The Chinese Society of Hepatology of the Chinese Medical Association invited relevantexperts to revise and update the Guideline of Prevention and Treatment of Nonalcoholic Fatty Liver Disease(2018Version) and renamed it as (Version 2024) Guideline for the Prevention and Treatment of MetabolicDysfunction-associated (non-alcoholic) Fatty Liver Disease. Herein, the guiding recommendations on clinicalissues such as screening and monitoring, diagnosis and evaluation, treatment and follow-up of metabolicdysfunction-associated fatty liver disease are put forward.

The nonalcoholic fatty liver disease (NAFLD) is the most common liver diseases worldwide. Currently, due to the lack of effective drugs for treatment of NAFLD, the scholars recommend reducing body weight and improving metabolism through dietary interventions. In this paper, we summarize the research progress of NAFLD-related dietary interventions and the mechanisms by which they play roles in therapeutic effects in order to better guide clinical practice.

The Epstein-Barr virus (EBV) is one of the members of the human herpesvirus family, which might cause many diseases. The children with EBV infection often have liver injury, which is usually manifested as mild to moderate liver dysfunctions. In severe cases, it can develop into liver failure and even lead to death. Most children with acute EB viral infection recover after supportive treatment. However, in cases of chronic infection or post-transplant infection, the immunomodulatory therapy, chemotherapy, and even bone marrow transplantation may be required in addition to actively management of the underlying diseases. In this review, we describes the comprehensive updates of the epidemiology, pathogenesis, diagnosis, treatment and prognosis of children with liver injury associated with EBV infection.

Objective The purpose of this study was to investigate the impact of hyperuricemia on virological response to sofosbuvir/daratavir therapy in patients with chronic hepatitis C (CHC). Methods 200 patients with CHC, including 38 patients with hyperuricemia, were recruited in our hospital between June 2018 and June 2023, and all received sofosbuvir/daratavir therapy for 24 weeks. The patients with CHC were followed-up for 24 weeks after discontinuation of the antiviral treatment. Results The body mass index, serum triglyceride level and the controlled attenuation parameter of liver in patients with hyperuricemia were (26.9±3.5)kg/m², (2.8±0.5)mmol/L and (273.5±15.3)dB/m, all significantly higher than (24.2±2.5)kg/m²,(1.9±0.6)mmol/L and (236.8±16.1)dB/m, respectively, P<0.05] in 162 patients with normal serum uric acid levels; the rapid virological response (RVR) and early virological response (EVR) in patients with hyperuricemia were 78.9% and 84.2%, both significantly lower than 96.9% and 100.0% (P<0.05) in patients with normal serum uric acid levels, while there were no significant differences as respect to the end of treatment virological response (94.7% vs. 100.0%) and the sustained virological response (97.4% vsl 100.0% (P>0.05) between the two groups; generally, serum uric acid levels in 16 male and 22 female patients with hyperuricemia at presentation decreased at the end of antiviral treatment, and the percentages of patients with decreased serum uric acid levels was 93.7% in male and 72.7% in female patients. Conclusion The hyperuricemia in patients with CHC might interfere with the early virological response to direct acting agent therapy, but do not impact the sustained virological response, and serum uric acid levels in most patients with hyperuricemia will return to normal.

Objective This study was conducted to explore the functional enrichment pathways and key genes in hepatocarcinogenesis. Methods We downloaded liver transcriptome data from the Gene Expression Database (GEO) at different stages of hepatitis B infection to hepatocellular carcinoma occurrence. Genes were categorized into different modules by weighted gene co-expression network analysis (WGCNA), and genes in different modules were enriched and analyzed. Important gene levels were further validated by GEO dataset. Results A total of 6145 differential genes were involved in the construction of WGCNA, which categorized genes into nine modules. The evolutionary trajectory from early liver lesions to tumorigenesis was further analyzed, e.g., a linear activation of pathways related to cell proliferation, DNA damage repair, and cellular senescence during the process from normal tissues to oncogenesis; a gradual suppression of pathways related to liver function, such as lipid metabolism and coagulation was found with disease progression; and activation of immune-related pathways was also revealed during the period of chronic inflammation prior to tumors, with a gradual convergence to an inhibitory state in the later stage; Three important senescence-related genes, e.g., CCNA2, UBE2C and ANAPC1, were identified, and the levels of the 3 genes were validated in an external dataset. Our further analysis demonstrated that the levels of the 3 genes were strongly associated with poor prognosis of patients with hepatocellular carcinoma. Conclusion By through bioinformatics analysis, we identify potential pathways and important genes involved in hepatocarcinogenesis, which might provide potential targets for diagnosis and therapeutic intervention in the future.

Objective The aim of this study was to investigate the evaluation of hepatic steatosis by controlled attenuation parameter (CAP) of ultrasonic transient elastography in patients with nonalcoholic fatty liver diseases (NAFLD). Methods 78 patients with NAFLD were enrolled in our hospital between May 2020 and May 2022, and they all received liver ultrasonography and ultrasonic transient elastography for CAP. The receiver operating characteristic curve (ROC) was plotted and the area under the curve (AUC) was calculated to evaluate the efficacy of CAP in predicting the degree of hepatic steatosis in patients with NAFLD. Results The liver ultrasonography showed that out of the 78 patients with NAFLD in our series, there were mild hepatic steatosis in 41 cases, moderate hepatic steatosis in 23 cases and severe hepatic steatosis in 14 cases; serum ALT and AST levels in patients with severe liver steatosis were (77.2±14.9) U/L and (59.1±11.7)U/L, significantly higher than in patients with moderate or in patients with mild liver steatosis; serum triglyceride level and the CAP in patients with severe liver steatosis were (3.5±0.7)mmol/L and (317.7±27.6)dB/m, both significantly higher than in patients with mild or in patients with moderate, while serum high-density lipoprotein cholesterol level was (0.8±0.4)mmol/L, much lower than in patients with mild or in patients with moderate liver steatosis; with the CAP>280.4dB/m as the cut-off value for the diagnosis of moderate hepatic steatosis in patients with NAFLD, the AUC, sensitivity (Se) and specificity (Sp) were 0.783 (95%CI: 0.669-0.896), 78.3% and 75.6%, and with the CAP>309.1 dB/m as the cut-off value for the diagnosis of severe hepatic steatosis, the AUC was 0.696 (95% CI: 0.515-0.876), with the Se of 78.6% and the Sp of 69.6% (P<0.05). Conclusion The application of CAP obtained by ultrasonic transient elastography might help assess more accurately the severity of liver steatosis in patients with NAFLD.

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 study was conducted to analyze the changes of thyroid functions and their impact on response to standardized therapy in patients with autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC). Methods 30 patients with AIH, 28 patients with PBC and 32 volunteers were recruited in our hospital between January 2020 and January 2022, and the patients with AIH or with PBC were treated by standardized immunosuppression or ursodeoxycholic acid therapy. Serum total-triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), free thyroxine T4 (FT4) and thyroid-stimulating hormone (TSH) levels were routinely detected. Serum anti-thyroglobulin antibodies (TRAb), thyroid-peroxidase antibody (TPO-Ab), anti-thyroglobulin antibodies (TGAb), thyroxine-binding globulin (TBG) and thyroglobulin (TG) were also determined by radioimmunoassay. Results Serum FT3 and FT4 levels in patients with AIH were (4.2±0.2)pmol/L and (13.8±1.9)pmol/L, and in patients with PBC were (4.3±0.3)pmol/L and (13.9±1.3)pmol/L, significantly lower than [(4.9±0.6)pmol/L and (15.9±4.2)pmol/L, respectively, P＜0.05], while serum TSH levels in patients with AIH and in with PBC were (3.8±1.2)mIU/L and (3.7±0.5)mIU/L, significantly higher than [(2.6±0.5)mIU/L, P＜0.05] in healthy volunteers; serum TPO-Ab and TG positive rates in patients with AIH were 33.3% and 26.7%, and in patients with PBC were 39.3% and 25.0%, all significantly higher than 9.4% and 3.1%(P＜0.05) in healthy individuals; at the end of one-year treatment, the response rates to treatment in patients with AIH was 66.7% and in patients with PBC was 75.0%; serum FT3 and FT4 levels in responders no matter in AIH or PBC were significantly higher than, while serum TSH levels as well as serum TPO-Ab and TG positive rates were much lower than in non-responders(P＜0.05). Conclusion The hypothyroidism could occur in patients with autoimmune liver diseases, which might influence the response to standardized therapy, and warrants clinical careful surveillance.

The hepatolenticular degeneration (HLD), also known as Wilson's disease, is an entity of disordered copper metabolism caused by ATP7B gene mutation, which leads to intracellular copper transport dysfunction and excessive accumulation of copper in various organs. The early diagnosis and treatment can improve the prognosis of patients with HLD and reduce disability and early death. The current treatments include a diet with low copper, medical intervention and liver transplantation. However, the low copper diet could not significantly reduce the amount of copper absorption in intestinal epithelial cells, and excessive restriction of it will cause nutrient absorption disorders in normal tissue cells. The present treatment regimens often face problems such as poor adherence and worsening neurological symptoms. The application of liver transplantation is often limited by the shortage of donor organs and the need for lifelong immunosuppression. The new therapies, such as new medicine preparations, cell and gene therapy have brought new hopes for patients with HLD.

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 aim of this study was to compare the clinical characteristics of patients with autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) with concomitant Sjogren's syndrome (SS). Methods A retrospective study was conducted to summarize 200 patients with autoimmune liver diseases (AILD) admitted to our hospital between June 2015 and June 2023, including 50 cases of AIH, 20 cases of AIH with SS, 85 cases of PBC, and 45 cases of PBC concomitant with SS. The clinical manifestations, laboratory tests, positive rates of serum autoantibodies, and histopathology characteristics of liver were compared. Results The incidence of dry mouth/dry eye in patients with AIH /SS was 95.0%, significantly higher than 10.0% in patients with AIH (P<0.05), the incidence of dry mouth/dry eye in patients with PBC/SS was 97.8%, much higher than 12.9%(P<0.05), while the incidences of itching and jaundice were 37.8% and 40.0%, much lower than 67.1% and 60.6%(P<0.05)in patients with PBC; total serum bilirubin level (TSB) in patients with AIH/SS was (14.4±3.1)μmol/L, much lower than in patients with AIH; serum bilirubin and ALP levels in patients with PBC/SS were(26.7±6.6)μmol/L and (159.1±14.3)U/L, significantly lower than , while serum IgG level was (20.6±3.6)g/L, much higher than in patients with PBC; the positive rate of serum anti- Ro-52 in patients with AIH/SS was 55.0%, much higher than 16.0%(P<0.05) in patients with AIH, and that was 53.3% in patients with PBC/SS, much higher than 25.9%(P<0.05) in patients with PBC; there were no significant differences respect to liver histopathological features among patients with AIH/SS or with PBC/SS, as compared to in patients with AIH or with PBC(P＞0.05). Conclusion There are some differences in clinical manifestations and laboratory results between patients with AIH and with PBC with or without concomitant SS, the internists should take care of them and deal with appropriately in clinical practice.

Objective The aim of this study was to investigate the etiology and diagnostic roadmap in patients with non-cirrhotic portal hypertension (NCPH). Methods 105 patients with NCPH were encountered in the First Affiliated Hospital, Guangxi Medical University between September 2020 and March 2022, and the etiologies and the main diagnostic methods were summarized retrospectively. Results The etiologies of NCPH in our series included prehepatic, hepatic and posthepatic entities; the common diseases were found with prehepatic portal hypertension (PH) in 69 cases (65.7%), the hepatic PH in 21 cases (20.0%) and the posthepatic PH in 4 cases (3.8%); the common diseases in patients with prehepatic ph were pancreaticogenic diseases in 22 cases (31.9%), portal vein obstruction in 15 cases (21.7%), and hematologic diseases in 15 cases (21.7%); the main diagnostic methods were imaging examination in 28 cases (40.6%), gastrointestinal endoscopy in 14 cases (20.3%) and bone marrow biopsies in 12 cases (17.4%); the top three methods for the etiological diagnosis in patients with NCPH were imaging examination (33.3%), comprehensive analysis (18.1%) and gastrointestinal endoscopy (13.9%). Conclusion The prehepatic PH should be considered firstly in patients with NCPH presentation, the laboratory and imaging examinations should be performed routinely, and the gastrointestinal endoscopy and bone marrow biopsy might be performed if necessary. For those without clear diagnosis after routine examination, the hepatic and posthepatic PH must be considered, and liver biopsy and inferior vena cava puncture angiography should be done for further validation of diagnosis.

Objective The aim of this study was to investigate the pathogenic bacteria distribution and serum interferon-gamma (IFN-γ) and interleukin-6 (IL-6) level changes in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) complicated by bacterial infections. Methods 86 patients with HBV-ACLF were admitted to our hospital between December 2019 and January 2023, and the bacteria were isolated and identified routinely. Serum procalcitonin (PCT) level was detected by electrochemiluminescence immunoassay, and serum IFN-γ and IL-6 levels were assayed by ELISA. The diagnostic performance was evaluated by the area under the receiver operating characteristic (ROC) curve. Results 37 patients in our series were found having bacterial infection, and out of them, 68 pathogenic bacteria strains were characterized with Gram-negative bacteria infection in 41 strains and Gram-positive bacterial infection in 27 strains(39.7%); serum PCT, IFN-γ and IL-6 levels in patients with bacterial infection were (10.9±3.1)μg/L, (46.5±1.9)pg/mL and (16.9±1.6)pg/mL, all significantly higher [(0.9±0.1)μg/L, (20.1±2.4)pg/mL and (4.8±0.9)pg/mL, respectively, P＜0.05], and 28-day and 90-day fatality rates were 67.6% and 75.7%, both significantly higher than 8.2% and 12.2% (P＜0.05) in patients without bacterial infection; the ROC analysis showed that the AUC was 0.874, with the sensitivity of 93.6% and the specificity of 84.1%, when the combination of serum parameters was applied to predict bacterial infection as serum PCT＞3.3μg/L, serum IFN-γ＞45.5 pg/mL and IL-6＞15.4 pg/mL was set as the cut-off-value. Conclusion The distribution of pathogenic bacteria in patients with HBV-ACLF complicated by bacterial infections is characteristic, and the Gram-negative bacteria is the main common pathogenic bacteria. Besides serum PCT level, the surveillance of serum IFN-γ and IL-6 levels is helpful for early diagnosis of bacterial infection in this setting.

Objective The aim of this study was to explore the clinical implications of serum interleukin-1 receptor antagonist (IL-1RA), complement C1q tumor necrosis factor related protein 13 (CTRP13) and cytokeratin 18 (CK-18) levels in patients with non-alcoholic fatty liver diseases (NAFLD). Methods 67 patients with NAFLD and 55 healthy individuals at physical examination were enrolled in our hospital between January 2021 and January 2023, and all patients received liver biopsies for hepatic steatosis classification. Serum IL-1RA, CTRP13 and CK-18 levels were detected by ELISA, and the risk factors for severe liver steatosis was determined by multivariate Logistic regression analysis. Results Serum IL-1RA and CTRP13 levels in patients with NAFLD were (328.6±54.3)pg/ml and (2634.2±397.5)pg/ml, both significantly lower than [(673.1±125.4)pg/ml and (3425.7±423.8)pg/ml, P<0.05], while serum CK-18 level was (15.2±3.1)ng/ml, significantly higher than in healthy persons; serum IL-1RA and CTRP13 levels in 17 patients with severe liver steatosis of F3 were (256.3±47.6)pg/ml and (2056.3±308.4) pg/ml, significantly lower than [(388.3±59.4) pg/ml and (3071.5±409.3)pg/ml, P<0.05] in 29 patients with F1 steatosis or in 21 patients with F2 steatosis, while serum CK-18 level was (23.4±4.7)ng/ml, significantly higher than in patients with F1 or in patients with F2 steatosis; the percentages of concomitant obesity, diabetes mellitus, hyperlipidemia, family history of metabolic syndromes, low serum IL-1RA and CTRP13, and high serum CK-18 levels in patients F3 steatosis were 70.6%, 76.5%, 88.2%, 70.6%, 35.3%, 35.3% and 70.6%, significantly different compared to 38.0%, 42.0%, 40.0%, 30.0%, 92.0%, 80.0% and 10.0% in 50 patients with F1/F2 steatosis (P<0.05); the multivariate Logistic regression analysis showed that the obesity , diabetes , hyperlipidemia , low serum IL-1RA and CTRP13 and high serum CK-18 were the risk factors for severe liver steatosis in patients with NAFLD (P<0.05). Conclusion The abnormal changes of serum IL-1RA, CTRP13 and CK-18 levels in patients with NAFLD might help evaluate hepatic steatosis, and warrants further clinical investigation.

Objective The aim of this study was to explore the correlation of liver Young's modulus by two-dimensional shear wave elastography (SWE) and alkaline phosphatase (ALP)/platelet (PLT) ratio to liver fibrosis in patients with chronic hepatitis B (CHB). Methods 120 patients with CHB were admitted to the Provincial People's Hospital, Inner Mongolia Autonomous Region between May 2019 and May 2022, and all patients underwent liver biopsy. The liver Young's modulus was obtained by ultrasonography, and serum ALP and whole blood PLT counts were detected routinely. The correlation of ALP / PLT ratio and Young's modulus to liver fibrosis was determined by Spearman correlation analysis. Results Out of the 120 patients with CHB, the liver histopathological examination showed F0/F1 stage in 38 cases(31.7%), F2 stage in 32 cases(26.7%), F3 stage in 32 cases(26.7%) and F4 stage in 18 cases (15.0%); serum ALP, blood PLT counts, ALP/PLT ratio and Young's modulus in patients with F4 were (197.1±39.7)U/L, (114.2±35.1)×10⁹/L, (1.7±0.3) and (11.7±1.7)kPa, all significantly different compared to [(180.9±43.8)U/L, (137.1±38.6)×10⁹/L, (1.3±0.4) and (8.6±1.5) kPa, respectively, all P＜0.05] in patients with F3 or [(162.7±41.1)U/L,(154.6±39.8)×10⁹/L,(0.9±0.2) and (6.4±1.0)kPa, respectively, all P＜0.05] in patients with F2 or [(150.5±36.4)U/L, (181.7±37.2)×10⁹/L, (0.7±0.2) and (5.3±1.1)kPa, respectively, all P＜0.05] in patients with F0/F1; the Spearman analysis showed that the Young's modulus and ALP/PLT ration in patients with CHB were positively correlated to liver fibrosis staging (r=0.79, P＜0.05; r=0.75, P＜0.05). Conclusion The Young's modulus and ALP / PLT ratio in patients with CHB are correlated to liver fibrosis, which might help predict the liver fibrosis staging and warrants further clinical investigation.

Nonalcoholic steatohepatitis (NASH),with pathological characteristics of hepatic steatosis, ballooning, and lobular inflammation, reflects the chronic liver disases induced by metabolic stress. Here, we summarize the regulatory effect of gut microbia-derived butyrate on the docosahexaenoic acid (DHA) metabolic phenotype of hepatic mononuclear phagocyte system through HDAC/12/15-LOX/maresin signaling. Its role in NASH amelioration is further reviewed on the basis of proinflammatory mediators/maresins rebalancing and spontaneous resolution of inflammation.

Objective The aim of this study was to analyze the clinical features and influencing factors of drug-induced liver injury (DILI) in patients with severe infection receiving tigecycline therapy. Methods 74 patients with severe infection were encountered in the intensive care unit of our hospital between January and December 2022, and all were treated with tigecycline at 50 mg(n=27) or 100 mg(n=47), intravenously, q12h, for 7-14 days. The multivariate Logistic regression analysis were applied to reveal the risk factors of DILI occurrence, and the receiver operating characteristic curve (ROC) was applied to predict the efficacy. Results During the antibacterial treatment period, the DILI was found in 36 cases (48.6%); the incidence of concomitant diabetes, hypertension and malignant tumors in patients with DILI were 50.0%, 47.2% and 33.3%, all significantly higher than 18.4%, 23.7% and 13.2% (P<0.05) in patients without DILI; the AUC_0-24h of blood tigecycline concentration in patients with DILI was (17.6±6.6) mg·h·L^-1, much higher than in patients without DILI; the multivariate Logistic regression analysis showed that the concomitant diabetes, malignant tumors and AUC_0-24h were all the independent risk factors for the occurrence of DILI (P<0. 05); the ROC analysis showed that when serum tigecycline’s AUC_0-24h=14.78 mg·h·L^-1 was set as the cut-off-value in predicting DILI occurrence, the sensitivity and specificity were 66.7% and 65.8%, respectively. Conclusion The clinicians should take the precipitating factors of DILI into consideration in critically infected patients when the tigecycline is used, and we recommend monitoring blood drug concentration for making a personalized therapeutic plan to reduce DILI occurrence.

Objective The aim of this study was to investigate the short-term efficacy of entecavir (ETV) and peginterferon-α 2b (Peg-IFN-α 2b) combination in treatment of patients with hepatitis B-induced liver cirrhosis (LC). Methods 40 patients with compensated hepatitis B-induced LC were randomly assigned to the ETV group (control) and 38 to the combination group (observation) between March 2019 and March 2021. After 24 week treatment, all patients in the two groups received ETV continuously and were followed-up for another 24 weeks. The liver function indexes, liver fibrosis indexes, serum HBsAg and HbeAg quantification and HBV DNA loads were routinely measured. Results At the end of 24 week follow-up, serum albumin level in the observation group was (45.7±3.2)g/L, significantly higher than in the control; serum collagen type IV, hyaluronic acid, procollagen Ⅲ peptide and laminin levels in the observation were (154.3±11.7)μg/L, (130.9±17.5)μg/L, (110.6±16.2)μg/L and (152.7±14.3)μg/L, all significantly lower than[(200.7±12.4)μg/L, (161.8±18.7)μg/L, (157.4±17.3)μg/L and (200.9±16.3)μg/L, respectively, P＜0.05] in the control; serum HBsAg level was 1363.8(623.1, 2767.6) IU/ml, much lower than , while serum HBsAg negative rate was 15.8%, much higher than 0.0%(P＜0.05) in the control group. Conclusion The combination of ETV and Peg-IFN-α 2b in the treatment of patients with compensated hepatitis B LC could decrease serum liver fibrosis markers and increase serum HBsAg negative rates, which might delay the progression of the entity.

Objective The aim of this study was to investigate the predictive performance of prognostic nutritional index (PNI) and systemic immunoinflammatory index (SII) in patients with hepatitis B associated acute-on-chronic liver failure (HBV-ACLF). Methods The clinical data of 308 patients with HBV-ACLF admitted to the First Affiliated Hospital, Naval Medical University the past eight years, were retrospectively analyzed, and the PNI and SII were calculated. The multivariate Logistic regression analysis was applied to reveal the factors impacting the prognosis, and the ROC curve was applied to evaluate the predictive efficacy. Results At the end of 1 to 3 month treatment, 192 patients (62.3%) survived and 116 patients (37.7%) died in our series; there was no significant difference in gender between the two groups(P>0.05), while the medium age of the dead patients was significantly older than in survivals (P<0.05); the PT or INR, total serum bilirubin (TSB) level in dead patients were significantly longer or greater than in those who survived (P<0.05); the incidences of ascites, infection, hepatic encephalopathy, gastrointestinal bleeding or hepatorenal syndrome in dead patients were significantly higher than in survivals (P＜0.05); the MELD scores and SII scores in the dead patients were significantly higher than, while the PNI scores was significantly lower than in survivals (P<0.05); the multivariate Logistic regression analysis showed that the PLT counts, TSB, PNI and SII scores were the independent risk factors impacting the prognosis of patients with HBV-ACLF; the sensitivities and specificities were 53.4% and 81.2%, and 30.2% and 88.0% when the PNI=37.77 and the SII=508.55 were set as the cut-off-value, respectively, in predicting the prognosis. Conclusion The early prediction of prognosis in patients with HBV-ACLF is beneficial for appropriate management, and the PNI is an independent protective factor for good and the SII is an independent risk factor for poor outcomes, and they both have to a certain extent a prognostic efficacy.

Objective This study was conducted to investigate the clinical feature and gene mutation in patients with hepatolenticular degeneration (HLD). Methods 79 consecutive patients with HLD were encountered in our hospital between January 2017 and December 2022, and the basic clinical materials were retrieved. TheATP7B gene mutation was assayed by high throughput gene sequencing. Results There were 55 patients with hepatic, 12 with cerebral and 12 with mixed phonotypes in our series; the disease onset age of patients with hepatic phonotype was much younger than those with cerebral or mixed phonotypes(P<0.05), while the percentage of K-F ring in patients with cerebral phonotype was 100.0%, greatly higher than 45.5% in patients with hepatic or 66.7% in patients with cerebral phonotype(P<0.05); serum AST, ALT and ceruloplasmin levels in patients with hepatic phonotype were 83.7(52.8, 137.5)U/L, 83.6(33.2, 163.6)U/L and 0.12(0.083, 0.22)g/L, significantly higher than [29.6(21.3, 46.1)U/L, 27.5(18.9, 38.8)U/L and 0.031(0.011, 0.058)g/L, respectively, P<0.05] in patients with cerebral phonotype or [37.2(27.8, 56.4)U/L, 23.2(18.4, 45.0)U/L and 0.057(0.040, 0.096)g/L, respectively, P<0.05] in patients with mixed phonotype; the ATP7B gene mutation was found in 11 sites in our series, and the incidences of EX11, EX13/CDS13, EX16 and EX18 mutation in patients with mixed phonotype were 41.7%, 25.0%, 25.0% and 16.7%, significantly higher than 7.3%, 5.5%, 3.6% and 3.6%(P<0.05) in patients with hepatic or 8.3%, 8.3%, 8.3% and 0.0%(P<0.05) in patients with cerebral phonotype, while the incidences of EX13 and EX8 mutation in patients with hepatic phonotype were 34.5% and 7.3%, much higher than 16.7% and 0.0%(P<0.05) in patients with cerebral or 16.7% and 0.0%(P<0.05) in those with mixed phonotype. Conclusion The clinical features of patients with HLD varies, and the ATP7B gene mutation differs, which needs further foundational verification.

Objective The aim of this study was to explore the implications of hepatic homeobox gene C9 (HOXC9) and kinesin family member 4A (KIF4A) protein expression in patients with hepatocellular carcinoma (HCC). Methods 86 patients with HCC were enrolled in our hospital between January 2018 and January 2021, and all underwent hepatectomy. The patients with HCC were all followed-up for two years after operation. The cancerous and the adjacent non-cancerous tissues were collected, and the protein expressions of HOXC9 and KIF4A in tissues were detected by immunohistochemical staining. Results The intensified expression rates of HOXC9 and KIF4A in cancerous tissues were 69.8% and 51.2%, both significantly higher than 15.1% and 16.3% in adjacent liver tissues (P<0.05); the intensified expression rates of HOXC9 in 56 patients with low/moderate tumor cell differentiation, in 40 patients withⅡb/Ⅲb stages, in 38 patients with tumor capsule invasion and 37 patients with microvascular invasion were 78.6%, 85.0%, 71.1% and 83.8%, all significantly higher than 53.3%, 56.5%, 47.9% and 59.2% (P<0.05) in 30 patients with high tumor cell differentiation, in 46 patients with Ⅰa/Ⅱa stages, in 48 patients without tumor capsule invasion and in 49 patients without microvascular invasion; the intensified expression rates of KIF4A in low/moderate tumor cell differentiation, Ⅱb/Ⅲb stages, with tumor capsule invasion and microvascular invasion were 60.7%, 80.0%, 60.5% and 89.2%, also significantly higher than 33.3%, 26.1%, 43.8% and 22.4% (P<0.05) in their parallel adjacent non-cancerous tissues; at the end of two-year follow-up, 38 patients(44.2%)survived and 48 patients (55.8%) died; the overall survivals (OS) in 60 patients with intensified cancerous HOXC9 expression was 14.0(7.8, 26.7)mon, much shorter than [27.0(18.8, 30.5)mon, P<0.05] in 26 patients with weak HOXC9 expression; the OS in 44 patients with intensified cancerous KIF4A expression was 9.0(7.0, 26.3)mon, also significantly shorter than [15.3(26.0, 28.8) mon, P<0.05] in 42 patients with weak HOXC9 expression. Conclusion The upregulation of cancerous HOXC9 and KIF4A in patients with HCC might be correlated to the malignant quality of tumor cells, and to the poor prognosis.

Objective The aim of this study was to investigate the risk factors for microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC). Methods 206 patients with HCC were encountered in our hospital between March 2018 and March 2022, and all underwent MRI and hepatectomy. The MVI was diagnosed by histopathology. The univariate and multivariate Logistic regression analysis were applied to predict the existence of MVI in patients with HCC. Results Out of the 206 patients with HCC, the MVI was found in 50 cases (24.3%); there were no significant differences as respect to serum AFP levels, Child-Pugh classes and the tumor envelope intact or not between patients with and without MVI(P>0.05), while the percentages of tumor diameter ≥5 cm and low tumor cell differentiation in patients with MVI were 56.0% and 58.0%, both much higher than 32.7% and 35.3% (P<0.05) in patients without MVI; the multivariate Logistic regression analysis showed that the tumor diameter ≥5 cm and low tumor cell differentiation were the independent risk factors for the existence of MVI in patients with HCC (OR=1.166, OR=1.141, bot P<0.05). Conclusion The large tumor and low differentiation of tumor cells are the independent risk factors of MVI happening in patients with HCC, and the preoperative imaging could help determine the size of tumors, and thus make the therapeutic strategy.

Objective The aim of this study was to investigate the twenty-four month follow-up efficacy for patients with chronic hepatitis C (CHC) after sustained virological response (SVR) to different direct-acting antiviral agents (DAAs) treatment regimen. Methods 123 patients with CHC were enrolled in our hospital between January 2018 and December 2020, and were divided into three groups, receiving sofosbuvir/velpatasvir (SOF/VEL) in 52 cases, elbasvir/grazoprevir (EBR/GZR) in 43 cases, and ledipasvir/sofosbuvir (LDV/SOF) in 28 cases. The antiviral regimen lasted for 12 weeks and all patients were followed-up for 24 weeks. Serum HCV RNA loads were detected by real-time fluorescence quantitative RT-PCR. The rapid virological response (RVR), early virological response (EVR), end of treatment virological response (ETVR) and SVR were recorded in three groups. Results The RVR in SOF/VEL-, EBR/GZR- and LDV/SOF-treated patients were 96.2%, 93.0% and 92.9%, the EVR were 98.1%, 97.7% and 96.4%, the ETVR and SVR in all patients were 100.0%, not significantly different among the three groups ( all P＞0.05); during the treatment, the incidences of untoward effects, such as nausea, fatigue and dizziness, in the three groups were 13.5%, 11.6% and 21.4%, not significant different among them (P＞0.05); 7, 7 and 5 patients with SVR in the three groups lost, all other patients with SVR were followed-up for 24 months, and no relapse or liver cancer were found. Conclusion All the antiviral regimen, with different DAAs have good efficacy as HCV GT1b infection is common in China, and no relatively long-term relapse.