Primary biliary cholangitis (PBC), also known as primary biliary cirrhosis, is a chronic intrahepatic autoimmune cholestatic disease. Ursodeoxycholic acid (UDCA) is first line of treatment for PBC, which can improve biochemical indicators and slow down disease progress, while 30% to 40% of patients with PBC still have poor response to UDCA therapy, which is called refractory PBC. These patients have a higher incidence of cirrhosis and related complications, and early warning, institution treatment and prognosis evaluation for these patients remain a major challenge. The aim of this review is to present the latest research on the clinical features, influencing factors, therapeutic medicines and prognosis of patients with refractory PBC.

The application of immune checkpoint inhibitors is becoming more and more extensive,which plays an important role in the treatment of patients with malignant neoplasmas,and the adverse events are more common.Bile duct injury is rare, but once happening, the immunosuppressive therapy tends to be insensitive in most patients,so individualized management is recommended. In this article, we review the epidemiology,pathogenesis,biochemical indexes,clinical and pathological manifestations,imaging and treatment of patients with immune checkpoint inhibitors-associated bile duct injury.

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

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

Liver fibrosis (LF) is closely related to poor outcomes in patients with non-alcoholic fatty liver disease (NAFLD), and early intervention is expected to improve prognosis of the disease. Percutaneous liver biopsy is the primary method for the diagnosis and staging of LF, but its wide application is limited as its invasiveness, sampling inconsistency and subjective evaluation. Recently, a lot of new non-invasive techniques have emerged for LF assessment, with advantage of convenience and repeatability. In this article, we provides a review on this topic.

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

Objective The aim of this study was to explore diagnostic performance of FibroTouch parameters in the diagnosis of non-alcoholic steatohepatitis (NASH) from individuals with non-alcoholic fatty liver diseases (NAFLD). Methods 149 patients with NAFLD were encountered in our hospital between March 2022 and March 2023, and all underwent liver biopsies. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were obtained by FibroTouch detection. Multivariate Logistic regression analysis was applied to find risk factors, and the area under the receiver operating characteristic curve (AUC) was used to analyze diagnostic efficacy of above parameters for NASH occurrence. Results Histo-pathological examination diagnosed NASH in 45 cases (30.2%) and simple fatty liver (SFL) in 104 cases (69.8%) in our series; body mass index (BMI), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and low density lipoprotein levels in patients with NASH were (29.7±1.8)kg/m², (82.6±25.7)U/L, (107.4±10.5)U/L, (74.2±16.0)U/L, (65.6±11.1)U/L and (4.2±0.9)mmol/L, all significantly higher than【 (25.6±1.5)kg/m², (50.3±19.4)U/L, (82.5±8.5)U/L, (28.9±15.2)U/L, (21.2±12.4)U/L and (3.1±0.8)mmol/L, respectively, P<0.05] in patients with SFL; CAP and LSM in NASH patients were (304.0±19.6)db/m and (13.1±2.1)kPa, both much higher than [(263.9±15.4)db/m and (8.2±1.6)kPa, respectively, P＜0.05] in SFL patients; multivariate Logistics regression analysis showed that CAP and LSM were independent risk factors for NASH occurrence (P＜0.05); the AUC was 0.901, with sensitivity of 96.8% and specificity of 82.5%, when CAP=303.7 db/m and LSM=12.9 kPa were set as cut-off-value in predicting NASH existence in individuals with NAFLD. Conclusion FibroTouch-detected LSM and CAP could help screen NASH preliminarily in individuals with NAFLD, which might guide appropriate management in clinical practice.

Objective The aim of this study was to summarize morphology and enhancement feature of hepatic hemangioma (HH)by multi-slice spiral CT (MSCT). Methods A total of 110 patients with HH were encountered in our hospital between January 2021 and December 2023, and all patients underwent MSCT scan. The morphology and blood supply was analyzed by 3D software. Results Of the 110 patients with HH, MSCT plain scan showed 152 lesions, including 68 (61.8%) single lesions and 42 (38.2%) multiple lesions; there were 104 (68.4%) lesions in right lobe of liver and 48 (31.6%) in left lobe; there were 122 lesions (80.3%) with circular or circular-like shape with edges clear and 30 lesions (19.7%) with irregular edges; 128 (84.2%) lesions were smaller than 10 cm and 24 (15.8%) were larger than 10 cm; 144 (94.7%) lesions were with low density shadow and 8 (5.3%) lesions with high density shadow; with spotty or nodular enhancement at edge or in center of lesions at arterial stage accounted for 83.6%, and no enhancement for 16.4%; there were 118 (77.6%) lesions with reduced enhancement and 34 (22.8%) lesions without enhancement at portal stage; of 34 lesions without enhancement at portal stage, 18 lesions(52.9%) presented with enhancement and 16 lesions(47.1%) left still without enhancement; tumor volume and enhancement volume in large HH lesions were (318.4±53.1) cm³ and (52.0±9.1) cm³, both significantly larger than [(131.7±25.8) cm³ and (38.4±7.9) cm³,P<0.05], while enhancement ratio was (16.3±4.6) %, significantly lower than (29.1±12.0) % (P<0.05) in small lesions. Conclusion MSCT scan could show HH morphology and enhancement feature, which might help clinicians determine the quality of intrahepatic lesions and make appropriate diagnostic and therapeutic measures.

Objective The aim of this study was to investigate changes of serum arginase-1 (Arg-1) levels and apolipoprotein B/apolipoprotein A1 ((ApoB/ApoA1) ratio in patients with non-alcoholic fatty liver disease (NAFLD). Methods 69 patients with NAFLD and 50 healthy volunteers were recruited in Gaochun Hospital, affiliated to Jiangsu University between February 2021 and December 2023, all patients with NAFLD underwent liver biopsies, and nonalcoholic steatohepatitis (NASH) and liver fibrosis were diagnosed based on NAFLD activity score (NAS). Serum Arg-1 levels were detected by ELISA, and serum ApoB/ApoA1 ratio was calculated. Receiver operating characteristic curve (ROC) was drawn and area under the curve (AUC) was obtained to predict NASH with liver fibrosis. Results Of 69 patients with NAFLD, liver histo-pathological examination showed simple fatty liver(SFL) in 23 cases, NASH in 32 cases [including significant liver fibrosis (SLF) in 18 cases] and NASH-related liver cirrhosis in 14 cases; serum Arg-1 level and ApoB/ApoA1 ratio in patients with liver cirrhosis were (5.7±1.4)ng/ml and (1.0±0.2), both significantly higher than [(4.6±1.2)ng/ml and (0.8±0.1), P<0.05] in patients with NASH or [(3.1±1.0)ng/ml and (0.7±0.1), P<0.05] in patients with SFL or [(1.5±0.4)ng/ml and (0.5±0.1), P<0.05] in healthy control; serum Arg-1 level and ApoB/ApoA1 ration in patients with NASH and SLF were (5.5±1.2)ng/ml and (0.9±0.2), both significantly higher than [(3.4±1.0)ng/ml and (0.7±0.1), respectively, P<0.05] in patients with NASH; ROC analysis showed that the AUC was 0.960(95%CI:0.893-1.000), with sensitivity of 94.4% and specificity of 92.9%, when serum Arg-1 levels and ApoB/ApoA1 ratio combination was applied to predict NASH with SLF, much superior to any parameters did alone (P<0.05). Conclusion Serum Arg-1 levels and ApoB/ApoA1 ratio significantly elevate, which might hint existence of NASH or even SLF, and need carefully concerned.

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

Objective The aim of this study was to investigate efficacy of estimated glucose disposal rate (eGDR) in predicting risk of metabolism-associated fatty liver disease (MAFLD) in individuals without type 2 diabetes mellitus (T2DM). Methods 468 non-diabetic individuals with MAFLD and 100 non-diabetic healthy persons were encountered in the First Affiliated Hospital, Naval Medical University between July and December 2023, clinical materials were routinely obtained, and eGDR were calculated. Multivariate Logistic regression analysis was applied to reveal risk factors of MAFLD in non-diabetic population. All subjects were divided into Q1 to Q4 groups based on the eGDR quartiles, and the prevalence of MAFLD in each group was compared. ROC curve was plotted to evaluate the efficacy of eGDR in predicting MAFLD. Results Of individuals without diabetes in our series, MAFLD patients were older and more male than in healthy controls; BMI, systolic blood pressure, diastolic blood pressure, serum triglyceride, total cholesterol, low density lipoprotein-cholesterol, fasting blood glucose, glycated hemoglobin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transpeptidase, creatinine, urea nitrogen and uric acid levels were all higher (all P<0.001) , while serum high density lipoprotein-cholesterol and eGDR were lower (all P<0.001) than in control persons; multivariate Logistic regression analysis showed that age and BMI were independent risk factors for the occurrence of MAFLD, while diastolic blood pressure and eGDR were independent protective factors (P<0.05) in persons without diabetes; ROC analysis showed that the AUC of eGDR reduction in predicting the risk of MAFLD existence was 0.939 (95% CI:0.910 to 0.969, P<0.001), with a maximum Yoden index of 0.775, corresponding to an optimal cut-off value of 10.85 mg/kg/min, with a sensitivity of 89.5% and a specificity of 88.0%; Q4 group had the lowest prevalence of MAFLD (38.0%) compared to other three groups. Conclusions eGDR is a non-invasive and easily available indicator of insulin resistance. The decrease of eGDR is associated with the increased risk of MAFLD in non-diabetic individuals, and it has a good predictive efficacy for MAFLD.

Objective The aim of this study was to investigate short-term efficacy of Wuzhi capsule, a herbal medicine compound, and compound glycyrrhizin combination in the treatment of patients with non-alcoholic steatohepatitis(NASH). Methods 120 patients with NASH were encountered in our hospital between May 2021 and December 2024, and were randomly assigned to receive compound glycyrrhizin intravenously in 60 cases in the control or to receive oral herbal medicine plus compound glycyrrhizin in another 60 cases in the observation for 8 weeks. Serum procollagen-III (PC-III),laminin (LN),collage type Ⅳ(IV-C) and hyaluronidase (HA) levels were detected by RIA; serum(cortisol(COR),glutathione (GSH),superoxide dismutase(SOD) and malondialdehyde (MDA) levels were assayed by chemiluminescence; Serum interleukin-6 (IL-6),IL-1βand tumor necrosis factor-α(TNF-α) levels were determined by ELISA. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were determinedby Fibrotouch. Results By end of eight week treatment, serum alanine aminotransferase,aspartate aminotransferase and γ-glutamyl transpeptidase levels in the observation group were (38.9±2.7)U/L, (31.8±5.0)U/L and (46.7±3.8)U/L, all significantly lower than [(57.1±6.9)U/L, (43.7±6.9)U/L and (70.1±6.2)U/L, respectively, P＜0.05] in the control; serum HA, PC-III and IV-C levels were (132.3±21.8)ng/mL, (85.2±17.0)mg/L and (34.6±5.0)μg/L, all significantly lower than [(181.9±20.6)ng/mL, (122.4±15.3)mg/L and (65.8±7.2)μg/L, respectively, P＜0.05] in the control group; serum COR and MDA levels were (231.7±23.6)nmol/L and (1.9±0.7)μmol/L, both much lower than [(390.7±30.5)nmol/L and (5.0±1.2)μmol/L, respectively, P＜0.05], while serum GSH and SOD levels were (85.1±9.8)mg/L and (187.3±19.2)U/ml, both much higher than [(49.6±7.4)mg/L and (151.2±14.3)U/ml, respectively, P＜0.05] in the control; CAP was (271.9±17.6)db/m, much lower than [(287.2±25.1)db/m, P＜0.05], and serum cytokine levels were also much lower than in the control group (P＜0.05). Conclusion Combiantion ofWuzhi capsule and compound glycyrrhizin in treatment of patients with NASH is short-termly efficacious, which might relieve oxidative stress and cytokine reactions.

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

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

Objective The aim of this study was to investigate clinical efficacy of endoscopic tissue gel injection (ETGI) and endoscopic variceal ligation (EVL) in treatment of cirrhotics with esophagogastric variceal bleeding (EVB). Methods 89 patients with liver cirrhosis (LC) and complicated EVB were encountered in our hospital between January 2017 and November 2023, and were divided into control (n=45) and observation group (n=44). All patients were well treated by internal comprehensive supporting measurement, including hemostasis, blood transfusion and intravenous somatostatin administration, and patients in the observation group received ETGI and/or EVL at base of supporting treatment. Portal vein diameter (PVD), portal vein velocity (PVV) and splenic vein velocity (SVV) were detected by ultrasonography, and serum lipid peroxide (LPO), motilin (MTL) and gastrin (GAS) levels were assayed by ELISA. Results Successful hemostasis rate in the observation group was 97.7%, much higher than 88.9%(P<0.05) in the control; blood transfusion was (1.8±0.4)u, much less than [(4.2±2.0)u, P<0.05], hemostasis time was (0.8±0.2) day, much shorter than [(3.1±1.1)day, P<0.05] in the control, and disappearance of EV at re-gastroscopy in 9 cases (20.9%) in the observation group; there were no significant differences as respect to PVD, PVV and SVV in the two groups (P>0.05); after treatment, serum LPO, MTL and GAS levels in the observation group were (4.3±1.1)U/L, (193.6±20.4)ng/L and (85.5±9.2)μg/mL, all much lower than [(7.1±1.6)U/L, (254.9±24.9)ng/L and (112.4±10.3)μg/mL, respectively, P<0.05] in the control; by end of six-month follow-up, re-bleeding was found in 3 cases (7.0%) in the observation group, and they recovered after ETGI and/or EVL, while re-bleeding occurred in 17 cases (42.5%, P<0.05) in the control, and 5 (29.4%)of them died. Conclusion ETGI and/or EVL at supporting measures in dealing with emergent patients with EVB is efficacious in saving patient’s lives, which might be carried out by qualified clinicians.

Objective The aim of this study was to explore the implication of serum ferritin (SF) levels in patients with Dengue fever. Methods 65 patients with Dengue fever at acute fever phase, including typical patients in 43 cases, severe type in 22 cases and with liver injury in 31 cases, were encountered in our hospital between October 2021 and October 2022. Serum SF and C-reactive protein (CRP) levels were routinely detected. The patients with liver injury were carefully managed with liver-protecting medicines. The multivariate Logistic regression analysis was applied to reveal the risk factors for the occurrence of severe type of the entity. Results Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), SF, CRP levels and platelet (PLT) count in patients with severe Dengue fever were (113.3±36.1)U/L, (93.2±22.4)U/L, (2214.4±519.3)ng/mL, (54.7±1.6)mg/L and (33.1±10.9)×10⁹/L, and in patients with liver injury were (86.3±7.1)U/L, (74.2±7.9)U/L,(1935.4±568.2)ng/mL, (33.2±3.2)mg/L and (55.4±11.7)×10⁹/L, they all decreased or got back to normal at the convalescent stage; the multivariate Logistic regression analysis showed that the greatly increased serum SF levels and the decreased PLT counts were the risk factors for the occurrence of severe Dengue fever(P<0.05); serum AST and ALT levels peaked at one week of onset of the disease, and gradually returned to normal, without liver failure happening. Conclusion Serum SF level increase in patients with Dengue fever, which might hint liver injury or even deterioration of the disease, and needs carefully monitored.

Objective The aim of this study was to summarize clinical feature and outcomes of 80 patients with drug-induced liver injury (DILI). Methods The clinical data of 80 patients with DILI were retrospectively analyzed in our hospital between January 2021 and December 2023, the alleged medicines were discontinued and liver-protecting agents were given for one to three weeks. The outcomes was recorded. Results As for clinical catalogue in 80 patients with DILI, hepatocellular type was found in 41 cases (51.3%), cholestatic type in 14 cases (17.5%) and mixed type in 25 cases (31.2%); gastrointestinal symptoms was found in 51.2% of patients with hepatocellular type, much higher than 21.4% of patients with cholestatic type or 24.0% of those with mixed type; serum ALT level in patients with hepatocellular type was (646.2±177.5) U/L, much higher than [(91.4±28.9)U/L, P<0.05] in with cholestatic type or [(140.8±42.4)U/L, P<0.05] in with mixed type, AST level was 430.7±123.9)U/L, much higher than [(111.4±42.6)U/L, P<0.05] in cholestatic type or [(129.1±60.7)U/L, P<0.05] in mixed type, ALP level was (90.6±19.4)U/L, much lower than [(258.1±83.3)U/L, P<0.05] in with cholestatic type or [(191.4±50.8)U/L, P<0.05] in mixed type, and GGT level was (263.9±100.7)U/L, much lower than [(881.4±350.2)U/L, P<0.05] in with cholestatic type or [(475.1±192.3)U/L, P<0.05] in mixed type; 69 patients (86.3%) in our series recovered and 11 patients (13.7%) didn’t, without significant differences among patients with different clinical catalogue (P>0.05). Conclusion The most common clinicaltype of patients with DILI is hepatocellular, with digestive symptoms more common. Most DILI patients have good prognosis, while liver injury caused by herbal medicines cannot be ignored.

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

Objective The aim of this study was to investigate diagnostic performance of ultrasonography and shear wave elastography (SWE) in predicting high risk esophageal varices (HREV) in patients with liver cirrhosis (LC). Methods 92 patients with LC and cirrhotic portal hypertension were admitted to our hospital between January 2022 and April 2024, and all underwent ultrasonography for portal vein diameter (PVD), splenic vein diameter (SVD), portal vein maximum velocity (PVVmax) and splenic vein maximum velocity (SVVmax). Liver stiffness measurement (LSM) and splenic stiffness measurement (SSM) were measured by using SWE mode. Multivariate Logistic regression analysis was applied to reveal impacting factors, and receiver operating characteristic (ROC) curve was used to evaluate diagnostic efficacy. Results Endoscopy found HREV in 35 cases (38.0%) in 92 patients with cirrhotic portal hypertension in our series; there were significant differences as respect to percentages of Child-Pugh class B/C and blood platelet counts between HREV and non-HREV groups (P＜0.05); PVD and SVD in HREV group were (16.7±3.1)mm and (11.2±2.1)mm, both significantly greater than [(13.4±1.7) mm and (8.6±1.7)mm, respectively, P＜0.05], while PVVmax and SVVmax were (12.6±2.4)cm/s and (14.3±3.0) cm/s, both significantly less than [(15.7±1.9)cm/s and (17.2±2.1)cm/s, respectively, P＜0.05] in non-HREV group; LSM and SSM were (18.4±3.8)kPa and (31.5±6.4)kPa, both much greater than [(12.3±2.4)kPa and (25.7±5.8)kPa, respectively, P＜0.05] in non-HREV group; multivariate Logistic regression analysis showed that PVD and LSM were independent risk factors impacting occurrence of HREV, while the PVVmax was a protecting factor (all P＜0.05); ROC analysis demonstrated that PVD, PVVmax and LSM had a diagnostic efficacy in predicting existence of HREV (Z=2.87, P=0.13; Z=2.74, P=0.15; Z=2.35, P=0.37), while combination of the three parameters could improve specificity with a slight reduction of sensitivity. Conclusion Ultrasonography and SWE have a certain clinical implication in predicting occurrence of HREV in cirrhotics with portal hypertension, which warrants further investigation.

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

Objective This study was conducted to explore the qualitative diagnostic efficacy of focal nodular lesions of liver (FNLL) by magnetic resonance imaging (MRI) in patients with nonalcoholic fatty liver diseases(NAFLD). Methods A total of 113 patients with FNLL under the background of NAFLD were enrolled in our hospital between December 2019 and December 2022, and all patients were examined by diffusion-weighted magnetic resonance imaging (MRI-DWI) and dynamic enhanced magnetic resonance imaging (DCE-MRI), with the time-signal curve types recorded. The fine needle aspiration biopsy was performed for pathological diagnosis as the gold standard. The consistency of diagnoses by MRI-DWI and DCE-MRI with the gold standard was compared by Kappa test. Results Out the 113 patients with FNLL and NAFLD, the pathological examination showed focal nodular hyperplasia (FNH) in 69 cases and hepatocellular carcinoma (HCC) in 44 cases; the percentages of typeⅠ, type Ⅱ and type Ⅲ of time-signal curve in malignant lesions were 38.6%, 52.3% and 9.1%, significantly different compared to 2.9%, 20.3% and 76.8% in benign lesions (P＜0.05); the sensitivity, specificity and accuracy were 93.2%,100.0% and 97.3% when the qualitative diagnosis was made by the combination of MRI-DWI and DCE-MRI, much superior to 90.9%, 88.4% and 89.4% by DCE-MRI alone or 90.9%,91.3% and 91.2% by MRI-DWI alone (P＜0.05). Conclusion Theapplication of MRI, especially with DCE-MRI and MRI-DWI models, in the qualitative diagnosis of FNLL under the background of NAFLD is efficacious, which might help the clinicians make a correct diagnosis and deal with appropriately.

Objective This study was conducted to investigate steatosis-activity-fibrosis-based SAF score and fatty liver inhibition of progression (FLIP) algorithm in evaluation of liver fibrosis in patients with metabolic associated fatty liver disease (MAFLD). Methods This study recruited 113 individuals with MAFLD in our hospital between August 2020 and March 2021, and all underwent liver biopsies. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were detected by FibroScan. Compensated progressive chronic liver disease (cACLD) was determined by Baveno VII consensus. Results Of 113 patients with MAFLD, liver histo-pathological examination showed F0-F2 liver fibrosis (non-cACLD) in 91 cases and F3-F4(cACLD) in 22 cases; there were significant differences as respect to percentages of concomitant type 2 diabetes, etiologies and alcohol intake between patients with and without cACLD (P<0.05); CAP and LSM in patients with cACLD were 247.5(230.0-301.5) dB/m and (22.0±16.2)kPa, much different as compared to [299.0(260.2-325.2)dB/m and (9.6±4.4)kPa] in non-cACLD (P<0.05); platelet count, total serum bilirubin, uric acid and LDL-C levels in cACLD were all significantly different compared to in non-cACLD (P<0.05); SAF score in cACLD was(8.4±1.1), much higher than [(5.7±1.8), P<0.05] in non-cACLD; FLIP algorithm found nonalcoholic steatohepatitis (NASH) accounted for 86.4% and no fatty liver disease for 13.6% in cACLD, while found NASH for 40.7%, nonalcoholic simple fatty liver for 53.8% and no fatty liver disease for 5.5% in non-cACLD. Conclusion MAFLD could include multiple etiologies, SAF score could diagnose cACLD and FLIP algorithm could help screen existence of NASH, which warrants further clinical investigation.

Objective This study was conducted to analyze influencing factors of delayed postoperative intestinal paralysis (DPOI) in patients with primary liver cancer (PLC) after radical hepatectomy and to construct and validate a nomogram prediction model based on risk factors for prediction. Method A total of 135 patients with PLC were encountered in our hospital between January 2022 and October 2023, and 51 patients received open surgery and 84 patients received laparoscopic hepatectomy. Systemic immune inflammation index (SII), and C-reactive protein/albumin ratio (CAR) were calculated. Univariate and multivariate Logistic regression analysis were applied to reveal risk factors, and receiver operating characteristic (ROC) curve was drawn for prediction efficacy. Result Of 135 patients with PLC in our series, DPOI occurred in 38 cases (28.2%) after hepatectomy; univariate Logistic regression analysis showed that ages, China liver cancer staging scheme (CNLC), operation, opioid use, SII and CAR were all related to DPOI happening (P＜0.05), and multivariate Logistic regression analysis demonstrated that CNLC(OR=5.273, 95%CI:2.195-12.663), operation (OR=3.046, 95%CI:1.721-5.388), opioid use (OR=4.457, 95%CI:2.166-9.168) and CAR (OR=5.856, 95%CI: 3.177-10.793) were all the independent risk factors for DPOI occurrence (P＜0.05); ROC analysis showed the AUC was 0.894(95%CI: 0.813-0.974, P＜0.05), with sensitivity of 89.5% and specificity of 90.7%, when the nomogram prediction model based on risk factors was applied for predicting DPOI occurrence. Conclusion Postoperative DPOI could occur in patients with PLC after radical resection of liver cancer, and early warning and intervention might improve the recovery.

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

Objective The aim of this study was to investigate the prevalence of third-generation cephalosporin resistance in patients with decompensated hepatitis B liver cirrhosis (LC) and spontaneous bacterial peritonitis (SBP). Methods 117 patients with decompensated hepatitis B-induced LC and SBP who had ascites culture bacterial positive were encountered in our hospital between March 2020 and March 2023, and all received one of third generation cephalosporin treatment for 7 to 14 days. The univariate and multivariate Logistic regression were analyzed for the factors of third-generation cephalosporin resistance. Results Out of the 117 cirrhotics with SBP, we separated 143 strains of bacteria, including Gram-positive bacteria in 54 strains (18 Streptococcus, 11 Enterococcus and 25 Staphylococcus) and Gram-negative bacteria in 89 strains (43 strains of Escherichia Coli, 22 strains of other Enterobacter, 10 strains of Acinetobacter and 14 strains of Pseudomonas Aeruginosa); 47 patients received ceftriaxone, 26 patients received cefepime, 19 patients received ceftazidime and 25 patients received cefoperazone treatment with the effective rates of 78.7%, 73.1%, 78.9% and 80.0%, respectively; the resistant rates of Streptococcus to ceftriaxone, cefepime, ceftazidime and cefoperazone were 68.0%, 52.0%, 40.0% and 56.0%, and the resistant rates of Escherichia Coli to ceftriaxone, cefepime, ceftazidime and cefoperazone were 62.8%, 39.5%, 25.6% and 32.6%; the percentages of previous SBP episode history and broad-spectrum antibiotic exposure history in 47 patients with resistance to cephalosporin treatment were 23.4% and 27.7%, much higher than 7.1% and 10.0%(P＜0.05) in patients who sensitive to the therapy; the multivariate Logistic regression analysis showed that the previous SBP episode(OR:2.673,95%CI:1.556-4.592) and broad-spectrum antibiotic exposure history(OR:2.295,95%CI:1.309-4.024) were both the independent risk factors for resistance to cephalosporin (P＜0.05). Conclusion The cirrhotics with complicated SBP is commonly infected by Gram-negative bacteria, Escherichia Coli, for example, and is usually resistant to cephalosporins, and the clinicians should deal with it appropriately.

Objective This experiment was performed to investigate protective effects of silencing information regulator 2 related enzyme 1 (SIRT1) agonist CAY10602 on liver injuries in mice with acute liver failure (ALF). Methods Forty mice were randomly divided into 5 groups, e.g., control, model, CAY10602-intervend, glycyrrhizin (GLY)-intervened and CAY10602 and GLY combination-intervened group, with 8 mice in each group. A model of ALF was established by intraperitoneal injection of lipopolysaccharide and D-galactosamine (LPS/D-Gal). SIRT1 agonist CAY10602 and high mobility group box-1 protein (HMGB1) inhibitor glycyrrhizin (GLY) were used for intervention. Hepatic expression of SIRT1, HMGB1, and ferroptosis-related protein glutathione peroxidase 4 (GPX4), and Acyl-CoA synthetase long-chain family member 4 (ACSL4) was detected by Western blot. Results Liver tissue structure of mice in LPS/D-Gal model group was seriously disordered, necrosis of hepatocytes was found, and liver tissue congestion was serious; However, SIRT1 agonist CAY10602 intervention could significantly ameliorate liver tissue injuries; serum ALT, AST and bilirubin levels in LPS/D-Gal model group mice were (3278.3±520.8) U/L, (2457.0±545.5) U/L and (96.4±16.5) μmol/L, significantly higher than in control group [(32.1±10.3) U/L, (67.8±12.8) U/L and (4.7±2.3) μmol/L, P<0.05]; serum ALT, AST and bilirubin levels in LPS-Gal/D/CAY10602-intervened group mice were significantly lower than in the model group; compared with in the model group, CAY10602 significantly decreased hepatic expression of HMGB1 (P <0.05), while promoted ferroptosis-related protein GPX4 expression, and decreased expression of ACSL4 (P<0.05), suggesting that SIRT1 agonist CAY10602 might alleviate liver injuries by inhibiting HMGB1 expression and reducing ferroptosis in liver tissues. Conclusions SIRT1 agonist CAY10602 can protect liver tissue injuries, and the mechanism might be involved inhibition of hepatic HMGB1 release and ferroptosis occurrence.

Objective The aim of this study was to investigate correlation of serum volatile organic compounds (VOCs) to and body inflammatory index in patients with metabolism-related fatty liver disease(MAFLD): an analysis based on 2017-2020 National Health and Nutrition Examination Survey database (NHANES). Methods Data from NHANES database from 2017 to 2020 were retrieved, patients who met diagnosis of MAFLD were enrolled and their laboratory tests, including serum VOCs levels and results of questionnaires were collected. Systemic inflammatory response index (SIRI) and systemic iImmunoinflammatory index (SII) were calculated. Multivariate Logistic regression modeling was applied to analyze correlation of the two inflammatory indicators to serum VOC content. Results SII in 2991 patients with MAFLD was (531±325), SIRI was (1.8±1.01), serum 1,4-dichlorobenzene level was (1.2±8.2) ng/mL, and serum 2,5-dimethylfuran level was (0.1±0.1) ng/mL; serum 2,5-dimethylfuran level was positively correlated with SIRI (r=0.3, P<0.05) and with SII (r=0.3, P<0.05) in patients with MAFLD; by multivariate Logistic regression modeling analysis, serum 2,5-dimethylfuran level was found to be associated with SIRI (β=1.8±0.3, P<0.05) and with SII (β=696.7±122.4, P<0.05) in unadjusted model; the model adjusted by age found that SIRI (β=2.0±0.3, P<0.05) and SII (β=709.1±123.9, P<0.05) were positively correlated to serum 2,5-dimethylfuran level; serum 2,5-dimethylfuran level was found to be still correlated to SIRI (β=1.7±0.3, P<0.05) or to SII (β=655.8±129.7, P<0.05) by adjusting the model for age, gender, body mass index (BMI), waist circumference (WC), smoking, hypertension, diabetes, total triglycerides (TG), alanine Aminotransferase (ALT), high-density lipoprotein (HDL) and high sensitivity C-reactive protein (hsCRP). Conclusion Exposure of individuals to higher levels of 2,5-dimethylfuran could exacerbate body systemic inflammatory response, which might trigger MAFLD occurrence.

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