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

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 The aim of this study was to investigate magnetic resonance cholangiopancreatography (MRCP) and abdominal CT scan in preoperative evaluation of surgical difficulty in patients with gallstones and cholecystitis. Methods A total of consecutive 102 patients with gallstones and cholecystitis were encountered in our hospital between January 2022 and June 2024, and all underwent laparoscopic cholecystectomy (LC). Prior to operation, all patients received MRCP and abdominal CT scan. Operation difficulty was evaluated according to literature report, and readability of cystic arteries and cystic ducts were assessed based on imaging. Results Of the 102 patients with gallstones and cholecystitis, the imaging showed types of cystic arteries weretypeⅠa in 81 cases, type Ⅰb in 9 cases, type Ⅱa in 5 cases and type Ⅱb in 7 cases, with normal shape in 81 cases (79.4%), and abnormal in 21 cases (20.6%); the imaging also showed normal cystic duct shape in 85 cases (83.3%) and abnormal in 17 cases (16.7%);the scores of gallbladder artery display and gallbladder duct display in24 patients with surgical difficulty as assessed pre-operationally were (1.3±0.3) points and (1.4±0.3)points, both significantly lower than [(1.6±0.3) points and (1.7±0.3)points, respectively, P＜0.05] in 78 patients with operation easily, while the gallbladder wall thickness, gallbladder volume and stone diameter were (10.1±2.3)mm, (53.2±8.3)mm³ and (18.2±3.3)mm, all significantly greater than [(7.5±2.1)mm, (46.4±7.1)mm³ and (14.4±5.1)mm, respectively, P＜0.05] in easy operation group. Conclusion MRCP and abdominal CT scan could clearly display anatomic structure around gallbladder artery and cystic duct, which might help evaluate pre-operationally LCdifficulty in patients with gallstones and cholecystitis.

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 This experiment aimed to investigate the mechanism by which dual specificity protein phosphatases 10(DUSP10) mediates lenvatinib resistance by through regulating stemness characteristics in hepatocellular carcinoma (HCC) in vitro. Methods Lenvatinib-resistant cell lines, e.g., Huh7-resistant and Hep3B-resistant, were established, and stable DUSP10-overexpressing (Huh7 and PLC/PRF/5) and knockdown (Huh7-resistant, Hep3B-resistant, Hep-12) cell models were constructed. Western blot was conducted to detect stemness markers (Nanog, BMI1, ABCG2) expression, and CCK-8 assay was performed to determine IC50 values and calculate the resistance index (RI). Results DUSP10 expression in resistant cell lines was up-regulated by 2.1 to 3.8 fold compared to in wild-type cells (P<0.01); overexpression of DUSP10 increased the IC50 of lenvatinib in Huh7 cells from 1.376 μM to 28.44 μM (RI=20.67) and in PLC/PRF/5 cells from 4.118 μM to 18.01 μM (RI=4.37), accompanied by a 1.5 to 2.3 fold up-regulation of stemness genes; conversely, DUSP10 knockdown reduced the IC50 in Huh7-resistant, Hep3B-resistant, and Hep-12 cells by 6.53 fold, 12.02 fold, and 3.29 fold, respectively (all P<0.001), with a 40% to 60% down-regulation of stemness genes. Conclusion DUSP10 significantly decreases the sensitivity of HCC cells to lenvatinib by probably up-regulating stemness-related genes, such as Nanog/BMI1/ABCG2, and targeting the DUSP10-stemness pathway might reverse drug resistance.

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

Objective The aim of this study was to summarize etiology and prognosis of children with non-hepatophilic viral infection with liver injury. Method 102 children with non-hepatotropic virus infection-induced liver injury were encountered in our hospital between January 2022 and December 2023, serum viral RNA loads were assayed by RT-PCR, and liver-protecting procedures were given. Result Of 102 children with non-hepatotropic virus infection-induced liver injury, the etiologies included respiratory tract infection in 43 cases (41.7%), gut infections in 32 cases (31.1%), infectious mononucleosis in 10 cases (9.7%), drug-induced liver injury (DILI) in 9 cases (8.8%)and hand-foot-mouth disease in 8 cases(7.8%); fever in 58 cases (56.9%), diarrhea in 37 cases (36.3%), cough in 33 cases (32.4%), nausea and vomiting in 27 cases (26.5%), anorexia in 17 cases (16.7%), itching in 3 cases(2.9%); hepatomegaly in 26 cases (25.2%), lymphadenopathy in 21 cases (20.6%), tonsillitis in 19 cases (18.6%), splenomegaly in 13 cases (12.8%), rash in 8 cases (7.8%) and eyelid edema in 6 cases (5.9%); liver function tests recovered at 7 to 18 days, averaged in two weeks, in 73 cases (71.6%), and other 29 children (28.4%) got their liver function tests normal after 4 to 6 (average 5) week treatment. Conclusion The common causes of liver damage in children with non-hepatotropic virus infection are mainly respiratory tract, intestinal infection, and infectious mononucleosis. The overall prognosis of children with non-hepatotropic virus infection-induced liver injury is good as protecting liver function treatment is given.

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

Objective The aim of this study was to investigate the clinical efficacy of silymarin and diammonium glycyrrhizinate combination in the treatment of patients with non-alcoholic steatohepatitis(NASH). Methods 97 patients with NASH were encountered in our hospital between October 2022 and June 2024, and were randomly assigned to receive oral diammonium glycyrrhizinate in control (n=48), or to receive diammonium glycyrrhizinate with combination of silymarin in observation (n=49) at base of sport exercise and food guidance for six months. Serum hyaluronic acid (HA), laminin (LN), IV collagen (Ⅳ-C) and III procollagen (PCⅢ) levels were assayed by RIA, and serum interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) and IL-6 levels were detected by ELIS. Liver stiffness measurements (LSM) and controlled attenuation parameter (CAP) were measured by Fibrotouch. Results By end of six month treatment, serum ALT, AST, GGT levels, and LSM and CAP in the observation group were (49.4±4.2)U/L, (41.1±3.9)U/L, (60.1±5.5)U/L, (7.3±1.2)kPa and (272.3±10.6)dB/m, all significantly lower than [(57.2±6.3)U/L, (49.5±5.2)U/L, (81.5±7.3)U/L, (8.8±2.5)kPa and (289.5±13.8)dB/m, respectively, P<0.05] in the control; serum HA, Ⅳ-C and PCⅢ levels were (62.1±5.7)μg/L, (60.5±6.2)μg/L and (90.3±10.4)μg/L, all much lower than [(73.2±7.4)μg/L, (68.2±8.7)μg/L and (148.5±13.7)μg/L, respectively, P<0.05] in the control; serum IL-10 level was (30.5±7.6)mg/L, much higher than [(25.2±6.3)mg/L, P<0.05], while serum TNF-α and IL-6 levels were (13.1±3.8)mg/L and (13.6±4.0)ng/L, both much lower than [(26.2±5.7)mg/L and (20.1±6.4)ng/L, respectively, P<0.05] in the control group. Conclusion Combination of oral silymarin and diammonium glycyrrhizinate at base of sport and diet guidance in patients with NASH is short-termly efficacious, which needs further clinical investigation.

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

Objective This study was conducted to investigate targeted and immunotherapy plus transarterial chemoembolization (TACE) in the treatment of patient with primary liver cancer (PLC). Methods A total of 100 PLC patients were encountered in our hospital between May 2021 and April 2023, randomly divided into control (n=50) and observation (n=50) groups, and all patients in the two groups underwent TACE for two to five times. Patients in the observation group received target medicine, including apatinib or cangvatinib, and immunomodulators, including carilizumab or trelizumab, etc., combination therapy for three months. Peripheral blood lymphocyte subsets were detected by FCM, serum AFP level were routinely obtained, and serum macrophage metastasis inhibitor (MIF) and vascular endothelial growth factor (VEGF) levels were determined by ELISA. Results By end of three month treatment, Objective response rate (ORR) in the observation group was 62.0%, much higher than 42.0% in the control group (P<0.05); after treatment, percentage of peripheral blood CD4⁺ cells and ratio of CD4⁺/CD8⁺cells in the observation group were (46.8±4.6)% and (1.8±0.3), both much higher than [(37.3±4.2)% and (1.3±0.3), respectively, P＜0.05], while percentage of CD8⁺ cells was (25.1±2.4)%, much lower than [(28.5±2.5)%, P＜0.05] in the control; serum AFP, MIF and VEGF levels were (110.2±27.5)μg/L, (55.8±10.1)ng/mL and (180.1±48.7)pg/mL, all significantly lower than [(288.1±31.5)μg/L, (80.1±11.3)ng/mL and (261.1±54.3)pg/mL, respectively, P＜0.05] in the control; by end of one-year follow-up, survival rate in the observation group was 66.0%, not statistically significantly different as compared to 46.7% in the control group (Log-Rank=2.643, P=0.104). Conclusin Targeted and immunotherapy with combination of TACE in dealing with patients with advanced PLC could get a satisfactory short-term clinical efficacy, which might be related to improvement of body immune functions, but the long-term efficacy should be investigated further.

Objective This study aimed to investigate iron metabolism index changes in patients with nonalcoholic fatty liver disease (NAFLD). Methods Ninety-eight patients with NAFLD and ninety-eight healthy individuals for physical examination were encountered in Yizheng People's Hospital between January 2022 to March 2024, and all underwent abdominal CT scan and total adipose area (TAA), total skeletal muscle area (SMA), liver-to-spleen CT value ratio (CT_L/S) and visceral adipose volume/subcutaneous adipose volume (VAV/SAV)ratio were measured and calculated by Reformate software. Serum ferritin light chain (FTL)was detected by ELISA, serum iron (SI)and unsaturated iron binding capacity (UIBC) were detected by colorimetry, and transferrin receptor (TRF) were assayed by turbidimetry. Fatty liver degree was determined by ultrasonography. Result Ultrasonography found mild, moderate and severe fatty liver in 31 cases, 33 cases and 34 cases in our series; serum ALT, AST, TG and TC levels in patients with moderate fatty liver were much higher than in those with mild fatty liver or healthy persons (P<0.05), and they were much higher in patients with severe fatty liver than in those with moderate (P<0.05);serumSI, FTLand UIBC levels in patients with moderate fatty liver were (29.6±3.3)μmol/L,(439.5±15.6)μg/L and (73.1±5.7)μmol/L, all much higher than [(20.9±3.9)μmol/L, (417.5±16.6)μg/Land (62.6±6.6)μmol/L, respectively, P<0.05] in patients with mild fatty liver or [(14.3±3.0)μmol/L, (303.6±18.5)μg/L and (50.5±7.5)μmol/L, respectively, P<0.05] in healthy persons, while serum TRF level was (2.6±0.3)g/L, much lower than [(3.0±0.4)g/L, P<0.05] in patients with mild fatty liver or [(3.5±0.6)g/L, P<0.05] in healthy individuals; TAA,SMA and VAV/SAV ratio in patients with moderate fatty liver were much greater (P<0.05), while CT_L/S was much less than in patients with mild fatty liver (P<0.05);TAA, SMA and VAV/SAV ratio in patients with severe fatty liver were much greater (P<0.05), while CT_L/S was much less than in patients with moderate fatty liver(P<0.05). Conclusion Iron metabolism is unstable in patients with NAFLD, which might be related to liver steatosis and inflammation and needs further investigation.

Objective The purpose of this study was to investigate diagnostic performance of ultrasound-derived fat fraction (UDFF) in patients with metabolic associated fatty liver disease (MAFLD). Methods 54 allegedpatients with fatty liver were encountered in our hospital between October and December 2023, and all received MRI proton density fat fraction sequence (MRI-PDFF) and UDFF examination simultaneously. Intragroup correlation coefficient (ICC) was conducted to compare the consistency, and area underreceiver operating characteristic curve (AUC) was applied to assess the diagnostic efficacy. Results Based onMRI-PDFF results, non-fatty liver was found in 16 cases, mild fatty liver in 28 cases, moderate fatty liver in 3 cases and severe fatty liver in 7 cases; UDFF in 10 patients with moderate/severe fatty liver was 20.5(15.8, 28.0) %, much higher than [13.0(11.0,17.0)%, P＜0.01] in 28 patients with mild fatty liver or [5.5(4.0,7.0)%, P＜0.01] in 16 persons without fatty liver; ICC between MRI-PDFF and UDFF was 0.808,presenting as satisfactory diagnostic consistency; AUC in diagnosing MAFLD by UDFF was 0.987 (P<0.001), when the cut-off value was set as 8.0%,with the sensitivity (Se) of 97.4%, and the specificity (Sp) of 93.8%, and the AUC in diagnosing moderate/severe fatty liver was 0.908(P<0.001), when the cut-off value was set as 14.0%, with Se of 91.7% and Sp of 79.6%; our study didn't found difference of point shear wave elastography (pSWE) among individuals with or without fatty liver(P>0.05). Conclusion We recommendUDFF for diagnosis of metabolic associated fatty liver disease as its excellent efficacy, while the application of pSWE still needs multiple center validation.

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 The purpose of this study was to investigate prevalence and risk factors of overt hepatic encephalopathy (HE) in hepatitis B-induced liver cirrhosis (LC). Methods 60 patients with hepatitis B-induced LC were recruited in our hospital between March 2019 and March 2021, and consecutively followed-up for two years. Third lumbar skeletal muscle index (L3-SMI) was obtained by abdominal CT scan, esophageal varices (EV) was determined by gastroscopy, and HE was diagnosed by West Haven score. Multivariate Logistic regression analysis was applied to find risk factors. Results HE was found in 25 cases during the two-year follow-up period; baseline serum bilirubin, INR, EV incidence, hepatorenal syndrome, Child-Pugh score, MELD score and sarcopenia incidence in patients with HE were (35.3±8.5)μmol/L, (1.4±0.5), 68.0%, 72.0%, (15.6±2.3) points, (21.6±2.5)points and 80.0%, all much higher than [(20.6±9.3)μmol/L, (1.2±0.3), 25.7%, 17.1%, (9.2±1.6)points, (15.5±3.2)points and 34.3%, respectively, P＜0.05], while serum albumin level, peripheral blood platelet count and L3-SMI were (29.3±5.6)g/L, (62.3±13.5)×10⁹/L and (43.1±8.9)cm²/m², all much lower than [(33.2±5.9)g/L, (85.2±15.6)×10⁹/L and (46.3±8.5)cm²/m², respectively, P＜0.05] in cirrhotics without HE; multivariate Logistic regression analysis showed that PLT(OR=3.442, INR(OR=3.677), EV (OR=3.647, Child-Pugh class (OR=4.191), MELD score (OR=4.614), sarcopenia (OR=4.651) and L3-SMI (OR=4.468) were all the independent risk factors for occurrence of HE in patients with LC (P<0.05). Conclusion Clinicians should take common risk factors of complications, such as HE, into consideration as dealing with patients with LC, which might improve the prognosis.

Objective The aim of this study was to investigate combination of Xuezhikang, a herbal medicine compound, and atorvastatin in treatment of patients with non-alcoholic fatty liver disease (NAFLD) and hyperlipidemia. Methods 124 patients with NAFLD and hyperlipidemia were enrolled in our hospital between January 2022 and July 2024, and were randomly assigned to receive atorvastatin in 63 cases in control, or receive Xuezhikang at base of atorvastatin in another 61 cases in observation for 24 weeks. Fasting insulin was assayed by immunoassay, and HOMA-IR and HOMA-β were calculated. Serum tumor necrosis factor(TNF-α), interleukin -6(IL-6) and IL-8 levels were detected by ELISA. Results By end of 24-week treatment, serum ALT, AST and GGT levels in the observation group were (36.5±3.3)U/L, (32.7±2.8)U/L and (46.4±4.7)U/L, all significantly lower than [(62.8±3.6)U/L, (58.9±3.2)U/L and (64.1±5.3)U/L, respectively, P<0.05] in the control; there were no significant differences as respect to serum TC, TG, LDL-C and HDL-C levels in the two groups (P>0.05); serum FINS and HOMA-IR were (5.3±1.5)μU/ml and (2.7±0.8), both much lower than [(6.4±1.2)μU/ml and (4.1±1.3), respectively, P<0.05], while HOMA-β was (92.3±15.4), much greater than [(77.2±13.7), P<0.05] in the control; serum TNF-α, IL-6 and IL-8 levels were (15.5±6.3)pg/ml, (16.2±5.1)ng/L and (5.5±1.1)μg/L, all significantly lower than [(27.6±6.8)pg/ml, (26.6±5.8)ng/L and (7.2±1.4)μg/L, respectively, P<0.05] in the control group. Conclusion Application of Xuezhikang with combination of atorvastatin in treatment of patients with NAFLD and hyperlipidemia could improve liver function test normal, which might be related to modulation of glycolipid metabolism and inhibition of cytokine reactions.

Objective The aim of this study was to summarize magnetic resonance imaging (MRI) manifestation of atypical focal nodular hyperplasia (FNH) of the liver. Methods 116 patients with liver FNH were encountered in our hospital between January 2022 and July 2024, all underwent plain, enhanced MRIscan, including diffusion weighted imaging (DWI), and the diagnosis was confirmed by biopsies or post-operational histo-pathological examinations. Results Of the 116 patients with liver FNHA, all had solitary intrahepatic nodule, located at right and/or left lobe, with diameters of 1.0to 11.2 cm, averaged with (6.1±1.3)cm, including≤2.0 cm in 31 cases, 2.0-5.0 cm in 51 cases and ＞5.0 cm in 34 cases; equal or slightly lower signals on T1WI, equal or slightly higher signals on T2WI, slightly higher signals on DWI, high signals at arterial phase, slightly high or equal signals at portal phase, equal or low signals at delayed phase, and high or equal signals at hepatobiliary phase; without central scar in 49lesions(42.2%),with pseudocapsule in 69lesions(59.5%),with internal bleeding or necrosis in 43lesions (37.1%),with fat infiltration in 37lesions (31.9%) and without significant enhancement at arterial phase in 56lesions(48.3%); percentages of without central scar, pseudocapsule, internal bleeding or necrosis, fat infiltration and non-significant enhancement at arterial phase in lesions >5.0cm were 64.7%, 88.2%, 61.8%, 52.9%and 73.5%, all significantly higher than 41.2%, 56.9%, 35.3%,31.4% and 47.1%(P＜0.05)in lesions of 2.0 to 5.0 cm or 19.4%, 32.3%, 12.9%, 9.7%and 22.6%(P＜0.05)in ≤2.0 cm of lesions. Conclusion Liver FNH, including atypical ones could have specific MRI feature, which might help clinicians make an appropriate measures to deal with.

Objective The aim of this study was to investigate acupoint application and exercise prescription in the treatment of patients with non-alcoholic fatty liver disease (NAFLD). Methods 81 patients with NAFLD were encountered in our hospitalbetween June 2022 and June 2024, and were randomly divided into control group (n=40) and observation group (n=41). Patients in the control group received lipid-lowering therapy with dietary intervention, and those in the observation received acupoint application and exercise prescription. The intervention lasted for three months in the two groups. Serumtumor necrosis factor-α(TNF-α), interleukin 6 (IL-6), irisin and adiponectin (APN) levels were detected by ELISA, controlled attenuation parameter (CAP) was determined byFibrotouch, and generic quality of life inventory 74 (GQOLI-74) and health promoting lifestyle profile (HPLP)were evaluated. Results By end of three month intervention, body mass index, waist-to-hip ratio and ,WHR and percentage of body fat in the observation group were(24.3±2.6)kg/m², (0.6±0.2)and (27.3±2.8)%, all much lower than [(26.1±2.7)kg/m², (0.7±0.1)and (29.6±3.1)%,P<0.05] in the control; serum total cholesterol,triacylglycerol and low-density lipoprotein cholesterol levels were(5.5±0.7)mmol/L, (1.7±0.3)mmol/Land (3.2±0.5)mmol/L, all much lower than[(5.9±0.7)mmol/L, (2.6±0.4)mmol/L and (4.2±0.5)mmol/L, respectively, P<0.05], while serum high-density lipoprotein cholesterol level was(1.3±0.4)mmol/L, much higher than [(1.0±0.3) mmol/L,P<0.05] in the control; serumalanine aminotransferase,aspartate aminotransferase and CAP were(40.3±4.5)IU/L, (42.1±4.6)IU/L and (267.8±7.8)dB/m, all significantly lower than[(93.4±5.6)IU/L, (61.7±5.9)IU/Land (288.3±10.9)dB/m, respectively, P<0.05] in the control; serum TNF-α and IL-6 levels were(401.5±42.3)pg/mL and (18.6±2.8)mg/L, both significantly lower than [(461.2±48.6)pg/mLand (28.7±3.1)mg/L, respectively, P<0.05], while serum irisin and APN levels were (9.4±1.2)ng/mL and (19.3±2.1)μg/mL, both significantly higher than[(7.6±0.9)ng/mLand (13.4±1.8)μg/mL, respectively,P<0.05] in the control group; GQOLI-74 score, and regular exercise, scientific dietand adequate sleep rates were(81.2±8.5)points, and 87.8%, 85.4%and 82.9%, all much higher than [(76.3±7.6)points, 62.5%, 60.0%and 62.5%, respectively, P<0.05] in the control. Conclusion Acupoint application and exercise prescription is efficacious in the treatment ofpatients with NAFLD,which might improve body fat metabolism and alleviate inflammatory reactions.

Objective The aim of this study was to compare conventional and contrast-enhanced ultrasonography (CEUS) features of hepatocellular carcinoma (HCC0 and intrahepatic cholangiocarcinoma(ICC) for differentiation of the two entities. Methods 86 patients with HCC and 16 patients with ICC were encountered in our hospital between March 2019 and May 2024, and all underwent conventional and contrast-enhanced ultrasonography. The imaging features were compared between the two malignant tumors. Results There were no significant differences as respect to numbers of intrahepatic space-occupying lesions, shapes, diameters, intratumor echos, echo features and portal thrombosis between the two groups (P＞0.05), while the percentage of bile duct dilatation in patients with ICC was 37.5%, much higher than 2.3%(P＜0.05)in those with HCC; CEUS demonstrated that percentages of arterial-phase ring enhancement, arterial-phase hypo-enhancement, portal-phase hypo-enhancement andclearing time at delayed phase in ICC group were 37.5%, 18.8%, 93.8% and (45.2±8.1)s, all significantly higher or shorter than 10.5%, 2.3%,59.3% and (66.7±11.8)s in HCC group (P＜0.05). Conclusion The imaging features, such as bile duct dilation, arterial phase enhancement mode, arterial phase enhancement characteristics, and significant differences in clearance time in patients with ICC and HCC are obvious different, which might help clinicians differentiate the two liver cancers.

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 experiment was to investigate molecular mechanism of diethyldithiocarbamate (DDC) in improving metabolic dysfunction associated steatohepatitis (MASH) by regulating Insr/Akt signaling pathway. Methods 18 male C57BL/6 mice were randomly divided into control, MASH and DDC-intervened group (n=6 in each) and MASH model was established by feeding a choline-deficient, L-amino acid-defined (CDAA) diet, and the intervention was carried out by DDC gavage simultaneously. The expression of insulin receptor (Insr) and pro-apoptotic molecule, e.g., Bax in mouse liver tissue were detected by real-time PCR and Western blot. Model of lipotoxicity was established by induction of palmitic acid (PA) on AML12 cells, and was treated with DDC simultaneously. The expression of Insr, Akt, pAkt, Bax and Bcl2 were detected by Western blot. Results Insr mRNA level in liver tissue in MASH group was (0.38±0.13), significantly lower than [(1.03±0.27), P<0.05] in the control; the expression of Insr protein in liver tissues in MASH group was (0.61±0.11), significantly lower than [(1.68±0.58),P<0.05] in the control, while the expression of Insr protein in liver tissues in DDC-intervened group was (1.03±0.11), significantly higher than that in MASH group (P<0.05); the expression of Bax protein in liver tissue in MASH group was (1.14±0.39), significantly higher than [(0.47±0.26), P<0.05] in the control; the expression of Bax protein in liver tissues in DDC-intervened group was (0.66±0.19), significantly lower than that in MASH group (P<0.05); the expression of Insr protein in AML12 cells in PA group was (0.38±0.13), significantly lower than [(0.74±0.21), P<0.05] in the control, while the expression of Insr protein in AML12 cells in DDC-intervened group was (0.71±0.20), significantly higher than that in PA group (P<0.05); the ratio of pAkt/Akt protein in AML12 cells in PA group was (0.28±0.07), significantly lower than [(0.69±0.06), P<0.05] in the control, while the ratio of pAkt/Akt protein in AML12 cells in 25 μM or in 50 μM DDC-intervened groups were (0.85±0.02) and (0.97±0.04), both significantly increased than in PA group (P<0.05); the ratio of Bcl2/Bax in AML12 cells in PA group was (1.28±0.29), much lower than [(1.74±0.10),P<0.05] in the control, while the ratio of Bcl2/Bax in AML12 cells in DDC-intervened group was (2.30±0.78), much higher than that in PA group (P<0.05). Conclusion The Insr/Akt pathway is inhibited and apoptosis is increased in liver tissues in mice with CDAA diet-induced MASH, and DDC might inhibit hepatocyte apoptosis by stimulating Insr/Akt signaling pathway, thereby improving MASH progression.

Objective The purpose of this experiment was to investigate the protective effect of histone deacetylase (HDAC) inhibitor ACY1215 on acute liver failure (ALF) in mice and to explore its possible mechanism. Methods 18 mice were randomly divided into control, model and ACY1215-intervened group, with 6 in each. The ALF model was induced by intraperitoneal injection of lipopolysaccharide (LPS) and D-galactosamine (D-Gal). Liver tissue PANoptosis associated protein expression, such as receptor-interacting serine-threonine kinase 1(RIPK1), gas derivative D protein (GSDMD), Caspase-3, Caspase-8 and mixed lineage kinase domain protein (ML) were detected by Western blot. Results Liver histopathological examination showed that disordered intrahepatic parenchymal cell arrangement, with lamellar cell necrosis, a large number of blood cell exudation, and inflammatory cell infiltration in ALF group, while liver tissue damage alleviated in ACY1215-intervened group; serum ALT, AST and total bilirubin levels in ALF group were (3279.8±639.0)U/L,(2510.1±383.2)U/L and (85.5±6.8)μmol/L, while they all decreased to [(987.6±254.3)U/L, (426.3±105.6)U/L and (38.1±8.9)μmol/L, respectively, P<0.05] in ACY1215-intervened group; intrahepatic tissue PANoptosis-related protein, such as RIPK1, GSDMD, Caspase-3, Caspase-8 and MLKL intensified in ALF group, while they all obviously weakened in ACY1215-intervened group (P<0.05). Conclusion Histone deacetylase inhibitor ACY1215 could play a protective role in mice with ALF, probably by regulating PANoptosis-related protein expression.

Objective The aim of this study was to investigate immunological response of infants born to hepatitis B viral infected mothers to hepatitis B vaccination and its influencing factors. Methods 86 HBV-infected pregnant women and their 86 infants were encountered in our hospital between January 2019 and December 2020, and out of the 86 hepatitis B viral carriers, 64 women received oral tenofovir at 28 gestational week for blocking hepatitis B viral mother-to-infant transmission until delivering. All infants received hepatitis B immunoglobulin and hepatitis B vaccine routinely, and were followed-up for three years. Serum HBsAg and anti-hepatitis B surface antigen antibody (HBsAb) were detected by ELIS, and serum HBV DNA loads was assayed by PCR. Results By delivery, serum HBV DNA loads transferred to negative in tenofovir-treated women, and by end of three-year follow-up, serum HBsAb positive in 82 infants(95.3%), including weak positive in 16 cases (19.5%) and strong positive in 66 cases (80.5%), and negative in 4 infants (4.7%) in the 86 infants; concomitant diabetes percentage in mother with their infants positive response was much lower than in those with weak response (12.1% vs. 31.2%), while birth weights and gestational weeks were significantly heavier than(3442.7±333.1 g vs. 3385.4±370.6 g)or longer than(39.3±1.2 w vs. 37.4±1.2 w) in weak responders (P<0.05); multivariate Logistic regression analysis showed that concomitant diabetes, low infant birth weight and short gestational weeks at birth were all the risk factors impacting immunological response (P<0.05). Conclusion Hepatitis B vaccination might fails in infants who have a hepatitis B viral infection mothers, the surveillance is important and should re-vaccinates sometimes.

Objective The aim of this study was to investigate ultrasound-guided polidocanol sclerotherapy in patients with hepatic cysts (HC). Methods Ninety-one patients with HC were recruited in Henan Provincial Children's Hospital between March 2022 and March 2024, and were randomly divided into control group (n=45) and observation group (n=46), receiving ethanol sclerotherapy, or polidocanol sclerotherapy under ultrasound-guidance. Serum Golgi protein 73 (GP73), protein disulfide isomerase A3 (PDIA3) and chitinase 3-like protein 1 (CHI3L1) levels were detected by using automatic immunoassay analyzer, and serum superoxide dismutase (SOD), nuclear factor E2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) levels were measured by ELISA. Results After treatment, serum ALT and AST levels in the observation group were 48.4±9.2U/L and 38.4±7.3U/L, both significantly lower than [59.8±11.3U/L and 62.0±14.3U/L, P<0.05] in the control; serum GP73, PDIA3 and CHI3L1 levels were 24.4±3.6pg/L, 67.7±5.2ng/mL and 46.4±5.8ng/L, all much lower than [36.4±5.1pg/L, 92.7±5.4ng/mL and 65.8±6.4ng/L, respectively, P<0.05] in the control group; serum SOD, Nrf2 and HO-1 levels were 83.5±8.3 U/L, 713.3±82.3 U/L and 27.7±3.1U/L, all much higher than [77.5±7.8U/L, 664.7±75.3U/L and 23.7±2.5U/L, respectively, P<0.05] in the control; post-operationally, incidence of adverse effects in the observation group was 6.5%, much lower than 24.4%(P<0.05)in the control; six months after sclerotherapy, disappearance rate of HC in the observation group was 87.0%, much higher than 66.7%(P<0.05)in the control group. Conclusion Our observation backs up lauromacrogol sclerotherapy under ultrasound-guidance in patients with HC, which is efficacious and safe.

Objective The aim of this study was to investigate clinical efficacy of rosiglitazone and metformin combination in the treatment of patients with non-alcoholic fatty liver disease (NAFLD)and type 2 diabetes mellitus(T2DM). Methods A total of 98 patients with NAFLD and T2DMwere enrolled in our hospital between January 2023 and March 2024, and were randomly assigned to receive oral metformin (control, n=49) or combination of metformin and rosiglitazone (observation, n=49) for six months. Serum high density lipoprotein cholesterol(HDL-C), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) levels were routinely detected. Fasting insulin level was detected by radioimmunoassay. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were detected by Fibroscan. Results By end of six-month treatment, serum HDL-C level in the observation group was(1.3±0.3)mmol/L, much higher than [(1.1±0.2)mmol/L, P＜0.05], while serum TG level was(2.0±0.3)mmol/L, much lower than [(2.9±0.5)mmol/L, P＜0.05] in the control; fasting insulin level in the observation was (6.5±1.3)μU/ml, much lower than [(7.4±1.6)μU/ml, P＜0.05] in the control, while there were no significant differences as respect to HbA1c and FBG between the two groups(P>0.05); serum AST and CAP were (38.9±4.3)U/L and (266.1±10.7)dB/m, both much lower than [(45.4±4.8)U/L and (286.0±11.9)dB/m, respectively, P＜0.05]in the control group. Conclusion Rosiglitazone and metformin combination in the treatment of patients with NAFLD and T2DM could improve lipid metabolism disorder, which is worthy of further clinical study.

Objective Theaim of this study was to compare clinical efficacy of lauromacrogol or anhydrous alcohol sclerotherapyin the treatment of patients with simple hepatic cysts(SHC) under ultrasound (US) guidance. Methods An consecutive 58 patients with SHC were encountered in the First Hospital of Yulin between June 2022 and January 2024, and were randomly divided into lauromacrogolgroup (n=28) and ethanol group (n=30). Patients received percutaneous transhepatic puncture under US guidance for cyst fluid extraction, then the sclerotherapy was carried out. Serum Golgi protein 73 (GP73), protein disulfide isomerase A3 (PDIA3) and chitosinase 3-like protein 1 (CHI3L1) levels were detected by ELISA, and post-operational pain was evaluated by visual analogue scale (VAS) score. Results At three days post-operationally, serumGP73, PDIA3 and CHI3L1 levels in patients with lauromacrogol sclerotherapy were (24.0±4.7)pg/L, (73.2±6.6)ng/ml and (41.7±4.5)ng/L, all much lower than [(36.7±6.1)pg/L, (92.8±7.9)ng/ml and (65.8±6.3)ng/L, respectively, P<0.05] in patients with ethanol sclerotherapy; at 2hour and 24hour, the resting and motion VAS scores in lauromacrogol group were all much lower than in ethanol group (P<0.05); incidence of adverse effects in lauromacrogol group was 14.3%, much lower than 36.7%(P<0.05) in ethanol group; by end of six months after treatment, disappearance rate of cysts in lauromacrogol group was 78.6%, much higher than 53.3%(P<0.05), and reduction of cyst volume was (93.7±9.7)%, much higher than [(83.0±9.2)%, P<0.05] in ethanol group. Conclusion Our results suggest that US-guided liver cyst puncture and fluid drainage with lauromacrogol sclerotherapy in dealing with patients with SHC has a satisfactory efficacy with less adverse effects.

Objective The aim of this study was to investigate therapeutic efficacy of FOLFOX in hepatic artery infusion chemotherapy (HAIC) with combination of lenvatinib and PD-1 inhibitors in treatment of patients with advanced primary liver cancer(PLC). Methods 86 patients with advanced, unresectable PLC were encountered in our hospital between January 2020 and December 2022, and were randomly assigned to receive FOLFOX through HAIC chemotherapy plus lenvatinib in 43 patients (control), or to receive sintilimab at base of regimen mentioned above in another 43 patients (observation) for three months, and followed-up for two years. Peripheral blood lymphocyte subsets were detected by FCM, and serum alpha-fetoprotein (AFP) level was assayed by ELISA. Results Complete remission rate and partial remission rate in the observation group were 11.6% and 74.4%, with total effective rate of 86.1%, both significantly higher than 4.7% and 60.5%, with total effective rate of 65.1%(P＜0.05) in the control; after treatment, percentages of peripheral blood CD3⁺ and CD4⁺ cells were (46.9±5.3)% and (40.4±5.2)%, both much higher than [(40.4±4.8)% and (34.1±4.3)%, respectively, P＜0.05], while percentage of CD8⁺ cells was (16.1±2.4)%, much lower than [(22.3±3.5)%, P＜0.05) in the control; serum AFP level was (102.6±11.2)ng/mL, much lower than [(143.0±15.4)ng/mL, P＜0.05]in the control group; serum ALT and AST levels were (49.0±4.0)U/L and (44.4±5.0)U/L, both much higher than [(41.8±4.8)U/L and (38.2±5.3)U/L, respectively, P＜0.05]in the control; by end of two-year follow-up, the survival rate in the observation group was 67.4%, with progression-free survival (PFS) of (16.2±2.8)m, significantly higher than 39.5%, with PFS of (11.8±3.2)m in the control (P＜0.05). Conclusion The combination of FOLFOX through HAIC and Lenvatinib plus sintilimab in dealing with patients with advanced PLC could elevate short-term remission rate and prolong survival, and warrants further clinical investigation.

Objective The aim of this study was to compare conventional ultrasonography and contrast-enhanced ultrasonography(CEUS) in assessing stent function in patients with cirrhotics with portal hypertension (PH) after transjugular intrahepatic portosystemic shunt (TIPS) treatment. Methods 80 patients with hepatitis B-induced liver cirrhosis (LC) with PH were encountered in our hospital between November 2021 and October 2024, and all underwent TIPS routinely. Patients received digital subtraction angiography (DSA), conventional ultrasonography and CEUS examinations after surgery. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate diagnostic efficacy, and diagnostic consistency was assessed by Kappa analysis. Results By end of six months after TIPS, DSA found stent function normal in 73 cases(91.3%) and disabled stent function in 7 cases (8.7%) in the 80 patients with LC; conventional ultrasound found disabled stent function in 5 cases and CEUS found in 6 cases; the AUC was 0.857(95%CI:0.761-0.925)by conventional ultrasound in judging stent function disable, with sensitivity(Se), specificity(Sp), accuracy(Ac), positive predictive value (PPV) and negative predictive value (NPV) of 57.1%, 98.6%, 95.0%, 80.0% and 96.0%, and the AUC was 0.929(95%CI:0.848-0.974)by CEUS, with Se, Sp, Ac, PPV and NPV of 71.4%, 98.6%, 96.3%, 83.3% and 97.3%, respectively, with the consistence satisfactory (Kappa>0.640). Conclusion We recommend conventional ultrasonography for assessing stent function in patients with cirrhotic portal hypertension after TIPS, and CEUS could be done unless necessary.

Objective The aim of this study was to observe clinical feature, pathogen distribution and prognosis in patients with pyogenic liver abscess (PLA). Methods A total of 122 patients with PLA were admitted to our hospital between April 2022 and April 2025, and all were treated by percutaneous catheter drainage (PCD) and intravenous antibiotics. The pathogens identification was performed by full-automatic microbial identification instrument. Results The diameter of abscess was(4.8±0.9)cm, WBC count was (13.6±2.5)×10⁹/L, serum CRP level was (124.2±26.8)mg/L and serum procalcitonin level was (4.8±1.2)ng/mL; underlying diseases, such as diabetes accounted for 42.6% and biliary tract diseases for 45.9%; abscess located at right lobe accounted for 62.3% and single abscess for 74.6%; main pathogens were Kleebsiella pneumoniae (45.1%), Escherichia coli (17.6%) and Staphylococcus aureus (11.8%); after 2 to 6, with average of (3.5±0.8)week treatment, two patients with PLA died of septic shock or multiple organ failure, and other 120 patients with PLA recovered. Conclusion In patients with PLA, the main underlying diseases are diabetes mellitus and biliary tract diseases, common pathogens are Klebsiella pneumoniae, and the prognosis of patients with PLA are satisfactory.

Objective The aim of this study was to investigate clinical efficacy of endoscopic variceal ligation (EVL) and somatostatin and esomeprazole combination in the treatment of patients with liver cirrhosis (LC) with complicated esophagogastric variceal bleeding(EVB). Methods Consecutive 77 patients with LC and complicated EVB were encountered in our hospital between April 2022 and April 2024, and were randomly divided into control (n=38) and observation (n=39) group, receiving intravenous infusion of somatostatin and esomeprazole, or receiving EVL plus intravenous infusion of the two medicines. Portal vein diameter (Dpv), portal vein blood flow velocity (Vpv) and portal vein blood flow volume (Qpv) were detected by Doppler ultrasonography. Results For hemostasis, blood transfusion, bleeding-stopping time, supplemented albumin and hospital stay in the observation group were (240.3±131.4)mL,(3.7±0.5)h,(10.4±2.9)g and (5.7±0.8)d, all much less or shorter than [(596.2±238.9)mL, (44.3±4.1)h, (44.2±12.5)g and (11.6±1.4)d, respectively, P<0.05]in the control; 14 days after treatment, Vpv and Qpv in the observation were (15.8±2.2)cm/s and (944.2±245.5)mL/min, both significantly faster or greater than [(13.4±2.3)cm/s and (776.7±170.6)mL/min, respectively, P<0.05] in the control; serum fibrinogen level was(2.9±0.5)g/L, much higher than [(2.2±0.6)g/L, P<0.05] in the control; the emergent hemostasis rate in the observation was 97.4%, much higher than 84.2%(P<0.05)in the control; by end of six month follow-up, re-bleeding rate was 2.6% and esophagogastric varices relapse was 7.9%, both much lower than 18.8% and 25.0%(P<0.05)in the control group. Conclusion EVL at base of intravenous infusion of somatostatin and esomeprazole in the treatment of patients with LC and EVB is efficacious with high emergent hemostasis, and less rebleeding and low EV relapse.

Objective The aim of this study was to investigate efficacy of local transhepatic arterial chemoembolization (TACE) with combination of immune and targeted therapy in the treatment of patients with advanced primary liver cancer(aPLC). Methods 86 patients with aPLC were encountered in Department of Hepatobiliary Surgery, Xiangxi Autonomous Prefecture People's Hospital affiliated to Jishou University between January 2021 and January 2025, and assigned to undergo TACE in 42 cases in the control, or to receive TACE with combination of lenvatinib and tislelizumab treatment in another 44 cases in the observation for three months. Serum alpha-fetoprotein (AFP) and abnormal prothrombin-II (PIVKA-II) levels were detected routinely, and peripheral blood lymphocyte subsets were determined by FCM. Results By end of three-month treatment, the disease control rate was 70.5% and the objective remission rate was 36.4% in the observation group, both much higher than 47.6% and 16.7% (P＜0.05) in the control group; serum AFP and PIVKA-Ⅱ levels were (653.5±131.5)ng/mL and (864.5±89.6)ng/mL, both much lower than [(965.5±152.2)ng/mL and (1038.4±91.3)ng/mL, respectively, P＜0.05] in the control; percentage of peripheral blood CD⁺₄ cells and CD⁺₄/CD⁺₈ cell ratio were (33.6±3.1) % and (1.2±0.3), both significantly higher than [(29.5±2.7 %) and (0.9±0.2), respectively, P＜0.05] in the control; after treatment, the successful conversion surgery rate in the observation group was 22.7%, not significantly different as compared to 7.1% (P>0.05) in the control group. Conclusion Local TACE in combination with immune and targeted therapy in dealing with patients with aPLC is short-termly efficacious, which might alleviate immune suppression with control of tumor progression.

Objective This clinical trial was conducted to compare anticoagulational effect of nafamostat mesylate (NM) and unfractionated heparin (UFH) during double plasma molecular adsorption system (DPMAS) treatment in patients with liver failure(LF). Methods We retrospectively analyzed clinical materials of LF patients underwent DPMAS treatment in Department of Gastroenterology, Shanxi Bethune Hospital between May 2023 and May 2024. During the procedure, NM as an anticoagulant was given at dose of 60 mg for piping with thereafter 35 mg.h^-1 maintaining. Prothrombin time activity(PTA), international normalized ratio (INR), activated partial thromboplastin time (APTT) and blood platelet counts were routinely detected. Results 27 patients with LF were enrolled and received 62 times of DPMAS treatments, of which UFH was used in 21 times and NM was used in 41 times; after DPMAS treatment, elongation APTT and INR in NM group were 1.3(-3.6, 9.0)% and 2.5(-8.5, 16.6)%, both significantly less than [271.1(49.0, 816.5)% and 68.9(44.8, 118.8)%, respectively, P<0.05] in UFH group, and reduction rates of PTA and PLT counts were (4.2±23.7)% and 4.6(1.3, 7.6)%, both significantly lower than [(46.5±24.3)% and (13.0±12.6)%, respectively, P<0.05] in UFH group; there was no significant difference as respect to incidences of hypotension (9.8% vs. 14.3%, P>0.05), and no bleeding was found between the two groups. Conclusion Impact of nafamostat mesylate on coagulation function tests and platelet counts in patients with LF during DPMAS treatment is relatively small, and needs further clinical investigation as a limited cases observed.

Objective The aim of this study was to investigate characteristics of ileal microbiota in patients with metabolic associated fatty liver disease (MAFLD). Methods 54 patients with MAFLD and 18 individuals for physical examination were recruited in our hospital between January 2024 and November 2024, all underwent FibroScan scan for controlled attenuation parameter (CAP) and endoscopy with special device for ileal specimen collection. 16S rDNA sequencing was performed. Results Patients with MAFLD in our series were divided into mild, moderate and severe liver steatosis, with 18 cases in each; patients with MAFLD had an elevated Alpha diversity of ileal flora, with a gradual decrease in percentage of Turicibacter, a reduction in abundance of Lactobacillus and Veillonella, while having an increase in the abundance of Prevotella, Leptotrichia and Porphyromonas. Conclusion The diversity and abundance of ileal microbiota in patients with MAFLD change, which is related to the severity of the entity. The reduction of Turicibacter and the migration of oral colonizing bacteria might be characteristics of the ileal microbiota in patients with MAFLD.