Objective The aim of this experiment was to investigate the molecular mechanism by which regulating synaptic membrane exocytosis 3 (RIMS3) mediated lenvatinib resistance in hepatocellular carcinoma (HCC) cells by regulation of γ-aminobutyric acid (GABA) secretion in vitro. Methods Lenvatinib-resistant Hep3B-LR and MHCC97H-LR were established by using a concentration gradient induction in Hep3B and MHCC97H cells. Bioinformatic analysis was employed to screen differentially expressed genes from transcriptome sequencing data of resistant and wild-type cell lines, as well as from external drug resistance datasets (GSE186191 and GSE211850). Cox proportional hazards regression analysis and survival analysis were applied to evaluate the impact of key genes on the survival and prognosis of patients with HCC. The IC₅₀ values were determined by CCK-8 assay, and the resistance index was calculated. siRNAs targeting RIMS3 were synthesized, and its mRNA and protein expression were detected by qRT-PCR and Western blotting, respectively. GABA levels in the cell culture supernatant was measured by ELISA. Results Resistance indices of Hep3B-LR and MHCC97H-LR were 3.3 and 3.1, respectively, greater compared to wild type; 29 drug resistance-related differentially expressed genes were identified, among which RIMS3 was significantly upregulated in resistant cells (P<0.01); RIMS3 served as an independent risk factor, and its high expression was associated with poor prognosis compared to HCC patients with low RIMS3 expression (P<0.05); targeted silencing RIMS3 (siRIMS3-1 and siRIMS3-2) significantly reduced the IC₅₀ values of resistant cells (Hep3B-LR decreased from 40.3 μM to 23.9 μM and 19.1 μM; MHCC97H-LR decreased from 20.2 μM to 8.3 μM and 12.3 μM); GABA levels in the supernatant of Hep3B-LR and MHCC97H-LR cells increased by (1.6±0.3)-fold and (1.4±0.2)-fold, respectively (P<0.05) compared to in wild cells; targeted silencing RIMS3 reduced GABA levels in the supernatant of Hep3B-LR cells by (0.3±0.1)-fold and (0.3±0.1)-fold (P<0.01), and in MHCC97H-LR cells by (0.5±0.2)-fold and (0.5±0.1)-fold (P<0.01); addition of exogenous GABA increased the IC₅₀ value of Hep3B-LR from 18.6 μM to 30.5 μM and that of MHCC97H-LR from 9.7 μM to 18.9 μM as compared with RIMS3-silenced resistant cells. Conclusion RIMS3 mediates lenvatinib resistance in HCC cells, maybe by regulating GABA secretion, and targeting RIMS3 might represent a novel strategy for reversing lenvatinib resistance.

Objective The aim of this study was to investigate CT-measured extracellular volume fraction (fECV) in combination with serum nicotinamide adenosine diphosphate oxidase 2 (NOX2) and chitinase-3-like protein 1 (YKL-40) levels in predicting hepatic fibrosis (HF) in patients with chronic hepatitis B (CHB). Methods A total of 113 patients with CHB were encountered in Xingtai Central Hospital between May 2023 and May 2025, and all of them underwent CT scan to measure fECV and liver biopsy. Serum NOX2 and YKL-40 levels were detected by ELISA. Multivariate Logistic regression analysis was applied to analyze the factors influencing the degree of HF in patients with CHB, and the receiver operating characteristic (ROC) curve and its area under the curve (AUC) were used to evaluate diagnostic efficacy. Results Of the 113 patients with CHB, liver histo-pathological examination found stage F0 of HF in 13 cases, stage F1 in 34 cases (e.g., non-significant HF in 47 cases),stage F2 in 38 cases, stage F3 in 18 cases (significant HF in 56 cases), and stage F4 in 10 cases; fECV, serum NOX2 and YKL-40 levels in significant HF group were (35.1±10.4)%, (16.8±3.4)ng/mL and (31.1±8.2)ng/mL, all much higher than [(26.9±7.6)%, (9.6±2.5)ng/mL and (21.6±6.5)ng/mL, respectively,P＜0.05] in non-significant HF group; multivariate Logistic regression analysis showed that fECV(OR=1.696,95%CI:1.057-2.719), NOX2(OR=1.853,95%CI:1.025-3.350) and YKL-40(OR=0.441,95%CI:1.044-2.314) were all the independent impacting factors for HF in patients with CHB; ROC analysis demonstrated that the AUC was 0.914(95%CI:0.842-0.960),with sensitivity of 92.9% and specificity of 76.6%, when the fECV was combined with serum NOX2 and YKL-40 levels in predicting significant HF in patients with CHB, much superior to any single parameter doing (P＜0.05). Conclusion The combination of fECV, and serum NOX2 and YKL-40 levels could help clinicians initially screen liver fibrosis in patients with CHB, which might lead to further management.

Objective The aim of this study was to observe silybin and polyene phosphatidyl choline combination in treatment of patients with alcoholic steatohepatitis (NASH). Methods A total of 178 consecutive patients with NASH were recruited in our hospital between May 2023 and May 2025, and were randomly assigned to receive oral polyene phosphatidyl choline therapy in 82 cases in group A, or receive oral polyene phosphatidyl choline and silybin capsule combination therapy in 96 cases in group B for six months. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were determined by Fibrotouch, and serum hyaluronic acid (HA), laminin (LN), IV collagen (IV-C), III procollagen (PCIII) and interleukin-10 (IL-10), IL-6 and tumor necrosis factor-α (TNF-α) levels were detected by ELISA. Results By end of six month treatment, serum ALT and AST, and CAP in group B were (50.3±4.2)U/L and (42.8±3.4)U/L, and (274.6±10.8)dB/m, all much lower than [(58.7±6.6)U/L, (48.9±5.1)U/L and (286.2±13.2)dB/m, respectively, P＜0.05] in group A; LSM, serum HA, Ⅳ-C and PCⅢ levels were (7.1±1.1)kPa, (60.9±5.2)μg/L, (58.6±6.7)μg/L and (92.5±10.1)μg/L, all significantly lower than [(8.6±1.9)kPa, (74.7±7.8)μg/L, (82.9±8.2)μg/L and (149.8±11.9)μg/L, respectively, P＜0.05] in group A; serum IL-6 and TNF-α levels were (13.6±4.2)ng/L and (14.4±3.6)mg/L, both much lower than [(20.2±5.1)ng/L and (25.1±3.3)mg/L, respectively, P＜0.05], while serum IL-10 level was (30.1±7.1)mg/L, much higher than [(24.9±6.4)mg/L, P＜0.05] in group A. Conclusion Effectiveness of silybin capsule and polyene phosphatidyl choline combination in treatment of patients with NASH is short-termly satisfactory, which could improve normalization of liver function tests, and might be due to inhibition of cytokine reactions.

Objective The aim of this study was to investigate diagnostic performance of Fibroscan in evaluating hepatic steatosis in patients with non alcoholic fatty liver diseases (NAFLD). Methods A total of 115 patients with NAFLD were encountered in our hospital between July 2022 and December 2024, and all underwent liver biopsies and Fibroscan for controlled attenuation parameter (CAP) and liver stiffness measurement (LSM). Serum cytokeratin 18 M30 fragment (CK 18-M30) level were detected by ELISA. Receiver operating characteristic curve (ROC) was applied to assess diagnostic efficacy. Results Of the 115 patients with NAFLD in our series, liver pathological examination found hepatic steatosis S0 in 5 cases, S1 in 21 cases, S2 in 46 cases and S3 in 43 cases; serum CK 18-M30 level in S3 group was (145.6±27.3)U/L, much higher than [(123.7±25.2)U/L, P＜0.05] in S 2 group or [(100.1±24.5)U/L, P＜0.05] in S0-S1 group; serum total cholesterol, triglycerides and low-density lipoprotein levels in patients with S3 were much higher, while high-density lipoprotein level was much lower than in patients with S0-S1 or S2 group(P＜0.05); CAP and LSM in S3 group were (332.8±30.1)dB/m and (8.5±1.3)kPa, significantly higher than [(298.9±31.5)dB/m and (6.8±1.4)kPa, respectively, P＜0.05] in S2 group or [(252.1±9.7)dB/m and (5.7±0.9)kPa, respectively, P＜0.05] in S0-S1 group; the AUC was 0.890, with sensitivity (Se) of 84% and specificity (Sp) of 74%, when CAP was applied to evaluate equal to or greater than S2 liver steatosis, much superior to serum CK 18-M30 did (the AUC was 0.620, Se of 78% and Sp of 46%). Conclusion The CAP obtained by Fibroscan scan could accurately stratify liver steatosis in patients with NAFLD, and merits further clinical verification.

Objective The aim of this study was to investigate the clinical efficacy of an herbal, Qinghua Quyu, compound in combination with acupuncture in the treatment of patients with metabolic-associated fatty liver disease (MAFLD) with dampness-heat accumulation TCM type. Methods 70 patients with MAFLD and a damp-heat accumulation TCM type were encountered in our hospital and in Rugao Traditional Chinese Medicine Hospital between January 2024 and September 2025, and were randomly assigned to receive general diet and exercise guidance in 35 cases in control, or receive an oral herbal medicine compound and acupuncture at base of general intervention in another 35 cases in observation group for 8 weeks. TCM syndrome scores were evaluated. Ultrasound attenuation parameter (UAP) and liver stiffness measurement (LSM) were detected by ultrasonography. Fatty liver index (FLI) was calculated based on clinical materials. Results By end of eight week treatment, total effectiveness about TCM syndrome improvement in the observation was 94.3%, much higher than 77.1%(P＜0.05) in the control; serum ALT and AST levels in the observation were (42.7±19.3)U/L and (29.5±9.3)U/L, both significantly lower than [(76.2±20.6)U/L and (43.7±10.4)U/L, respectively, P＜0.05] in the control; serum TC and TG levels were (5.4±0.8)mmol/L and (1.7±0.6)mmol/L, both significantly lower than [(6.0±0.4)mmol/L and (2.3±0.8)mmol/L, respectively, P＜0.05] in the control; UAP and FLI were (263.6±24.8)dB/m and (38.1±16.3), both much lower than [(277.5±23.5)dB/m and (55.7±21.5), respectively, P＜0.05] in the control group. Conclusion Combination of Qinghua Quyu decoction with acupuncture could effectively ameliorate clinical TCM-symptoms, improve liver function test and blood lipid normalization at base of diet control and exercise in dealing with patients with MALFD, which needs further clinical investigation.

Objective The aim of this study was to investigate dapagliflozin and metformin combination therapy in patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Methods A total of 105 patients with T2DM and NAFLD were encountered in our hospital between March 2023 and March 2025, and were randomly assigned to receive metformin in 52 cases for control, or take oral dapagliflozin and metformin in 53 cases for 24 weeks. Serum fasting insulin (FINS) was detected by electrochemiluminescence, and homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. The area of visceral fat was measured by visceral fat detector. The densities of liver and spleen were detected by CT scanner, and liver to spleen CT ratio was calculated. The heart rate variability indexes, e.g., standard deviation of NN intervals (SDNN), standard deviation of the average NN intervals (SDANN), root mean square of successive differences (rMSSD), percent of NN50 in the total number of NN intervals (pNN50), low frequency (LF) and high frequency (HF) were monitored by 24 h electrocardiogram. Results By end of 24-week treatment, visceral fat area in combination group was(126.6±15.8)cm², much less than [(135.8±17.0)cm²,P<0.05],while liver/spleen CT ratio was (0.9±0.2),much greater than [(0.8±0.2)cm²,P<0.05] in the control; HbA1c, FPG and HOMA-IR were (7.0±0.9)%, (6.0±0.8)mmol/L and (2.2±0.3), all significantly lower than [(7.7±1.0)%, (6.8±0.9)mmol/L and (2.7±0.3), respectively, P<0.05] in the control; SDNN, SDANN, rMSSD, pNN50, LF and HF were (111.2±13.9)ms, (106.9±13.4)ms, (21.9±4.7)ms, (4.2±0.9)%, (801.5±100.2)ms² and (494.8±91.9)ms²,all much higher than [(98.1±12.3)ms, (89.3±11.2)ms, (19.5±4.4)ms, (3.7±0.8)%, (724.9±90.6)ms² and (415.6±82.0)ms², respectively, P<0.05] in the control group. Conclusion Combination of dapagliflozin and metformin in treatment of patients with T2DM and NAFLD could significantly improve glucose metabolism, reduce visceral fat, and improve autonomic nerve functions.

Objective The aim of this study was to investigate diagnostic efficacy of FibroScan and liver-spleen CT (CT_L/S) ratio combination in predicting hepatic steatosis in patients with nonalcoholic fatty liver disease (NAFLD). Methods 106 patients with NAFLD were enrolled in our hospital between January 2023 and June 2025, and they all received liver biopsy for pathological examination, FibroScan for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP), and CT scan for CT_L/S ratio. Multivariate linear regression analysis was applied to evaluate the correlation between FibroScan parameters, CT_L/S ratio and hepatic steatosis in patients with NAFLD. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic performance of FibroScan parameters and CT_L/S ratio in predicting severe hepatic steatosis. Results Liver histo-pathological examination found mild hepatic steatosis in 32 cases, moderate in 39 cases and severe in 35 cases; body mass index, waist-to-hip ratio, LSM and CAP in patients with severe liver steatosis were (29.3±2.1)kg/m², (1.3±0.4), (10.1±1.4)kPa and (327.6±32.0)dB/m, all significantly higher than [(26.0±2.2)kg/m², (1.1±0.2), (8.4±1.2)kPa and (288.7±27.6)dB/m, respectively, P<0.05] in those with moderate liver steatosis or [(24.7±2.1)kg/m², (0.9±0.1), (7.5±1.3)kPa and (265.8±25.9)dB/m, respectively, P<0.05] in those with mild liver steatosis, while CT_L/S ratio was (0.5±0.1), significantly lower than [(0.6±0.1), P<0.05] in those with moderate or [(0.7±0.1), P<0.05] in those with mild liver steatosis; multivariate linear regression analysis found CAP was positively correlated to(β=0.366, 95%CI 0.148-0.687, P=0.006), while CT_L/S ratio was negatively correlated to liver steatosis(β=-0.235, 95%CI -0.101-0.393, P=0.015); ROC analysis showed that the AUC was 0.880 (95% CI:0.809-0.950), with sensitivity of 80.0% and specificity of 74.6%, when CAP was combined with CT_L/S ratio in predicting severe liver steatosis in patients with NAFLD. Conclusion CT_L/S ratio and CAP combination is helpful in screening liver steatosis in patients with NAFLD, which might guide clinicians take appropriate measures for intervention.

Objective The aim of this study was to investigate semaglutide in combination with pioglitazone/metformin in the treatment of patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Methods A retrospective study was performed on the clinical materials in 124 patients with T2DM and NAFLD, who were admitted to our hospital between September 2023 and March 2025, and were randomly assigned to receive oral pioglitazone/ metformin in 60 cases for control, or receive intramuscular injection of semaglutide weekly in another 64 cases for 12 weeks. Serum biochemical, sugar and fat parameters were monitored. Results By end of 12-week treatment, serum aspartate aminotransferase and gamma glutamyl transferase levels in combination-treated group were(43.9±5.5)U/L and (63.8±7.1)U/L, both significantly lower than [(49.8±5.7)U/L and (71.5±6.6)U/L, respectively, P<0.05] in the control group; serum fasting insulin level and homeostasis model assessment of insulin resistance in the combination group were(12.1±2.3)μU/mL and (2.4±0.5), both significantly lower than [(14.2±2.6)μU/mL and (2.9±0.6), respectively, P<0.05] in the control, while there was no significant difference as respect to fasting blood glucose levels in the two groups (P>0.05); serum triglyceride, cholesterol and low-density lipoprotein cholesterol in the combination group were(2.0±0.3)mmol/L, (5.3±1.0)mmol/L and (3.0±0.8)mmol/L, all significantly lower than [(2.5±0.6)mmol/L, (5.6±0.8)mmol/L and (3.4±0.9)mmol/L, respectively, P<0.05] in the control; there was no significant difference as respect to incidence of adverse effects, such as nausea and vomiting, fatigue and hypoglycemia between the two groups(7.8% vs. 1.7%, P>0.05). Conclusion Administration of semaglutide plus pioglitazone/metformin therapy in dealing with patients with T2DM and NAFLD is short-termly efficacious, which might improve liver function tests, blood sugar and fat metabolism, and needs further long-term clinical observation.

Objective The aim of this study was to summarize the features and outcomes of 710 patients with primary biliary cholangitis (PBC) with different clinical classification. Methods A retrospective cohort study was conducted to summarize clinical materials in 710 hospitalized PBC patients admitted to Beijing Ditan hospital between August 2008 and December 2019, and all patients were followed-up for ten years. Results The cohort included 219 patients with chronic progressive type, 224 patients with portal hypertension type and 267 patients with jaundice/liver failure type; patients with jaundice/liver failure type had a significantly higher neutrophil-to-lymphocyte ratio (NLR), total bilirubin (TBIL), gamma-glutamyl transferase (GGT), international normalized ratio (INR), and alkaline phosphatase (ALP) levels compared to those with chronic progressive or portal hypertension types (P<0.05); patients with portal hypertension type had the highest positive rate of anti-centromere antibodies (ACA) (P<0.05); patients with chronic progressive type exhibited the lowest fibrosis 4 score (FIB-4); during the 5-year follow-up, patients with chronic progressive type had significantly lowest incidences of esophageal-gastric varices, ascites and hepatic encephalopathy compared to those with portal hypertension or jaundice/liver failure types (P<0.05); 1-year mortality rates in patients with portal hypertension and jaundice/liver failure types were 1.3% and 5.6%, respectively (P<0.05), while the cumulative 5-year mortality rates were 6.3% and 7.5%, with no significant differences between the two groups (P>0.05); over a 10-year of follow-up, 24 patients with chronic progressive type progressed to portal hypertension type, and 7 progressed to jaundice/liver failure type. Conclusion Among the three clinical types of patients with PBC, the chronic progressive type exhibites the best liver reserve function and prognosis, while those with jaundice/liver failure type is associated with more pronounced cholestasis, severe liver damage, higher short-term mortality and poorer prognosis.

Objective The purpose of this study was to analyze pathogen distribution and factors impacting subsidence of ascites in patients with hepatitis B-induced liver cirrhosis (LC) complicated with spontaneous bacterial peritonitis (SBP). Methods 62 patients with hepatitis B-induced LC complicated by SBP were encountered in our hospital between March 2020 and December 2023, ascites pathogens were routinely separated and characterized, and all patients were carefully managed with antibiotics at base of supporting treatment. Multivariate Logistic regression analysis was applied to identify risk factors impacting subsidence of ascites. Results Of the 62 patients with SBP, 77 pathogenic strains were isolated, including 27 Gram-positive bacteria, e.g., Streptococcus pneumonia in 11, Staphylococcus epidermidis in 9, and Enterococcus faecium in 7, and 50 Gram-negative bacteria, e.g., Escherichia coli in 27, Pseudomonas aeruginosa in 14, Klebsiella pneumonia in 7, and Enterobacter cloacae in 2; the resistance of Staphylococcus epidermidis and Enterococcus faecium to cefotaxime reached to 55.6% and 100.0%, and that of Pseudomonas aeruginosa and Klebsiella pneumonia to ceftriaxone reached to 100.0% and 71.4%, respectively; by end of six-month follow-up, ascites subsided in 37 cases(59.7%), and didn’t in 25 cases (40.3%); percentage of concomitant diabetes, albumin-bilirubin scores (ALBI), Child-Pugh score, ascites polymorphonuclear cell (PMN) count and serum procalcitonin (PCT) level in patients without ascites subsidence were 28.0%, (-1.1±0.5), (11.4±2.9), (502.5±162.3)×10⁶/L and (4.2±0.4)ng/ml, all significantly higher than [5.4%, (-1.5±0.5), (8.0±2.4), (282.9±53.7)×10⁶/L and (0.7±0.3)ng/ml, respectively, P<0.05] in those with ascites subsided; multivariate Logistic regression analysis showed that concomitant diabetes, ALBI, Child-Pugh score and ascites PMN counts were all the independent risk factors impacting ascites subsidence(P<0.05). Conclusion Gram-negative bacteria are the predominant microbes in patients with hepatitis B-induced LC and complicated SBP. Effective prevention and treatment for SBP should be based on precise microbiological identification and individualized strategies.

Objective The purpose of this study was to investigate diagnostic performance of first-phase ejection fraction (EF1) in combination with left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) in predicting cirrhotic cardiomyopathy (CCM). Methods 127 patients with liver cirrhosis (LC) and 40 healthy individuals for physical examination were encountered in our hospital between July 2024 and June 2025, and all underwent conventional echocardiography for EF1, LVEF and GLS. Receiver operating characteristic (ROC) curve was applied to evaluate diagnostic efficacy. Results CCM was found in 44 cases (34.6%) in our series; LVEF, GLS and EF1 in CCM group were (55.3±4.6)%, (17.4±2.0)% and (24.2±3.4)%, all significantly lower than [(62.1±4.1)%, (21.7±2.2)% and (32.1±3.4)%, respectively, P<0.05] in patients with LC or [(60.9±3.5)%, (20.7±1.9)% and (30.5±2.5)%, respectively, P<0.05] in healthy control; AUC was 0.969, when EF1 in combination with LVEF and GLS was applied to predict CCM in patients with LC, much superior to any parameter did alone. Conclusion EF1 sensitively reflects alterations of left ventricular systolic functions in patients with CCM, and the combination of EF1, LVEF and GLS could help clinicians early screen CCM.

Objective The aim of this study was to investigate impact of intravenous somatostatin and omeprazole treatment on hepatic venous pressure gradient (HVPG) in patients with hepatitis B-induced liver cirrhosis (LC) and esophagogastric variceal bleeding (EVB) after endoscopic variceal ligation (EVL). Methods 76 consecutive patients with hepatitis B-induced LC and complicated EVB were encountered in our hospital between January 2022 and January 2025, were randomly assigned to underwent EVL in 38 cases in control, or to receive intravenous somatostatin and omeprazole treatment after EVL in another 38 cases in observation. The free pressure and wedge pressure of hepatic vein were detected by jugular vein puncture, and HVPG was calculated. Serum malondialdehyde, cortisol and C-reactive protein (CRP) levels were detected by ELISA. Results Blood transfusion volume, hemostasis time, incidence of re-bleeding at 72 hours and hospital stay in the observation group were(2.1±0.4)U, (1.8±0.7)h, 2.6% and (9.1±2.0)d, all not significantly different as compared to [(2.4±0.5)U, (2.2±0.6)h, 7.9% and (10.8±2.4)d] in the control group (P＜0.05); HVPG in the observation group was (6.6±1.4)mmHg, much lower than [(8.3±1.8)mmHg, P＜0.05] in the control; serum malondialdehyde, cortisol and CRP levels were(30.1±5.2)U/L, (264.3±15.4)μg/L and (9.7±1.9)mg/L, all significantly lower than [(40.5±6.4)U/L, (297.8±19.1)μg/L and (14.2±3.3)mg/L, respectively, P＜0.05] in the control group. Conclusion The maintained intravenous administration of somatostatin and omeprazole after EVL might decreased HVPG, which might decrease the risk of re-bleeding in patients with LC and EVB.

Objective The aim of this study was to investigate endoscopic lauromacrogol sclerosis injection with combination of intravenous pumping of somatostatin in treatment of patient with hepatitis B-induced liver cirrhosis (LC) and esophageal and gastric variceal bleeding (EGVB). Methods A total of 94 patients with hepatitis B-induced LC and EGVB were encountered in our hospital between May 2023 and May 2025, and were randomly assigned to receive internal comprehensive supporting treatment, including intravenous pumping of somatostatin for 3 to 5 days in 47 cases for control, or underwent endoscopic lauromacrogol sclerosis injection at basis of supporting therapy in the control in another 47 cases. Serum motilin (MTL), somatostatin (SS) and fibrinogen (FIB) levels were detected by radioimmunoassay, and prothrombin time (PT) was detected by blood analyzer. Results Two patients in the control and one in the combination group died of emergent bleeding in our series; total blood transfusion volume in the combination group was (1.9±0.3)U, much less than [(4.1±0.7)U, P＜0.05], and hemostasis time and hospital stay were (15.3±4.5) h and (12.4±2.9)d, both much shorter than [(22.6±5.8)h and (16.8±3.5)d, respectively, P＜0.05] in the control; after hemostasis, serum MLT and SS levels were (210.3±16.2)ng/L and (69.4±11.0)ng/L, both significantly lower than [(285.2±19.3)ng/L and (93.5±14.2)ng/L, respectively, P＜0.05], while serum FIB level was (2.7±0.9)g/L, significantly higher than [(2.0±0.5)g/L, P＜0.05] in the control; re-bleeding rates at 2 week, 1 month and 3 month were 0.0%, 0.0% and 2.2%, all much lower than 11.1%, 17.8% and 31.1%(P＜0.05) in the control group. Conclusion Endoscopic lauromacrogol sclerosis injection in combination with somatostatin in dealing with LC patients with EGVB could obtain rapid hemostasis, and maybe regulate gastrointestinal hormones balance, which warrants further clinical investigation.

Objective The aim of this study was to summarize the feature spontaneous splenorenal shunts (SSRS) diagnosed by abdominal contrast-enhanced CT scan and CT portal venography (CTV) in patients with liver cirrhosis (LC). Methods A total of 131 patients with LC were admitted to our hospital between December 2022 and January 2025, all patients underwent CT scan, and post-processed by multiplanar reconstruction,maximum intensity projection and volume reconstruction. Results Of the 131 patients with LC, SSRS was found in 29 cases (22.1%); incidence of esophagogastric varices, diameters of splenic vein and superior mesenteric vein in SSRS group were 82.8%, (1.2±0.3)cm and (1.1±0.2)cm, all significantly higher or greater than [62.7%, (1.0±0.3)cm and (0.9±0.2)cm, respectively, P<0.05], while diameters of main portal vein, left and right branches were (1.2±0.3)cm, (0.8±0.2)cm and (0.8±0.2)cm, all significantly smaller than [(1.4±0.3)cm, (1.0±0.3)cm and (0.9±0.2)cm, respectively, P<0.05] in non-SSRS group; multivariate Logistic regression analysis showed that diameter of splenic vein (OR<0.001), diameter of main portal vein (OR=0.003), diameter of right branch of portal vein (OR=0.025) and diameter of superior mesenteric vein (OR=0.008) were all the independent risk factors for SSRS occurrence. Conclusion CTV could help find SSRS existence in patients with LC, and its impact on clinical outcomes needs further investigation.

Objective This study aimed to investigate clinical efficacy of endoscopic therapy in combination with somatostatin or terlipressin in treatment of patients with hepatitis B-induced liver cirrhosis (LC) and esophagogastric variceal bleeding (EVB). Methods Forty-eight patients with hepatitis B-induced LC and EVB were encountered in our hospital between June 2022 and June 2025, and all underwent endoscopic variceal ligation or tissue glue injection. Intravenous somatostatin was given in 22 cases (observation group) or terlipressin was given in 26 cases (control group). Esophagogastric varices (EV) grading was evaluated by gastroscopy, and Child-Pugh and MELD scores were obtained routinely. Results Initial hemostasis, hemostasis at 24 hours and at 72 hours in the observation group were 50.0%, 95.5% and 100.0%, all significantly higher than 34.6%, 76.9% and 84.6%, while red blood cell suspension infused was (2.1±0.9)U, significantly less than [(3.4±1.2)U, P<0.05] in the control group; re-examination of gastroscopy found improved EV grading in the observation group was 77.3%, much higher than 53.8% in the control group(P<0.05); decreased Child-Pugh and MELD scores in the observation group were (-0.9±0.4) and (-1.8±0.7), both much higher than [(-0.3±0.1) and (-0.6±0.3), respectively, P<0.05], while incidence of hepatic encephalopathy, 30-day re-bleeding and 30-day mortality were 4.5%, 9.1% and 4.5%, all much lower than 19.2%, 30.8% and 30.8%(P<0.05), and hospital stay was (10.2±2.1)d, much shorter than [(13.5±2.8)d, P<0.05] in the control group. Conclusion Emergency endoscopic therapy followed by intravenous somatostatin or terlipressin administration in dealing with patients with LC and EVB is certainly efficacious, with high successful hemostasis and short-term survivals.

Objective The aim of this study was to investigate the prevalence of sarcopenia (Sp) in patients with hepatitis B-induced liver cirrhosis(LC) and its impact on occurrence of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS). Methods This retrospective study included 128 patients with hepatitis B-induced LC who underwent TIPS at the First Affiliated Hospital, University of Science and Technology of China between March 2019 and December 2022. Sp was diagnosed by measurement and calculation of the ratio of the maximal transverse diameter of the right psoas muscle at the umbilical level on CT images to height (TPMT/H), with a cutoff value of ≤16.8 mm/m. Risk factors for HE were analyzed by using Cox regression models. Patients were followed-up until March 2024,with a median follow-up period of 39(15,60) months. Results Of the 128 patients, Sp was found in 54 cases (42.2%); age and blood ammonia levels in patients with Sp were (56.3±11.8) yr and (56.3±22.2)μmol/L, both significantly older or higher than [(50.2±10.6) yr and (48.6±20.4)μmol/L, respectively, P<0.05], while TPMT/H ratio and serum albumin levels were (14.2±1.9)mm/m and (30.9±5.3)g/L, both significantly lower than [(19.9±2.3)mm/m and (33.1±5.6)g/L, respectively, P<0.05] in those without Sp; by end of 6-month of follow-up, the incidence of HE after TIPS in Sp group was 53.7%, much higher than 16.2% (P<0.001) in patients without Sp; patients with HE after TIPS had significantly older age, high blood ammonia levels, Child-Pugh scores, MELD scores and lower TPMT/H ratio compared to those without HE (P<0.05); Cox univariate analysis identified these factors as significantly associated with HE occurrence (P<0.05), and multivariate Cox analysis revealed only TPMT/H as the independent predictor for post-TIPS HE (HR=0.779,95% CI: 0.708-0.858, P<0.001). Conclusion Sp is highly prevalent among patients with hepatitis B-induced LC, which might greatly increases the risk of HE after TIPS.

Objective This study aimed to build up and validate a machine learning model by integrating clinicopathological data and contrast-enhanced computed tomography (CT) imaging to predict the risk of early tumor recurrence in patients with hepatocellular carcinoma (HCC) with China Liver Cancer (CNLC) stage Ⅰ/Ⅱa after radical tumor resection. Methods 182 patients with CNLC stage I/IIa HCC were encountered in our hospital between July 2020 and June 2023, and all underwent radical hepatectomy. Patients were followed-up for two years after resection. They were randomly divided into a training set (n=127) and a validation set (n=55) at a ratio of 7:3. Clinical and pathological data were collected, and radiomic features were extracted from contrast-enhanced CT scan. Logistic regression analysis, least absolute shrinkage and selection operator (LASSO) regression were applied to screen key features. Clinical and radiomics models were constructed by using adaptive boosting (Adaboost) algorithm and integrating the two types of features to build up a fusion model. The area under the receiver operating characteristic curve (AUC) was drawn and calculated to evaluate the model's risk prediction performance. Results Of the 182 patients with HCC, intrahepatic tumor recurrence were found in 85 cases (46.7%) and not found in 97 cases (53.3%) within 2 years post-surgery; univariate and multivariate Logistic regression analysis showed that serum alpha-fetoprotein levels, tumor diameters and microvascular invasion (MVI) were the risk factors for postoperative tumor recurrence (P<0.05); LASSO regression had selected 8 radiomic features to construct the model (λ_1se=0.085), and by using the Adaboost algorithm to integrate two types of features to construct a fusion model, the AUC to predict in the training set was 0.903 (95% CI: 0.826-0.979), with accuracy (Ac) and specificity (Sp) of 0.856 and 0.859, respectively, while the AUC in the validation set was 0.848 (95% CI: 0.749-0.948), with Ac and Sp of 0.767 and 0.722, respectively; the predictive efficacy in the training set by fusion model was much better than that by clinical model or imaging model(P<0.05) alone. Conclusion The multimodal machine learning model integrating clinical, pathological data and contrast-enhanced CT scan could effectively assess the risk of early tumor recurrence in patients with CNLC stage I/IIa HCC after radical resection, which might provides a reliable tool for individualized postoperative follow-up and intervention strategies.

Objective The aim of this study was to investigate clinical efficacy of lenvatinib mesylate in combination with toripalimab in the treatment of patients with advanced primary liver cancer(aPLC). Methods 102 patients with aPLC were encountered in our hospital between August 2021 and August 2024, and were randomly divided into control and observation group, with 51 cases in each group. Patients in the control group were treated with lenvatinib mesylate alone, while those in the observation group received lenvatinib mesylate and toripalimab combination therapy. Anti-tumor regimen lasted for three cycles (21 days one cycle) in the two groups. Serum tumor-specific growth factor (TSGF), alpha-fetoprotein (AFP) and abnormal prothrombin-Ⅱ (PIVKA-Ⅱ) levels were detected by chemiluminescence immunoassay. Peripheral blood T lymphocyte subsets were determined by flow cytometry. Results Objective remission rate and disease control rate in the observation group were 58.8% and 82.4%, both much higher than 37.3% and 62.8%(P<0.05) in the control group; serum TSGF, AFP and PIVKA-Ⅱ levels were (60.3±6.5)U/mL, (142.9±19.1)μg/L and (871.8±91.4)ng/mL, all significantly lower than [(70.2±7.3)U/mL, (227.1±31.8)μg/L and (1029.7±95.3)ng/mL, respectively, P<0.05] in the control; percentages of peripheral blood CD3⁺ and CD4⁺ cells, and CD4⁺/CD8⁺ cell ratio were (42.3±5.4)%, (33.4±3.9)% and (1.4±0.4), all much higher than [(39.5±4.8)%, (29.3±3.5)% and (1.1±0.3), respectively, P<0.05], while percentage of CD8⁺ cells was (23.2±3.1)%, much lower than [(26.3±3.7)%, P<0.05] in the control group. Conclusion Lenvatinib mesylate in combination with toripalimab therapy exhibits a short-term promising efficacy in the treatment of patients with aPLC, which might be owning to improvement of body immune functions and inhibition of tumor growth.

Objective The aim of this study was to investigate the application of MRI feature in combination with serum alpha fetoprotein and protein induced by vitamin K antagonist-Ⅱ(PIVKA-II) levels in early diagnosis of patients with hepatocellular carcinoma (HCC). Methods A total of 121 patients with HCC were encountered in our hospital between January 2020 and March 2025, and all underwent Gd-EOB-DTPA-enhanced MRI scan. Serum AFP and PIVKA-II levels were detected routinely. ROC curve was plotted to analyze the diagnostic efficacy of Gd-EOB-DTPA-enhanced MRI feature in combination with serum AFP and PIVKA-II levels for HCC. Results The percentages of enhancement at arterial phase, hypointensity at portal phase, hypointensity at hepatobiliary-specific phase and hyperintensity on DWI in HCC lesions were 85.1％, 73.6％, 85.1％ and 79.3％ in our series; serum AFP level was (665.5±150.6)ng/mL and serum PIVKA-II level was (1374.8±46.7)mAU/mL; when serum AFP level >400 ng/mL and PIVKA-II level >400 mAU/mL were set as the cut-off-value, the ROC analysis showed that the AUC was 0.987(95%CI:0.964-0.997), with sensitivity of 97.5% and specificity of 93.2% in diagnosing HCC based on MRI feature, and serum AFP and PIVKA-II level combination. Conclusion Gd-EOB-DTPA-enhanced MRI in combination with serum AFP and PIVKA-II levels demonstrates a satisfactory diagnostic efficacy for HCC, which might provide useful basis for clinical diagnosis and management.

Objective This study was to summarize enhanced magnetic resonance imaging (MRI) features of patients with biphenotypic hepatocellular carcinoma (BPHCC). Methods 50 patients with BPHCC were encountered in our hospital between January 2019 and October 2023, and the diagnosis and pathological microvascular invasion (pMVI) were determined by histo-pathological examination. All patients underwent gadolinium disulfide (Gd-EOB-DTPA) enhancement scan to record signal intensity ratio in arterial phase (SIR-AP), signal intensity ratio in portal venous phase (SIR-PP), signal intensity ratio in transitional phase (SIR-EP), signal intensity ratio in hepatobiliary phase (SIR-HBP) and contrast enhancement ratio in arterial phase (CER-AP). Multivariate Logistic regression analysis was applied to find factors that hinted pMVI positive. Results Well-differentiated and pMVI negative BPHCC presented as lesions with distinct edges on MRI, heterogeneous enhancement in arterial phase and low signals in hepatobiliary phase, while poorly-differentiated and pMVI positive tumors exhibited large tumor volume, vague edges, peri-tumor enhancement in arterial phase, with low signals in portal and in equilibrium phase; of the 50 patients with BPHCC, histo-pathological examination found pMVI positive in 14 cases and pMVI negative in 36 cases; serum alpha-fetoprotein (AFP) level, tumor size, percentages of Edmondson-Steiner stage Ⅲ, peri-tumor enhancement in arterial phase and Mosaic signs in pMVI positive tumor were (421.2±123.7)ng/ml, (7.1±0.9)cm, 42.9%, 42.9% and 35.7%, all much greater or higher than [(311.6±127.6)ng/ml, (3.8±0.6)cm, 19.4%, 11.1% and 19.4%, respectively, P＜0.05] in pMVI negative tumor; SIR-PP and SIR-EP in pMVI positive tumor were (0.8±0.2) and (0.8±0.2), both significantly lower than [(1.1±0.2) and (1.0±0.1), respectively, P＜0.05] in pMVI negative tumor; multivariate Logistic regression analysis showed that SIR-PP[OR: 2.7(95％ CI:1.2-6.2)] and peri-tumor enhancement in arterial phase [OR: 3.6(95％ CI:1.4-9.6)] were the independent factors suggesting pMVI positive in patients with BPHCC(P＜0.05). Conclusion We don’t find special imaging features of patients with BPHCC, who might have early pMVI positive lesions, which needs further studies pathologically and clinically.

Objective This study aimed to investigate regional hepatic inflow occlusion (RHIO) for laparoscopic precision liver resection (LPLR) in treatment of patients with primary liver cancer (PLC). Methods 83 patients with PLC were encountered in our hospital between October 2022 and October 2024, all underwent LPLR and for RHIO, they were randomly assigned to either the observation group (n=42) for RHIO, or the control group (n=41) with conventional Pringle maneuver, e.g., intermittent total hepatic inflow occlusion (ITHIO). Serum malondialdehyde (MDA) level was detected by thiobarbituric acid method, and superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activity were measured by xanthine oxidase method. Peripheral blood lymphocyte subsets was determined by FCM. Results Intraoperative blood loss and operation time in the observation group were much greater or longer than in the control group(P＜0.05); by 3 days after operation, serum bilirubin, AST and INR in the observation group were (20.7±3.2)μmol/L, (38.6±5.1)U/L and (1.1±0.1), all much lower than [(25.7±4.9)μmol/L, (49.8±5.2)U/L and (1.2±0.2), respectively, P＜0.05] in the control; percentage of peripheral blood CD4⁺ cells and CD4⁺／CD8⁺ cell ratio were (62.2±4.9)% and (2.2±1.2), both significantly greater than [(55.3±4.5)% and (1.6±0.2), respectively, P＜0.05] in the control; serum MDA level was (3.4±0.9)mmol/mL, much lower than [(4.2±1.1)mmol/mL, P＜0.05], while serum SOD and GSH-Px levels were(108.5±18.7)U/mL and(69.0±7.8)U/L,both much higher than [(92.2±18.0)U/mL and (61.2±7.2)U/L, respectively, P＜0.05] in the control; post-operationally, incidence of complications in the observation was 28.6%, much lower than 65.9%(P＜0.05) in the control group. Conclusion LPLR under support of RHIO for patients with PLC is superior to under ITHIO, which might lead to mild liver injury and accelerate postoperative recovery.

Objective The aim of this study was to investigate the diagnostic performance of CT and magnetic resonance imaging (MRI) scan in combination with serum alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) PIVKA-II levels in patients with hepatitis B-induced liver cirrhosis (LC) with space-occupying lesions(SOL). Methods A total of 108 patients with hepatitis B-induced LC were encountered in our hospital between January 2022 and January 2025, and all had intrahepatic SOL as showed by CT and/or MRI. Serum AFP and PIVKA-II levels were routinely assayed. The diagnosis was proven by histo-pathological examination based on fine needle aspiration or post-operational specimen. Receiver operating characteristic (ROC) curves was applied to evaluate the diagnostic efficacy. Results Of the108 patients with LC, histo-pathological examination diagnosed hepatocellular carcinoma (HCC) in 70 cases(64.8%) and focal nodular hyperplasia (FNH) in 38 cases (35.2%); serum AFP and PIVKA-II levels in patients with HCC were(321. 3±50.8)ng/mL and (458.6±136.5)mAU/mL, both significantly higher than [(8.2±1.1)ng/mL and (48.6±5.1)mAU/mL, respectively, P<0.05]in those with FNH; in our series, CT found malignant lesions in 64 cases and MRI diagnosed in 69 cases; the AUC was 0.976 (95%CI:0.926-0.996), with sensitivity of 100.0%, specificity of 94.7% and accuracy of 100.0%, when CT and MRI in combination with serum AFP and/or PIVKA-II levels in diagnosing HCC. Conclusion Multi-phase CT and MRI dynamic contrast-enhanced scan in combination with serum special tumor markers in differentiating intrahepatic SOL has a satisfactory efficacy in patients with hepatitis B-induced LC, which warrants multiple center investigation.

Objective The purpose of this study was to investigate the clinical efficacy and safety of nanoknife irreversible electroporation (IRE) under ultrasound (US) guidance in the treatment of patients with unresectable hepatocellular carcinoma (nrHCC). Methods A total of 102 patients with nrHCC were encountered in our hospital between January 2021 and December 2024, and were assigned to undergo radiofrequency ablation (RFA) under US guidance in 51 cases in control, or undergo nanoknife IRE under US guidance in another 51 cases in observation. Serum alpha-fetoprotein (AFP) level was routinely detected, and peripheral blood lymphocyte subsets was determined by FCM. Results Objective remission rate and disease control rate in the observation group were 64.7% and 84.3%, both significantly higher than 41.2% and 64.7% (both P＜0.05) in the control group; by end of one month after treatment, serum AFP level in the observation group was (96.3±9.6)ng/mL,significantly lower than [(218.7±12.5)ng/mL,P＜0.05] in the control; percentages of peripheral blood CD3⁺ cells, CD4⁺ cells and CD4⁺/CD8⁺ cell ratio were (71.5±9.1)%, (40.7±6.5)% and (1.8±0.4), all significantly higher than [(62.4±8.8)%, (36.8±7.0)% and (1.4±0.3), respectively, P＜0.05], while percentage of CD8⁺ cells was (22.1±5.4)%, significantly lower than [(26.4±5.9)%, P＜0.05] in the control; by end of three month and six month after treatment, disease progression rates in the observation group were 2.0% and 5.9%, and in the control were 7.8%(P>0.05) and 21.6%(P＜0.05). Conclusion Nanoknife IRE under US guidance is short-termly effective in treatment of patients with nrHCC, which might improve body immune system functions.

Objective The aim of this study was to explore feasibility of enhanced CT texture parameters in predicting pathological tumor cell differentiation in patients with single-centered hepatocellular carcinoma (HCC). Methods 86 patients with single-centered HCC were encountered in our hospital between January 2023 and March 2025, and all patients received enhanced CT scan before surgery to record average CT value, kurtosis, skewness, energy and entropy in regions of interest. Tumor cell differentiation was determined by pathological exam. Univariate and multivariate Logistic regression analyses were applied to identify the influencing factors of poorly differentiated HCC, and the receiver operating characteristic (ROC) curves were drawn to evaluate the predictive efficacy of enhanced CT texture parameters for the degree of pathological differentiation of tumor cells. Results Of the 86 patients with solitary HCC, histo-pathological examination diagnosed poorly differentiated tumors in 27 cases (31.4%) and moderately to well-differentiated tumors in 59 cases (68.6%); the average CT value, kurtosis, skewness and entropy in the poor differentiation group were(88.7±10.3), (5.1±0.6), (1.4±0.5) and (2.4±0.4), all much higher than [(75.1±8.2), (4.6±0.7), (0.9±0.3) and (1.9±0.3), respectively, P<0.05], while energy was(4.1±0.3)×10⁶, much lower than [(4.9±0.6)×10⁶,P<0.05] in moderately to well-differentiation group; multivariate Logistic regression analysis showed that kurtosis(OR=1.844, 95%CI:1.020-3.333), skewness(OR=1.684, 95%CI:1.029-2.754) and entropy(OR=1.824, 95%CI:1.091-3.048) were all the independent impacting factors for poor differentiation(P<0.05); ROC analysis demonstrated that the AUC was 0.919, with sensitivity of 88.9% and specificity of 94.9%, when CT kurtosis was combined with skewness and entropy in predicting poor differentiation of tumor cells, much superior to any single parameter doing (P<0.05). Conclusion We tentatively recommend enhanced CT texture parameters for prediction of tumor cell differentiation in patients with single-centered HCC, which needs further clinical verification.

Objective This study aimed to investigate impact of immune microenvironment feature on liver metastasis in patients with colorectal cancer (CRC) and to construct a predictive model based on immune biomarkers to assess the risk of liver metastasis. Methods 216 patients with CRC, including liver metastasis in 92 cases and no liver metastasis in 124 cases, were encountered in our hospital beween January 2019 and December 2022, and all underwent surgery for resection of tumors. Pathological examination determined lymphovascular invasion (LVI), perineural invasion (PNI) and tumor-stroma ratio (TSR). Immunohistochemistry was performed for Ki67, p53, CD8, PD-L1, FOXP3, galectin-9, VISTA, CD39, CCR8 and CXCL13 expression, and semiquantitative H-scores were calculated. The effector score (CD8+CXCL13), suppressor score (FOXP3+PD-L1), and dysregulation score were subsequently constructed. Multivariate Logistic regression analysis was performed to identify independent factors, and an XGBoost model was developed based on selected variables to assess predictive performance, and decision curve analysis (DCA) was established to determine its clinical application. Results The Ki67 index was 62.0 (51.0-71.0)%, much higher than 39.0 (31.8-54.0)% in non-liver metastasis group (P<0.05); positive rates of LVI and PNI in the liver metastasis group were 65.2% and 44.6%, both significantly higher than 1.6% and 2.4% (P<0.05) in the non-liver metastasis group; the CD8 H-score was much lower than that in the non-liver metastasis group [130.5 (87.5-183.0) vs. 203.5 (144.0-255.5), P<0.05], while the H-scores of PD-L1, FOXP3, Galectin-9, VISTA, CD39 and CCR8 were higher than those in the non-liver metastasis group (all P<0.05); the effector score was 272.0 (208.0-330.0), much lower than that in the non-liver metastasis group [393.5 (298.2-460.5), P<0.05]; the suppressor score was 387.5 (315.0-461.0), much higher than that in the non-liver metastasis group [260.5 (198.5-321.2), P<0.05]; multivariate Logistic regression analysis showed that CXCL13 (OR = 0.04, 95% CI: 0.01-0.10, P<0.05) and dysregulation score (OR=0.29, 95% CI: 0.09-0.84, P<0.05) were protective factors, while CCR8 (OR=2.15, 95% CI: 1.27-3.92, P<0.05) and VISTA (OR=1.85, 95% CI: 1.03-3.46, P<0.05) were the risk factors; the XGBoost model predicted liver metastasis with an AUC of 0.828 (P<0.05), and within the threshold range of 1% to 43%, the net benefit was superior to the "treat all" and "treat none" strategies. Conclusion Patients with CRC and liver metastasis exhibit an immunosuppressive microenvironment characterized by decreased effector factors and increased suppressor factors, which might promote metastasis. The XGBoost model we constructed based on immune biomarkers demonstrate a good predictive performance and clinical application, which provide a reference for early prediction and individualized management of patients with CRC.

Objective The purpose of this study was to evaluate efficacy of preoperative neoadjuvant chemotherapy followed by high-intensity focused ultrasound (HIFU) ablation in the treatment of children with hepatoblastoma (HB). Methods 26 children with HB were encountered in our hospital between January 2015 and June 2022, neoadjuvant chemotherapy were conducted in 14 children as for control, and HIFU after neoadjuvant chemotherapy were performed in another 12 children for observation. All children were followed-up for two years. Results There were no significant differences as respect to baseline demography, diameters and locations of tumors and serum alpha-fetoprotein levels between the two groups(P>0.05); complete remission, partial remission, stable disease, objective remission rate (ORR) and disease control rate (DCR) in the observation were50.0%, 25.0%, 16.7%, 75.0% and 91.7%, while they were 14.3%, 28.6%, 35.7%, 42.8% and 78.6% in the control, only ORR significantly different between the two groups (P<0.05); during period of antitumor therapy, there were no significant differences as respect to incidences of adverse effects, such as alopecia, nausea and vomiting, granulocytopenia, thrombocytopenia, hemoglobin reduction and sinus tachycardia between the two groups (P>0.05); by end of two-year follow-up, the mortality rates in the observation group was 25.0%, not significantly different as compared to 35.7% in the control group (P>0.05). Conclusion The strategy of HIFU ablation after neoadjuvant chemotherapy in treatment of children with HB is efficacious, which might improve short-term remission, while the long-term survival benefit needs further observation.

Objective The aim of this study was to investigate the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) in combination with serum alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-II) and tumor-specific protein 70 (SP70) levels in patients with intrahepatic space-occupying lesions (SOL). Methods 81 patients with intrahepatic SOL were encountered in our hospital between June 2021 and October 2024, and the diagnosis was proven by histo-pathological examination. At presentation, all patients underwent CEUS to record onset time (OT), initial enhancement intensity (IEI), time to peak (TTP), peak acceleration time (PAT), peak intensity (PI) and echo intensity at 120 seconds (EI-120s). Serum AFP, PIVKA-II and SP70 levels were detected by ELISA. Multivariate Logistic regression analysis was performed to assess risk factors associated with malignant liver tumors, and ROC curve analysis was applied to evaluate diagnostic efficacy. Results Of the 81 patients with intrahepatic SOL, histo-pathological examination proved benign lesions in 35 cases and hepatocellular carcinoma (HCC) in 46 cases; the TIP from CEUS in patients with HCC was (48.4±5.6)s, much shorter than [(56.8±8.1)s, P<0.05], while the PI was (162.5±37.5)dB, much greater than [(124.4±26.4)dB, P<0.05] in those with benign lesions; serum AFP, PIVKA-II and SP70 levels in patients with HCC were (782.9±189.2)ng/mL,(136.3±59.1)mAU/mL and (16.1±6.9)ng/mL, all significantly higher than [(7.9±1.8)ng/mL, (44.6±18.5)mAU/mL and (9.1±4.0)ng/mL, respectively, P<0.05] in those with benign lesions; multivariate Logistic regression analysis showed that PT, TIP, serum AFP, PIVKA-II and SP70 levels were all the independent risk factors for malignant quality (P<0.05); ROC analysis demonstrated that the AUC was 0.980(95%CI:0.948-1.000), with sensitivity of 93.5% and specificity of 97.1%, when the CEUS parameters combined with serum markers in judging the quality of intrahepatic SOL. Conclusion The combination of serum AFP, PIVKA-II and SP70 levels with CEUS has a high diagnostic efficacy in patients with intrahepatic SOL, which might provide a relatively reliable diagnostic tool.

Objective The purpose of this study was to investigate pre- and post-operative evaluation of hepatic blood supply by CT angiography (CTA) in patients undergoing liver transplantation(LT). Methods A total of 129 patients with various liver diseases were encountered in our hospital between December 2020 and May 2023, and all underwent LT. Pre- and post-operationally, CTA and ultrasonography (US) were conducted to evaluate the general structure of the hepatic artery and vein, including inferior vena cava, portal vein and hepatic vein. Results Of the 129 patients receiving LT, CTA showed Michels type I hepatic artery in 99 cases (76.7%), type II in 8 cases, type III in 7 cases, type IV in 5 cases, type V in 3 cases, type VI in 3 cases and others in 4 cases, all proven by surgery; the sensitivity by CTA for combined trunk of middle and right hepatic veins, for combined trunk of middle and left hepatic veins, for combined trunk of left, middle and right hepatic veins, the accuracy for left, middle and right hepatic veins and sensitivity for no combined vein were 86.2%, 94.7%, 100.0%, 80.6% and 89.1%, all much superior to 58.6%, 65.8%, 60.0%, 52.4% and 62.2%(P<0.05) by US; post-operationally, the sensitivity for portal vein thrombosis, for portal vein tumorous thrombus, the accuracy for portal vein tumorous thrombus, for hepatic vein occlusion, the sensitivity and accuracy forinferior vena cava stenosis by CTA were 89.5%, 80.0%, 71.4%, 96.7%, 88.9% and 87.5%, all much superior to 52.6%, 50.0%, 50.4%, 65.6%, 44.4% and 57.5%(P<0.05) by US. Conclusion The CTA has a accuracy in examining the patency of liver vasculature, which might guide surgery strategy and post-operational surveillance.

Objective The aim of this study was to summarize imaging feature of atypical hepatic abscesses (AHA) and intrahepatic metastases (IMT) by MR and diffusion-weighted imaging (DWI). Methods 30 patients with AHA and 50 patients with IMT were admitted to our hospital between January 2020 and January 2025, and all underwent conventional and enhanced MR scan with DWI quantitative parameters recorded. Results Diameter and multiple lesion percentage in AHA lesions were(3.4±1.0)cm and 26.7%, both much smaller or lower than [(4.4±1.3)cm and 62.0%, respectively, P<0.05], while percentages of distinct edge, intralesional homogeneous signal at T2WI, capsule-like structures and perilesional hepatic parenchymal reaction were 76.7%, 66.7%, 46.7% and 50.0%, all much higher than 42.0%, 36.0%, 18.0% and 14.0%(P<0.05) in IMT lesions; AHA lesion exhibited 40.0% of ring-like enhancement at arterial phase, while IMT showed irregular or nodular enhancement for 72.0%; AHA lesions were homogeneously enhanced in 36.7% and 60.0% at portal and delayed phases, both much higher than 16.0% and 30.0%(P<0.05) in IMT lesion, and IMT presented central necrosis in 58.0%; mean ADC (ADCmean) and relative ADC (rADC) at DWI sequence in AHA were(1.7±0.4)×10^-3mm²/s and (0.7±0.2)×10^-3mm²/s, both significantly greater than [(1.0±0.3)×10^-3mm²/s and (0.4±0.1)×10^-3mm²/s, respectively, P<0.05], while lesion-to-liver signal ratio and contrast-to-noise ratio were (1.9±0.3) and (18.4±3.2), both significantly greater than [(2.4±0.3) and (24.7±4.1), respectively, P<0.05] in IMT lesions. Conclusion AHA and IMT exhibit significantly different MRI features, which might help differentiate diagnosis of the two different entities, especially based on clinical materials.

Objective The aim of this study was to investigate transarterial embolization (TAE) and hemangioma enucleation (HE) in the treatment of patients with hepatic hemangioma (HH). Methods 93 patients with HH were recruited in our hospital between March 2022 and March 2025, and TAE was conducted in 42 cases and HE was performed in another 51 cases. Pain at 24 hours post-surgery was assessed by using visual analog scale (VAS). Results Both TAE and HE were successfully completed in the two groups; operation time, intraoperative blood loss and hospital stay in TAE group were (59.7±14.8)min, (10.3±2.7)mL and (4.1±1.9)d,all significantly shorter or less than [(124.5±28.6)min, (472.5±53.9)mL and (9.5±1.8)d,respectively, P＜0.05] in HE group, while there was no significant difference as respect to VAS scores at 24 hours after operation [(4.2±1.3) vs. (4.7±1.5)] in the two groups (P＞0.05); by 72 hours after surgery, serum ALT and AST levels in HE group were (134.5±9.1)U/L and(91.2±8.4)U/L, both significantly higher than [(82.6±20.8)U/L and (63.1±11.6)U/L, respectively, P＜0.05] in TAE group; post-operationally, incidences of complications, such as cholangitis, infection and right upper quadrant pain, in the two groups(28.6% vs. 23.5%, P＞0.05) were not significantly different. Conclusion We believe that both TAE and HE could be performed in patients with HH, and clinicians should make choice based both HH status and technical proficiency.

Objective The aim of this study was to summarize magnetic resonance imaging feature of focal nodular hyperplasia (FNH) of liver. Methods 35 patients with FNH were encountered in in our hospital from January 2021 to June 2024, and all underwent MR scan and hepatectomy for removal of the tumors. Diagnosis was confirmed by surgical tissue examination pathologically. Results Of the 35 patients with FNH, 63 nodules were found by MRI, present as lobulated or quasi-circular, main solitary, located in right lobe, with diameters of 0.5-14.3 cm (mean 4.1±0.9)cm, and lesions were ≤3.0 cm in 41 and ＞3.0 cm in 22; MRI sequence showed equal or slightly low signals on T₁WI, while slightly high signals on T₂WI and DWI, without diffusion limitation; multi-phase dynamic enhancement scan showed a fast-in and slow-out enhancement mode; proportions of steatosis, local necrosis, pseudocapsule, no central scar, no obvious enhancement at arterial phase and low signals at hepatobiliary phase in nodules with diameter >3.0 cm were 77.3%,68.2%, 86.4%, 63.6%, 73.7% and 63.6%, all significantly higher than 31.7%, 24.4%, 38.1%, 29.3%, 46.3% and 26.9% (P＜0.05) in those with diameter ≤3.0 cm. Conclusion MRI feature of FNH of liver is typical and some special, which might help clinicians differentiate it from malignant tumors.

Objective The aim of this study was to construct and evaluate a predictive model by abnormal total serum bilirubin (TSB) level at 72 hours after laparoscopic transcystic common bile duct exploration (LTCBDE). Methods A retrospective analysis was conducted on the clinical data of 158 patients with common bile duct stone who underwent LTCBDE at Gaoyou People's Hospital between January 2023 and December 2024. Lasso and multivariate Logistic regression analysis were employed to identify clinical risk indicators for elevated TSB levels, by which a Logistic predictive model was established. The discriminative ability of the model was assessed by using receiver operating characteristic (ROC) curves, while calibration curves were used to verify its predictive accuracy. Decision curve analysis (DCA) was applied to evaluate its clinical utility. Internal validation of the model was performed by Bootstrap method. Results TSB levels elevated in 44 cases (27.8%) post-operationally in our series; Lasso regression and multivariate Logistic regression analysis revealed that common bile duct stone diameter ≥10 mm (OR=12.272, 95% CI: 3.853-39.084, P<0.001), multiple stones (OR=11.317, 95% CI: 3.956-32.377, P<0.001) and serum albumin level (OR=0.841, 95% CI: 0.761-0.930, P<0.001) were the impacting factors for elevated TSB levels 72 hours after LTCBDE; the three predictors were incorporated into multivariate Logistic regression model, and the constructed predictive model demonstrated a significant diagnostic efficacy, with the area under the ROC curve (AUC) of 0.900 (95% CI: 0.8509-0.9484); the optimal cutoff value was 0.232, achieving a balance between specificity (0.798) and sensitivity (0.886); the calibration curve showed a high agreement with actual values, and the Brier score was 0.115, indicating excellent predictive performance; additionally, the decision curve revealed net clinical benefit; during internal validation, the model exhibited an AUC of 0.892 (95% CI: 0.8399-0.9442), demonstrating robust discriminative ability and calibration. Conclusion The clinical predictive model based on CBDS diameter, multiple CBDS and serum albumin level could effectively identify patients at risk of elevated TSB at 72 hours after LTCBDE, providing valuable reference for clinical decision-making and individualized assessment.

Objective The aim of this study was to investigate serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), C-reactive protein (CRP), direct bilirubin (DBIL) and albumin (ALB) levels in diagnosing acute severe cholangitis (ASC) in patients with common bile duct stones. Methods 201 patients with common bile duct stones were encountered in our hospital between January 2019 and December 2023, and ASC was diagnosed based on Charcot's triad, clinical tests and imaging manifestation. Serum sTREM-1 level was detected by flow fluorescence luminescence. Multivariate binary Logistic regression analysis was applied to analyze the factors impacting the occurrence of ASC. Receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to evaluate diagnostic efficacy. Results Of the 201 patients with common bile duct stones in our series, ASC was found in 28 cases (13.9%); incidences of impacted stone, gallbladder stones and Charcot's triad in ASC group were much higher than in patients without ASC (P<0.05); serum sTREM-1, CRP and DBIL levels were (313.7±53.6)pg/mL, (88.5±16.8)mg/L and (44.9±6.5)μmol/L, all significantly higher than [(178.9±29.5)pg/mL, (22.0±12.7)mg/L and (34.2±5.4)μmol/L, respectively, P<0.05], while serum albumin level was(32.9±4.9)g/L, significantly lower than [(39.1±5.6)g/L,P<0.05] in those without ASC; multivariate Logistic regression analysis showed that serum sTREM-1(OR=1.740,95%CI:1.267-2.391),CRP(OR=1.675,95%CI:1.157-2.426)and DBIL(OR=1.590,95%CI:1.197-2.113) were all the independent risk factors for occurrence of ASC (P<0.05), while serum ALB(OR=0.768,95%CI:0.629-0.938) was the protective one (P<0.05);ROC analysis demonstrated that the AUC was 0.903(95% CI:0.854-0.940), with a good diagnostic performance, when serum sTREM-1 was combined with CRP, DBIL and/or ALB levels. Conclusion Serum sTREM-1, CRP and DBIL levels elevate, and/or serum ALB level decrease in patients with common bile duct stones, which might help diagnose ASC when Charcot's triad appears.

Objective The aim of this study was to investigate the diagnostic performance of revolution CT multi-parameter spectral imaging and iterative reconstruction for microperforation in patients with cholecystitis. Methods A total of 102 patients with cholecystitis were admitted to Department of Radiology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine between April 2022 and April 2025, and all patients underwent revolution CT multi-parameter spectral imaging scan followed by iterative reconstruction. The optimal keV value was explored, and differences in CT values of the gallbladder wall and bile under various keV conditions were observed. Iodine-water-based substance maps were utilized to detect lipid/water concentration (L/W), iodine/water concentration (I/W), spectral curve slope (K) and effective atomic number (Eff-Z) at the perforation site. The efficacy of CT scan for microperforation was evaluated as operational finding was the golden criteria, and the consistence was assessed by Kappa test. Results The CT values of gallbladder wall and bile at low energy levels (40-60 keV) and at high energy levels (90-140 keV) showed statistically significant differences (P<0.05), while at 70-80 keV, the difference in CT values between the two was not statistically significant (P>0.05); iodine-water contrast images showed the clearest representation in lipid/water (L/W) mode, and the gallbladder wall exhibited a much higher L/W, I/W and K values than bile (P<0.05), while Eff-Z value was much lower than bile (P<0.05); of 102 patients with cholecystitis, microperforation of gallbladders was found in 74 cases (72.5%) during operation, and Revolution CT scan diagnosed in 70 cases, with sensitivity of 91.9%, specificity of 92.9% and accuracy of 92.2%, a good consistent with surgery (Kappa =0.811). Conclusion Revolution CT multi-parameter spectral imaging in combination with iterative reconstruction could clearly visualize microperforation in patients with cholecystitis, which might help clinicians make an appropriate plan for operation.

Objective The purpose of this study was to compare the analgesic efficacy of liposomal bupivacaine (LB) and ropivacaine (R) for transversus abdominis plane block (TAPB) after single-hole laparoscopic cholecystectomy (SHLC) in patients with gall bladder stones. Methods 79 patients with cholecystolithiasis were encountered in our hospital between March 2024 and March 2025, and all patients underwent SHLC. They were randomly divided into two groups when transferred into post-anesthesia care unit (PACU), for TAPB by LB (n=39) or by R(n=40) under ultrasound guidance. The numerical rating scale (NRS)for pain and Athens insomnia scale (AIS) were recorded. Results There were no statistically significant differences as respect to surgery time, anesthesia time and remifentanil doses used in the two groups (P>0.05); 12 h, 24 h, 48 h and 72 h post-operationally, the NRS scores at exercise in LB group were(3.1±1.1), (2.8±1.1), (2.6±0.9) and (2.1±0.8), all significantly lower than [(4.2±1.1), (4.4±1.2),(3.8±1.1) and (2.9±0.9), P＜0.05], and NRS scores at resting were (2.3±1.0), (2.1±0.9), (1.9±1.0) and (1.4±0.8), all significantly lower than [(3.6±1.0), (3.3±1.0), (2.7±0.9) and (2.1±1.0), respectively, P＜0.05] in R group; the AIS score at post of day one in LB group was(7.6±1.3), much lower than [(8.5±1.1), P＜0.05] in R group; post-operationally, first flatus and ambulation times in LB group were (26.1±4.4)h and (16.6±4.2)h, both significantly shorter than [(29.5±4.8)h and (22.4±4.2)h, respectively, P＜0.05], and incidence of rescue analgesia was 10.3%, much lower than 32.5%(P＜0.05) in R group. Conclusion Liposomal bupivacaine under ultrasound-guided TAPB could be safely and effectively conducted for postoperative analgesia in patients with cholecystolithiasis undergoing SHLC, which might provide ascertained analgesic efficacy.

Objective The aim of this study was to explore combination of high frame rate contrast-enhanced ultrasound (H-CEUS) and ultrasound micro-flow imaging (MFI) in the differential diagnosis of benign and malignant polypoid lesions of gallbladder (PLG). Methods 122 patients with PLG were enrolled in our hospital between June 2021 and June 2024, and all underwent surgical resection for histo-pathological examination. Before operation, H-CEUS by using Mindray Resona R9S ultrasound diagnostic instrument and equipped with contrast-enhanced ultrasound software and MFI by using Philips EPIQ7 color Doppler ultrasound diagnostic instrument was conducted to record special parameters. Receiver operating characteristic curve (ROC) was drawn to evaluate diagnostic performance. Results Post-operational histo-pathological examination found malignant lesions in 33 cases(27.1%) and benign lesions in 89 cases (72.9%); gallbladder wall thickness in malignant lesions was (1.6±0.3) cm, significantly thicker than (1.2±0.2) cm in benign lesions (P<0.05), percentages of continuous gallbladder outer wall and continuous gallbladder inner wall were 18.2% and 15.2%, much lower than 85.4% and 87.6%(P<0.05) in benign lesions, while percentages of high signal enhancement and branch-like blood vessels were 75.8% and 45.5%, much greater than 34.8% and 0.0% in benign lesions, and initial enhanced time, peak time and subside time were (14.5±2.1)s, (20.1±4.7)s and (35.6±5.1)s, all significantly shorter than [(17.3±3.5)s, (24.9±5.2)s and (40.5±6.3)s, respectively, P<0.05] in benign lesions; percentages of Alder’s blood flow grade 3 and 4 were 33.3% and 45.5%, both much higher than 13.5% and 2.2%(P<0.05) in benign lesions; ROC analysis showed that the AUC was 0.909(95%CI:0.856-0.962), with sensitivity of 90.9% and specificity of 79.8%, when H-CEUS was combined with MFI parameters in differentiating benign and malignant PLG. Conclusion H-CEUS in combination with MFI examination could improve diagnostic efficacy in differentiating benign and malignant PLG, and the increased gallbladder wall thickness and discontinuity of gallbladder walls might hint the malignant PLG existence, which should manage as sooner as possbile.