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 Primary biliary cholangitis(PBC)is characterized by a chronic autoimmune intrahepatic cholestasis,and autoimmune hepatitis (AIH) is a liver parenchymal inflammation mediated by autoimmune reaction. When the two entities coexist in a given patient, we call it "PBC-AIH overlap syndrome (PBC-AIH OS)". The prevalence of PBC-AIH OS is low, but it progresses faster and has a poorer prognosis. The clinical diagnosis and the choice of treatment are still challenging. Therefore, in this article, we reviewed the latest progress in the definition, epidemiology, clinical features, diagnosis, treatment and prognosis of patients with PBC-AIH OS, in order to help the appropriate diagnosis and treatment of the disease.

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.

The nonalcoholic fatty liver disease (NAFLD) is considered to be the metabolic disorders in liver and is closely related to obesity, insulin resistance (IR), type 2 diabetes mellitus (T2DM) and hyperlipemia, etc. The prevalence of NAFLD among adults worldwide is about 25% and it is to believe increasing year by year. The NAFLD is an important causes of liver cirrhosis, liver cancer and liver transplantation. A large number of studies have shown that thyroid hormone (THs) plays an important role in hepatic lipid metabolism and IR, and the thyroid hormone receptor agonists are expected to become new medicines for the treatment of patients with NAFLD. In this review, we mainly discuss the progress of THs in patients with NAFLD.

Objective The aim of this study was to investigate the short-term efficacy of dapagliflozin and liraglutide combination in treatment of patients with non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus type 2(T2MD). Methods 60 patients with NAFLD and T2MD were admitted to our hospital between September 2017 and October 2020, and were randomly divided into control and observation group, with 30 cases in each group. All the patients were supervised for routine lifestyle intervention and oral metformin administration for blood glucose control. In addition, the patients in the control group were treated with liraglutide intravenouly, and those in the observation group were treated with dapagliflozin and liraglutide combination. The regimen lasted for 3 months. The fasting plasma glucose (FPG), 2 hour-postprandial plasma glucose (2h PG) and glycated hemoglobin (HbA1c) as well as serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL－C) and high density lipoprotein cholesterol (HDL－C) levels were routinely obtained. Serum fasting insulin(Fins) and 2 h Ins levels were assayed, and the HOMA-IR was calculated. The controlled attenuation parameter (CAP) of livers was detected by FibroTouch. Results At the end of 3 month observation, the FPG, 2hPG and HbA1 levels in the observation group were(5.8±0.7)mmol/L, (6.9±0.8)mmol/L and (6.3±0.9)%, all significantly lower than [(6.6±0.6)mmol/L,(7.7±0.7)mmol/L and (7.2±1.0)%, respectively, P＜0.05] in the control group; serum Fins, 2hIns and HOMA-IR levels were (9.8±1.2)mIU/L, (20.2±1.7)mIU/L and (2.6±0.4)%, significantly lower than [(11.9±1.1)mmol/L, (24.8±1.6) mmol/L and (3.2±0.5)%, respectively, P＜0.05] in the control; serum TG level was (2.6±0.4) mmol/L, significantly lower than [(3.0±0.3)mmol/L, P＜0.05], while serum HDL-C level was (1.6±0.2) mmol/L, significantly higher than [(1.2±0.3)mmol/L, P＜0.05] in the control; the CAP was (249.2±7.5)dB/m, also significantly lower than [(264.7±8.6)dB/m, P＜0.05] in the control; serum AST level was (39.9±3.8)U/L, significantly lower than [(44.9±4.2)U/L, P＜0.05] in the control. Conclusion The application of dapagliflozin and liraglutide combination is efficacious in the treatment of patients with NAFLD and T2MD, which could effectively reduce blood glucose and lipid levels, improve liver function tests back to normal, with the ability of alleviation of insulin resistance.

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 Alcoholic liver disease (ALD) is one of the major causes of death related to liver disease over the world. The alcohol consumption and the related diseases have become a global health burden. There is growing evidence of strong correlation of intestinal microbiome disorders to liver diseases. The translocation of bacteria and their products caused by the destruction of the intestinal barrier is the key factor to lead to complications of liver diseases. In recent years, many new biomarkers and therapeutic targets are the hotspots in the field of ALD studies.

Objective The aim of this study was to investigate the short-term hemostatic effect of endoscopic variceal ligation (EVL) and omeprazole and octreotide combination in the treatment of cirrhotics with first esophageal varices bleeding (EVB). Methods 60 patients with cirrhosis and EVB were enrolled in this study between January 2018 and January 2021, and 30 patients in the control were treated with omeprazole and octreotide, while another 30 patients in the observation group were treated with EVL on the basis of medicines in the control group. The diameters, mean flow velocities and blood flows of portal vein and splenic vein were detected by color Doppler ultrasound. Serum gastrin (GAS) and glucagon (GLC) levels were detected by ELISA, and serum procollagen type III N-terminal peptide (PIIINP) level was detected by radioimmunoassay. Results 1 week after treatment, the total efficient rate in the observation group was significantly higher than that in the control group (96.7% vs. 76.8%, P<0.05), and the emergent hemostasis rate in the observation group was also higher than that in the control group (93.3% vs. 73.3%, P<0.05); the early re-bleeding rate and the delayed re-bleeding rate in the observation group were 10.0% and 3.3%, both significantly lower than 33.3% and 20.0% (P<0.05) in the control; the mean flow velocity and blood flow of portal vein in the observation group were (14.2±2.3) cm/s and (1224.6±173.2) mL/min, significantly higher than [(12.1±1.6) cm/s and (1030.7±164.5) mL/min, P<0.05], the mean flow velocity and blood flow of splenic vein in the observation group were (14.4±1.9)cm/s and (934.6±185.3)mL/min, both significantly higher than [(12.3±1.7)cm/s and (731.3±172.4)mL/min, respectively, P<0.05] in the control; serum PIIINP, GAS and GLC levels in the observation group were (173.6±19.5) μg/L, (69.7±9.6) ng/L and (52.3±7.1) ng/L, significantly lower than [(202.8±23.1) μg/L, (91.4±12.3) ng/L and (62.4±8.3) ng/L, respectively, P<0.05] in the control group; the total incidence of post-EVL complications, such as sore throat, retrosternal pain, dysphagia, abdominal distension, nausea and vomiting was 53.3%. Conclusion The short-term clinical hemostatic effect of EVL at base of omeprazole and octreotide combination is good in patients with liver cirrhosis and first EVB, which could improve hemodynamic states of portal system, with a relative safety.

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.

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 At present, the artificial intelligence (AI) has been widely used in many fields, and it also applied in medical diagnosis and treatment. In this paper, we mainly reviewed the AI research on the diagnosis, management and prognosis of patients with in liver diseases, in order to provide more effective measures. Finally, the future development of AI in the field of liver disease study is prospected.

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 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 aim of this study was to investigate the diagnostic performance of ultrasound attenuation parameters (UAP) in predicting fatty liver diseases (FLD) in individuals at physical examination. Methods The general data, biochemical indexes, ultrasonography, UAP and liver stiffness measurement (LSM) by iLivTouch in individuals at physical examination were collected in Physical Examination Center, Third Hospital, Hebei Medical University between November and December 2020, and the diagnostic efficacy of UAP was evaluated by the area under the receiver operating characteristic curve (AUC). Results Among the 308 subjects, the FLD was found in 252 cases, with 56 persons without; the male patients with FLD accounted for the most, much greater than female patients (P<0.001), while there was no significant difference as respect to ages between the those with and without FLD (P>0.05); serum HDL level in patients with FLD was significantly lower than, while the BMI, serum TG, TC, LDL, VLDL, ALT, AST, Cr, UA, GLU and UAP were significantly higher than those in healthy persons (P<0.05); the BMI, ALT and UA were the independent predictors for higher UAP, and the cut-off value was 251.35 dB/m, with the AUC of 0.856, the sensitivity of 0.710 and the specificity of 0.839, when the UAP was applied to diagnose the FLD; the diagnostic performance by the combination of UAP, BMI and ALT for FLD with AUC of 0.920 was superior to any parameter done alone. Conclusion The UAP obtained by iLivTouch scam could diagnose the FLD, and it might be helpful to take the BMI and serum ALT into consideration.

Objective This study was aimed to investigate the clinical utility of transient elastic (TE) imaging for the detection and quantification of liver fibrosis (LF) in patients with alcoholic liver cirrhosis diagnosed by histopathology. Methods 68 patients with alcoholic liver diseases (ALD) were encountered in our hospital between January 2019 and January 2022, and all underwent ultrasound-guided liver biopsy and TE imaging detection for liver stiffness measurement (LSM) and spleen stiffness measurement (SSM). The consistency of diagnosis by two methods was evaluated by Kappa. Results Based on the LSM, the patients without or mild LF were found in 28 cases (41.2%), with significant LF in 19 cases (27.9%), with advanced LF in 13 cases (19.1%) and liver cirrhosis (LC) in 8 cases (11.8%); the liver histopathological examination showed LF S0, S1, S2, S3 and S4 in 15 cases(22.1%), 11 cases (16.2%), 20 cases (29.4%), 12 cases (17.6%) and 10 cases (14.7%); the LSM and SSM in 8 patients with LC proven by TE were (18.4±5.6)kPa and (22.6±4.6)kPa, significantly greater than [(10.7±3.3)kPa and (14.9±3.8)kPa, respectively, P<0.05] in 60 patients without LC; based on the gold criteria by histopathology, the sensitivity, specificity and accuracy by TE in predicting LC were 70.0%, 98.3% and 94.1%, with good consistency (Kappa=0.744). Conclusion The TE imaging technique, as a good non-invasive approach, could be utilized in clinical practice for early diagnosis of LF and/or LC, which might be helpful for clinicians making interventional strategy.

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.

Objective The aim of this study was to analyze the risk factors of non-alcoholic fatty liver diseases (NAFLD) in physical examination individuals. Methods 1742 persons received physical examination in our hospital between January 2018 and January 2020, and 485 individuals were eligible for this study based on inclusion and exclusion criteria. The NAFLD was found by ultrasonography in 78 cases and not in 407 cases. The visceral adipose tissue (VAT)was obtained by CT scan, and fasting plasma glucose (FPG) and other common blood parameters were assayed. The risk factors for NAFLD was analyzed by univariate and multivariate Logistic regression. Results The incidences of concomitant blood hypertension, diabetes and hyperlipidemia in patients with NAFLD were 29.5%, 35.9% and 51.3%, much higher than 18.7%, 23.8% and 23.6% (P<0.05), the body mass index, waist and hip circumference were (25.1±1.)kg/m², (90.4±6.3)cm and (101.3±8.4)cm, much higher than [(22.4±1.1)kg/m², (81.6±5.7)cm and (95.7±6.2)cm, respectively, P<0.05] in persons without NAFLD; serum TG, LDL-C and VAT were (2.9±0.3)mmol/L,(3.7±0.4)mmol/L and (146.3±12.1)cm², significantly higher than [(1.6±0.2)mmol/L, (3.1±0.2)mmol/L and (70.5±4.6)cm², respectively, P<0.05] in persons without NAFLD; serum ALT, FPG and UA levels were (56.6±11.7)u/L, (5.8±0.7)mmol/L and (387.8±36.3)μmol/L, all significantly higher than [(32.4±3.1)u/L, (5.1±0.4)mmol/L and (313.6±51.4)μmol/L, respectively, P<0.05] in persons without NAFLD; the multivariate Logistic regression analysis showed that the increased BMI, elevated VAT, concomitant blood hypertension, and elevated serum TG, LDL-C, ALT and UA levels were all the independent risk factors, while the increased serum HDL-C level was the protective factor for the existence of NAFLD. Conclusion The prevalence of NAFLD in physical examination individuals is relative high, and some increased body health, blood and imaging parameters hints its existence, and warrants further check-up.

Objective The purpose of this study was to investigate the prevalence of bacterial infection in patients with hepatitis B viral infection-related acute-on-chronic liver failure (HBV-ACLF). Methods The clinical materials of 214 patients with HBV-ACLF between January 2015 and February 2022 were retrieved from His system in our hospital, and various infections were defined according to related criteria. The multivariate Logistic regression analysis was applied to reveal the impacting factors for infection. Results Out of the 214 patients with HBV-ACLF, the bacteria infection was found in 145 cases(67.7%), involving one organ in 113 cases, two in 28 cases and three in 4 cases, including spontaneous bacterial peritonitis (SBP) in 127 cases (85.2%), pulmonary infection in 41 cases (27.5%), acute cholecystitis in 25 cases(16.8%), urinary tract infection in 4 cases (2.7%) and perianal infection in 2 cases (1.3%); there were significant differences as respect to ages, systemic inflammatory response syndrome (SIRS) score, peripheral white blood cell counts, platelet counts, C-reactive protein, procalcitonin, prothrombin time activity (PTA), serum bilirubin, albumin, the incidence of hepatic encephalopathy (HE) and ascites between patients with and without bacterial infections(P<0.05); the multivariate Logistic analysis showed that the age, SIRS scores, WBC counts, PCT and ascites were the independent risk factors, while the PTA and serum albumin levels were the protective ones for bacterial infection in patients with HBV-ACLF(P<0.05); we set the SIRS score as the basic parameter, and its combination with age in predicting bacterial infection had the sensitivity (Se) and specificity (Sp) of 75.9% and 55.1%, with WBC counts of 77.2% and 62.3%, with PTA of 79.3% and 59.4%, with PCT of 89.7% and 46.4%, with ALB of 80.7% and 63.8%, and with ascites of 67.6% and 72.5%, suggesting a good Se with relatively low Sp. Conclusion The patients with HBV-ACLF are prone to bacterial infection, and some factors, such as elderly persons, hyperbilirubinemia and severe coagulation dysfunction, might trigger the infection, which should be appropriately dealt with as early as possible in clinical practice.

Objective There is a dense collagen deposition in hepatic sinusoide in patients with severe acute alcoholic hepatitis (SAAH), which increase the sinusoidal resistance with increased pressure and block blood flow through hepatic sinusoids. The portal vein blood flow is compromised in a retrograde manner with obviously reduced portal venous perfusion. Consequently, the hepatic artery buffering response (HABR) is triggered to counteract the decreased blood flow from hepatic artery or portal vein to maintain a physiological requirement and restore the hepatic perfusion, e.g., the sum of hepatic artery and portal vein blood flow. The hepatic hemodynamics and quantitative HABR can be assessed by Duplex Doppler ultrasonography, and the latter could be a noninvasive approach for the diagnosis of SAAH.

Objective The aim of this study was to explore the application of three-dimensional speckle tracking imaging (3D-STI) in the early diagnosis of cirrhotic cardiomyopathy (CCM) in patients with decompensated cirrhosis. Methods 82 patients with decompensated cirrhosis and 30 healthy individuals at the same time were enrolled in our hospital between February 2020 and February 2022. The scores of model for end-stage liver disease (MELD) were calculated for evaluation of liver functions. The left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs) and ratio of early and late peak diastolic velocity of mitral valve (E/A) were measured by routine two-dimensional ultrasound. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction ( LVEF) and left ventricular mass index (LVMI) were measured by real-time three-dimensional ultrasound. The left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and global area strain (GAS) were measured by 3D-STI. Results The E/A ratio in patients with liver cirrhosis was (1.0±0.2), significantly lower than [(1.2±0.3), P<0.05] in healthy individuals, while the LVDd and LVDs were (46.5±5.0) mm and (31.1±4.3) mm, both not significantly different compared to [(45.3±4.2) mm and (30.9±4.1) mm, respectively, P>0.05] in healthy persons; out of the 82 patients with liver cirrhosis, the CCM was found in 58 cases; there were no significant differences as respect to the LVEF, LVEDV, LVESV and LVMI among patients with, or without CCM and healthy persons(P＞0.05); the absolute GLS, GCS, GRS and GAS in cirrhotics with CCM were (14.5±3.8)%, (17.1±3.5)%, (40.7±6.0)% and (24.3±4.0)%, significantly lower than [(17.9±2.6)%,(19.5±2.9)%,(44.8±8.5)% and (27.7±4.2)%, respectively, P<0.05] in those without CCM or [(18.7±2.2)%, (19.7±3.0)%, (45.4±6.1)% and (28.7±3.4)%, respectively, P<0.05] in healthy persons. Conclusion The incidence of CCM is not uncommon in patients with decompensated cirrhosis, and the 3D-STI could help sensitively reflect the changes of left ventricular systolic functions and diagnose CCM, which warrants further clinical investigation.

Objective With the wide application of biologics, the hepatitis B virus (HBV) reactivation have been increasingly become a problem. The patients with HBV reactivation may suffer from liver failure, which might lead to death. The screening, prophylactic antiviral therapy and surveillance for the patients at a risk of HBV reactivation have become the consensus of major related guidelines. In this article, we reviewed the population risk stratification, mechanism by which the HBV reactivated, and the prophylactic antiviral agents.

Objective The aim of this study was to observe the short-term efficacy of ornithine aspartate at base of colon dialysis in treatment of patients with hepatic encephalopathy (HE). Methods 123 patients with liver cirrhosis and complicated HE were encountered in our hospital between January 2019 and December 2021, and were randomly divided into control (n=61)and observation group (n=62), receiving colon dialysis or colon dialysis and intravenous ornithine aspartate administration at base of conventional supporting treatment for 7 to 10 days. Serum tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), IL-6, plasma β-endorphin (β-EP) and endotoxin (LPS) were detected by ELISA. The blood ammonia was routinely detected. The cognitive function was assessed by mini-mental state examination (MMSE) and by number connection test (NCT). Results At the end of the treatment, the mortality rate in the observation group was significantly lower than that in the control group (16.1% vs. 36.1%, P<0.05); the total serum bilirubin level in the observation group was (41.6±8.2) μmol/L, significantly lower than [(50.8±9.4) μmol/L, P<0.05] in control group, and blood ammonia level was (60.8±6.3) μmol/L, significantly lower than [(82.4±9.6) μmol/L, P<0.05] in the control group; serum TNF-α, IL-8, IL-6, β-EP and LPS levels in the observation group were (27.5±5.3)ng/L, (44.9±7.2)ng/L, (50.6±8.4)ng/L, (38.6±3.8)pg/mL and (17.5±3.1)pg/mL, all significantly lower than [(39.7±6.8) ng/L, (62.8±9.3)ng/L, (74.8±11.5)ng/L, (50.7±4.9)pg/mL and (24.8±3.6)pg/mL, respectively, P＜0.05] in the control; the MMSE score was (27.4±3.8), much higher than [(23.9±3.6), P＜0.05], while the time of NCT was (50.3±4.8) s, much quicker than [(60.5±5.9)s, P＜0.05] in the control group. Conclusion The intravenous infusion of ornithine aspartate at base of colon dialysis in the treatment of patients with HE could improve the short-term survival, which might be related to the reduction of blood ammonia andβ-EP levels as well as the inhibition of inflammatory reaction.