Hepatocellular carcinoma (HCC) has complex biological characteristics, highly heterogeneous property and immunosuppressive tumor microenvironment. HCC carries a dismal prognosis. Metabolic reprogramming (MR) is one of the most important features of tumor cells and the lipid metabolism has been an important mechanism underlying HCC growth and metastasis. In this article, we review the roles of common lipid and its metabolism-related molecules in carcinogenesis of HCC and provides new targets for therapy of HCC.

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 mechanisms of hepatocarcinogenesis have not been fully elucidated. Krüppel-like factors (KLFs), the largest family of zinc finger protein (ZFP) transcription factors in humans, have recently been found to play a promoting or inhibiting role in hepatocellular carcinoma (HCC) progression. Basic and clinical studies have shown that part of KLFs might be used as molecular markers for diagnosis and for predicting prognosis of patients with HCC. It is also possible as a molecular targets for gene therapy. This article reviews the tissue distribution, expressing features and clinical application of HCC-related KLFs.

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

Objective The aim of this study was to explore causal relationship between cholelithiasis and primary sclerosing cholangitis (PSC). Methods Materials of patients with PSC were retrieved from International PSC Genetics Research Group (IPSCSG) and Finnish Biobank (FinnGen R10), and Mendelian randomization (MR) analysis was conducted by integrating summary data of published genome-wide association studies. Genetic instruments closely associated with cholelithiasis were extracted, and then causal relationship between cholelithiasis and PSC was estimated by using inverse-variance weighted (IVW) and weighted median (WM) methods. Finally, reverse MR was applied to assess whether PSC could lead to altered risk of cholelithiasis. Results Forward MR analysis found that genetic susceptibility to cholelithiasis could increase the risk of PSC (OR_IVW: 1.379, 95%CI: 1.052-1.807, P=0.020; OR_WM: 1.450, 95%CI: 1.014-2.074, P=0.042), and this result was validated in the FinnGen (OR_IVW: 1.989, 95%CI: 1.517-2.610, P=6.76×10^-7; OR_WM: 1.931, 95%CI: 1.302-2.865, P=0.001); reverse MR analysis found that genetically-predicted PSC did not alter the risk of cholelithiasis (OR_IVW: 1.008, 95%CI: 0.991-1.024, P=0.356). Conclusion This MR study find cholelithiasis is an important risk factor for occurrence of PSC, and the reverse causality is not established.

Objective This study was conducted to investigate the assessment of significant liver fibrosis (SLF) by visual instantaneous elastography (VIE) and acoustic palpation elastography (APE) in patients with chronic hepatitis B (CHB). Methods 121 patients with CHB were encountered in our hospital between October 2020 and October 2022, and all patients underwent liver biopsies for liver fibrosis staging and ultrasonography for liver stiffness measurement (LSM). The area under the receiver operating characteristic curve (AUROC) was drawn to reveal the diagnostic performance of LSM for predicting the SLF. Results Out of the 121 patients with CHB, the liver histo-pathological examination showed SLF in 95 cases, and non-significant liver fibrosis (NSLF) in 26 cases; the LSMvie and LSMape, serum aspartate aminotransferase and alanine aminotransferase levels in patients with SLF were (9.3±3.0)kPa,(9.3±3.1)kPa, (127.5±33.4)U/L and (137.8±38.8)U/L, all significantly higher than [(5.9±1.4)kPa, (6.0±1.5)kPa, (98.6±25.8)U/L and (90.5±28.7)U/L, respectively,P<0.05], while the blood platelet count was (125.8±41.5)×10⁹/L, much lower than [(192.3±51.7)×10⁹/L, P<0.05] in patients with NSLF; the sensitivity, specificity, accuracy, positive predictive value and negative predictive value by VIE in predicting SLF in patients with CHB were 95.8%, 88.5%, 94.2%, 96.8% and 85.2%, not significantly different as compared to 94.7%, 84.6%, 92.6%, 95.7% and 81.5% by APE (P>0.05). Conclusion The diagnostic accuracies of VIE and APE in predicting SLF in patients with CHB are both great, which might be useful in clinical practice, and warrants further investigation.

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 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 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 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 compare efficacy of laparoscopic transcystic common bile duct exploration (LTCBDE) andlaparoscopic common bile duct exploration (LCBDE) in dealing with patients with gallbladder stones (GS) and extrahepatic bile duct stones(EBDS). Methods A total of 168 patients with GS and EBDS were enrolled in our hospital between January 2022 and January 2024, and we assigned them to LCBDE in 123 cases in control groupand to LTCBDE in 45 cases in observation group. Serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) levels were detected by ELISA, and blood biochemical parameters were routinely assayed. Results Operation time, intra-operational bleeding, anal exhaust time, post-operationalhospital stay and medical cost in the observation group were(104.4±34.2)min,(29.9±11.2)ml, (22.3±10.1)h, (6.5±2.9)d and (14000±600)yuan, all significantly shorter or less tan [(149.9±37.4)min, (43.6±16.3)ml, (28.4±9.6)h, (9.2±2.4)d and (18000±700)yuan, respectively, P＜0.05] in the control; total stone clearance was obtained in the two groups; three days after operation, serum TNF-α and IL-6 levels in the observation group were(32.5±5.9)ng/L and (25.4±7.1)pg/L, both significantly lower than [(40.3±6.8)ng/L and (35.6±6.4)pg/L, respectively, P＜0.05] in the control; post-operationally, incidences of biliary leakage, biliary tract infection, abdominalinfection, biliary tract hemorrhage and acute pancreatitis in the observation were 0.0%, 2.2%, 2.2%, 0.0% and 0.0%, all not significantly different compared to 2.4%, 0.0%, 4.1%, 1.6%and 2.4% in the control group (P＞0.05). Conclusion Both LCBDE and LTCBDE have good efficacy for stone clearance in patients with GS and EBDS, and we recommend LTCBDE for good postoperative recovery and less economic costs.

Objective This experiment was conducted to explore the mechanism of protective roles of histone deacetylase (HDAC) inhibitor ACY1215 in inhibition of acute liver failure (ALF). Methods Thirty mice were randomly divided into control, model and ACY1215-intervened groups, with 10 animals in each. ALF model was established by combination of lipopolysaccharide and D-aminogalactose intraperitoneal injection, and early intraperitoneal ACY1215 injection was carried out as intervention. Histopathological examination was performed. Hepatic expression of malate dehydrogenase 1 (MDH1),isocitrate dehydrogenase (IDH1),and fructose-2,6-bisphosphatase 2 (PFKFB2) as well as interleukin-1β (IL-1β) and IL-18 were detected by Western blot. Results Histopathological examination demonstrated the ALF model was successfully established, and ACY1215 intervention greatly ameliorate liver injuries; serum ALT, AST and total bilirubin levels in the model group were (3743.5±655.9)U/L, (2539.4±488.1)U/L and (89.56±7.2)μmol/L, significantly higher than [(34.5±7.6)U/L, (32.3±9.3)U/L and (6.2±2.4)μmol/L, respectively, P < 0.05] in the control, while ACY1215 intervention greatly decreased those parameters, e.g., (951.5±328.9)U/L, (475.3±131.24)U/L and (38.41±9.5)μmol/L (P<0.05); hepatic expression of MDH1 and IDH1 in the model was obviously weaker, that of PFKFB2, IL-18 and IL-1β was greatly intensified as compared to in the control, while in ACY1215-intervende group, the expression of MDH1 and IDH1 intensified, and PFKFB2, IL-18 and IL-1β weakened compared to in the model group. Conclusion The histone deacetylase inhibitor, ACY1215, could have a protective effects on mice with ALF, the mechanism by which it exert might be related to regulation of energy metabolism enzymes.

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.

Objective The aim of this study was to investigate efficacy of tenofovir alafenamide fumarate (TAF) and Ganshuang granules, a herbal medicine compound, combination in the treatment of patients with chronic hepatitis B (CHB). Methods 76 patients with CHB were enrolled in our hospital between January 2020 and December 2023, and were randomly divided into control (n=38) and observation group (n=38). They were treated with TAF or TAF and herbal medicine combination for 48 weeks. Serum HBV DNA load was assayed by real-time fluorescence quantitative PCR, and serum HBeAg level was detected by chemiluminescence immunoassay. TCM syndromes scores were evaluated according to the Guidelines for the Traditional Chinese Medicine Diagnosis and Treatment of Chronic Hepatitis B (2018 Edition). Fibrosis index based on four factors (FIB-4) was obtained and liver stiffness measurement (LSM) was detected by transient elastography. Serum transforming growth factor-β1 (TGF-β), matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels were determined by ELISA. Results By end of 48 week treatment, ALT normalization rate in the observation group was 94.7%, much higher than 78.9%(P<0.05) in the control; scores of distending pain at hypochondrium, yellow and greasy tongue coating, poor appetite and nausea and yellow urine in the observation group were(0.9±0.1), (1.0±0.2), (0.9±0.1) and (0.7±0.1), all much lower than [(1.3±0.2), (1.3±0.2), (1.2±0.2) and (0.9±0.2), all P<0.05] in the control; FIB-4 score, LSM, serum TGF-β1 and TIMP-1 levels were (1.8±0.3), (7.0±0.6)kPa, (21.4±5.4)ng/mL and (119.3±19.5)ng/mL, all significantly lower than [(2.2±0.4), (9.7±1.1)kPa, (39.1±6.1)ng/mL and (168.9±22.3)ng/mL, respectively, P<0.05], while serum MMP-1 level was (9.8±1.2)ng/mL, significantly higher than [(7.1±1.0)ng/mL, P<0.05] in the control group. Conclusion Combination of TAF and Ganshuang granules in the treatment of patients with CHB could significantly reduce TCM syndrome scores, improve liver function and relieve liver fibrosis.

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 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 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 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 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 antiviral efficacy of tenofovir alafenamide (TAF) and peginterferon interferon α-2b (PEG-IFNα-2b) combination in treatment of patients with chronic hepatitis B (CHB). Methods A total of 122 patients with CHB were enrolled in our hospital between March 2021 and March 2023, and were randomly divided into control (n=61) and observation (n=61) group, receiving TAF or TAF and PEG-IFNα-2b combination for antiviral therapy for 48 weeks. Serum HBV DNA loads were detected by real-time fluorescence quantitative PCR, serum HBeAg and HBsAg levels were assayed by electrochemiluminescence, and serum Toll-like receptor 4 (TLR4) and interleukin-35 (IL-35) levels were determined by ELISA. Results By end of 24-week and 48 week treatment, serum HBeAg levels in the combination group were(195.3±36.4)IU/ml and (180.6±25.9)IU/ml, both significantly lower than [(236.1±42.5)IU/ml and (217.5±33.8)IU/ml, P＜0.05], and serum HBsAg levels were (925.1±226.9)IU/ml and (816.2±175.3)IU/ml, significantly lower than [(1028.4±251.5)IU/ml and (921.7±226.8)IU/ml, P＜0.05] in TAF-treated patients; serum HBeAg negativity rates was 21.3% and 29.5%, both significantly higher than 3.3% and 6.6%(P＜0.05) in TAF group; serum TLR4 levels were (68.6±17.4)pg/mL and (41.4±15.9)pg/mL, both much lower than [(90.1±20.5)pg/mL and (73.5±18.2)pg/mL, respectively, P＜0.05], and serum IL-35 levels were (127.9±25.5)pg/mL and (73.5±18.6)pg/mL, both much lower than [(191.4±30.6)pg/mL and (102.7±26.1)pg/mL, respectively, P＜0.05] in TAF group. Conclusion TAF and PEG-IFNα-2b combination in treatment of patients with CHB is efficacious, with a satisfactory serumHBeAg negativity, which might be related to reduced expressions of TLR4 and IL-35 and needs further 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 purpose of this study was to investigate short-term and long-term efficacy of patients with primary liver cancer (PLC) after hepatic arterial chemoembolization (TACE) and radiofrequency ablation (RFA) combination therapy. Methods A total of 92 patients with PLC were encountered in our hospital between January 2016 and March 2018, and were randomly divided into control group (n=46) and observation group (n=46), receiving TACE or TACE and RFA combination treatment. All patients were followed-up for three years. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin-2(IL-2), IL-6 and tumor necrosis factor-α(TNF-α) levels were detected. Results Short-term efficacy (complete and partial remission) in the observation group was 82.6%, much higher than 58.7%(P＜0.05) in the control; by end of one year after treatmenyt, serum hs-CRP, IL-6 and TNF-α levels in 44 survivals in the observation group were(5.1±2.0)ng/L, (97.3±12.2)ng/L and (47.8±5.8)pg/mL, significantly lower than [(8.2±1.6)ng/L, (110.3±15.5)ng/L and (53.5±6.8)pg/mL, respectively, P＜0.05], while serum IL-2 level was (3.4±0.4)ng/L, significantly higher than [(3.0±0.5)ng/L, P＜0.05] in 38 survivals in the control group; one-year, two-year and three-year survival rates in the observation group were 95.7%, 84.8% and 78.3%, all much higher than 82.6%, 65.2% and 54.4%(P＜0.05) in the control. Conclusion Application of TACE and RFA combination in the treatment of patients with PLC is efficacious, with a satisfactory short-term and long-term survivals, which might improve body immune functions.

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 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 The aim of this study was to investigate clinical antiviral efficacy of tenofovir amibufenamide (TMF) and entecavir (ETV) in the treatment of patients with chronic hepatitis B (CHB) and low-level viremia (LLV). Methods 79 patients with CHB were encountered in our hospital between April 2021 and April 2023, and all met enrollment criteria, e.g., receiving nucleos(t)ide analogues (NAs), including lamivudine, adefovir and ETV antiviral treatment for 4 to 22(12.1±3.6)yrs and having LLV (21 to 1999 IU/mL). Patients were divided into control (n=39) and observation (n=40) groups, receiving ETV or TMF treatment for 12 months. Serum HBV DNA loads were detected by high-sensitive real-time fluorescence quantitative PCR, serum HBsAg and HBeAg were assayed by chemiluminescence immunoassay, and routine blood and biochemical parameters were determined to obtain fibrosis-4 index (FIB-4) and estimated glomerular filtration rate (eGFR). Liver stiffness measurement (LSM) was detected by Fibroscan. Peripheral blood T lymphocyte subsets were measured by flow cytometry. Results By end of 48-week treatment, serum ALT and AST levels in the observation group were(30.2±4.0)U/L and (31.8±6.2)U/L, both not significantly different compared to [(30.9±3.6)U/L and (33.7±7.0)U/L, respectively] in the control (P>0.05), while serum HBV DNA loads was 25(14.8, 51.9)IU/mL, much lower than [223.8(87.2, 327.5)IU/mL, P<0.05] in the control; LSM, FIB-4 and eGFR were (7.0±0.8)kPa, (1.9±0.3) and (104.9±10.3)mL/min/1.73m², not significantly different as compared to [(7.1±0.9)kPa, (1.8±0.3) and (105.1±11.2)mL/min/1.73m², respectively, P>0.05] in the control; percentages of peripheral blood CD3⁺, CD4⁺, CD8⁺ cells and CD4⁺/CD8⁺ cell ratio were (66.9±6.9)%, (37.5±4.9)%, (24.0±2.5)% and (1.5±0.3), not significantly different compared to [(67.4±7.3)%, (38.8±4.6)%, (23.6±2.7)% and (1.6±0.4), respectively, P>0.05] in the control group. Conclusion TMF treatment could relatively radically inhibit HBV DNA replication in CHB patients with LLV, and long-term benefit needs further clinical investigation.

Objective The aim of this study was to investigate assessment of stent function by color Doppler ultrasonography in patients with liver cirrhosis (LC) and portal hypertension (PH) after transjugular intrahepatic portosystemic shunt (TIPS). Methods 136 patients with LC were enrolled in our hospital between January 2020 and December 2022, and PH was defined as hepatic venous pressure gradient (HVPG)≥10 mmHg. Color Doppler ultrasonography was used to measure portal vein blood flow velocity (Vpv), portal vein diameter (Dpv) and portal vein blood flow (Qpv), and receiver operating characteristic (ROC) curve was applied to evaluate diagnostic efficacy of portal vein hemodynamic indicator combination in predicting PH. TIPS was performed routinely, and postoperative stent functions was assessed by color Doppler ultrasonography and digital subtraction angiography (DSA). Results Of 136 patients with LC in our series, PH was found in 62 cases(45.6%) based on HVPG measurement and 52 of them received TIPS; Vpv in patients with LC and PH was (13.1±2.3)cm/s, much lower than [(15.9±3.2)cm/s, P<0.05], while Dpv and Qpv were (1.3±0.3)cm and (626.8±106.8)mL/min, both much higher than [(1.1±0.2)cm and (499.9±97.2)mL/min, P<0.05] in cirrhotics without PH, and portal hemodynamic indicators restored to almost normal and showing no significant differences as compared to those in patients without PH [(16.2±2.5)cm/s, (1.1±0.2)cm and (502.1±99.4)mL/min, respectively, P<0.05]; ROC analysis showed that the AUC was 0.902(95%CI:0.849-0.955,P<0.05), with sensitivity (Se) of 79.0%, specificity (Sp) of 83.8%, when combination of Vpv, Dpv and Qpv in predicting PH; by end of one year follow-up in 52 patients after TIPS, DSA found stent dysfunction in 8 cases (15.4%), and consistency of ultrasonography was satisfactory (Kappa=0.680, P<0.05), with Se of 87.5%, Sp of 90.9%, and accuracy of 90.4%. Conclusion Color Doppler ultrasound has a good application in identifying stent dysfunction after TIPS in patients with LC and PH.

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 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.