Objective This experiment was conducted to explore the mechanism of protective roles of histone deacetylase (HDAC) inhibitor ACY1215 in inhibition of acute liver failure (ALF). Methods Thirty mice were randomly divided into control, model and ACY1215-intervened groups, with 10 animals in each. ALF model was established by combination of lipopolysaccharide and D-aminogalactose intraperitoneal injection, and early intraperitoneal ACY1215 injection was carried out as intervention. Histopathological examination was performed. Hepatic expression of malate dehydrogenase 1 (MDH1),isocitrate dehydrogenase (IDH1),and fructose-2,6-bisphosphatase 2 (PFKFB2) as well as interleukin-1β (IL-1β) and IL-18 were detected by Western blot. Results Histopathological examination demonstrated the ALF model was successfully established, and ACY1215 intervention greatly ameliorate liver injuries; serum ALT, AST and total bilirubin levels in the model group were (3743.5±655.9)U/L, (2539.4±488.1)U/L and (89.56±7.2)μmol/L, significantly higher than [(34.5±7.6)U/L, (32.3±9.3)U/L and (6.2±2.4)μmol/L, respectively, P < 0.05] in the control, while ACY1215 intervention greatly decreased those parameters, e.g., (951.5±328.9)U/L, (475.3±131.24)U/L and (38.41±9.5)μmol/L (P<0.05); hepatic expression of MDH1 and IDH1 in the model was obviously weaker, that of PFKFB2, IL-18 and IL-1β was greatly intensified as compared to in the control, while in ACY1215-intervende group, the expression of MDH1 and IDH1 intensified, and PFKFB2, IL-18 and IL-1β weakened compared to in the model group. Conclusion The histone deacetylase inhibitor, ACY1215, could have a protective effects on mice with ALF, the mechanism by which it exert might be related to regulation of energy metabolism enzymes.

Objective The purpose of this experiment was to investigate effects of naringin (Nar) on lipid metabolism in mice with high-fat diet (HFD) induced non-alcoholic fatty liver diseases (NAFLD). Methods Twenty-four C57BL/6J mice were randomly divided into control, model and HFD/Nar-intervention groups, with eight mice in each group. The model of NAFLD was established by HFD intake, and the intervention was carried out by naringin gavage at dose of 100 mg.kg^-1 for four weeks. Drug intervention with differential gene enrichment pathways was determined by transcriptome sequencing. Hepatic lipid metabolism related genes and their protein expression were detected by qPCR and Western blot. Results Body mass of mice in model group increased by 57.8% (P<0.01) as compared with in the control, while in naringin-intervention group, it decreased by 13.5% (P<0.01); hepatic TG and TC levels in the model were (3.5±0.4)mmol/g protein and (3.1±0.5)mmol/g protein, both much higher than [(1.0±0.3)mmol/g protein and (0.8±0.1)mmol/g protein, P<0.01] in the control, while in HFD/Nar-intervention group, they significantly decreased to [(2.1±0.4)mmol/g protein and (1.11±0.3)mmol/g protein, P<0.05]; KEGG enrichment analysis by transcriptome sequencing showed obvious impacts of naringin on nine pathways related to lipid metabolism, presenting with hepatic sterol regulatory element binding protein 1 (SREBP1), peroxisome proliferator-activated receptor-γ (PPAR-γ), thrombospondin receptor (CD36) and liver-type fatty acid-binding protein 1 (FABP1) down-regulation(P<0.05), and PPAR-α and recombinant carnitine palmitoyltransferase 1A (CPT-1A) up-regulation(P<0.05). Conclusion Naringin could significantly ameliorate hepatic lipid deposition, the mechanisms by which it work might be related to regulation of some gene expression and inhibit lipid uptake and synthesis, and accelerate fatty acid oxidation.

Objective The aim of this study was to investigate efficacy of tenofovir alafenamide fumarate (TAF) and Ganshuang granules, a herbal medicine compound, combination in the treatment of patients with chronic hepatitis B (CHB). Methods 76 patients with CHB were enrolled in our hospital between January 2020 and December 2023, and were randomly divided into control (n=38) and observation group (n=38). They were treated with TAF or TAF and herbal medicine combination for 48 weeks. Serum HBV DNA load was assayed by real-time fluorescence quantitative PCR, and serum HBeAg level was detected by chemiluminescence immunoassay. TCM syndromes scores were evaluated according to the Guidelines for the Traditional Chinese Medicine Diagnosis and Treatment of Chronic Hepatitis B (2018 Edition). Fibrosis index based on four factors (FIB-4) was obtained and liver stiffness measurement (LSM) was detected by transient elastography. Serum transforming growth factor-β1 (TGF-β), matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels were determined by ELISA. Results By end of 48 week treatment, ALT normalization rate in the observation group was 94.7%, much higher than 78.9%(P<0.05) in the control; scores of distending pain at hypochondrium, yellow and greasy tongue coating, poor appetite and nausea and yellow urine in the observation group were(0.9±0.1), (1.0±0.2), (0.9±0.1) and (0.7±0.1), all much lower than [(1.3±0.2), (1.3±0.2), (1.2±0.2) and (0.9±0.2), all P<0.05] in the control; FIB-4 score, LSM, serum TGF-β1 and TIMP-1 levels were (1.8±0.3), (7.0±0.6)kPa, (21.4±5.4)ng/mL and (119.3±19.5)ng/mL, all significantly lower than [(2.2±0.4), (9.7±1.1)kPa, (39.1±6.1)ng/mL and (168.9±22.3)ng/mL, respectively, P<0.05], while serum MMP-1 level was (9.8±1.2)ng/mL, significantly higher than [(7.1±1.0)ng/mL, P<0.05] in the control group. Conclusion Combination of TAF and Ganshuang granules in the treatment of patients with CHB could significantly reduce TCM syndrome scores, improve liver function and relieve liver fibrosis.

Objective The aim of this study was to investigate antiviral efficacy of tenofovir alafenamide (TAF) and peginterferon interferon α-2b (PEG-IFNα-2b) combination in treatment of patients with chronic hepatitis B (CHB). Methods A total of 122 patients with CHB were enrolled in our hospital between March 2021 and March 2023, and were randomly divided into control (n=61) and observation (n=61) group, receiving TAF or TAF and PEG-IFNα-2b combination for antiviral therapy for 48 weeks. Serum HBV DNA loads were detected by real-time fluorescence quantitative PCR, serum HBeAg and HBsAg levels were assayed by electrochemiluminescence, and serum Toll-like receptor 4 (TLR4) and interleukin-35 (IL-35) levels were determined by ELISA. Results By end of 24-week and 48 week treatment, serum HBeAg levels in the combination group were(195.3±36.4)IU/ml and (180.6±25.9)IU/ml, both significantly lower than [(236.1±42.5)IU/ml and (217.5±33.8)IU/ml, P＜0.05], and serum HBsAg levels were (925.1±226.9)IU/ml and (816.2±175.3)IU/ml, significantly lower than [(1028.4±251.5)IU/ml and (921.7±226.8)IU/ml, P＜0.05] in TAF-treated patients; serum HBeAg negativity rates was 21.3% and 29.5%, both significantly higher than 3.3% and 6.6%(P＜0.05) in TAF group; serum TLR4 levels were (68.6±17.4)pg/mL and (41.4±15.9)pg/mL, both much lower than [(90.1±20.5)pg/mL and (73.5±18.2)pg/mL, respectively, P＜0.05], and serum IL-35 levels were (127.9±25.5)pg/mL and (73.5±18.6)pg/mL, both much lower than [(191.4±30.6)pg/mL and (102.7±26.1)pg/mL, respectively, P＜0.05] in TAF group. Conclusion TAF and PEG-IFNα-2b combination in treatment of patients with CHB is efficacious, with a satisfactory serumHBeAg negativity, which might be related to reduced expressions of TLR4 and IL-35 and needs further investigation.

Objective The aim of this study was to investigate clinical antiviral efficacy of tenofovir amibufenamide (TMF) and entecavir (ETV) in the treatment of patients with chronic hepatitis B (CHB) and low-level viremia (LLV). Methods 79 patients with CHB were encountered in our hospital between April 2021 and April 2023, and all met enrollment criteria, e.g., receiving nucleos(t)ide analogues (NAs), including lamivudine, adefovir and ETV antiviral treatment for 4 to 22(12.1±3.6)yrs and having LLV (21 to 1999 IU/mL). Patients were divided into control (n=39) and observation (n=40) groups, receiving ETV or TMF treatment for 12 months. Serum HBV DNA loads were detected by high-sensitive real-time fluorescence quantitative PCR, serum HBsAg and HBeAg were assayed by chemiluminescence immunoassay, and routine blood and biochemical parameters were determined to obtain fibrosis-4 index (FIB-4) and estimated glomerular filtration rate (eGFR). Liver stiffness measurement (LSM) was detected by Fibroscan. Peripheral blood T lymphocyte subsets were measured by flow cytometry. Results By end of 48-week treatment, serum ALT and AST levels in the observation group were(30.2±4.0)U/L and (31.8±6.2)U/L, both not significantly different compared to [(30.9±3.6)U/L and (33.7±7.0)U/L, respectively] in the control (P>0.05), while serum HBV DNA loads was 25(14.8, 51.9)IU/mL, much lower than [223.8(87.2, 327.5)IU/mL, P<0.05] in the control; LSM, FIB-4 and eGFR were (7.0±0.8)kPa, (1.9±0.3) and (104.9±10.3)mL/min/1.73m², not significantly different as compared to [(7.1±0.9)kPa, (1.8±0.3) and (105.1±11.2)mL/min/1.73m², respectively, P>0.05] in the control; percentages of peripheral blood CD3⁺, CD4⁺, CD8⁺ cells and CD4⁺/CD8⁺ cell ratio were (66.9±6.9)%, (37.5±4.9)%, (24.0±2.5)% and (1.5±0.3), not significantly different compared to [(67.4±7.3)%, (38.8±4.6)%, (23.6±2.7)% and (1.6±0.4), respectively, P>0.05] in the control group. Conclusion TMF treatment could relatively radically inhibit HBV DNA replication in CHB patients with LLV, and long-term benefit needs further clinical investigation.

Objective This study was conducted to investigate the assessment of significant liver fibrosis (SLF) by visual instantaneous elastography (VIE) and acoustic palpation elastography (APE) in patients with chronic hepatitis B (CHB). Methods 121 patients with CHB were encountered in our hospital between October 2020 and October 2022, and all patients underwent liver biopsies for liver fibrosis staging and ultrasonography for liver stiffness measurement (LSM). The area under the receiver operating characteristic curve (AUROC) was drawn to reveal the diagnostic performance of LSM for predicting the SLF. Results Out of the 121 patients with CHB, the liver histo-pathological examination showed SLF in 95 cases, and non-significant liver fibrosis (NSLF) in 26 cases; the LSMvie and LSMape, serum aspartate aminotransferase and alanine aminotransferase levels in patients with SLF were (9.3±3.0)kPa,(9.3±3.1)kPa, (127.5±33.4)U/L and (137.8±38.8)U/L, all significantly higher than [(5.9±1.4)kPa, (6.0±1.5)kPa, (98.6±25.8)U/L and (90.5±28.7)U/L, respectively,P<0.05], while the blood platelet count was (125.8±41.5)×10⁹/L, much lower than [(192.3±51.7)×10⁹/L, P<0.05] in patients with NSLF; the sensitivity, specificity, accuracy, positive predictive value and negative predictive value by VIE in predicting SLF in patients with CHB were 95.8%, 88.5%, 94.2%, 96.8% and 85.2%, not significantly different as compared to 94.7%, 84.6%, 92.6%, 95.7% and 81.5% by APE (P>0.05). Conclusion The diagnostic accuracies of VIE and APE in predicting SLF in patients with CHB are both great, which might be useful in clinical practice, and warrants further investigation.

Objective This study was aimed to investigate serum von Willebrand factor (vWF) and soluble vascular cell adhesion molecule-1 (VACM-1) level changes in patients with hepatitis C viral infection. Methods 38 patients with chronic hepatitis C (CHC) and 38 patients with hepatitis C-induced liver cirrhosis (LC) were enrolled in our hospital between June 2020 and December 2022, and all received sofosbuvir, daclatasvir and ribavirin combination therapy for 12 weeks. Serum HCV RNA loads were detected by RT-PCR, and serum vWF, VACM-1 and interleukin-6 levels were assayed by ELISA. Results The rapid virological response, end treatment of virological response and sustained virological response rates in patient with LC were 81.5%,89.5% and 97.4%, not significantly different as compared to 89.5%, 92.1%and 100.0%in patients with CHC (P>0.05); at the end of antiviral therapy, the white blood cell count and platelet count in patients with LC were(4.7±0.9)×10⁹/L and (139.5±42.1)×10⁹/L, much lower than [(6.8±2.2)×10⁹/L and (275.6±65.3)×10⁹/L, P<0.05], while the FIB-4 and APRI scores were (2.8±1.6) and (0.6±0.3), much higher than [(0.7±0.9) and (0.2±0.1), respectively, P<0.05] in patients with CHC; serum vWF and sVCAM-1 levels in patients with LC were (134.3±44.3)ng/mL and (36.6±14.9)ng/mL, significantly higher than [(103.9±33.0)ng/mL and (18.7±8.9)ng/mL, respectively, P<0.05] in patients with CHC. Conclusion The application of DAAs in treating patients with HCV infection is efficacious, which might improve endothelial function, and needs further study.

Objective The aim of this study was to investigate the clinical antiviral efficacy of dalatavir (DCV) and asulivir (ASV) combination in the treatment of naïve patients with chronic hepatitis C (CHC) with genotype 1b infection. Methods 53 naïve patients with CHC and genotype 1b infection were enrolled in our hospital between October 2019 and October 2021, and all of them received the combination regimen of DCV and ASV therapy for 24 weeks, and were followed-up for 24 weeks. Serum HCV RNA loads, blood biochemical indexes and liver fibrosis index levels were detected. The drug resistance-related mutations of NS5A were detected by direct sequencing. Results At week 1, 2, 4, 8, 12 and 24 treatment, and at the end of 24 week follow-up, serum HCV RNA loss rates in the 53 patients with CHC were 3.7%, 9.4%, 43.3%, 69.8%, 83.0%, 94.3% and 94.3%, and serum HCV RNA loads were (5.8±0.1)lg IU/ml, (5.3±0.6)lg IU/ml, (3.5±0.5)lg IU/ml, (2.2±0.6)lg IU/ml, (1.0±0.2)lg IU/ml, (0.7±0.5)lg IU/ml and (0.7±0.4)lg IU/ml, all significantly lower than [(6.1±0.4)lg IU/ml, P＜0.05] at baseline; at treatment week 24 and at the end of follow-up, serum AST levels were (22.7±11.4)U/L and (20.9±9.9)U/L, both significantly lower than [(63.5±6.6)U/L, P<0.05], and serum ALT levels were (19.3±10.7)U/L and (19.2±8.5)U/L, both significantly lower than [(80.2±65.3)U/L, P＜0.05] at baseline; there were no obvious changes as respect to estimated glomerular filtration rate and blood routines during the treatment; at the end of treatment and follow-up, serum liver fibrosis indexes, such as Pc-III, HA and IV-c levels decreased greatly (P＜0.05); the drug resistance-related mutations of NS5A was found in 3 cases (5.6%), out of which, the L31Y and Y93H simultaneous mutation in one case, and Y93H mutation in two cases. Conclusion The combination of DAC and ASV in treatment of naïve patients with CHC with genotype 1b infection is definitely efficacious, without renal function injury, while the NS5A mutations needs further investigation.

Objective The aim of this study was to investigate efficacy and safety of sofosbuvir and dacatavir combination in the treatment of patients with end-stage renal disease (ESRD) and concomitant chronic hepatitis C (CHC). Methods 42 CHC patients with ESRD were encountered in our hospital between May 2020 and May 2022, and all underwent maintenance hemodialysis. DAAs regimen was carried out by sorfosbuvir and dacatavir combination for all patients for 12 weeks and followed-up for 12 months. HCV genotypes was conducted by Simmonds gene typing. Rapid virological response (RVR), end of treatment virological response (ETVR), sustained virologic response six month (SVR6) and SVR12 were recorded. Results Genotypes infected in our series were 1b in 22 cases, 2a in 9 cases, 2b in 6 cases and 3 in 5 cases; except for SVR6 and SVR12 were 80.0% in patients with genotype 3 infection, the RVR, ETVR and SVR6 and SVR12 were all 100.0%(P>0.05) in patients with other three HCV genotype infection; by end of 12 month follow-up, serum ALT level in 42 patients with CHC was 23(20, 38)U/L, AST was 21(17, 35)U/L, both significantly lower than [61(42, 92)U/L and 59(45, 83)U/L, respectively, P<0.05] at baseline, while peripheral blood platelet count was 155(130, 194)×10⁹/L, and estimated glomerular filtration rate (eGFR) was 14.9(12.5,17.3)ml/min×1.73 m², both significantly higher than [122(98, 141)×10⁹/L and 9.3(8.0, 11.5)ml/min×1.73m², respectively, P<0.05] at baseline; there were no significant differences as respect to serum creatinine and urea levels before and after antiviral treatment (P>0.05); during direct antiviral agent (DAA) therapy, incidence of eight adverse events, including nausea, fatigue, itching, anorexia, hyperkalemia, hypoglycemia, hypertension and joint pain occurred in 55 episodes. Conclusion Application of DAA in dealing with patients with ESRD and complicated CHC have a satisfactory efficacy and safety, which warrants further clinical investigation.

Objective The purpose of this study was to compare performance of NucliSens miniMag system and QIAamp Viral RNA Mini Kit in detecting serum HCV RNA loads. Methods 103 serum samples with anti-HCV positive were collected in our hospital between June 2021 and June 2023, and serum RNA was extracted by NucliSens miniMag system or QIAamp Viral RNA Mini Kit, respectively. Serum HCV RNA loads were detected by real-time fluorescence quantitative RT-PCR. Repetition and sensitivity were assessed. Results Of 103 anti-HCV positive serum samples, serum HCV RNA positive rates by NucliSens miniMag system and QIAamp system were 86.4% and 82.5% (P＞0.05); serum HCV RNA load by NucliSens miniMag system was (5.4±1.2) lg IU/mL, much higher than (5.0±1.6)lg IU/mL by QIAamp kit (t=2.078, P=0.039); coefficient of variation of lowest and highest serum HCV RNA loads by NucliSens miniMag system were 2.4% and 2.2%, much superior to 4.7% and 4.5% by QIAamp kit; lowest serum HCV RNA load by NucliSens miniMag system detection was 2.8×10^-6 lg IU/mL, much sensitive than 3.5×10^-6 lg IU/mL by QIAamp kit. Conclusion Efficacy of serum HCV RNA assay by NucliSens miniMag system is satisfactory, which could help clinicians diagnose patients with chronic hepatitis C.

Objective The aim of this study was to investigate serum interleukin-6 (IL-6), IL-8 and IL-10 level changes and their impact on response to steroid therapy in patients with autoimmune hepatitis (AIH). Methods 60 patients with AIH and 60 healthy individuals were recruited in our hospital between January 2020 and December 2023, and all patients received prednisone treatment for six months. Serum IL-6, IL-8 and IL-10 levels were measured by chemiluminescence method. Performance for predicting response to therapy was analyzed by using receiver operating characteristic (ROC) curves. Results At admission, serum IL-6 and IL-8 levels in patients with AIH were (7.5±2.5)pg/mL and (70.2±26.7)pg/mL, both significantly higher than [(4.8±1.4)pg/mL and (42.4±13.2)pg/mL, respectively, P＜0.05], while serum IL-10 levels was (4.2±1.1)pg/mL, much lower than [(7.3±2.6)pg/mL, P＜0.05] in healthy individuals; by end of six month treatment, serum IL-6 and IL-8 levels obviously decreased and serum IL-10 level increased (P＜0.05) in patients with AIH; 56.7% of patients with AIH in our series responded, while 43.3% of them didn’t completely responded to steroid therapy; at presentation, serum IL-6 and IL-8 levels in responders were (4.9±1.4)pg/mL and (47.4±15.2)pg/mL, both significantly lower than [(9.9±2.8)pg/mL and (108.3±28.7)pg/mL, respectively, P＜0.05], while serum IL-10 level was (6.9±1.9)pg/mL, much higher than [(2.7±1.6)pg/mL, P＜0.05] in non-responders; ROC analysis showed that AUC was 0.816, with sensitivity of 100.0% and specificity of 50.0%, when serum IL-6, IL-8 and IL-10 (≤4.8 pg/mL, ≤48.0 pg/mL and ＞6.8 pg/mL as cut-off-value, respectively) combination in predicting response to steroid therapy. Conclusion Serum IL-6, IL-8 and IL-10 levels in patients with AIH change abnormally, which might be involved in pathogenesis of the disease, and impact response to immunosuppression therapy.

Objective The aim of this study was to explore implication of single nucleotide polymorphism (SNP) of Rs3184504 loci in SH2B adaptor protein 3 (SH2B3) gene in patients with autoimmune liver diseases (AILD). Methods 58 patients with autoimmune hepatitis (AIH), 62 patients with primary biliary cholangitis (PBC) and 60 healthy persons were recruited in our hospital between June 2017 and October 2023, and SNP of blood SH2B3 gene at Rs3184504 locus were detected by PCR. The correlation between Rs3184504 SNP of SH2B3 gene and morbidity risk of AILD was analyzed by Logistic regression analysis. Results Proportions of TT genotype and allele T of SH2B3 gene at Rs3184504 locus in patients with AIH were 53.4% and 66.4%, and they were 54.8% and 69.4% in patients with PBC, all significantly higher than 16.7% and 26.7% (P＜0.05), while proportions of CC genotype of SH2B3 gene at Rs3184504 locus in patients with AIH and PBC were 20.7% and 16.1%, both significantly lower than 63.3%(P＜0.05) in healthy individuals; Logistic regression analysis showed morbidity risk of AIH significantly increased 2.529 times (OR=2.529, P<0.05) in patients with TT genotype of SH2B3 gene Rs3184504 locus, relatively compared to those carrying CC genotype, and morbidity risk of PBC increased 2.812 times(OR=2.812, P＜0.05) in patients with CT genotype of SH2B3 gene Rs3184504 locus and it increased 2.370 times(OR=2.370, P＜0.05) in patients with TT genotype, relatively compared to those carrying CC genotype. Conclusion Morbidity risk of AILD is related to SNP changes of SH2B3 gene at Rs3184504 locus, TT is susceptibility genotype of AIH, CT and TT are susceptible genotypes of PBC and risk of AILD is higher in individuals with T allele.

Objective The aim of this study was to explore causal relationship between cholelithiasis and primary sclerosing cholangitis (PSC). Methods Materials of patients with PSC were retrieved from International PSC Genetics Research Group (IPSCSG) and Finnish Biobank (FinnGen R10), and Mendelian randomization (MR) analysis was conducted by integrating summary data of published genome-wide association studies. Genetic instruments closely associated with cholelithiasis were extracted, and then causal relationship between cholelithiasis and PSC was estimated by using inverse-variance weighted (IVW) and weighted median (WM) methods. Finally, reverse MR was applied to assess whether PSC could lead to altered risk of cholelithiasis. Results Forward MR analysis found that genetic susceptibility to cholelithiasis could increase the risk of PSC (OR_IVW: 1.379, 95%CI: 1.052-1.807, P=0.020; OR_WM: 1.450, 95%CI: 1.014-2.074, P=0.042), and this result was validated in the FinnGen (OR_IVW: 1.989, 95%CI: 1.517-2.610, P=6.76×10^-7; OR_WM: 1.931, 95%CI: 1.302-2.865, P=0.001); reverse MR analysis found that genetically-predicted PSC did not alter the risk of cholelithiasis (OR_IVW: 1.008, 95%CI: 0.991-1.024, P=0.356). Conclusion This MR study find cholelithiasis is an important risk factor for occurrence of PSC, and the reverse causality is not established.

Objective The aim of this study was to investigate implication of serum macrophage migration inhibitory factor (MIF) and interleukin-21 (IL-21) level changes in patients with autoimmune hepatitis (AIH). Methods 61 consecutive patients with AIH were encountered in our hospital between December 2017 and November 2022, and all received standardized immunosuppressive therapy by prednisone and azathioprine combination. Liver biopsies were performed and serum MIF and IL-21 levels were assayed by ELISA at presentation. Results Serum MIF and IL-21 levels in 17 patients with clinically determined severe liver injury were (2.5±0.9)μg/L and (321.5±34.2)pg/mL, both much higher than [(1.5±0.5)μg/L and (174.7±20.5)pg/mL, respectively, P<0.05] in 44 patients with mild to moderate liver injury; serum MIF and IL-21 levels in 26 patients with histo-pathologicall proved G3-G4 inflammatory activity were (2.6±1.1)μg/L and (332.9±35.4)pg/mL, both much higher than [(1.5±0.6)μg/L and(170.8±25.4)pg/mL, respectively, P<0.05] in 35 patients with G1-G2 inflammatory activity; of our series, 54 patients (88.5%) responded biochemically to standardized immunosuppressive therapy, and serum MIF and IL-2 levels in 19 patients responded late after six months were(2.9±1.5)μg/L and (334.5±40.6)pg/mL, significantly higher than [(1.5±0.3)μg/L and (194.8±19.5)pg/mL, respectively, P<0.05] in 22 patients who responded less than six months or [(0.9±0.2)μg/L and (100.6±9.2)pg/mL, respectively, P<0.05] in 23 patients who responded less than three months. Conclusion Serum MIF and IL-21 levels in patients with AIH elevate, which might influence liver injury and response to immunosuppressive therapy, and warrants further investigation.

Objective The aim of this study was to summarize clinical feature of patients with drug-induced liver injury (DILI) in order to improve clinical management. Methods 230 patients with DILI were encountered in our hospital between March 2020 and March 2023, and the demographic data, clinical manifestations, and clinical tests were retrospectively reviewed and summarized. Serum antinuclear antibody (ANA) was assayed by Western blot, and serum IgG and IgM were detected routinely. Results Of 230 patients with DILI, obesity accounted for 45.7%, diabetes type 2 for 37.8% and hyperlipidemia for 43.5%; as for underlying diseases, infection accounted for 23.5%, cardiovascular diseases for 17.0% and tumor for 13.0%; patients with hepatocellular injury accounted for 61.7%, cholestatic injury for 24.4% and mixed type for 13.9%; one single alleged medicines accounted for 58.3%, double for 22.6%, trible for 13.0% and quadruplex for 6.1%; mild to moderate liver injury accounted for 58.7% and severe for 41.3%; serum IgM and IgG levels were normal, and serum ANA positive for 27.5%; all patients in our series recovered without death. Conclusion Patients with DILI in our series is relatively young, inappropriate medication might be involved in pathogenesis and the prognosis is good.

Objective The aim of this study was to analyze the change trends of discharge mode of hospitalized patients with liver failure over the last ten years. Methods The clinical materials of patients with liver failure, including acute liver failure (ALF), subacute liver failure (SALF), and acute-on-chronic liver failure (ACLF) and chronic liver failure (CLF), admitted to Beijing You'an Hospital between 2012 and 2021 was retrospectively collected, and analyzed. Results A total of 8512 patients with liver failure were hospitalized, of them, 5789 patients were enrolled as 2723 patients were ruled out based on exlusion criteria, with the mean age of (50.31 ± 13.49) year old, 28.7% of female, and mean hospital stay of 19.46 ± 15.19 days; the ACLF accounted for 47.3%, CLF for 42.0%, SALF for 7.9% and ALF for 2.9%; in terms of the way of discharging, the ordered accounted for 57.6%, non-ordered for 27.5%, and dead for 15.0%; the in-hospital mortality of ALF, CLF, ACLF and SALF were 52.2%, 14.2%,13.7% and 11.4%; the longitudinal analysis showed that in ALF patients, the percentage of doctor's order for discharge did not significantly changed, with in-hospital mortality fluctuating between 31.2% and 70.0%; in SALF, the percentage of discharge by medical advice increased from 55.6% to 70.8% year by year, and the in-hospital mortality decreased from 25.9% to 8.3% (P<0.001); in patients with ACLF, the proportion of discharge by medical orders increased from 47.9% to 59.7% (z=1.9677, P=0.049); in CLF patients, the proportion of patients discharged by medical order also increased from 55.8% to 75.2% (P<0.05), while the in-hospital mortality rate showed a downward trend from 20.9% to 9.3% (P<0.05) year by year. Conclusion The prognosis of patients with liver failure in our hospital has improved greatly over the past ten years, especially the discharging way by medical advice in patients with SALF, ACLF and CLF has increased year by year, but the in-hospital mortality of patients with ALF is still at a high level, so new diagnosis and treatment strategies need to be further explored.

Objective The aim of this study was to analyze influencing factors of patients with acute-on-chronic hepatitis B liver failure (HBV-ACLF) complicated by hospital-acquired pneumonia (HAP). Methods A total of 101 patients with HBV-ACLF and HAP were encountered in our hospital between January 2018 and December 2022, and all received comprehensive internal medical and liver-supporting treatment. Sputum culture and bacteria characterization were routinely performed. Univariate and multivariate Logistic regression analysis was applied to analyze independent risk factors influencing prognosis. Results Of 101 patients with HBV-ACLF and HAP, sputum obtained positive results in 76 cases (75.3%), and out of them, Gram positive pathogenic bacteria strain was found in 30 cases (39.5%), Gram negative in 11 cases (14.5%) and fungus in 35 cases (46.1%); 50 patients (49.5%) died and 51 patients (50.5%) survived during (44.7±24.4)day hospital stay; ages, plasma lactate level, model of end-stage liver disease score, percentages of concomitant spontaneous bacterial peritonitis (SBP) and gastrointestinal bleeding (GIB) in dead patients were(57.3±12.1)yr, (2.7±2.1)mmol/L, (27.5±6.9)point, 66.0% and 42.0%, all much higher than [(50±12.8)yr, (1.6±0.8)mmol/L, (22.5±7.3)point, 31.4% and 5.9%, respectively, P＜0.05] in survivals; multivariate Logistic regression analysis showed that age (OR=1.054, 95%CI:1.005-1.110), plasma lactate level (OR=2.339, 95%CI:1.255-5.031), concomitant SBP(OR=6.784, 95%CI:2.139-25.206) and GIB (OR=18.504, 95%CI:3.973-122.636) were the independent risk factors impacting prognosis (P＜0.05). Conclusion The patients with HBV-ACLF and HAP have a poor prognosis, clinicians should pay more attention to those who are elderly and with more than one complications, and take an appropriate measures in time to improve the outcomes.

Objective The purpose of this study was to analyze hospitalization costs of patients with acute-on-chronic liver failure (ACLF) under background of diagnosis-related groups (DRG) payment system with aim of providing reference for optimization of DRG payment reform. Methods Patients with ACLF were encountered in Beijing You'an Hospital, Capital Medical University between March 2022 and December 2023, clinical materials were retrieved from HIS, cost data bank and medical insurance (MI) bank, and age-adjusted Charlson comorbidity index (aCCI) was calculated. Results 377 MI-paid patients with ACLF were encountered and 147 enrolled after exclusion, male 120, female 27, with median ages of 56.0(43.5, 64.0)yr, hospital stay of 17.0(12.0, 26.5)days, aCCI of 5.0(4.0, 6.0), medical costs of 38(25, 67) thousand yuan and 2 (2, 3) thousand yuan daily, hospital fatality of 37.4%, and medical deficit rate of 53.7%; medical deficits occurred in 30% HS11 group and 49.1% HS15 group, both with mean deficits of 2 thousand yuan; patients underwent artificial liver supporting system (ALSS) therapy were assigned to HJ1 group, and 78.9% of HJ11 group cost more medical burden than MI payment, with average deficit of 100.3 thousand yuan; deficit occurred in 90.9% of HJ13 group, with average deficit of 30.5 thousand yuan; medical material costs in HJ11 group and HJ13 group accounted for 17.5% and 21.0%, both much higher than 3.8% in HS11 group or 3.0%in HS15 group(P<0.001); median hospital stay in HS11 group and HS15 group with medical surplus were 12.0 days, while hospital stays were 28.0 days and 18.5 days in those with medical deficit P<0.001); patients in HJ11 group with medical deficit were much younger and the aCCI even lower than in those with medical surplus (P<0.05). Conclusion Under implementation of DRG payment reform, patients with ACLF in most DRG-assigned groups cost medical deficits, especially in those with ASLL therapy. We recommend the hospital stay should be enrolled for DRG cost, and appropriately increase payment criteria.

Objective The aim of this study was to explore clinical efficacy ofFibroTouchand virtual touch tissue quantification (VTQ) parameters in evaluating liver fibrosis in patients with schistosomiasis-induced liver disease (SILD). Methods 58 patients withSILDwere enrolled in our hospital between February 2019 and February 2023, and they all received etiological, liver-protecting and symptomatic supporting treatment. After recovery, FibroTouch was used to detect liver stiffness measurement (LSM), and VTQ was applied to detect liver shear wave velocity (SWV). Liver biopsy was performed to evaluate liver fibrosis staging, and receiver-operating characteristic curve (ROC) was adopted to analyze diagnostic performance of FibroTouch and VTQ parameters in predicting significant liver fibrosis (SLF). Results Of 58 patients with SILD, liver histo-pathological examination showed liver fibrosis S0 stage in 7 cases (12.1%), S1 stage in 15 cases (25.9%), S2 stage in 16 cases (27.6%), S3 stage in 12 cases (20.7%) and S4 stage in 8 cases (13.8%); LSM and SWV in patients with S4 liver fibrosis were (17.4±2.0)kPa and (1.9±0.2)m/s, both significantly greater than [(15.7±3.4)kPa and (1.7±0.3)m/s,P<0.05] in patients with S3 or [(12.4±2.8)kPa and (1.5±0.4)m/s, P<0.05] in those with S2 or [(8.7±2.0)kPa and (1.3±0.3)m/s, P<0.05] in S1 or [(5.8±0.9)kPa and (1.1±0.2)m/s,P<0.05] in S0; ROC analysis showed that AUCwas 0.937, with sensitivity of 87.5% and specificity of 90.0%, when LSM and SWV combination (with 12.8 kPa and 1.5 m/s as cut-off-value, respectivley) in predicting SLF in patients with SILD. Conclusion Combination of LSM and SWV in predicting SLF in patients with SILD really has certain clinical diagnostic efficacy, which might help guide clinicians to make intervention early.

Objective The aim of this study was to investigate influencing factors of infections in patients with hepatitis B-induced liver cirrhosis (LC) and acute-on-chronic liver failure (ACLF). Methods 323 patients with hepatitis B-induced LC, 124 patients with ACLF type A (with underlying chronic hepatitis B) and 184 patients with ACLF type B (with underlying compensated LC) were encountered in our hospital during last eight years. Multivariate Logistics regression analysis was applied for influencing factors of infections, and Kaplan-Meier curves were used for 90-day survival analysis. Results Incidences of infections in patients with LC, with ACLF type A and ACLF type B were 31.0%, 32.1% and 44.0%, with spontaneous bacterial peritonitis more common; age older, serum albumin level decreased, total serum bilirubin (TSB) level and prothrombin time international standardized ratio increased, incidence of hepatic encephalopathy and gastrointestinal hemorrhage (GIH) increased in patients with infections no matter in which groups(P＜0.05); Logistics regression analysis showed that age, TSB, and GIH were all the independent risk factors for infections, while serum albumin level was a protective one; fatality rate in patients with LC was 16.0%, not significantly different compared to 15.2% in those without infection(P>0.05), while they were 57.5% in those with ACLF type A and 65.4% in with ACLF type B, both significantly higher than 14.3% and 27.2% (P＜0.05) in patients without infections; survival curve analysis showed that survival rate in HBV-ACLF type A patients without infection was 5.713 times higher than in patients with infection, and survival rate in HBV-ACLF type B patients without infection was 3.364 times higher than in those with infection. Conclusion Patients with HBV-induce LC and ACLF have higher risk of infection, and we should take risk factors into consideration in clinical practice, which might improve outcomes of them.

Objective The aim of this study was to investigate prevalence of nutrition and sarcopenia in patients with hepatitis B-induced liver cirrhosis (LC). Methods 156 patients with hepatitis B-induced LC were encountered in our hospital between January 2019 and December 2023, subjective global assessment (SGA) was applied to screen nutritional risk, and sarcopenia was diagnosed based on criteria proposed out by Asian Working Group for Sarcopenia 2019 (AWGS2019). Multivariate Logistic regression analysis was used to predict risk factors for sarcopenia. Results Of 156 patients in our series, incidence of malnutrition was 59.0% and incidence of sarcopenia was 29.5%, and they were 20.5% and 7.7% in 39 patients with Child-Pugh class A, 50.0% and 25.0% in 48 patients with class B and 87.0% and 44.9% in 69 patients with class C, significantly different among them (P<0.05); age, basic mass index (BMI), serum albumin level and SGA score in 46 patients with sarcopenia were (64.1±12.5)yr, (19.3±2.2)kg/m², (24.1±3.9)g/L and (21.3±3.4) points, significantly different as compared to [(54.7±11.2)yr, (23.9±3.0) kg/m², ((34.3±4.8)g/L and (28.7±4.0)point, all P<0.05] in 110 patients without sarcopenia; multivariate Logistic regression analysis showed that BMI(OR=0.683), serum albumin level (OR=0.631) and SGA score (OR=0.653) were all risk factors for occurrence of sarcopenia in patients with LC (P<0.05). Conclusion Malnutrition is common in patients with hepatitis B-induced LC, and the risk of sarcopenia is also relatively high. Clinicians should take these incidents into consideration and deal with as early as possible.

Objective The aim of this study was to investigate assessment of stent function by color Doppler ultrasonography in patients with liver cirrhosis (LC) and portal hypertension (PH) after transjugular intrahepatic portosystemic shunt (TIPS). Methods 136 patients with LC were enrolled in our hospital between January 2020 and December 2022, and PH was defined as hepatic venous pressure gradient (HVPG)≥10 mmHg. Color Doppler ultrasonography was used to measure portal vein blood flow velocity (Vpv), portal vein diameter (Dpv) and portal vein blood flow (Qpv), and receiver operating characteristic (ROC) curve was applied to evaluate diagnostic efficacy of portal vein hemodynamic indicator combination in predicting PH. TIPS was performed routinely, and postoperative stent functions was assessed by color Doppler ultrasonography and digital subtraction angiography (DSA). Results Of 136 patients with LC in our series, PH was found in 62 cases(45.6%) based on HVPG measurement and 52 of them received TIPS; Vpv in patients with LC and PH was (13.1±2.3)cm/s, much lower than [(15.9±3.2)cm/s, P<0.05], while Dpv and Qpv were (1.3±0.3)cm and (626.8±106.8)mL/min, both much higher than [(1.1±0.2)cm and (499.9±97.2)mL/min, P<0.05] in cirrhotics without PH, and portal hemodynamic indicators restored to almost normal and showing no significant differences as compared to those in patients without PH [(16.2±2.5)cm/s, (1.1±0.2)cm and (502.1±99.4)mL/min, respectively, P<0.05]; ROC analysis showed that the AUC was 0.902(95%CI:0.849-0.955,P<0.05), with sensitivity (Se) of 79.0%, specificity (Sp) of 83.8%, when combination of Vpv, Dpv and Qpv in predicting PH; by end of one year follow-up in 52 patients after TIPS, DSA found stent dysfunction in 8 cases (15.4%), and consistency of ultrasonography was satisfactory (Kappa=0.680, P<0.05), with Se of 87.5%, Sp of 90.9%, and accuracy of 90.4%. Conclusion Color Doppler ultrasound has a good application in identifying stent dysfunction after TIPS in patients with LC and PH.

Objective The aim of this study was to investigate clinical efficacy of endoscopic variceal ligation (EVL) and intravinous octreotide and esomeprazole infusion in the treatment of patients with liver cirrhosis (LC)and esophagogastric variceal bleeding(EVB). Methods 99 patients with LC and EVB were admitted to our hospital between December 2020 and December 2022, and were randomly divided into observation (n=49) and control group (n=50). All patients received EVL and intrvinous esomeprazole infusion, and those in the observation were additionally given intravenous octreotide bumping for 7 days. Serum nitric oxide (NO), endothelin (ET) and angiotensinⅡ (ATⅡ) levels were assayed. Portal vein diameter (PVD), portal vein flow (PVF), splenic vein diameter (SVD) and splenic vein flow (SVF) were detected by ultrasonography. Results Two and two patients didn’t survive emergent bleeding in both groups; of survivals, hemostasis rates at 24 h, 48 h and 72 h in the observation group were 66.0%, 95.7%and 100.0%, not significantly different compared to 62.5%, 85.4%and 100.0%(P＞0.05)in the control; after treatment, PVD, PVF and SVF in the observation were(10.5±1.6)mm,(252.4±42.6)mL/min and(526.3±68.9)mL/min, all significantly lower than [(12.1±1.4)mm, (304.5±41.6)mL/minand (611.4±64.5)mL/min, respectively, P＜0.05] in the control; serum NO level in the observation was (73.2±7.6) mol/L, much higher than [(64.9±7.4) mol/L, P＜0.05], while serum ET and ATⅡ levels were (90.2±9.3)ng/L and (3.0±0.5)pg/mL, much lower than [(104.8±11.4)ng/L and (4.1±0.6)pg/mL, P＜0.05] in the control group; one year of follow-up after treatment, re-bleeding rates in the observation and control groups were not much statistically significantly different (10.6%vs. 12.5%,P＞0.05). Conclusion EVL and octreotide and esomeprazole combination in dealing urgently with patients with EVB has a satisfactory hemostasis efficacy, which might improve liver hemodynamicsand serum vascular activity.

Objective The purpose of this study was to summarize the enhanced magnetic resonance imaging (MRI) feature in differential diagnosis of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC). Methods 120 patients with primary liver cancer (PLC) were encountered in our hospital between December 2019 and July 2023, and there all underwent enhanced MR scan before hepatectomy. The enhancement MR feature included arterial phase reinforcement characteristics, dynamic reinforcement patterns, abnormal blood perfusion, target sign at hepatobiliary phase, lesion signal form, distal bile duct dilation, and lesion capsule. The receiver operating characteristic curve (ROC) was applied to evaluate the differential diagnostic performance of MRI scanning. Results Out of the 120 patients with PLC, the histo-pathological examination diagnosed ICC in 23 cases and HCC in 97 cases; the percentages of edge of lesion enhancement at arterial phase, gradually dynamic enhancement mode, hepatobiliary target and distal bile duct dilatation in ICC lesions were 69.6%,56.5%, 65.2% and 39.1%, all significantly higher than 44.3%, 17.5%,9.3% and 3.1%, while the percentage of lesion envelope was 4.3%, much lower than 45.4%(P＜0.05) in HCC lesions; based on comprehensive features, the MRI diagnosed ICC in 31 cases and HCC in 89 cases, with the sensitivity of 78.3%, the specificity of 86.6%, the positive predicting value of 58.1% and negative predicting value of 94.4%. Conclusion The enhanced MRI scanning could provide the clues for differentiating the ICC and HCC before surgery, which might help the clinicians make an appropriate management plans.

Objective The aim of this study was to investigate diagnostic performance of MRI scan based on liver imaging report and data system (LI-RADS) in diagnosis of patients with hepatocellular carcinoma (HCC). Methods 100 patients with intra-hepatic space-occupying lesions (IH-SOL) were encountered in our hospital between June 2021 and July 2023, all underwent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) MR scan, and lesions were classified based on LI-RADS v2018. The main MRI features of HCC included non-circular arterial phase hyperintense (APHE), rapid clearance and enhanced capsule, and the possible auxiliary signs considered as malignant included non-enhanced capsules, mosaic structures, nodules, fat inside lesions, hemorrhage, halo enhancement, fat deficiency in lesions, iron deficiency, limited diffusion of DWI and mild and moderate T2 high signals. Results Liver histo-pathological examination showed HCC in 79 cases, including 92 lesions, dysplasia nodule (DN) in 14 cases, including 22 lesions and cirrhotic regenerative nodule (RN) in 7 cases, including 11 lesions; incidences of acyclic APHE, rapid clearance and enhanced capsule in HCC lesions were 82.6%, 80.4% and 33.7%, all much higher than 45.4%, 45.4% and 9.1% (P<0.05) in DN lesions or 36.4%, 45.4% and 0.0% (P<0.05) in RN lesions; as for auxiliary signs of HCCs lesions, the incidences of DWI diffusion limitation, mild to moderate T2 hyper-intensity, low signal at transitional phase and low signal at hepatobiliary phase were 85.9%, 88.0%, 84.8% and 91.3%, all much higher than 59.1%, 63.6%, 45.4% and 63.6% (P<0.05) in DN lesions or 45.4%, 54.5%, 45.4% and 54.5% (P<0.05) in RN lesions; the sensitivity by main and auxiliary signs in predicting HCC for LR-4/5 lesions was 95.6%, much higher than 79.3%(P<0.05) by main signs alone, while there were no significant differences as respect to specificity (51.5% vs. 42.4%) or accuracy(84.0% vs. 72.0%) by MRI main or main and auxiliary sign combination (P>0.05). Conclusion The diagnostic efficacy of MRI LI-RADS in differentiating malignant and benign IH-SOL is satisfactory, which might help clinicians make correct diagnosis early and make an appropriate measures for good outcomes.

Objective The purpose of this study was to investigate the image quality and diagnostic efficacy of dual-source CT dual-energy true non-contrast enhanced (TNC) technique in patients with hepatocellular carcinoma(HCC). Methods 85 patients with intrahepatic space-occupying lesions were admitted to our hospital between January 2020 and January 2023, and all underwent dual-source CT dual-energy enhanced scanning to obtain the TNC and virtual non-contrast enhanced (VNC) imaging, signal to noise ratio (SNR) and contrast noise ratio (CNR). The imaging quality was subjectively evaluated by five scores. Results Out of the 85 patients with intrahepatic space-occupying lesions, the histopathological examination diagnose HCC in 48 cases, focal nodular hyperplasia (FNH) in 23 cases and hepatic hemangioma (HH) in 14 cases; the standard deviation (SD) of CT value of the hepatic lesion/right erector spinalis muscle at same level and the radiation dose in TNC-showed HCC foci were(7.9±1.8)HU and (5.9±0.6)mSv, both significantly greater than [(6.7±1.3)HU and (3.6±0.7)mSv, respectively, P<0.05] showed by VNC, while the SNR was (5.4±1.6), much smaller than [(6.5±1.7), P<0.05] showed by VNC; all the SD and the radiation dose in HCC, FNH and HH foci by TNC imaging were significantly greater than by VNC imaging(P＜0.05), while the SNR was much lower than by VNC imaging (P＜0.05); the CT values of HCC lesions by both TNC and VNC were greater than in FNH or HH foci (P＜0.05); the subjective image quality score of HCC lesions by TNC was superior to by VNC imaging (P＜0.05); the sensitivity, specificity and accuracy of TNC imaging in diagnosing HCC were 89.6%, 91.9% and 90.6%, much superior to 72.9%, 78.4% and 75.3%, respectively (P＜0.05) by VNC imaging. Conclusion In dual-source CT dual-energy enhanced scan, although TNC images have higher radiation dose, the quality of TNC images is higher than that of VNC images, and the accuracy of TNC images in diagnosing hepatocellular carcinoma is higher, which has certain guiding value for clinical diagnosis of hepatocellular carcinoma.

Objective The aim of this study was to investigate diagnostic efficacy of CT dynamic enhancement scan in patients with liver cirrhosis and intrahepatic space-occupying lesions (SOL). Methods 120 patients with intrahepatic SOL were encountered in our hospital between February 2018 and May 2023, and all underwent CT dynamic enhancement scan. Golden diagnosis was based on histo-pathological examination by fine needle aspiration biopsies or post-operational tissues. Results Pathological diagnosis included hepatocellular carcinoma (HCC) in 84 cases (70.0%)and focal proliferative nodules (FPN) in 36 cases(30.0%) in our series; in lesions of HCC, percentage of intensified enhancement at arterial phase was 100.0%, equal enhancement at portal phase was 56.0% and low enhancement at delayed phase was 97.6%, while in lesions of FPN, the percentages of equal enhancement at arterial, portal and delayed phases were 88.9%, 94.4% and 100.0%; of the 120 cirrhotics with intrahepatic SOL, CT scan diagnosed primary liver cancer in 83 cases (69.2%) and FPN in 37 cases (30.8%), with sensitivity, specificity, accuracy, negative predictive value and positive predictive value of 96.4%, 94.4%, 95.8%, 91.9% and 97.6%, respectively (Kappa=0.902). Conclusion The feature of intrahepatic SOL showing by CT dynamic enhancement scan at different phases could help clinicians make a correct diagnosis, and deal with it appropriately.

Objective The aim of this study was to investigate remimazolam and low-dose of propofol combination in induction of general anesthesia in patients with primary liver cancer (PLC) undergoing hepatectomy. Methods 80 patients with PLC were encountered in our hospital between January 2020 and January 2024, and all underwent hepatectomy. For induction of anesthesia, we assigned patients into group A (n=40), receiving combination agents, and group B (n=40), receiving remimazolam and low-dose of propofol, intravenously. All patients received routine anesthesia maintenance. Before anesthesia induction (T₀), after anesthesia induction (T₁), at intubation (T₂) and at end of surgery (T₃), sedation and postoperative cognitive function were evaluated by using Riker sedation/anxiety scale (SAS) and mini mental state examination (MMSE) scale. Results There was no significant differences in eye-opening time, extubation time and post-anesthesia care unit stay between the two groups (P>0.05); by T₂, mean arterial pressure and heart rate in group B were(80.1±7.5)mmHg and (71.9±8.1)beats/min, both significantly lower than [(84.5±8.3)mmHg and (76.7±8.0)beats/min, respectively, P<0.05] in group A; by 1 min, 5 min and 10 min after removal of tracheal catheter, SAS scores in group B were (3.2±0.4)points, (3.6±0.5)points and (3.7±0.6)points, all significantly lower than [(3.9±0.7)points, (4.2±0.8)points and (4.5±0.9)points, respectively, P<0.05] in group A; by 6 hours after operation, MMSE score in group B was (25.7±3.0)points, much higher than [(22.5±2.1)points, P<0.05] in group A; post-operationally, adverse effect in group B was 2.5%, much lower than 17.5%(P<0.05) in group A. Conclusion Combination of remimazolam and low-dose of propofol in induction of general anesthesia in patients with PLC undergoing hepatectomy could maintain hemodynamic stability, improve sedation and cognitive function restoration.

Objective The purpose of this study was to investigate short-term and long-term efficacy of patients with primary liver cancer (PLC) after hepatic arterial chemoembolization (TACE) and radiofrequency ablation (RFA) combination therapy. Methods A total of 92 patients with PLC were encountered in our hospital between January 2016 and March 2018, and were randomly divided into control group (n=46) and observation group (n=46), receiving TACE or TACE and RFA combination treatment. All patients were followed-up for three years. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin-2(IL-2), IL-6 and tumor necrosis factor-α(TNF-α) levels were detected. Results Short-term efficacy (complete and partial remission) in the observation group was 82.6%, much higher than 58.7%(P＜0.05) in the control; by end of one year after treatmenyt, serum hs-CRP, IL-6 and TNF-α levels in 44 survivals in the observation group were(5.1±2.0)ng/L, (97.3±12.2)ng/L and (47.8±5.8)pg/mL, significantly lower than [(8.2±1.6)ng/L, (110.3±15.5)ng/L and (53.5±6.8)pg/mL, respectively, P＜0.05], while serum IL-2 level was (3.4±0.4)ng/L, significantly higher than [(3.0±0.5)ng/L, P＜0.05] in 38 survivals in the control group; one-year, two-year and three-year survival rates in the observation group were 95.7%, 84.8% and 78.3%, all much higher than 82.6%, 65.2% and 54.4%(P＜0.05) in the control. Conclusion Application of TACE and RFA combination in the treatment of patients with PLC is efficacious, with a satisfactory short-term and long-term survivals, which might improve body immune functions.

Objective The aim of this study was to explore imaging feature of atypical hepatic abscess (AHA) for early diagnosis. Methods 42 patients with AHA and 42 patients with intrahepatic metastatic tumor (IMT) were encountered in our hospital between January 2019 and January 2024, and all underwent MRI and diffusion-weighted imaging (DWI) scan. Plain and enhanced scan signals, DWI signals, enhancement features at arterial phase, apparent diffusion coefficient (ADC) and relative ADC (rADC) of solid part in lesion margin were compared between the two groups. Results Proportion of target-like high signals by DWI in AHA lesions was significantly lower than that in IMT lesions (64.3% vs. 90.5%(P＜0.05); proportions of margin enhancement at arterial phase and uneven enhancement at portal vein phase and at equilibrium phase in AHA lesions were 45.2%, 71.4% and 23.8%, significantly lower than 76.2%, 100.0% and 88.1% (P<0.05) in the IMT lesions; proportions of significant enhancement and continuity interruption at arterial phase were 9.5% and 0.0%, significantly lower than 88.1% and 73.8% (P<0.05) in IMT lesions; ADC and rADC of solid parts at AHA lesion margin were (1.8±0.4) ×10^-3mm²/s and (0.7±0.2) ×10^-3mm²/s, both significantly higher than [(1.0±0.2) ×10^-3mm²/s and (0.4±0.1) ×10^-3mm²/s, P<0.05] at IMT lesions. Conclusion AHA lesions at routine MRI and DWI scan has a unique feature, by which clinicians might differentiate it from IMT lesions.

Objective The aim of this study was to summarize the clinical feature of patients with bacterial liver abscess (BLA) and concurrent underlying type 2 diabetes mellitus(T2DM). Methods 102 consecutive patients with BLA, of which, with concurrent underlying T2DM in 41 cases, were encountered in our hospital between May 2021 and October 2023, and all received antibiotics and intra-purulent cavity catheterization and pus drainage. Blood and/or pus bacterial culture and identification were conducted. Serum interleukin-6 (IL-6),C-reactive protein (CRP), procalcitonin (PCT), amyloid A (SAA) and D-dimer (D-D) levels were detected. Results Concurrent blood hypertension and pulmonary infections in patients with BLA and T2DM were 51.2% and 36.6%, both significantly higher than 18.0% and 8.2% (P<0.05) in those with BLA without T2DM; serum IL-6, CRP, PCT and SAA levels in patients with BLA and T2DM were 344.3(155.0, 511.9)pg/ml, 180.9(82.1, 270.7)mg/L, 8.6(5.7, 10.6)μg/L and 19.3(14.2, 25.5)mg/L, all significantly higher than [195.5(136.6, 274.1)pg/ml,124.8(52.5,190.4)mg/L, 2.2(1.4, 2.7)μg/L and 14.5(12.6, 20.1)mg/L, respectively, P＜0.05] in those with BLA; Klebsiella Pneumoniae infection rate in patients with BLA and T2DM was 78.0%, much higher than 57.4%(P＜0.05) in patients with BLA; catheterization for pus drainage and antibiotics therapy in patients with BLA and T2DM lasted for 6(3,10)d and 13(5, 20)d, both much longer than [4(2, 8)d and 10(4, 16)d,P＜0.05] in patients with BLA; all but one patient (2.4%) with BLA and T2DM who died recovered. Conclusion Pulmonary and Klebsiella pneumoniae infection is more common in patients with BLA and concurrent underlying T2DM, and antibiotics and intra-purulent cavity catheterization for pus drainage is efficacious with a satisfactory outcomes.

Objective The aim of this study was to observe the efficacy of laparoscopic precision liver segment resection under CT three-dimensional visualization technology guidance in the treatment of patients with complex hepatolithiasis. Methods 63 patients with complex hepatolithiasis were encountered in our hospital between January 2016 and December 2022, were divided into observation and control groups, and all patients underwent segmental hepatectomy and fiberoptic cholangioscopy. In the observation group, the CT three-dimensional visualization technology was applied to personally reveal, design operation plan and mimic the operation pre-operationally. All patients were followed-up for one year. Results The surgical time, intraoperative blood loss and hospital stay after operation in the observation group were 101.8(96.4,117.6)min, (25.9±6.7)mL and (9.6±1.5)d, all significantly shorter or less than [121.3(98.5,135.4)min, (37.7±15.9)mL and (11.9±2.7)d, respectively, P<0.05] in the control, while there was no significant difference as respect to recovery of intestinal functions in the two groups [(2.6±0.3)d vs. (2.8±0.6)d, P＞0.05]; post-operationally, total serum bilirubin, albumin and ALP levels in the observation group were (15.6±8.4)μmol/L, (35.6±2.3)g/L and (78.1±21.2)U/L, all not significantly different compared to [(17.1±1.4)μmol/L, (36.8±2.7)g/L and (99.2±21.3)U/L, P＞0.05] in the control; the incidence of complications, such as incision infection, biliary bleeding, biliary injury and biliary leakage in the observation was 16.1%, much lower than 53.1%(P<0.05) in the control; two weeks after surgery, the imaging showed that the stone clearance rate in the observation group was 96.8%, much higher than 75.0%(P<0.05) in the control, and at the end of one-year follow-up, the imaging demonstrated that the stone recurrence rate in the observation group was 3.2%, much lower than 18.8%(P<0.05) in the control group. Conclusion The laparoscopic precision liver segment resection under CT three-dimensional visualization technology guidance in the treatment of patients with complex hepatolithiasis is efficacious, which could improve stone clearance rate, with less complications and low stone recurrence, and warrants further clinical exploration.

Objective The aim of this study was to investigate application of serratus anterior plane block and posterior rectus sheath block under general anesthesia in patients undergoing intrahepatic bile duct stone (IHS) removal. Methods 60 patients with HIS were encountered in our hospital between April 2020 and January 2024, and all underwent surgery operation for removal of the stones under general anesthesia. For analgesia, patients were divided into control (n=28), receiving thoracic paravertebral nerve block, and observation (n=32), receiving serratus anterior plane block and posterior rectus sheath block. Post-anesthesia care unit (PACU) stay and other operation parameters were recorded, Ramsay sedation scores, resting and motion visual analogue scale (VAS) scores, and quality of recovery-40 questionnaire (QoR-40) were assessed. Results PACU stay in the observation was (35.1±2.0)min, much shorter than [(40.3±2.1)min,P＜0.05] in the control; by 2 and 24 hours after operation, resting VAS scores in the observation were(2.9±1.4)points and (2.5±1.1)points, both significantly lower than [(3.7±1.7)points and (3.3±1.4)points, respectively, P＜0.05], and motion VAS scores were (3.7±1.6)points and (2.9±1.5)points, both significantly lower than [(4.4±1.5)points and (3.6±1.4)points, P＜0.05] in the control; pain perception, physical comfort and postoperative QoR-40 score in the observation were (35.3±1.2)points, (52.8±2.3)points and (175.0±8.0)points, all significantly higher than [(28.4±1.5)points, (45.8±2.8) points and (165.1±9.7)points, respectively, P＜0.05] in the control. Conclusion In patients with HIS undergoing surgery operation for removal of stones under general anesthesia, serratus anterior plane block and posterior rectus sheath block have a satisfactory analgesic effects, and improve quality of recovery.

Objective The aim of this study was to compare efficacy of laparoscopic transcystic common bile duct exploration (LTCBDE) andlaparoscopic common bile duct exploration (LCBDE) in dealing with patients with gallbladder stones (GS) and extrahepatic bile duct stones(EBDS). Methods A total of 168 patients with GS and EBDS were enrolled in our hospital between January 2022 and January 2024, and we assigned them to LCBDE in 123 cases in control groupand to LTCBDE in 45 cases in observation group. Serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) levels were detected by ELISA, and blood biochemical parameters were routinely assayed. Results Operation time, intra-operational bleeding, anal exhaust time, post-operationalhospital stay and medical cost in the observation group were(104.4±34.2)min,(29.9±11.2)ml, (22.3±10.1)h, (6.5±2.9)d and (14000±600)yuan, all significantly shorter or less tan [(149.9±37.4)min, (43.6±16.3)ml, (28.4±9.6)h, (9.2±2.4)d and (18000±700)yuan, respectively, P＜0.05] in the control; total stone clearance was obtained in the two groups; three days after operation, serum TNF-α and IL-6 levels in the observation group were(32.5±5.9)ng/L and (25.4±7.1)pg/L, both significantly lower than [(40.3±6.8)ng/L and (35.6±6.4)pg/L, respectively, P＜0.05] in the control; post-operationally, incidences of biliary leakage, biliary tract infection, abdominalinfection, biliary tract hemorrhage and acute pancreatitis in the observation were 0.0%, 2.2%, 2.2%, 0.0% and 0.0%, all not significantly different compared to 2.4%, 0.0%, 4.1%, 1.6%and 2.4% in the control group (P＞0.05). Conclusion Both LCBDE and LTCBDE have good efficacy for stone clearance in patients with GS and EBDS, and we recommend LTCBDE for good postoperative recovery and less economic costs.

The mechanisms of hepatocarcinogenesis have not been fully elucidated. Krüppel-like factors (KLFs), the largest family of zinc finger protein (ZFP) transcription factors in humans, have recently been found to play a promoting or inhibiting role in hepatocellular carcinoma (HCC) progression. Basic and clinical studies have shown that part of KLFs might be used as molecular markers for diagnosis and for predicting prognosis of patients with HCC. It is also possible as a molecular targets for gene therapy. This article reviews the tissue distribution, expressing features and clinical application of HCC-related KLFs.

Hepatocellular carcinoma (HCC) has complex biological characteristics, highly heterogeneous property and immunosuppressive tumor microenvironment. HCC carries a dismal prognosis. Metabolic reprogramming (MR) is one of the most important features of tumor cells and the lipid metabolism has been an important mechanism underlying HCC growth and metastasis. In this article, we review the roles of common lipid and its metabolism-related molecules in carcinogenesis of HCC and provides new targets for therapy of HCC.