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.

Objective The pyroptosis is an inflammatory programmed cell death,which is characterized by the formation of plasma membrane pores mediated by caspase and the release of a large number of inflammatory mediators.In recent years,the morphological characteristics,induction mechanism and action process of pyroptosis have been gradually revealed. The pyroptosis is related to the progress of many diseases,especially in the pathogenesis of malignant tumors. In this article, we reviewed the pyroptosis and its roles in the occurrence,development and treatment of patients with hepatocellular carcinoma.

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

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 explore the diagnostic performance of FibroScan, magnetic resonance imaging proton density fat-fraction (MRI-PDFF) and FibroScan-AST(FAST)score in judging patients with high risk non-alcoholic steatohepatitis (NASH) from those with non-alcoholic fatty liver diseases (NAFLD). Mthods A total of 107 patients with NAFLD were encountered in our hospital between June 2017 and December 2021, and all patients underwent liver biopsies. FibroScan, MRI-PDFF and serological detection were completed and three non-invasive models of FAST, FIB-4 and APRI were calculated. Univariate and multivariate Logistic regression analysis was used to screen out factors impacting high-risk NASH. The diagnostic performance of relevant parameters and three non-invasive models to identify high risk NASH was analyzed by ROC curve. Result Of 107 patients with NAFLD, the histo-pathological examination showed high risk NASH in 13 cases (12.1%), and simple alcoholic fatty liver and non-high risk NASH in 94 cases (87.9%); liver stiffness measurement (LSM) by Fibroscan, FAST score and aspartate aminotransferase/platelets (APRI) in patients with high risk NASH were significantly higher than in those with non-high risk NASH (P＜0.05);multivariate Logistic regression analysis showed that only the LSM was the independent risk factor impacting high risk NASH(P＜0.05);ROC analysis demonstrated that the LSM, FAST and APRI could identify high risk NASH(P＜0.05), with AUCs of 0.795, 0.713 and 0.682, and the LSM got the optimal diagnostic efficacy, with sensitivity (Se) and specificity (Sp) of 92.3%and 54.3% based on exclusion cut-off-value, and with Se and Sp of 53.8%and 90.4% based on inclusion cut-off-value. Conclusion The simultaneous increased LSM in patients with NAFLD hints existence of NASH, which might help clinicians make appropriate measures to tackle it.

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.

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 The clinical feature and biochemical response to immunosuppressive therapy were compared between patients with primary biliary cholangitis (PBC) and PBC-autoimmune hepatitis (AIH)overlap syndrome (OS). Methods 64 patients with PBC and 27 patients with PBC-AIH OS were encountered in our hospital between May 2017 and February 2023, and all undergone liver biopsies. The patients in the two groups were treated by ursodeoxycholic acid (UDCA) or UDCA and prednisone combination, and response were assessed by one year. Results Serum AST, globulin and IgG levels in patients with PBC-AIH OS were 103.5(74.5, 213.3)U/L, 34.2±7.3g/L and 19.1±8.1g/L, all significantly higher than [71.0(32.0, 119.0)U/L,30.2±6.2g/L and 14.7±5.3g/L, respectively, P<0.05] in patients with PBC; histo-patholocially, hepatic activity index, fibrosis staging, interfacial inflammation, fusion necrosis and portal inflammation in patients with PBC-AIH OS were much more severe than in those with PBC(P<0.05); by one year, complete, partial and non-biochemical response were 56.3%, 26.7% and 17.2% in 64 patients with PBC, while they were 44.4%, 37.0% and 18.5% in 27 patients with PBC-AIH OS. Conclusion PBC and PBC-AIH OS predominantly involve in middle-aged and elderly women, and there is little discrepancy in clinical manifestations and characteristic serum autoimmune antibodies between the two groups, while the intrahepatic histo-pathologic damage were obviously severe in patients with PBC-AIH OS, with relatively poor response rate to immunosuppressive therapy, which warrants close surveillance in clinical practice.

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 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 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 The aim of this study was to investigate intestinal barrier function index changes in patients with compensated hepatitis B liver cirrhosis (LC) and high serum viral loads undergoing tenofovir alafenamide fumarate (TAF) or entecavir (ETV) therapy. Methods 64 patients with compensated hepatitis B-induced LC and high serum viral loads (HBVDNAswere 1equal to or greater than×10⁶ IU/mL) were enrolled in our hospital between January 2020 and January 2023, and we randomly assigned them to receive TAF (observation, n=32) or to ETV (control, n=32) therapy. The regimen continued and antiviral efficacy was assessed by end of 12 months. Urine lactulose/mannitol (L/M) ratio was detected by high performance liquid chromatography. Serum D-lactic acid was measured by colorimetry, serum diamine oxidase (DAO) by ultraviolet colorimetry, and serum endotoxin and interleukin-7 (IL-7) levels was assayed by EIISA. Serum procalcitonin (PCT) level was determined by chemiluminescence immunoassay, and heparin-binding protein (HBP) level was detected by immunofluorescence quantitative method. Results By end of 12-month antiviral treatment, complete virological and biochemical responses were obtained in the two groups, and there were no significant differences as respect to serum bilirubin, ALT and AST levels in the two groups (P>0.05); serum DAO, D-lactic acid, endotoxin and urine L/M ratio in the observation group were (2.8±0.6)U/mL, (7.9±1.8)μg/mL, (0.5±0.1)EU/mL and (7.3±1.6)%, all not significantly different compared to [(3.0±0.5)U/mL, (7.8±2.2)μg/mL,(0.6±0.1)EU/mL and (8.1±1.9)%, respectively, P>0.05] in the control; serum PCT, HBP and IL-7 levels were (0.01±0.00)μg/L, (43.1±3.7)ng/mL and (768.9±20.3)pg/mL, also not significantly different as compared to [(0.02±0.01)μg/L,(47.6±3.2)ng/mL and (743.4±21.5)pg/mL, respectively, P>0.05] in the control groups. Conclusion Both TAF or ETV has a satisfactory antiviral efficacy in treatment of patients with compensated hepatitis B-induced LC, without intestinal barrier function damage.

Objective This experiment was conducted to explore effect of liraglutide (Lira) on steatosis in HepG2 cells in vitro. Methods The HepG2 cells were divided into five groups, cell steatosis model were induced by 0.25 mmol/L palmitic acid (PA) incubation, and then intervened by silent information regulator 1(Sirt1) inhibitor, Lira or Sirt1 and Lira combination. Oil red O was stained for lipid droplets, and nicotinamide adenine dinucleotide oxidation/reduced state ratio (NAD⁺/NADH), ALT, AST and triglyceride (TG) contents were determined. Liver kinase B1 (LKB1), free fatty acid (FFA), acetyl-CoA carboxylase (ACC) and adiposetriglyceride lipase (ATGL) mRNA loads were detected by RT-qPCR, and p-adenosine monophosphate-activated protein kinase (AMPK)/sterol regulatory element binding protein 1c(SREBP1c) and p-Sirt1 expression were detected by Western blot. Results Intrahepatocellular lipid droplets were clearly observed in PA-intervened HepG2 cells, which were even more severe in PA/Sirt1-intervened cells, while the lipid droplets obviously reduced in PA/Lira- and PA/Sirt1/Lira-intervened cells, suggesting the model establishment successful and protective effect of Lira; FFA and ACC mRNA loads in PA-intervened cells increased greatly compared to that in control cells (P<0.01), LKB1 and ATGL mRNA loads in PA/Lira-treated cells increased greatly compared to that in PA-treated cells (P<0.001), while FFA and ACC mRNA loads decreased greatly as compared to that in PA-treated cells (P<0.01); LKB1 and ATGL mRNA loads in PA/Sirt1/Lira-treated cells were much higher (P<0.01), while FFA mRNA loads was much lower than in PA/Sirt1-treated cells (P<0.05); p-AMPK and p-Sirt1 protein expression in PA-intervened cells were down-regulated, while SREBP1c expression was up-regulated as compared to that in control cells; p-AMPK expression in PA/Lira-treated cells was up-regulated, while SREBP1c expression was down-regulated compared to that in PA-treated cells; p-AMPK expression in PA/Sirt1/Lira-treated cells was up-regulated compared to that in PA/Sirt1-treated cells. Conclusion Lira could attenuate intracellular fat accumulation in HepG2 cells in vitro, which might be ascribed to direct up-regulation of SIRT1/AMPK signaling pathway or to partially activation of LKB1 leading to increased expression of AMPK protein and inhibition of SREBP1c expression.

Objective The aim of this study was to explore bile acid (BA) composition changes and their impact of response to immunosuppressant or ursodeoxycholic acid (UCDA) therapy in patients with autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC). Methods 28 patients with AIH and 55 patients with PBC were encountered in our hospital between January 2020 and January 2023, and they received prednisone or UDCA therapy. Serum free BAs, including cholic acid (CA), deoxycholic acid (DCA), chenodeoxycholic acid (CDCA), ursodeoxycholic acid (UDCA) and lithocholic acid (LCA), lycine-binding BAs(G-BAs), including glycocholic acid (GCA), glycodeoxycholic acid (GDCA), glycodeoxycholic acid (GCDCA) and glycodeoxycholic acid (GUDCA), and taurocholate-binding bile acid (T-BAs), including taurine cholic acid (TCA), taurine deoxycholic acid (TDCA), taurine deoxycholic acid (TCDCA) and taurine lithocholic acid (TLCA) levels were detected by liquid chromatography tandem mass spectrometry. Results By end of six month treatment, complete response to therapy in patients with AIH was found in 20 cases (71.4%) and in patients with PBC was found in 42 cases (76.4%); serum CA, CDCA, UDCA and LCA levels in AIH responders were (1.6±0.5)ng/ml, (2.6±0.4)ng/ml, (2.0±0.3)ng/ml and (0.7±0.4)ng/ml, all significantly lower than [(2.4±0.7)ng/ml, (2.9±0.4)ng/ml, (2.4±1.0)ng/ml and (0.9±0.7)ng/ml, respectively, P<0.05], serum GCA, GDCA, GCDCA and GUDCA levels were (1.3±0.5)ng/ml, (2.6±0.3)ng/ml, (2.9±0.3)ng/ml and (1.6±0.5)ng/ml, all significantly lower than [(3.0±1.0)ng/ml, (3.2±0.6)ng/ml, (3.8±0.8)ng/ml and (2.6±1.2)ng/ml, respectively, P<0.05], and serum TCA, TDCA, TCDCA and TLCA levels were (0.5±0.1)ng/ml, (2.6±0.2)ng/ml, (2.5±0.3)ng/ml and (0.1±0.0)ng/ml, all significantly lower than [(2.1±1.2)ng/ml, (3.3±0.6)ng/ml, (2.7±0.4)ng/ml and (0.4±0.1)ng/ml, respectively, P<0.05] in non-responders; serum CA, CDCA, UDCA and LCA levels in PBC responders were(1.7±0.4)ng/ml, (2.7±0.4)ng/ml, (2.1±0.4)ng/ml and (0.8±0.4)ng/ml, all significantly lower than [(2.3±0.9)ng/ml, (3.0±0.4)ng/ml, (2.5±0.7)ng/ml and (1.3±0.7)ng/ml, respectively, P<0.05], serum GCA, GDCA, GCDCA and GUDCA levels were (1.4±0.7)ng/ml, (2.6±0.4)ng/ml, (3.0±0.5)ng/ml and (2.0±0.9)ng/ml, all significantly lower than [(2.9±0.9)ng/ml, (3.2±0.5)ng/ml, (3.8±0.7)ng/ml and (3.0±1.1)ng/ml, respectively, P<0.05], and serum TCA, TDCA, TCDCA and TLCA levels were (0.5±0.2)ng/ml, (2.7±0.3)ng/ml, (2.5±0.4)ng/ml and (0.2±0.1)ng/ml, all significantly lower than [(2.1±0.9)ng/ml, (3.2±0.5)ng/ml, (2.8±0.4)ng/ml and (0.5±0.2)ng/ml, respectively, P<0.05] in non-responders. Conclusion There are significant differences in serum bile acid levels between patients with PBC and with AIH, and serum BAs changes might be involved in pathogenesis of autoimmune liver diseases, and have some influence on outcomes of the diseases.

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 experiment aimed at exploring the mechanism ofprotective role of puerarin on ketoconazole-induced liver injury in rats. Method 48 male SD rats were randomly divided into control, model, low-dose and high-dose of puerarin-intervened groups (n=12 in each).Model was established by oral ketoconazole gavage, and intervention was carried out by oral ketoconazole and low-dose and large-dose of puerarin gavage simultaneously. Hepatic tissue aromatic hydrocarbon receptors (AHR), cytochrome P450 1A1(CYP1A1), and CYP2E1 mRNA levelswere assayed by RT-PCR, and hepatic expression of AHR protein was detected immunohistochemically. Results The model of liver injury was successfully established as proved enzymologically and histopathologically, and the intervention of puerarin greatly improved liver injury; hepatic tissue GSH level in low-dose puerarin-intervened group was (148.2±9.5)μM, much higher than [(77.0±9.1)μM,P<0.05], while GSSG level was (84.7±9.3)μM, much lower than [(131.4±13.4)μM, P<0.05] in the model, and in large-dose of puerarin intervention group, the changes were even more obviously; relative hepatic loads of AHR, CYP1A1 and CYP2E1 mRNA in low-dose of puerarin intervention were (28.4±3.3), (23.7±1.8)and (9.0±1.5), all significantly lower than [(51.7±7.8),(36.2±4.7) and (14.0±1.5), respectively, P<0.05] in the model, and the changes were even more obvious in large-dose of puerarin intervention; AHR expression in liver tissues with puerarin intervention was obviously weaker as compared in the model. Conclusion Puerarin could ameliorate ketoconazole-induced liver injury in rats, which might be related to inhibition of oxidative stress pathway mediated by AHR.

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.

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

Objective This study was conducted to investigate 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.

Objective The aim of this study was to investigate prediction of nonalcoholic steatohepatitis (NASH) by ultrasonic attenuation coefficient (UAC) or controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) combination in patients with nonalcoholic fatty liver diseases (NAFLD). Methods 87 patients with NAFLD were recruited in our hospital between June 2020 and June 2023, and all underwent liver biopsies and ultrasonography for UAC detection or Fibrotouch for CAP and LSM detection. Receiver operating characteristic (ROC) was applied to predict existence of NASH. Results Histopathological examination showed simple fatty liver(SFL) in 61 cases and NASH in 26 cases; the UAC, CAP and LSM in patients with NASH were (0.9±0.1)dB/cm·MHz, (327.4±30.6)dB/mand (11.6±1.6)kPa, all significantly greater than [(0.6±0.1)dB/cm·MHz, (266.3±21.5)dB/m and (6.7±0.4)kPa, respectively, P＜0.05] in patients with SFL; the area under ROC (AUC) was 0.9, with sensitivity (Se) of 84.0% and specificity (Sp) of 87.6%, when CAP of 315.2 dB/m and LSM of 10.3 kPa were combined as cut-off-value (COV) in predicting existence of NASH, much superior to that by UAC (COV was 0.9 dB/cm·MHz, AUC was 0.8, Se was 80.0% and Sp was 72.4%, P<0.05). Conclusion Combination of CAP and LSM in predicting occurrence of NASH in patients with NAFLD has a satisfactory diagnostic performance, which might help to screen in clinical practice.

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 analyze influencing factors of patients with acute-on-chronic hepatitis B liver failure (HBV-ACLF) complicated by hospital-acquired pneumonia (HAP). Methods A total of 101 patients with HBV-ACLF and HAP were encountered in our hospital between January 2018 and December 2022, and all received comprehensive internal medical and liver-supporting treatment. Sputum culture and bacteria characterization were routinely performed. Univariate and multivariate Logistic regression analysis was applied to analyze independent risk factors influencing prognosis. Results Of 101 patients with HBV-ACLF and HAP, sputum obtained positive results in 76 cases (75.3%), and out of them, Gram positive pathogenic bacteria strain was found in 30 cases (39.5%), Gram negative in 11 cases (14.5%) and fungus in 35 cases (46.1%); 50 patients (49.5%) died and 51 patients (50.5%) survived during (44.7±24.4)day hospital stay; ages, plasma lactate level, model of end-stage liver disease score, percentages of concomitant spontaneous bacterial peritonitis (SBP) and gastrointestinal bleeding (GIB) in dead patients were(57.3±12.1)yr, (2.7±2.1)mmol/L, (27.5±6.9)point, 66.0% and 42.0%, all much higher than [(50±12.8)yr, (1.6±0.8)mmol/L, (22.5±7.3)point, 31.4% and 5.9%, respectively, P＜0.05] in survivals; multivariate Logistic regression analysis showed that age (OR=1.054, 95%CI:1.005-1.110), plasma lactate level (OR=2.339, 95%CI:1.255-5.031), concomitant SBP(OR=6.784, 95%CI:2.139-25.206) and GIB (OR=18.504, 95%CI:3.973-122.636) were the independent risk factors impacting prognosis (P＜0.05). Conclusion The patients with HBV-ACLF and HAP have a poor prognosis, clinicians should pay more attention to those who are elderly and with more than one complications, and take an appropriate measures in time to improve the outcomes.

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.

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.

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 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 influencing factors of infections in patients with hepatitis B-induced liver cirrhosis (LC) and acute-on-chronic liver failure (ACLF). Methods 323 patients with hepatitis B-induced LC, 124 patients with ACLF type A (with underlying chronic hepatitis B) and 184 patients with ACLF type B (with underlying compensated LC) were encountered in our hospital during last eight years. Multivariate Logistics regression analysis was applied for influencing factors of infections, and Kaplan-Meier curves were used for 90-day survival analysis. Results Incidences of infections in patients with LC, with ACLF type A and ACLF type B were 31.0%, 32.1% and 44.0%, with spontaneous bacterial peritonitis more common; age older, serum albumin level decreased, total serum bilirubin (TSB) level and prothrombin time international standardized ratio increased, incidence of hepatic encephalopathy and gastrointestinal hemorrhage (GIH) increased in patients with infections no matter in which groups(P＜0.05); Logistics regression analysis showed that age, TSB, and GIH were all the independent risk factors for infections, while serum albumin level was a protective one; fatality rate in patients with LC was 16.0%, not significantly different compared to 15.2% in those without infection(P>0.05), while they were 57.5% in those with ACLF type A and 65.4% in with ACLF type B, both significantly higher than 14.3% and 27.2% (P＜0.05) in patients without infections; survival curve analysis showed that survival rate in HBV-ACLF type A patients without infection was 5.713 times higher than in patients with infection, and survival rate in HBV-ACLF type B patients without infection was 3.364 times higher than in those with infection. Conclusion Patients with HBV-induce LC and ACLF have higher risk of infection, and we should take risk factors into consideration in clinical practice, which might improve outcomes of them.

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 This study was conducted to investigate the therapeutic efficacy of prednisone and azathioprine combination in the treatment of patients with autoimmune hepatitis (AIH). Methods There were 52 consecutive patients with AIH recruited in our hospital between January 2020 and January 2023, and they were randomly divided into observation (n=26) and control (n=26). All the patients in the two groups took prednisone and azathioprine combination therapy, the dose of prednisone in the control group was tapered relatively rapidly, while in the combination group was slowly week by week. Serum IgG, IgA and IgM levels were detected by ELISA, and peripheral blood lymphocyte subsets were determined by FCM. Results At the end of six-month treatment, serum ALT and AST levels in the observation group were (32.4±7.5)U/L and (31.9±5.2)U/L, both significantly lower than [(46.8±10.1)U/L and (43.6±7.7)U/L, respectively, P<0.05] in the control; serum IgA, IgM and IgG levels were (3.4±0.6)g/L, (3.5±0.8)g/L and (15.3±2.1)g/L, all much lower than [(4.1±0.5)g/L, (4.1±0.6)g/L and (19.8±6.7)g/L, P<0.05] in the control group; the percentages of peripheral blood T lymphocytes, B lymphocytes, inhibitory/cytotoxic T lymphocytes and the ratio of CD4⁺/CD8⁺ cells were(0.7±0.2)%, (12.1±3.5)%, (24.1±3.4)% and (1.2±0.2), all significantly lower thn [(0.9±0.2)%, (16.4±5.1)%, (28.4±3.1)% and (1.4±0.3), respectively, P<0.05] in the control; the incidence of untoward effects in the observation group was 50.0%, much higher than 7.7%(P<0.05) in the control group. Conclusion The regimen of prednisone and azathioprine combination in treatment of patients with AIH has definite clinical efficacy, while the way of dose tapering needs further investigation.

Objective The aim of this study was to investigate efficacy and safety of sofosbuvir and dacatavir combination in the treatment of patients with end-stage renal disease (ESRD) and concomitant chronic hepatitis C (CHC). Methods 42 CHC patients with ESRD were encountered in our hospital between May 2020 and May 2022, and all underwent maintenance hemodialysis. DAAs regimen was carried out by sorfosbuvir and dacatavir combination for all patients for 12 weeks and followed-up for 12 months. HCV genotypes was conducted by Simmonds gene typing. Rapid virological response (RVR), end of treatment virological response (ETVR), sustained virologic response six month (SVR6) and SVR12 were recorded. Results Genotypes infected in our series were 1b in 22 cases, 2a in 9 cases, 2b in 6 cases and 3 in 5 cases; except for SVR6 and SVR12 were 80.0% in patients with genotype 3 infection, the RVR, ETVR and SVR6 and SVR12 were all 100.0%(P>0.05) in patients with other three HCV genotype infection; by end of 12 month follow-up, serum ALT level in 42 patients with CHC was 23(20, 38)U/L, AST was 21(17, 35)U/L, both significantly lower than [61(42, 92)U/L and 59(45, 83)U/L, respectively, P<0.05] at baseline, while peripheral blood platelet count was 155(130, 194)×10⁹/L, and estimated glomerular filtration rate (eGFR) was 14.9(12.5,17.3)ml/min×1.73 m², both significantly higher than [122(98, 141)×10⁹/L and 9.3(8.0, 11.5)ml/min×1.73m², respectively, P<0.05] at baseline; there were no significant differences as respect to serum creatinine and urea levels before and after antiviral treatment (P>0.05); during direct antiviral agent (DAA) therapy, incidence of eight adverse events, including nausea, fatigue, itching, anorexia, hyperkalemia, hypoglycemia, hypertension and joint pain occurred in 55 episodes. Conclusion Application of DAA in dealing with patients with ESRD and complicated CHC have a satisfactory efficacy and safety, which warrants further clinical investigation.

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.