The Chinese Society of Hepatology of the Chinese Medical Association invited relevantexperts to revise and update the Guideline of Prevention and Treatment of Nonalcoholic Fatty Liver Disease(2018Version) and renamed it as (Version 2024) Guideline for the Prevention and Treatment of MetabolicDysfunction-associated (non-alcoholic) Fatty Liver Disease. Herein, the guiding recommendations on clinicalissues such as screening and monitoring, diagnosis and evaluation, treatment and follow-up of metabolicdysfunction-associated fatty liver disease are put forward.

Objective This study was conducted to explore the qualitative diagnostic efficacy of focal nodular lesions of liver (FNLL) by magnetic resonance imaging (MRI) in patients with nonalcoholic fatty liver diseases(NAFLD). Methods A total of 113 patients with FNLL under the background of NAFLD were enrolled in our hospital between December 2019 and December 2022, and all patients were examined by diffusion-weighted magnetic resonance imaging (MRI-DWI) and dynamic enhanced magnetic resonance imaging (DCE-MRI), with the time-signal curve types recorded. The fine needle aspiration biopsy was performed for pathological diagnosis as the gold standard. The consistency of diagnoses by MRI-DWI and DCE-MRI with the gold standard was compared by Kappa test. Results Out the 113 patients with FNLL and NAFLD, the pathological examination showed focal nodular hyperplasia (FNH) in 69 cases and hepatocellular carcinoma (HCC) in 44 cases; the percentages of typeⅠ, type Ⅱ and type Ⅲ of time-signal curve in malignant lesions were 38.6%, 52.3% and 9.1%, significantly different compared to 2.9%, 20.3% and 76.8% in benign lesions (P＜0.05); the sensitivity, specificity and accuracy were 93.2%,100.0% and 97.3% when the qualitative diagnosis was made by the combination of MRI-DWI and DCE-MRI, much superior to 90.9%, 88.4% and 89.4% by DCE-MRI alone or 90.9%,91.3% and 91.2% by MRI-DWI alone (P＜0.05). Conclusion Theapplication of MRI, especially with DCE-MRI and MRI-DWI models, in the qualitative diagnosis of FNLL under the background of NAFLD is efficacious, which might help the clinicians make a correct diagnosis and deal with appropriately.

Objective Liver is an important organ for the metabolism of sex hormones, lipids and other substances. Male patients with chronic liver disease often suffer from a variety of dysfunctions, such as sex hormone metabolism, glucose and lipid metabolism and mental and psychological disorder. Erectile dysfunction is easy to occur, which affects the physical and mental health and the family life of patients.Existing studies have shown that the prevalence of male erectile dysfunction in patients with chronic liver disease was 24.6% to 85%, the prevalence in chronic hepatitis patients was 8.6% to 78%, and in patients with cirrhosis was 41.2% to 92%.In this paper, we reviewed the incidence, impacting factors, possible pathogenesis, and treatment of erectile dysfunctions in male patients with chronic liver disease.

Objective The aim of this study was to investigate multimodal nalbuphine hydrochloride analgesia in patients with gallbladder polyps (GP) after laparoscopic cholecystectomy(LC). Methods 78 patients with GP were encountered in our hospital between November 2020 and March 2024, and all underwent LC surgery. For post-operational analgesia, patients were randomly divided into control and observation groups, 39 cases in each. Bilateral transversus abdominis plane block (TAP) and patient-controlled intravenous analgesia (PCIA) were conducted, nalbuphine were given in observation, and flurbiprofen ester were administered in the control. Visual analogue scale (VAS) and Ramsay sedation scale (RSS) were evaluated, and serum substance P (SP) and prostaglandin E2 (PGE2) levels were assayed by RIA. Results By 1, 4 and 12 hours after surgery, VAS scores in the observation group were(3.7±0.7)points, (4.0±0.8)points and (4.3±0.9)points, all much lower than [(4.3±0.7)points, (4.6±0.9)points and (4.9±1.0)points, P＜0.05] in the control; by 1, 4, 12 and 24 hours, RSS scores were (2.4±0.5)points, (2.6±0.6)points, (2.9±0.6)points and (2.5±0.6)points, all not significantly different compared to [(2.5±0.6)points, (2.7±0.6)points, (3.0±0.7)points and (2.6±0.5)points, P>0.05]; by 1, 4 and 12 hours, serum SP levels were (0.9±0.2)μg/mL, (2.7±0.6)μg/mL and (4.3±1.0)μg/mL, all much lower than [(1.3±0.3)μg/mL, (4.4±1.1)μg/mL and (6.5±1.3)μg/mL, respectively, P＜0.05], and serum PEG2 levels were (91.9±11.5)pg/mL, (265.3±29.6)pg/mL and (168.3±18.7)pg/mL, all much lower than [(108.8±12.7)pg/mL, (304.2±32.8)pg/mL and (183.2±20.6)pg/mL, respectively, P＜0.05] in the control group; post-operationally, first exhaust time, food intake and removal of drainage tube in the observation were(40.7±4.2)h, (41.6±3.9)h and (90.6±8.4)h, all much shorter than [(49.8±5.3)h, (50.4±21.5)h and (103.7±4.1)h, respectively, P＜0.05] in the control. Conclusion Application of nalbuphine hydrochloride in multimodal analgesia after LC is beneficial to relieve pain, which might be related to inhibition of pain-related substance release.

Objective The aim of this study was to investigate characteristics of ileal microbiota in patients with metabolic associated fatty liver disease (MAFLD). Methods 54 patients with MAFLD and 18 individuals for physical examination were recruited in our hospital between January 2024 and November 2024, all underwent FibroScan scan for controlled attenuation parameter (CAP) and endoscopy with special device for ileal specimen collection. 16S rDNA sequencing was performed. Results Patients with MAFLD in our series were divided into mild, moderate and severe liver steatosis, with 18 cases in each; patients with MAFLD had an elevated Alpha diversity of ileal flora, with a gradual decrease in percentage of Turicibacter, a reduction in abundance of Lactobacillus and Veillonella, while having an increase in the abundance of Prevotella, Leptotrichia and Porphyromonas. Conclusion The diversity and abundance of ileal microbiota in patients with MAFLD change, which is related to the severity of the entity. The reduction of Turicibacter and the migration of oral colonizing bacteria might be characteristics of the ileal microbiota in patients with MAFLD.

Objective The aim of this study was to explore CT portography (CTP) quantitative parameters in predicting portal hypertension and esophagogastric variceal bleeding (EVB) in patients with decompensated liver cirrhosis (DLC). Methods A total of 98 patients with decompensated hepatitis B-induced liver cirrhosis were encountered in our hospital between January 2021 and March 2023, and all underwent CTP, gastroscopy and portal pressure gradient (PPG) determination. Patients were followed-up for 12 months, and receiver operating characteristic (ROC) curve was applied to evaluate predictive performance. Results Of 98 patients with liver cirrhosis in our series, esophagogastric varices (EV) was found in 47 cases(48.0%) and significant portal hypertension (SPH) in 45 cases (45.9%); diameters of main portal vein, splenic vein, left gastric vein, left branch and right branch of intrahepatic portal vein in patients with SPH were (17.6±1.8)mm, (15.9±1.9)mm, (6.1±1.3)mm, (13.0±1.3)mm and (12.6±1.7)mm, all significantly greater than [(14.9±2.0)mm, (14.0±2.0)mm, (4.6±1.6)mm, (11.3±1.4)mm and (11.3±1.6)mm, respectively, P＜0.05] in those with non-SPH(NSPH); during 12-month follow-up, EVB occurred in 22 cases (22.5%), and baseline diameters of five portal veins mentioned above in patients with EVB were all much greater than in those without EVB(P＜0.05); the AUC was 0.830(P＜0.05), with sensitivity (Se) of greater than 75.6% and specificity (Sp) of greater than 79.3%, or the AUC was 0.755(P＜0.05, with Se of greater than 68.2% and Sp of greater than 71.1% in predicting SPH or EVB when any combination of three parameters from the five was met. Conclusion CTP quantitative parameters have certain clinical diagnostic efficacy in predicting SPH and EVB in cirrhotic patients, and needs further investigation.

Objective Bile acid(BA) is synthesized in the liver and is the major component of bile. BAs accumulates in serum and liver when BAs secretion is impaired, which is followed by liver injury. The molecular mechanism of cholestasis has been extensively studied, however, it remains controversial. Recent studies showed that BAs might induce hepatocyte injury under pathological conditions, and the mechanism involved inflammatory response induced by stressed hepatocytes. In this article, we reviewed recent advances in the pathogenesis of liver injury induced by BAs and we focused on how BAs induce the activation of inflammatory cytokines that further induce the aggregation of immune cells. Based on these pathogenesis, we tentatively point out a number of novel treatments for cholestatic liver damage.

Primary biliary cholangitis (PBC), also known as primary biliary cirrhosis, is a chronic intrahepatic autoimmune cholestatic disease. Ursodeoxycholic acid (UDCA) is first line of treatment for PBC, which can improve biochemical indicators and slow down disease progress, while 30% to 40% of patients with PBC still have poor response to UDCA therapy, which is called refractory PBC. These patients have a higher incidence of cirrhosis and related complications, and early warning, institution treatment and prognosis evaluation for these patients remain a major challenge. The aim of this review is to present the latest research on the clinical features, influencing factors, therapeutic medicines and prognosis of patients with refractory PBC.

Objective To estimate the effectiveness and safety of magnesium isoglycyrrhizinate injection （MIG） for the treatment of patients with cirrhosis. Methods All the randomized controlled trials（RCT） about the effectiveness and safety of MIG for the treatment of patients with cirrhosis were collected by searching databases including Pubmed，Embse，Cochrane library，CBM，Wanfang，CNKI and VIP. The screening of literatures，extraction of information and evaluation of the risk of bias were accomplished by two independent reviewers. Statistical analyses were performed with RevMan 5.2 software. Results A total of 9 RCTs involving 576 patients were included，while the methodology of the included studies was of low quality. The meta-analysis showed that the clinical effective rate of MIG used alone or in combination with other liver-protecting agents was significantly higher than in other hepatoprotective drugs （RR: 1.23，95%CI: 1.07 to 1.42，P<0.01） and （RR:1.31，95%CI: 1.13 to 1.51，P<0.01） with remarkably improved liver function and no severe side effects. Conclusion MIG injection is superior to other hepatoprotective drugs for liver cirrhosis with fewer side effects. However，more controlled trials of high quality are required to further assess the effectiveness and safety of MIG for patients with cirrhosis.

Hepatocellular carcinoma (HCC) has complex biological characteristics, highly heterogeneous property and immunosuppressive tumor microenvironment. HCC carries a dismal prognosis. Metabolic reprogramming (MR) is one of the most important features of tumor cells and the lipid metabolism has been an important mechanism underlying HCC growth and metastasis. In this article, we review the roles of common lipid and its metabolism-related molecules in carcinogenesis of HCC and provides new targets for therapy of HCC.

Wilson's disease (WD) is an autosomal recessive genetic disease characterized by abnormal copper metabolism, which can cause secondary damage to pathological organs, mainly liver and brain. The current basic treatment for patients with WD is based on medicines that increase excretion of copper from the body,such as chelators or zinc salts, etc. The choices of these agents should be based on patients' clinical manifestations and tolerance to them owing to side effects, physicians' experience and the cost and availability of them. The treatment of WD remains challenging for its side effects, compliance problems and life-long treatment. The shortage of donor liver, high cost, and the need for sustained immunosuppressive therapy after operation restrict the application of liver transplantation. Therefore, new treatment or methods, especially ones with better safety and permanent cure, are also attracting more and more attention. Therefore, this article systematically reviews the current research progress in treatment of patients with WD.

Objective The aim of this study was to compare the curative efficacy of ultrasound-guided cyst aspiration, laparoscopic fenestration and laparotomic fenestration drainage in patients with simple hepatic cysts. Methods A total of 117 patients with simple hepatic cysts were admitted to our hospital between April 2017 and November 2019, and out of them, 45 cases underwent ultrasound-guided cyst puncture drainage and sclerified, 42 cases underwent laparoscopic fenestration drainage and 30 cases underwent laparotomic fenestration drainage. Results The disappearance and effective rates in puncture drainage-treated patients were 71.1% and 22.2%, 66.7% and 23.8% in laparoscopic fenestration drainage-treated patients and 66.7% and 26.7% in laparotomic fenestration drainage-treated patients (P>0.05); after treatment, serum ALT, AST and bilirubin levels were (28.6±4.3)U/L, (28.6±3.9)U/L and (16.4±2.8)μmol/L,(29.4±3.9)U/L,(29.8±4.0)U/L and (16.8±3.2)μmol/L, and (29.7±3.4)U/L, (28.4±3.7)U/L and (16.2±3.1)μmol/L, respectively, in the three groups (P>0.05); the incidences of post-operational complications, such as nausea and vomiting, abdominal pain, fever and unformed stool were 15.6%, 6.7%, 13.3% and 4.4%, 21.4%, 14.3%, 19.0% and 7.1%, and 23.3%, 23.3%, 26.7% and 6.7%, no significant differences in the three groups (P>0.05). Conclusion The clinical efficacy of the three surgical approaches are similar for patients with simple liver cysts. However, the ultrasound-guided puncture drainage and sclerotherapy is easy and simple way in this setting.

The application of immune checkpoint inhibitors is becoming more and more extensive,which plays an important role in the treatment of patients with malignant neoplasmas,and the adverse events are more common.Bile duct injury is rare, but once happening, the immunosuppressive therapy tends to be insensitive in most patients,so individualized management is recommended. In this article, we review the epidemiology,pathogenesis,biochemical indexes,clinical and pathological manifestations,imaging and treatment of patients with immune checkpoint inhibitors-associated bile duct injury.