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 compare the efficacy of glycyrrhizic acid diamine and compound glycyrrhizin in the treatment of patients with drug-induced liver injuries (DILI). Methods 97 tumor patients with DILI caused by cyclophosphamide were encountered in Nantong Tumor Hospital between July 2018 and January 2021, and were randomly divided into control group (n=47) and observation group (n=50), receiving compound glycyrrhizin or glycyrrhizic acid diamine, respectively for six months. Serum malonaldehyde (MDA), reduced glutathione (GSH), superoxide dismutase, (SOD) and advanced protein oxidation products (APOPs) levels were detected by purine oxidase; Serum interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), nitric oxide (NO) and macrophage migration inhibitory factor (MIF) levels were determined by ELISA. Results At the end of six month observation, serum bilirubin, ALT and GGT levels in the observation group were(12.3±1.5)μmol/L, (34.9±9.5)U/L and (36.9±8.8)U/L, significantly lower than [(21.7±3.1)μmol/L, (75.3±18.2)U/L and (74.2±15.2)U/L, respectively, P＜0.01] in the control; serum TNF-α, IL-6 and MIF levels were (4.1±0.8)ng/ml, (17.6±5.3)pg/ml and (6.0±0.5)ng/mL, significantly lower than [(5.9±1.2)ng/ml,(28.8±6.1)pg/ml and (10.7±0.9)ng/mL, respectively, P＜0.01] in the control group; serum MDA and APOPs levels were (4.3±0.7)μmol/L and (2.4±0.2)μmol/L, significantly lower than [(6.4±1.2)μmol/L and (4.3±0.5)μmol/L, P＜0.01], while serum SOD and GSH levels were (83.6±7.9)U/L and (7.6±1.5)μmol/L, significantly higher than [(75.2±9.2)U/L and (6.4±1.2)μmol/L, P＜0.01] in the control; at the end of one-year follow-up, 25 patients(25.8%) died of malignant tumors in our series. Conclusion The oral administration of glycyrrhizic acid diamine in the treatment of patients with DILI caused by cyclophosphamide is convenient and seems to be more efficacious compared with compound glycyrrhizin, which could improve liver function index normal and inhibit the inflammatory reactions and oxidative stress.

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.

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.

Chronic hepatitis B virus infection is an important factor in the progression of liver disease and hepatocellular carcinoma. The complete life cycle of hepatitis B virus is dependent on the host cell, which makes host-targeting antiviral (HTA) treatment options promising. The HTA includes inhibition of virus entry, destabilization of viral nucleic acids and enhancement of host immune response to HBV infection. This paper reviewed the development of medicines that target hosts and host factors in order to achieve the goal of hepatitis B virus suppression, with a view to providing a reference for subsequent antiviral research and clinical treatment.

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

Objective The purpose of this study was to establish a rapid and efficient liquid chromatography tandem mass spectrometry(LC-MS/MS) for simultaneous determination of 15 bile acids in mouse liver tissues. Methods The activated charcoal was utilized to prepare bile acid-free liver, which served as the biological matrix for the preparation of standard and quality control samples. The mouse liver tissue was homogenized, and a basic acetonitrile solution, including 5% NH₄OH was added to precipitate proteins. The proteins were separated on an Agilent Poroshell 120 EC C18 column (100 mm×4.6 mm,2.7 μm) by using ²H₄-DCA, GUDCA-d₅, and LCA-d₄ as internal standards. The mobile phase is ammonium acetate aqueous solution and methanol acetonitrile mixed solution for gradient elution, the column temperature was 30℃, the flow rate was 0.3mL/min, and the injection volume was 2 μL. The electrospray ion source (ESI) was operated in negative ion mode, and in multiple reaction monitoring (MRM). Results The linearity of the 15 bile acids was good with R² greater than 0.993, the limits of determination were less than 2 ng/mL, and the matrix effects were 90.76%-109.25%; the intra-day and inter-day accuracy and precision were less than 15%, and the stability was good under 4℃ for 24 h, repeated freeze-thaw, and freeze-storage for one month, meeting the analytical requirements of biological samples; the detection of mouse liver tissues showed that both unconjugated BAs and conjugated BAs (G-BAs, T-BAs) were dominated by maternal CA, with the highest content of TCA; the concentration of unconjugated BAs was (723.89±50.65) ng/mL, significantly higher than that of G-BAs [(56.90±11.28) ng/mL, P<0.001]; the concentration of T-BAs was (40322.90±14034.80)ng/mL, significantly higher than unconjugated BAs (P＜0.001), and also significantly higher than G-BAs (P＜0.001). Conclusion The LC-MS/MS method we established is sensitive, accurate, reliable, and suitable for the determination of bile acids concentrations in mouse liver tissues, which might help for further studies.

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

Objective The aim of this study was to investigate the preventive efficacy of liver-protecting medicines on the incidence of drug-induced liver injury (DILI). Methods A total of 324 patients with tubercular pleurisy and/or pulmonary tuberculosis were encountered in our hospital between March 2015 and March 2022, and all received standardized six-month anti-tubercular therapy. Simultaneously, the patients were randomly divided into group A (n=80), group B (n=81), group C (n=80) and group D (n=83), receiving oral silibinin, compound glycyrrhizin, polyene phosphatidyl choline and no liver-protecting medicine administration, respectively, until the discontinuation of anti-tubercular therapy. Serum interleukin-2 (IL-2), IL-10 and tumor necrosis factor-ɑ (TNF-ɑ) levels were detected by ELISA. Results The incidences of DILI in group A, group B, group C were 22.5%, 27.2% and 21.3%, all significantly lower than 45.8%(P<0.05) in group D; serum peak levels of biochemical parameters in the four groups with DILI were not significantly different (P>0.05), while at the end of six-month anti-tubercular therapy, serum ALT, AST and bilirubin levels in group A were (43.3±5.1)U/L, (36.9±5.0)U/L and (22.1±4.6)μmol/L, in group B were (54.3±5.3)U/L, (37.5±4.5)U/L and (13.5±4.4)μmol/L, and in group C were (39.1±5.5)U/L,(34.6±4.1)U/L and (18.6±4.4)μmol/L, all significantly lower than [(99.0±5.4)U/L, (146.5±14.8)U/L and (54.3±4.4)μmol/L, respectively, P<0.05] in group D; there were no significant differences respect to serum peak cytokine levels in the four groups(P>0.05); at the end of anti-tubercular therapy, serum IL-2 and IL-10 in group A were (149.3±3.0)ng/L and (50.1±5.7)ng/mL, in group B were (146.3±3.1)ng/L and (27.3±4.4)ng/mL, and in group C were (143.2±3.5)ng/L and (82.9±5.9)ng/mL, all significantly higher than [(72.6±3.7)ng/L and (25.3±5.1)ng/mL, while serum TNF-α levels in group A, B and C were (2.2±0.5)ng/mL, (2.3±0.4)ng/mL and (2.3±0.4)ng/mL, all significantly lower than [(13.0±0.5)ng/mL, P<0.05] in group D. Conclusion The application of liver-protecting medicines could remarkably reduce the incidence of DILI, relieve liver injuries, which might guarantee the anti-tubercular therapy going.

Immune checkpoint inhibitor is a kind of cancer immunotherapy agents, which has anti-tumor activities by improving immune microenvironment around the tumors. The hepatocellular carcinoma (HCC) is the most common primary liver cancer, and the treatment efficacy of advanced disease is poor. The immune checkpoint inhibitors have a certain effects on advanced HCC. In this article, we will review the mechanism, treatment and adverse events of immune checkpoint inhibitors in treating patients with advanced HCC.

Objective The aim of this study was to investigate the clinical implication of serum alpha-fetoprotein (AFP), alpha-fetoprotein-L-3 ratio (AFP-L3%) and protein induced by vitamin K antagonist-II (PIVKA-II) in early diagnosing and predicting prognosis of patients with primary liver cancer(PLC) . Methods A total of 87 patients with PLC, 79 patients with hepatitis B cirrhosis, 73 patients with chronic hepatitis B and 65 healthy persons were enrolled in our hospital between January 2016 and December 2018. All PLC patients underwent transcatheter arterial chemoembolization (TACE) and were followed-up for 3 years. Serum AFP and PIVKA-II levels were detected by chemiluminescence immunoassay, and serum AFP-L3 level was assayed by immumofluorescence. The independent risk factors of impacting 3-year survival in patients with PLC were analyzed by Logistic regression analysis, and the prognostic value of serum AFP, AFP-L3% and PIVKA-II levels was evaluated by the area under the receiver operating characteristic (ROC) curves (AUC). Results Serum AFP, AFP-L3% and PIVKA-II levels in patients with PLC were 402.5±95.3)μg/L, (12.9±3.1) and (824.5±82.1) mAU/mL, significantly higher than [(17.9±2.6)μg/L, (8.6±1.2) and (30.4±3.2)mAU/mL, P＜0.05] in patients with liver cirrhosis or [(20.3±6.4)μg/L,(5.4±0.9) and(29.8±3.0)mAU/mL, P＜0.05]in patients with CHB or [(2.2±0.1)μg/L, (2.7±0.4) and (26.3±3.4)mAU/mL, P＜0.05] in healthy individuals; serum AFP, AFP-L3% and PIVKA-II levels in 52 dead patients with PLC one month after TACE were (447.1±71.2)μg/L, (14.1±2.2) and (883.9±50.8) mAU/mL, much higher than [(336.2±58.4)μg/L, (11.0±1.8) and (736.2±37.0)mAU/mL, respectively, P＜0.05] in 35 survivals; the univariate analysis showed that TNM staging, Child class, extrahepatic metastasis, serum AFP, AFP-L3% and PIVKA-II levels were all influencing prognosis of patients with PLC (P<0.05), and the multivariate Logistic regression analysis showed that TNM staging III-IV, Child class C, extrahepatic metastasis, serum AFP ≥410.5μg/L, AFP-L3% ≥12.1 and PIVKA-II≥807.2 mAU/mL were all independent risk factors for poor prognosis of patients with PLC(P<0.05); the ROC analysis showed that the AUC was 0.908 when combination of serum AFP, AFP-L3% and PIVKA-II level detection in predicting the 3-year survival of patients with PLC, greatly superior to any parameter alone (the AUC were 0.763, 0.830 or 0.792, respectively, P<0.05). Conclusion The combination detection of serum AFP, AFP-L3% and PIVKA-II levels could help diagnose and early predict prognosis of patients with PLC after TACE treatment.

Objective The purpose of this clinical trial was to investigate the auxiliary treatment of a herbal compound, Ganshuang granule, with entecavir for patients with chronic hepatitis B (CHB). Methods 60 patients with CHB were enrolled in our hospital between January 2019 and January 2021, and were randomly divided into control and observation groups, with 30 cases in each. The patients in the control group received entecavir, and those in the observation were treated with entecavir and a herbal compound, Ganshuang granule, for 48 weeks. The AST to platelet ratio index (APRI), fibrosis 4 score (FIB-4) were obtained, and the liver stiffness measurement (LSM) was determined by FibroTouch scan. Serum interleukin-6(IL-6), transforming growth factor-beta (TGF-β), platelet-derived growth factor (PDGF) and C-reactive protein (CRP) levels were assayed by ELISA. Results At the end of 48 week treatment, serum ALT and AST levels in the observation group were significantly lower than in the control group (P<0.05); serum HBV DNA loss in the two groups were both 100.0%, and serum HBeAg negative rates were both 0.0% (P>0.05); the APRI, FIB-4 and LSM in the observation group were (1.02±0.23), (4.38±0.77) and (7.73±1.53), all significantly lower than [(1.30±0.33), (5.26±0.85) and (9.68±2.02), respectively, P<0.05] in the control; serum IL-6, TGF-β, PDGF and CRP levels in the observation were much lower than in the control (P<0.05). Conclusion The auxiliary treatment of Ganshuang granule at base of entecavir antiviral therapy could significantly improve biochemical response in patients with CHB, which might be related to the anti-fibrotic effect and inhibition of body inflammatory reaction of the herbal compound.

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

Objective The aim of this study was to investigate the diagnostic efficacy of liver contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE) and contrast-enhanced CT scan in patients with occupying lesions in liver (OLL). Methods 128 patients with OLL were encountered in our hospital between June 2020 and June 2022, and all underwent CEUS, SWE and CT scan at presentation. The histopathological and/or cytology examination were performed after operation. Results Out of the 128 patients with OLL, the pathological examination showed hepatocellular carcinoma (HCC) in 72 cases and benign lesions in 56 cases; there were obvious differences as respect to the enhancement patterns in arterial, portal and delayed phases between malignant and benign lesions (P＜0.05). 79.2% HCC presented with “fast in and fast out”, with 81.9% of increased enhancement at arterial phase, 62.5% of low enhancement at portal phase and 79.2% of low enhancement at delayed phase, while 80.4% benign lesions showed "slow in and slow out", with 44.6%, 76.8% and 80.4% of equal enhancement at arterial, portal and delayed phases. The diagnostic sensitivity (Se), specificity (Sp) and accuracy (Ac) by CEUS detection were 83.3%, 87.5% and 85.2%; the Young's modulus (Emax) in malignant lesions was (42.5±7.1)kPa, much higher than [(36.3±6.5)kPa, t=5.064, P＜0.01] in benign lesions. When the Emax≥39.6 kPa was set as the cut-off-value, the Se, Sp and Ac by SWE were 79.2%, 76.8% and 78.9%; 77.8%HCC presented as “fast in and fast out” at contrast-enhanced CT scan, with 83.3% of intensified enhancement at arterial phase, 59.7% of low enhancement at portal phase and 77.8% of low enhancement at delayed phase, while 82.1% of benign lesions presented with "slow in and slow out", with 42.9%, 78.6% and 82.1% of equal enhancement at arterial, portal and delayed phases. The Se, Sp and Ac by CT scan were 77.8%, 87.5% and 82.0%. Conclusion The CEUS and CT scan are both important measures for the diagnosis of patients with HCC, and the SWE might be an alternative approach for auxiliary diagnosis.

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.

With the increasing prevalence of obesity and diabetes, the incidence of nonalcoholic fatty liver diseases(NAFLD)has gradually increased. More and more patients with chronic hepatitis B (CHB) are complicated with NAFLD. The chronic HBV infection and NAFLD are both causes of hepatocellular carcinoma(HCC), and the patients with CHB and NAFLD might have the increased risk of HCC. In this article, we review the hepatocarcinogenesis, prevention and control management of patients with CHB and NAFLD, and patients with HCC.

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.

Objective The aim of this study was to compare contrast-enhanced ultrasound (CEUS) manifestation differences in patients with hepatocellular carcinoma (HCC) and hepatic hemangioma (HH). Methods A retrospective analysis was performed on the clinical data of 95 patients with liver space-occupying lesions between January 2020 and December 2021, and all patients underwent hepatectomy, having pathologically confirmed diagnosis, e.g. HCC in 51 cases and HH in 44 cases. All patients underwent CEUS examination before operation, and the arrival time (AT), time to peak (TTP), peak enhancement intensity, enhancement rate and 50% gradient of slope were obtained and compared between the two groups. The diagnostic performance of CEUS for liver space-occupying lesions was analyzed by receiver operating characteristic (ROC) curves. Results The conventional ultrasonography showed that the percentages of clear edge, hyperecho, regular shape and even intratumor echo in cancerous foci were 19.6%, 21.6%, 17.7% and 13.7%, all significantly lower than 68.2%, 65.9%, 72.7% and 75.0%(P<0.05) in HH foci, and the grade Ⅱ and Ⅲ blood signals in cancerous lesions were 68.6% and 17.7%, both significantly higher than 11.4% and 4.6%(P<0.05) in HH lesions; the rapid enhancement and hyperechoic tumor tissues in arterial phase was found, while in HH foci, there was a peripheral slow enhancement in early arterial phase, a centripetal filling enhancement in portal phase and an increased enhancement in delayed phase; the AT in cancerous lesions was (14.6±4.5) s, much longer than [(11.4±3.3)s, P<0.05], and the TTP was (36.8±9.7) s, significantly shorter than [(44.2±11.6) s, P<0.05] in HH lesions, the peak enhancement intensity and 50% gradient of slope were (8.8±2.5) and (0.4±0.2), significantly lower than [(12.5±3.6) and (0.9±0.4), P<0.05] in HH lesions, and the enhancement velocity was (0.8±0.3), much higher than [(0.6±0.2), P<0.05] in HH lesions; the ROC analysis showed that the sensitivity and the specificity were 92.5％ and 77.4％, when the combination of the AT, TTP, peak enhancement intensity, enhancement velocity and 50％ gradient of slope was applied to predict the quality of the space-occupying lesions of liver. Conclusion There are some different features of CEUS manifestations, which might help effectively differentiate lesions of HCC and HH.

Objective The aim of this study was to compare whether or not different for Young's modulus in predicting liver fibrosis (LF) in patients with chronic hepatitis B (CHB) obtained by two-dimensional shear wave elastography (2D-SWE). Methods 72 patients with CHB were enrolled in our hospital between October 2019 and June 2022, and all underwent liver biopsies. The LF was determined by Scheuer score, and Scheuer score≥S2 was defined as significant LF. Based on 2D-SWE of color Doppler ultrasonography, the Young's modulus was determined by its median value (Method 1) or by its mean value (Method 2). The diagnostic performance of Young's modulus was evaluated by the area under the receiver operating characteristic curve (AUC). Results The liver histopathological examination showed S0/S1 stage in 31 cases, S2 stage in 19 cases, S3 stage in 12 cases and S4 stage in 10 cases, that’s S2-S4 stage in 41 cases in our series; the Young's modulus by method one in patients with S0/S1, S2, S3 and S4 were (6.1±1.2)kPa, (8.1±1.1)kPa, (11.5±1.8)kPa and (20.9±2.5)kPa, all not significantly different compared to(6.0±1.1)kPa, (8.3±1.2)kPa, (11.6±1.5)kPa and (21.1±2.8)kPa obtained by method two (P>0.05); the Young's modulus by method one or two was positively correlated to LF(r=0.427, P<0.05; r=0.442, P<0.05); the AUCs were 0.938 or 0.956 (P>0.05) in predicting LF in patients with CHB as the Young's modulus equal to 6.04 kPa by method one or 6.14 kPa by method two was set as the cut-off-value, and the AUCs were 0.973 or 0.968(P>0.05) in predicting significant LF as the Young's modulus equal to 8.12 kPa by method one or 8.25 kPa by method two was set as the cut-off-value. Conclusion The median or mean value of five measurements of liver elastic modulus as the final parameter by 2D-SWE might have the equivalent diagnostic performance in the diagnosis of LF in patients with CHB.

Objective Most patients with liver cirrhosis (LC) have a certain degree of malnutrition, mainly protein-calorie malnutrition. The portal hypertension in patients with LC can lead to gastrointestinal congestion and edema, ascites, overgrowth of intestinal bacteria, gastrointestinal bleeding, secondary infections, and other complications, resulting in reduced intake, absorption disorders and excessive loss of nutrients. It can also lead to metabolic disorders, with increased incidence of complications and risk of death. Therefore, nutritional support should be take into consideration during the treatment of patients with LC. In this article, we mainly focuses on the nutritional evaluation and diet management for them.

Objective The purpose of this study was to analyze the clinical features of patients with pyogenic liver abscess (PLA) with different underlying diseases. Methods The adult PLA patients were encountered in our hospital between January 2007 and December 2020, and the clinical materials were collected and analyzed. Results Out of the 1930 patients with PLA in our series, 926 patients (group A) had no underlying diseases, 592 patients (group B) had type two diabetes mellitus (T2DM), 261 patients (group C) had biliary diseases, and 151 patients (group D) had T2DM and biliary diseases; the percentage of neutrophils in group D was (83.6±9.3)％, much higher than in other three groups (P<0.05), serum albumin levels in group B and group D were 30.3(26.1, 35.1)g/L and 30.8(26.9, 34.1)g/L, much lower than [32.3(28.3, 36.8) g/L, P<0.05] in group A; the incidence of jaundice in group C was 11.9％, significantly higher than 5.5％in group A and 2.7％ in group B(P<0.05), the incidence of pulmonary lesions in group D was 39.1％, significantly higher than 28.3％(P<0.05) in group A, the proportions of aerogenic abscess in group B and group D were 15.4％ and 12.6％, significantly higher than 6.6％(P<0.05) in group A, and the diameter of hepatic abscess in group D was 68.0(50.0, 87.0)mm, significantly higher than in other three groups (P<0.05); the medical costs in group B, group C and group D were 20000.2(10000.5,30000.3) yuan, 20000.3(10000.5, 30000.4) yuan and 20000.4(10000.5, 40000.2) yuan, significantly higher than [10000.9(10000.2, 20000.9) yuan (P<0.05) in group A. Conclusion The PLA patients with underlying diseases might have a severe disease, and have a relatively high hospitalization costs.

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.

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