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.

In view of the high prevalence of diabetes mellitus in patients with liver cirrhosis and the increasing trend of non?alcoholic fatty liver disease?associated cirrhosis, the diagnosis and treatment of diabetes mellitus in patients with liver cirrhosis are becoming widespread concerns. Therefore, the Chronic Disease Management Branch, China Pharmaceutical Biotechnology Association, organized multidisciplinary experts from gastroenterology, infective disease, endocrinology, etc, to draw up expert consensus on the management of diabetes mellitus in patients with liver cirrhosis, with focusing on the classification and management of hyperglycemia in cirrhotic patients. The consensus summarizes the prevalence, pathogenesis, clinical setting and prognosis of the concomitant diabetes mellitus in patients with liver cirrhosis, and definitely puts forward a proposal regarding "hepatogenous diabetes" as one of the four subtypes of diabetes mellitus in cirrhotic patients, and further recommends the basic principles for diagnosing and monitoring diabetes mellitus and the selection of antidiabetic drugs based on liver functions in patients with liver cirrhosis.

Objective Dietary copper restriction has long been considered an important treatment for patients with hepatolenticular degeneration (HLD). However, evidence supporting this approach is limited. There are no published randomised controlled trials for the recommendation due to rarity of the disease and variable presentation. This review summarized current knowledge on the absorption and regulation of copper in humans and its relevance to patients with HLD. Studies have demonstrated that as the level of dietary copper increases, the proportion absorbed decreases. This observation implies that ‘high copper' foods that HLD patients are generally advised to avoid would need to be consumed in large amounts to impact markedly on the quantity absorbed. Dietary copper restriction is unlikely to reduce the amount absorbed significantly and is not only difficult to manage but restricts food supply unnecessarily, detracting from the provision of substrates essential for improving nutritional status in a nutritionally compromised group. Medical management for HLD is effective in compliant patients, allowing stabilization of the liver disease. Based on current evidence, dietary copper restrictions in stable HLD patients who are adherent to medical therapy are unnecessary with two food exceptions (shellfish and liver organ).

Objective The aim of this study was to investigate the efficacy of lauromacrogol or anhydrous ethanol sclerotherapy under the guidance of color Doppler ultrasound (US) in patients with liver-kidney cysts. Methods 72 patients with liver-kidney cysts were encountered in our hospital between January 2019 and December 2020, and they all underwent cyst puncture under US guidance and sclerotheray. Out of them, 36 patients had lauromacrogol, and another 36 patients had ethanol sclerotherapy. They all were followed-up for six months. Results At the end of six month follow-up, the disappearance or obvious shrink of liver and kidney cysts in lauromacrogol-treated patients was 94.4%, not significantly different compared to 91.7% in patients with ethanol sclerotherapy(P>0.05); at one, three and six month after operation, the cyst reduction rates in lauromacrogol-treated patients were(67.5±8.1)%, (81.6±5.5)% and (95.2±4.9)%, all significantly lower than [(53.9±6.4)%, (73.2±4.7)% and (85.6±3.5)%, respectively, P＜0.05] in ethanol-treated patients; the incidences of side effects, such as fever, drunkenness-like reaction and nausea in lauromacrogol-treated patients was 8.3%, significantly lower than 27.8%(P＜0.05) in ethanol-treated patients. Conclusion The anhydrous ethanol or lauromacrogol sclerotherapy under US guidance in the treatment of patients with liver-kidney cysts is efficacious, and we recommend lauromacrogol sclerotherapy because of its high reduction rates of cysts and low incidences of adverse reactions.

Objective The aim of this study was to summarize the imaging features of multi-slice spiral CT (MSCT) in patients with gallbladder adenomyosis and in patients with gallbladder carcinoma. Methods 113 patients with gallbladder adenomyosis and 78 with gallbladder carcinoma were enrolled in our hospital between September 2015 and September 2020, and all patients underwent MSCT and ultrasonography. The histophthological examination was performed after surgery. Results The consistency of diagnosis by MSCT based on postoperative histopathological examination (Kappa=0.749) was stronger than that by ultrasonography (Kappa=0.577); the accuracy rate by MSCT scan in the diagnosis of patients with gallbladder adenomyosis was higher than that by ultrasonography(88.0% vs. 79.6%, P<0.05); the diagnosis of special, local gallbladder adenomyosis, by MSCT was also higher than that by ultrasonography (97.1% vs. 82.9%, P<0.05); the CT scan showed that the percentages of smooth gallbladder walls, RAS sinus display and clear boundary between liver and gallbladder in patients with gallbladder adenomyosis were 36.3%, 36.3% and 69.0%, all significantly higher than 9.0%, 6.4% and 38.5% in patients with gallbladder carcinoma (P<0.05). Conclusion The diagnostic accuracy of patients with gallbladder adenomyosis by MSCT is relatively high, and its imaging feature might help discriminate gallbladder adenomyosis from cancer.

Objective The aim of this study was to summarize the ultrasonographic and biochemical features of patients with non-alcoholic heterogeneous fatty liver (NAHFL). Methods 90 patients with NAHFL and 30 healthy persons were enrolled in our hospital between January 2016 and December 2018, and ultrasonography and blood biochemical indicators were carried out. Results Out of the 90 patients with NAHFL, 23 cases (25.6%) belonged to type I (local invasive type), 29 cases (32.2%) belonged to type II (segmental infiltration type) and 38 cases (42.2%) belonged to type III (diffuse heterogeneous infiltration) type); serum transferrin (SF) level in patients with type II fatty liver was (254.2±98.7) μg/L, significantly higher than [(175.1±98.4) μg/L, P<0.05] in healthy control; the fasting blood glucose level in patients with type III fatty liver was (6.37±0.79) mmol/L, significantly higher P<0.05] in the control, and HbA1c was than in the control, blood uric acid level was (418.3±40.5)μmol/L, significantly higher than in the control, and SF was (287.3±105.1) mg/l, significantly higher than in the control; serum AST level in patients with type II fatty liver was (51.5±13.4) IU/L, significantly higher than in the control, serum GGT level was (59.3±31.2) IU/L, significantly higher than in the control, blood TC in patients with type III fatty liver was (4.7±0.8) mmol/L, significantly higher than in the control, blood TG was (3.2±1.5) mmol/L, significantly higher than in the control, serum AST was (60.2±18.7) IU/L, significantly higher than , serum ALT was (54.2±29.8) IU/L, significantly higher than , and serum GGT level was (59.3±31.2) IU / L, significantly higher than in the control. Conclusion Ultrasonography might show a characteristic features in patients with NAHFL, and the diagnosis might be made at the base of blood analysis in clinical practice.

Objective The aim of this study was to investigate combination of Xuezhikang, a herbal medicine compound, and atorvastatin in treatment of patients with non-alcoholic fatty liver disease (NAFLD) and hyperlipidemia. Methods 124 patients with NAFLD and hyperlipidemia were enrolled in our hospital between January 2022 and July 2024, and were randomly assigned to receive atorvastatin in 63 cases in control, or receive Xuezhikang at base of atorvastatin in another 61 cases in observation for 24 weeks. Fasting insulin was assayed by immunoassay, and HOMA-IR and HOMA-β were calculated. Serum tumor necrosis factor(TNF-α), interleukin -6(IL-6) and IL-8 levels were detected by ELISA. Results By end of 24-week treatment, serum ALT, AST and GGT levels in the observation group were (36.5±3.3)U/L, (32.7±2.8)U/L and (46.4±4.7)U/L, all significantly lower than [(62.8±3.6)U/L, (58.9±3.2)U/L and (64.1±5.3)U/L, respectively, P<0.05] in the control; there were no significant differences as respect to serum TC, TG, LDL-C and HDL-C levels in the two groups (P>0.05); serum FINS and HOMA-IR were (5.3±1.5)μU/ml and (2.7±0.8), both much lower than [(6.4±1.2)μU/ml and (4.1±1.3), respectively, P<0.05], while HOMA-β was (92.3±15.4), much greater than [(77.2±13.7), P<0.05] in the control; serum TNF-α, IL-6 and IL-8 levels were (15.5±6.3)pg/ml, (16.2±5.1)ng/L and (5.5±1.1)μg/L, all significantly lower than [(27.6±6.8)pg/ml, (26.6±5.8)ng/L and (7.2±1.4)μg/L, respectively, P<0.05] in the control group. Conclusion Application of Xuezhikang with combination of atorvastatin in treatment of patients with NAFLD and hyperlipidemia could improve liver function test normal, which might be related to modulation of glycolipid metabolism and inhibition of cytokine reactions.

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 The aim of this study was to investigate short-term efficacy of Wuzhi capsule, a herbal medicine compound, and compound glycyrrhizin combination in the treatment of patients with non-alcoholic steatohepatitis(NASH). Methods 120 patients with NASH were encountered in our hospital between May 2021 and December 2024, and were randomly assigned to receive compound glycyrrhizin intravenously in 60 cases in the control or to receive oral herbal medicine plus compound glycyrrhizin in another 60 cases in the observation for 8 weeks. Serum procollagen-III (PC-III),laminin (LN),collage type Ⅳ(IV-C) and hyaluronidase (HA) levels were detected by RIA; serum(cortisol(COR),glutathione (GSH),superoxide dismutase(SOD) and malondialdehyde (MDA) levels were assayed by chemiluminescence; Serum interleukin-6 (IL-6),IL-1βand tumor necrosis factor-α(TNF-α) levels were determined by ELISA. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were determinedby Fibrotouch. Results By end of eight week treatment, serum alanine aminotransferase,aspartate aminotransferase and γ-glutamyl transpeptidase levels in the observation group were (38.9±2.7)U/L, (31.8±5.0)U/L and (46.7±3.8)U/L, all significantly lower than [(57.1±6.9)U/L, (43.7±6.9)U/L and (70.1±6.2)U/L, respectively, P＜0.05] in the control; serum HA, PC-III and IV-C levels were (132.3±21.8)ng/mL, (85.2±17.0)mg/L and (34.6±5.0)μg/L, all significantly lower than [(181.9±20.6)ng/mL, (122.4±15.3)mg/L and (65.8±7.2)μg/L, respectively, P＜0.05] in the control group; serum COR and MDA levels were (231.7±23.6)nmol/L and (1.9±0.7)μmol/L, both much lower than [(390.7±30.5)nmol/L and (5.0±1.2)μmol/L, respectively, P＜0.05], while serum GSH and SOD levels were (85.1±9.8)mg/L and (187.3±19.2)U/ml, both much higher than [(49.6±7.4)mg/L and (151.2±14.3)U/ml, respectively, P＜0.05] in the control; CAP was (271.9±17.6)db/m, much lower than [(287.2±25.1)db/m, P＜0.05], and serum cytokine levels were also much lower than in the control group (P＜0.05). Conclusion Combiantion ofWuzhi capsule and compound glycyrrhizin in treatment of patients with NASH is short-termly efficacious, which might relieve oxidative stress and cytokine reactions.

Objective The aim of this study was to analyze the differential diagnosis of enhanced multi-slice spiral CT scanning in patients with hepatic hemangioma (HH) and malignant liver metastasis. Methods A total of 133 patients with space occupying lesions inside livers were encountered in our hospital between January 2018 and January 2020, and the comprehensive diagnosis based on imaging and histopathological examination revealed HH in 102 cases and malignant liver metastasis in 31 cases. All patients underwent enhanced multi-slice spiral CT scanning. Results In patients with HH, the blood flow passing time was (14.3±1.7) s, the liver blood volume was (25.4±2.6) ml/100 g, and the capillary surface permeability was (33.1±4.6), significantly higher than [(9.4±1.0)s, (13.7±1.6)ml/100 g and (27.1±3.1), respectively, P＜0.05], while the proportion of hepatic artery perfusion was (0.3±0.1)%, and the hepatic blood flow was (151.3±15.9)ml/100g/min, significantly lower than [(0.5±0.2)% and (189.3±19.6)ml/100g/min, respectively, P＜0.05] in patients with malignant liver metastasis; the incidences of lesion fusion was 60.8%, the distribution under liver capsules was 74.5%, and the target ring sign was 33.3%, significantly higher than 3.2%, 0.0% and 0.0%, respectively (P＜0.05), while the quasi circular central low-density mass was 2.0%, and the bovine eye sign was 1.0%, significantly lower than 61.3% and 48.4%(P＜0.05)in patients with malignant liver metastasis; based on the golden criteria, the sensitivity, specificity and accuracy by CT scan in diagnosing HH were 89.2%, 77.4% and 86.5%, with the Kappa of 0.638 consistent with histopathological diagnosis. Conclusion The diagnostic performance of enhanced multi slice spiral CT scanning in patients with HH is efficacious, which might guide the clinicians to make suitable plans for the patients with HH.

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 summarize the value of three-phase enhancement scan of 64-slice spiral CT in measuring hepatic hemangioma (HH) volume. Methods 88 patients with HH were enrolled in our hospital between June 2020 and March 2021, and all underwent 64-slice spiral CT three-phase enhancement scan. The enhancement volumes in different phases were detected and measured. Results Out of the 88 patients with HH, the CT plain scan showed that there were 122 lesions, including 54 cases (61.4%) with single lesions and 34 cases (38.6%) with multiple lesions; there were 95 lesions (77.9%) in the right lobe of livers and 27 lesions (22.1%) in the left lobe; there were 100 (82.0%) round or quasi-circular lesions, with clear boundaries, and 22 (18.0%) irregular lesions; there were 87 (71.3%) lesions with diameters of 2 to 10 cm and 35 (28.7%) lesions greater than 10 cm; the CT plain scan showed that there were 111 (91.0%) low-density, 7 (5.7%) iso-density and 4 (3.3%) high-density lesions; the enhancement scan showed that there were 102 (83.6%) lesions with marginal nodular and plaque-like enhancement in arterial phase, including 25 (24.5%) with mild, 37 (36.3%) with moderate and 40 (39.2%) with significant enhancement; in portal phase, there were 98 (80.3%) lesions filled with contrast agents, and the density as gradually decreased, and the other 24 (19.7%) lesions were not accompanied with enhancement; after 3D post-processing, the tumor volume and the arterial enhancement volume in lesions greater than 10 cm were(370.1±52.8)cm³ and (50.7±10.9)cm³, both significantly greater than [(118.8±24.6)cm³ and (42.3±10.6)cm³, respectively, P<0.05], while the arterial enhancement ratio of the lesions was (13.7±4.3)%, significantly less than [(35.6±10.2)%, P＜0.05] in lesions less than or equal to 10 cm. Conclusion The 64-slice spiral CT three-phase enhancement scan could determine the morphology, size and density of hepatic hemangioma, and the enhancement ratio of hepatic hemangioma in arterial phase could accurately reflect blood supply of the lesions, which might be beneficial to the subsequent intervention treatment.

Objective The aim of this study was to investigate the performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in diagnosis andevaluation of transcatheter arterial chemoembolization (TACE) efficacy in patients with primary liver cancer (PLC). Methods 68 patients with intrahepatic spaceoccupying lesions were encountered in our hospital between January 2017 and June 2021, and all patients underwent DCE-MRI and fine needle aspiration biopsies. The patients with PLC were treated by TACE. The clinical epidemiology analysis skills was applied toevaluate the performance of DCE-MRI in diagnosing PLC. Results The DCE-MRI showed that the intrahepatic malignant lesions had some special feature, such as low frequency signal in T1WI, high frequency signal in T2WI, arterial enhancement, rapid disappeared in portal stage; the cytolgical examination demonstrated the PLC in 64 cases, and non-cancerous foci in 4 cases out of our series; the sensitivity, specificity, accuracy, positive and negative predictive values by DCE-MRI diagnosis were 95.2%,75.0%, 89.7%, 93.8%, and 25.0%; after TACE treatment, the DCE-MRI scan showed complete remission in 18 cases (28.1%), partial remission in 25 cases (39.1%), stable disease in 15 case (23.4%) and disease progression in 6 cases (9.3%). Conclusion The DCE-MRI is a great importance in preoperative diagnosis and postoperative efficacy evaluation in patients with PLC, which could guide clinicians to make appropriate decisions for management.

Objective The aim of this study was to investigate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative parameters in the differential diagnosis of small benign and malignant liver space-occupying lesions (LSOL). Methods 83 patients with LSOL were admitted to our hospital between March 2020 and March 2022, the patients included had their liver lesions less than 3 cm, and all underwent DCR-MRI scan to obtain the volume transfer constant (Ktrans), rate constant (Kep), extravascular extracellular volume fraction (Ve) and initial area under the curve (IAUC) by Tissue4D software automatically at region of interest. The diagnosis was pathologically confirmed from post-operational or fine needle aspiration tissues. The diagnostic efficacy was assessed by the receiver operating characteristic (ROC) curves. Results Out of the 83 patients with LSOL, the pathological examination found benign lesions in 38 cases and malignant ones in 45 cases; the Krans, Kep, Ve and IAUC in malignant lesions were (0.4±0.2)min^-1, (0.9±0.3)min^-1,(0.5±0.2) and (37.2±7.1), all significantly greater than [(0.1±0.1)min^-1, (0.4±0.2)min^-1, (0.3±0.1) and (11.1±2.9), respectively, P<0.05] in their adjacent liver tissues, and also much greater than [(0.2±0.1)min^-1, (0.4±0.3)min^-1, (0.3±0.2) and (22.1±5.7), respectively, P<0.05] in benign lesions; the ROC analysis showed that the combination of Krans, Kep, Ve and IAUC in differentiating small intrahepatic LSOL was much superior to any parameter alone, with the AUC of 0.920, the sensitivity of 95.0%, and the specificity of 78.5%(P<0.05). Conclusion The DCE-MRI quantitative parameters are efficacious in the differential diagnosis of small benign and malignant intrahepatic LSOL.

Objective The aim of this study was to analyze the diagnostic performance of high-frequency and color Doppler ultrasonography in judging the benign and malignant gallbladder polyps. Methods 71 patients with polypoid lesions of gallbladder (PLG) were encountered in our hospital between April 2019 and April 2022, and all patients underwent HD11-type high-frequency and SONOLINE Premier color Doppler ultrasonography. All patients received laparoscopic cholecystectomy (LC) and histopathological examination was performed after operation. Results Out of the 71 patients with PLG, the histopathological examination showed that the benign lesions were found in 67 cases and the adenocarcinoma was found in 4 cases; the high-frequency and color Doppler ultrasonography demonstrated the benign gallbladder polyps in 66 cases(98.5%), and that was 64 cases (95.5%) by high-frequency ultrasonography or 63 cases (94.0%) by color Doppler ultrasonography(P>0.05); the sensitivity, specificity and accuracy were 98.5%, 100.0% and 98.6% by the high-frequency and color Doppler ultrasonography combination detection with the Kappa of 0.881, much excellent compared to 95.5%, 75.0% and 94.4% by high-frequency ultrasonography (Kappa=0.571) or 94.0%, 75.0% and 93.0% by color Doppler ultrasonography (Kappa=0.510). Conclusion The combination of high-frequency and color Doppler ultrasonography in diagnosing gallbladder polyps is efficacious, which could guide the clinicians to make an appropriate decisions.

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 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.

Objective The aim of this study was to observe the curative effect of CT-guided one-step percutaneous transhepatic cholangial drainage (PTCD) in the treatment of patients with malignant obstructive jaundice (MOJ). Methods 60 patients with MOJ were enrolled in our hospital between January 2017 and December 2019, and they were divided randomly into control (n=30) and observation group (n=30). The patients were given PTCD under the guidance of X-ray fluoroscopy in the control or CT-guided one-step puncture in the observation. Results During the operation, the one-time success rate of puncture in the observation group was significantly higher than that in the control group (96.7% vs. 43.3%, P<0.05), the fluoroscopy time was significantly shorter than that in the control group [(13.6±2.1) s vs. (32.6±4.1) s, P<0.05], the total puncture time was significantly shorter than that in the control group [(48.9±10.3) s vs. (92.3±13.6) s, P<0.05], and the radiation exposure dose was significantly less than that in the control group [(2.5±0.3) mGy vs. (5.8±1.1) mGy, P<0.05]; at the end of two weeks after the surgery, total serum bilirubin level in the observation group decreased from (241.8±83.6) μmol/L to (109.8±45.6) μmol/L, that in the control decreased from (242.4±91.2)μmol/L to (108.4±61.9)μmol/L, and there were no significant differences respect to other liver function tests between the two groups (P>0.05); at the end of three month, the post-operational complications such as biliary infection, bleeding, liver abscess and peritonitis in the observation was 3.3%, significantly lower than 26.6% in the control(P<0.05). Conclusion CT-guided one-step PTCD in dealing with patient with malignant obstructive jaundice could improve the puncture successfully, which might be applied in clinical practice overwhelmingly.

Objective The aim of this study was to compare the clinical efficacy of laparoscopic puncture drainage (LPD) and laparoscopic incision drainage (LID) in treatment of patients with bacterial liver abscess (BLA). Methods 63 patients with BLA were admitted to our hospital between January 2019 and December 2020, and were divided into observation (n=32), underwent LPD, and control group (n=31), underwent LID. They were all followed-up for 3 months after surgery. Serum interleukin 6 (IL-6), C-reactive protein (CRP)and procalcitonin (PCT) levels were detected. Results All but one patients in the observation group who died from concomitant diabetes and pulmonary infection recovered in the two groups; the hospitalization stay and medical cost in the observation group were (14.2±2.3)d and (13.0±2.0) thousand yuan, both significantly shorter or lower than [(16.1±2.5)d and (16.0±3.0)thousand yuan, respectively, P＜0.05], while the body temperature normal and hepatic abscess disappearance time were (2.3±0.4)d and (10.3±1.5)d, both significantly longer than [(1.7±0.4)d and (8.4±1.2)d, respectively, P＜0.05] in the control; there were no significant differences respect to serum ALT, AST, GGT and albumin levels, as well as serum CRP, PCT, IL-6 levels or white blood cell counts between the two groups at presentation or after surgery (P＞0.05). Conclusion The clinical efficacy of laparoscopic puncture drainage and laparoscopic incision drainage in dealing with patients with BLA is comparable, but the former is more beneficial to accelerate recovery of patients.

Objective The aim of this study was to investigate the efficacy of one-step and step-by-step laparoscopic cholecystectomy (LC) in the treatment of patients with gallbladder stones and common bile duct stones. Methods 152 patients with gallbladder stones and common bile duct stones were admitted to our hospital between January 2016 and June 2019, 87 patients received one-step surgery, e.g., LC and laparoscopic common bile duct exploration (LCBDE), and 65 patients received step-by-step surgery, e.g., endoscopic retrograde cholangiopancreatography/papillary endoscopic sphincterotomy (ERCP/EST) and afterward LC.Results The total surgical time and postoperative catheter placement rate in patients with one-step surgery were (156.3±42.6)min and 98.9%, significantly longer or higher than [(124.4±31.4)min and 15.4%, P<0.05] in patients receiving step-by-step surgery, while the hospital stay and hospitalization cost were (14.4±3.9)d and (27.9±7.0)thousand yuan, significantly shorter or lower than(18.7±4.2)d and(31.24±5.8)thousand yuan (P<0.05) in the latter; there were no statistically significant differences in the surgical success rate and stone clearance rate between the two groups (95.4% vs. 93.1% and 100.0% vs. 96.9%, respectively, P>0.05); the incidence rate of reflux cholangitis in one-step-treated patients was significantly lower than step-by-step surgery-treated patients (0.0% vss 7.7%, P<0.05), while there was no significant difference in the total incidence of complications between the two groups (19.5% vs. 32.1%, P>0.05).Conclusion Both the one-step and step-by-step with patients with gallbladder surgery are efficacious in dealing stones and common bile duct stones, and under some circumstances, the one-step surgery might eradicate the stones rapidly and get a good efficacy.

Objective The aim of this study was to investigate summarize the ultrasonographic features of cavernous transformation of the portal vein (CTPV) in patients with chronic liver diseases (CLD). Methods Abdominal ultrasonography was conducted in 101 patients with CLD, who was diagnosed with CTPV by CT or MRI in Beijing Ditan Hospital affiliated to Capital Medical University between June 2017 and June 2020. The ultrasonic image features of CTPV and its related complications were summarized, and the causes of ultrasonic missed diagnosis were analyzed with the solutions proposed. Results Out of the 101 patients with CTPV proven by CT and/or MRI, the ultrasonic diagnosis was correct in 82 cases (82.2%), with 19 cases (17.8%) missed; among the cases correctly diagnosed by ultrasonography, 82 patients (100.0%) showed extensive or local cellular vascular structures around the portal vein trunk and its branches, the wall of portal vein was thickened in 70 cases (85.4%), the tortuously dilated cellular vascular structure showed red and blue interlaced rich blood flow signals in 76 patients (92.7%), the low-speed blood flow spectrum of portal vein was measured by pulse Doppler, the tortuously dilated honeycomb vessels around the portal vein compressed the bile duct, resulting in bile duct dilatation in ten cases (12.2%), the gallbladder enlargement occurred in 8 patients (9.6%), the cholecystolithiasis was present in 6 patients (7.4%), the bile duct stones were found in 5 cases (6.1%) and the portal shunt occurred in 5 cases (6.1%). Conclusion Ultrasonography is an important imaging method for the diagnosis of cavernous transformation of portal vein. The main reasons for ultrasonic missed diagnosis are small vascular lumen, small lesion scope, abdominal distension, pseudotumor of bile duct, narrow intercostal space and substernal angle. The enhanced CT or MRI examinations need to perform for correct diagnosis. The liver is scanned at acoustic windows of abdominal effusion or gallbladder and the contrast-enhanced ultrasonography might help reduce the missed diagnosis.

Objective The aim of this study was to investigate the application of preoperative bile CT value in the diagnosis of patients with gallbladder muddy stones.Methods 72 patients with routine imaging false-negative gallbladder muddy stones and 40 patients undergoing gallbladder excision due to liver surgery were enrolled in Hepatobiliary Surgery of PLA General Hospital between September 2018 and September 2020, and all patients underwent abdominal CT scan. Serum interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) levels were obtained. The area under the receiver operating characteristic curve (AUC) was applied to predict the diagnostic value.Results There were no significant differences in changes of liver function tests and blood parameters between the two groups (P>0.05); the bile CT value in gallbladder stone group was significantly higher than that in control group [(66.01±18.24) Hu vs. (25.40±8.23) Hu, P<0.05; there was no significant differences as respect to serum cytokines and PCT levels; the ROC curves analysis showed that the AUC, sensitivity and specificity were 0.954, 92.3% and 91.0%, respectively as the bile CT value greater than 25.60 Hu was set as the cut-off-value for the diagnosis of gallbladder muddy stones.Conclusion The imaging examination shows that bile CT value in patients with false-negative gallbladder muddy stones is significantly higher than that in the subjects with normal gallbladder without stone. The accuracy of bile CT value is relatively higher in the diagnosis of gallbladder muddy stones.

Objective The spontaneous bacterial peritonitis (SBP) is one of the most common complications in patients with cirrhosis, with high clinical incidence, rapid disease development and high mortality. The clinical manifestations of SBP are often not very typical, and the diagnosis of celiac infection is mainly based on the white blood cell counts in celiac fluid. The treatment is mainly empirical antibiotic administration and intestinal flora modulation. Early diagnosis and active intervention are of great importance to improve the prognosis and reduce the mortality, but there are still some great challenges in the diagnosis, treatment and prevention of the entity, which require in-depth study to further solve the relevant problems, so as to guide the clinical practice and improve the patient's prognosis.

Objective The aim of this study was to investigate the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) time-intensity curve (TIC) parameters and liver imaging reporting and data system (LI-RADS) classification in differentiating diagnosis of liver space-occupying lesions (SOL). Methods 82 patients with liver SOL were encountered in our hospital between January 2020 and December 2024, and the diagnosis was proven by liver histo-pathological examination. All patients underwent CEUS to record TIC parameters, including peak intensity, time to peak, rise time, mean transit time and blood flow perfusion index. Intrahepatic lesions were classified according to LI-RADS criteria, with LR-4a as the cut-off value, e.g., LR-1 to LR-4a were classified as benign, and LR-4b to LR-5 were defined as malignant lesions. Results Of the 82 patients with liver SOL, liver histo-pathological examination found malignant lesions in 43 cases (52.4%), and benign ones in 39 cases (47.6%); peak intensity and mean transit time in malignant lesions were(126.2±15.7)% and (126.8±26.0)s, both significantly lower or faster than [(140.5±18.4)% and (246.6±42.6)s, respectively, P<0.05], while time to peak, rise time and blood flow perfusion index were (21.4±3.9)s, (34.4±6.3)s and (85.2±14.6), all much slower or greater than [(17.3±3.2)s, (30.3±5.6)s and (50.4±7.8), respectively, P<0.05] in benign lesions; false negative false positive rates by LI-RADS diagnosis was 13.9% and 10.2%; the sensitivity and specificity by CEUS quantitative parameters were 95.3%(41/43) and 84.6%(33/39), and they were 86.0%(37/43)and 89.7%(35/39) by LI-RADS. Conclusion Both the quantitative parameters of CEUS TIC and the LI-RADS classification demonstrate satisfactory diagnostic performance in distinguishing benign from malignant liver SOL, which warrants further clinical investigation.

Objective The aim of this study was to observe the clinical efficacy of adenosylmethionine and reduced glutathione in treating patients with drug-induced liver injury (DILI). Methods 90 patients with DILI were enrolled in our hospital between October 2017 and October 2020, and were randomly divided into control and observation group, with 45 cases in each group. The patients in the control group was treated with reduced glutathione, while those in the observation group was additionally treated with adenosylmethionine at base of reduced glutathione. Serum malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were routinely detected. Results After two to six (3.1±1.4) week treatment, serum ALT, AST and bilirubin levels in the observation group were (61.2±8.3)U/L, (54.5±7.4)U/L and (14.4±4.1)μmol/L, all significantly lower than [(86.5±11.5)U/L, (63.1±8.0)U/L and (21.5±5.4)μmol/L, respectively, P<0.05] in the control; serum prealbumin and cholinesterase levels were (205.5±1.9)mg/L and (5224.1±589.9)u/L, both significantly higher than [(188.5±34.2)mg/L and (4933.9±602.2)u/L, respectively, P<0.05], while serum total bile acids was (7.1±1.7)μmol/L, significantly lower than [(9.5±2.1)μmol/L, P<0.05] in the control; serum MDA level was (4.5±0.7)μmol/L, significantly lower than [(6.5±0.9)μmol/L, P<0.05], while serum SOD and GSH-Px levels were (83.1±7.9)U/L and (125.1±13.7)u/L, both significantly higher than [(75.9±7.2)U/L and (105.5±11.1) u/L, respectively, P<0.05] in the control group. Conclusion The short-term clinical efficacy of adenosylmethionine and reduced glutathione combination in treatment of patients with DILI is good, which could effectively inhibit inflammatory reactions and oxidative stress, and protect the liver functions.

Objective We explored the effect of nursing care and its impact on rehabilitation in patients with primary liver cancer （PLC） after transhepatic arterial chemoembolization （TACE） in order to provide guidance for improving the life quality of patients. Methods 50 patients with moderate and advanced PLC underwent TACE with hepatic artery perfusion of raltitrexed，and we carried out holistic nursing，including psychological，febrile，dietary，abdominal and local nursing post-operatively for them. We also measured blood liver function indexes and alpha-fetoprotein（AFP） before and after the treatment. Results Four weeks after TACE， serum alanine transaminase，aspartic transaminae，total bilirubin and albumin levels decreased from（43.58±10.15）U/L，（41.25±11.34）U/L，（22.46±6.49） μmol/L and （35.32±4.12） g/L at admission to （38.23±7.86） U/L，（38.56±8.49）U/L，（16.84±10.16） μmol/L and（31.49±5.48） g/L，post-operatively，all no significant difference（P>0.05）；serum AFP decreased from（1215.46±125.14） ng/mL to（811.27±165.28） ng/mL（P＜0.01）；The white blood cell counts decreased in two （4%），fever in two （4%），psychological stress in three（6%），local pain in six（14%），and nausea/vomiting in eight（16%），suggesting the improvement by nursing care in this setting. Conclusions TACE with raltitrexed in treatment of patients with PLC is effective，and the postoperative nursing care might reduce the occurrence of complications，which greatly improve the postoperative rehabilitation of patients.

Objective The aim of this study was to investigate the diagnostic performance of simplified animal nomenclature test (S-ANT) in predicting minimal hepatic encephalopathy (MHE) in patients with liver cirrhosis (LC). Methods 142 patients with LC were encountered in the Department of Infectious Diseases, First Affiliated Hospital, Bengbu Medical College and the Department of Hepatology, Second People's Hospital, Fuyang, Anhui province between July 2020 and June 2021, and the number connection test-A (NCT-A), digit symbol test(DST), simplified animal naming test(ANT) were conducted for the diagnosis of MHE. The multivariate Logistic regression analysis was performed, the receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was calculated to evaluate the diagnostic performance of S-ANT for MHE. Results Among the 142 patients with LC, the MHE was found in 39 cases (27.5%); there were significant differences with respect to the ages, education periods and the percentage of alcoholic liver disease between patients with and without MHE(P<0.05);serum ammonia level in patients with MHE was 61.0(36.0, 94.0)μmol/L, much higher than [(47.1(33.0, 69.0)μmol/L, P<0.05] in patients without MHE; the NCT-A in patients with MHE lasted for (93.5±38.9)s, much longer than [(61.5±23.7)s, P<0.05], and the DST, ANT and S-ANT scores were (22.7±5.7), (12.5±1.5) and (14.4±2.0), all significantly higher than [(36.9±10.4), (17.6±3.9) and (18.7±3.8), respectively, P<0.05] in patients without MHE; the multivariate Logistic regression analysis showed that the age(OR=1.07, 95%CI 1.02-1.14, P<0.05), education period (OR=0.78, 95%CI 0.65-0.94, P<0.05) and serum ammonia level (OR=1.02, 95%CI 1.00-1.04, P<0.05) were all the independent factors for the occurrence of MHE; the AUC was 0.781, with the sensitivity of 71.8％ and the specificity of 84.5％, when the cut-off-value of S-ANT less than 16 was applied to predict the MHE in patients with LC. Conclusion The S-ANT is a good diagnostic tool for the assessment of MHE in patients with LC, which might be applied to screen and early find the suspicious patients.

Objective The aim of this study was to explore the clinical value of 256-slice CT scan in differentiating hepatic echinococcosis from hepatic cysts. Methods 77 patients with hepatic echinococcosis and 34 patients with hepatic cysts were enrolled in our hospital between April 2017 and November 2020, and all underwent CT scan. Serum anti-cystic fluid antigen antibody (anti-EgCF antibody), anti-cephalomere antigen antibody (anti-EgP antibody), anti-cyst fluid semi-purified antigen antibody (anti-EgB antibody) and anti-echinococcus multilocularis antibody (anti-Em2 antibody) were detected by ELISA. Results Before surgery, the blood eosinophil count in patients with hepatic echinococcosis was (0.3±0.1)×10⁹/L, significantly higher than [(0.1±0.1)×10⁹/L, P<0.05] in patients with hepatic cysts; serum anti-EgCF and anti-EgB positive rates in patients with hepatic echinococcosis were 85.3% and 61.8%, significantly higher than (31.2% and 0.0%, respectively, P<0.05) in patients with hepatic cysts; the CT scan showed hepatic round, round-like or lobulated cysts with calcified cyst walls in patients with hepatic echinococcosis, significantly different to that in patients with hepatic cysts; out of the 111 patients, the CT scan misdiagnosed hepatic echinococcosis as hepatic cysts in 3 cases(2.7%), as hepatic metastasis in 1 case (1.0%), and misdiagnosed hepatic cysts as hepatic echinococcosis in 2 cases (1.8%). Conclusion The 256-slice CT examination can display the characteristic imaging of hepatic echinococcosis lesions, which can help differentiating hepatic echinococcosis from hepatic cysts, and provide a reliable imaging evidence for management of patients with hepatic cysts.

Drug-induced liver injury (DILI) refers to varying degrees of liver damage which caused by the drug itself or its metabolites. In recent years, there has been an increasing number of reports about DILI. However, it is often misdiagnosed for the low incidence of DILI symptoms and lack of specificity. There are various diagnostic criteria of DILI in different countries. So it is of great significance to compare the advantages and disadvantages of these criteria and to find the best diagnostic strategy for early treatment and prognosis of DILI.