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.

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.

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 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.

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 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 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.

Objective The aim of this study was to analyze the clinical and imaging feature in patients with focal nodular hyperplasia of the liver (FNH) . Methods A total of 96 patients with FNH were encountered in our hospital between March 2020 and March 2023, and all underwent color Doppler ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI). The diagnosis was made based on histo-pathological examinations. Results Among the 96 patients with FNH, the upper abdominal fullness and discomfort was found in 19 cases (19.8%), hepatitis B carriers in 8 cases (8.3%) , serum alpha-fetoprotein (AFP) negative in 95 cases (99.0%) and slightly elevated in 1 case (1.0%), slight serum alanine aminotransferase and/or aspartate aminotransferase level elevation in 14 cases (14.6%) ; the pathological examination diagnosed typical FNH in 86 cases (89.6%) and non-typical FNH in 10 cases (10.4%); the abdominal color Doppler ultrasonography showed most of the lesions with clear boundaries, low echo area in 79 cases, even echo in 13 cases, high echo in 4 cases, and abundant blood flow signals in 57 cases; the CT imaging showed that there were slightly low-density or isodensity or uniform density nodules, with clear boundary from the surrounding liver parenchyma, and uniform enhancement at arterial phase in 83 cases, and without enhancement in 13 cases; out of the 38 patients underwent upper abdominal MRI scan, showed equal or low signals of the lesions on T1WI, equal or high signals on T2WI, with clear boundaries, and the lesions were obviously enhanced at arterial phase, equal or slightly high signals at portal venous phase and reduced enhancement at delayed phase. Conclusion There is a lack of specific clinical and imaging manifestations in most patients with FNH, and the biopsies or even direct surgery might be the optimal choice at this scenario.

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.

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.

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 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.

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 summarize morphology and enhancement feature of hepatic hemangioma (HH)by multi-slice spiral CT (MSCT). Methods A total of 110 patients with HH were encountered in our hospital between January 2021 and December 2023, and all patients underwent MSCT scan. The morphology and blood supply was analyzed by 3D software. Results Of the 110 patients with HH, MSCT plain scan showed 152 lesions, including 68 (61.8%) single lesions and 42 (38.2%) multiple lesions; there were 104 (68.4%) lesions in right lobe of liver and 48 (31.6%) in left lobe; there were 122 lesions (80.3%) with circular or circular-like shape with edges clear and 30 lesions (19.7%) with irregular edges; 128 (84.2%) lesions were smaller than 10 cm and 24 (15.8%) were larger than 10 cm; 144 (94.7%) lesions were with low density shadow and 8 (5.3%) lesions with high density shadow; with spotty or nodular enhancement at edge or in center of lesions at arterial stage accounted for 83.6%, and no enhancement for 16.4%; there were 118 (77.6%) lesions with reduced enhancement and 34 (22.8%) lesions without enhancement at portal stage; of 34 lesions without enhancement at portal stage, 18 lesions(52.9%) presented with enhancement and 16 lesions(47.1%) left still without enhancement; tumor volume and enhancement volume in large HH lesions were (318.4±53.1) cm³ and (52.0±9.1) cm³, both significantly larger than [(131.7±25.8) cm³ and (38.4±7.9) cm³,P<0.05], while enhancement ratio was (16.3±4.6) %, significantly lower than (29.1±12.0) % (P<0.05) in small lesions. Conclusion MSCT scan could show HH morphology and enhancement feature, which might help clinicians determine the quality of intrahepatic lesions and make appropriate diagnostic and therapeutic measures.

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

Objective The aim of this study was to 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 This study was conducted to investigate diagnostic performance of atherogenic index of plasma (AIP)in predicting patients with metabolic-associated fatty liver disease (MAFLD) from physical examination population. Methods 4988 individuals underwent physical examination in the Physical Examination Center, West China Hospital, affiliated to Sichuan University between July 2020 and December 2022. Routine blood fat was detected for calculation of AIP. Multivariate Logistic regression analysis was applied to reveal risk factors, and receiver operating characteristic curve (ROC) was used to assess diagnostic efficacy. Results Of 4988 individuals at physical examination, 1589 patients(32.4%)was found having MAFLD; hyperlipidemia was common in patients with MAFLD, and AIP was 0.2(0.0-0.4), much greater than [0.1(0.1-0.3), P<0.001] in those without MAFLD; multivariate Logistic regression analysis showed that AIP, TG, HDL, LDL and TC were all the independent risk factors for MAFLD existence (P<0.05); ROC analysis demonstrated the AUC was 0.785 by AIP predicting MAFLD, much higher than TG(0.764), HDL (0.750), LDL (0.568) OR TC (0.552) doing; the AUC was 0.817 by AIP in diagnosing female MAFLD, much higher than 0.714 in diagnosing male MAFLD, and it was 0.825 in predicting MAFLD in persons younger than 45 year old, much higher than 0.742 in predicting MAFLD in those older than 45 year old (P<0.001). Conclusion AIP has a satisfactory diagnostic performance in predicting MAFLD, which might be used for screening at physical examination centers.

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.