Acute-on-chronic liver failure (ACLF) is one of the leading causes of mortality among patients with chronic liver disease. Potentially reversible, ACLF requires precise clinical classification to facilitate accurate diagnosis, targeted treatment, and comprehensive management. Based on the latest research findings and clinical evidence, the Severe Liver Disease and Artificial Liver Group and the Nutrition and Regeneration in End-Stage Liver Disease Group, Chinese Society of Hepatology, Chinese Medical Association, together with multidisciplinary experts, have jointly compiled China's first guideline for the diagnosis and treatment of ACLF. The guideline aims to provide guidance for the diagnosis, treatment, and individualized management of patients with ACLF in clinical practice.

Objective The liver is the only visceral organ with significant self-regeneration capability, which is fundamental to the success of liver surgical procedures. This study aimed to investigate the role of N-acetyltransferase 10 (NAT10) in liver regeneration process. Methods A hepatocyte-specific NAT10 conditional knockout (CKO) mouse model was established by using the Cre-Lox P system, and partial hepatectomy (PH) was performed both in Twenty wild-type (WT) C57BL/6J mice (Flox) and in CKO mice. By 0 h,24 h,48 h and 72 h after PH, NAT10 and proliferating cell nuclear antigen (PCNA) RNA and protein expression were detected by qPCR and Western bloting. Liver index was also calculated. Results In WT mice, hepatic NAT10 mRNA and protein expression levels at 24 hours after PH were (1.4±0.1) and (3.6±0.2), respectively, both significantly higher than [(1.0±0.1) and (0.9±0.3), P<0.05] at 0 hour, but significantly lower than [(1.9±0.1) and (10.0±1.6), P<0.05] at 48 hour; by 72 hours, hepatic NAT10 mRNA and protein levels were (0.9±0.1) and (1.0±0.4), also significantly lower than [(1.9±0.1) and (10.0±1.6), respectively, P<0.05] by 48 hour; a CKO mouse model was successfully established and the knockout efficiency was confirmed; NAT10 mRNA level in the CKO group was (0.2±0.1), significantly lower than [(1.0±0.1, P<0.05), and NAT10 protein level was (0.1±0.0), also significantly lower than [(1.0±0.1, P<0.05) in the Flox group; at 0 hours after PH, the liver index in the Flox and CKO groups were (5.0±0.5)% and (5.5±0.3)%, showing no significantly different (P>0.05); at 24 h, 48 h and 72 h after PH, the liver index in the CKO group were (2.7±0.1)%, (2.7±0.0)% and (3.1±0.0)%, all significantly lower than[(3.6±0.1)%, (3.9±0.1)% and (4.6±0.1)%, respectively, P<0.05] in the Flox group; additionally, the PCNA mRNA levels in the CKO group were (0.6±0.0), (0.3±0.0) and (0.5±0.0), all significantly lower than [(1.1±0.1), (1.0±0.1) and (1.0±0.2), respectively, P<0.05] in the Flox group; the PCNA protein levels in the CKO group were (0.3±0.1), (0.7±0.0) and (0.7±0.0), all significantly lower than [(1.0±0.1), (1.0±0.1) and (1.0±0.1), respectively, P<0.05] in the Flox group. Conclusion NAT10 promotes liver regeneration in a mouse model of PH. These findings suggest that NAT10 might be a potential biomarker for predicting prognosis after liver resection or liver transplantation.

Objective The aim of this study was to compare antiviral efficacy of pegylated interferon (peg-IFN)-α2b and entecavir (ETV)or tenofovir combination in the treatment of patients with serum HBeAg-positive chronic hepatitis B (CHB). Methods 84 patients with serum HBeAg-positive CHB were enrolled in our hospital between January 2022 and December 2023, and were randomly assigned to receive peg-IFN-α2b and ETV combination in 42 patients or to receive peg-IFN-α2b and tenofovir disoproxil fumarate (TDF) combination for 48 weeks. Serum HBV DNA loads were detected by real-time fluorescence quantitative PCR, serum HBeAg and HBsAg levels were measured by chemiluminescence immunoassay, and serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine (sCr), β₂-microglobulin (β₂-MG) levels were detected by automatic biochemical analyzer, with estimated glomerular filtration rate (eGFR) calculated by using modified formula of kidney disease. Liver stiffness measurement (LSM) was determined by liver transient elastography. Results By end of 48 weeks of antiviral treatment, serum HBV DNA loss, HBeAg seroconversion and serum ALT normalization rates in peg-IFN-α2b and TDF combination-treated patients were 100.0%, 40.5% and 100.0%, all not significantly different as compared to 100.0%, 40.5% and 100.0% (P>0.05) in peg-IFN-α2b and ETV combination-treated patients; serum ALT, AST and LSM levels were (31.4±4.9)IU/L, (28.4±4.5)IU/L and (6.9±0.8)kPa, all not significantly different compared to [(33.2±4.5)IU/L, (32.1±4.3)IU/L and (6.5±0.9) kPa, P>0.05] in peg-IFN-α2b and ETV combination-treated patients; there were no significant differences as respect to sCr, serum β₂-MG level and eGFR between the two groups (P＞0.05). Conclusion Both peg-IFN-α2b and ETV or TDF combination in the treatment of patients with serum HBeAg-positive CHB have a satisfactory short-term antiviral efficacy, but the long-term outcomes still needs further investigation.

Objective This study was conducted to explore impact of apolipoprotein B (ApoB) gene polymorphisms on response to pegylated interferon alpha-2b (peg-IFN-α2b) treatment in patients with serum HBeAg-positive chronic hepatitis B (CHB). Methods Sixty-five serum HBeAg-positive patients with CHB were encountered in our hospital between May 2019 and May 2022, and all received peg- IFN-α2b antiviral treatment for 48 weeks. Serum HBsAg and HBeAg, and HBV DNA loads were routinely assayed, and single nucleotide polymorphism (SNP) of ApoB gene was determined by gene chip. Multivariate Logistic regression analysis was applied to predict impacting factors. Results By end of 48-week antiviral treatment, complete response (CR) was 38.5% and partial response (PR) was 61.5%; baseline serum HBsAg and HBV DNA loads in patients with CR were (2.2±0.5)lg IU/mL and (6.1±1.5)lg IU/mL, both significantly lower than [(6.2±1.7)lg IU/mL and (7.1±1.3)lg IU/mL, respectively, P<0.05], while serum ALT and AST levels were (134.6±17.6)U/L and (112.6±16.3)U/L, both significantly higher than [(62.6±14.8)U/L and (60.6±10.2)U/L, respectively, P<0.05] in those with PR; as for ApoB gene rs10199768 locus, percentage of AC genotype and A allele frequencies in patients with CR were 80.0% and 60.0%, both significantly higher than 37.5% and 25.0%(P<0.05) in those with PR; as for rs1367117 gene, percentage of GG genotype and G allele frequencies in patients with CR were 28.0% and 20.0%, both significantly lower than 67.5% and 60.0% in those with PR (P<0.05); multivariate Logistic regression analysis showed that rs10199768 and rs1367117 SNP were independent factors impacting response to peg-IFN-α2b treatment in patients with serum HBeAg positive CHB (OR=5.078, OR=4.933, both P<0.05). Conclusion SNP of ApoB gene might impact response to peg-IFN-α2b antiviral treatment in patients with serum HBeAg positive CHB, and needs further clinical verification.

Objective The aim of this study was to investigate shear wave elastography(SWE) combined with aspartate aminotransferase (AST)/platelet (PLT) ratio index (APRI) and fibrosis factor 4 index (FIB-4) in predicting liver fibrosis (LF) in patients with serum HBeAg positive chronic hepatitis B (CHB). Methods 98 patients with serum HBeAg positive CHB were encountered inour hospital between September 2019 and September 2023, all underwent blood, serum, SWE and liver biopsies, and APRI and FIB-4 were calculated. Receiver operating characteristic curve (ROC) was applied to assess diagnostic efficacy. Results Of the 98 patients with serum HBeAgCHB, liver histo-pathological examination showed≤S1LF in 20 cases, S2 in 38 cases, S3 in 26 cases and S4 in 14 cases; serum AST and ALT levels in patients with ≤S1 were (39.8±6.0)U/L and (42.8±8.2)U/L, while they were much elevated in those with S2, S3 and S4(P＜0.05);APRI, FIB-4and Yang’s model in patients with S3 were (0.6±0.3),(1.7±0.5)and (10.1±0.7)kPa, in with S2 were (0.4±0.2),(1.2±0.4)and (7.1±0.5)kPa, all significantly greater than [(0.3±0.2),(0.8±0.3)and (6.3±0.7)kPa, respectively, P＜0.05]in patients with ≤S1; ROCanalysis demonstrated that the AUC was 0.84, with sensitivity (Se)and specificity(Sp)of 91% (P＜0.05)and 67%, in predicting significant LF, and theAUC was 0.92, with Se and Sp of 93%(P＜0.05)and 74%, in predicting advanced LF when combination of Yang’s model, APRI and FIB-4was used. Conclusion SWE and APRI plus FIB-4 would help clinicians preliminarily screen LF in patients with CHB.

Objective The aim of this study was to investigate clinical efficacy of tenofovir amibufenamide (TMF) and tenofovir alafenamide fumarate (TAF) in rescue treatment of entecavir (ETV)-treated patients with chronic hepatitis B(CHB) and low-level viremia (LLV). Methods 68 patients with CHB were enrolled in our hospital between January 2022 and January 2024, the enrolled patients were all ETV-treated for at least 12 months, showing poor virological response with LLV and were randomly assigned to receive TMF or TAF for 48 weeks. Liver stiffness measurement (LSM) was evaluated by ultrasonic liver transient elastography, serum HBV markers, biochemical parameters and HBV DNA loads were routinely detected. Serum laminin(LN),collagen type Ⅳ(Ⅳ-C), precollagen-Ⅲ (PC-Ⅲ)and hyaluronic acid(HA)levels were assayed by ELISA. Results By end of 48 week treatment, LSM as well as serum HA, LN, Ⅳ-C and PCⅢ levels in TMF-treated patients were (6.8±1.2)KPa, (171.2±25.9)ng/mL, (147.5±42.3)ng/mL, (174.3±46.3)ng/mL and (56.8±12.4)ng/mL, all not significantly different as compared to [(6.9±1.2)KPa, (175.2±34.6)ng/mL, (148.2±46.3)ng/mL, (175.4±42.1)ng/mL and (55.5±19.5)ng/mL, respectively] in TAF-treated patients (P>0.05); serum bilirubin, ALT and AST levels in TMF-treated patients were (16.4±1.4)μmol/L, (40.3±4.8)U/L and (32.4±5.1)U/L, all not significantly different as compared to [(17.3±1.2)μmol/L, (41.8±4.5)U/L and (36.9±4.9)U/L, respectively] in TAF-treated patients (P>0.05); virological and biochemical response rates in the two groups were not significantly different as serum HBV DNA transferred to negative and serum ALT level returned to normal(P>0.05) in all patients. Conclusion As for patients with CHB and poor response to ETV treatment, rescue antiviral therapy with TMF or TAF is both satisfactory, with complete virological response, and the long-term efficacy should be followed-up in the future.

Objective The aim of this study was to investigate clinical efficacy of tenofovir amibufenamide (TMF) and Biejiajian compound, a herbal medicine pill, combination in the treatment of patients with chronic hepatitis B (CHB). Methods A total of154 naïve patients with CHB were enrolled in our hospital between August 2022 and July 2024, and were randomly assigned to receive TMF in 77 cases in the control group or to receive TMF and herbal medicine combination therapy in another 77 cases in the observation group. Serum HBV DNA loads was detected by real-time fluorescence quantitative PCR, serum HBsAg and HBeAg, precollagen type Ⅲ(PC-Ⅲ), collagen type IV(IV-Col), laminin (LN) and hyaluronic acid(HA), and interleukin(IL)-6,IL-8, tumor necrosis factor -ɑ(TNF-ɑ) and high-sensitive C reactive protein (hs-CRP) levels were measured by ELISA. Results By end of 48 week treatment, serum HBV DNA transferred to negative in all the patients with CHB in the two groups, and serum alanine aminotransferase level in the observation group was(42.4±7.4)IU/L, much lower than [(56.5±9.3)IU/L, P<0.05] in the control; serum PC-Ⅲ,HA and IV-Col levels were (112.5±18.3)μg/L, (132.5±17.9)μg/L and (159.7±11.8)μg/L, all significantly lower than [(157.3±21.3)μg/L, (162.9±20.2)μg/L and (197.5±29.2)μg/L, respectively, P<0.05] in the control; serum IL-6, IL-8 and TNF-ɑ levels were (6.3±1.1)pg/mL, (15.7±6.5)pg/mL and (20.5±9.5)pg/mL, all much lower than [(11.8±2.3)pg/mL,(28.1±9.1)pg/mL and (37.6±8.8)pg/mL, respectively, P<0.05] in the control group. Conclusion TMF and Biejiajian pill combination in the treatment of patients with CHB has a satisfactory efficacy, which might inhibit body inflammatory reaction and relieve liver fibrosis.

Objective The purpose of this study was to investigate normalized follow-up for hepatitis C micro-elimination strategy (MES) in a general tertiary hospital. Methods The clinical materials of hospitalized patients with serum anti-HCV and/or HCV RNA positive in our hospital between October 2020 and May 2022 were retrieved, and all patients were informed by phone call or text message for them recall. Results Rates of serum anti-HCV screening and HCV RNA load detection after normalized follow-up were 83.7% and 83.5%, both were significantly higher than 70.6% and 72.3% (x²=3141.888, P<0.001;x²=25.474, P <0.001) in the past period; patients lost to followed-up in the normalized follow-up period was 28.0%, significantly lower than 44.8% (x²=23.439, P <0.001) in the past; percentage of patients with knowledge of hepatitis C prevention and treatment was as high as 72.0%, and 66.0% of patients expressed positive, 21.0% expressed inactive and only 13.0% had negative attitude towards antiviral treatment intention; effective recall rate in normalized follow-up perios was 44.3$, much higher than 32.9% (x²=4.183, P<0.05) in the past; of 122 successfully recalled patients, direct antiviral agent therapy was initiated in all, all except for one who lost visit achieved sustained virological response (SVR24 of 100.0%(121/121)/SVR48 of 100.0%(121/121). Conclusion The in-hospital hepatitis C MES has the advantages of simple, low cost and sustainability, which might help achieving goals of elimination of hepatitis C in the near future.

Objective The aim of this study was to investigate the efficacy of daclatasvir and asunaprevir combination in the treatment of patients with naïve hepatitis C viral genotype 1b-infected chronic hepatitis C (CHC) and changes of peripheral blood lymphocyte subsets. Methods 65naïve patients with HCV genotype 1b-infected CHC were enrolled in our hospital between January 2022 and July 2024, and were randomly assigned to receive sofosbuviranddaclatasvir in 32 patients in control, or to receive asunaprevir and daclatasvir combination in 33 patients in the observation group for 12 weeks. Serum HCV RNA loads were routinely detected, and peripheral blood lymphocyte subsets were determined by FCM. Rapid virological response (RVR), end of treatment virological response (ETVR) and sustained virologicalresponse (SVR) were evaluated. Results RVR, ETVR and SVRin the observation group were 84.9%, 100.0%and 100.0%, not significantly different as compared to 84.4%, 100.0% and 96.9% in the control (P>0.05); by end of the antiviral regimen, serum AST and ALT levels in the observation group were (32.5±5.3)U/L and (39.4±5.9)U/L, both not significantly different as compared to[(33.6±6.2)U/Land (40.5±6.3)U/L, respectively] in the control (P>0.05); percentages of peripheral bloodCD4⁺ and CD8⁺cells as well as CD4⁺/CD8⁺ cell ratio were (36.4±4.8)% and (24.6±2.4)%, and (1.1±0.4), all not significantly different compared to [(35.2±4.2)%,(24.5±2.5)% and (1.1±0.3), respectively] in the control group (P>0.05). Conclusion Daclatasvir and asunaprevir combination in the treatment of naïve patients with HCV genotype 1b-infected CHC is also efficacious, which needs further clinical long-term follow-up.

Objective The aim of this study was to investigate efficacy of dacatevir (DCV) and asurevir (ASV) combination in the treatment of patients with chronic hepatitis C (CHC) with hepatitis C virus (HCV) genotype 1b infection. Methods 56 patients with CHC with HCV genotype 1b infection were recruited in our hospital between January 2020 and January 2023, and 55 patients but 1 patient dropped out received dacatavir plus asulivir combination treatment for 12 weeks, and all were followed-up for 24 weeks. Serum HCV RNA loads were determined by RT-PCR, and aspartate aminotransferase/platelet ratio (APRI) was routinely calculated. Results At baseline, serum HCV RNA load in the 55 patients with CHC was (6.0±0.6)lg IU/mL, and it transferred to (4.3±0.5)lg IU/mL, (＜1.7)lg IU/mL and (＜1.7)lg IU/mL 4 weeks and 12 weeks during antiviral therapy and 24 weeks of follow-up, with complete virological response(CVR) of 20.0%, 100.0% and 100.0%, respectively; serum AST, ALT levels and APRI were (74.5±24.5)U/L, (83.0±9.6)U/L and (4.3±1.7), and all returned to normal at end of antiviral regimen and at end of 24 week of follow-up; peripheral white blood cell count, neutrophils count and platelet count elevated to normal(P＜0.05), and blood hemoglobin level didn’t change (P＞0.05)at end of 24 week of follow-up. Conclusion Combination of DCV and ASV antiviral therapy have a good short-term efficacy in the treatment of patients with CHC with hepatitis C virus genotype 1b infection, and long-term efficacy needs further observation.

Objective The purpose of this study was to explore diagnostic efficacy of non-alcoholic fatty liver diseases (NAFLD) by quantitative CT (QCT) measurement in individuals for physical examination. Methods 935 individuals were encountered for physical examination in our hospital between July 2020 and March 2022, and all underwent ultrasonography (US) and CT scan. Computed tomography value and bone mineral concentration were measured at four regions of interest by QCT Pro Model 4 system, and liver fat contents were calculated automatically. Receiver operating characteristic curve was drawn and the area under the curve (AUC) was calculated for evaluating diagnostic performance. Results Of 935 persons in our series, ultrasonography found NAFLD in 264 cases(28.2%), while it was 104 cases(11.1%) by liver /spleen CT value ratio; liver fat content in 264 persons with NAFLD proven by US was 8.7(6.6, 14.8), much higher than [4.6(3.4, 6.3), Z=-18.019, P<0.001] in 671 persons without NAFLD; liver fat content in 104 individuals with NAFLD diagnosed by CT was 16.7(13.5, 21.1), much higher than [5.2(3.8, 6.9), Z=-16.349, P<0.001] in 831 individuals without NAFLD; the sensitivity (Se) was 69.3% and the specificity (Sp) was 86.7%, based on ultrasonography diagnosis, when liver fat contents greater than 3.6% was set as the cut-off-value; the Se was 93.3% and the Sp was 98.4%, based on liver/spleen CT value ratio diagnosis, when liver fat contents equal to 2.1% was set as the cut-off-value. Conclusion Diagnosis of fatty liver by QCT scan is objective with reliability, which might provide a choice for clinical application.

Objective The aim of this study was to investigate changes of serum sex hormones and thyroid hormones in patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Methods The general clinical materials were collected from 100 patients with T2DM and NAFLD, and 100 patients with T2DM in our hospital between January 2021 and December 2023. Serum testosterone (T), estradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH), as well as serum free triiodothyronine (FT3), free tetraiodothyronine (FT4) and thyroid stimulating hormone (TSH) were detected by chemiluminescence immunoassay. The risk factors of NAFLD in patients with T2DM were analyzed by multivariate Logistic regression analysis. Results Waist circumference (WC), body mass index (BMI), serum E2 and TSH levels in male patients with T2DM and concomitant NAFLD were (92.4±11.2)cm, (26.5±2.5)kg/m², (23.5±7.8)pg/mL and (3.1±0.5)mU/L, all significantly higher or greater than [(87.7±9.4)cm, (24.6±2.2)kg/m², (17.2±5.6)pg/mL and (2.1±0.4)mU/L, respectively, P＜0.05], while serum T level was (3.5±1.1)ng/mL, significantly lower than [(4.6±1.5)ng/mL, P＜0.05] in patients with T2DM; multivariate Logistic regression analysis showed that serum T, E2 and TSH levels were all the independent risk factors for NAFLD existence in patients with T2DM(P＜0.05); WC, BMI and serum TSH level in female patients with T2DM and NAFLD were(81.6±8.0)cm, (26.7±2.3)kg/m² and (3.3±0.6)mU/L, all significantly greater or higher than [(77.3±7.1)cm, (24.4±2.1)kg/m² and (2.5±0.5)mU/L, respectively, P＜0.05], while serum E2 and FSH levels were (20.4±6.5)pg/mL and (59.8±11.5)mIU/mL, both significantly lower than [(26.3±7.9)pg/mL and (71.7±13.8)mIU/mL, respectively, P＜0.05] in patients with T2DM; multivariate Logistic regression analysis demonstrated that serum E2, FSH and TSH levels were all the independent risk factors for NAFLD existence in patients with T2DM(P＜0.05). Conclusion Sex hormones and thyroid hormones are obviously abnormal in both male and female patients with T2DM and NAFLD, and the in-depth study might clarify the mechanism of the entity.

Objective This study was conducted to explore clinical implications of serum miR-122, miR-140-5p and miR-34alevels in patients with nonalcoholic fatty liver disease (NAFLD). Methods 104 patients with NAFLD and 60 healthy individuals for physical examination were encountered in our hospital between December 2021 and December 2023, and liver biopsies were performed in all patients with NAFLD. Serum miR-122, miR-140-5p and miR-34a levels were detected by real-time fluorescence quantitative RT-PCR. Risk factors of nonalcoholic steatohepatitis (NASH) were analyzed by multivariate Logistic regression. Receiver operating characteristic curve (ROC) and the area under the curve (AUC) were applied to evaluate diagnostic efficacy of serum miR-122, miR-140-5p, and miR-34a levels for NASH occurrence. Results Of 104 patients with NAFLD, NASH was found in 43 cases and simple fatty liver (SFL) was found in 61 cases based on NAFLD activity scores; serum miR-122 and miR-34a levels in NASH patients were (8.1±1.3) and (1.8±0.4), both significantly higher than [(2.6±0.7) and (1.3±0.4), respectively, P<0.05] in SFL patients or [(1.3±0.2) and (0.8±0.2), respectively, P<0.05] in healthy control, while serum miR-140-5p level in NASH patients was (24.1±5.1) ×10^-4, significantly lower than [(71.2±11.3) ×10^-4, P<0.05] in SFL patients or [(258.9±71.5) ×10^-4, P<0.05] in healthy persons; multivariate Logistic regression analysis showed that BMI (OR=1.793,95%CI: 1.352-2.378), ALT (OR=1.522,95%CI: 1.127-2.055), AST (OR=1.419,95%CI: 1.205-1.671), TG (OR=1.715,95%CI:1.194-2.463), LDL-C (OR=1.537,95%CI:1.264-1.869), HDL-C (OR=1.631,95%CI:1.207-2.204), miR-122 (OR=1.409,95%CI:1.228-1.617), miR-140-5 p (OR=0.639,95%CI:0.477-0.856) and miR-34a (OR=1.745,95%CI:1.162-2.621) were all the independent risk factors for NASH (P<0.05); ROC analysis showed that the AUC of combined serum miR-122, miR-140-5p and miR-34alevels for the diagnosis of NASH was 0.954, with the sensitivity of 88.4%, thespecificity of 90.2% and the accuracy of 89.4%, much superior to any one of the parameters alone (P<0.05). Conclusion Serum miR-122, miR-34aand miR-140-5p levels might help screening of patients with NASH in population of NAFLD, which needs further clinical investigation.

Objective The aim of this study was to investigate clinical efficacy of semaglutide and metformin combination in treatment of patients with type 2 diabetes mellitus (T2DM) and concomitant nonalcoholic steatohepatitis (NASH). Methods Eighty patients with T2DM and NASH were encountered in our hospital between October 2022 and October 2023, and were randomly assigned to receive metformin in control or to receive metformin with combination of semaglutide subcutaneously in observation group for 24 weeks. Liver biopsies at presentation and at end of 24 week treatment were performed, and liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were detected by Fibroscan 502. Results By end of 24-week treatment, body mass index (BMI), fasting blood glucose (FPG), 2-hour postprandial blood glucose (2hPG), hemoglobin A1c (HbAlc) and insulin resistance index (HOMA-IR)) in observation group were (23.9±0.7)kg/m², (5.5±0.5)mmol/L, (6.5±1.2)mmol/ L, (6.3±0.7)% and (3.6±0.5), all significantly lower than [(25.6±0.8)kg/m², (6.0±0.7)mmol/L, (7.9±1.0)mmol/L, (7.5±0.8)% and (4.7±0.7), respectively P<0.05] in the control; serum triglycerides (TG), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels were(2.7±0.7)mmol/L,(5.1±1.0)mmol/L and (3.3±0.5)mmol/L, all much lower than [(3.4±0.8)mmol/L, (5.8±1.1)mmol/L and (3.7±0.6)mmol/L, respectively, P<0.05], while serum high-density lipoprotein cholesterol (HDL-C)) level was (1.3±0.2)mmol/L, much higher than [(1.1±0.2)mmol/L, P<0.05] in the control; serum liver function tests in the observation group improved greatly (P<0.05); LSM and CAP were (8.6±1.0)kPa and (251.0±18.5)db/m, both much lower than [(10.1±0.9)kPa and (273.0±19.1)db/m, respectively, P<0.05] in the control; liver histo-pathological examination showed that NASH activity score (NAS) improved in 72.5%, much higher than 25.0% in the control group. Conclusion The combination of semaglutide and metformin in treatment of patients with T2DM and NASH is efficacious short-termly, which might modulate blood sugar and lipid metabolism, and improve liver function tests.

Objective The aim of this study was to investigate magnetic resonance imaging proton density fat fraction (MRI-PDFF) in predicting liver steatosis in patients with nonalcoholic fatty liver disease (NAFLD). Methods 96 patients with NAFLD and 55 healthy volunteers were enrolled in our hospital between December 2022 and December 2023, and all underwent MRI scan for MRI-PDFF measurement. Liver stiffness measurement (LSM) AND controlled attenuation parameter (CAP) were detected by transient elastography. Liver biopsy was performed in patients with NAFLD. Results MRI-PDFF, CAPand LSM in patients with NAFLD were (27.5±9.6)%,(297.2±35.2)dB/m and (10.3±2.3)kPa, all significantly higher than [(9.8±3.3)%, (251.7±14.4)dB/m and (5.1±1.3)kPa, respectively, P<0.05] in healthy persons; LSM,CAPand MRI-PDFF in 16 patients with histology-proven severe liver steatosis were (11.8±2.0)kPa, (341.1±32.2)dB/m and (37.3±8.3)%, all significantly higher than [(10.4±1.8)kPa, (284.0±12.7)dB/m and (25.1±3.4)%, respectively, P<0.05] in 29 patients with moderate liver steatosis or [(8.9±1.7)kPa, (263.5±7.7)dB/m and (14.4±3.2)%, respectively, P<0.05] in 51 patients with mild liver steatosis; ROC analysis showed that the AUC was 0.903, with sensitivity of 87.5% and specificity of 93.1%(P<0.05), when MRI-PDFF equal to or greater than 31.4% was set as the cut-off-value in predicting severe liver steatosis in patients with NAFLD. Conclusion Utility of MRI-PDFF could help clinicians for surveillance of liver steatosis in patients with NAFLD in clinical practice, especially for dynamic evaluation in process of intervention.

Objective This study aimed to assess disease burden of nonalcoholic fatty liver disease (NAFLD) in China from 1990 to 2021 and to predict its trends from 2020 to 2040. Methods This study retrieved database from the Global Burden of Disease (GBD) and Excel software was applied toillustrate the incidence, mortality, prevalence and disability-adjusted life years (DALYS) burden of NAFLD during 1990 to 2021 period. R software was used to predict burden trends of the disease, and a Bayesian age-period-cohort model (BAPC) was constructed to predict the incidence of the disease between 2020 and 2040. Results From 1990 to 2021, the overall burden of NAFLD demonstrated a rising trend, the standardized prevalence rate increased by 22.0% (AAPC = 0.6%, P< 0.01), and the standardized incidence rate increased by 18.3% (AAPC = 0.7%, P< 0.01);the BAPC model predicted that the disease burden of NAFLD would continue to rise over the next 20 years; by 2040, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) were expected to reach 780.0, 17706.9, 11306.1, and 8.2 per 100,000, respectively, representing increases of 25.6%, 13.5%, 78.9%, and 7.8%, respectivley compared to in 2021. Conclusion The disease burden of NAFLD in Chinese population increasesgreatly from 1990 to 2021, with younger men being at higher risk. Tailored prevention and treatment strategies should be developed based on the current disease burden characteristics to effectively reduce the negative impact on human health.

Objective The purpose of this study was to analyze the histo-pathological manifestations of liver biopsy tissues in patients with metabolic-associated fatty liver disease (MAFLD). Methods In this study, a retrospective analysis was performed to collect liver tissue data in 35 patients with MAFLD. All patients underwent liver biopsies in our hospital between August 2017 and December 2022, and the histological manifestations of liver tissues were observed. Results Of the 35 patients with MAFLD, liver histo-pathological examination showed liver steatosis F0 in 8 cases(22.9%), F1 in 16 cases (45.7%), F2 in 5 cases (14.3%) and F3 in 6 cases (17.1%), e.g., liver steatosis in 27 cases (77.1%), of them, the MAFLD activity score (MAS)≥5, suggesting MASH in 11 cases (31.4%); hepatocellular ballooning in 26 cases (74.4%), with and without lobular inflammation in 32 cases (91.4%)and in 3 cases (8.6%), of them, grade 1 in 14 cases (40.0%), grade 2 in 12 cases (34.3%) and grade 3 in 6 cases (17.1%); Mallory-body was found in 5 cases (14.3%); no liver fibrosis in 5 cases (14.3%), significant liver fibrosis in 16 cases (45.7%) and advanced liver fibrosis in 14 cases (40.0%). Conclusion Liver biopsy is important for clarification of histopathological changes, which might help clinicians make an appropriate measures to deal with it.

Objective The aim of this study was to investigate therapeutic efficacy of exenatideplus oralpolyenephosphatidylcholine in the treatment of patients with alcoholic hepatitis (AH). Method A total of 102 patients with AH were recruited in our hospital between January 2022 and January 2024,and were randomly assigned to receive oral polyene phosphatidylcholine in 50 patients in control, or receive subcutaneous exenatide injection plus oral polyene phosphatidylcholine in 52 patients in combination group for three months. Serum hyaluronic acid (HA), type III procollagen (PC-Ⅲ), collagen fiber Ⅳ (ⅳ-C) and laminin (LN)) levels were detected by radioimmunoassay, and serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-8 levels were assayed by ELISA. Result By end of three month treatment, serum ALT, AST,GGT and total bilirubin levels in combination groupwere(48.9±15.2)U/L, (45.6±12.5)U/L, (119.5±30.6)U/L and (23.1±5.6)μmol/L, all significantly lower than [(69.3±20.1)U/L,(79.6±18.1)U/L, (168.8±50.7)U/Land (33.5±6.9)μmol/L,respectively, P<0.05] in the control; serum HA, PC-Ⅲ,Ⅳ-C and LN levels in the combination group were (128.5±20.3)μg/L, (132.3±29.1)μg/L, (41.2±9.1)mg/mL and (105.4±20.6)mg/mL, all significantly lower than [(152.2±22.1)μg/L, (186.5±30.4)μg/L, (57.3±10.2)mg/mL and (134.5±20.1)mg/mL, respectively, P<0.05] in the control group; serum TNF-α,IL-6 and IL-8 levels in the combination group were (236.1±100.8)pg/L, (35.1±10.8)pg/L and (10.5±3.8)ng/L, all much lower than [(286.7±105.6)pg/L, (50.1±11.4)pg/L and (17.1±4.5)ng/L, respectively, P<0.05] in the control group; there was no significant difference in the incidence of adverse reactions between the two groups (13.5% vs. 10.0%, P>0.05). Conclusion Additional injection of exenatideat basis of oral polyenephosphatidylcholine therapy could improve liver function normal in patients with alcoholic hepatitis, which might be related to inhibition of body inflammatory reactions.

Objective The aim of this study was to summarize clinical feature of patients with IgG4-related sclerosing cholangitis (IgG4-SC) and concomitant autoimmune pancreatitis (AIP). Methods 28 patients with AIP and 19 patients with AIP and concomitant IgG4-SC were encountered in our hospital between November 2020 and April 2023, and all underwent liver biopsies and abdominal CT scan. Serum IgG and IgG4 levels were detected by ELISA, and IgG4-RD activity responder index (RI) were calculated. Patients were treated by prednisone and/or ursodeoxycholic acid (UDCA). Results Percentage of concomitant diabetes, involved organ and RI in patients with AIP and IgG4-SC were 68.4%, 3.0(2.5, 4.5) and 12.5(12.0, 14.5), all significant higher than [35.7%, 2.0(1.0, 2.5) and 7.0(5.0, 8.0), respectively, P<0.05] in patients with AIP; incidence of abdominal pain in patients with AIP and IgG4-SC was 73.7%, much higher than 42.9%(P<0.05) in patients with AIP; serum GGT, ALP, IgG, amylase and lipase levels in patients with AIP and IgG4-SC were 574.7(76.8, 965.2)U/L, 438.0(274.4, 638.7)U/L, 141.6(134.7, 208.5)g/L, 38.5(29.7, 79.2)U/L and 49.3(36.1, 108.5)U/L, all much higher than [298.8(37.5, 685.3)U/L, 168.5(109.4, 374.3)U/L, 45.3(30.5, 69.4)g/L, 16.6(10.6, 28.0)U/L and 14.5(8.5, 25.8)U/L, respectively, P<0.05] in patients with AIP; percentages of diffuse pancreatic enlargement, pancreatic stones or calcification and intrahepatic bile duct wall thickening in patients with AIP and IgG4-SC were 78.9%, 15.8% and 15.8%, all much higher than 46.4%, 3.6% and 3.6% (P<0.05) in patients with AIP. Conclusion Autoimmune pancreatitis and concomitant IgG4-SC might be clinically sophisticated, and clinicians should assess the disease carefully. We recommend prednisone and UDCA treatment for them.

Objective This clinical trial was conducted to observe combination of polyene phosphatidylcholine and silybin in treatment of patients with drug-induced liver injury (DILI) . Methods 102 patients with DILI were recruited in our hospital between January 2021 and July 2024, and the patients were randomly assigned to receive intravenous polyene phosphatidylcholine in control group (n=51) or receive intravenous polyene phosphatidylcholine and oral silybin capsules in observation group (n=51) for 2 to 4 weeks. Serum superoxide dismutase(SOD), malondialdehyde(MDA) and glutathione(GSH) levels were routinely obtained, and serum C-reactive protein (CRP), interleukin-6 (IL-6), IL-1β and tumor necrosis factor-α (TNF-α) levels were detected by ELISA. Results Normalization rates of liver function tests in our series was 91.2%, with slight liver function tests abnormal in 9 cases (8.8%); after treatment, serum ALT, AST and ALP levels in the observation group were (33.6±6.7)U/L, (35.8±7.1)U/L and (62.3±11.4)U/L, all significantly lower than [(47.9±7.4)U/L, (52.8±7.0)U/L and (73.1±11.9)U/L, respectively, P<0.05] in the control; serum SOD and GSH levels were 86.0(74.6, 93.2)U/L and (7.9±1.3)μmol/L, both much higher than [73.5(69.1, 81.2)U/L and 6.3±1.0)μmol/L, P<0.05], while serum MDA level was (5.2±1.1)nmol/L, much lower than [(6.4±1.2)nmol/L, P<0.05] in the control; serum TNF-α and IL-1β levels were (4.6±1.8)pg/mL and (11.3±4.4)ng/mL, both significantly lower than [(9.3±2.6)pg/mL and (26.4±6.7)ng/mL, respectively, P<0.05] in the control group. Conclusion The combination of polyene phosphatidylcholine and silybin could improve liver function test back to normal in patients with DILI, which might be related to inhibition of oxidative stress and cytokine release, and is worthy of further clinical observation.

Objective The aim of this study was to investigate risk factors of acute liver injury (ALI) in patients with sepsis. Methods 207 patients with sepsis were encountered in our hospital between August 2021 and August 2024, and out of them, ALI was found in 107 cases according to diagnostic criteria. All patients received antibiotics and life-supporting therapy, and those with ALI were carefully dealt with liver-supporting approaches. Serum C-reaction protein (CRP), procalcitonin (PCT) and D-dimer (D-D) levels were determined by fluorescent immunochromatography. Multivariate Logistics regression analysis was applied to analyze the risk factors for ALI occurrence. Results Platelet count and serum albumin level in patients with ALI were (123.6±26.0)×10⁹/L and (29.9±5.4)g/L, both significantly lower than [(170.4±30.3)×10⁹/L and (32.9±6.0)g/L, respectively, P＜0.05], while serum CRP, D-D, APACHE Ⅱ score, ICU stay, mechanical ventilation and intravenous administration of antibiotics were (90.9±18.7)mg/L, (4.1±0.8)μg/ml, (21.5±3.5)points, (11.3±1.5)d, (130.5±13.1)h and (14.4±2.8)d, all significantly higher or longer than [(46.9±8.3)mg/L, (2.3±0.5)μg/ml, (16.7±3.4), (4.8±1.0)d, (45.4±4.8)h and (7.3±1.2)d, respectively, P＜0.05] in patients with sepsis without ALI; multivariate Logistic regression analysis showed that ICU stay, mechanical ventilation, intravenous administration of antibiotics and APACHE Ⅱ score were all the independent risk factors for occurrence of ALI in patients with sepsis(P<0.05). Conclusion The patients with sepsis could be complicated with ALI, and acknowledge of them and giving an early prevention and treatment might improve prognosis of them.

Objective The purpose of this study was to investigate clinical efficacy of endoscopic tissue glue injection (ETG) and esophageal variceal ligation (EVL) in the treatment of patients with hepatitis B-induced liver cirrhosis complicated with esophageal variceal bleeding (EGVB). Methods 68 patients with hepatitis B-induced liver cirrhosis and complicated with EGVB were encountered in our hospital between September 2019 and December 2022, and were randomly divided into observation group (n=34) and control group (n=34), received ETG or EVL treatment, respectively, and all were followed-up for one year. The general data, perioperative indexes, blood biochemical indexes before and after treatment and the outcome were compared. Successful hemostasis is based on no active bleeding within 72 hours after operation. Early rebleeding is hematemesis or black stool again within 72 hours to 6 weeks after bleeding control, and delayed rebleeding was confirmed by gastroscopy with active bleeding 6 weeks after operation. Results There were no significant differences as respect to EV (F1, F2 and F3 in the observation group were 32.3%, 50.0% and 17.6%, and in the control were 38.2%, 41.2% and 20.6%, all P>0.05) or Child-Pugh class (class B and C were 76.5% and 23.5%, vs. 76.5% and 23.5%, P>0.05)between the two groups; three patients in the control group died of hemorrhagic shock at emergent stage; of survivals, there were no significant differences respect to liver function tests before and after operation between the two groups(P>0.05); successful hemostasis rate in the observation group was 100.0%, much higher than 83.9% in the control, while re-treatment times, early rebleeding and delayed rebleeding rates were (1.4±0.6)times, 2.9% and 5.9%, all significantly less or lower than [(2.1±0.8)times, 12.9% and 22.6%, respectively, P<0.05] in the control group; post-operationally, incidence of retrosternal pain in the observation was 23.5%, much higher than 6.5% in the control group, while there were no significant differences as respect to incidences of dysphagia, fever, spontaneous bacterial peritonitis and death owing to re-bleeding(8.8%, 8.8%, 5.9% and 8.8% vs. 0.0%, 12.9%, 9.7% and 22.6%, all P>0.05) between the two groups. Conclusion Endoscopic tissue glue injection and EVL in dealing with cirrhotics with urgent EGVB could obtain hemostasis and rescue patients life, and warrants further clinical investigation.

Objective The aim of this study was to investigate antiviral efficacy of entecavir (ETV) based on Beijing Standard in patients with hepatitis B-induced liver cirrhosis (LC). Method 145 patients with hepatitis B-induced LC were treated with ETV for 12 months in our hospital between July 2021 and July 2024. Serum HBV DNA loads were detected by PCR, and liver stiffness measurement (LSM) was finished by FibroScan 502 elastography. Liver biopsies was completed and evaluated by Ishak and Knodell scores, and reassessed by Beijing standard for predominantly progressive (P), indeterminate(I) and predominately regressive (R) typing. Result By end of 12 month treatment, liver histo-pathological examination showed out of the 145 patients with LC, liver injuries demonstrated in P typing, I typing and R typing were 45 cases(31.0%), 32 cases (22.1%) and 68 cases (46.9%), respectively; alcohol hobby, serum HBV DNA load and HBsAg levels at baseline in P group were 46.7%, (7.6±1.8)lg IU/mL and (8751.9±220.5)IU/mL, all significantly higher than [23.5%, (5.7±1.6)lg IU/mL and (2003.0±60.9)IU/mL, respectively, P<0.05] in R group or [34.4%, (6.5±1.7)lg IU/mL and (4312.4±111.4)IU/mL, respectively, P<0.05] in I group; by end of 12 month treatment, serum ALT, AST, LSM, Ishak score and histological activity index score in P group were (47.9±13.1)U/L, (53.1±14.2)U/L, (6.7±1.7)kPa, (3.6±0.4) points and (5.1±0.5)points, all significantly higher than [(36.2±10.9)U/L, (37.0±11.2)U/L, (5.2±1.2)kPa, (3.2±0.3) points and (4.5±0.3)points, respectively, P<0.05] in R group; serum ALT normalization rate and HBV DNA loss rate in P group were 46.7% and 71.1%, both much lower than 100.0% and 100.0%(P<0.05) in R group. Conclusion Liver histo-pathological response to ETV antiviral treatment varies, which might assessed by Beijing standard for efficacy classification.

Objective This study was conducted to evaluate predictive performance of thromboelastogram (TEG)parameters and blood coagulation indexes for portal vein thrombosis (PVT)in patients with liver cirrhosis (LC) after splenectomy. Methods 129 patients with hepatitis B-induced LC were recruited in our hospital between January 2020 and June 2024, and all underwent splenectomy. Baseline thromboelastography was performed for measurement of coagulation reaction time (R), blood coagulation time (K), solidification angle and maximal amplitude (MA). Portal vein diameter (PVD) and splenic vein diameter (SVD) were measured by endoscopic ultrasonography(EUS). Multivariate Logistic regression analysis was applied to assess risk factors, and area under receiver operating characteristic curve (AUC) was used to evaluate predicting efficacy. Results Of the 129 patients with LC, the incidence of PVT after splenectomy as confirmed by imaging was 29.5%; baseline platelet count in PVT group was 77.4(50.3, 101.2)×10⁹/L, much lower than [107.5(81.8, 159.7)×10⁹/L,P<0.05], while MELD score, PVD and SVD were 22.3(20.1, 24.8)points, 17.0(16.2, 17.8)mmand 14.0(13.2,15.4)mm, all much greater than [18.2(16.9, 20.0)points, 15.1(13.7, 16.4)mmand 11.9(10.9, 13.5)mm, respectively, P<0.05] in non-PVT group; prothrombin time (PT) and activated partial thromboplastin time (APTT) in PVT group were 16.5(15.1,18.0)s and 43.1(39.7, 45.9)s, both significantly longer than [15.1(14.0, 16.3)s and 40.3(37.4, 43.0)s, respectively, P<0.05], whilie serum fibrinogen (FIB) level was 2.0(1.6, 2.4)g/L, much lower than [2.3(1.9, 3.0)g/L, P<0.05] in non-PVT group, and K was 2.6(2.0, 3.4)min, much less than [3.7(1.8, 5.7)min,P<0.05], while MA was 52.7(43.7, 57.9)mm, much greater than [41.6(36.0, 53.1)mm, P<0.05] in non-PVT group; multivariate Logistic regression analysis showed that PVD, SVD, K and MA were all the independent risk factors for PVT occurrence in patients with LC after splenectomy (P<0.05);ROC analysis demonstrated thatthe AUC was 0.90, with sensitivity of 95.6% and specificity of 81.6%, when combination of PVD, SVD, K and MA in predicting PVT occurrence in LC patients after splenectomy, much superior to any parameter did alone (P<0.05). Conclusion Surveillance of TEG parameters, e.g., K and MA in patients with LC after splenectomy might help predict PVT occurrence, and an appropriate interventional measures should be given early and prevent it happening.

Objective The purpose of this study was to investigate Doppler tissue imaging (DTI) and echocardiography (ECG) index in diagnosing cirrhotic cardiomyopathy (CCM) in patients with hepatitis B-induced liver cirrhosis (LC). Methods 120 patients with hepatitis B-induced LC were encountered in Second Affiliated Hospital, Xi 'an Medical University between February 2019 and February 2024, all patients underwent DTI and ECG for left atrial diameter (LAD)and ratio of peak velocity of left ventricular diastolic blood flow in early and late stages (E/A ratio), etc., and transferred to TDI model for detection and calculation of Tei index. Univariate and multivariate Logistic regression analysis was used to reveal influencing factors of occurrence of CCM, and the area under the receiver-operating characteristic (ROC) curve (AUC) was applied to assess diagnostic performance. Results Of 120 patients with LC, CCM was found in 37 cases(30.8%)base on QT-c interval＞440ms; ages, percentages of smoking, alcohol hobby, Child-Pugh class C, total serum bilirubin and creatine kinase isoenzyme (CKMB) levels in patients with CCM were (62.6±5.9)yr, 43.2%, 62.2%, 35.1%, (47.3±9.4)μmol/l and (28.4±6.3)U/l, all significantly higher or greater than [(58.2±5.4)yr, 8.4%, 4.8%, 4.8%, (14.8±7.4)μmol/l and (20.9±4.8)U/l, respectively, P＜0.05] in cirrhotics without CCM; portal vain diameter, LAD and Tei index in patients with CCM were (16.2±2.1)mm, (39.6±4.4)mm and (0.6±0.2), all significantly greater than [(13.2±1.2)mm, (34.2±3.6)mm and (0.4±0.1), respectively, P＜0.05], while E/A ratio was (0.8±0.1), much less than [(1.0±0.2), P＜0.05] in patients with LC; multivariate Logistic regression analysis showed that ages, Child-Pugh class, LAD and Tei index were all the independent risk factors for occurrence of CCM in patients with LC (P＜0.05);ROC analysis demonstrated that the AUCwas 0.901(95%CI:0.836-0.967), with sensitivity of 86.5% and specificity of 84.3%, when LAD and Tei index combination was applied to predict CCM in patients with LC, much superior to any one parameter did (P＜0.05). Conclusion Combination of LAD and Tei index could help clinicians find secondary CCM in patients with LC early, which might guide them to take appropriate measures.

Objective The aim of this study was to investigate incidence and risk factors of portal venous system thrombosis(PVST)in patients with hepatitis B-induced liver cirrhosis (LC) and hypersplenism after partial splenic artery embolization (PSE). Methods 90 patients with hepatitis B-induced LC with complicated hypersplenism were encountered in our hospital between January 2020 and June 2024, and all underwent PSE for ameliorating decreased peripheral blood cell counts. Abdominal CT scan was routinely carried out. Multivariate Logistic regression analysis was applied to find impacting factors. Results By three months after PSE, PVST was proven by CT scan in 17 cases (18.9%) out of our 90 patients; percentage of patients with intravenous low molecular dextran and low molecularweight heparin administration after operation in patients with PVST were 11.8% and 17.6%, much lower than 37.0% and 42.5%(P<0.05)in those without PVST; diameter of spleen, diameter of portal vein, diameter of splenic vein, diameter of superior mesenteric vein and percentage of splenic embolism area in patients with PVST were all significantly greater than, while blood flow velocity of portal vein was much slower than in those without PVST (P<0.05); multivariate Logistic regression analysis showed thatno anticoagulant intervention, portal vein diameter >1.58 cm, portal vein blood flowvelocity <13.1cm/s and spleen embolism area percentage >39.0% were all independent risk factors for occurrence of PVST after PSE (P<0.05). Conclusion PVST could occur after PSE in patients with hepatitis B-induced LC and complicated hypersplenism, which might be prevented by in time anticoagulation intervention, and appropriate percentage of splenic embolism area.

Objective The aim of this study was to investigate clinical efficacy of bevacizumab and sintilimab combination after transcatheter arterial chemoembolization (TACE) in the treatment of patients with unresectable hepatocellular carcinoma (HCC). Methods 96 patients with unresectable HCC were enrolled in our hospital between June 2021 and January 2024, and were randomized into two groups, with 48 cases in each group. Patients in control group were treated with intravenously sintilimab after TACE, and those in the observation were dealt with intranenous bevacizumab and sintilimab combination after TACE for 4 treatment course. Serum alpha-fetoprotein (AFP), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF) and protein induced by vitamin K absence or antagonist-II (PIVKA-Ⅱ) levels were detected by ELISA, and peripheral blood lymphocyte subsets were detected by flow cytometry. The 1-year overall survival rate and progression-free survival rate were recorded. Results By end of treatment course, the objective remission rate assessed by modified response evaluation criteria in solid tumors in the observation group was 83.3%, significantly higher than 62.5% in the control (P<0.05); serum AFP, bFGF, VEGF and PIVKA-Ⅱ levels in the observation group were (77.9±31.7)ng/mL, (4.2±0.8)pg/mL, (82.7±18.3)pg/mL and (652.9±102.4)mAU/L, all much lower than [(169.4±57.4)ng/mL, (5.3±1.0)pg/mL, (124.5±20.9)pg/mL and (764.0±113.9)mAU/L, respectively, all P<0.05] in the control; percentage of peripheral blood CD4⁺ cells and CD4⁺/CD8⁺ cell ratio were (34.5±2.8)% and (1.4±0.2), both much higher than [(30.1±3.1)% and (1.2±0.2), P<0.05] in the control; incidence of adverse effects in the two groups were not significantly different(P＞0.05); by end of one-year follow-up, the total survival rate in the observation was 83.3%, not significantly different compared to 68.8% in the control (P＞0.05), while the progression-free survival rate was 79.2%, much higher than 58.3%(P<0.05) in the control group. Conclusion Combination of bevacizumab and sintilimab after TACE in the treatment of patients with advanced HCC is short-termly efficacious, which might be related to modulation of body immune functions and inhibition of angiogenesis.

Objective The aim of this study was to investigate diagnostic performance of contrast-enhanced ultrasonography(CEUS) and enhanced CT (CECT)/magnetic resonance imaging (MRI) liver image reporting and data system (LI-RADS) in the diagnosis of patients with small hepatocellular carcinoma (sHCC). Methods A total of 102 patients with intrahepatic space-occupying lesions (SOL) were encountered in our hospital between January 2019 and December 2023, and the patients enrolled all had SOL less than 1 cm. All patients underwent CEUS and CECT /MRI check-up, intrahepatic SOL were assorted based on LI-RADS, and diagnosis was determined by histo-pathological examination. Results Of 102 SOL, CEUS judged as LR3, LR4, LR5 and LRM in 11, 13, 67 and 11 cases, significantly different as compared to 18,20, 61 and 3 cases by CECT/MRI did(P=0.033); final diagnosis was made by pathological examination and showed sHCC in 92 cases and mixed liver cancer in 2 cases, and benign lesions in 8 cases, including cirrhotic nodules in 4 cases and focal proliferative nodule (FPN) in 4 cases; sensitivity, specificity and accuracy by CEUS were 62.5%, 98.9% and 96.1%, all not significantly different compared to 75.0%,97.9% and 96.1% by CECT/MRI (P＞0.05). Conclusion CECT/MRI and CEUS could help clinicians make an appropriate diagnosis early in patients with intrahepatic small SOL, and we recommend the LI-RADS for relatively correct diagnosis. For patients with intrahepatic SOL, the histo-pathological examination is never too important in clinical practice.

Objective The aim of this study was to investigate therapeutic efficacy of attilizumab and targeting and immune checkpoint inhibitor (ICPI) combination after transhepatic arterial chemoembolization (TACE) in the treatment of patients with advanced primary liver cancer (aPLC). Methods 126 patients with aPLC were recruited in our hospital between March 2017 and March 2021, and were randomly divided into observation and control group, with 63 cases in each group. TACE was routinely conducted in the two groups, patients in the control group were given apatinib, or sorafenib, and bevaccinium monoantibody therapy, and those in the observation group were treated with attilizumab at base of regimen in the control. All patients were followed-up for two years, and objective response rate (ORR) and disease control rate (DCR) 3 months after treatment were recorded. Peripheral blood T lymphocyte subsets were detected by flow cytometry and serum carcino-embryonic antigen (CEA), alpha-fetoprotein (AFP) and tissue polypeptide antigen (TPA) levels were assayed by ELISA. Results ORR and DCR in the observation group were 60.3% and 87.3%, significantly higher than 41.3% and 71.4% (P<0.05) in the control; after treatment, percentage of peripheral blood CD4⁺ cells and ratio of CD4⁺/CD8 ⁺ cells in the observation group were (38.4±4.3)% and (1.3±0.2), both significantly higher than [(33.6±3.8)% and (1.1±0.2), respectively, P＜0.05] in the control group; serum AFP and TPA levels were (92.6±25.8)ng/mL and (308.2±50.9)U/L, both much lower than [(177.6±41.3)ng/mL and (359.7±56.3, respectively, P＜0.05] in the control; 2-year survival rate in the observation group was 66.1%(41/62), much higher than 45.0%(27/60, x²=5.518, P=0.019) in the control group. Conclusion Combination of attillizumab, and target and ICPI therapy after TACE in the treatment of patients with aPLC is efficacious, which could prolong survivals, and might be related to the improvement of immune functions.

Objective The aim of this study was to investigate clinical efficacy of sintilimaband anti-vascular endothelial growth factor (VEGF) antibody in the treatment of patients with unresectable hepatocellular carcinoma(HCC). Methods 90 patients with unresectable HCC were encountered in our hospital between January 2022 and January 2024, and were randomly divided into control group (n=45) and observation group (n=45), receiving sintilimab alone or combination of sintilimab with anti-VEGF antibody treatment for four to six regimen. SF-36 questionnaire was applied to assess life quality. Serum VEGF, alpha-fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9) levels were detected routinely. Peripheral blood lymphocyte subsets were determined by FCM. Results Objective remission rate and disease control rate in the observation group were 28.9% and 77.8%, both much higher than 8.9% and 55.6%(P＜0.05) in the control; after treatment, role limitation, physiological function, physical function and overall health scores in the observation were (47.1±4.5)points, (43.5±5.3)points, (47.9±4.1)points and (55.8±5.7)points, all significantly greater than [(42.5±5.6)points, (38.7±3.7)points, (43.7±3.8)points and (48.0±5.3)points, respectively, P＜0.05] in the control; serum VEGF and AFP levels were (114.3±18.7)pg/ml and (73.4±8.6)μg/L, both significantly lower than [(132.8±17.6)pg/ml and (158.0±9.2)μg/L, respectively, P＜0.05] in the control group; percentages of peripheral blood CD⁺₃ and CD⁺₄ cells, and CD₄/CD₈ cell ratio were (41.7±4.9)%, (30.0±3.5)% and (1.6±0.2), all much higher than [(38.2±4.0)%, ⁺(27.1±3.6)% and (1.4±0.2), respectively, P＜0.05] in the control group. Conclusion The short-term efficacy of sintilimab plus anti-VEGF antibody combination is relatively satisfactory, which might be related to transiently improvement of body immune functions and inhibition of vascular formation of tumors.

Objective This study aimed to investigate diagnostic performance of serum alpha-fetoprotein (AFP) levels and multilayer spiral CT-detected parameters in evaluating qualities of liver nodules. Methods Clinical data of 124 patients with liver nodules were collected in our hospital between October 2021 and October 2023, and all underwent CT scan for determination of mean transit time (MTT),permeability surface area product (PS), blood volume (BV) and blood flow (BF) of regions of interest. Serum AFP, carcinoembryonic antigen (CEA),carbohydrate antigen 199 (CA-199) and tumor specific growth factor (TSGF) levels were assayed by ELISA. Multivariate Logistic regression analysis and area under receiver operating characteristic curve (AUC) were applied to assess diagnostic efficacy. Results Of 124 patients with intrahepatic nodules, histo-pathological examination found benign lesions in 83 cases (66.9%) and malignant lesions in 41 cases (33.1%);PS, BV and BF in malignant lesions were (10.4±3.2)mL/(min·100 g), (4.0±1.6)mL/100 g and (26.5±5.6)mL/(min·100 g), all much higher than [(6.2±1.5)mL/(min·100 g), (1.9±0.5)mL/100 g and (17.9±3.5)mL/(min·100 g), respectively, P＜0.05] in benign ones; serum AFP, CA-199 and TSGF levels were (416.4±150.1)μg/L,(44.6±5.9)U/L and (78.3±8.3)U/mL, all much higher than [(11.8±2.3)μg/L,(36.2±4.5) U/L and (59.7±6.2)U/mL, respectively, P＜0.05] in benign lesions; multivariate Logistic regression analysis showed that PS, BV and BF as well as serum AFP levels were independent risk factors for HCC existence (P＜0.05);ROC analysis demonstrated that the AUC was 0.967(95%CI:0.927-1.000), with sensitivity of 985.1% and specificity of 95.1%, when CT parameters and serum AFP level combination in judging the quality of intrahepatic nodules. Conclusion CT parameters in combination with serum AFP levels could help in the differential diagnosis of benign and malignant intrahepatic nodules,which could guide clinical management.

Objective The aim of this study was to investigate the clinical efficacy of transcatheter arterial chemoembolization (TACE) in combination with lenvatinib and sintilimab in treating patients with exceeding up-to-seven criteria primary liver cance (PLC). Methods 96 patients with PLC beyond the up-to-seven criteria were admitted to our hospital between June 2021 and September 2024, 48 patients in the observation group received TACE with combination of lenvatinib and sintilimab, and another 48 patients in the control group received TACE in combination with lenvatinib alone. Tumor response was evaluated based on mRECIST criteria. Univariate and multivariate Cox regression analysis were performed to identify factors influencing progression-free survival (PFS) in PLC patients. Results The objective response rate (ORR) and disease control rate (DCR) in the observation group were 43.8% and 89.6%,both significantly higher than 22.9% and 72.9% in the control group (P<0.05); the progression-free survival (mPFS) and overall survival (OS) in the observation group were 15.3 months and 23.0 months , both significantly higher than 11.2 months and 15.0 months in control group (P<0.05); the multivariate Cox regression analysis identified that the treatment regimen, portal vein tumor thrombus (PVTT) and serum AFP >400μg/L were the independent prognostic factors affecting PFS(P<0.05). Conclusion The combination of lenvatinib and sintilimab after TACE could effectively reduce tumor burdens and prolong survival in patients with PLC exceeding the up-to-seven criteria.

Objective The aim of this study was to investigate diagnostic performance of quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)in patients with focal liver lesions (FLL). Methods 103 consecutive patients with FLL were encountered in Second People's Hospital, Lianyungang, Jiangsu Province between February 2022 and July 2024, and all of them underwent DCE-MRI scan and had had histology-proven diagnosis. Quantitative parameters of DCE-MRI , e.g., volume transfer constant (Ktrans), reverse rate constant (Kep)and extracellular volume fraction (Ve) were recorded, and receiver operating characteristic (ROC) curveswere applied to evaluate diagnostic efficacy of DCE-MRI scan. Results Of 103 patients with FLL in our series, histo-pathological examination made diagnosis of hepatocellular carcinoma(HCC)in 64 cases, intrahepatic cholangiocarcinoma (ICC) in 12 cases, focal nodular hyperplasia (FNH) in 8 cases and hepatic hemangioma (HH) in 19 cases; proportions of lesions with rich blood supply at arterial phase of DCE-MRI in HCC group and in HH group were 90.6% and 100.0%, both much higher than 41.7% in ICC group or 75.0% in FNH group (P＜0.05); Ktrans, Kep and Ve in HH were (0.4±0.1),(0.5±0.1) and (0.7±0.2), and were (0.3±0.1),(0.4±0.1) and (0.5±0.1) in FNH, all significantly lower than [(0.7±0.2),(0.9±0.3) and (1.1±0.4), respectively, P＜0.05] in HCC or [(0.6±0.2),(0.8±0.3) and (1.0±0.3), respectively, P＜0.05] in ICC; sensitivity, specificity and accuracy by DCE-MRI in diagnosing HCC were 93.8%, 92.3% and 93.2%, in diagnosing ICC were 83.3%, 95.6%and 94.2%, in diagnosing FNH were 75.0%, 97.9%and 96.1%, and in diagnosing HH were 89.5%, 98.8% and 97.1%, very promising consistency with histo-pathological diagnosis (all kappa>0.7). Conclusion Quantitative DCE-MRI scan has a high diagnostic efficacy in evaluating intrahepatic FLL, which might help clinicians make an appropriate medical intervention choice.

Objective The aim of this study was to summarize enhanced CT scan features of patients with cholelithiasis and their guidance on clinical decision-making. Methods 160 patients with cholelithiasis were encountered in our hospital between May 2022 and April 2024, and all of them underwent enhanced CT scan. Clinical management included laparoscopic cholecystectomy (LC), endoscopic retrograde cholangiopancreatography (ERCP) and antibiotics. Results Of the 160 patients with cholelithiasis, cholecystolithiasis was found in 46 cases, cholangiolithiasis in 54 cases and cholecystolithiasis/cholangiolithiasis in 60 cases; in our series, incidence of bile duct dilatation was 60.0%, intrahepatic density changes was 30.0% and bile duct wall thickening was 32.5%; incidences of intrahepatic bile duct dilatation in patients with cholangiolithiasis and cholecystolithiasis/cholangiolithiasis were 77.8% and 80.0%, both much higher than 21.7%(P＜0.05)in patients with cholecystolithiasis, incidences of bile duct wall thickening were 51.9% and 60.0%, both much higher than 17.4% (P＜0.05)in patients with cholecystolithiasis; incidences of complicated cholangitis in patients with cholangiolithiasis and cholecystolithiasis/cholangiolithiasis were 44.4% and 46.7%, both much higher than 8.7%(P＜0.05) in patients with cholecystolithiasis, incidences of liver abscess were 11.1% and 13.3%, both much higher than 0.0%(P＜0.05)in patients with cholecystolithiasis; all patients in our series recovered after personalized LC, ERCP and/or supporting therapy. Conclusion Enhanced CT scan could clearly display imaging features of patients with cholelithiasis, which might provide a reliable basis for disease classification, complications assessment and individualized treatment decision-making.

Objective The purpose of this study was to compare laparoscopic cholecystectomy (LC) by through posterior Calot’ s triangle approach (PCTA) or through anterior Calot’ s triangle approach (ACTA) in dealing with patients with cholecystolithiasis and chronic cholecystitis. Methods 197 patients with cholecystolithiasis and chronic cholecystitis were encountered in our hospital between June 2021 and June 2024, and all underwent LC surgery. For the operation, by through PCTA in 96 cases, and by through ACTA in 101 cases. Visual analogue scale (VAS) was evaluated for postoperative pain. Serum C-reactive protein level was detected by immunoturbidimetry, serum interleukin (IL)-6 and tumor necrosis factor (TNF)-α were detected by ELISA, plasma superoxide dismutase (SOD) level was detected by ammonium phosphate method, plasma glutathione peroxidase (GSH-Px) level was detected by DTNB direct color development, and plasma malondialdehyde (MDA) level was assayed by thiobarbituric acid. Results Surgical time and postoperative exhaust time in PCTA group were(33.6±7.3)min and (22.3±5.6)h, both much shorter than [(39.1±7.1) minand (28.8±6.1)h, respectively, P<0.05], and operational bleeding was (36.9±11.4)mL, much less than [(49.5±12.9)mL, P<0.05] in ACTA group; by end of three days, VAS score in PCTA group was (2.5±0.4)points, much lower than [(3.1±0.5)points, P<0.05] in ACTA group; by 24 h, serum IL-6, IL-8, TNF-α and CRP levels in PCTA group were (12.1±2.0)ng/L, (17.3±2.7)ng/L, (19.5±2.7)ng/L and (18.3±1.6)mg/L, all significantly lower than [(15.2±1.4)ng/L, (22.7±3.1)ng/L, (23.6±3.5)ng/L and (29.1±1.1)mg/L, respectively, P<0.05] in ACTA group; serum SOD level was (121.0±18.4)U/ml, much higher than [(105.3±19.2)U/ml, P<0.05]in ACTA group. Conclusion For LC operation, by through PCTA could be relatively easy, which might cost less operational time and induce less body inflammatory and oxidative stress.

Objective The aim of this study was to investigate analgesiaof ultrasound-guided subcostal anterior quadratus lumborumblockwith ropivacaine in patients with gallbladder diseases undergoinglaparoscopic cholecystectomy (LC). Methods 106 patients with gallbladder diseases, including gallbladder stones were encountered in our hospital between March 2022 and September 2023, and were randomly divided into control group (n=53) and observation group (n=53). All patients underwent LC, and after induction of general anesthesia, thepatients in the control group were given bilateral transversus abdominis plane block with 20 mL of 0.25% ropivacaine,while the patients in the observation group was given ultrasound-guided subcostal anterior quadratus lumborumblock with 20 mL of 0.25% ropivacaine. Hemodynamic parameters was monitored before (TO) and 10 minafter intubation (T1), and 10 minafter extubation (T2). Serum interleukin-6 (IL-6),C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α), cortisol (Cor), norepinephrine (NE) and adrenaline (AD) levels were assayed by ELISA. Results Time of first pressing analgetic pump in the observation groupwas (5.5±0.7) h, significantly longer than that in the control group [(2.4±0.5) h, P<0.05], timeof first off-bed activity and times of remedial analgesia in the observation group were (16.3±1.7)h and (2.5±0.4)times, much shorter or less than [(20.5±2.4)h and (3.3±0.5)times, P<0.05] in the control; by 6 h, 12 h and 24 h after operation, resting visual analogue scale score was much lower than in the control (P<0.05); by T1 and T2, systolic blood pressure, diastolic blood pressure and heart rate were much lower or slower than in the control(P<0.05); at 6 h after operation, serum IL-6, CRP and TNF-α levels were (70.3±8.2)pg/mL, (69.5±8.4)mg/L and (12.6±1.4)pg/mL, all significantly lower than [(85.2±8.6)pg/mL, (84.5±8.6)mg/L and (19.3±1.6)pg/mL, respectively, P<0.05] in the control; serum Cor, NE and AD levels were (162.5±16.7)ng/mL, (231.5±24.6)μg/L and (106.4±12.7)μg/L, all much lower than [(194.3±19.5)ng/mL, (266.7±28.3)μg/L and (134.3±13.5)μg/L, respectively, P<0.05] in the control group; incidence of adverse effects in the observation was 9.5%, much lower than 24.5%(P<0.05)in the control. Conclusion Ultrasound-guided subcostal anterior quadratus lumborum block with ropivacaine could achieve a good analgesic effect in patients with gallbladder diseases undergoing LC, which might be related to inhibition of body inflammation and stress reactions.

Objective Acute-on-chronic liver failure (ACLF) is a clinical syndrome that occurs after severe impairment of hepatic synthesis, detoxification, metabolism, and transformation functions, and can be complicated by multiple organ failure with a high morbidity and mortality rate. Hepatorenal syndrome (HRS) is one of the serious complications of ACLF, which is a special form of acute kidney injury (AKI) and an independent risk factor affecting the prognosis of patients with ACLF, and early diagnosis and treatment of AKI might effectively improve the prognosis of patients with ACLF.