The Chinese Society of Hepatology of the Chinese Medical Association invited relevantexperts to revise and update the Guideline of Prevention and Treatment of Nonalcoholic Fatty Liver Disease(2018Version) and renamed it as (Version 2024) Guideline for the Prevention and Treatment of MetabolicDysfunction-associated (non-alcoholic) Fatty Liver Disease. Herein, the guiding recommendations on clinicalissues such as screening and monitoring, diagnosis and evaluation, treatment and follow-up of metabolicdysfunction-associated fatty liver disease are put forward.

Objective This clinical trial aimed to compare the efficacy of lorazepam and oxazepam in treatment of patients with alcoholic liver diseases (ALD) and alcohol withdrawal syndrome (AWS). Methods A total of 127 patients with ALD and AWS were enrolled in our hospital between November 2017 and November 2020, and were randomly divided into control (n=63) and observation group (n=64), receiving lorazepam and oxazepam, respectively, for seven days. The scores of alcohol withdrawal syndrome scale (AWSS) and self-rating anxiety scale (SAS) score were evaluated. Serum hyaluronic acid (HA), laminin (LN), type III procollagen N-terminal peptide (PC-III) and type-IV collagen (IV-C) were detected by ELISA. Results At the end of 7 day treatment, the efficient rate in observation group was 96.9％, significantly higher than 81.0％ in the control (P<0.05); at presentation, the AWSS and SAS, serum alanine transaminase (ALT), aspartate aminotransferase (AST), glutamyl transpeptidase (GGT),total bilirubin (TBIL) and alkaline phosphatase (ALP) as well as HA, LN, PC-Ⅲ and IV-C levels were not significantly different between the two groups(P>0.05); after treatment, the AWSS and SAS in observation were (9.5±2.4) and (30.8±6.4), significantly different as compared to in the control; serum ALT, AST, GGT, TBIL and ALP levels were (30.5±8.1)U/L, (71.6±15.3)U/L, (466.1±22.7)U/L, (23.5±6.5)μmol/L and (82.3±12.4)U/L, all much lower than in the control; serum HA, PC-Ⅲ and IV-C levels were (116.8±18.3)μg/L,(123.1±12.3)μg /L and (80.2±11.6)μg /L, significantly lower than in the control. Conclusion The clinical efficacy of oxazepam is good in treatment of ALD patients with complicated AWS, which could improve clinical symptom and anxiety relieving.

Objective The aim of this study was to observe the efficacy of silibinin and polyene phosphatidylcholine combination therapy in patients with anti-tuberculosis drugs-induced liver injury (DILI). Methods 118 patients with pulmonary tuberculosis were encountered in our hospital between June 2018 and June 2021, and all received standardized anti-tuberculosis treatment by 2HRS( E) Z /4HR for six months. During the process, 63 patients were found having DILI, and were randomly divided into control (n=30) and observation (n=33) groups, receiving polyene phosphatidylcholine or silibinin capsule and polyene phosphatidylcholine combination therapy until the anti-tuberculosis regimen ended. Serum interleukin-2 (IL-2), IL-6, IL-1β and tumor necrosis factor-α (TNF-α) levels were detected by ELISA, serum superoxide dismutase (SOD) was detected by radioimmunoassay and serum reduced glutathione (GSH) and malondialdehyde (MDA) levels were assayed by biochemical colorimetry. Results After treatment, serum ALT, AST and GGT levels in the observation group were (32.8±6.1)U/L, (41.2±8.3)U/L and (36.1±6.5)U/L, all significantly lower than [(48.6±8.4)U/L, (53.8±9.2)U/L and (53.8±9.6)U/L, respectively, P<0.05] in the control; serum IL-6, IL-1β and TNF-α levels in the observation were (6.3±1.0)ng/L, (11.0±2.3)μg/L and (6.8±1.5)ng/L, all much lower than [(9.5±1.2)ng/L, (19.2±3.6)μg/L and (9.9±1.3)ng/L, respectively, P<0.05] in the control, while there was no significant difference respect to serum IL-2 levels in the two groups (P>0.05); serum SOD and GSH levels in the observation group were (597.3±71.6)U/L and(7.6±1.5)μmol/L, both significantly higher than [(542.8±68.2)U/L and (6.2±1.3)μmol/L, P<0.05], while serum MDA level was (4.0±0.7)nmol/L, much lower than [(5.8±0.9)nmol/L, P<0.05] in the control. Conclusion The administration of silibinin capsule and polyene phosphatidylcholine combination in treatment of patients with pulmonary tuberculosis during anti-tuberculosis therapy could protect the liver function test normal, and maintain the accomplishment of anti-tuberculosis treatment, which might be related to the relieving inflammation and oxidative stress response.

Objective The purpose of this clinical trial was to investigate the auxiliary treatment of a herbal compound, Ganshuang granule, with entecavir for patients with chronic hepatitis B (CHB). Methods 60 patients with CHB were enrolled in our hospital between January 2019 and January 2021, and were randomly divided into control and observation groups, with 30 cases in each. The patients in the control group received entecavir, and those in the observation were treated with entecavir and a herbal compound, Ganshuang granule, for 48 weeks. The AST to platelet ratio index (APRI), fibrosis 4 score (FIB-4) were obtained, and the liver stiffness measurement (LSM) was determined by FibroTouch scan. Serum interleukin-6(IL-6), transforming growth factor-beta (TGF-β), platelet-derived growth factor (PDGF) and C-reactive protein (CRP) levels were assayed by ELISA. Results At the end of 48 week treatment, serum ALT and AST levels in the observation group were significantly lower than in the control group (P<0.05); serum HBV DNA loss in the two groups were both 100.0%, and serum HBeAg negative rates were both 0.0% (P>0.05); the APRI, FIB-4 and LSM in the observation group were (1.02±0.23), (4.38±0.77) and (7.73±1.53), all significantly lower than [(1.30±0.33), (5.26±0.85) and (9.68±2.02), respectively, P<0.05] in the control; serum IL-6, TGF-β, PDGF and CRP levels in the observation were much lower than in the control (P<0.05). Conclusion The auxiliary treatment of Ganshuang granule at base of entecavir antiviral therapy could significantly improve biochemical response in patients with CHB, which might be related to the anti-fibrotic effect and inhibition of body inflammatory reaction of the herbal compound.

Objective The purpose of this study was to observe the application of entecavir and magnesium isoglycyrrhizinate combination in the treatment of patients with chronic hepatitis B (CHB). Methods A total of 98 patients with CHB were enrolled in our hospital between January 2019 and February 2020, and were randomly divided into control (n=49) and observation group (n=49), receiving entecavir or entecavir and magnesium isoglycyrrhizinate combination therapy for 48 weeks. Serum hyaluronan (HA), laminin (LN), type-IV collagen (CIV) and type-III procollagen (PIIIP) levels were detected by radioimmunoassay. Serum interleukin 2 (IL-2), interleukin 4 (IL-4), interleukin 10 (IL-10) and tumor necrosis factor α (TNF-α) levels were detected by ELISA. The peripheral blood T lymphocyte subsets were detected by flow cytometry. Results At the end of 48 week observation, serum ALT normalization rate in the observation group was 87.8%, significantly higher than 71.4%(P＜0.05) in the control; serum ALT and AST levels in the combination group were (32.3±6.9)U/L and (38.3±4.7)U/L, both significantly lower than [(47.5±7.6)U/L and (52.9±5.1)U/L, respectively, P＜0.05] in the control; serum HA and PⅢP levels were (90.6±9.5)ng/mL and (141.6±32.6)ng/mL, both significantly lower than [(126.8±14.6)ng/mL and (168.2±29.9)ng/mL, respectively, P＜0.05] in the control; serum IL-4 and TNF-α levels were (48.8±7.9)ng/L and (11.3±1.9)ng/L, significantly lower than [(62.6±8.8)ng/L and (18.5±1.7)ng/L, respectively, P＜0.05], while serum IL-10 level was (19.2±2.5)ng/L, significantly higher than [(12.7±3.4)ng/L, P＜0.05] in the control; the percentage of peripheral blood CD4⁺ cells and the ratio of CD4⁺/CD8⁺ cells were (43.5±5.5)% and (1.6±0.2), both significantly higher than [(38.4±4.7)% and(1.4±0.4), respectively, P＜0.05] in the control group. Conclusion The application of entecavir and magnesium isoglycyrrhizinate combination in the treatment of patients with CHB could effectively improve liver function test normal, inhibit the process of liver fibrosis, which might be related to the inhibition of inflammatory reaction and modulation of immune system.

Objective To investigate the changes of serum carbohydrate antigen（CA）125,CA199, alpha-fetoprotein （AFP） and carcinoembryonic antigen （CEA） in patients with live cirrhosis and primary liver cancer（PLC）. Methods Serum levels of CA125,CA199,AFP and CEA in 440 individuals were detected by ELISA,including 223 patients with liver cirrhosis,97 patients with PLC and 120 healthy persons. Results The levels of CA125 in patients with liver cirrhosis and PLC were （261.64±32.47） U/ml and （265.80±30.44 ） U/ml, CA199 were （25.73±3.39） U/ml and （30.54±3.29） U/ml,CEA were （4.03±0.36） ng/ml and （3.87±0.21） ng/ml,much higher than those[（21.25±7.66） U/ml,（18.57±8.11） U/ml and （3.08±1.05） ng/ml,P<0.05] in healthy persons;serum AFP levels in patients with PLC were（20000.00±453.07） ng/ml,much higher than[（7.52±2.01） ng/ml,P<0.05] in patients with liver cirrhosis;The levels of CA125（474.52±59.80） U/ml],CA199 [（27.80±5.94） U/ml] and CEA [（5.80±0.63） ng/ml] in patients with liver cirrhosis of class C were significantly higher than those of class A [（55.65±8.82） U/ml,（18.81±0.46） U/ml and （3.20±0.10） ng/ml,respectively,P<0.05];The levels of CA125[（385.16±36.09） U/ml],CA199[（26.55±2.87） U/ml],AFP[（13.63±1.82） ng/ml] and CEA [（4.85±0.39） ng/ml] in patients with cirrhotic ascites were higher than those without ascites[（62.75±15.45） U/ml,（19.58±0.75） U/ml,（9.39±1.26） ng/ml and （3.54±0.16） ng/ml,P<0.05];The levels of CA125 [（318.48±48.80）U/ml] and CA199 [（26.63±3.22）U/ml] in patients with alcoholic liver cirrhosis were higher than those in patients with viral cirrhosis [（215.77±26.26）U/ml and（19.06±0.64）U/ml,P<0.05] or in patients with primary biliary cirrhosis [（129.73±28.55）U/ml and（18.00±0.00） U/ml,P<0.05];The level of AFP [（56.41±26.75）ng/ml] in patients with viral cirrhosis was higher than[（5.44±0.30） ng/ml or（7.35±1.47） ng/ml,respectively,P<0.05],while the CEA level[（3.53±0.17） ng/ml] was lower than [（5.19±0.35） ng/ml or（5.73±0.98） ng/ml,P<0.05] in patients with alcoholic liver cirrhosis or primary biliary cirrhosis. Conclusion The serum levels of CA125,CA199,AFP and CEA in patients with liver cirrhosis and PLC were different. The serum levels of CA125,CA199,AFP and CEA in patients with liver cirrhosis were associated with Child-Pugh scores,ascites and etiology.

Objective The aim of this study was to investigate the short-term efficacy of dapagliflozin and liraglutide combination in treatment of patients with non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus type 2(T2MD). Methods 60 patients with NAFLD and T2MD were admitted to our hospital between September 2017 and October 2020, and were randomly divided into control and observation group, with 30 cases in each group. All the patients were supervised for routine lifestyle intervention and oral metformin administration for blood glucose control. In addition, the patients in the control group were treated with liraglutide intravenouly, and those in the observation group were treated with dapagliflozin and liraglutide combination. The regimen lasted for 3 months. The fasting plasma glucose (FPG), 2 hour-postprandial plasma glucose (2h PG) and glycated hemoglobin (HbA1c) as well as serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL－C) and high density lipoprotein cholesterol (HDL－C) levels were routinely obtained. Serum fasting insulin(Fins) and 2 h Ins levels were assayed, and the HOMA-IR was calculated. The controlled attenuation parameter (CAP) of livers was detected by FibroTouch. Results At the end of 3 month observation, the FPG, 2hPG and HbA1 levels in the observation group were(5.8±0.7)mmol/L, (6.9±0.8)mmol/L and (6.3±0.9)%, all significantly lower than [(6.6±0.6)mmol/L,(7.7±0.7)mmol/L and (7.2±1.0)%, respectively, P＜0.05] in the control group; serum Fins, 2hIns and HOMA-IR levels were (9.8±1.2)mIU/L, (20.2±1.7)mIU/L and (2.6±0.4)%, significantly lower than [(11.9±1.1)mmol/L, (24.8±1.6) mmol/L and (3.2±0.5)%, respectively, P＜0.05] in the control; serum TG level was (2.6±0.4) mmol/L, significantly lower than [(3.0±0.3)mmol/L, P＜0.05], while serum HDL-C level was (1.6±0.2) mmol/L, significantly higher than [(1.2±0.3)mmol/L, P＜0.05] in the control; the CAP was (249.2±7.5)dB/m, also significantly lower than [(264.7±8.6)dB/m, P＜0.05] in the control; serum AST level was (39.9±3.8)U/L, significantly lower than [(44.9±4.2)U/L, P＜0.05] in the control. Conclusion The application of dapagliflozin and liraglutide combination is efficacious in the treatment of patients with NAFLD and T2MD, which could effectively reduce blood glucose and lipid levels, improve liver function tests back to normal, with the ability of alleviation of insulin resistance.

Objective This study was designed to evaluate of reliability and validity of self-rating anxiety scale（SAS） and self-rating depression scale（SDS） in patients with liver cirrhosis. Methods A total of 138 patients with liver cirrhosis were enrolled in this study. The reliability and validity of the two scales was evaluated by Cronbach’s α co-efficient,intraclass correlation co-efficient （ICC）,Kaiser-Meyer-Olkin （KMO） score and Bartlett’s test of sphericity（BTS）. Results The prevalence of anxiety and depression in this series were 38.2% and 63.1%,respectively;SAS scale’ Cronbach's α coefficient was 0.777 and SDS scale’ was 0.782, indicating better homogeneity reliability; Twenty items of SAS and SDS scales were analyzed by exploratory factors to construct validity and four main factors were extracted from the SAS scale that showed the variances ratio were 15.4%,14.9%,10.6% and 10.2%,respectively,and four factors accounted for 51.1% of the total variance of accumulated explanation;Five main factors were extracted from SDS scales that showed the variance ratio were 14.0%,12.6%,11.9%,10.3% and 8.4%,respectively,with 57.4% of the total variance;The re-measurement analysis of SAS and SDS scale’s items found that the two measurements were highly correlated with each other （P<0.001）. Conclusion SAS and SDS scales have a better reliability and validity in the investigation of psychological and mental impairment in patients with liver cirrhosis.

Objective The aim of this study was to explore the clinical implication of serum triglyceride-glucose index (TyG), visceral/subcutaneous fat area ratio (VSR) and cardiac metabolic index (CMI) in elderly patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). Methods A total of 98 elderly patients with NAFLD and concomitant T2DM and another 98 elderly patients with NAFLD were enrolled in our hospital between January 2021 and December 2022, and routine biochemical parameters were determined for calculation of TyG and CMI. The VSR was obtained from calculation of body fat detected by special apparatus. The multivariate Logistic regression analysis was applied for risk factor finding. Results The fasting blood glucose, glycosylated hemoglobin, the HOMA-IR and serum triglyceride level in NAFLD patients with T2DM were(9.3±0.7)mmol/L, (9.1±1.6)%, (5.7±0.8) and (3.7±0.5)mmol/L, all significantly higher than [(5.8±0.5)mmol/L, (6.1±1.2)%, (3.9±0.4) and (1.9±0.3)mmol/L, respectively, P<0.05], while serum high-density lipoprotein cholesterol level was (1.2±0.2)mmol/L, significantly lower than [(1.5±0.4)mmol/L, P<0.05] in patients with NAFLD; the TyG, VSR and CMI were (10.8±1.5)%, (0.9±0.2)% and (1.2±0.3)%, all much higher than [(8.7±0.4)%, (0.3±0.1)% and (0.6±0.2)%, respectively, P＜0.05] in patients with NAFLD; the multivariate Logistic regression analysis showed that the TyG(OR=3.124, 95%CI:1.101-8.862), the VSR(OR=2.601, 95%CI:1.035-6.535) and CMI(OR=2.832,95%CI: 1.061-7.561) elevation were all the independent risk factors for T2DM in elderly patients with NAFLD (P＜0.05); the TyG, VSR and CMI in 37 patients with severe NAFLD and concomitant 2DM were (12.4±1.9)%, (1.2±0.3)% and (1.7±0.4)%, all much higher than [(9.7±0.6)%,(0.7±0.1)% and (0.9±0.2)%, respectively, P＜0.05] in 61 patients with mild to moderate NAFLD and T2DM. Conclusion The detection and calculation of relatively simple TyG, VSR and CMI might be help for screening T2DM in elderly patients with NAFLD, and needs further investigation.

Objective Bile acid(BA) is synthesized in the liver and is the major component of bile. BAs accumulates in serum and liver when BAs secretion is impaired, which is followed by liver injury. The molecular mechanism of cholestasis has been extensively studied, however, it remains controversial. Recent studies showed that BAs might induce hepatocyte injury under pathological conditions, and the mechanism involved inflammatory response induced by stressed hepatocytes. In this article, we reviewed recent advances in the pathogenesis of liver injury induced by BAs and we focused on how BAs induce the activation of inflammatory cytokines that further induce the aggregation of immune cells. Based on these pathogenesis, we tentatively point out a number of novel treatments for cholestatic liver damage.

Objective The aim of this study was to summarize the clinical features of patients with benign recurrent intrahepatic cholestasis (BRIC). Methods The clinical manifestations, laboratory tests, imaging, pathological examinations, and genetic analysis in three patients with BRIC in Zhongshan Hospital, Fudan University, were retrospectively reviewed. Results The three patients were all male and their initial onset ages were below 20 year old; the common symptoms of the patients were jaundice and pruritus, and two of them also experienced abdominal distension, irregular defecation, and appetite loss; serum total bilirubin, direct bilirubin, ALP and TBA levels increased significantly, while serum GGT, ALT and AST levels stayed normal or increased slightly during the disease attack duration; no abnormal intrahepatic and extrahepatic bile ducts were found in magnetic resonance cholangiopancreatography (MRCP) examination, but obvious cholestasis of hepatocytes and capillary bile duct embolism were observed in liver histopathology; the ATP8B1 gene mutation sites with functional prediction of "potentially harmful" or "likely pathogenic" in pathogenic classification were all detected in three patients; all patients were excluded from other known causes of cholestasis, and the disease was recurrent, but with self-limiting. Conclusion The BRIC is rarely reported and its pathogenesis remains unclear currently. The clinical diagnosis might be made based on clinical manifestations, ancillary tests, and pathological findings after excluding other common causes of liver damage. For patients with high suspicion of BRIC, the genetic tests should be performed as early as possible to clarify the diagnosis and guide the management.

Objective The aim of this study was to investigate the early efficacy of tenofovir amibufenamide (TMF) in the treatment of naïve patients with chronic hepatitis B (CHB). Methods A total of 90 naïve patients with CHB were recruited in the First Affiliated Hospital, China University of Science and Technology between January 2020 and March 2022, and were divided into observation (n=50) and control group (n=40), receiving TMF or tenofovir disoproxil fumarate (TDF) treatment for 48 weeks. Serum alanine transaminase (ALT), HBV DNA loads, HBeAg and HBsAg levels were detected routinely. Results At 12, 24, 36 and 48 weeks of treatment, serum ALT levels in the observation group were 38.0(25.0,55.0)U/L, 31.5(23.8,35.0)U/L, 29.5(22.8,35.0) U/L and 26.0(21.8,34.0)U/L, all not significantly different compared to 38.5(25.0,60.0)U/L, 30.0(22.0,44.0)U/L, 31.0(22.8,44.5)U/L and 28.0(19.8,42.0)U/L (P>0. 05), serum HBV DNA loads were 0(0, 3)lgIU/ml, 0(0, 0.5)lgIU/ml, 0(0, 0)lgIU/ml and 0(0, 0)lgIU/ml, not significantly different compared to 2(0, 3)lgIU/ml, 0(0, 2)lgIU/ml, 0(0, 1.5)lgIU/ml and 0(0,0)lgIU/ml (P >0.05) in the control; serum HBV DNA loss were 58%, 76%, 78% and 88%, not significantly different compared to 45%, 65%, 75% and 85%(P >0.05) in the control; at 12, 24 and 36 week treatment, serum ALT normalization rates in the observation group were 56%, 80% and 92%, all not significantly different compared to 55%, 70% and 65%(P >0.05) , while at the end of treatment 48 week, serum ALT normalization rate in the observation group was 100.0%, much higher than 72.5%(P＜0.01) in the control; during the period of antiviral regimen, there was no obvious untoward effects in the two groups. Conclusion The antiviral performance of TMF in the treatment of naïve patients with CHB is as efficacious as of TDF, while the long-term efficacy and its impact on renal functions needs further clinical investigation.

Objective The aim of this study was to explore the clinical efficacy of programmed cell death protein-1 (PD-1) inhibitor and lenvatinib in the treatment of elderly patients with advanced primary liver(PLC). Methods 56 patients with advanced PLC were admitted to our hospital between February, 2017 and February, 2020, and were divided into control (n=28) and observation group (n=28), receiving lenvatinib or PD-1 inhibitor, tirelizhu, and lenvatinib combination therapy. The peripheral blood lymphocyte subsets, CD4⁺ cell surface PD-1 and cytotoxic T-lymphocyte antigen 4 (CTLA-4) were detected by FCA. Serum acidic fibroblast growth factor (aFGF), basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) levels were detected by ELISA. Results At the end of three month treatment, there were no significant differences as respect to the objective remission rate (42.9% vs. 25.0%) and local control rate(78.6% vs. 64.3%, P>0.05); the percentages of CD3⁺, CD4⁺ and CD8⁺ cells in the combination treatment group were much higher than, while the CD4⁺/CD8⁺ cell ratio, as well as the cell PD-1 and CTLA-4 expression were much lower than in the control (P<0.05); serum aFGF, bFGF and VEGF levels in the observation group were (4.1±0.8)pg/L, (5.1±1.0)pg/L and (13.5±2.7)ng/ml, all significantly lower than [(5.3±0.9)pg/L, (6.1±0.8)pg/L and (18.6±3.1)ng/ml, respectively, P<0.05] in the control; at the end of two-year follow-up, there was no significant difference respect to the progression free survival (10.7% vs. 21.4%, P>0.05) between the two groups, while the overall survival in the observation group was 60.7%, much higher than 25.0% (P<0.05) in the control. Conclusion The strategy of PD-1 inhibitor and lenvatinib combination in the treatment of elderly patients with advanced PLC could improve immune functions and prognosis, which needs further investigation.

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

Objective The aim of this study was to investigate the short-term efficacy of silybin meglumine and Danning tablet, a herbal medicine, combination in treatment of patients with alcoholic hepatitis (AH). Methods 146 consecutive patients with AH were recruited in our hospital between March 2017 and June 2019, and were randomly divided into control group (n=73) and observation group (n=73). The patients in the control group were given Danning tablets, and those in the observation group were treated with silybin meglumine and Danning combination for 3 months. Serum superoxide dismutase (SOD), alondialdehyde (MDA) and free fatty acid (FFA) were detected. Results Serum total cholesterol (TC) level in the combination group was (4.9±0.7)mmol/L, significantly lower than 【(5.5±1.2)mmol/L, P<0.05】, and high density lipoprotein cholesterol (HDL-C) was (1.3±0.9)mmol/L, much higher than 【(1.0±0.5)mmol/L, P<0.05】 in the control, and serum triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) levels in the two groups were not significantly different 【(1.7±0.3)mmol/L vs. (1.7±0.7)mmol/L and (3.2±0.4)mmol/L vs. (3.4±0.7)mmol/L, respectively, P>0.05】; serum alanine aminotransferase level was (35.9±7.7)U/L, serum aspartate aminotransferase level was (39.5±6.3)U/L, serum glutamyl transpeptidase level was (123.8±6.6)U/L, and serum alkaline phosphatase level was (57.3±12.5)U/L, all significantly lower than those in the control [(63.5±9.2)U/L,(65.5±7.8)U/L,(145.7±7.2)U/L and (78.4±13.1)U/L, respectively, P<0.05】; serum SOD level was (132.9±19.3)nmol/L, much higher than 【(105.5±12.6)nmol/L, P<0.05】, serum MDA level was (9.5±2.3)nmol/L, significantly lower than 【(14.4±3.6)nmol/L, P<0.05】, and serum FFA level was (24.3±3.1)nmol/L, much lower than 【(30.2±3.3)nmol/L, P<0.05】 in the control. Conclusion The administration of silybin meglumine and a herbal medicine combination in treatment of patients with AH might in short-term ameliorate blood lipid metabolism, inhibit oxidative stress and improve liver functions, which needs further multi-central investigations.

Objective The aim of this study was to summarize the imaging features of multi-slice spiral CT (MSCT) in patients with gallbladder adenomyosis and in patients with gallbladder carcinoma. Methods 113 patients with gallbladder adenomyosis and 78 with gallbladder carcinoma were enrolled in our hospital between September 2015 and September 2020, and all patients underwent MSCT and ultrasonography. The histophthological examination was performed after surgery. Results The consistency of diagnosis by MSCT based on postoperative histopathological examination (Kappa=0.749) was stronger than that by ultrasonography (Kappa=0.577); the accuracy rate by MSCT scan in the diagnosis of patients with gallbladder adenomyosis was higher than that by ultrasonography(88.0% vs. 79.6%, P<0.05); the diagnosis of special, local gallbladder adenomyosis, by MSCT was also higher than that by ultrasonography (97.1% vs. 82.9%, P<0.05); the CT scan showed that the percentages of smooth gallbladder walls, RAS sinus display and clear boundary between liver and gallbladder in patients with gallbladder adenomyosis were 36.3%, 36.3% and 69.0%, all significantly higher than 9.0%, 6.4% and 38.5% in patients with gallbladder carcinoma (P<0.05). Conclusion The diagnostic accuracy of patients with gallbladder adenomyosis by MSCT is relatively high, and its imaging feature might help discriminate gallbladder adenomyosis from cancer.

Objective The aim of this experiment was to investigate the changes of lipid metabolism related genes in liver tissues of mice with nonalcoholic fatty liver diseases (NAFLD). Methods A NAFLD model was established in ten mice by feeding high-fat diet. The histopathological changes of the liver tissues were observed. Blood total cholesterol (TCH) and triglycerides (TG) levels were detected, and sterol regulatory element-binding proteins (SREBPs), acetyl coenzyme carboxylase (ACC) and fatty acid synthase (FAS) mRNA were detected by reverse transcription-polymerase chain reaction. Results The steatosis of liver cells was found in mice in NAFLD model group; blood TG and TCH levels in NAFLD model group were (0.63±0.13) mmol/L and (7.23±0.7) mmol/L, significantly higher than [(0.28± 0.06) mmol/L and (2.78±0.6) mmol/L, P<0.001] in ten mice in the control; at the end of 24 w experiment, hepatic FAS and SREBP-1 mRNA in NAFLD mice were (3.9±1.1) and (1.8±0.7), significantly higher than 【(1.0±0.3) and (1.0±0.4), FAS: t = 6.231, P<0.001; SREBP-1: t = 2.431, P =0.035】, while the ACC mRNA was (1.2±0.5), not significantly different as compared to 【(1.0±0.4), t = 0.765, P =0.462】 in the control. Conclusion The lipid metabolism related genes in liver tissue of mice with NAFLD are significantly up-regulated, which might play a pivotal role in the pathogenesis of NAFLD.

Objective The purpose of this study was to investigate the prevalence of serum anti-mitochondrial antibody-M2 (AMA-M2) antibody in physical examination individuals. Methods 18515 serum samples were collected from the Physical Examination Center, Shanghai General Hospital between May 2012 and December 2014. Serum AMA-M2 was quantitatively detected by ELISA, and blood biochemical parameters were assayed. Results Among 18515 screened people, 245 persons (1.3%) were serum AMA-M2 positive, of which 97 were men and 148 were women, with the ratio of men to women of about 1∶1.5, and the highest positive rate (28.6%) was found in 46 to 55 year old age group(n=70); serum alkaline phosphatase levels increased in 12 persons with serum AMA-M2 positive, who met the diagnostic criteria of primary biliary cholangitis (PBC); serum ALP level in 54 persons with higher serum AMA-M2 (＞150U/ml) was (92.8±85.6 U/L), and serum GGT level was (84.3±118.5 U/L, significantly higher than [(67.7±38.3U/L) and (39.1±61.8U/L), respectively, P<0.05] in 191 individuals with low serum AMA-M2. Conclusion It is not uncommon that serum AMA-M2 antibody is positive in healthy people, and early screening serum AMA-M2 antibody is helpful for early diagnosis of PBC.

Objective The aim of this study was to summarize the clinical features of patients with Dengue fever (DF), especially in those with liver injuries. Methods 70 patients with DF were encountered in our hospital from January to December 2020, and were carefully managed by supporting treatment. The patients with liver injuries were dealt with liver-protecting medicines. The clinical feature, including blood and biochemical parameters was collected. Results Out of 70 patients with DF, the main symptoms included fever, arthralgia, rash, abdominal pain, diarrhea, respiratory and urinary tract infections, and the leukopenia in 34 cases, thrombocytopenia in 35 cases and abnormal liver function tests in 33 cases; the hospital stay in 33 patients with liver injuries was (7.1±2.2) d, significantly longer than [(5.8±2.0), P<0.05] in 37 patients without liver injuries; all the 70 patients recovered; there was no significant difference as respect to peripheral white blood cell counts between patients with and without liver injuries (P>0.05), while the platelet counts in patients with liver injuries was (105.0±48.6)×10⁹/L, significantly lower than [(156.2±88.7)×10⁹/L, P<0.05] in those without liver injuries; serum ALT, AST, GGT, C-reactive protein and MB isoenzyme of creatine kinase levels slightly increased in patients with liver injuries and the outcomes was good. Conclusions The patients with Dengue fever could have complicated slight liver injuries, and the liver-protecting management could improve the recovery.

The hepatolenticular degeneration (HLD), also known as Wilson's disease, is an entity of disordered copper metabolism caused by ATP7B gene mutation, which leads to intracellular copper transport dysfunction and excessive accumulation of copper in various organs. The early diagnosis and treatment can improve the prognosis of patients with HLD and reduce disability and early death. The current treatments include a diet with low copper, medical intervention and liver transplantation. However, the low copper diet could not significantly reduce the amount of copper absorption in intestinal epithelial cells, and excessive restriction of it will cause nutrient absorption disorders in normal tissue cells. The present treatment regimens often face problems such as poor adherence and worsening neurological symptoms. The application of liver transplantation is often limited by the shortage of donor organs and the need for lifelong immunosuppression. The new therapies, such as new medicine preparations, cell and gene therapy have brought new hopes for patients with HLD.

Objective Liver injury is common in many chronic liver disease, and liver disease has a systemic impact, and vice versa. Diagnosis and treatment of patients with liver disease should not only consider the liver disease itself, but also need to clarify patho-physiological mechanisms by which the interaction occur between various systemic diseases and inflammatory liver injury. Therefore, the dealing with liver injury often require multidisciplinary discussions and joint decision-making. One of the important aspects of liver disease treatment is to protect and maintain the stability of liver functions, and how to carry out anti-inflammatory and liver protection involves etiology and liver injuries for appropriate treatment strategies. Bicyclol is a chemical agent independently developed in China and has a widespread administration to treat patients with inflammatory liver injury. Bicyclol has a good preventive and therapeutic efficacy on inflammatory liver injury caused by various etiologies documented in literature, and has been registered and listed in nine countries along the Belt and Road. We have organized domestic experts from relevant disciplines all over the country to summarize multidisciplinary clinical application of bicyclol in the prevention and treatment of inflammatory liver injury abide on liver disease diagnosis and treatment guidelines/consensus/clinical pathways and evidence-based medicine, combined with clinical practice in China. The aim of this consensus is to improve the reasonable and standardized clinical application of bicyclol in the treatment of patients with inflammatory liver injury.

Objective To investigate the therapeutic efficacy of polyene phosphatidylcholine in patients with anti-tuberculosis agents-induced liver injury and its effect on serum heme oxygenase (HO-1), glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD) levels. Methods 78 patients drug-induced liver injury (DILI) during anti-tuberculosis therapy for pulmonary tuberculosis were enrolled in our hospital between March 2018 and March 2019, and were randomly divided into control and observation group with 39 in each, receiving diammonium glycyrrhizinate or polyene phosphatidylcholine orally for 12 weeks. Serum interleukin-6, IL-1β and tumor necrosis factor-α(TNF-ɑ) as well as serum HO-1, GSH-Px and SOD levels were detected.Results At the end of 12 week observation, serum level of alanine aminotransferase (ALT) in the observation group was (28.1 ± 20.5) U/L, which was significantly lower than that in the control group [(59.4 ± 22.7) U/L, P <0.05], and serum level of aspartate aminotransferase (AST) in the observation group was (345.1 ± 17.3) U/L, which was significantly lower than that in the control group [(45.1 ± 17.3) U/L, P <0.05]; serum TNF-ɑ level inthe observation group was (7.4 ± 1.5) pg/mL, which was significantly lower than that in the control group [(10.3 ± 1.8) pg/mL, P <0.05], and serum IL-1β level in the observation group was (13.7 ± 2.1) ng/mL, which was significantly lower than that in the control group [(34.2 ± 4.8) ng / mL, P <0.05]; serum HO-1 level in the observation group was (294.1 ± 16.9) U/L, which was significantly higher than that in the control group [(198.8 ± 17.2) U/L, P <0.05], and serum level of SOD was (544.2 ± 13.3) U/L, which was significantly higher than that in the control group [(421.0 ± 12.8) U/L, P <0.05]. Conclusion The administration of polyene phosphatidylcholine in the treatment of patients with DILI caused by anti-tuberculosis medicine is efficacious, which could significantly increase serum HO-1 and SOD levels, and reduce oxidative stress response, and needs further clinical investigation.

Objective The aim of this experiment was to explore the effect and underlying mechanism of curcumin on oleic acid-induced steatosis of HepG2 cells in vitro. Methods HepG2 cells were treated with or without 1 mmol/L oleic acid (OA) to establish nonalcoholic fatty liver disease (NAFLD) cell model. The HepG2 cells were divided into four groups, e.g. control (con), steatosis model (OA) , curcumin control and curcumin-intervened groups. Bodipy493/503 staining was used to detect the distribution of lipid droplets in the HepG2 cells. The ultrastructure of mitochondria was examined by transmission electron microscopy. Reactive oxygen species (ROS) levels were detected by DCFH-DA. The TNF-α and IL-6 levels in the supernatants were measured by a commercial kit. The apoptosis was determined by Hoechst 33258 staining. Western blott was applied to determine the expression of Bcl-2, Bax, mCytc, NF-κB, and Caspase-3/9 proteins. Results Compared with in the control cells, the cells treated with OA showed significantly increased lipid droplets accumulation, while the cells treated with curcumin showed reduced lipid droplets accumulation; the mitochondrial damage including mitochondrial swelling and vesiculation in OA group was more obvious than that in control group, while the mitochondrial damage treated by curcumin was significantly improved; the TNF-α and IL-6 levels in OA group were much higher than that in the control group , while they decreased greatly in curcumin-inervened group ; the ROS levels was (52.24±5.11)% in OA group, significantly higher than (6.71±2.31)% in the control group, while it decreased to (37.44±7.21)% in curcumin-treated group (P<0.05); the apoptosis rate in OA group was (12.12±0.72)%, significantly higher than (2.04±0.57)% in the control group, while it decreased significantly in curcumin-treated group ; the expressions of Bax, NF-κB and cleaved-Caspase-3/9 intensified, and Bcl-2 and mCytc decreased greatly in OA group as compare to those in the control, while the expressions of Bax, NF-κB and Caspase-3/9 decreased, and Cytc and Bcl-2 increased (P<0.05) in curcumin-intervened group. Conclusion Curcumin effectively prevent oleic acid-induced steatosis in HepG2 cells, which might be related to the alleviation of inflammatory reaction, oxidative stress and inhibition of apoptosis.

Objective The aim of this study was to investigate the therapeutic efficacy of bifidobacterium triple viable capsule and metformin in the treatment of patients with nonalcoholic fatty liver disease (NAFLD) and the changes of blood dark incubation of insulin receptor substrate 1(IRS1), IRS2 and glucose transporter -4(GLUT4) mRNA. Methods 70 patients with NAFLD were enrolled in our hospital between June 2018 and December 2019,and were randomly divided into control (n=35) and observation (n=35), receiving metformin hydrochloride or bifidobacterium triple viable capsules at base of metformin for three months. Peripheral blood IRS1, IRS2 and GLUT4mRNA were assayed by RT-PCR, and serum highly sensitive c-reactive protein (hs-CRP), interleukin -6 (IL-6) and IL-10 levels were also detected. Results At the end of three month treatment, the total fatty liver improvement rate in the observation group was 91.4%, which was significantly higher than that in the control group (68.6%, P<0.05); serum aspartate aminotransferase (AST) level in the observation group was (23.9±9.7) U/L, significantly lower than that in the control group , serum alanine aminotransferase (ALT) level was (45.5±12.3) U/L, much lower than that in the control group , and serum glutamyltranspeptidase (GGT) level was (66.9±11.9) U/L, significantly lower than that in the control group ; blood IRS1 mRNA was (2.1±0.2), which was much higher than that in the control group , peripheral blood IRS2 mRNA level was (2.3±0.4), which was significantly higher than that in the control group , and peripheral blood GLUT4 mRNA level was (2.5±0.4), which was also significantly higher than that in the control group ; serum hs-CRP level was (3.4±0.7) mg/L, significantly lower than that in the control group , serum interleukin-6(IL-6) level was (26.9±7.4)ng/L, significantly lower than that in the control group , and serum IL-10 level was (46.5±12.8)ng/L, significantly lower than that in the control group .Conclusion The combination of bifidobacterium triple viable capsule and metformin in treatment of patients with NAFLD could effectively improve the hepatic steatosis, which might be related to the elevation of peripheral blood IRS1, IRS2 and GLUT4 and inhibition of serum inflammatory factors.

Objective The aim of this study was to observe the clinical efficacy of silymarin and compound methionine choline combination in treating patients with alcoholic hepatitis (AH). Methods 101 patients with AH were admitted to our hospital between January 2021 and January 2023, and were randomly divided into control (n=50) and observation (n=51) groups, receiving oral compound methionine choline or oral compound methionine choline and silymarin combination treatment for six months. The liver function tests were detected by fully automatic biochemical analyser, serum laminin (LN), hyaluronic acid (HA), type Ⅲ procollagen N-terminal peptide (PCⅢ) and type Ⅳ collage (Ⅳ-C) levels were assayed by radioimmunoassay and serum peroxisome proliferators-activated receptor γ (PPARγ), leptin (LEP), adiponectin (APN) and interleukin 18 (IL-18) were determined by ELISA. Results At the end of six-month treatment, serum alanine transferase and aspartate transaminase levels in the observation group were(41.8±4.9)IU/L and (42.5±4.9)IU/L, both significantly lower than [(75.3±6.8)IU/L and (62.7±5.8)IU/L, respectively, P<0.05] in the control group; serum HA, PCⅢ and Ⅳ-C levels in the observation group were (103.6±13.5)μg/L, (94.2±9.8)μg/L and (75.2±8.6)μg/L, all significantly lower than [(146.2±15.3)μg/L, (125.8±13.3)μg/L and (112.3±14.5)μg/L, P<0.05] in the control; serum PPARγ, LEP and IL-18 levels in the observation group were (231.7±26.8)pg/mL, (5.4±0.7)μg/L and (92.5±11.7)ng/mL, all significantly lower than [(285.3±29.4)pg/mL, (8.3±0.9)μg/L and (118.5±12.4)ng/mL, respectively, P<0.05], while serum APN level was (15.4±1.7)ng/L, significantly higher than [(11.3±1.9)ng/L, P<0.05] in the control group. Conclusion The oral administration of compound methionine choline and silymarin combination in treatment of patients with AH is short-termly efficacious, which could improve liver function tests back to normal, and relieve liver fibrosis and body inflammatory reactions.

Objective Esophageal and gastric varices bleeding (EGVB) is a common complications of liver cirrhosis, with a high mortality rate. Therefore, the prevention and treatment of EGVB is very important for patients with liver cirrhosis. Internal medicine, endoscopic management, interventional and surgical operation are all important approaches for the prevention and treatment of EGVB, which greatly improves the survival rate of cirrhotic patients. In this paper, we reviewed the current progress of primary prevention, emergent hemostasis and secondary prevention of patients with different types of esophageal and gastric varices.

Objective The aim of this study was to compare the antiviral response to pegylated interferon-α (PEG-IFNα-2a) or PEG-IFNα-2b in patients with chronic hepatitis B (CHB). Methods 74 patients with CHB were enrolled in our hospital between July 2016 and May 2018, and were randomly divided into group A (n=37) and group B (n=37). The patients in group A were treated with PEG-IFNα-2a, and those in group B were treated with PEG-IFNα-2b. The antiviral therapy lasted for 48 w, and all patients were followed-up for 24 weeks. Results At the end of 12 w, 24 w and 48 w treatment and 24 w followed-up, serum alanine aminotransaminase (ALT) normalization rates in goup A were 29.7%, 35.1%, 83.8% and 75.7%, all not significantly different as compared to 27.0%, 29.7%, 86.5% and 78.4%, respectively, (P>0.05) in group B; serum HBV DNA loss were 59.5%, 73.0%, 78.4% and 75.7%, all not significantly different as compared to 45.9%, 51.4%, 81.1% and 75.7%, respectively, (P>0.05) in group B; serum HBeAg negative rates were 33.3%, 36.7%, 36.7% and 40.5%, all not significantly different as compared to 29.2%, 29.2%, 33.3% and 35.1%, respectively, (P>0.05) in group B; during the treatment, the incidences of flu-like symptoms and abnormal thyroid functions in the two groups were the same, and the incidences of thrombocytopenia and granulocytopenia in group A were 40.0% and 76.6%, both notsignificantly different as compared to 37.8% and 75.7% in group B (P>0.05).Conclusion At present, both PEG-IFNα-2a and PEG-IFNα-2b could be selected for the treatment of patients with CHB, and the surveillance of untoward effects is pivotally important for the regimen going and the achievement of antiviral therapy.

Objective The aim of this study was to investigate the clinical predicting value of serum ascites albumin gradient (SAAG) on esophageal variceal bleeding (EVB) risk in patients with decompensated hepatitis B cirrhosis. Methods 84 patients with decompensated hepatitis B cirrhosis were admitted to our hospital between April 2017 and October 2019, and the SAAG and modified SAAG werecalculated. The Logistic multivariate analysis was used to analyze the independent impacting factors on EVB in patients with decompensatedhepatitis B cirrhosis. The receiver operating characteristic curve (ROC) was drawn and the area under the ROC (AUROC) was calculated to predict the EVB risk. Results 18 out of our series had, and 66 patients had not EVB during six-month followed-up period; the percentage of male cases older than 65 yr in patients with EBV was 72.2%,greatly older than in patients without EBV (43.9%,P<0.05); serum albumin level in patients with EVB was (35.8±2.7)g/L, significantly lower than , blood platelet count was (52.3±10.7)×10⁹/L, significantly lower than , the APTT was (45.8±5.9)s, significantly longer than ,the SAAG was (18.7±5.1), significantly higher than , and the modified SAAG was (9.2±2.4), significantly higher than in patients without EVB; the spleen thickness was (5.2±1.3)cm, significantly higher than , and the portal vein blood flow velocity was (15.2±2.9) cm/s, significantly slower than in patients without EVB; the multivariate Logistic analysis showed that serum albumin level (OR=0.435, 95%CI=0.287-0.659), ascites albumin level(OR=1.845, 95%CI=1.063-3.202), the APTT(OR=1.469,95%CI=1.272-1.697), the MELD score (OR=3.285, 95%CI=1.697-6.359) and the modified SAAG(OR=2.917, 95%CI=1.337-6.364) were the independent impacting factors for EVB in patients with decompensated hepatitis B cirrhosis(P<0.05); the AUCs of modified SAAG and MELD score for predicting EVB were 0.827 and 0.791, respectively, and theirsensitivities were 0.889 and 0.787, and the specificities were 0.636 and 0.612, respectively. Conclusion The application of SAAG is helpful to predict the risk of EVB in patients with decompensated hepatitis B cirrhosis, and worth further clinical investigation.

Objective The purpose of this study was to establish a rapid and efficient liquid chromatography tandem mass spectrometry(LC-MS/MS) for simultaneous determination of 15 bile acids in mouse liver tissues. Methods The activated charcoal was utilized to prepare bile acid-free liver, which served as the biological matrix for the preparation of standard and quality control samples. The mouse liver tissue was homogenized, and a basic acetonitrile solution, including 5% NH₄OH was added to precipitate proteins. The proteins were separated on an Agilent Poroshell 120 EC C18 column (100 mm×4.6 mm,2.7 μm) by using ²H₄-DCA, GUDCA-d₅, and LCA-d₄ as internal standards. The mobile phase is ammonium acetate aqueous solution and methanol acetonitrile mixed solution for gradient elution, the column temperature was 30℃, the flow rate was 0.3mL/min, and the injection volume was 2 μL. The electrospray ion source (ESI) was operated in negative ion mode, and in multiple reaction monitoring (MRM). Results The linearity of the 15 bile acids was good with R² greater than 0.993, the limits of determination were less than 2 ng/mL, and the matrix effects were 90.76%-109.25%; the intra-day and inter-day accuracy and precision were less than 15%, and the stability was good under 4℃ for 24 h, repeated freeze-thaw, and freeze-storage for one month, meeting the analytical requirements of biological samples; the detection of mouse liver tissues showed that both unconjugated BAs and conjugated BAs (G-BAs, T-BAs) were dominated by maternal CA, with the highest content of TCA; the concentration of unconjugated BAs was (723.89±50.65) ng/mL, significantly higher than that of G-BAs [(56.90±11.28) ng/mL, P<0.001]; the concentration of T-BAs was (40322.90±14034.80)ng/mL, significantly higher than unconjugated BAs (P＜0.001), and also significantly higher than G-BAs (P＜0.001). Conclusion The LC-MS/MS method we established is sensitive, accurate, reliable, and suitable for the determination of bile acids concentrations in mouse liver tissues, which might help for further studies.

Objective The incidence rate of nonalcoholic fatty liver disease (NAFLD) is increasing. It might progress to the end-stage liver disease. However, there is still no specific treatment for this entity. Therefore, the establishment of representative animal models reflecting disease characteristics has become especially important. Although there are many different disease models, there is still a lack of NAFLD model which could cover the whole spectrum of this entity in human. In this paper, we reviewed the current progress on NAFLD model, focusing on animal model, 2D cell model, 3D liver model and their advantages and disadvantages.

Objective The aim of this experiment was to explore the changes of NADPH oxidase 4 (NOX4) gene and its protein in liver tissues of mice with carbon tetrachloride (CCl₄)-induced liver fibrosis and hepatic stellate HSC-T6 cells.Methods The liver fibrosis model was established by intraperitoneal injection of CCl₄ in ten mice, and the NOX4 mRNA and its protein in liver tissues were detected by qRT-PCR and Western bloting. The HSC-T6 cells were normally cultured and divided into blank, nonsense and NOX4-siRNA-intervened groups, which were transfected by liposome 2000-coated meaningless sequence or NOX4-siRNA in the two latter groups. The expression ofNOX4, α-smooth muscle actin (α-SMA), type I collagen (Col1a I), tissue inhibitor of metalloproteinase-1 (TIMP-1), matrix metalloproteinase-2 (MMP-2), transforming growth factor-β1 (TGF-β1), Smad2 and Smad3 in HSC-T6 cells was detected by qRT-PCR and Western bloting. The intracellular reactive oxygen species (ROS) content was detected by DCFH-DA fluorescent probe, the cell proliferation was detected by MTT assay, and the cell cycles and apoptosis were detected by flow cytometry.Results There was a significant pathological damage, with a large amount of collagen fiber deposition in liver tissues of mice in model; the NOX4 mRNA level in liver tissues of mice in model was significantly higher than that in control group (P<0.05); the NOX4 mRNA and its protein, ROS, proliferation activity, percentage of cells in S phase, the α-SMA, Col1a I, TIMP-1, MMP-2, TGF-β1, p-Smad2/Smad2 and p-Smad3/Smad3 expression were significantly decreased, while the percentage of cells in G0/G1 phase, and apoptosis rate were significantly increased (P<0.05) in NOX4-siRNA-intervened group. Conclusion The NOX4 is highly expressed in liver fibrotic tissues, and the down-regulation of NOX4 could inhibit proliferation and activation of HSCs, and promote their apoptosis, which mmight be related to the inhibition of TGF-β/Smad signaling pathway.

Objective At present, the artificial intelligence (AI) has been widely used in many fields, and it also applied in medical diagnosis and treatment. In this paper, we mainly reviewed the AI research on the diagnosis, management and prognosis of patients with in liver diseases, in order to provide more effective measures. Finally, the future development of AI in the field of liver disease study is prospected.

Objective The aim of this study was to observe the efficacy of combination of ursodeoxycholic acid (UDCA) and prednisone and azathioprine in the treatment of patients with autoimmune hepatitis (AIH).Methods 120 AIH patients were recruited in the Department of Gastroenterology in our hospital between February 2017 and December 2019, and were randomly divided into control and observation groups with 60 cases in each group. The patients in the control received prednisone and azathioprine, while those in the observation group received UDCA at base of prednisone and azathioprine therapy. The regimen lasted for 21 months. Serum complement 3 (C3), C4, as well as immunoglobulin were detected.Results At the end of the treatment, serum alanine aminotransferase level in the observation group was (55.2±6.9)U/L, significantly lower than 【(91.2±12.8)U/L, P<0.05】, serum aspartate aminotransferase level was (59.7±7.5)U/L, significantly lower than 【(101.5±13.5)U/L, P<0.05】, serum alkaline phosphatase level was (122.4±15.7)U/L, much lower than 【(138.9±15.2)U/L, P<0.05】, and serum glutamyl transpeptidase level was (120.7±10.1)U/L, significantly lower than 【(161.5±20.7)U/L, P<0.05】 in the control; serum C3 level in the observation was (0.6±0.1)g/L, significantly lower than 【(0.8±0.2)g/L,P＜0.05】, and serum C4 level was (0.1±0.1)g/L, significantly lower than 【(0.2±0.1)g/L, P＜0.05】 in the control; serum IgG level in the observation group was (12.5±2.0)g/L, significantly lower than 【(20.4±2.7)g/L, P＜0.05】, and serum IgM level was (2.7±0.9)g/L, significantly lower than 【(3.4±1.1)g/L, P＜0.05】 in the control.Conclusion The administration of ursodeoxycholic acid at base of prednisolone and azathioprine combination in the treatment of patients with AIH could effectively reduce serum C3 and C4 levels, improve immune functions and alleviate liver injury, which needs further investigation.

Objective Most patients with liver cirrhosis (LC) have a certain degree of malnutrition, mainly protein-calorie malnutrition. The portal hypertension in patients with LC can lead to gastrointestinal congestion and edema, ascites, overgrowth of intestinal bacteria, gastrointestinal bleeding, secondary infections, and other complications, resulting in reduced intake, absorption disorders and excessive loss of nutrients. It can also lead to metabolic disorders, with increased incidence of complications and risk of death. Therefore, nutritional support should be take into consideration during the treatment of patients with LC. In this article, we mainly focuses on the nutritional evaluation and diet management for them.

Objectiv To establish a reliable animal model of primary biliary cholangitis（PBC） and to investigate the therapeutic effect of umbilical cord-derived mesenchymal stem cells （UC-MSC） on STAT3 signal in intrahepatic biliary epithelial cells（IBECs） of this PBC animal. Methods C57BL/6 mice were intraperitoneally injected with 2-octynyl acid （2-OA）-bovine serum albumin （BSA） adjuvanted with Freund's adjuvant/incomplete Freund's adjuvant （CFA/IFA） or with same amount of BSA adjuvanted with IFA,or untreated as control. The model mice 22 weeks later were randomly divided into model （n=4）,MSCs transplantation （n=6） and STAT3 inhibitors-treated group（n=6）. The intrahepatic biliary tree and IBECs were obtained,and STAT3/pSTAT3,p62,LC3,PKR/pPKR,Beclin-1,eIF2α/peIF2α and LAMP-1 expression were detected by WB,and STAT3,LC3 and p62-mRNA were detected by RT-PCR. Results The lymphocyte infiltration and granuloma in portal area were found in liver tissues of model mice,while they were obviously alleviated in MSCs-or Stattic-intervened groups;the expressions of Beclin-1,STAT3 and pSTAT3 in IBECs from model intensified as compared to those in BSA-treated group,while they were weaken in MSCs-or Stattic-intervened groups;p62 mRNA levels decreased in model and MSC transplanted grous as compared to that in BSA-treated group,and STAT3 mRNA level in model decreased as compared to that in BSA-treated group. Conclusion Our findings indicate that MSC transplantation might regulate the autophagy and decrease the expression of STAT3 signals in mice with primary biliary cholangitis.