Primary liver cancer （PLC） is one of the most common malignant tumors in China. Early diagnosis of liver cancer is crucial for the outcome of patients with PLC. Protein induced by vitamin K absence or antagonist II（PIVKA-II） is a new serum tumor marker documented in recent years. It has a diagnostic value for hepatocellular carcinoma,reportedly better than the widely used serum tumor marker alpha-fetoprotein （AFP）. In this paper,we reviewed the progress of PIVKA-II in the fundamental research and clinical application.

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.

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

Objective Sarcopenia is defined as loss of systemic skeletal muscle mass and functions. It may affect the physiological functions and leads to the declined quality of life, and even death. Sarcopenia occurs in up to 70% of patients with advanced liver diseases, which is associated with untoward clinical outcomes and poor prognosis. At present, most treatments are based on nutrition and exercise, however, there is still a lack of effective targeted molecular therapy. This review summarizes the pathogenesis of sarcopenia in liver diseases, in order to identify potential biomarkers for treatment and improve the clinical prognosis.

Objective Hepatocellar carcinoma (HCC) is still a heavy health burden in China. Hepatitis B and C infection is the main cause for it. Most patients with HCC are diagnosed at advanced stage with poor prognosis, owing to the lack of early symptoms. The present available monitoring approaches seem to unable to find liver cancer early. It is urgent to explore more sensitive markers to facilitate the early screening of liver cancer. The current research confirms that protein induced by vitamin K absence (PIVKA-II) is conducive to solving the problem. In this paper, we reviewed the progress on PIVKA-II as a new biological marker in this field.

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.

Vascular inteventional therapy has played an important role in patients with unresectable primary liver cancer（PLC）,while the effect of vascular interventional therapy is closely related to the choice of embolic materials. We reviewed the characteristics and the clinical application of common embolic materials used in vascular inteventional therapy.

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 investigate clinical efficacy of tenofovir amibufenamide (TMF) and tenofovir alafenamide fumarate (TAF) in rescue treatment of entecavir (ETV)-treated patients with chronic hepatitis B(CHB) and low-level viremia (LLV). Methods 68 patients with CHB were enrolled in our hospital between January 2022 and January 2024, the enrolled patients were all ETV-treated for at least 12 months, showing poor virological response with LLV and were randomly assigned to receive TMF or TAF for 48 weeks. Liver stiffness measurement (LSM) was evaluated by ultrasonic liver transient elastography, serum HBV markers, biochemical parameters and HBV DNA loads were routinely detected. Serum laminin(LN),collagen type Ⅳ(Ⅳ-C), precollagen-Ⅲ (PC-Ⅲ)and hyaluronic acid(HA)levels were assayed by ELISA. Results By end of 48 week treatment, LSM as well as serum HA, LN, Ⅳ-C and PCⅢ levels in TMF-treated patients were (6.8±1.2)KPa, (171.2±25.9)ng/mL, (147.5±42.3)ng/mL, (174.3±46.3)ng/mL and (56.8±12.4)ng/mL, all not significantly different as compared to [(6.9±1.2)KPa, (175.2±34.6)ng/mL, (148.2±46.3)ng/mL, (175.4±42.1)ng/mL and (55.5±19.5)ng/mL, respectively] in TAF-treated patients (P>0.05); serum bilirubin, ALT and AST levels in TMF-treated patients were (16.4±1.4)μmol/L, (40.3±4.8)U/L and (32.4±5.1)U/L, all not significantly different as compared to [(17.3±1.2)μmol/L, (41.8±4.5)U/L and (36.9±4.9)U/L, respectively] in TAF-treated patients (P>0.05); virological and biochemical response rates in the two groups were not significantly different as serum HBV DNA transferred to negative and serum ALT level returned to normal(P>0.05) in all patients. Conclusion As for patients with CHB and poor response to ETV treatment, rescue antiviral therapy with TMF or TAF is both satisfactory, with complete virological response, and the long-term efficacy should be followed-up in the future.

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 compare the therapeutic efficacy of magnesium isoglycyrrhizinate and compound glycyrrhizin monoamine in treatment of patients with drug-induced liver injury (DILI). Methods A total of 102 patients with DILI were enrolled in our hospital between January 2018 and January 2020, and were randomly divided into observation and control group, with 51 cases in each group. The patients in the observation were treated by intravenous administration of magnesium isoglycyrrhizinate, those in the control were treated by intravenous compound glycyrrhizin monoamine, and the regimen lasted for 14 to 28 days. Serum laminin (LN), hyaluronidase (HA), procollagen-III (PC-III) and collage type IV (IV-Col) were detected by radioimmunoassay. Serum superoxide dismutase (SOD), nitric oxide (NO), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected by ELISA. Results At the end of the treatment, serum ALT and AST levels in the observation group were (42.7±12.5)U/L and (38.2±9.4)U/L, both significantly lower than [(64.5±21.9)U/L and (55.6±15.2)U/L, respectively, P＜0.05] in the control; serum HA, PC-III and IV-Col levels were (138.2±21.5)mg/L, (85.6±17.4)μg/L and (141.5±16.4)μg/L, all significantly lower than [(182.1±23.9)mg/L, (123.8±19.4)μg/L and (175.4±18.7)μg/L, respectively, P＜0.05]; serum SOD and NO levels were (90.3±10.1)U/L and (79.8±9.3)μmol/L, both significantly higher than [(74.9±8.6)U/L and (54.0±7.9)μmol/L, respectively, P＜0.05], while serum IL-6 and TNF-α levels were (11.2±2.5)pg/mL and (26.4±3.6)ng/L, both significantly lower than [(16.8±2.7)pg/mL and (41.3±5.9) ng/L, respectively, P＜0.05] in the control. Conclusion The therapeutic efficacy of magnesum isoglycyrrhizinate is promising in dealing with patients with DILI, which could effectively improve serum biochemical indexes normal and alleviate oxidative stress.

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

Objective The aim of this study was to compare the curative efficacy of laparoscopic-choledochoscopic cholelithotomy and laparoscopic cholecystectomy (LC) in patients with gallbladder stones. Methods 78 patients with gallbladder stones were admitted to our hospital between February 2015 and February 2020, and out of them, 36 patients underwent laparoscopic-choledochoscopic cholelithotomy and 42 patients underwent LC. They were followed up for 12 months after surgery. Serum cortisol and C-reactive protein (CRP) levels were detected by ELISA or double-antibody sandwich immunoluminescence assay. Results The operation time and hospitalization cost in observation group were (53.3±17.7) min and (3.2±0.5) ten thousand yuan, significantly longer or higher than [(36.7±10.8) min and (2.3±0.4) ten thousand yuan, P<0.05], and the postoperative eating time and anal exhaust time were (2.8±0.9) h and (14.9±3.2) h, significantly shorter than [(3.3±0.7) h and (19.3±4.1) h, respectively, P<0.05] in the control; 3 days after surgery, serum CRP and COR levels in the observation group were (11.2±3.1) mg/L and (195.6±30.8) ng/mL, significantly lower than [(19.0±4.9) mg/L and (211.6±32.7) ng/mL, respectively, P<0.05] in the control; the ultrasonography 2 weeks after surgery showed that there were no residual stones in the observation group, and the gallbladder function was intact; at 3 months of follow-up, the incidence of complications, such as incision infection, abdominal distension and diarrhea, reflux gastritis, biliary hemorrhage and acute pancreatitis in the observation group was significantly lower than that in the control group (11.1% vs. 31.0%, P<0.05); at the end of 12-month follow-up, one patient (2.8%) had stone recurrence. Conclusion The application of laparoscopic-choledochoscopic cholelithotomy in the treatment of patients with gallbladder stone might be more beneficial to the recovery of gastrointestinal functions with less postoperative complications.

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 investigate the clinical efficacy of silymarin and diammonium glycyrrhizinate combination in the treatment of patients with non-alcoholic steatohepatitis(NASH). Methods 97 patients with NASH were encountered in our hospital between October 2022 and June 2024, and were randomly assigned to receive oral diammonium glycyrrhizinate in control (n=48), or to receive diammonium glycyrrhizinate with combination of silymarin in observation (n=49) at base of sport exercise and food guidance for six months. Serum hyaluronic acid (HA), laminin (LN), IV collagen (Ⅳ-C) and III procollagen (PCⅢ) levels were assayed by RIA, and serum interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) and IL-6 levels were detected by ELIS. Liver stiffness measurements (LSM) and controlled attenuation parameter (CAP) were measured by Fibrotouch. Results By end of six month treatment, serum ALT, AST, GGT levels, and LSM and CAP in the observation group were (49.4±4.2)U/L, (41.1±3.9)U/L, (60.1±5.5)U/L, (7.3±1.2)kPa and (272.3±10.6)dB/m, all significantly lower than [(57.2±6.3)U/L, (49.5±5.2)U/L, (81.5±7.3)U/L, (8.8±2.5)kPa and (289.5±13.8)dB/m, respectively, P<0.05] in the control; serum HA, Ⅳ-C and PCⅢ levels were (62.1±5.7)μg/L, (60.5±6.2)μg/L and (90.3±10.4)μg/L, all much lower than [(73.2±7.4)μg/L, (68.2±8.7)μg/L and (148.5±13.7)μg/L, respectively, P<0.05] in the control; serum IL-10 level was (30.5±7.6)mg/L, much higher than [(25.2±6.3)mg/L, P<0.05], while serum TNF-α and IL-6 levels were (13.1±3.8)mg/L and (13.6±4.0)ng/L, both much lower than [(26.2±5.7)mg/L and (20.1±6.4)ng/L, respectively, P<0.05] in the control group. Conclusion Combination of oral silymarin and diammonium glycyrrhizinate at base of sport and diet guidance in patients with NASH is short-termly efficacious, which needs further clinical investigation.

Objective The aim of this study was to investigate the liver pathological features of patients with drug-induced liver injury(DILI). Methods Thirty-eight patients with DILI was encountered in our hospital between January 2017 and December 2020, and all were evaluated by structured expert opinion process(SEPO)and underwent liber biopsies. The diagnostic performance of DILI-pathological scroring system (DILI-PSS) was verified by the area under the receiver operating characteristic curve (AUROC). Results Out of the 38 patients with DILI, 14 patients (36.8%) had taken chemical medicines and biological products, 12 patients (31.6%) had taken Chinese herbal medicines, 9 patients (23.7%) had taken Chinese herbal, chemical medicines and biological products, and 3 patients (7.9%) had taken dietary supplements; the pathological examination showed that hepatic steatosis in 20 cases(52.6%), hepatic cholestasis in 22 cases(57.9%), bile duct damage in 15 cases(39.4%), eosinophil immersion in 11 cases(28.9%), hepatocellular wreaths in 9 cases (23.7%), and granuloma in 6 cases (15.8%); the AUROC was 0.775 with 95% confidence interval of 0.669-0.880 (P<0.05), and the sensitivity of 81.6% and the specificity of 65.8% when the DILI-pathological scroring system (DILI-PSS) was applied to predict the diagnosis. Conclusion The application of DILI-PSS might help diagnose patients with DILI, which needs further clinical investigation.

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.

Objective The purpose of this study was to investigate the efficacy of polyene phosphatidylcholine and Fuzheng Huayu capsule, a herbal medicine, combination in the treatment of patients with non-alcoholic fatty liver diseases (NAFLD) and its effect on hepatic steatosis score (HSSu) by ultrasonography. Methods A total of 132 patients with NAFLD were recruited in our hospital between January 2018 and January 2020, and were randomly divided into control (n=66) and observation group (n=66), receiving orally polyene phosphatidylcholine or polyene phosphatidylcholine and Fuzheng Huayu combination therapy for 24 weeks. Serum tumor necrosis factor-α (TNF-α), high sensitivity C-reactive protein (hs-CRP) and interleukin-10 (IL-10) levels were assayed. The hepatic steatosis scores was evaluated by ultrasonography. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamine transferase (GGT), serum alkaline phosphatase (ALP), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL - C) and low density lipoprotein cholesterol (LDL-c) levels were detected routinely. Results At the end of 24 week observation, serum ALT, AST and GGT levels in the observationgroup were (39.4±4.1)U/L, (35.8±6.6)U/L and (81.4±10.1)U/L, significantly lower than [(54.3±5.2)U/L, (50.9±7.4)U/L and (108.8±12.6)U/L, respectively, P＜0.05] in the control; blood TC, TG and LDL-C levels were (3.5±1.0)mmol/L, (2.2±0.6)mmol/L and (2.7±0.6)mmol/L, significantly lower than [(4.2±1.2)mmol/L, (2.9±0.8)mmol/L and (3.4±0.8)mmol/L, respectively, P＜0.05], while blood HDL-C level was (1.7±0.6)mmol/L, significantly higher than [(1.3±0.5)mmol/L, P＜0.05] in the control group; the hepatic steatosis score and serum TNF-α level were (0.9±0.2) and (3.5±0.8)ng/L, significantly lower than [(1.7±0.3) and (4.2±1.0)ng/L, while serum IL-10 level was (28.9±7.4)ng/L, significantly higher than (24.1±6.7)ng/L, P＜0.05] in the control. Conclusion The oral administration of polyene phosphatidylcholine and Fuzheng Huayu combination in the treatment of patients with NAFLD could improve liver function test normal and decrease blood lipids, which might be related to the intrahepatic steatosis and inflammatory reactions.

Objective The aim of this study was to investigate the clinical efficacy of Wuling capsule, a herbal compound, in the treatment of patients with metabolic associated steatohepatitis (MASH). Methods 117 patients with MASH were enrolled in our hospital between January 2018 and December 2023, and were randomly assigned to receive oral polyene phosphatidylcholine capsule in 58 cases in control or receive Wuling capsule and polyene phosphatidylcholine capsule combination in another 59 cases in observation for six months. All patients were carefully supervised with food intake and exercise, and hypolipidemic therapy when necessary. Serum hyaluronic acid (HA), laminin (LN), type Ⅲ procollagen N-terminal peptide (PCⅢ) and type Ⅳ collage (IV-C), and serum interleukin-1β(IL-1β), IL-6, IL-18, IL-37 and tumor necrosis factor-α(TNF-α) levels were detected by ELISA. Results By the end of 6 month treatment, serum alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase levels in the observation group were(39.7±7.2)U/L, (36.3±8.6)U/L and (63.6±5.8)U/L, all significantly lower than [(60.5±8.9)U/L, (56.7±9.2)U/L and (72.5±9.2)U/L, respectively, P<0.05] in the control; serum HA, PCⅢ and Ⅳ-C levels were (166.3±30.8)μg/L, (106.1±34.2)μg/L and (108.2±18.4)μg/L, all much lower than [(189.6±36.3)μg/L, (147.4±36.4)μg/L and (126.5±20.7)μg/L, respectively, P<0.05] in the control; serum IL-1β, IL-6, IL-18 and TNF-α levels were (11.8±2.4)pg/ml, (18.2±3.1)mg/L, (139.2±34.7)pg/ml and (3.6±1.1)ng/L, all much lower than [(16.4±2.7)pg/ml, (27.4±3.3)mg/L, (206.5±52.3)pg/ml and (6.3±1.2)ng/L, respectively, P<0.05] in the control group. Conclusion Wuling capsule has exact efficacy in the treatment of patients with MASH, which effectively improve liver function tests, and relieve liver fibrosis and 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 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 CT imaging feature in patients with non-alcoholic fatty liver diseases (NAFLD) with different traditional Chinese medicine (TCM) syndrome.Methods 240 patients with NAFLD were enrolled in our hospital between January 2017 and January 2020, and the TCM syndrome were determined. All patients underwent CT scan.Results The percentage of mild fatty liver by CT diagnosis in patients with liver depression and spleen deficiency was 88.9%, significantly higher than 17.6%, 25.8%, 6.5% and 0.0%(P＜0.05) in patients with damp phlegm and internal resistance syndrome, damp heat and internal gathering syndrome, phlegm and blood stasis syndrome and liver and kidney deficiency syndrome; the percentage of severe fatty liver in patients with liver and kidney deficiency syndrome was 85.7%, and that in patients with phlegm and blood stasis syndrome was 51.6%, significantly higher than 0.0% in patients with liver depression and spleen deficiency, 8.8% in with damp phlegm and internal resistance and 15.7% in damp heat and internal gathering syndrome(P＜0.05); the CT score in patients with liver depression and spleen deficiency was (42.4±4.7)HU and the CT score in patients with damp phlegm and internal resistance was(37.0±5.6)HU, both significantly higher than [(32.0±5.8)HU, (27.0±6.2)HU and (22.8±7.9)respectively, P＜0.05】 in patieHU,nts with damp heat and internal gathering, in with ph legm and blood stasis syndrome and in with liver and kidney deficiency syndrome, while the liver/spleen ratio were (0.8±0.1) and (0.7±0.2),significantly higher than【(0.6±0.1), (0.5±0.1) and (0.4±0.1), respectively, P＜0.05】 in patients with damp phlegm and internal resistance, in patients with damp heat and internal gathering and in with liver and kidney deficiency syndrome.Conclusion The CT imaging of patients with NAFLD with different TCM syndromes is characteristic, which might help the TCM doctors to deal with the entity appropriately in clinical practice.

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 compare the value of contrast-enhanced CT and contrast-enhanced ultrasonography in the diagnosis of patients with focal liver lesions. Methods 81 patients with focal liver lesions were recruited in our hospital between March 2012 and May 2015. All the patients underwent contrast-enhanced CT check-up and contrast-enhanced ultrasonography. The imaging characteristics and the imaging parameters of ultrasonic contrast of benign and malignant liver lesions were recorded. Then，a comparison of the diagnostic efficacy of the two Methods was conducted. Results This study included 41 patients with hepatocellular carcinoma（HCC） and 40 with benign liver lesions. The quantitative analysis of the Results of contrast-enhanced ultrasonography revealed that time to peak，rise time and mean transit time in patients with malignant liver lesions were significantly shorter than those in patients with benign lesions [（33.2±5.8） s vs. （48.6±13.2） s，（24.1±4.9） s vs. （38.7±11.5） s，（108.5±21.3） s vs. （156.7±35.6） s，respectively，P<0.05 for all]，while the perfusion index in patients with malignant liver lesions was significantly higher than that in patients with benign lesions[（145.3±39.2） vs.（83.6±17.9），P<0.05]；The sensitivity，specificity，and accuracy of the contrast-enhanced ultrasonography were 97.1%， 92.3% and 96.3%，while those of contrast-enhanced CT were 80.3%（P<0.05），91.2%（P>0.05）and 85.2%（P<0.05）. Conclusion Contrast-enhanced ultrasonography could provide abundant imaging information of hepatic lesions in terms of morphology and data measurement，with high sensitivity and diagnostic accuracy in diagnosis of patients with liver lesions.

Objective The incidence rate of nonalcoholic fatty liver disease (NAFLD) is increasing. It might progress to the end-stage liver disease. However, there is still no specific treatment for this entity. Therefore, the establishment of representative animal models reflecting disease characteristics has become especially important. Although there are many different disease models, there is still a lack of NAFLD model which could cover the whole spectrum of this entity in human. In this paper, we reviewed the current progress on NAFLD model, focusing on animal model, 2D cell model, 3D liver model and their advantages and disadvantages.

Objective The aim of this study was to summarize the magnetic resonance imaging (MRI) characteristics of patients with wall-thickening gallbladder carcinoma. Methods A total of 60 patients with gallbladder diseases were admitted to our hospital between January 2019 and December 2020, and all patients underwent MR scan and surgical cholecystectomy or radical cholecystectomy. Results The gallbladder width and gallbladder wall thickness in 21 patients with wall-thickening gallbladder carcinoma were (3.5±0.4)cm and (1.5±0.2)cm, significantly larger than in 39 patients with chronic cholecystitis, and the incidences of blurred interface with adjacent tissues, biliary obstruction, gallbladder wall stiffness, irregular gallbladder morphology and incomplete gallbladder mucosal line in patients with thick-thickening gallbladder carcinoma were 61.9%, 76.2%, 71.4%, 85.7% and 95.2%, all significantly higher than 0.0%, 10.3%, 2.6%, 25.6% and 0.0%, respectively, in patients with chronic cholecystitis (P＜0.05). Conclusion MRI is high valuable in diagnosis and differentiation of patients with wall-thickening gallbladder carcinoma, which has some characteristic features for clinicians to make medical plan early for them.

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.