in patients with LC, while total serum bilirubin level and international normalization rate of prothrombin time were (29.5±6.3)μmol/L and (1.4±0.3), both much greater than [(17.1±5.9)μmol/L and (1.0±0.2),P<0.05] in patients with CHC; the early virological response, end-of-treatment response and sustained virological response in patients with LC and TP were 60.3%, 70.6% and 66.2%, all significantly lower than 87.0%, 100% and 97.1%(P<0.05) in patients with CHC or 73.9%, 82.6% and 82.6%(P<0.05) in patients with LC; at the end of the antiviral regimen, serum TPO levels in patients with LC and LC with complicated TP increased greatly [(68.3±15.0)pg/ml vs. (42.5±17.6)pg/ml, P<0.05]and [(52.8±16.7)pg/mlvs. (37.2±13.5)pg/ml, P<0.05], and peripheral blood platelet counts increased simultaneously [(184.9±33.8)×10⁹/L vs. (145.5±27.6)×10⁹/L,P<0.05]and [(101.0±26.3)×10⁹/L vs. (67.2±13.5)×10⁹/L, respectively, P<0.05]. Conclusion The DAA treatment could improve thrombocytopenia besides antiviral efficacy, which might be related to the elevated serum TPO levels in patients with hepatitis C-induced LC, and warrants further clinical investigation.

Objective This study was conducted to summarize clinical feature, risk factors and prognosis of patients with extra-liver abscesses(ELA) and decompensated liver cirrhosis(DLC). Methods 79 DLC patients with ELA and 49 cirrhotics with liver abscesses (LA) were encountered in our hospital between October 2016 and October 2021, and all patients in the two groups were managed by antibiotic administration and local drainage or surgical operation. Bacterial culture and characterization were carried out routinely. Results The causes of LC in both groups were predominantly hepatitis B viral infections, accounting for 60.8% and 50.1%, respectively (P>0.05), and a significant lower proportion (2.5%)of concurrent biliary stones in the ELA group was foundas compared to (59.2%) in the LA group (P<0.05); there was no significant disparity in the prevalence of coexisting diabetes mellitus between the two groups(3.9% vs.22.4%(P>0.05); predominant causative organisms in both groups were gram-negative bacteria,withEscherichia Coli(22.5% vs. 17.6%) and KlebsiellaPneumoniae(20.0% vs. 35.3%) being the most prevalent; the abscess inELA group included skin and soft tissue abscess (SSTA) in 42 cases and deepabscess (DA) in 37 cases; the recovery rate in patients with ELA was 67.1%, much lower than91.8%(P＜0.05) in those with LA; the predisposing factors in patients with DA included recurrent fever, repeated hospitalization because of infection, liver failure and invasive manipulation, and delayed hospitalization was more common (P＜0.05). Conclusion ELA is frequently occurred in patients withDLC with a bleak prognosis, especially in those with DA, and the prevalent pathogens are Klebsiella Pneumoniae and Escherichia Coli. Refraining from predisposing factors and early seeing doctors might improve the prognosis.

Objective This study was aimed at investigating clinical efficacy and safety of camrelizumab and sorafenibcombination therapy in the treatment of patients with advanced hepatocellular carcinoma (aHCC). Method 62 consecutive patients with aHCC were encountered in our hospital between January 2021 to January 2023, and we assigned them to receive camrelizumab and sorafenib combination or to receive sorafenib alone treatment. All patients were followed-up to September 30, 2023. Results Objective response rate was 41.9%, and disease control rate was 87.1%, both much higher than 16.1% and 64.5%(P<0.05) in the control; up to September 30, 9 patients (29.0%) in the combination group and 8 patients (25.8%, P>0.05) in sorafenib-treated group survived; in combination group, median progression free survival was 7.3 mon (95% CI:5.66-8.94), and overall survival was 15.6 mon(95% CI:11.84-19.34), while in the control, they were 4.9 mon(95%CI:3.92-5.88)and 10.1 mon(95% CI:8.59-11.71), both significantly different between the two groups (P<0.05);the incidence of immune thyroiditis was 25.8%, reactive cutaneous capillary hyperplasia was 32.2% and fatigue was 64.5% in the combination group, much higher than 0.0%, 0.0% and 35.5% (P<0.05) in the control. Conclusion Combination of camrelizumab and sorafenib in the treatment of patients with aHCC is encouraging, which might prolong survival and the adverse effect is under control.

Objective The aim of this study was to investigate CT wholeliver perfusion image feature in patients with primary liver cancer (PLC) and evaluation of residual lesions after transcatheter arterial chemoembolization (TACE). Methods 94 patients with PLC were enrolled in our hospital between January 2021 and August 2023, and all underwent TACE therapy. All patients were examined by 128-slice dual-source CT machine before andone month after surgery, and blood volume (BV), blood flow (BF), hepatic artery perfusion volume (ALP), hepatic perfusion index (HPI), starting time (TTS) and portal vein perfusion volume (PVP) were recorded. Receiver operating characteristic curve (ROC) was applied toevaluate efficacy of CTperfusion parameters in evaluating residual lesions after TACE. Results Before TACE, CT scan revealed uniform hyperperfusion in 59 lesions, uneven hyperperfusion in 35 lesions and low perfusion on PVP image; one month after TACE, complete remission was found in 21 cases (22.3%), with low perfusion on ALP image, and lipiodol deposition or partial deposition in 73 cases, with high hyperperfusion on ALP image; one month after TACE, BV,BF, ALP and HPI in 21 complete remission lesions were (5.3±1.2)ml/100 ml, (42.7±7.6)ml/(100 ml·min^-1), (15.1±3.7)ml/(100 ml·min^-1) and (19.5±2.1)%, all significantly lower than [(11.2±1.9)ml/100ml, (84.4±10.4)ml/(100 ml·min^-1), (38.9±5.7)ml/(100 ml·min^-1) and (74.4±8.9)%, P<0.05], while TTS and PVP were (11.9±2.1)s and (45.7±4.5)ml/(100 ml·min^-1), both significantly greater than [(6.4±1.4)s and (12.2±2.1)ml/(100 ml·min^-1), P<0.05] before TACE; after TACE, ALP and HPI in residual lesions were (46.1±6.2)ml/(100 ml·min^-1)and (81.0±5.9)%, both much greater than [(38.5±5.3)ml/(100 ml·min^-1)and (75.3±5.6)%, P<0.05], while PVP was (7.7±2.5)ml/(100 ml·min^-1), much lower than [(11.8±2.1)ml/(100 ml·min^-1),P<0.05] before TACE; ROC analysis showed that the AUC was 0.940, with sensitivity of 87.7% and specificity of 89.4%, when combination of CT wholeliver perfusion image parameters in evaluating residual lesions after TACE. Conclusion Primary liver cancer lesions are highly perfused on dual-source CT whole liver perfusion imaging, and combined perfusion imaging parameters has a satisfactory evaluation of residual lesions after TACE.

Objective The aim of this study was to investigate postoperative analgesia by transversus abdominis plane block(TAPB) with ropivacainein patients with primary liver cancer (PLC) undergoing laparoscopic hepatectomy. Methods 49 patients with PLC were encountered in our hospital between April 2021 and June 2023, and all underwent laparoscopic hepatectomy. The patients were assigned to receive TAPB with ropivacaine (n=26) or normal saline (n=23) for post-operational analgesia. Visual analogue scales (VAS)was conducted, and peripheral blood lymphocyte subsets were determined by FCM. Serummalondialdehyde(MDA), superoxide dismutase(SOD)and total-antioxidant capability(T-AOC)were assayed. Results by 24 hours and 48 hours after operation, rest VAS score in TAPB group were (2.1±0.5)points and (2.0±0.6)points, both significantly lower than [(2.8±0.7)points and (2.7±0.6)points, P＜0.05], and motion VAS score were (3.5±0.8)points and (2.8±0.6)points, also much lower than [(4.1±1.0)points and (3.7±1.0)points, P＜0.05] in control group; before and after operation, there were no significant differences as respect to peripheral blood lymphocyte subset percentages between the two groups (P＞0.05); by 24 hours, serum MDA level in the TAPB group was (3.6±0.8)mmol/L, significantly lower than [(4.9±1.6)mmol/L, P<0.05], while serum SOD and T-AOC levels were (81.0±10.3)U/mL and (21.4±3.9)U/mL, both much higher than [(72.2±11.3)U/mL and (15.6±4.3)U/mL, P<0.05] in the control; there was no significant difference in adverse events between the two groups (7.7% vs. 17.4%,P=0.400). Conclusion The TAPB with ropivacaine in PLC patients after laparoscopic hepatectomy could alleviate postoperative pain, which might inhibit body inflammatory reaction and protect antioxidant capacity.

Objective The aim of this study was to observe the contrast-enhanced ultrasound (CEUS) feature and short-term efficacy of microwave ablation (MWA) in patients with liver metastatic neuroendocrine tumors(LMNET). Methods 30 patients with LMNET arose from gastrointestinal tract were admitted to the First Affiliated Hospital, Air Force Military Medical University between January 2017 and January 2022, and all underwent CEUS check-up and MWA under US guidance. Results The arrival time, time to peak and resolution time by CEUS in the 30 patients with LMNET were (17.2±3.5)s, (22.3±4.5)s and (40.9±13.1)s, and the enhancement modes included global enhancement in 24 cases (80.0%) and centripetal enhancement in 6 cases (20.0%); at peak enhancement, the lesions showed uniform, heterogeneous and circular enhancement in 18 cases (60.0%), in 8 cases (26.7%) and 4 cases (13.3%); at portal vein phase, the lesions showed mild and obvious subsides in 10 cases (33.3%) and in 20 cases (66.7%); the CEUS enhancement patterns of the lesions included fast-in and fast-out, average-in and fast-out, slow-in and fast-out in 15 cases (50.0%), in 9 cases (30.0%) and 6 cases (20.0%); after intervention of MWA, the complete remission, partial remission, stable disease and progressive disease were obtained in 21 cases(70.0%),4 cases(13.3%),3 cases (10.0%) and 2 cases (6.7%). Conclusion The most LMNET arise from the gut, and the CEUS scan showoverall and uniform enhancement, with obvious subside at portal vein phase. The short-term efficacy by MWA ispromising.

Objective This study was conducted to investigate impact of activation of bile neutrophil extracellular trap network(NETN) on relapse of patients with choledocholithiasis after endoscopic retrograde cholangiopancreatography (ERCP) treatment. Methods 120 patients with choledocholithiasis were encountered in our hospital between January 2020 and December 2021, all patients underwent ERCP for removal of bile stones and were followed-up for 18 months. During ERCP, bile was collected for detection of myeloperoxidase (MPO), neutrophil elastase (NE) and citrullinated histone H3(CitH3) levels. Multivariate Logistic regression analysis was used to reveal risk factors affecting recurrence of common bile duct stones after surgery. Results The ERCP was completed successfully in our series, and by 18 months after operation, bile stone recurred in 21 cases (17.5%); baseline numbers of duodenal papilla diverticulum and common bile duct stones and incidences of mechanical lithotripsy in patients with recurred stones were 28.6%,(2.6±0.7) and 57.1%, all significantly higher than 5.0%, (1.9±0.8) and 28.3%(P<0.05), peripheral white blood cell count and neutrophil ratio were (7.7±2.0)×10⁹/L and (83.8±8.7)%, much higher than [(6.2±2.1)×10⁹/L and (70.5±6.2)%, respectively, P<0.05], and serum C-reactive protein, total serum bilirubin and carbohydrate antigen 199levels were (37.2±4.7)mg/L,(65.4±14.3)μmol/L and (152.9±37.4)kU/L, all significantly higher than [(8.8±2.2)mg/L, (16.7±4.2)μmol/L and (17.2±2.9)kU/L, respectively, P<0.05] in patients without stone recurrence; bile MPO, NE and CitH3 levels in patients with recurred stones were (34.7±5.4)U/L, (22.4±5.0)ng/L and (0.34±0.09)μg/L, all much higher than [(18.1±2.9)U/L, (14.5±2.7)ng/L and (0.12±0.05)μg/L, respectively, P<0.05] in patients without recurred stones; multivariate Logistic regression analysis showed that baseline concurrent duodenal papilla diverticulum, common bile duct stone numbers, mechanical lithotripsy, as well as bile MPO, NE and CitH3 levels were all the risk factors for recurrence of bile stones after ERCP (P<0.05). Conclusion Activation of bile NETN could be involved in the formation of bile stones, and detection of its markers might be helpful in predicting recurrence of bile duct stones after operation.

Objective The aim of this study was to investigate effects of nalmefene on cognitive function recovery after anesthesia in patients with cholecystolithiasisundergoing laparoscopic cholecystectomy (LC). Methods 94 patients with gallstones were enrolled in our hospital between February 2022 and December 2023, and all underwent LC surgery. At end of conventional anesthesia, patients were randomly assigned to receive nalmefene in observation (n=47) or normal saline in control (n=47) to improve recovery. Emergence agitation was evaluated by Richmond sedation-agitation scale (RSAS), postoperative pain was evaluated by visual analogue scale (VAS), and postoperative cognitive function was evaluated by mini-mental state examination (MMSE). Serum soluble protein-100β (S100β) and neuron-specific enolase (NSE) levels were detected by ELISA. Results Spontaneous respiration recovery, eye opening, extubation time and orientation recovery in observation group were (7.1±1.3) min, (8.5±1.4)min, (10.5±1.9)min and (13.6±2.2)min, all significantly shorter than [(9.3±1.5)min, (10.4±1.7)min, (14.3±2.8)min and (18.4±2.7)min, respectively, P＜0.05] in the control; there was no significant difference respect to RSAS scores between the two groups (P＞0.05), while 30min, 60min and 3hours after extubation,VAS scores in the observation were (2.8±0.5)points, (3.2±0.8)points and (3.5±0.4)points, all much lower than [(3.8±0.9)points, (4.1±0.7)points and (4.3±0.6)points, P＜0.05] in the control; one and three days after operation, MMSE score in the observation were (26.8±1.0)points and (27.7±0.7)points, both significantly higher than [(25.1±0.9)points and (26.0±0.8)points, P＜0.05] in the control; one day after surgery, serum NSE and S100β levels in the observation were (14.7±2.1)μg/L and (155.6±17.8)pg/mL, both much lower than [(17.3±2.7)μg/L and (169.5±20.4)pg/mL, P＜0.05]in the control group. Conclusion Administration of nalmefene at end of conventional anesthesia could relieve postoperative pain and accelerate cognitive function recovery in patients with cholecystolithiasis after LC operation.

Objective The aim of this study was to compare post-operational analgesia by erector spinae plane block (ESPB) or by transversus abdominis plane block (TAPB) in patients with intrahepatic lithiasis undergoing laparoscopic hepatic lobectomy. Methods 94 patients with intrahepatic bile duct stones were enrolled in our hospital between October 2021 and October 2023, and all patients underwent laparoscopic hepatic lobectomy. For post-operational analgesia, 47 patients were assigned to receive ESPB under ultrasound (US) guidance and another 47 patients to receive TAPB under US guidance. Visual analogue scale (VAS) and Ramsay sedation score scale were applied to assess the postoperative analgesia and sedation. Serum cortsisol (Cor), norepinephrine (Ne) and epinephrine (E) levels were detected by ELISA. Results At 6 hours, 12 hours and 24 hours after surgery, VAS scores in patients receiving ESPB were (3.1±0.6)points, (3.3±0.7) points and (3.2±0.6)points, all significantly lower than [(3.8±0.7)points, (4.1±0.7)points and (3.9±0.8)points, P<0.05] in patients receiving TAPB; at 48hours after operation, serum Cor, Ne and E levels were (264.2±29.7)pg/ml, (2.8±0.6)pg/ml and (203.9±26.8)pg/ml, all significantly lower than [(306.3±33.2)pg/ml, (3.5±0.8)pg/ml and (257.8±32.3)pg/ml, respectively, P<0.05] in those receiving TAPB; analgesic pump compressions was (4.8±1.3) times, much less than [(6.1±1.8) times, P<0.05] in patients receiving TAPB; incidence of adverse events were 14.9% vs. 17.0%, not statistically different between the two groups (P>0.05). ConclusionIn patients with intrahepatic lithiasis undergoing laparoscopic hepatic lobectomy, ultrasound-guided ESPB could achieve a satisfactory analgesia post-operationally, which might relieve bodystress reactions.

Objective The aim of this study was to investigate anesthesia of oxycodone hydrochloride and propofol combination by target-controlled infusion in patients with choledocholithiasis undergoing endoscopic retrograde cholangiopancreatography (ERCP) treatment. Methods In this clinical trial, we enrolled 75 patients with imaging-confirmed choledocholithiasis between June 2021 and June 2023, and all underwent ERCP for removal of common bile duct stones. We randomly assigned patients to receive target-controlled infusion of propofol and remifentanil (control, n=37) or intravenous infusion of oxycodone hydrochloride before target-controlled infusion of propofol for anesthesia induction and maintenance. The mean arterial pressure (MAP), heart rate (HR) and anesthesia depth (BIS) were routinely monitored before induction (T0), 5 min after induction (T1), at the time of endoscopy to duodenal papilla (T2) and at the end of surgery (T3). Serum cortisol (Cor) levels was detected by radioimmunoassay, serum norepinephrine (NE) level was measured by ELISA, and serum glucose (Glu) level was detected by hexokinase method. Ramsay score was used to evaluate the sedation status, and visual analogue scale (VAS) was adopted to evaluate the analgesia effect. Results By T2, MAP in the observation decreased by 2.8%(95%CI:-5.0%-0.1%, P<0.05),HR decreased by 4.3%(95%CI:-6.6%-0.1%, P<0.05), and BIS decreased by 2.1%(95%CI:-2.4%-0.2%, P<0.05) as compared to in the control; serum Cor level decreased by -11.7%(95%CI:-13.6%-1.1%, P<0.05), serum NE level decreased by 10.3%(95%CI:-15.4%-0.04%, P<0.05), and blood Glu level decreased by 11.9%(95%CI:-16.2%-1.7%, P<0.05) compared to those in the control; by 30 minutes after waking-up (N1) and 2 hours after waking-up (N2), the VAS scores in the observation decreased by 14.3%(95%CI:-16.0%-1.6%, P<0.05) and 16.0%(95%CI:-18.1%-1.9%,P<0.05) as compared to those in the control; the dosage of propofol used in the observation decreased by 9.6%(95%CI:-14.7%-3.1%, P<0.05) compared to that in the control. Conclusion The intravenous administration of oxycodone hydrochloride and target-controlled infusion of propofol for anesthesia in patients with choledocholithiasis undergoing ERCP has clinically meaningful anesthesia, with relatively small effect on intraoperative hemodynamics and less body stress reaction.

Objective The pyroptosis is an inflammatory programmed cell death,which is characterized by the formation of plasma membrane pores mediated by caspase and the release of a large number of inflammatory mediators.In recent years,the morphological characteristics,induction mechanism and action process of pyroptosis have been gradually revealed. The pyroptosis is related to the progress of many diseases,especially in the pathogenesis of malignant tumors. In this article, we reviewed the pyroptosis and its roles in the occurrence,development and treatment of patients with hepatocellular carcinoma.