Objective The purpose of this study was to investigate sequential or combined rescue antiviral therapy by tenofovir amibufenamide (TMF) in entecavir(ETV)-treated chronic hepatitis B (CHB) patients with low-level viremia(LLV). Methods Eighty-nine patients with CHB who had ETV treatment for at least 24 months were encountered in our hospital between January 2021 and December 2023, and high-sensitive PCR detection found complete virological response (CVR) in 52 cases and LLV in 37 cases. For rescue antiviral therapy, ETV and TMF combination was given in 14 patients, switching to TMF in 12 patients and continuation on ETV in 11 patients for 48 weeks. Multivariate Logistic regression analysis was applied to find risk factors for LLV occurrence. Results Baseline serum ALT and AST levels in patients with LLV were (36.0±5.2)yr, (54.2±7.0)U/L and (43.5±7.4)U/L, all much younger or lower than [(38.9±5.8)yr, (143.0±6.8)U/L and (85.4±7.1)U/L, respectively, P<0.05], while serum HBV DNA load, HBeAg positive rate, HBsAg level and liver stiffness measurement (LSM) were (7.2±2.6)lg IU/ml, 82.7%, 6300.8(5123.9, 8912.4)IU/ml and (8.6±1.0)kPa, all much higher than [(5.4±1.4)lg IU/ml, 40.5%, 3002.0(2413.4, 4512.4)IU/ml and (7.1±0.7)kPa, respectively, P<0.05] in those with CVR; multivariate Logistic regression analysis showed that high serum HBV DNA loads, serum HBeAg positive and high serum HBsAg levels were all the independent risk factors for occurrence of LLV (P<0.05) in CHB patients receiving ETV antiviral treatment; by end of 48 week rescue therapy, serum HBV DNA transferred to negative, serum ALT and LSM were (35.1±4.7)U/L and (6.9±0.6)kPa in patients with ETV and TMF combination treatment, much superior to in other two groups (P<0.05). Conclusion LLV could occur in CHB patients receiving ETV antiviral therapy, and combination of ETV and TMF is an efficacious choice for rescue therapy, which needs long-term clinical observation.

Objective The aim of this study was to investigate changes of peripheral blood mononuclear cell (PBMC) galectin-3 and galectin-9 in patients with chronic hepatitis B (CHB) and concomitant metabolism-related fatty liver disease(MAFLD). Methods 138 CHB patients with MAFLD and 95 CHB patients were admitted to Affiliated Hospital, Hebei University between January 2021 and February 2024, and PBMCs were isolated and galectin-3 messenger ribonucleic acid (mRNA) and galectin-9 mRNA was detected by real-time fluorescence quantitative PCR. The influencing factors were determined by multivariate unconditional Logistic regression analysis, and the diagnostic performance of galectin-3 mRNA and galectin-9 mRNA for CHB with MAFLD was analyzed by receiver operating characteristic curve (ROC). Results Galectin-3 mRNA and galectin-9 mRNA in PBMCs in CHB and MAFLD group were (1.6±0.3) and (1.4±0.2), both significantly higher than in CHB group [(1.3±0.1) and (1.2±0.1), respectively, P＜0.05]; Logistic analysis showed that body mass index, hypertension, type 2 diabetes, hyperlipidemia, HOMA-IR, galectin-3 mRNA and galectin-9 mRNA loads were all the independent risk factors for CHB patients having MAFLD (P<0.05); the area under the curve (AUC) for PBMC galectin-3 mRNA and galectin-9 mRNA combination in predicting CHB with MAFLD was 0.888, much greater than 0.785 by galectin-3 mRNA or 0.791 by galectin-9 mRNA alone (P＜0.05). Conclusion PBMC galectin-3 mRNA and galectin-9 mRNA loads are abnormally increased in patients with CHB and concomitant MAFLD, and the combination of the two parameters might help predict the existence of MAFLD in patients with CHB.

Objective The aim of this study was to investigate sound touch elastography (STE) in predicting liver fibrosis (LF) in patients with chronic hepatitis B (CHB). Methods 79 patients with CHB were recruited in our hospital between January 2021 and March 2024, and all of them underwent liver biopsy. Liver stiffness measurement (LSM) was obtained by STE. The receiver operating characteristic (ROC) curve was applied to evaluate diagnostic performance of LSM in predicting significant LF. Results Of 79 patients with CHB, liver histo-pathological examination showed S0 in 17 cases, S1 in 30 cases, S2 in 15 cases, S3 in 10 cases and S4 in 7 cases; serum ALT and AST levels in patients with S2/S3 were much higher than in patients with S0/S1 (P<0.05); LSM in patients with SO, S1, S2, S3 and S4 were (6.3±0.5)kPa, (7.7±1.2)kPa, (8.9±1.4)kPa, (11.3±1.0)kPa and (15.7±1.2)kPa, suggesting gradually increasing trend; the AUC was 0.974 (95%CI:0.912-0.996), with sensitivity of 97.1%, specificity of 85.1% and accuracy of 94.6%, when LSM=8.3 kPa was set as cut-off-value in predicting significant LF (defined as >=S2). Conclusion STE technique could be used in predicting LF in patients with CHB, which might add more measures for early diagnosis.

Objective This study was conducted to investigate efficacy of pegylated interferon α-2a (peg-IFNα-2a) and albavir/granrivir combination in the treatment of patients with chronic hepatitis C (CHC). Methods 74 patients with CHC were encountered in our hospital between January 2018 and January 2022, and we assigned them to receive peg-IFNα-2a and albavir/granrivir combination therapy (observation, n=37) for 12 weeks, or to receive peg-IFNα-2a and ribavirin combination therapy (control, n=37) for 24 weeks. Serum HCV RNA loads and other laboratory tests were recorded. Results Rapid virological response rate, end of treatment virological response rate and sustained virological response rate in observation group were 70.3%, 97.3% and 94.6%, all significantly higher than 37.8%, 62.2% and 54.1% in the control (P<0.05); by week 4, week 12 and week 24 of follow-up, serum HCV RNA loads in the observation were (1.6±0.8)lg u/ml, (1.5±0.9)lg u/ml and (1.2±0.3)lg u/ml, all significantly lower than [(4.3±0.9)lg u/ml, (4.5±0.8)lg u/ml and (3.2±0.5)lg u/ml, respectively, P<0.05] in the control; by end of antiviral treatment, peripheral blood WBC, RBC, PLT counts and Hb concentration in the observation were (5.1±1.0)×10⁹/L, (4.9±0.6)×10¹²/L, (101.8±17.5)×10⁹/L and (120.5±19.5)g/L, all significantly higher than [(3.3±0.9)×10⁹/L, (4.3±0.5)×10¹²/L, (85.8±17.3)×10⁹/L and (100.3±16.3)g/L, respectively, P<0.05] in the control, and serum ALT and AST levels were (34.6±5.8)U/L and (36.4±6.9)U/L, both much lower than [(46.3±6.9)U/L and (49.1±7.5)U/L, respectively, P<0.05] in the control group. Conclusion Combination of peg-IFN α-2a and albavir/graniclovir in treatment of patients with CHC could obtain a satisfactory antiviral efficacy, improve liver function recovery.

Objective The aim of this study was to investigate correlation of serum volatile organic compounds (VOCs) to and body inflammatory index in patients with metabolism-related fatty liver disease(MAFLD): an analysis based on 2017-2020 National Health and Nutrition Examination Survey database (NHANES). Methods Data from NHANES database from 2017 to 2020 were retrieved, patients who met diagnosis of MAFLD were enrolled and their laboratory tests, including serum VOCs levels and results of questionnaires were collected. Systemic inflammatory response index (SIRI) and systemic iImmunoinflammatory index (SII) were calculated. Multivariate Logistic regression modeling was applied to analyze correlation of the two inflammatory indicators to serum VOC content. Results SII in 2991 patients with MAFLD was (531±325), SIRI was (1.8±1.01), serum 1,4-dichlorobenzene level was (1.2±8.2) ng/mL, and serum 2,5-dimethylfuran level was (0.1±0.1) ng/mL; serum 2,5-dimethylfuran level was positively correlated with SIRI (r=0.3, P<0.05) and with SII (r=0.3, P<0.05) in patients with MAFLD; by multivariate Logistic regression modeling analysis, serum 2,5-dimethylfuran level was found to be associated with SIRI (β=1.8±0.3, P<0.05) and with SII (β=696.7±122.4, P<0.05) in unadjusted model; the model adjusted by age found that SIRI (β=2.0±0.3, P<0.05) and SII (β=709.1±123.9, P<0.05) were positively correlated to serum 2,5-dimethylfuran level; serum 2,5-dimethylfuran level was found to be still correlated to SIRI (β=1.7±0.3, P<0.05) or to SII (β=655.8±129.7, P<0.05) by adjusting the model for age, gender, body mass index (BMI), waist circumference (WC), smoking, hypertension, diabetes, total triglycerides (TG), alanine Aminotransferase (ALT), high-density lipoprotein (HDL) and high sensitivity C-reactive protein (hsCRP). Conclusion Exposure of individuals to higher levels of 2,5-dimethylfuran could exacerbate body systemic inflammatory response, which might trigger MAFLD occurrence.

Objective The aim of this study was to investigate characteristics of ileal microbiota in patients with metabolic associated fatty liver disease (MAFLD). Methods 54 patients with MAFLD and 18 individuals for physical examination were recruited in our hospital between January 2024 and November 2024, all underwent FibroScan scan for controlled attenuation parameter (CAP) and endoscopy with special device for ileal specimen collection. 16S rDNA sequencing was performed. Results Patients with MAFLD in our series were divided into mild, moderate and severe liver steatosis, with 18 cases in each; patients with MAFLD had an elevated Alpha diversity of ileal flora, with a gradual decrease in percentage of Turicibacter, a reduction in abundance of Lactobacillus and Veillonella, while having an increase in the abundance of Prevotella, Leptotrichia and Porphyromonas. Conclusion The diversity and abundance of ileal microbiota in patients with MAFLD change, which is related to the severity of the entity. The reduction of Turicibacter and the migration of oral colonizing bacteria might be characteristics of the ileal microbiota in patients with MAFLD.

Objective The aim of this study was to investigate oral bicyclol administration in patients with type 2 diabetes mellitus (T2DM) and non-alcoholic steatohepatitis (NASH). Methods A total of 102 patients with T2DM and nonalcoholic fatty liver disease (NAFLD) were enrolled in our hospital between January 2021 and October 2023, and out of them, NASH was diagnosed in 48 cases. Patients with NASH were randomly assigned to receive metformin in 24 cases (control) or receive metformin and bicyclol combination in another 24 cases (observation) for six months. Fasting blood glucose (FPG) and glycosylated hemoglobin (HbA1C) were routinely detected, fasting insulin (FINS) level was determined by radioimmunoassay, and homeostasis model assessment of insulin resistance index (HOMA-IR) was calculated. Results By end of six month treatment, serum AST and ALT levels in the observation group were (51.3±7.3)U/L and (49.6±9.4)U/L, both much lower than [(82.8±7.6)U/L and(98.7±11.1)U/L, respectively, P<0.05] in the control; serum total cholesterol, triacylglycerol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol levels in the observation were(5.5±0.7)mmol/L, (2.7±0.4)mmol/L, (3.2±0.4)mmol/L and (1.1±0.4)mmol/L, all not significantly different compared to [(5.5±0.6)mmol/L, (2.6±0.5)mmol/L, (3.2±0.5)mmol/L and (1.1±0.3)mmol/L] in the control (P>0.05); HbA1c, FPG, FINS and HOMA-IR were (6.9±0.8)%, (5.4±1.2)mmol/L, (5.4±0.7)μU/ml and (1.2±0.3), all not significantly different as compared to [(6.7±0.7)%, (5.2±1.1)mmol/L, (5.3±1.1)μU/ml and (1.2±0.5)] in the control group (P<0.05). Conclusion Oral bicyclol could short-termly reduce serum liver function test parameters in patients with NASH and underlying T2DM, which is worthy of further study.

Objective The aim of this study was to investigate efficacy of estimated glucose disposal rate (eGDR) in predicting risk of metabolism-associated fatty liver disease (MAFLD) in individuals without type 2 diabetes mellitus (T2DM). Methods 468 non-diabetic individuals with MAFLD and 100 non-diabetic healthy persons were encountered in the First Affiliated Hospital, Naval Medical University between July and December 2023, clinical materials were routinely obtained, and eGDR were calculated. Multivariate Logistic regression analysis was applied to reveal risk factors of MAFLD in non-diabetic population. All subjects were divided into Q1 to Q4 groups based on the eGDR quartiles, and the prevalence of MAFLD in each group was compared. ROC curve was plotted to evaluate the efficacy of eGDR in predicting MAFLD. Results Of individuals without diabetes in our series, MAFLD patients were older and more male than in healthy controls; BMI, systolic blood pressure, diastolic blood pressure, serum triglyceride, total cholesterol, low density lipoprotein-cholesterol, fasting blood glucose, glycated hemoglobin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transpeptidase, creatinine, urea nitrogen and uric acid levels were all higher (all P<0.001) , while serum high density lipoprotein-cholesterol and eGDR were lower (all P<0.001) than in control persons; multivariate Logistic regression analysis showed that age and BMI were independent risk factors for the occurrence of MAFLD, while diastolic blood pressure and eGDR were independent protective factors (P<0.05) in persons without diabetes; ROC analysis showed that the AUC of eGDR reduction in predicting the risk of MAFLD existence was 0.939 (95% CI:0.910 to 0.969, P<0.001), with a maximum Yoden index of 0.775, corresponding to an optimal cut-off value of 10.85 mg/kg/min, with a sensitivity of 89.5% and a specificity of 88.0%; Q4 group had the lowest prevalence of MAFLD (38.0%) compared to other three groups. Conclusions eGDR is a non-invasive and easily available indicator of insulin resistance. The decrease of eGDR is associated with the increased risk of MAFLD in non-diabetic individuals, and it has a good predictive efficacy for MAFLD.

Objective The aim of this study was to evaluate diagnostic performance of six non-invasive evaluation scores for type 2 diabetes mellitus (T2DM) with metabolic associated fatty liver disease (MAFLD). Methods A total of 282 patients T2DM, of them MAFLD was diagnosed in 158 cases, were enrolled in our hospital between January and December 2023, and from conventional clinical materials, metabolic score for insulin resistance (METS-IR), triglyceride-glucose index(TyG), triglyceride glucose-body mass index (TyG-BMI), hepatic steatosis index (HSI), Framingham steatosis index (FSI) and Zhejiang University index (ZJUI) were calculated. The diagnostic efficacy of these scores was assessed by using receiver operating characteristic (ROC) curve analysis. Results All the six non-invasive evaluation scores were significantly greater in patients with T2DM and MAFLD than in those with T2DM (P<0.05); the predicting AUC by TyG-BMI was 0.857(95% CI:0.814-0.900), and the AUC by ZJUI was 0.852(95% CI:0.808-0.896), suggesting both having a satisfactory diagnostic performance. Conclusion Both TyG-BMI and ZJU index have an excellent predictive value for identifying MAFLD from patients with T2DM, offering potential tools for clinical screening and monitoring.

Objective The aim of this study was to investigate acupoint application and exercise prescription in the treatment of patients with non-alcoholic fatty liver disease (NAFLD). Methods 81 patients with NAFLD were encountered in our hospitalbetween June 2022 and June 2024, and were randomly divided into control group (n=40) and observation group (n=41). Patients in the control group received lipid-lowering therapy with dietary intervention, and those in the observation received acupoint application and exercise prescription. The intervention lasted for three months in the two groups. Serumtumor necrosis factor-α(TNF-α), interleukin 6 (IL-6), irisin and adiponectin (APN) levels were detected by ELISA, controlled attenuation parameter (CAP) was determined byFibrotouch, and generic quality of life inventory 74 (GQOLI-74) and health promoting lifestyle profile (HPLP)were evaluated. Results By end of three month intervention, body mass index, waist-to-hip ratio and ,WHR and percentage of body fat in the observation group were(24.3±2.6)kg/m², (0.6±0.2)and (27.3±2.8)%, all much lower than [(26.1±2.7)kg/m², (0.7±0.1)and (29.6±3.1)%,P<0.05] in the control; serum total cholesterol,triacylglycerol and low-density lipoprotein cholesterol levels were(5.5±0.7)mmol/L, (1.7±0.3)mmol/Land (3.2±0.5)mmol/L, all much lower than[(5.9±0.7)mmol/L, (2.6±0.4)mmol/L and (4.2±0.5)mmol/L, respectively, P<0.05], while serum high-density lipoprotein cholesterol level was(1.3±0.4)mmol/L, much higher than [(1.0±0.3) mmol/L,P<0.05] in the control; serumalanine aminotransferase,aspartate aminotransferase and CAP were(40.3±4.5)IU/L, (42.1±4.6)IU/L and (267.8±7.8)dB/m, all significantly lower than[(93.4±5.6)IU/L, (61.7±5.9)IU/Land (288.3±10.9)dB/m, respectively, P<0.05] in the control; serum TNF-α and IL-6 levels were(401.5±42.3)pg/mL and (18.6±2.8)mg/L, both significantly lower than [(461.2±48.6)pg/mLand (28.7±3.1)mg/L, respectively, P<0.05], while serum irisin and APN levels were (9.4±1.2)ng/mL and (19.3±2.1)μg/mL, both significantly higher than[(7.6±0.9)ng/mLand (13.4±1.8)μg/mL, respectively,P<0.05] in the control group; GQOLI-74 score, and regular exercise, scientific dietand adequate sleep rates were(81.2±8.5)points, and 87.8%, 85.4%and 82.9%, all much higher than [(76.3±7.6)points, 62.5%, 60.0%and 62.5%, respectively, P<0.05] in the control. Conclusion Acupoint application and exercise prescription is efficacious in the treatment ofpatients with NAFLD,which might improve body fat metabolism and alleviate inflammatory reactions.

Objective The aim of this study was to investigate diagnostic performance of ultrasound attenuation coefficient (AC) and serum alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio in evaluating liver steatosis in patients with nonalcoholic fatty liver disease (NAFLD). Methods 70 patients with NAFLD and 30 volunteers for healthy physical examination were admitted to our hospital between May 2021 and May 2024, and all patients with NAFLD received liver biopsies. Ultrasonic attenuation imaging (ATI) was performed to measure AC, and serum ALT and AST levels were routinely detected. Receiver operating characteristic (ROC) curves were applied to analyze predicting efficacy of AC and serum ALT/AST ratio combination for liver steatosis in patients with NAFLD. Results Of 70 patients with NAFLD in our series, liver histo-pathological examination showed liver steatosis of mild degree in 20 cases, moderate in 28 cases and severe in 22 cases; AC in patients with severe liver steatosis was (1.1±0.4)dB·cm^-1·MHz^-1, much higher than [(0.8±0.3)dB·cm^-1·MHz^-1, P＜0.05] in moderate or [(0.6±0.2)dB·cm^-1·MHz^-1, P<0.05] in mild and [(0.5±0.1)dB·cm^-1·MHz^-1, P＜0.05] in healthy persons, and serum ALT/AST ratio was (1.0±0.1), much lower than [(1.3±0.2), P＜0.05] in moderate or [(1.7±0.4), P＜0.05] in mild and [(1.8±0.5), P＜0.05] in healthy control; ROC analysis showed that the AUC was 0.882(95%CI:0.745-0.961), with sensitivity (Se) of 92.9% and specificity (Sp) of 75.0%, when AC and ALT/AST ratio combination in predicting moderate liver steatosis (P＜0.05), and the AUC was 0.902(95%CI:0.804-0.978), with Se of 95.5% and Sp of 85.0%, when the two parameters combined in predicting severe liver steatosis, much superior to any parameter doing alone (P＜0.05). Conclusion Combination of AC and serum ALT/AST ratio might help clinicians for early liver steatosis screening, which needs further clinical investigation.

Objective The aim of this study was to explore implication of serum osteocalcin (OCN), β-I type collagen carboxy-terminal peptide (β-CTX) and angiotensin-II(Ang-II) levels in patients with non-alcoholic fatty liver diseases(NAFLD). Methods 101 patients with NAFLD, including simple fatty liver (SFL) in 32 cases, nonalcoholic steatohepatitis (NASH) in 50 cases and fatty-related liver cirrhosis (LC) in 19 cases, and 53 healthy individuals who underwent for physical examinations were enrolled in our hospital between June 2022 and December 2023, and all received Fibroscan scan for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). Serum OCN level was detected by ELISA, serum β-CTX level was determined by electrochemiluminescence immunoassay, and serum Ang-II level was measured by using fully automated chemiluminescence instrument. Results CAP in patients with SFL was much higher than in healthy control(P＜0.05), serum ALT and AST levels, as well as LSM and CAP in patients with NASH and with LC were much higher than in patients with SFL or healthy individuals (P＜0.05), and LSM in patients with LC was much higher than in with NASH(P＜0.05); serum OCN and β-CTX levels in patients with NASH were (17.3±6.3)ng/mL and (0.3±0.1)ng/mL, both significantly lower than [ (22.8±6.4)ng/mL and (0.4±0.2)ng/mL, respectively, P＜0.05] in patients with SFL, while serum Ang-Ⅱ level was (2.7±0.5)μg/L, significantly higher than [(2.4±0.4)μg/L, P＜0.05] in patients with SFL; serum Ang-Ⅱ level in patients with LC was (3.0±0.6)μg/L, much higher than in with NASH(P＜0.05); serum OCN and β-CTX levels in 19 patients with advanced liver fibrosis were(16.0±6.9)ng/mL and (0.2±0.1)ng/mL, both significantly lower than [(19.6±6.0)ng/mL and (0.4±0.1)ng/mL, respectively, P＜0.05], while serum Ang-Ⅱ level was (3.1±1.5)μg/L, much higher than [(2.5±0.7)μg/L, P＜0.05] in 31 patients with significant liver fibrosis. Conclusion Abnormal changes of serum OCN, β-CTX and Ang-II levels in patients with NAFLD is common, which might help assess steatosis and fibrosis.

Objective The aim of this study was to explore diagnostic performance of shear wave elastography and aspartate aminotransferase/platelet ratio index (APRI) combination in predicting significant liver fibrosis (SLF) in patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Methods 73 patients with T2DM and NAFLD were enrolled in our hospital between January 2021 and December 2023, and all underwent transient elastography (TE) to obtain liver stiffness measurement (LSM), underwent shear wave elastography to obtain Yang’s modulus, and routine blood detection for APRI. Receiver operating characteristic (ROC) curves were drawn for assess diagnostic efficacy, and the consistency between shear wave elastography and APRI combination, and LSM in the diagnosis of SLF was analyzed by Kappa test. Results SLF was found in 19 cases (26.0%) based on LSM＞7.4 kPa; body mass index, percentage of concomitant renal injury, serum AST, ALT level, LSM, APRI and Yang’s modulus in patients with SLF were (30.7±2.8)kg/m², 42.1%, (92.3±10.5)U/L, (120.5±9.6)U/L, (12.7±3.1)kPam (1.2±0.4) and (10.7±3.1)kPa, all much higher than [(25.2±2.4)kg/m², 20.4%, (49.8±8.1)U/L, (47.8±7.3)U/L, (6.1±1.6)kPa, (0.8±0.3) and ((5.1±1.6))kPa, respectively, P＜0.05] in patients without SLF; the ROC analysis showed that the AUC was 0.891, with sensitivity of 94.7% and specificity of 74.1%, when Yang’s modulus and APRI combination in predicting SLF in patients with T2DM and with underlying NAFLD, much superior to any parameters doing alone (P＜0.05); Kappa value between shear wave elastography and APRI combination, and TE in the diagnosis of SLF was 0.563 (P<0.05), suggesting moderate result. Conclusion Shear wave elastography and APRI combination in predicting SLF in patients with T2DM and NAFLD is efficacious, which might guide clinicians for further management.

Objective The aim of this study was to explore clinical implication of serum microRNA-122 (miR-122), interleukin-1beta (IL-1β) and IL-10 levels in patients with drug-induced liver injury (DILI). Methods 139 patients with DILI and 75 individuals for physical examination were admitted to our hospital between January 2023 and June 2024, and thecatalogue of patients with DILI included cholestatic type in 39 cases, hepatocyteinjury type in 86 cases and mixed type in 14cases, and grade 1 in 43 cases, grade 2 in 60 cases and grade 3 in 36 cases based on liver injury severity. Serum miR-122 level was detected by real-time reverse transcription polymerase chain reaction (RT-PCR), and serum IL-1β and IL-10 levels were assayed by ELISA. Results Serum bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gamma-glutamyl transferase levels in patients with DILI were(48.6±7.9)μmol/L, (117.9±35.8)U/L,(112.8±42.3)U/L, (193.2±46.5)U/L and (377.6±88.8)U/L, all significantly higher than [(10.3±3.2)μmol/L, (24.8±5.4)U/L, (23.1±4.0)U/L, (49.7±17.8)U/L and (50.4±4.2)U/L, respectively, P＜0.05] in the control; serum miR-122 level in patients with mixed type was(11.5±2.6)and in those with hepatocyteinjury typewas(10.9±1.6), both much higher than [(9.0±1.5),P＜0.05] in those with cholestatic type, serum IL-1β level in patients with mixed type was (105.3±3.8)pg/mL and in those with hepatocyte injury type was (101.8±3.2)pg/mL, both much higher than [(90.6±13.0)pg/mL, P＜0.05] in those with cholestatic type, while there were no significant differences as respect to serum IL-10 levels among the three groups (P＞0.05); serum miR-122 level in patients with grade 3 was (12.5±1.2), and in those with grade 2was (10.3±1.4), both much higher than [((8.6±1.5),P＜0.05] in patients with grade 1 liver injury, serum IL-1β level in patients with grade 3 was (105.1±13.2)pg/mL, and in those with grade 2 was (100.7±13.4)pg/mL, both significantly higher than [(88.8±13.1)pg/mL, P＜0.05] in those with grade 1, while serum IL-10 level in patients with grade 3 was (1.9±0.8)pg/mL, and in those with grade 2 was (2.1±0.9)pg/mL, both significantly lower than [(2.8±1.1)pg/mL, P＜0.05]in those with grade 1 liver injury. Conclusion Serum miR-122,IL-1β and IL-10 level changes in patients with DILI might hint severity of liver injuries, and warrant further clinical investigation.

Objective The purpose of this study was to summarize clinical feature of patients with drug-induced autoimmune-like hepatitis(DI-ALH). Method A retrospective analysis was conducted on clinical data of patients with drug-induced liver injury (DILI) in our hospital between January 2018 and January 2023, and all patients underwent liver biopsies. Immunosuppressant was given to those with autoimmune phenomenon. Result Of 312 patients with DILI, DI-ALH was found in 73 patients who presented as persistent liver injury after discontinuation of suspected medicine, elevated serum globulin level, and positive autoantibodies; percentage of herbal medicine-induced liver injury (HILI) in patients with DI-ALH was much higher than in patients with DILI(P＜0.05), serum cholinesterase level was much lower, while total serum bile acid (TBA), bilirubin, globumin and IgG levels were much higher than in patients with DILI (P＜0.05); liver histo-pathological injuries were more severe in patients with DI-ALH; of 70 patients with DI-ALH receiving immunosuppressant, disease remission (DR) rate was found as 48.6% and incomplete response (ICR) was 51.4% after three month treatment; baseline serum IgG levels in patients with ICR was much higher than in those with DR (P＜0.05), and liver injuries in ICR group were more severe (P＜0.05). Conclusion Autoimmune reaction might be involved in patients with DILI, especially in those who take herbal medicine, immunosuppressant might be tentatively given and the long-term efficacy still need observation.

Objective The aim of this study was to compare the efficacy of plasma exchange (PE) and hemofiltration (HF) at different start-up time in the treatment of patients with acute-on-chronic hepatitis B liver failure (HBV-ACLF). Methods 126 patients with HBV-ACLF were enrolled in our hospital between March 2021 and March 2024, and all patients underwent PE/HF therapy. Artificial liver supporting system (ALSS) treatment started early (less than 72 hours after admission) in 89 cases (observation), and started lately (72 hours thereafter) in 37 cases (control). Results ALSS carried out repeatedly for (3.4±1.4)times in the observation group, much less than [(4.6±1.1)times, P<0.05] in the control, while 28-day and 90 day survivals were 84.2% and 67.4%, much higher than 67.6% and 48.6%(P<0.05) in the control; by three months after treatment, serum HBV DNA went to negative in all the patients in the two groups; there were no significant differences as respect to serum potassium, sodium and chlorine levels before and after ALSS treatment in the two groups(P>0.05); after treatment, total serum bilirubin level, prothrombin time activity and serum albumin level in 60 survivals in the observation group were (25.8±7.6)μmol/L, (68.2±9.3)% and (34.7±2.8)g/L, not significantly different as compared to [(28.4±5.9)μmol/L, (63.7±8.6)% and (35.6±2.5)g/L, respectively, P<0.05] in 18 survivals in the control group. Conclusion ALSS treatment should start as early as possible after admission in patients with ACLF, and any delay and hesitancy might decrease successful rescue rate.

Objective This clinical trial was conducted to compare anticoagulational effect of nafamostat mesylate (NM) and unfractionated heparin (UFH) during double plasma molecular adsorption system (DPMAS) treatment in patients with liver failure(LF). Methods We retrospectively analyzed clinical materials of LF patients underwent DPMAS treatment in Department of Gastroenterology, Shanxi Bethune Hospital between May 2023 and May 2024. During the procedure, NM as an anticoagulant was given at dose of 60 mg for piping with thereafter 35 mg.h^-1 maintaining. Prothrombin time activity(PTA), international normalized ratio (INR), activated partial thromboplastin time (APTT) and blood platelet counts were routinely detected. Results 27 patients with LF were enrolled and received 62 times of DPMAS treatments, of which UFH was used in 21 times and NM was used in 41 times; after DPMAS treatment, elongation APTT and INR in NM group were 1.3(-3.6, 9.0)% and 2.5(-8.5, 16.6)%, both significantly less than [271.1(49.0, 816.5)% and 68.9(44.8, 118.8)%, respectively, P<0.05] in UFH group, and reduction rates of PTA and PLT counts were (4.2±23.7)% and 4.6(1.3, 7.6)%, both significantly lower than [(46.5±24.3)% and (13.0±12.6)%, respectively, P<0.05] in UFH group; there was no significant difference as respect to incidences of hypotension (9.8% vs. 14.3%, P>0.05), and no bleeding was found between the two groups. Conclusion Impact of nafamostat mesylate on coagulation function tests and platelet counts in patients with LF during DPMAS treatment is relatively small, and needs further clinical investigation as a limited cases observed.

Objective The aim of this study was to investigate the diagnostic performance of sound touch elastography (STE) and semi-quantitative ultrasound scoring in assessing early liver cirrhosis (LC) in patients with chronic hepatitis B(CHB). Methods A total of 103 patients with CHB were enrolled in our hospital between January 2022 and June 2024, and all underwent liver biopsies and Color Doppler ultrasonography for semi-quantitative ultrasound scores and elasticity modulus (E) values. Fibrosis index based on 4 factors (FIB-4) was routinely calculated. The diagnostic efficacy of ultrasonic indexeswas analyzed by receiver operating characteristic (ROC) curves. Results Of 103 patients with CHB, liver histo-pathological examination found early LC in 37 cases (35.9%); total score of semi-quantitative ultrasound in patients with LC was (13.9±1.7)points, much higher than [(8.6±1.2)points, P＜0.05] in patients with CHB; E value in LC group was (11.5±2.9)kPa, significantly greater than [(7.4±1.6)kPa, P＜0.05] in CHB group; peripheral blood platelet count in LC group was (112.7±41.9)×10⁹/L, much lower than [(159.6±58.3)×10⁹/L, P＜0.05], while FIB-4 score was (2.4±0.3)points, much greater than [(1.5±0.6),P＜0.05] in CHB group; the AUC was 0.963(95%CI:0.906-0.990), with sensitivity of 89.2% and specificity of 94.5%, when the E value with combination of semi-quantitative ultrasound score in predicting early LC in patients with CHB, much superior to that by any one of the parameters(P＜0.05). Conclusion STE and semi-quantitative ultrasound score have a very satisfactory diagnostic efficacy in predictingearly LC in patients with CHB, which warrant further clinical investigation.

Objective The purpose of this study was to investigate prevalence and risk factors of overt hepatic encephalopathy (HE) in hepatitis B-induced liver cirrhosis (LC). Methods 60 patients with hepatitis B-induced LC were recruited in our hospital between March 2019 and March 2021, and consecutively followed-up for two years. Third lumbar skeletal muscle index (L3-SMI) was obtained by abdominal CT scan, esophageal varices (EV) was determined by gastroscopy, and HE was diagnosed by West Haven score. Multivariate Logistic regression analysis was applied to find risk factors. Results HE was found in 25 cases during the two-year follow-up period; baseline serum bilirubin, INR, EV incidence, hepatorenal syndrome, Child-Pugh score, MELD score and sarcopenia incidence in patients with HE were (35.3±8.5)μmol/L, (1.4±0.5), 68.0%, 72.0%, (15.6±2.3) points, (21.6±2.5)points and 80.0%, all much higher than [(20.6±9.3)μmol/L, (1.2±0.3), 25.7%, 17.1%, (9.2±1.6)points, (15.5±3.2)points and 34.3%, respectively, P＜0.05], while serum albumin level, peripheral blood platelet count and L3-SMI were (29.3±5.6)g/L, (62.3±13.5)×10⁹/L and (43.1±8.9)cm²/m², all much lower than [(33.2±5.9)g/L, (85.2±15.6)×10⁹/L and (46.3±8.5)cm²/m², respectively, P＜0.05] in cirrhotics without HE; multivariate Logistic regression analysis showed that PLT(OR=3.442, INR(OR=3.677), EV (OR=3.647, Child-Pugh class (OR=4.191), MELD score (OR=4.614), sarcopenia (OR=4.651) and L3-SMI (OR=4.468) were all the independent risk factors for occurrence of HE in patients with LC (P<0.05). Conclusion Clinicians should take common risk factors of complications, such as HE, into consideration as dealing with patients with LC, which might improve the prognosis.

Objective The aim of this study was to investigate clinical efficacy of endoscopic variceal ligation (EVL) and somatostatin and esomeprazole combination in the treatment of patients with liver cirrhosis (LC) with complicated esophagogastric variceal bleeding(EVB). Methods Consecutive 77 patients with LC and complicated EVB were encountered in our hospital between April 2022 and April 2024, and were randomly divided into control (n=38) and observation (n=39) group, receiving intravenous infusion of somatostatin and esomeprazole, or receiving EVL plus intravenous infusion of the two medicines. Portal vein diameter (Dpv), portal vein blood flow velocity (Vpv) and portal vein blood flow volume (Qpv) were detected by Doppler ultrasonography. Results For hemostasis, blood transfusion, bleeding-stopping time, supplemented albumin and hospital stay in the observation group were (240.3±131.4)mL,(3.7±0.5)h,(10.4±2.9)g and (5.7±0.8)d, all much less or shorter than [(596.2±238.9)mL, (44.3±4.1)h, (44.2±12.5)g and (11.6±1.4)d, respectively, P<0.05]in the control; 14 days after treatment, Vpv and Qpv in the observation were (15.8±2.2)cm/s and (944.2±245.5)mL/min, both significantly faster or greater than [(13.4±2.3)cm/s and (776.7±170.6)mL/min, respectively, P<0.05] in the control; serum fibrinogen level was(2.9±0.5)g/L, much higher than [(2.2±0.6)g/L, P<0.05] in the control; the emergent hemostasis rate in the observation was 97.4%, much higher than 84.2%(P<0.05)in the control; by end of six month follow-up, re-bleeding rate was 2.6% and esophagogastric varices relapse was 7.9%, both much lower than 18.8% and 25.0%(P<0.05)in the control group. Conclusion EVL at base of intravenous infusion of somatostatin and esomeprazole in the treatment of patients with LC and EVB is efficacious with high emergent hemostasis, and less rebleeding and low EV relapse.

Objective The aim of this study was to explore prediction of esophageal varices bleeding (EVB) by liver ultrasound blood flow parameters and liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) in patients with liver cirrhosis (LC). Methods 89 patients with hepatitis B-induced LC were enrolled in our hospital between January 2022 and February 2023, all underwent gastroscopy and EV was recorded and classified. All patients underwent Doppler ultrasonography to detect portal vein diameter (PVD), congestion index of portal vein (PV-CI), portal vein velocity (PVV) and damping index of hepatic vein (HV-DI). LSM and SSM were detected by FibroTouch. The sensitivity (Se) and specificity (Sp) of different indexes in predicting EVB were analyzed by area under the receiver operating characteristic (ROC) curve (AUC). Results Gastroscopy showed EV in 57 cases(64.1%)in our series; HV-DI, PVD, PV-CI as well as LSM and SSM in patients with EV were (0.9±0.2), (1.7±0.4)cm, (0.4±0.1)cm/s, (19.3±3.6)kPa and (46.1±11.6)kPa, all significantly higher than [(0.7±0.1), (1.4±0.2)cm, (0.2±0.1)cm/s, (12.3±3.1)kPa and (34.5±7.9)kPa, respectively, P<0.05], while PVV was (15.8±3.3)cm/s, significantly lower than [(19.2±2.5)cm/s, P<0.05] in those without EV; HV-DI, PVD, PV-CI, LSM and SSM in 16 patients with severe EV were significantly higher than in 20 patients with moderate EV or in 21 patients with mild EV, while PVV was much lower than in with moderate or mild EV (P<0.05); during one year of follow-up, EVB occurred in 34 cases (59.7%) of 57 patients with EV; ROC analysis showed that HV-DI, PVV, PVD, PV-CI, LSM and SSM could predict EVB occurrence, and combination of them had a satisfactory efficacy, with the AUC of 0.885(95%CI:0.757-0.916), Se of 97.1% and Sp of 80.0%, much superior to mono-parameter(P<0.05). Conclusion Liver ultrasonic blood flow parameters and LSM and SSM combination has a high efficacy in predicting EVB occurrence in patients with LC, which warrants further clinical investigation.

Objective The aim of this study was to explore CT portography (CTP) quantitative parameters in predicting portal hypertension and esophagogastric variceal bleeding (EVB) in patients with decompensated liver cirrhosis (DLC). Methods A total of 98 patients with decompensated hepatitis B-induced liver cirrhosis were encountered in our hospital between January 2021 and March 2023, and all underwent CTP, gastroscopy and portal pressure gradient (PPG) determination. Patients were followed-up for 12 months, and receiver operating characteristic (ROC) curve was applied to evaluate predictive performance. Results Of 98 patients with liver cirrhosis in our series, esophagogastric varices (EV) was found in 47 cases(48.0%) and significant portal hypertension (SPH) in 45 cases (45.9%); diameters of main portal vein, splenic vein, left gastric vein, left branch and right branch of intrahepatic portal vein in patients with SPH were (17.6±1.8)mm, (15.9±1.9)mm, (6.1±1.3)mm, (13.0±1.3)mm and (12.6±1.7)mm, all significantly greater than [(14.9±2.0)mm, (14.0±2.0)mm, (4.6±1.6)mm, (11.3±1.4)mm and (11.3±1.6)mm, respectively, P＜0.05] in those with non-SPH(NSPH); during 12-month follow-up, EVB occurred in 22 cases (22.5%), and baseline diameters of five portal veins mentioned above in patients with EVB were all much greater than in those without EVB(P＜0.05); the AUC was 0.830(P＜0.05), with sensitivity (Se) of greater than 75.6% and specificity (Sp) of greater than 79.3%, or the AUC was 0.755(P＜0.05, with Se of greater than 68.2% and Sp of greater than 71.1% in predicting SPH or EVB when any combination of three parameters from the five was met. Conclusion CTP quantitative parameters have certain clinical diagnostic efficacy in predicting SPH and EVB in cirrhotic patients, and needs further investigation.

Objective The aim of this study was to investigate the efficacy of endoscopic variceal ligation (EVL) with intravenously administered somatostatin and omeprazole in the treatment of liver cirrhosispatients complicated withesophagogastric variceal bleeding (EVB). Methods 103 patients with liver cirrhosisand EVB were encountered in our hospital between January 2020 and January 2023, and were randomly divided into control (n=51) and observation (n=52) group. All patients in the two groups underwent EVL, and those in the observation were given intravenously omeprazole and somatostatin for 3 to 5 days until hemostasis, and all were followed-up for six months. Diameter and venous flow of portal vein and splenic vein were measured by color Doppler ultrasonography. Results Three patients (5.8%) in the observation group and eight patients (15.7%) in the control group died of emergent bleeding; blood transfusion volume, hemostasis time and hospitalization days in 49 survivals in the observation were (406.5±138.1)mL, (1.6±0.7)d and (5.8±1.5)d, much less or shorter than [(615.7±240.3)mL, (4.1±0.5)d and (9.1±1.7)d, respectively, P<0.05] in 43 survivals in the control; after treatment, serum albumin level in the observation was (33.4±5.3)g/L, much higher than [(31.3±4.6)g/L, P<0.05], and serum fibrinogen level was (4.2±0.5)g/L, much higher than [(3.8±0.4)g/L, P<0.05] in the control; peripheral blood platelet count, hematocrit and hemoglobin levels in the observation group were(219.3±20.1)×10⁹/L, (36.4±4.2)% and (109.6±6.1)g/L, all much higher than [(176.2±19.5)×10⁹/L, (31.7±4.3)% and (91.2±7.0)g/L, respectively, P<0.05] in the control; there were no significant differences as respect to diameters and blood flow of portal vein and splenic vein in the two groups (P>0.05); by end of six month follow-up, re-bleeding occurred in one patient (2.0%)in the observation group and survived, and it occurred in three patients (7.0%)in the control, and one (2.3%)of them died. Conclusion EVL and intravenous administration of somatostatin and omeprazole in dealing with patients with EVB is efficacious, which could stop intragastric bleeding definitely and effectively, and warrants further clinical investigation.

Objective The aim of this study was to investigate therapeutic efficacy of FOLFOX in hepatic artery infusion chemotherapy (HAIC) with combination of lenvatinib and PD-1 inhibitors in treatment of patients with advanced primary liver cancer(PLC). Methods 86 patients with advanced, unresectable PLC were encountered in our hospital between January 2020 and December 2022, and were randomly assigned to receive FOLFOX through HAIC chemotherapy plus lenvatinib in 43 patients (control), or to receive sintilimab at base of regimen mentioned above in another 43 patients (observation) for three months, and followed-up for two years. Peripheral blood lymphocyte subsets were detected by FCM, and serum alpha-fetoprotein (AFP) level was assayed by ELISA. Results Complete remission rate and partial remission rate in the observation group were 11.6% and 74.4%, with total effective rate of 86.1%, both significantly higher than 4.7% and 60.5%, with total effective rate of 65.1%(P＜0.05) in the control; after treatment, percentages of peripheral blood CD3⁺ and CD4⁺ cells were (46.9±5.3)% and (40.4±5.2)%, both much higher than [(40.4±4.8)% and (34.1±4.3)%, respectively, P＜0.05], while percentage of CD8⁺ cells was (16.1±2.4)%, much lower than [(22.3±3.5)%, P＜0.05) in the control; serum AFP level was (102.6±11.2)ng/mL, much lower than [(143.0±15.4)ng/mL, P＜0.05]in the control group; serum ALT and AST levels were (49.0±4.0)U/L and (44.4±5.0)U/L, both much higher than [(41.8±4.8)U/L and (38.2±5.3)U/L, respectively, P＜0.05]in the control; by end of two-year follow-up, the survival rate in the observation group was 67.4%, with progression-free survival (PFS) of (16.2±2.8)m, significantly higher than 39.5%, with PFS of (11.8±3.2)m in the control (P＜0.05). Conclusion The combination of FOLFOX through HAIC and Lenvatinib plus sintilimab in dealing with patients with advanced PLC could elevate short-term remission rate and prolong survival, and warrants further clinical investigation.

Objective The aim of this study was to summarize clinical feature of gastrointestinal perforation (GIP) in patients with hepatocellular carcinoma (hcc). Methods 15 patients with GIP and underlying HCC were encountered in our hospital between January 2017 and July 2024, and all patients were carefully dealt with conventionally or surgically. Results Of the 15 patients with GIP and HCC, 11 were male and 4 female, with average age of (9.4±9.8) year old; 12 patients were infected with hepatitis B virus, 1 had alcoholic liver disease and 2 were cryptogenic; all the 15 patients had abdominal pain with a median duration of 2 d(1 hour,10 d); blood WBC count was (8.3±4.9×10⁹/L) with neutrophil percentage of(82.5±9.8%), serum albumin level was (29.3±5.6 g/L), and prothrombin time activity was (59.5±10.3%); the perforated sites in stomach, duodenum, jejunum, ileum and colon were 6 cases (40.0%), 2 cases (13.3%), 1 case (6.7%), 2 cases (13.3%) and 4 cases (26.7%), respectively; three patients died after supporting treatment, with an average survival of 15 days, the remaining 12 patients underwent surgical repairment, with 3 died and 9 survived; of the 9 survivals, 2 underwent liver transplantation, 4 underwent hepatic artery embolization and/or targeted and/or immune therapy, 2 underwent internal supporting treatment and 1 had regular monitoring, the outcomes were 7 died and 2 survived, with mean survival time of (22.2±19.3) months. Conclusion The patients with HCC have the risk of GIP during invasive and systemic treatment, and an appropriate surgical repairment should be done in time once it occur.

Objective The aim of this study was to investigate evaluation of intrahepatic residual lesions by magnetic resonance imaging (MRI) scan in patients with primary liver cancer (PLC) after transcatheter arterial chemoembolization (TACE). Methods 116 patients with PLC were encountered in our hospital between June 2020 and August 2022, and all underwent TACE therapy for one to three times at interval of one month. Patients were followed-up and had digital subtraction angiography (DSA), MRI and CT scan by end of three months. Diagnostic performance of MRI and CT scan was evaluated based on DSA golden criteria. Results Of 146 lesions in 116 patients with PLC, there were 103 residual tumor lesions and 43 lesions at complete remission states showed by DSA by end of three months after TACE; sensitivity, accuracy and negative predictive value by MRI scan in determining residual tumors were 92.2%, 94.5% and 84.3%, all significantly higher than 73.8%, 81.5% and 61.4% (P＜0.05) by CT scan; of 103 residual tumors after TACE, DSA found iodine oil deposition type Ⅰ in 10 cases, type Ⅱ in 51 cases, type Ⅲ in 35 cases and type Ⅳ in 7 cases; the positive rates of type Ⅰ and Ⅱ showed by MRI scan were 70.0% and 90.2%, both much higher than 10.0% and 64.7%, respectively (P＜0.05) by CT scan; after TACE therapy, MRI scan showed enveloped tumors in 54 cases (37.0%), much higher than 16 cases (11.0%) by CT scan (P＜0.05). Conclusion MRI scan has a satisfactory diagnostic efficacy in assessing residual tumor lesions after TACE therapy, which might play a pivotal role in making strategy for further treatment in this setting.

Objective This study was conducted to evaluate diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)and diffusion-weighted imaging(DWI)in patients with intrahepatic space-occupying lesions (SOL). Methods 96 patients with SOL were encountered in our hospital between January 2022 and December 2023, and all patients underwent DCE-MRI scan to record constant (Kep), volume transfer constant (Ktrans), extracellular extravascular space volume ratio (Ve) and initial enhancement curve area (iAUC) as well as apparent diffusion coefficient (ADC). Diagnosis was based on post-operational histo-pathological examination as gold standard. Diagnostic efficacy was assessed by receiver operating characteristic curve (ROC). Results Post-operational histo-pathological examination proved benign lesions in 55 cases, including hepatic adenoma in 27 cases, cirrhotic nodules in 13 and focal nodular hyperplasia of the liver in 15 cases, and malignant lesions in 41 cases, including hepatocellular carcinoma in 31 cases and intrahepatic cholangiocarcinoma in 10 cases; percentages of tumors withirregular shapes, rough edgesand uneven internal enhancement in malignant tumors were 68.3%, 65.9% and 68.3%, all much higher than 36.4%, 34.6%and 38.2%(all P＜0.05) in benign lesions; K_ep, K^trans ,V_e and iAUC in malignant lesions were (0.8±0.3)min^-1, (0.4±0.1)min^-1, (0.4±0.2) and (1.0±0.3), all significantly greater than [(0.4±0.1)min^-1, (0.2±0.1)min^-1, (0.3±0.1) and (0.7±0.2), respectively, P＜0.05], while ADC was (1.0±0.4), significantly smaller than [(1.7±0.6),P＜0.05] in benign lesions; ROC analysis showed that the specificity reached to 94.5%, with sensitivity of 70.2%, when parameters of DCE-MRI and ADC combination in determining malignant lesions. Conclusion DCE-MRI is helpful in judging the quality of intrahepatic SOL, which warrants further clinical investigation.

Objective The aim of this study was to explore implication of serum carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), cytokeratin fragment antigen( CYFRA ) 21-1 and vascular endothelial growth factor (VEGF) level changes in patients with intrahepatic cholangiocarcinoma (ICC). Methods 81 patients with ICC were admitted to our hospital between February 2020 and February 2023, and all received GEMOX chemotherapy and carelizumab treatment for 4 cycles with one cycle of 21 days. Serum CEA, CA125, CYFRA21-1 and VEGF levels were routinely detected by electrochemiluminescence immunoassay. The influencing factors of prognosis in ICC patients were analyzed by multivariate Cox regression model. Results Serum CEA, CA125, CYFRA21-1 and VEGF levels in 26 patients with multiple ICC were (18.9±3.4)ng/mL, (110.3±9.5)ng/mL, (22.1±3.8)U/mL and (268.8±12.6)pg/mL, all significantly higher than [(11.8±3.3)ng/mL, (66.8±18.0)ng/mL, (10.8±3.7)U/mL and (199.6±37.1)pg/mL, respectively, P＜0.05] in 55 patients with single ICC, serum CEA, CA125, CYFRA21-1 and VEGF levels in 52 ICC patients with lymph node metastasis were (16.5±3.4)ng/mL, (93.7±23.1)ng/mL, (17.6±5.6)U/mL and (249.6±24.5)pg/mL, all significantly higher than [[(10.4±3.6)ng/mL, (59.6±14.8)ng/mL, (9.1±3.7)U/mL and (173.6±29.5)pg/mL, respectively, P＜0.05] in 29 ICC patients without lymph node metastasis, serum CEA, CA125, CYFRA21-1 and VEGF levels in 38 patients with tumor diameter greater than 5 cm were (17.5±4.2)ng/mL, (106.5±11.0)ng/mL, (19.0±5.8)U/mL and 259.8±17.9)pg/mL, all significantly higher than [(11.2±3.1)ng/mL, (58.5±9.7)ng/mL, (10.4±3.8)U/mL and (187.9±33.6)pg/mL, respectively, P＜0.05] in 43 patients with tumor less than 5 cm, serum CEA, CA125, CYFRA21-1 and VEGF levels in 39 patients with TNM phase Ⅳ were(17.5±4.2)ng/mL, (105.5±12.1)ng/mL, (18.8±5.8)U/mL and (258.1±20.6)pg/mL, all significantly higher than [(11.1±3.0)ng/mL, (58.1±9.5)ng/mL, (10.4±3.8)U/mL and (187.8±34.0)pg/mL, respectively, P＜0.05] in 42 patients with phase Ⅱ/Ⅲ; one-year survival in 81 patients with ICC in our series was 71.6%, and multivariate Cox regression analysis showed that TNMphase Ⅲ/Ⅳ, high serum CEA, CA125 and VEGF levels were all the independent risk factors impacting prognosis of patients with ICC (P＜0.05). Conclusion High serum CEA, CA125, CYFRA21-1 and VEGF levels in patients with ICC might be related to poor prognosis, which warrants further clinical investigation.

Objective The aim of this study was to investigate serum alpha fetoprotein (AFP) level changes in predicting prognosis of children with hepatoblastoma (HB) after radical resection of tumor. Method 105 pediatric patients with HB were encountered in our hospital between January 2018 and December 2020, all underwent radical tumor resection, and were followed-up for five years. Kaplan-Meier was applied for survival analysis, and event-free survival (EFS) and overall survival (OS) were documented. Result Based on PRETEXT staging, there were stage I in 18 cases, stage II in 39 cases, stage III in 41 cases and stage IV in 7 cases in our series; at presentation, serum AFP levels in stage I, stage II, stage III and stage IV were (43261.3±17236.9)μg/L, (47823.4±16921.3)μg/L, (60489.2±18638.3)μg/L and (73482.1±20496.5)μg/L, which decreased to(11.4±0.3)μg/L, (16.5±0.9)μg/L, (28.4±4.6)μg/L and (416.3±12.1)μg/L, respectively, six months after operation; during follow-up, incidences of tumor relapse, metastasis, EFS and OS in stage I were 16.7%, 5.6%, 77.8% and 94. 4%, in stage II were 20.5%, 7.7%, 71.8% and 92.3%, in stage III were 34.1%, 12.2%, 53.7% and 78.0%, and in stage IV were 42.9%, 57.1%, 0.0% and 57.1%. Conclusion Serum AFP levels in pediatric patients with HB is correlated to tumor stages, and those with stage III and stage IV might have even high serum AFP levels, which decreases hard to normal, and indicating poor prognosis.

Objective The aim of this study was to investigate ultrasound manifestations in children with different pathological types hepatoblastoma (HB). Methods 64 children with HB were encountered in our hospital between October 2021 and October 2024, and all of them underwent abdominal color Doppler ultrasonography and surgery or biopsy for pathological examination. Expression of alpha fetoprotein, glycoprotein CD34, cytokeratin 7, CK19, integrase interactor-1, hepatocyte paraffin-1 and beta-catenin were detected immunohistochemistry. Results Liver histo-pathological examination diagnosed complete epithelial type in 43 cases, including fetal type in 14 cases and embryonic type in 29 cases, and mixed epithelial mesenchymal type in 21 cases, including teratoma-like in 13 cases and without teratoma-like in 8 cases; diameter of tumor in fetal type was (8.5±2.4)cm, much less than [(11.4±2.1)cm, P＜0.05] in tumor in embryonic type or [(10.7±2.2)cm, P＜0.05] in tumor in mixed epithelial mesenchymal type or [(10.5±2.0)cm, P＜0.05] in tumor in without teratoma-like type; percentage of hyperechoic in fetal type was 92.9%, and in embryonic type was 93.1%, both much greater than 23.1%(P＜0.05) in mixed teratoma-like or 37.5%(P＜0.05) in without teratoma-like; percentage of calcification in fetal type was 21.4% and in embryonic type was 27.6%, both much lower than 76.9%(P＜0.05)in mixed tumors with teratoma-like features or 62.5%(P＜0.05)in mixed tumors without teratoma-like features; percentage of intratumoral necrotic cystic changes in fetal tumors was 35.7%, significantly lower than 79.3% (P＜0.05)in embryonic tumors or 76.9%(P＜0.05)in mixed tumors with teratoma-like features or 75.0%(P＜0.05)in mixed tumors without teratoma-like features. Conclusion Different pathological features of HB in children could have different ultrasound manifestations, which might provide hints for pathological subtyping preliminarily.

Objective The aim of this study was to investigate intrapurulent catheter drainage under ultrasound guidance in the treatment of patients with bacterial liver abscess (BLA). Method A total of 96 patients with BLA were encountered in our hospital between October 2020 and October 2023, and were randomly divided into observation group (n=48) and control group (n=48), received intrapurulent catheter drainage or puncture drainage under ultrasound guidance. Supporting management was given in the two groups. Serum malondialdehyde (MDA), superoxide dismutase (SOD) and cortisol (COR) levels were assayed by ELISA, and serum interleukin-6 (IL-6),IL-8 and IL-12 levels were also detected by ELISA. Result All patients with BLA recovered in our series after one to three week treatment, presenting with disappeared purulent cavity, and no relapse was found by end of three month follow-up; after treatment, serum bilirubin, ALT and GGT levels in the observation group were(15.3±2.4)μmol /L, (72.4±7.5)U/L, (39.3±2.8)g/L and (79.3±19.4)U/L, all not significantly different compared to [(16.5±2.3)μmol /L, (73.2±10.3)U/L, (36.6±2.9)g/L and (73.1±22.3)U/L, respectively] in the control (P>0.05); serum SOD, COR and MDA levels in the observation were (73.3±7.5)U/mL, (117.8±8.4)nmol/L and (5.1±0.8)μmol/mL, all not significantly different as compared to [(75.4±7.1)U/mL, (118.8±8.5)nmol/L and (5.5±0.9)μmol/mL, respectively] in the control group (P>0.05); serum IL-6, IL-8and IL-12 levels in the observation were (0.2±0.1)ng/mL, (0.3±0.1)ng/mL and (81.3±16.5)ng/mL, all much lower than [(0.3±0.1)ng/mL, 0.4±0.1)ng/mL and (95.2±17.1)ng/mL, respectively, P＜0.05] in the control group. Conclusion We recommend intrapurulent catheter drainage under ultrasound guidance in dealing with patients with BLA, which might need less puncture and less antibiotic administration, with relatively quick recovery.

Objective The aim of this study was to investigate selective laparoscopic cholecystectomy (LC) after ultrasound-guided percutaneous transhepatic gallbladder puncture drainage (UG-PTGD) in treatment of patients with acute calculous obstructive cholecystitis (ACOC). Methods A total of 109 patients with ACOC were encountered in our hospital between May 2020 and May 2024, and were randomly assigned to receive LC (control, n=54) or selective LC after UG-PTGD (observation, n=55). Serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) levels were detected by ELISA. Results Operation time, intraoperative blood loss, postoperative drainage volume, anal exhaust time, extubation time and hospital stay in the observation group were (54.5±8.1)min, (33.8±7.9)mL,(18.5±2.9)mL,(21.5±4.2)h, (3.3±0.6)d and (4.5±1.5)d, all much less or shorter than [(72.6±11.4)min,(44.1±6.7)mL,(26.9±4.2)mL,(27.4±3.9)h,(4.8±0.7)d and (10.6±2.9)d, respectively, P＜0.05] in the control; post-operationally, serum AST and ALT levels were much lower than in the control (P＜0.05); serum TNF-α, IL-6 and CRP levels were (32.2±11.4)ng/mL, (116.7±12.3)pg/mL and (25.8±5.2)mg/L, all significantly lower than [(39.6±12.7)ng/mL, (127.1±19.2)pg/mL and (46.7±8.1)mg/L, respectively, P＜0.05] in the control; incidence of complications was 9.1%, much lower than 24.1%(P＜0.05) in the control group. Conclusion Emergent management by UG-PTGD, and thereafter selective LC in the treatment of patients with ACOC were safe, efficacious, which might be an alternative option in this clinical scenario.

Objective The purpose of this study was to observe the efficacy of percutaneous transhepatic gallbladder drainage (PTGD) and sequential laparoscopic cholecystectomy (LC) with preservation of main cystic artery in the treatment of patients with acute cholecystitis (AC). Methods 206 patients with AC were encountered in our hospital between October 2020 and September 2023, and were randomly divided into control (n=103) and observation group (n=103). The patients in the control group underwent PTGD and sequential conventional LC, and those in the observation group underwent PTGD and sequential LC with preservation of main cystic artery. Serum C-reactive protein (CRP), interleukin-6 (IL-6) , tumor necrosis factor (TNF-α), plasma cortisol (Cor) and norepinephrine (NE) levels were measured by ELISA. Results The operation time in the observation group was (56.5±7.2)min, much longer than [(44.3±10.4)min,P＜0.05], while the intraoperative blood loss was (16.5±3.2)ml, much less than [(67.4±14.5)ml, P＜0.05] in the control; there were no significant differences as respect to serum liver function tests before and after the operation between the two groups (P>0.05); five days after operation, serum CRP, IL-6, TNF-α and Cor levels in the observation were (18.5±2.3)mg/L, (14.5±12.3)mmol/L, (12.1±6.1)mmol/L and (56.5±17.1)ng/mL, all significantly lower than [(27.4±25.4)mg/L, (29.6±18.5)mmol/L, (25.1±8.1)m mol/L and (79.4±30.2)ng/mL, respectively, P＜0.05] in the control group; post-operationally, there was no significant difference respect to complications, such as incision infection, bile leakage and biliary injuries, between the two groups (4.9% vs. 5.8%, P>0.05). Conclusion The PTGD and sequential LC with preservation of main cystic artery could effectively reduce the intraoperative blood loss, and warrants further clinical investigation.

Objective The aim of this study was to compare the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic choledochotomy and exploration (LCE) in the treatment of patients with post-cholecystectomy choledocholithiasis. Methods Sixty patients with choledochal stones who had cholecystectomy were recruited in our hospital between February 2020 and February 2022, and we randomly assigned patients to receive LCE (observation, n=30) or ERCP (control, n=30). Serum C-peptide, cortisol (Cor), norepinephrine (Ne) and adrenocorticotrophic hormone (ACTH) levels were determined. Results The surgical successful rate and stone clearance rate in the observation group were 96.7% and 93.3%, both significantly higher than66.7% and 66.7% (P<0.05) in the control group; the operational time and medical cost in the observation group were (62.4±6.5)min and (20000.4±5000.0)yuan RMB, both much shorter or less than(106.3±8.7)min and (30000.0±8000.0)yuan RMB, P<0.05], while postoperative exhaustion time, ambulation time and hospital stay were much longer than in the control(P<0.05); five days after operation, serum Cor and Ne levels in the observation were (211.2±32.1)nmoL/mL and (5.0±0.6)nmoL/mL, significantly higher than [(152.1±41.2)nmoL/mL and (3.1±0.8)nmoL/mL, respectively, P<0.05] in the control; there were no significant differences in post-operational complications, such as bile leakage, infection, bleeding and pancreatitis between the two groups (20.0% vs. 16.7%, P>0.05). Conclusion The surgery by LCE in dealing with patients with choledocholithiasis who have gall bladder removed is promising, with high surgery success and stone clearance.

Objective The aim of this study was to investigate multimodal nalbuphine hydrochloride analgesia in patients with gallbladder polyps (GP) after laparoscopic cholecystectomy(LC). Methods 78 patients with GP were encountered in our hospital between November 2020 and March 2024, and all underwent LC surgery. For post-operational analgesia, patients were randomly divided into control and observation groups, 39 cases in each. Bilateral transversus abdominis plane block (TAP) and patient-controlled intravenous analgesia (PCIA) were conducted, nalbuphine were given in observation, and flurbiprofen ester were administered in the control. Visual analogue scale (VAS) and Ramsay sedation scale (RSS) were evaluated, and serum substance P (SP) and prostaglandin E2 (PGE2) levels were assayed by RIA. Results By 1, 4 and 12 hours after surgery, VAS scores in the observation group were(3.7±0.7)points, (4.0±0.8)points and (4.3±0.9)points, all much lower than [(4.3±0.7)points, (4.6±0.9)points and (4.9±1.0)points, P＜0.05] in the control; by 1, 4, 12 and 24 hours, RSS scores were (2.4±0.5)points, (2.6±0.6)points, (2.9±0.6)points and (2.5±0.6)points, all not significantly different compared to [(2.5±0.6)points, (2.7±0.6)points, (3.0±0.7)points and (2.6±0.5)points, P>0.05]; by 1, 4 and 12 hours, serum SP levels were (0.9±0.2)μg/mL, (2.7±0.6)μg/mL and (4.3±1.0)μg/mL, all much lower than [(1.3±0.3)μg/mL, (4.4±1.1)μg/mL and (6.5±1.3)μg/mL, respectively, P＜0.05], and serum PEG2 levels were (91.9±11.5)pg/mL, (265.3±29.6)pg/mL and (168.3±18.7)pg/mL, all much lower than [(108.8±12.7)pg/mL, (304.2±32.8)pg/mL and (183.2±20.6)pg/mL, respectively, P＜0.05] in the control group; post-operationally, first exhaust time, food intake and removal of drainage tube in the observation were(40.7±4.2)h, (41.6±3.9)h and (90.6±8.4)h, all much shorter than [(49.8±5.3)h, (50.4±21.5)h and (103.7±4.1)h, respectively, P＜0.05] in the control. Conclusion Application of nalbuphine hydrochloride in multimodal analgesia after LC is beneficial to relieve pain, which might be related to inhibition of pain-related substance release.

Liver fibrosis (LF) is closely related to poor outcomes in patients with non-alcoholic fatty liver disease (NAFLD), and early intervention is expected to improve prognosis of the disease. Percutaneous liver biopsy is the primary method for the diagnosis and staging of LF, but its wide application is limited as its invasiveness, sampling inconsistency and subjective evaluation. Recently, a lot of new non-invasive techniques have emerged for LF assessment, with advantage of convenience and repeatability. In this article, we provides a review on this topic.