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

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

Objective This study aimed to investigate and summarize magnetic resonance imaging (MRI) feature in patients with primary liver cancer (PLC) and radiation-induced liver injury RILI) after three-dimensional conformal radiotherapy (3D-CRT). Methods A total of 92 patients with PLC were encountered in our hospital between January 2023 and September 2025, and all received 3D-CRT therapy and underwent gadopentetate dimeglumine (Gd-DTPA)-enhanced MRI scan. MRI signal, dynamic contrast-enhancement patterns, distribution morphology, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values were recorded. Results By end of radiotherapy, RILI occurred in 22 cases (23.9%); tumor volume, doses of radiation, target volume and mean hepatic doses of radiation in patients with RILI were all greater than in those without RILI(P<0.05); percentages of hypointensity on T1-weighted imaging, hyperintensity on T2-weighted imaging, abnormal enhancement at arterial phase, decreased enhancement at portal venous phase and persistent hypointensity at delayed phase in lesions in patients with RILI were 77.3%, 86.4%, 81.8%, 72.7% and 68.2%, all significantly greater than 27.1%, 30.0%, 20.0%, 25.7% and 17.1%(P<0.05) in those without RILI; percentages of wedge-shaped distribution, insistency of enhanced area with radiotherapy dose distribution, distributed along hepatic segments or vascular courses and hyperintensity on DWI in patients with RILI were 86.4%, 90.9%, 68.2% and 81.8%, all much greater than 15.7%, 12.9%, 14.3% and 28.6%(P<0.05) in those without RILI; ADC value in patients with RILI was (1.5±0.2)×10^-3mm²/s, much greater than [(1.2±0.2)×10^-3mm²/s, P<0.05] in those without RILI. Conclusion Patients with PLC and RILI could have special MRI features, which might help clinicians make diagnosis and managements.

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.

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.

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

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

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

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

Objective The aim of this study was to explore gene polymorphisms of human leukocyte antigen (HLA) and apolipoprotein E (ApoE)in pathogenesis of chronic hepatitis B (CHB) . Methods 79 patients with CHB and 100 chronic HBV carriers were enrolled in our hospital between April 2021 and April 2024, and peripheral bloodgene polymorphisms of HLA (HLA-DQA1, HLA-DQB1, HLA-DRB1)and ApoE were detected by direct gene sequencing. Results The frequencies of HLA-DQA1*0102 and HLA-DRB1*15 allelesin patients with CHB were 13.9% and 5.7%, significantly lower than 25.0% and 14.5% (P<0.05), while the frequencies of HLA-DQA1*0501, HLA-DQB1*0301, HLA-DRB1*03 and HLA-DRB1*07 alleleswere 20.3%, 31.7%, 9.5% and 15.8%, significantly higher than 12.5%, 20.5%, 4.0% and 7.5% in HBV carriers (P<0.05); the frequencies of ε2/3 genotype and ε2 allele of ApoE gene in patients with CHB were 15.2% and 8.2%, significantly higherthan 5.0% and 3.0% in HBV carriers (P<0.05). Conclusion The gene polymorphisms of HLA and ApoE are related to pathogenesis of chronic hepatitis B. Individuals carrying HLA-DQA1*0102 and HLA-DRB1*15 alleles might protect the infection from episode, while carrying HLA-DQA1*0501, HLA-DQB1*0301, HLA-DRB1*03 and HLA-DRB1*07 allelesand/or ApoE ε2 allele might have more chances to breakout.

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

Objective The aim of this study was to 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.

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

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

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

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

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

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

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

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

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

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

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

Objective The aim of this study was to investigate ultrasonic transient elastography (TE) in predicting liver fibrosis (LF) in patients with chronic hepatitis B (CHB) and concomitant liversteatosis(LS). Methods 100 patients with CHB and LS were encountered in our hospital between January 2023 and June 2024, and all underwent MRI for proton density fat fraction (MRI-PDFF) and TE scan for controlled attenuation parameter (CAP) and liver stiffness measurement (LSM). Multivariate Logistic regression analysis was applied to evaluate risk factors for LS occurrence. Results Of the 100 patients with CHB and LS, MRI-PDFF found mild LS in 49 cases (49.0%), moderate LS in 28 cases (28.0%) and severe LS in 23 cases (23.0%); body mass index (BMI), serum triglyceride, low density lipoprotein cholesterol (LDL-C), LSMand CAP in CHB patients with severe LS were (28.8±2.2)kg/m², (3.6±0.3)mmol/L, (3.9±0.5)mmol/L, (10.5±2.0)kPa and (317.5±20.0)dB/m, all significantly higher than [(26.5±2.1)kg/m², (2.5±0.3)mmol/L, (3.3±0.4)mmol/L, (7.2±1.4)kPa and (280.5±11.4)dB/m, respectively, P<0.05] in those with moderate LS or [(23.2±2.1)kg/m², (1.8±0.3)mmol/L,(2.9±0.3)mmol/L, (6.4±0.8)kPa and (257.4±4.1)dB/m, respectively, P<0.05] in those with mild LS; multivariate Logistic regression analysis showed that BMI(OR=2.818), LDL-C(OR=2.179)and CAP(OR=1.852)were all risk factors for occurrence of LS in patients with CHB(P<0.05);incidences of significant LF in CHB patients with severe, moderate and mild LS were 69.6%, 35.7% and 10.2%, significantly different among them (P<0.05). Conclusion Application ofTE is efficacious in predicting LF in patients with CHB and LS, which might help preliminarily screening in clinical practice.

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

Objective The aim of this study was to investigate differential diagnosis of dysplastic nodule (DN) and small hepatocellular carcinoma (sHCC) under background of liver cirrhosis (LC) by enhanced magnetic resonance imaging (MRI). Methods A total of 104 patients with LC and intrahepatic nodular lesions were encountered in our hospital between July 2022 and July 2025, and all underwent Gd-EOB-DTPA enhancement of 3.0 T MR. The diagnosis was proven by histo-pathological examination. Results The histo-pathological examination diagnosed DN with dimeter of (0.9±0.2)cm in 46 cases and sHCC with diameter of (1.1±0.2)cm in 58 cases in our series; DN lesions presented with high or equal signals on T1WI mostly, and with low signals on T2WI and DWI mostly, while sHCC lesions showed with low or equal signals on T1WI mostly, and with high signals on T2WI and DWI mostly; sHCC lesions demonstrated with enhancement at arterial phase, clearance at portal vein phase, low signals at hepatobiliary phase and "fast-in and fast-out" mode, and their relative apparent diffusion coefficient (ADC)was much lower than ADC lesions; the differential diagnosis by MRI was excellent with sensitivity of 89.7%, the specificity of 91.3% and the accuracy of 90.4%, and the Kappa was 0.81 as compared to histo-pathological diagnosis. Conclusion MRI by Gd-EOB-DTPA enhancement could provide differential diagnosis of DN and sHCC, and the signal intensity and enhancement mode between the two lesions were mostly different.