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 The aim of this study was to observe the combination of glutathione and tiopronin in the treatment of patients with drug-induced liver injury (DILI). Methods 72 patients with DILI were enrolled in our hospital between December 2019 and August 2022, and were randomly divided into control (n=36) and observation (n=36) group, receiving tiopronin alone or tiopronin and glutathione combination treatment for two to four weeks. Serum malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were detected by thibabituric acid, xanthine oxidation or dithiobis-nitrobenzoic acid methods, respectively. Serum human heme oxygenase-1 (HO-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), IL-1β and C-reactive protein (CRP) levels were detected by ELISA. Results At the end of treatment, serum ALT and AST levels in the observation group were (40.6±11.5)U/L and (31.0±2.6)U/L, both significantly lower than [(64.6±13.9)U/L and (63.7±15.3)U/L, respectively, P＜0.05] in the control, while there were no significant differences respect to serum bilirubin and GGT levels in the two groups [(16.8±3.9) μmol/L and (59.2±13.3)U/L vs. (20.2±4.2)μmol/L and (60.8±14.7)U/L, respectively, P>0.05]; serum SOD, GSH-Px and HO-1 levels in the observation group were (82.4±12.7)U/L, (99.8±16.6)U/L and (256.7±20.8)U/L, all significantly higher than [(75.6±10.9)U/L, (80.6±15.4)U/L and (197.5±24.9)U/L, respectively, P＜0.05], while serum MDA level was (5.1±0.8)μmol/L, much lower than [(6.2±1.3)μmol/L, P＜0.05] in the control; serum IL-6, TNF-α, IL-1β and CRP levels were (5.1±1.7)pg/mL, (4.4±1.7)pg/mL, (11.2±4.1)ng/mL and (3.9±2.0)mg/L, all significantly lower than [(9.7±1.1)pg/mL, (10.2±1.8)pg/mL, (25.3±4.8)ng/mL and (13.6±2.9)mg/L, respectively, P＜0.05] in the control group. Conclusion The combination of glutathione and tiopronin in the treatment of patients with DILI could effectively improve liver function tests back to normal, which might alleviate body inflammatory and oxidative stress reactions, and warrants further clinical investigation.

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 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 investigate the efficacy of transcatheter arterial chemoembolization (TACE) with CalliSpheres drug-loaded microspheres followed by radiofrequency ablation (RFA) in the treatment of patients with primary liver cancer (PLC). Methods 79 patients with PLC were enrolled in our hospital between January 2019 and January 2021, and were divided into observation (n=43) and control group (n=36), receiving TACE with CalliSpheres drug-loaded microspheres followed by RFA, or the routine TACE followed by RFA. All patients were followed-up for two years. The disease control rate in the two groups after treatment was evaluated according to the Response Evaluation Criteria in Solid Tumors. Serum alpha-fetoprotein (AFP) and human heat shock protein 90α (HSP90α) levels were detected by electrochemiluminescence analyzer. Results At the end of one month after treatment, the complete remission, partial remission, stable disease and the total disease control rate in the observation group were 23.3%, 46.5%, 16.3% and 86.1%, while they were 11.1%, 36.1%, 19.4% and 66.7% in the control, with the latter significantly different (P<0.05) between the two groups; at the end of three months after treatment, serum AFP and HSP90α levels in the observation group were (87.5±14.5)μg/L and (126.1±13.3)ng/mL, both significantly lower than [(164.6±17.2)μg/L and (150.8±19.7)ng/mL, respectively, P<0.05] in the control; during the period of treatment, the incidence of side effects in the two groups were 48.8% and 50.0%, not significantly different (P>0.05); the one-year survival rates in the observation and control groups were 83.7% and 72.2%, not significantly different (P>0.05), while the two-year survival rates were 69.8% and 47.2%, significantly different (P<0.05). Conclusion The TACE with CalliSpheres drug-loaded microspheres followed by RFA has a definite efficacy in the treatment of patients with PLC, which might prolong the survival rates.

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 The aim of this study was to compare the antiviral efficacy of tenofovir amibufenamide to tenofovir disoproxil fumarate (TDF) in the treatment of patients with chronic hepatitis B (CHB). Methods 62 patients with CHB were enrolled in our hospital between August 2021 and February 2022, and were randomly divided into group A and group B, with 31 cases in each group, receiving tenofovir amibufenamide or TDF for 48 weeks. Serum HBV DNA loads were detected by real-time fluorescence quantitative PCR, serum HBsAg and HBeAg levels were detected by ELISA, and blood routine and serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were obtained to calculate fibrosis index based on 4 factor (FIB-4) and estimated glomerular filtration rate (eGFR). The liver stiffness measurement (LSM) was determined by liver transient elastography. Results At 24 weeks of treatment, serum ALT, AST levels and serum HBV DNA load in group A were (64.3±13.6)IU/L, (61.5±4.0)IU/L and (1.2±0.2)Ig IU/mL, and at the end of 48 week treatment, they were (40.1±3.8)IU/L, (39.4±3.3)IU/L and (0.9±0.2)In IU/mL, all not significantly different compared to [(67.2±3.8)IU/L, (65.3±4.2)IU/L and (1.2±0.3)Ig IU/mL, and (38.4±4.1)IU/L, (42.8±3.9)IU/L and (0.9±0.2)Ig IU/mL, respectively, P<0.05] in group B; the LSM, FIB-4 and eGFR in group A were (7.1±1.7)kPa, (2.0±0.4) and (101.3±7.9)mL/min/1.73 m², and (7.2±1.5)kPa, (1.6±0.3) and (100.9±8.2)mL/min/1.73 m², and they were (7.3±1.6)kPa, (2.2±0.5) and (95.6±8.0)mL/min/1.73 m²(P<0.05), and (7.1±1.6)kPa, (1.6±0.4) and (94.0±7.6)mL/min/1.73 m²(P<0.05), not but eGFR, significantly different compared to in group B. Conclusion The oral administration of tenofovir amibufenamide in the treatment of patients with CHB could obtain the same good antiviral efficacy, but might has less untoward impact on renal functions, and warrants further clinical investigation.

Objective The aim of this study was conducted to explore the clinical prediction of significant liver fibrosis by transient ultrasound elastography and the aspartate aminotransferase/platelet ratio index (APRI) combination in patients with autoimmune hepatitis (AIH). Methods 67 patients with AIH and 54 healthy individuals at physical examination were enrolled in our hospital between August 2019 and August 2022, and all received FibroScan detection for liver stiffness measurement (LSM) and blood routine for the calculation of APRI. The patients with AIH underwent liver biopsies. The receiver operating characteristic curve (ROC) was applied to analyze the diagnostic performance of APRI and LSM for predicting significant liver fibrosis (SLF, >=S2) in patients with AIH. Results Serum AST level in patients with AIH was (104.3±21.9)U/L, significantly higher than [(30.5±5.1)U/L, P<0.05], the APRI and LSM were (1.4±0.1) and (8.1±1.2)kPa, both significantly greater than [(0.4±0.1) and (4.3±0.7)kPa, P<0.05], while the peripheral blood platelet count was (157.8±23.1)×10⁹/L, significantly less than [(208.5±20.7)×10⁹/L, P<0.05] in the healthy control; the liver histopathological examination showed the liver fibrosis S0 stage in 10 cases, S1 in 17 cases, S2 in 19 cases, S3 in 13 cases and S4 in 8 cases in our series; the APRI and LSM in patients with liver fibrosis S4 were(2.1±0.3) and (13.9±2.8)kPa, in S3 were (1.8±0.2) and (11.2±2.1)kPa, and in S2 were (1.5±0.2) and (7.6±1.5)kPa, all significantly higher than(1.1±0.2) and (6.1±1.2)kPa in S1 (P<0.05) or (0.8±0.1) and (4.0±0.5)kPa in S0 (P<0.05); the ROC analysis showed that the AUC was 0.950, with the sensitivity (Se) of 95.0% and the specificity (Sp) of 85.2%, when the APRI (with the cut-off-value of 1.5) and the LSM (with the cut-off-value of 7.5 kPa) were combined in predicting SLF, much superior to that by APRI(with the Se of 90.0% and the Sp of 81.5%) or by the LSM(with the Se of 75.0% and the Sp of 96.3%)diagnosis. Conclusion The combination of LSM and APRI might a high diagnostic efficacy in predicting SLF in patients with AIH, and warrants further clinical investigation.

Objective Nonalcoholic fatty liver diseases (NAFLD) is a kind of liver injury caused by metabolic stress. With the prevalence of obesity and metabolic syndrome (MetS), the NAFLD has become the most popular chronic liver disease in China. Betatrophin is a newly discovered glycoprotein closely related to glucose and lipid metabolism and insulin resistance (IR), which may be closely related to the onset and progression of NAFLD. This article reviewed the role of betatrophin in the process and development of NAFLD.

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 study was conducted to assess the prediction of non-alcoholic fatty liver diseases (NAFLD) in patients with type 2 diabetes mellitus (T2DM) by neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte ratio(PLR) . Methods 110 patients with T2DM and 121 patients with T2DM and NAFLD were included in the Department of Endocrinology, Second Provincial People's Hospital between January 2021 and October 2022, and the NAFLD was proven by ultrasonography. The blood routine was checked-up. The risk factors of T2DM with NAFLD were assessed by multivariate Logistic analysis, and predictive efficacy was evaluated by ROC curve. Results The body mass index in patients with T2DM and concomitant NAFLD was (25.4±3.5)kg/m², much greater than [(23.2±3.1)kg/m², P<0.05], while the course of disease was 5.0(2.0, 8.0)yr, significantly shorter than [8.0(3.0, 13.0)yr, P<0.05] in patients with T2DM; serum alanine aminotransferase, aspartate aminotransferase, glutamyl transpeptidase, uric acid, triglyceride and total cholesterol levels in patients with T2DM and NAFLD were all significantly greater than in patients with T2DM, while serum high density lipoprotein cholesterol level was much lower than in patients with T2DM (P＜0.05); the blood lymphocyte count in patients with T2DM and NAFLD was (1.7±0.4)×10⁹/L, much lower than [(2.2±0.6)×10⁹/L, P<0.05], while the NLR and PLR were (2.4(1.8, 3.2)) and (126.1(93.3, 157.8)), both significantly greater than [1.5(1.2, 2.3) and 89.6(66.9, 116.5), respectively, P<0.05] in patients with T2DM; the Logistic analysis showed that the BMI, NLR and PLR were the risk factors for coincidence of NAFLD in patients with T2DM (P＜0.05); the ROC analysis demonstrated that the sensitivities and the specificities by NLR and PLR in prediction of NAFLD in patients with T2DM were 64.5% and 75.0%, and 71.9% and 65.4%, respectively. Conclusion The surveillance of NLR and PLR, easily accessible, in patients with T2DM might help screen preliminarily NAFLD, 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 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.

Objective The aim of this study was to investigate the clinical implications of cancerous tissue cytokeratin 7 (CK7) and glypican-3 (GPC3) expression in patients with hepatocellular carcinoma (HCC). Methods A total of 219 patients with HCC were enrolled in our hospital between April 2018 and January 2022, and all underwent radical hepatectomy. The patients were followed-up for one year. The expressions of CK7 and GPC3 in cancerous and its adjacent liver tissues were detected by immunohistochemistry. The survival curves were drawn by Kaplain-maier method and the differences of survival rate between patients with CK7 and GPC3 positive and negative were compared by Log Rank test. Results The positive rates of cancerous tissue CK7 and GPC3 expression were 33.3% and 63.5%, significantly higher than 15.5% and 21.9%(P＜0.05) in the adjacent liver tissues; the positive rates of cancerous tissue CK7 expression in low differentiated tumors, BCLC stage C, tumors with vascular invasion, portal cancerous embolus and extrahepatic metastasis were 57.1%, 47.2%, 50.0%, 51.9% and 59.5%, all significantly higher than 16.4%, 20.4%, 24.1%, 22.5% and 28.0%(P＜0.05), and the positive rates of cancerous tissue GPC3 expression were 79.1%, 76.4%, 82.1%, 81.5% and 86.5%, all much higher than 52.3%, 51.3%, 53.2%, 52.9% and 58.8%(P＜0.05) in their surrounding liver tissues; at the end of one-year follow-up, the survival rate in our series was 75.8%; the one-year survival rate in patients with cancerous tissue CK7 negative was 80.1%, much higher than 67.1%(P＜0.05)in those with CK7 positive, and the one-year survival rate of patients with cancerous GPC3 negative was 85.0%, much higher than 70.5%(P＜0.05) in those with GPC3 positive. Conclusion The expressions of CK7 and GPC3 in cancerous tissues are up-regulated in patients with HCC, which might be correlated to tumor malignance and invasiveness.

Objective This clinical trial was conducted to compare the anticoagulant efficacy and safety of nafmostat mesylate (NM) and heparin (HP) during double plasma molecular absorption system (DPMAS) treatment in patients with liver failure (LF). Methods 49 consecutive patients with LF or hyperbilirubinemia were encountered in You'an Hospital affiliated to Capital Medical University between April 2022 and March 2023, and all underwent at least twice DPMAS treatment. During the procedure, the anticoagulation was crossed by NM or HP once. The prothrombin time activity (PTA) and activated partial thromboplastin time (APTT) were monitored. Results Out of the 98 DPMAS treatment, the procedure successfully completed in 97 (99.0%), only discontinued once because of plugged pipes induced by insufficient anticoagulation of HP; the satisfactory anticoagulation rate in NM-managed group was 75.5%, significantly higher than 28.6%, and the over anticoagulation rate was 2.0%, much lower than 67.3%(P<0.05)in HP-intervened group; after the procedure, the PTA and APTT in NM anticoagulant group were 20.5(13.8, 38.0)% and 83.3(55.9, 138.8)s, significantly different compared to [19.5(14.6, 31.5)% and 400.0(303.3, 400.0)s, P<0.05] in HP anticoagulant group; there were no significant differences as respect to serum bilirubin, albumin levels and platelet counts between the two groups [(279.7±99.5)μmol/L, (24.4±4.2)g/L and 59.5(42.5, 119.0) ×10⁹/L vs. (271.7±98.1)μmol/L, 23.3(21.4, 26.6)g/L and 83.8±65.9×10⁹/L, respectively, P＞0.05]; 24 hours after DPMAS, the puncture skin haemorrhage was found in one case in HP anticoagulant group, and transient increased transmembrane pressure, or venous pressure or coagulation alert by the machine occurred in two cases in NM anticoagulant group. Conclusion The extracorporeal local anticoagulation of NM during DPMAS in patients with LF is efficacious and safer, and warrants further clinical investigation.

Objective This study aimed to explore the mechanism of miR-556-3p in the development of hepatocellular carcinogenesis. Methods The miR-556-3p level in cancerous and its adjacent non-cancerous tissues from patients with hepatocellular carcinoma was detected by real-time fluorescence quantitative PCR, and the phosphatase and tensin homolog (PTEN) expression was revealed by immunohistochemistry. The expression patterns of PTEN/ protein kinase B(Akt) signaling pathway-related proteins were detected by Western blotting after transfection of HepG2 cells with miR-556-3p mimic, miR-556-3p NC, PTEN cDNA and PTEN siRNA. The proliferation ability of HepG2 cells was studied by CCK-8 method, the invasion ability of cells was determined by Transwell method, and the apoptosis was detected by flow cytometry. The regulatory roles of miR-556-3p on PTEN/AKT pathway in HepG2 cells were evaluated by bioinformatics. Results The miR-556-3p loads in cancerous tissues was significantly lower than that in para-neoplastic tissues (P<0.05), and the miR-556-3p loads in HepG2 cells was also significantly lower than that in LO2 cells (P<0.05); the luciferase analysis showed that PTEN was a direct target of miR-556-3p; the proliferation rate, invasion rate and apoptosis rate in miR-556-3p-transfected HepG2 cells decreased significantly than in miR NC-transfected cells (P<0.05); the PTEN overexpression reversed the growth inhibition and apoptosis induction of miR-556-3p in HepG2 cells; the miR-556-3p inhibited PTEN/AKT activation by targeting PTEN. Conclusions The miR-556-3p loads decrease in hepatocellular carcinoma tissues, and the miR-556-3p inhibits the proliferation and invasion, and induce apoptosis in HepG2 cells. The PTEN is regulated by miR-556-3p in HepG2 cells. These findings above suggest that miR-556-3p is closely related to the transformation of liver cells, which needs further verification.

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.

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.

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 reasons of failed alcohol abstinence in patients with alcoholic liver diseases (ALD). Methods A total of 149 male patients with ALD or ALD with concomitant other liver diseases were admitted to our hospital between February 2021 and June 2022, and all were persuaded and encouraged for alcohol abstinence at first visit. The alcoholic behavior was evaluated by alcohol use disorders identification test (AUDIT), and the univariate and multivariate Logistic analysis was conducted for the factors of alcohol abstinence failure. Results The patients in our series included ALD in 88 cases, with concomitant chronic hepatitis B in 49 cases and with other liver diseases in 12 cases, characterized by mild liver disease in 27 cases, fatty liver in 36 cases, alcoholic hepatitis in 14 cases and liver cirrhosis (LC) or primary liver cancer (PLC) in 72 cases; at the end of three-month of follow-up, the alcohol abstinence failed in 53 cases (35.6%) and succeeded in 96 cases (64.4%); the ages, and the percentages of alcohol abuse longer than 30 yr, with concomitant other liver diseases and alcohol dependence in succeeded patients were (54.8±11.3)yr, 56.3%, 50.0% and 16.7%, significantly different compared to [(49.6±11.5)yr, 28.3%, 24.5% and 60.4%] in failed patients (P＜0.05); the percentages of mild liver diseases, fatty liver, alcoholic hepatitis and LC/PLC in succeeded patients were 17.7%, 15.6%, 6.3% and 60.4%, significantly different compared to 18.9%, 39.6%, 15.1% and 26.4% in failed patients (P＜0.05); the multivariate Logistic analysis showed that the alcohol dependence, simple ALD, mild liver diseases, fatty liver and alcoholic hepatitis were the main risk factors for short-term failed alcohol abstinence (P＜0.05). Conclusion More than one-third (35.6%) of patients with ALD or ALD with other liver diseases fail to abstain from drinking, and the alcohol dependence ALD alone and mild illness are the independent risk factors for abstinence failure.

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 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.

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.