Objective As an important transcription factor of NF-κB family, p65 plays a pivotal roles in progression of hepatocellular carcinoma (HCC). This study aimed to explore effect of p65 on regulation of lipid metabolism in HepG2 cells in vitro. Methods In this study, relationship between p65 and prognosis of patients with HCC was investigated in UCSC Xena and GEPIA database. ChIP-seq and RNA-seq technologies were conducted to explore DNA binding profile of p65 in HepG2 cells through bioinformatics analysis, and flow cytometry was applied to detect effect of p65 on the proliferation of HepG2 cells. p65 on expression of key genes and their proteins were detected by real-time quantitative PCR (qRT-PCR) and Western blot (WB), and effect of p65 on lipid metabolism in HepG2 cells was determined by flow cytometry and confocal microscopy fluorescence. Results Data analysis from database showed that p65 was often highly expressed in patients with HCC and the intensified expression was associated with poor prognosis of patients with HCC; p65 knockdown inhibited the proliferation of HepG2 cells, and overexpression of p65 boasted the proliferation of HepG2 cells as compared to in control; by comprehensive analysis of ChIP-seq and RNA-seq data, 205 common genes were obtained, and the most abundant genes were in the metabolic pathway, among which the key genes including ACSM2A, ACSM2B, ACSM3, ACSM5 and HMGCS2, were found to be related to lipid metabolism; ACSM5 and HMGCS2 mRNA and their protein were significantly decreased after p65 was knocked down, while they significantly increased after p65 was overexpressed; p65 knockdown promoted lipid accumulation, while p65 overexpression inhibited lipid accumulation in HepG2 cells. Conclusion p65 regulates lipid metabolism by up-regulating the expression of ACSM5 and HMGCS2 and promotes the proliferation of HepG2 cells, which provides research clues for the mechanism of p65 regulation of lipid metabolism in hepatocellular carcinoma.

Objective The aim of this study was to investigate fluoresce quantity PCR (fq-PCR) assay in monitoring antiviral efficacy in patients with chronic hepatitis B (CHB) with low-level viremia (LLV). Methods A total of 200 patients with CHB were encountered in our hospital between January 2019 and December 2022, and the alleged patients met oral entecavir (ETV) treatment for at least 48 weeks. All patients with complete virologic response (CVR) continued ETV treatment, those without switched to tenofovir alafenamide fumarate (TAF) antiviral treatment, and all patients were followed-up for 48 weeks. Serum HBV DNA loads were detected by quantitative real-time PCR (qPCR) and fq-PCR, respectively. Results Of 200 ETV-treated patient enrolled in this study, fq-PCR assay found CVR in 145 cases (72.5%), serum HBV DNA loads were greater than 2000 IU/mL(PR) in 13 cases (6.5%), and serum HBV DNA loads were at range of 21 to 2000 IU/mL(LLV) in 42 cases (21.0%); by end of 48 week TAF treatment, CVR by qPCR in PR group was found in 13 cases (100.0%), while only in 5 cases(38.5%, P＜0.05) by fq-PCR, and in LLV group were in 41 cases (97.6%) and in 30 cases (71.4%, P＜0.05), in which there was a significant difference between CVR in PR group and in LLV group by fq-PCR (x²=4.662, P＜0.05); there were no significant differences as respect to serum AST and ALT levels in patients with PR and with LLV(P>0.05), while serum HBV DNA loads in LLV group was (125.6±114.2)IU/mL, much lower than [(370.4±217.8)IU/mL, P＜0.05] in those with PR. Conclusion Surveillance of serum HBV DNA loads by high-sensitivity PCR detection could help clinicians find CHB patients receiving nucleos(t)ide analogue treatment at LLV status, and make an appropriate antiviral options as early as possible.

Objective The aim of this study was to compare efficacy and safety of tenofovir alafenamide fumarate (TAF) and tenofovir disoproxil fumarate (TDF) in terminating mother to child transmission (MTCT) of hepatitis B viral infection. Methods 112 pregnant hepatitis B virus carriers with serum HBeAg positive were encountered in Beijing You'an Hospital, Capital Medical University between July 2021 and August 2022, and all received TAF (n=57) or TDF (n=55) antiviral therapy for blocking viral transmission, which discontinued before giving birth. All infants received standardized immune inoculation and were evaluated for serum HBV markers and HBV DNA loads at seven to nine month ages. Results Before delivery, incidence rates of premature birth, intrahepatic cholestasis of pregnancy, hypertensive disorder complicating pregnancy, premature rupture of membranes, slightly less amniotic fluid and oligohydramnios in the TAF-treated group were 7.0%, 8.8%, 7.0%, 12.3%, 7.0% and 3.5%, all not much different compared to 5.5%, 9.1%, 5.5%, 10.9%, 3.6% and 0.0% in TDF-treated group (all P>0.05); serum ALP level in TAF group was (146.1±44.3)U/L, much lower than [(166.9±52.5)U/L, P＜0.05] in TDF group; urine protein positive rate in TAF group was 7.0%, much lower than 23.6%(P＜0.05) in TDF group; there were no significant differences as respect to serum ALT, AST, bilirubin, serum creatinine, phosphorus, calcium and glomerular filtration rates in the two groups (P>0.05); serum HBV DNA load in the TAF group was (3.4±0.7)lg IU/ml, much higher than [(2.9±0.8)lg IU/ml, P＜0.05] in TDF group; no MTCT occurred in the two group. Conclusion Antiviral therapy with TAF during pregnancy could efficaciously block MTCT of HBV infection in pregnant women with chronic HBV carriers, with higher renal safety.

Objective The aim of this study was to investigate influencing factors of low level viremia (LLV) in patients with chronic hepatitis B (CHB) during nucleos(t)ide analogues (NAs) antiviral treatment. Methods A retrospective study was conducted on 212 patients with CHB between May 2022 and May 2024, and all enrolled patients had received regular NAs treatment for more than 48 weeks in our hospital. Serum HBeAg and HBV DNA loads were routinely detected. AST/platelet count ratio index (APRI) and based on four fibrosis factors (FIB-4) score were calculated. LLV was defined as serum HBV DNA loads were at range of 20 to 2000 IU/ml. Peripheral blood T cells, B cells, NK lymphocyte subsets were determined by FCA. Liver stiffness measurement (LSM) was detected by Fibrotouch. Multivariate Logistic regression analysis was applied to reveal impacting factors for LLV occurrence. Results Of 212 patients with CHB in our series, prevalence of LLV was 33.5%, with complete virological response (CVR) of 66.5%; mean age at baseline in patients with LLV was (42.4±10.2)yr, much younger than [(46.4±12.0)yr, P＜0.05] in patients with CVR, percentages of hepatitis B family history, concomitant fatty liver, entevavir(ETV) antiviral treatment, high loads of serum HBV DNA, serum HBeAg positive and low serum AST level in patients with LLV were 80.3%, 53.5%, 63.4%, 83.1%, 93.0% and 66.2%, all significantly higher than 41.1%, 42.6%, 48.9%, 36.2%, 44.0% and 34.8%, respectively (all P＜0.05) in patients with CVR; FIB-4 score and LSM in patients with LLV were 1.21(0.87, 1.78) and 7.2(6.4, 8.1)kPa, both significantly greater than [1.76(1.23, 2.44) and 6.5(5.9, 7.1)kPa, respectively, P＜0.05] in those with CVR; multivariate Logistic regression analysis showed that hepatitis B family history (OR=0.181, P=0.002), serum HBeAg positive (OR=3.892, P＜0.001) and low serum AST level (OR=0.269, P==0.001) were all the independent risk factors impacting occurrence of LLV; there were no significant differences as respect to percentages of peripheral blood CD4⁺ and CDO8⁺ cells as well as CD4⁺/CD8⁺ cell ratio between patients with LLV and those with CVR [(35.9±6.9)%, (30.8±8.6)% and (1.3±0.5) vs. (36.0±7.7)%, (29.1±8.1)% and (1.4±0.6), respectively, P >0.05]. Conclusion Serum HBeAg positive, low serum ALT level and high serum HBV DNA loads, and family history of hepatitis B at baseline are the impacting factors of LLV during antiviral treatment by NAs in patients with CHB, which warrants further clinical investigation as early intervention might improve prognosis.

Objective The aim of this study was to investigate ultrasonic transient elastography (TE) in predicting liver fibrosis (LF) in patients with chronic hepatitis B (CHB) and concomitant liversteatosis(LS). Methods 100 patients with CHB and LS were encountered in our hospital between January 2023 and June 2024, and all underwent MRI for proton density fat fraction (MRI-PDFF) and TE scan for controlled attenuation parameter (CAP) and liver stiffness measurement (LSM). Multivariate Logistic regression analysis was applied to evaluate risk factors for LS occurrence. Results Of the 100 patients with CHB and LS, MRI-PDFF found mild LS in 49 cases (49.0%), moderate LS in 28 cases (28.0%) and severe LS in 23 cases (23.0%); body mass index (BMI), serum triglyceride, low density lipoprotein cholesterol (LDL-C), LSMand CAP in CHB patients with severe LS were (28.8±2.2)kg/m², (3.6±0.3)mmol/L, (3.9±0.5)mmol/L, (10.5±2.0)kPa and (317.5±20.0)dB/m, all significantly higher than [(26.5±2.1)kg/m², (2.5±0.3)mmol/L, (3.3±0.4)mmol/L, (7.2±1.4)kPa and (280.5±11.4)dB/m, respectively, P<0.05] in those with moderate LS or [(23.2±2.1)kg/m², (1.8±0.3)mmol/L,(2.9±0.3)mmol/L, (6.4±0.8)kPa and (257.4±4.1)dB/m, respectively, P<0.05] in those with mild LS; multivariate Logistic regression analysis showed that BMI(OR=2.818), LDL-C(OR=2.179)and CAP(OR=1.852)were all risk factors for occurrence of LS in patients with CHB(P<0.05);incidences of significant LF in CHB patients with severe, moderate and mild LS were 69.6%, 35.7% and 10.2%, significantly different among them (P<0.05). Conclusion Application ofTE is efficacious in predicting LF in patients with CHB and LS, which might help preliminarily screening in clinical practice.

Objective The purpose of this study was to investigate the changes and clinical implications of serum NoD-like receptor heat protein domain associated protein 3 (NLRP3), and its downstream interleukin 1β(IL-1β)and IL-18 (IL) levels in patients with chronic hepatitis C (CHC) undergoing sorfosbuvir/daratavir antiviral treatment. Methods 104 patients with CHC were enrolled in to our hospital between March 2018 and March 2022, and all were treated with sorfosbuvir/daratavir for 12 weeks. After discontinuation of the regimen, all patients were followed-up for 24 weeks. Serum NLRP3, IL-1β and IL-18 levels were detected by ELISA. Results At the end of the 12-week antiviral treatment, serum NLRP3,IL-1β and IL-18 levels in 104 patients with CHC were (713.5±136.7)pg/ml,(2.8±1.0)pg/ml and (644.3±130.8)pg/ml, all significantly decreased as compared to [(1137.1±172.8)pg/ml, (4.9±1.1)pg/ml and (1027.2±202.1)pg/ml, respectively, P＜0.05] at presentation; at the end of the 12-week antiviral treatment, serum NLRP3,IL-1β and IL-18 levels in 31 patients with low serum viremia at admission were(638.3±122.6)pg/ml, (2.5±0.6)pg/ml and (538.9±111.8)pg/ml, significantly lower than [(708.4±130.1)pg/ml, (2.8±0.9)pg/ml and (629.2±123.5)pg/ml, respectively, P＜0.05] in 44 patients with moderate serum viremia or [(802.5±137.0)pg/ml, (3.3±0.8)pg/ml and (801.3±140.8)pg/ml, respectively, P＜0.05] in 29 patients with high serum viremia; in our series, the early virologic response (VR) rate, end treatment of virologic response rate and sustained virologic response rate were 71.1%, 90.4% and 87.5%, after antiviral treatment, and serum NLRP3, IL-1β and IL-18 levels in patients with VR at any observation time were all significantly lower than in those without VR (P＜0.05). Conclusion The abnormal elevation of serum NLRP3 and its downstream cytokine levels in patients with CHC might be related to the hepatic pathogenesis and response to antiviral therapy, and we recommend to monitorthe changes of them during antiviral treatment, which might be helpful to predict the antiviral efficacy.

Objective The aim of this study was to investigate diagnostic performance of controlled attenuation parameter (CAP), liver stiffness measurement (LSM) and total adipose tissue (TAT) in screening patients with nonalcoholic steatohepatitis (NASH) from individuals with nonalcoholic fatty liver diseases (NAFLD). Methods 150 patients with NAFLD were enrolled in our hospital between January 2022 and January 2024, and all underwent liver biopsy. CAP and LSM were determined by FibroTouch^©, and quantitative TAT and ratio of liver/spleen CT value were obtained by CT scan. The diagnosis consistency between FibroTouch^© and CT scan and liver biopsy was analyzed by Kappa values. Area under receiver operating characteristic (ROC) curves (AUC) was applied to evaluate diagnostic efficacy. Results Liver histo-pathological examination found simple fatty liver (SFL) in 109 cases and NASH in 41 cases in our series; taking pathological diagnosis as golden standard, the good diagnostic consistence was found between FibroTouch^© or CT quantitative scan (Kappa=0.743, or Kappa=0.684), with sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 87.8%, 89.9%, 89.3%, 76.6% and 95.2%, or 85.4%, 87.2%, 86.7%, 71.4% and 94.1%; CAP, LSM and TAT in patients with NASH were (303.5±12.7)db/m, (11.1±2.9)kPa and (473.1±80.5)cm², all significantly higher than [(269.4±17.2)db/m, (6.4±1.6)kPa and (358.1±72.0)cm², respectively, P＜0.05], while ratio of liver/spleen CT value was (0.4±0.1), much lower than [(0.8±0.2), P＜0.05] in patients with SFL; ROC analysis showed the AUCs were 0.861, 0.864, 0.803 and 0.851, all with a satisfactory diagnostic efficacy (P＜0.05), when CAP, LSM, ratio of liver/spleen CT value and TAT were applied to predict NASH from individuals with NAFLD. Conclusion FibroTouch^© and CT quantitative scan both have certain diagnostic performance in assessing NASH in population of NAFLD, and warrants further clinical investigation.

Objective The aim of this study was to investigate diagnostic performance ofultrasound-guided attenuation parameter (UGAP)in predicting hepatic steatosis in patients with non-alcoholic fatty liver disease(NAFLD). Methods 91 patients with NAFLD were enrolled in our hospital between January 2023 and September 2024, and all underwent liver biopsy for liver steatosis grading andUGAP for measuring attenuation coefficient(AC). Receiver operating characteristic curve (ROC) and area under the curve (AUC) was adopted to analyze diagnostic efficacy. Results Of 91 patients withNAFLD, liver histo-pathological examination showed liver steatosis S1 grade in 45 cases, S2 in 28 cases and S3 in 18 cases; serum TC, TG, ALT and AST levels in patients with S3 liver steatosis were (6.4±1.3)mmol/L, (3.3±1.0)mmol/L, (78.4±15.2)U/L and (62.9±12.6)U/L, all significantly higher than [(4.7±1.1)mmol/L, (1.8±0.7)mmol/L, (27.1±6.3)U/L and (25.6±5.7)U/L, respectively, P<0.05] in patients with S1 or [(5.6±1.4)mmol/L, (2.6±0.8)mmol/L, (42.5±9.6)U/L and (37.2±7.4)U/L, respectively, P<0.05] in patients with S2, while serum HDL-C level was (0.8±0.3)mmol/L, much lower than [(1.2±0.4)mmol/L, P<0.05] in patients with S1 or [(1.0±0.3)mmol/L, P<0.05] in patients with S2; the AC in patients with S3 was (0.8±0.1)dB/cm/MHz, much greater than [(0.6±0.1) dB/cm/MHz, P<0.05] in patients with S1 or [(0.7±0.1)dB/cm/MHz, P<0.05] in patients with S2; ROC analysis showed that the AUC was 0.854(95% CI:0.772-0.935), with sensitivity (Se) of 82.6% and specificity (Sp) of 88.9%, when AC equal to or greater than 0.7dB/cm/MHz as the cut-off-value in predicting liver steatosis ≥S2, and the AUC was 0.834(95% CI:0.699-0.970), with Se of 77.8% and Sp of 93.2%(P<0.05), when the AC greater than 0.8dB/cm/MHz as the cut-off-value in predicting liver steatosis S3. Conclusion AC obtained by conventional ultrasound has a satisfactory clinical application value in the diagnosis of hepatic steatosis in patients with NAFLD, which might help screening preliminarily.

Objective The aim of this study was to investigate short-term efficacy of acupoint application at base of sport exercise in the treatment of patients with non-alcoholic fatty liver disease (NAFLD). Methods 119 patients with NAFLD were encountered in our hospital between January 2022 and March 2024, and were randomly divided into control (n=59) and combination group (n=60), receiving sport exercise under guidance or acupoint application at base of sport exercise for 3 months. Weight, waist circumference, and body fat percentage (BFP) were measured, and body mass index (BMI) and waist to hip ratio (WHR) were calculated. Serum leptin, adiponectin, resistin, tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) levels were assayed by ELISA. Results By end of 3 months of treatment, body weight, BMI and BFP in combination group were (62.3±7.8)kg, (24.5±3.3)kg/m² and (29.2±3.6)%, all significantly lower than [(68.2±8.9)kg,(26.8±2.8)kg/m² and (31.7±3.9)%, respectively, P<0.05] in the control; serum TG and LDL-C levels were (2.1±0.3)mmol/L and (2.3±0.5)mmol/L, both significantly lower than [(2.9±0.3)mmol/L and(2.8±0.7)mmol/L, P<0.05], while serum HDL-C level was (1.3±0.3) mmol/L, significantly higher than [(1.1±0.3)mmol/L, P<0.05] in the control group; serum ALT, AST and GGT levels were (45.1±8.7)U/L, (41.5±8.0)U/L and (38.7±7.8)U/L, all much lower than [(56.8±7.3)U/L, (52.4±6.6)U/L and (46.2±8.5)U/L, respectively, P<0.05] in the control; serum leptin, resistin, TNF-α and IL-6 levels were (9.7±2.1)pg/mL, (9.8±3.9)ng/mL, (21.2±5.2)ng/L and (20.1±2.3)mg/L, all much lower than [(11.8±2.0)pg/mL, (13.2±4.3)ng/mL, (27.8±4.7)ng/L and (27.5±2.7)mg/L, respectively, P<0.05], while serum adiponectin level was (3.1±1.0)ng/mL, much higher than [(2.5±0.8)ng/mL, P<0.05] in the control group. Conclusion Acupoint application in combination with exercise in treating patients with NAFLD is short-termly efficacious, with body weight loss and reduced blood fat, which might be related to inhibition of body inflammatory reactions.

Objective The aim of this study was to investigate changes of urine microalbumin(U-mAl), serum hemoglobin Alc (HbA1c) and thyroid hormones in patients with non-alcoholic fatty liver disease (NAFLD) and concomitant type 2 diabetes mellitus (T2DM). Methods 91 patients with NAFLD and T2DM [non-alcoholic fatty liver (NAFL) in 56 cases,non-alcoholic steatohepatitis (NASH) in 23 cases and cirrhosis in 12 cases] and 91 patients with T2DM were encountered in our hospital between January 2019 and January 2024, serum thyroid stimulating hormone (TSH), tetraiodothyronine(T4) and FT4 levels were assayed by RIA, and fasting blood glucose (FBG), HbAlC, fasting insulin(FINS) and U-mAllevel were routinely detected. Results FBG, serum FINS, HOMA-IR and HbAlC levels in patients with NAFLD and T2DM were (7.6±1.0)mmol/L, (12.6±2.7)μIU/mL, (4.3±1.1) and (8.2±0.9)%, all much higher than [(7.1±1.3)mmol/L, (9.4±3.1)μIU/mL, (3.0±1.3) and (7.0±1.2)%, respectively, P＜0.05] in patients with T2DM; U-mAl and serum T4 levels in patients with NAFLD and T2DMwere(71.6±10.1)mg/L and (134.7±16.6)nmol/L, both significantly higher than [(40.2±10.8)mg/L and (119.0±14.9)nmol/L, P＜0.05], while serum TSH and FT4 were (2.1±0.7)mU/L and (12.4±1.7)pmol/L, both significantly lower than [(3.5±0.7)mU/L and (16.8±3.0)pmol/L, P＜0.05] in patients with T2DM; there were no significant differences as respect to serum fat levels between the two groups (P>0.05). Conclusion U-mAl and serum thyroid hormone levels in patients with NAFLD and concomitant T2DM could elevate, which might sophisticate clinical management in this circumstances.

Objective This study was conducted to explore the impact of hepatic steatosis on biochemical remission in patients with autoimmune hepatitis (AIH) receiving standardized prednisone and azathioprine therapy. Methods 58 patients with AIH were encountered in our hospital between January 2018 and December 2022, and all received standardized prednisone and azathioprine therapy for six months. At admission, all patients underwent liver biopsies, and the controlled attenuation parameter (CAP) and liver stiffness measurement were detected by FibroScan 502. The therapeutic efficacy was assessed as complete remission (CR) and insufficient biochemical remission (IBR). The influencing factors on biochemical remission and untoward outcomes were analyzed by multivariate Logistic regression. Results At the end of six month treatment, 35 patients (60.3%) responded, while 23 patients (39.7%) didn't; the body mass index, the percentages of concomitant hypertension and diabetes, serum globulin level as well as the CAP and LSM in patients with IBR were (26.9±2.8)kg/m², 43.5% and 39.1%, 34.6(28.4, 38.4)g/L, and (275.6±16.5)dB/m and 9.8(6.5, 13.6) kPa, all significantly higher than [(22.1±2.8)kg/m², 11.4% and 5.7%, 25.3(23.6, 29.4)g/L, and (192.0±33.5)dB/m and 5.4(2.5, 8.0)kPa, respectively, P<0.05], while serum albumin level was 32.4(31.6, 35.7)g/L, much lower than [38.3(33.6, 43.7)g/L, P<0.05] in patients with CR; the multivariate Logistic regression analysis showed that the CAP, severe hepatic steatosis and the LSM were all the independent risk factors for the occurrence of IBR and untoward outcomes (P<0.05) in patients with AIH. Conclusion The hepatic steatosis could impact the response to standardized therapy in patients with AIH, which might lead to the untoward outcomes and needs carefully managed in clinical practice.

Objective This study was to summarize the clinical features of drug-induced liver injury (DILI) in patients with breast cancer during anthracycline chemotherapy. Methods A total of 155 patients with stage I/ IIbreast cancer after operation were encountered in our hospital between May 2020 and May 2023, and all received anthracycline chemotherapy. The clinicians maintained carefully surveillance on DILI, and the anti-tumor regimen was adjusted and the liver-protecting medicines were given in time according to the clinical types of DILI. Results During chemotherapy, the DILI was found in 92 cases (59.4%) out of our series, with the hepatocyte injury in 57 cases, the cholestasis in 25 cases and the mixed type in 10 cases; the age in patients with DILI was (45.6±7.2)yr, significantly older than [(40.5±8.5)yr, P<0.05], the body mass index was (26.2±2.2)kg/m², much greater than [(23.0±2.4)kg/m², P<0.05], and the incidences of concomitant hypertension, diabetes, hyperlipidemia and stage II tumor were 25.0%, 17.4%, 18.5% and 52.2%, all significantly higher than 6.3%, 4.8%, 4.8% and 31.7%, respectively(P<0.05)in patients without DILI; the chemotherapy was adjusted and the glycyrrhizic acid and/or ursodeoxycholic acid were given in patients with DILI, and the prognosis was promising. All patients went on chemotherapy thereafter. Conclusion The DILI occurs common in patients with breast cancer during anthracyclinechemotherapy period, and careful surveillance and appropriate management might obtain a good outcomes.

Objective The aim of this study was to investigate efficacy of magnesium isoglycyrrhizinate and reduced glutathione combination in treatment of patients with chemotherapeutic drug-induced liver injury (cDILI) and its impact on serum oxidative stress indexes. Methods 146 patients withcDILI were encountered in our hospital between January 2022 and January 2024, and were randomly divided into control (n=73) and observation (n=73) groups. Patients in the control group were treated with intravenous reduced glutathione, and those in the observation group were given intravenous magnesium isoglycyrrhizinate and reduced glutathione combination for two to four weeks. Serum malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels were assayed routinely. Serum tumor necrosis factor-α (TNF-α), macrophage migration inhibitory factor (MIF), soluble tumor necrosis factor receptor 1 (sTNFR1) and interleukin-10 (IL-10) levels were detected by ELISA. Results By the end of treatment, serum ALT,AST, ALPand GGT levels in the combination group were (58.5±10.1)U/L, (53.7±4.3)U/L, (79.2±13.1)U/L and (56.1±5.9)U/L, all significantly lower than [(76.2±10.9)U/L,(71.5±6.6)U/L, (92.2±12.7)U/Land (71.9±6.3)U/L, respectively, P<0.05] in the control; serum MDA level was (2.9±0.6)μmol/L, significantly lower than [(5.6±0.7)μmol/L, P<0.05], while serum SOD and GSH-Px levels were (96.5±7.1)U/L and (121.7±10.3)U/L, both significantly higher than [(80.6±7.5)U/Land (100.5±9.2)U/L, respectively, P<0.05] in the control; serum TNF-α and MIF levels in the combination group were (3.8±0.5)ng/mL and (9.1±1.5)ng/mL, both significantly lower than [(7.6±1.7)ng/mL and (13.2±1.3)ng/mL, respectively, P<0.05], while serum sTNFR1 and IL-10 levels were (3.1±0.5) pg/mL and (34.5±3.8)pg/mL, both significantly higher than [(1.5±0.4)pg/mL and (21.2±3.1)pg/mL, respectively, P<0.05] in the control. Conclusion Magnesium isoglycyrrhizinate and reduced glutathione combination in the treatment of patients with cDILI is efficacious, which might be related to reduction of body oxidative stress and modulation of cytokine metabolism. We hope that our experience could facilitate physicians to correctly identify DILI early in presentation and provide a choice of management.

Objective The aim of this study was to compare subjective global assessment (SGA) and global leaders malnutrition initiative (GLIM) standards in the assessment of malnutrition in patients with liver failure (LF). Methods A total of 110 patients with LF were encountered in Beijing You'an hospital between 2020 and 2023, including subacute liver failure (SALF) in 26 cases, acute-on-chronic liver failure (ACLF) in 43 cases and chronic liver failure (CLF) in 41 cases; Malnutrition was screened by nutritional risk screening 2002 (NRS2002), SGA and GLIM, and the consistency was compared by Kappa test. Results The nutritional risk incidence rate of all patients assessed by NRS2002 was 51.8%, by SGA was 60.9%, which was higher than 50.0% assessed by GLIM (P＜0.05); serum prealbumin (PA) level in malnutrition group was significantly lower than in normal nutrition group in patients with SALF (P<0.05); in patients with ACLF, the body mass index (BMI) in malnutrition group was significantly lower than in normal group, while total serum bilirubin (TSB) level was significantly higher than in normal group (P＜0.05). serum PA and prothrombin time activity (PTA) in malnutrition group evaluated by SGA were significantly lower than in normal group, and 28 d fatality rate in malnutrition group by GLIM was significantly higher than in normal (P<0.05); in patients with CLF, TSB level in malnutrition group was significantly higher than in normal group, while BMI, PA and PTA in malnutrition group by SGA were significantly lower than in normal group; the BMI, PA and blood hemoglobin (HGB) levels in malnutrition group by GLIM were significantly lower than in normal group (P<0.05); Kappa test showed that SGA and GLIM had a good consistency in the evaluation of malnutrition in patients with LF (Kappa = 0.615,P＜0.001). Conclusion The incidence rates of nutritional risk and malnutrition are high in patients with LF, and majority of patients with malnutrition con be identified by SGA than GLIM. The evaluation results in ACLF and CLF are consistent by SGA than GLIM, we recommend NRS2002 for nutritional risk assessment in patients with SALF, and those with malnutrition should be carefully supported.

Objective The aim of this study was to investigate the changes of serum soluble growth stimulating expression gene 2 (sST2), Toll-like receptor 4 (TLR4), soluble urokinase plasminogen activator receptor (suPAR) and Beclin 1 levels in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods 122 patients with HBV-ACLF were enrolled in our hospital between November 2019 and November 2023, all received conventional liver-supporting therapy and followed-up for 3 months. Serum sST2, TLR4, suPAR and Beclin1 levels were detected by ELISA, and receiver operating characteristic curve (ROC) was drawn to evaluate predicting efficacy of serum indicators in patients with HBV-ACLF. Results 90 d survival rate in our series was 52.5%, as 58 patients didn't survived; total serum bilirubin, INR and score of model for end-stage liver disease at presentation in dead patients were(342.3±97.4)μmol/L, (2.8±0.7) and 23.4(19.3,27.3), all significantly higher than [(223.6±63.7)μmol/L, (1.7±0.5) and 18.6(16.2, 21.8), respectively, P<0.05] in survivals; serum sST2, TLR4, suPAR and Beclin1 levels were (102.6±18.5)ng/mL, (38.7±7.2)pg/mL, (11.4±3.2)ng/mL and (13.4±2.6)mg/L, all significantly higher than [(74.8±13.4)ng/mL, (28.4±5.7)pg/mL, (7.2±1.9)ng/mL and (8.6±2.3)mg/L, respectively, P<0.05] in survivals; ROC analysis showed that the AUC was 0.908, with sensitivity of 70.8% and specificity of 89.1%, suggesting a satisfactory predicting performance, when any three of the four serum parameters reached to cut-off-value in patients with HBV-ACLF. Conclusion Monitoring serum sST2, TLR4, suPAR and Beclin1 levels might be helpful to predict the prognosis of patients with HBV-ACLF.

Objective The purpose of this study was to investigate changes of serum angiopoietin-like protein 2 (ANGPTL2), soluble vascular adhesion protein 1 (sVAP-1) and high mobility group box protein 1 (HMGB1) levels in patients with hepatitis B virus infection-related acute-on-chronic liver failure (HBV-ACLF). Methods 67 patients with HBV-ACLF (early stage in 21 cases, moderate stage in 26 and terminal stage in 20 cases), 60 patients with chronic hepatitis B (CHB) and 60 healthy individuals for physical examination were enrolled in our hospital between December 2021 and February 2024, and serum ANGPTL2, sVAP-1 and HMGB1 levels were assayed by ELISA. Model for end-stage liver disease (MELD) scores were routinely calculated. Linear correlation was applied for correlation analysis. Results Serum ANGPTL2, sVAP-1 and HMGB1 levels in patients with HBV-ACLF were (11.1±2.6) ng/mL, (848.5±237.6) ng/mL and (68.7±15.9) ng/mL, all significantly higher than [(9.3±2.0) ng/mL, (702.3±208.8) ng/mL and (58.8±12.1) ng/mL, respectively,P<0.05] in patients with CHB or [(4.6±1.2) ng/mL, (425.3±103.4) ng/mL and (38.8±8.1) ng/mL, respectively, P＜0.05] in healthy control; serum ANGPTL2,sVAP-1 and HMGB1 levels in patients with ACLF at terminal stage were all much higher than in those at moderate or early stages (P＜0.05); serum ANGPTL2,sVAP-1 and HMGB1 levels in patients with HBV-ACLF were positively correlated to MELD scores(P＜0.05), and they were significantly higher in 30 dead patients than in 37 survivals(P＜0.05). Conclusion Serum ANGPTL2, sVAP-1 and HMGB1 levels in patients with HBV-ACLF elevates greatly, which might be related to severity of the entity. Clinicians should put emphasis on surveillance of serum ANGPTL2, sVAP-1and HMGB1, and pay more attention to patients with increased serum markers.

Objective The aim of this study was to compare efficacy selective decongestive devascularization of gastrosplenic region (SDD-GSR) and splenectomy and pericardial devascularization (SPD) combination in the treatment of cirrhotics with portal hypertension (PHT). Methods Sixty-five patients with cirrhotic PHT were encountered in our hospital between January 2019 and January 2024, and out of them, 32 patients in observation group received SDD-GSR and 33 in control received SPD. Portal vein pressure was measured by glass water column manometer through right gastroepiploic vein. Portal vein flow (PVF), portal vein diameter (PVD) and portal vein velocity (PVV) were determined by color Doppler ultrasound. Peripheral blood T lymphocyte subsets were detected by flow cytometry. Results By end of surgery, the portal vein pressure in the observation group was (21.1±4.2) cmH₂O, much lower than [(25.7±5.3) cmH₂O, P<0.05] in the control group; by end of three months after operation, the PVD in the observation was (1.3±0.3)cm, much smaller than [(1.5±0.4)cm, P<0.05], while the PVV was (47.7±3.5)cm/s, much quicker than [(41.0±3.1)cm/s, P<0.05] in the control; before and after operation, there were no significant differences as respect to liver function tests and blood cell counts between the two groups (P>0.05); by three months after operation, percentage of peripheral blood CD4⁺ cells and CD4⁺/CD8⁺ cell ration in the observation group were (41.9±3.4)% and (1.4±0.3), both significantly higher than [(35.6±3.1)% and (1.2±0.2), respectively, P<0.05] in the control group. Conclusion The SDD-GSR operation has a satisfactory efficacy in the treatment of cirrhotic PTH, with improvement of portal vein hemodynamics and immune functions, which warrants further clinical investigation.

Objective This study aimed to investigate clinical efficacy of tenofovir and Anluo Huaxian capsule, a herbal medicine compound, combination in the treatment of patients with hepatitis B-induced liver cirrhosis (LC). Methods A prospective study was carried out at Xuzhou Central Hospital, enrolled 145 patients with hepatitis B-induced LC between March 2019 and March 2023, and all were randomly assigned to receive tenofovir disoproxil fumarate (TDF) in 73 cases (control) or TDF with combination of the herbal medicine in another 72 cases (observation) for 12 months. Serum tumor necrosis factor-α(TNF-α), interleukin -6(IL-6) and IL-8 levels were detected by ELISA, and serum laminin(LN), collagen type Ⅳ(Ⅳ-C), precollagen-Ⅲ (PC-Ⅲ) and hyaluronic acid(HA) levels were assayed by ELISA. Traditional Chinese Medicine (TCM) symptom scores were evaluated routinely. Results By end of 12 month treatment, serum bilirubin and alanine aminotransferase levels in the combination group were (23.2±5.3)μmol/L and (31.1±2.4)u/L, both significantly lower than [(36.6±5.1)μmol/L and (41.1±6.4)u/L, respectively, P＜0.05], while serum albumin level was (39.1±7.0)g/L, significantly higher than [(35.6±5.9)g/L, P＜0.05] in the control; serum IV-C, PCⅢ and HA levels were (62.5±11.7)ng/mL, (59.3±11.8)ng/mL and (67.0±17.7)ng/mL, all significantly lower than [(74.7±12.5)ng/mL, (77.5±11.5)ng/mL and (80.6±17.0)ng/mL, respectively, P＜0.05] in the control group; serum TNF-α, IL-6 and IL-8 levels were (6.5±2.2)ng/L, (4.1±1.0)ng/L and (3.1±0.6)ng/L, all significantly lower than [(10.0±2.4)ng/L, (6.2±1.2)ng/L and (4.4±0.8)ng/L, respectively, P＜0.05] in the control; TCM symptom scores, such as abdominal distension, jaundice, right hypochondrial pain and dry mouth were(0.8±0.1)points, (1.0±0.4)points, (0.9±0.4) points and (0.8±0.1)points, all much lower than [(1.7±0.2)points, (2.0±0.2)points, (1.7±0.5)points and (1.4±0.3)points, respectively, P＜0.05] in the control group. Conclusion The combination therapy of tenofovir and herbal medicine, Anluohuaxian capsule in treatment of patients with hepatitis B-related LC is found to be efficacious, with improvement of liver function tests and reduction of serum liver fibrosis markers, especially ameliorates TCM syndromes, and warrants further clinical long-term investigation.

Objective This study was conducted to explore application of splenic Gamna-Gandy vesicles by fast recovery fast spin echo pulse (FRFSE) sequence of MRI in predicting esophageal and gastric varices (EGV) in patients with hepatitis B-induced liver cirrhosis (LC). Methods 80 patients with hepatitis B-induced LC were encountered in our hospital between January 2020 and December 2022, and all underwent gastroscopy and MR scan. The portal vain diameters, splenic index and Gamna-Gandy bodies were determined and calculated under different MR sequences. The diagnostic performance was evaluated byreceiver operating characteristic curve (ROC). Results Among the 80 patients with LC, the gastroscopy found mild EGV in 23 cases, and moderate to severe EGV in 41 cases; the splenic Gamna-Gandy body positive rate and the number of greater than 3mm Gamna-Gandy body revealed by MR FRFSE sequence were 61.2% and (4.8±1.4), both significantly higher or greater than by T1W1, T2W1 or enhanced MR scan (P＜0.05); the portal vain diameter, splenic index and numbers of Gamna-Gandy bodies in patients with moderate to severe EGV were (17.6±2.1)mm, (158.9±32.6)mm³and (5.5±1.6), all significantly higher than [(14.6±1.2)mm,(119.6±10.6)mm³ and (3.2±1.0), respectively, P＜0.05] in patients with mild EGV; the ROC analysis showed that the AUC was 0.923, with sensitivity of 93.9% and specificity of 83.9%, when splenic Gamna-Gandy body greater than 4.7 was set as the cut-off-value in predicting the existence of moderate to severe EGV in patients with LC, much superior to portal diameter or splenic index did(P<0.05). Conclusion Thesplenic Gamna-Gandy body showed by FRFSE sequence of MRI might be used as a noninvasive tool for screening EGV in patients with hepatitis B-induced LC.

Objective This study was conducted to compare the clinical efficacy of splenic embolization (SPE) and splenectomy in the treatment of patients with hepatolenticular degeneration (HD) complicated with hypersplenism. Methods 105 HD patients with complicated moderate-to-severe hypersplenism were admitted in our hospital between May 2020 and June 2023, and out of them, the SPE was carried out in 61 patients and splenectomy in 40 patients. The mean arterial pressure (MAP), heart rate(HR) and blood oxygen saturation (SPO₂) were monitored during the operation, and serum cortisol (COR), C reactive protein (CRP) and interleukin-6 (IL-6) levels were assayed by ELISA. Results The intraoperative blood loss in patients receiving SPE was (4.2±0.6)ml, much less than [(162.3±54.2)ml, P＜0.05], while the MAP and HR were (84.6±11.8)mmHg and(79.8±7.3)beats/min. both significantly lower than [(89.6±8.5)mmHg and (84.2±8.5)beats/min, respectively, P＜0.05] in patients receiving splenectomy; after operation, serum COR and CRP levels in patients receiving splenectomy (487.8±50.2)nmol/L and (82.4±12.5)mg/L, much higher than [(370.8±47.3)nmol/L and (48.5±9.2)mg/L, respectively, P＜0.05] in patients receiving SPE; the white blood cell and platelet counts in patients receiving splenectomy (6.9±1.2)×10⁹/L and (164.5±27.3)×10⁹/L, significantly higher than [(4.9±1.3)×10⁹/L and (92.6±26.4)×10⁹/L, respectively, P＜0.05] in patients receiving SPE; there was no significant difference respect to post-operational complications between the two groups(P>0.05), although abdominal pain after SPE, and portal thrombosis after splenectomy was common. Conclusion We believe that the splenectomy could ameliorate hypersplenism radically, but it might induce portal thrombosis, which should be carefully managed perioperatively.

Objective Many studies have explored the role of RNA m6A methylation modifiers in hepatocellular carcinoma (HCC), but the current results are controversial. Therefore, we conducted a meta-analysis to comprehensively study the relationship between RNA m6A methylation and the risk of liver cancer and the prognosis of patients with HCC. Methods We searched Chinese and English literatures database before March 2024, including Chinese databases Wanfang and CNKI, and English databases, Pubmed, OVID, EBSCO and web of science. Related literatures as case-control studies, on RNA m6A methylation and the development and prognosis of patients with HCC were retrieved. The quality of the literature was evaluated according to the Newcastle- Ottawa scale (NOS) scoring system. Based on inclusion and exclusion criteria, the literature was screened and the data was extracted, and the RevMan5.3 software was applied for statistical analysis. Results A total of 11 articles were found, including 3586 patients with HCC (1071 HCC tissues and 2515 adjacent liver tissue); the positive rate of m6A methylation in HCC tissues was 61.7%, significantly higher than 38.5% [OR= 4.77, 95% CI (2.58-8.82), P<0.00001] in liver tissues; hepatic expressions of FTO, METTL3, YTHDF1 and ALKBH5 were positively correlated to poor prognosis of patients with HCC [HR=1.3, 95%CI(1.17-1.44),P<0.00001]. Conclusion RNA m6A hypermethylation is closely related to the occurrence of liver cancer, and the expressions of m6A methylation modifiers, such as FTO, METTL3,YTHDF1 and ALKBH5 genes in liver cancer tissues are closely related to the poor prognosis of patients with HCC.

Objective The aim of this study was to investigate the efficacy of transcatheter arterial chemoembolization (TACE) and targeted immunotherapy combination in treatment of patients with advanced primary liver cancer (aPLC). Methods A total of 128 patients with aPLC were enrolled in our hospital between April 2021 and September 2024, and were randomly assigned to receive TACE in 64 cases, or receive TACE plus lenvatinib and sintilimab monoclonal antibody combination therapy in another 64 cases. Short-term efficacy was evaluated according to mRECIST. Serum α-L-fucosidase (AFU), alpha-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9), hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF), cysteine aspartic protease-4 (Caspase-4) and survivin levels were detected by ELISA. Results Objective remission rate (ORR) and disease control rate (DCR) in combination treatment group were 42.2% and 79.7%, both significantly higher than 23.4% and 60.9% in TACE-treated group (P<0.05); after treatment, serum AFU,AFP and CA19-9 levels in combination-treated patients were (183.9±19.7)U/L, (349.7±21.8)ng/mL and (27.8±6.2)KU/L, all significantly lower than [(236.2±20.6)U/L, (461.3±24.6)ng/mL and (41.3±6.9)KU/L, respectively, P<0.05] in TACE alone-treated patients; serum HGF, VEGF, PDGFand bFGF levels were (71.5±7.9)ng/mL, (303.7±36.4)ng/L, (1507.4±302.4)ng/L and (101.3±14.5)ng/L, all much lower than [(94.9±8.7)ng/mL, (432.6±41.5)ng/L, (1963.6±314.7)ng/Land (141.5±15.3)ng/L, respectively, P<0.05] in the control; serum Caspase-4 level was (44.6±5.8)ng/mL, much higher than [(37.8±5.5)ng/mL, P<0.05), while serum survivin level was (21.1±3.9)ng/mL, much lower than [(26.1±3.7)ng/mL, P<0.05]in TACE alone-treated patients. Conclusion TACE plus targeted immunotherapy is an promising approach for management of patients with aPLC, which might relieve tumor burden and control the disease progression.

Objective The aim of this study was to investigate clinical efficacy and safety of radiofrequency ablation (RFA) plus atezolizumab in the treatment of patients with unresectable hepatocellular carcinoma (HCC). Methods A total of 112 patients with unresectable HCC were encountered in our hospital between March 2022 and April 2024, and were randomly assigned to receive RFA in 56 cases, or receive FRA plusatezolizumab combination therapy. Serum interferon-γ, transforming growth factor-β1(TGF-β1), interleukin-10(IL-10)and IL-4 levels were detected by ELISA, peripheral blood lymphocyte subsets were determined by FCA, and quality of life (QOL) was assessed byQLQ-C30 questionaire. Results After treatment, disease control rate and Objective remission rate in the combination group were89.3% and 57.1%, both much higher than 64.3% and 35.7%(P<0.05) in the control; serum IFN-γ,IL-4 and IL-10 levels were(255.3±10.2)ng/mL, (45.3±5.4)μg/mL and (25.5±3.2)μg/mL, all significantly higher than [(229.9±10.0)ng/mL, (34.6±4.3)μg/mL and (20.2±2.8)μg/mL, respectively, P<0.05], while serum TGF-β1 level was (21.2±3.7)μg/mL, significantly lower than [(28.2±3.0μg/mL,P<0.05] in the control group; percentages of peripheralblood CD3⁺ and CD4⁺T cells, and ratio ofCD4⁺/CD8⁺cells were (64.1±5.1)%, (33.8±2.8)% and (1.3±0.2), all significantly higher than[(57.9±5.0)%, (29.0±2.7)% and (1.0±0.2), respectively,P<0.05] in the control; improvement of quality of life in the combination group was much superior to that in the control(P<0.05); incidence of adverse effect in the combination group was 33.9%, much higher than 12.5%(P<0.05) in the control group. Conclusion RFA plus atezolizumab therapy is efficaciousin the treatment of patients with unresectable HCC, with significant improved QOL, which might be related to body immune modulation.

Objective The purpose of this study was to investigate efficacy of self-controlled intravenous analgesia of dexmedetomidine and sufentanil and butorphanol combination in patients with primary liver cancer (PLC) after laparoscopic hepatectomy (LH). Methods 72 patients with PLC were enrolled in our hospital between January 2020 and December 2023, and all underwent LH for resection of liver cancer. For post-operational analgesia after surgery, patients were randomly divided into control (n=36) and observation (n=36) groups, receiving intravenous pumping of sufentanil and butorphanol or sufentanil, butorphanol and dexmedetomidine combination by self-controlled way. Body pain was evaluated by visual analogue scale (VAS). Serum neuropeptide Y (NPY), substance P (SP) and 5-hydroxytryptamine (5-HT) levels were assayed by RIA, and serum cortisol (Cor), catecholamine (CA) and adrenocorticotropic hormone (ACTH levels were detected by ELISA. Results Recovery of autonomous respiration and waking in the observation group(16.7±2.2)min and (19.3±2.4)min, both much shorter than [(21.2±2.7)min and (23.8±3.1)min, respectively, P＜0.05] in the control; by 24 hours and 48 hours after operation, VAS scores in the observation were (1.6±0.3)points and (1.0±0.2)points, both significantly lower than [(2.1±0.4)points and (1.9±0.3)points, P＜0.05] in the control; by 24 hours after surgery, serum NPY, SP and 5-HT levels in the observation were (41.8±8.6)pg/mL, (52.5±10.4)pg/mL and (0.4±0.1)μmol/L, all significantly lower than [(54.4±10.7)pg/mL, (79.5±13.8)pg/mL and (0.5±0.1)μmol/L, respectively, P＜0.05] in the control; serum Cor, CA and ACTH levels were (211.5±29.0)nmol/L, (216.6±29.7)pg/mL and (6.6±1.3)pg/mL, all much lower than [(265.6±25.8)nmol/L, (240.7±26.3)pg/mL and (8.4±1.5)pg/mL, respectively, P＜0.05] in the control group. Conclusion The application of dexmedetomidine combined with sufentanil and butorphanol for analgesia in patients with PLC after LH have a perfect efficacy, which might be related to inhibition of stress reaction.

Objective The aim of this study was to investigate the prediction of complete remission (CR) by contrast-enhanced ultrasonography (CEUS) and serum prothrombin induced by vitamin K absence-II (PIVKA-II) levels in elderly patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) therapy. Method 87 elderly patients with HCC were encountered in the First Affiliated Hospital, Air Force Medical University between March 2020 and March 2023, and all underwent CEUS to detect the rise time (RT), time to peak (TTP) and maximum of intensity (IMAX). Serum PIVKA-II levels were routinely assayed. Based on appropriate preparing, the TACE was conducted for every patient. The receiver operating characteristic (ROC) curve was applied to predict the efficacy of TACE. Result Out of the 87 patients with HCC, the CR was obtained in 27 cases(31.0%), and the partial remission, stable disease and progression disease were found in 19 cases, 28 cases and 13 cases, e.g., the non-CR rate was 69.0%; before TACE, the TTP by CEUS in patients with CR was (35.3±3.2)s, significantly longer than [(18.3±3.5)s, P＜0.05], while serum PIVKA-Ⅱ level was (1253.7±307.4)mAU/mL, much lower than [(2784.1±221.7)mAU/mL, P＜0.05] in patients with non-CR; the ROC analysis showed that the predicting performance of the combination of TTP and serum PIVKA-II level for CR after TACE was promising, with the sensitivity of 96.3% and the specificity of 88.3%, much superior to any parameters of the two alone (P<0.05). Conclusion Both the CEUS and serum PIVKA-II level could be used to predict CR in elderly patients with HCC after TACE, which needs further multi-center clinical study for verification.

Objective The aim of this study was to investigate ultrasonographic feature and qualitative diagnosis of intrahepatic solid space-occupying lesions (SSOL) by contrast-enhanced ultrasound (CEUS). Methods A total of 118 patients with intrahepatic SSOL were encountered in our hospital between March 2021 and March 2024, and all patients underwent CEUS check-up and hepatectomy. The consistency between CEUS and histopathological golden standard in qualitative diagnosis of benign and malignant lesions was analyzed by Kappa. The diagnostic efficacy of CEUS was analyzed by receiver operating characteristic (ROC) curves. Results Of 118 patients with intrahepatic SSOL, histopathological examination found malignant lesions in 72 cases and benign ones in 46 cases; in benign lesions, arrival time was (2.5±0.6)s, much shorter than [(3.6±0.8)s, P＜0.05], time to peak was (9.5±1.6)s, much longer than [(7.3±1.2)s, P＜0.05], peak intensity was (9.4±2.1)dB, much greater than [(5.8±0.9)dB, P＜0.05] and sharpness of fitted curve was (0.4±0.1)l/s, much less than [(1.2±0.3)l/s, P＜0.05] in malignant focci; there was a satisfactory consistency between CEUS and golden standard with a Kappa of 0.754(P＜0.05); the sensitivity, specificity, accuracy, positive predictive value and negative predictive value by CEUS were 87.5%, 89.1%, 88.1%, 92.7% and 82.0%, suggesting a good diagnostic efficacy (P＜0.05). Conclusion The qualitative diagnosis of intrahepatic SSOL by CEUS is efficacious, which might help clinicians make an appropriate measures to deal with as early as possible.

Objective The aim of this study was to investigate CT three-dimensional reconstruction technology in guiding surgical resection of perihilar cholangiocarcinoma(PHCC). Methods 96 patients with PHCC were encountered in our hospital between June 2019 and June 2024, and all underwent CT scan for three-dimensional reconstruction, and tumor resection thereafter. Results Seventy-two patients (75.0%)with PHCC in our serieshad actually had their tumor resected, and the sensitivity (Se), specificity (Sp) and accuracy (Ac) of CT three-dimensional reconstruction in evaluating the resectability of PHCC were 97.2%, 54.2% and 86.5%; based on histopathological classification, the Ac of CT three-dimensional reconstruction in judging Bismuth-Corlette classification was 91.6%; histopathological examination found artery, portal, venous invasion and lymph node metastasis in 25 cases, 28 cases, 10 cases and 15 cases out of the 72 patients with resected tumors; the Se were 92.0%, 92.0%, 90.0% and 86.7%, Sp were 89.4%, 90.9%, 96.8% and 89.5%, and Ac were 90.3%, 90.3%, 95.8% and 88.9% by CT three-dimensional reconstruction in judging artery, portal, venous invasion and lymph node metastasis. Conclusion Three-dimensional CT reconstruction in determining resectability of PHCC pre-operationally is helpful for clinicians making appropriate surgical decisions.

Objective The aim of this study was to summarize manifestations of hepatic hemangioma (HH) by using grayscale ultrasound, color Doppler flow imaging (CDFI) and contrast-enhanced ultrasound (CEUS), in order to help clinicians making diagnosis. Methods 62 patients with HH were encountered in Jingmen People's Hospital, affiliated to Jingchu Institute of Technology between January 2022 and August 2024, all patients underwent grayscale ultrasound, CDFI and CEUS examination, and underwent surgical resection. Results Tumor resection completed successfully in all the 62 patients with HH in our series, and histopathological examination diagnosed cavernous hemangioma in 44 cases, sclerosing hemangioma in 7 cases, vascular endothelial cell tumor in 6 cases and capillary hemangioma in 5 cases; ultrasonography showed that the size of HH lesions in this group ranged from 1.5 to 84 cm, with an average of (4.6 ± 1.3) cm, and the lesions presented irregular edges and non-spherical shapes; the lesion presented as enhanced echo or uneven echo distribution; CDFI examination demonstrated the lesions presented as spotted short columnar blood flow signals, with blood flow phenomena found within and around the vascular tumor; CEUS examination showed a slightly hyperechoic nodule in the liver, which appeared as a nodular ring-shaped high-intensity enhancement at arterial phase, subsequently, the contrast agent cleared or manifested as a slightly hyperechoic nodule in the liver; at portal and delayed phases, the contrast agent gradually filled the center, showing high-intensity enhancement. Conclusions The HH is relatively easy to diagnose by gray scale and color Doppler ultrasonography, and for some lesions that are difficult to determine, CEUS examination might be used to help further clarify the diagnosis.

Objective This study was conducted to summarize the clinical feature and pathogen distribution in patients with bacterial liver abscess (BLA). Methods 60 consecutive patients with BLA were encountered in our hospital between January 2020 and April 2023, and all were treated with abscess puncture and aspiration or catheterization under ultrasound guidance at base of antibacterial therapy. Bacterial culture, separation and characterization was routinely carried out. Results The underlying diseases in our 60 patients with BLA were diabetes and hypertension, and the common symptoms and sign included anorexia, jaundice, peritonitis, high fever, chills, abdominal pain, nausea and vomiting and tapping pain in the liver area; the white blood cell counts, neutrophil cell counts, serum ALT and AST levels increased, while hemoglobin and albumin levels decreased; the abscess localized at left lobe, right lobe, double lobes and at junction of left and right lobes accounted for 26.7%, 58.3%, 8.3% and 6.7%, with the mean diameter of abscess of (3.6±0.9)cm; out of 89 strains of pathogens separated, the Lebsiella pneumonia, Escherichia coli and Staphylococcus aureus accounted for 46.1% (n=41), 20.2% (n=18) and 14.6% (n=13); the resistance of Lebsiella pneumonia to ampicillin was 100.0%, to seven antibiotics was greater than 30.0%, while to other nine antibiotics was less than 30%; the most Escherichia coliwas resistant to ampicillin, and the resistance to 13 antibiotics was over 30.0%, while to other three antibiotics was less 30%; at the end of 13-28 (15.2±3.6)day treatment, the recovery rate as showed by total disappearance of the abscess in our series was 88.3%, left 7 patients (11.7%)had their intrahepatic abscess uncurable, which disappeared after a little longer observation and management. Conclusion The BLA mostly often occurs in persons with diabetes and hypertension, and the common pathogens are Klebsiella pneumoniae and Escherichia coli. The percutaneous transhepatic drainage at base of antimicrobial treatment might obtain a promising outcomes.

Objective The aim of this study was to investigate application of transjugular liver biopsy (TJLB) in patients with creptogenic liver diseases. Methods Fouty-seven patients with creptogenic liver diseases were encountered in our hospital between December 2023 and May 2024, and all underwent TJLB for histo-pathological examination. The key operating points and possible complications were summarized. Results All patients (100.0%)completed the operation; the obtained liver tissues were one to five bars, average of 3.0±0.9 bars, with 0.2 to 2.5 cm (average:1.1±0.4 cm); under microscopy, 2 to 24 portal areas were found (average:7.8±4.9); with combination of serology study, the histo-pathological examination diagnosed autoimmune hepatitis (AIH)in 13 cases, creptogenic nodular liver cirrhosis in 6 cases, unavailable diagnosis because of too little tissues in 4 cases, primary biliary cholangitis (PBC) in 4 cases, drug-induced liver injury (DILI) in 3 cases, connective tissue hyperplasia(CTH) in 3 cases, fatty liver in 2 cases, creptogenic liver diseases in 2 cases, hepatocyte spotty necrosis in 2 cases, AIH-PBC overlapping syndrome (OS)in 2 cases, idiopathic non-cirrhotic portal hypertension in 1 case,cavernous transformation of the portal vein (CTPV) in 1 case, small bile duct hyperplasia in 1 case, scattered inflammatory cell infiltration in 1 case, nonalcoholic steatohepatitis (NASH) in 1 case and normal liver tissue manifestation in 1 case; 1 patient (2.1%)developed subcapsular hemorrhage after the operation and recovered by appropriate management. Conclusion Transjugular liver biopsy is an alternative useful approach to obtain liver tissue samples, which might helpful to determine diagnosis for clinicians to make an early management.

Objective The aim of this study was to investigate the diagnostic efficacy of multimodal contrast-enhanced ultrasound (CEUS) in diagnosing arterial complications (AC) in recipients of liver transplantation (LT). Methods A cohort of 79 patients with end-stage liver diseases were encountered in our hospital between May 2019 and May 2024, and all patients underwent orthotopic liver transplantation (OLT). After the operation, digital subtraction angiography (DSA) as golden criteria, 2D grey-scale ultrasonography, color Doppler imaging (CDI), spectral Doppler and pulsed wave Doppler imaging, and CEUS were conducted. Receiver operating characteristic curve (ROC) was applied to evaluate diagnostic performance. Results DSA showed normal hepatic arteries in 39 cases (49.4%), and ACs in 40 cases (50.6%)in our 79 recipients of LT, and of which were hepatic artery thrombosis (HAT)in 16 cases, hepatic artery stricture(HAS) in 13 cases, splenic arterial steal syndrome (ASS) in 6 cases and splenic artery aneurysm in 5 cases;there were no significant differences as respect to prevalence of ACs after OLT among patients with underlying liver cirrhosis in 35 cases, liver failure in 20 cases and primary liver cancers in 24 cases (P>0.05); the sensitivity, specificity, accuracy, positive predictive value and negative predictive value by CEUS in finding ACs were 90.0%,97.4%,93.7%,97.3%and 90.5%, while they were 97.5%(P<0.05), 89.7%(P<0.05),93.7%, 90.7% and 97.2% by conventional ultrasonography. Conclusions CEUS check-up for ACs could help clinicians make appropriate measures early and might improve the prognosis of recipients in this setting.

Objective The aim of this study was to investigate anesthetic efficacy of dexmedetomidine in combination with propofol in patients with intrahepatic bile duct stones (IHBDS) undergoing precise hepatectomy (pHT). Methods A total of 91 patients with IHBDS were encountered in our hospital between January 2018 and December 2022, and all underwent pHT. For anesthesia, 45 patients in control group received propofol and 46 patients in observation group received dexmedetomidine and propofol combination. Parameters were routinely monitored before anesthesia induction (T0), immediately after surgery (T1), at 2 hours after surgery (T2), 6 hours after surgery (T3) and 12 hours after surgery (T4). Postoperative analgesia and sedation efficacy were evaluated by numerical rating scale (NRS) and Ramsay sedation scale (RSS), respectively. Serum cortisol (Cor), adrenocorticotropin (ACTH) and malondialdehyde (MDA) levels were detected by ELISA. Results The extubation time and awaking time in the observation group were (14.3±2.9) min and (15.7±3.8) min, significantly shorter than those in control group [(17.0±3.2) min and (18.4±4.1) min, P<0.05]; by T2, T3 and T4, dynamic NRS scores in the observation groups were (3.5±0.7) points, (3.1±0.6) points and (2.8±0.4) points, significantly lower than those in control group [(4.1±1.1) points, (3.7±0.7) points and (3.3±0.6) points, P<0.05], while RSS scores were (2.6±0.5) points, (2.8±0.6) points and (2.9±0.8) points, significantly higher than those in the control group [(1.9±0.8) points, (2.1±0.8) points and (2.2±0.9) points, P<0.05]; at T4, serum Cor, ACTH and MDA levels in the observation group were (234.1±32.7) mmol/L, (17.6±5.3) pmol/L and (3.3±0.7) mmol/mL, all significantly lower than those in the control group [(274.3±38.4) mmol/L, (25.7±6.9) pmol/L and (4.2±0.9) mmol/mL, P<0.05]. Conclusion Combiantion of dexmedetomidine and propofol could improve anesthetic efficacy, with satisfactory postoperative analgesia and sedation, which might be related to inhibition of body oxidative stress response in patients with IHBDS undergoing pHT, and is worthy of further clinical study.

Objective The aim of this study was to observe analgesic efficacy of preemptive analgesia by subcostal transverse fascial block in patients with intrahepatic bile duct stones (IHBDS) undergoing laparoscopic hepatectomy (LH). Methods A total of consecutive 147 patients with IHBDS were encountered in our hospital between January 2021 and December 2023, and all patients underwent LH for removal of diseased liver lobe. Before anesthesia, patients were divided into two groups, 71 patients in the control received general intravenous anesthesia, while 76 patients in the observation group received preemptive analgesia with subcostal transverse fascial block and then the general anesthesia same as in the control. Visual analogue scale (VAS) was applied to assess post-operational pain, and serum epinephrine (E), norepinephrine (NE) and cortsisol (Cor) levels were assayed by ELISA. Results Intestinal function resumed and hospital stay in the observation were(2.1±0.9)d and (7.1±1.1)d, both much shorter than [(3.2±1.1)d and (8.5±1.3)d, respectively, P＜0.05] in the control; by 6 h and 24 h, resting VAS scores in the observation were (1.9±0.5) points and (2.2±0.5)points, both significantly lower than [(2.9±0.3)points and (2.8±0.5)points, respectively, P＜0.05], and VAS score at motion were (2.4±0.3) points and (2.6±0.5)points, both significantly lower than [(3.4±0.5)points and (3.4±0.7)points, P＜0.05] in the control; post-operationally, serum E and Cor levels in the observation were (200.1±27.4)pg/ml and (262.1±28.4)pg/ml, both much lower than [(240.3±33.5)pg/ml and (301.7±31.2)pg/ml, P＜0.05] in the control; there were no significant differences as respect to heart rates or mean arterial pressure at T1 to T4 in the two groups(P＞0.05), and there were also no significant differences respect to adverse effects in the two groups (9.8% vs. 7.8%, P＞0.05). Conclusion Preemptive analgesia by subcostal transverse fascial block could alleviate post-operational pain in patients with IHBDS undergoing LH, which might be related to inhibition of body inflammatory reactions.

Objective The aim of this study was to investigate clinical efficacy of laparoscopic cholecystectomy (LC) and choledochoscopy combination in the treatment of patients with recurrent common bile duct stones after biliary tract surgery. Methods 108 patients with recurrent choledocholithiasis who had had biliary tract surgery were enrolled in our hospital between January 2022 and June 2024, and were randomly divided into group A (n=45) and group B (n=63), receiving LC and choledochoscopy combination, or endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST), and all patients were followed-up for 6 months. Serum endotoxin (ET) level was detected by ELISA, and serum D-lactic acid level was routinely obtained. Results Surgical time, postoperative hospital stay and medical cost in group A were(102.8±19.1)min,(8.4±1.6)d and (20.6±4.0)thousand yuan, all significantly greater or longer than [(81.5±14.6)min, (5.1±1.3)d and (19.0±4.0)thousand yuan, respectively, P<0.05]; three days after surgery, serum ET and D-lactic acid levels in group A were(7.8±1.7)g/L and (0.5±0.1)mmol/L, both not significantly different as compared to [(8.6±1.9)g/L and (0.6±0.1)mmol/L, respectively] in group B(P>0.05); serum ALT, total bilirubin and albumin levels were (45.6±5.8)U/L, (17.2±3.3)μmol/L and (35.7±5.1)g/L, also not significantly different compared to [(43.8±6.0)U/L, (16.4±3.5)μmol/L and (34.6±4.7)g/L, respectively] in group B (P>0.05); incidences of post-operational complications, such as biliary infection, bleeding, bile leakage and acute pancreatitis in the two groups(11.1% vs. 19.1%) was not much different(P>0.05); by end of six-month follow-up, ultrasonography found no stone recurred in group A, but stone recurred in six cases(9.5%)in group B. Conclusion The efficacy of LC and choledochoscopy combination or ERCP/EST in the treatment of patients with recurrent common bile duct stones after biliary tract surgery is both satisfactory, but it seems more post-operational stone recurrence found after ERCP/EST, which needs further observation.

Objective This study aimed to investigate analgesia and sedation effects of pretreatment of esketamine and dexmedetomidine in patients with cholecystolithiasis undergoing laparoscopic cholecystectomy(LC). Methods 113 patients with cholecystolithiasis were encountered in our hospital between November 2022 and April 2024, and all underwent LC. Before anesthesia, patients were randomly divided into group D (n=37), group ED (n=38) and group C (n=38) to receive intravenous pumping of dexmedetomidine, esketamine and dexmedetomidine or normal saline for pretreatment. Postoperative sleep quality was assessed by Athens insomnia scale(AIS)and Pittsburgh sleep quality index(PSQI), emotional state was evaluated by self-rating anxiety scale (SAS) scores and self-rating depression scale (SDS) scores,postoperative pain was evaluated by NRS scores, and sedative effect was evaluated by Ramsay scores. Results At postoperative day 1(POD1) and POD3,AIS and PSQI scores in group ED were(8.4±1.3)points and (6.8±1.4)points, both much lower than [(8.7±1.1)points and (6.9±1.7)points, P＜0.05] in group D or [(9.7±1.1)points and (8.5±1.1)points, P＜0.05] in group C, PSQI scores were (9.1±1.3)points and (7.7±1.5)points, both much lower than [(9.2±1.5)points and (7.9±1.4)points, P＜0.05] in group D or [(10.9±2.3)points and (8.9±1.8)points, P＜0.05] in group C; at POD1, SAS and SDS scores in group ED and group D were much lower than in group C (P＜0.05); at extubation, 24 hours and 72 hours after operation, NRS scores in group ED and group D were much lower than in group C(P＜0.05); dose of sufentanil given for analgesia after operation in group ED was much smaller than in group D or group C (P＜0.05). Conclusion Pretreatment of esketamine and dexmedetomidine in patients with cholecystolithiasis undergoing LC could effectively alleviate postoperative pain, relieve depression and anxiety, and thereby enhance overall postoperative sleep quality.

Hepatic encephalopathy (HE) is a common complications of severe liver disease, with high recurrence rate and hard to deal with. Animal models are frequently employed in research to investigate pathophysiological mechanisms and explore potential therapeutic strategies. With advancements in modern medical technology, animal models for HE research have undergone remarkable improvements. In this review, we reviewed the latest research progress, focusing on establishment, evaluation, application, limitations, and future prospects of animal models in this field, with aiming to explore new therapeutic approaches for HE.