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 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 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 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 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 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.

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

Objective The aim of this study was to summarize the conventional and contrast-enhanced ultrasonography (CEUS)manifestations of intrahepatic cholangiocarcinoma (ICC).Methods 52 patients with ICC were recruited in our hospital, and all underwent conventional and CEUS check-up.Results The gray-scale ultrasonography showed than the tumors presented with uniform hypoechoic in 23 cases (44.2%, uneven hypoechoic in 22 cases (42.3%), slightly hyperechoic and hyperechoic in 7(13.5%); the color Doppler flow imaging showed that the blood supply of lesions was in grade 0 in 11 cases (21.2%), in grade 1 in 9 cases (17.3%), in grade 2 in 28 cases (53.8%), and in grade 3 in 4 cases(7.7%); out of 51 eligible cases of ICC, the CEUS demonstrated that the enhancement performance in arterial phase was in typeⅠ, e.g. rapid overall uniform enhancement, in 10 cases (19.6%), and in type Ⅱ, e.g. rapid uneven enhancement, in 41 cases (80.4%), out of which, in subtype Ⅱa, the overall uneven enhancement, in 19 cases (37.3%), in subtype Ⅱb, the dendritic enhancement, in 9 (17.6%), in subtype Ⅱc, thick-walled irregular ring-like enhancement, in 6 (11.8%), and in subtype Ⅱd, ring-like and dendritic enhancement, in 7 (13.7%).Conclusion ICCs have some CEUS characteristic features, which might help for the early diagnosis.

Objective The aim of this study was to explore the application of contrast-enhanced ultrasound (CEUS) parameters in the quantitative diagnosis of patients with hepatocellular carcinoma (HCC). Methods 50 patients with HCC and 5o patients with liver cirrhosis were admitted to our hospital between January 2018 and May 2021, and the diagnoses in all patients were confirmed by pathological examination after liver biopsies. The CEUS was conducted to obtain the peak intensity (PI), the time to peak (TTP), mean trasit time (mTT), the rise time (RT), and the blood perfusion feature was recorded. Results The local blood volume and local blood flow during arterial phase in patients with HCC were (3399.7±783.7) rBV and (64.1±18.7) rBF, significantly higher than [(1363.8±773.5) rBV and (41.9±10.6) rBF, respectively, P<0.05] in patients with cirrhosis, and the local blood volume during venous and delayed phases were (1325.8±546.3) rBV and (463.2±143.2) rBF, significantly lower than [(1775.4±541.3) rBV and (721.2±242.5) rBF, P<0.05] in patients with cirrhosis; the RT, TTP and mTT in cancerous foci were (15.7±8.3) s, (22.6±5.4) s and (133.5±92.3)s, significantly lower than [(26.3±6.4)s, (32.3±7.6)s and (160.4±112.8)s, respectively, P<0.05], while the PI was (85.2±48.2)dB, significantly higher than [(31.5±3.5)dB, P<0.05] in patients with cirrhosis; at the base of histopathological diagnosis as the gold criteria, the sensitivity, specificity and accuracy by CEUS diagnosis were 92.0%, 92.0% and 80.0%. Conclusion The CEUS quantitative parameters could help the diagnosis of patients with HCC, which is of great clinical application.

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 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 efficacy selective decongestive devascularization of gastrosplenic region (SDD-GSR) and splenectomy and pericardial devascularization (SPD) combination in the treatment of cirrhotics with portal hypertension (PHT). Methods Sixty-five patients with cirrhotic PHT were encountered in our hospital between January 2019 and January 2024, and out of them, 32 patients in observation group received SDD-GSR and 33 in control received SPD. Portal vein pressure was measured by glass water column manometer through right gastroepiploic vein. Portal vein flow (PVF), portal vein diameter (PVD) and portal vein velocity (PVV) were determined by color Doppler ultrasound. Peripheral blood T lymphocyte subsets were detected by flow cytometry. Results By end of surgery, the portal vein pressure in the observation group was (21.1±4.2) cmH₂O, much lower than [(25.7±5.3) cmH₂O, P<0.05] in the control group; by end of three months after operation, the PVD in the observation was (1.3±0.3)cm, much smaller than [(1.5±0.4)cm, P<0.05], while the PVV was (47.7±3.5)cm/s, much quicker than [(41.0±3.1)cm/s, P<0.05] in the control; before and after operation, there were no significant differences as respect to liver function tests and blood cell counts between the two groups (P>0.05); by three months after operation, percentage of peripheral blood CD4⁺ cells and CD4⁺/CD8⁺ cell ration in the observation group were (41.9±3.4)% and (1.4±0.3), both significantly higher than [(35.6±3.1)% and (1.2±0.2), respectively, P<0.05] in the control group. Conclusion The SDD-GSR operation has a satisfactory efficacy in the treatment of cirrhotic PTH, with improvement of portal vein hemodynamics and immune functions, which warrants further clinical investigation.

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

Objective The aim of this study was to explore application of MRI multi-sequence scan in the preoperative diagnosis of tumor staging in patients with primary gallbladder cancer. Methods 53 patients with primary gallbladder cancer were encountered in our hospital between March 2022 and March 2025, and all had tumor resection after multi-sequence MR scan. The diagnosis was confirmed by post-operational histo-pathological examination. Results Of the 53 patients with primary gallbladder cancer, the pathological study found tumor stageⅠ in 11 cases, stage Ⅱ in 15 cases and stage Ⅲ in 27 cases, and low differentiation in 21 cases, middle differentiation in 23 cases and high differentiation in 9 cases; the apparent diffusion coefficient (ADC) in stage Ⅲ foci was (1.0±0.1), much lower than [(1.5±0.2), P<0.05] in stage Ⅰ or [(1.2±0.2), P<0.05] in stage Ⅱ, while there were no significant differences among different cell differentiation groups(P>0.05); conventional MRI diagnosed tumor stage Ⅰ, Ⅱ and Ⅲ in 10 cases, 18 cases and 25 cases, while they were 9 cases, 18 cases and 26 cases by multi-sequence MR scan, with the accuracy of 90.6%, much higher than 67.9(P<0.05) by conventional MRI. Conclusion Multi-sequence of MRI scan is beneficial to improve the diagnostic accuracy of the tumor staging in patients with primary gallbladder cancer, which might help surgeons make an appropriate operation plan preoperatively.

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

Objective The aim of this study was to investigate different dosage of sevoflurane and propofol combination venous-inhalation anesthesia in patients with primary liver cancer (PLC) undergoing radical hepatectomy. Methods A total of 110 patients with PLC were recruited in our hospital between November 2019 and November 2021, and all underwent radical hepatectomy. During anesthesia, the patients were divided into group A (n=54) and group B (n=56), receiving 0.5 minimum alveolar concentration (MAC) or 1.0 MAC sevoflurane and propofol combination intravenous- inhalation anesthesia. The Ramsay sedation, Aldrete scores and mini-mental state examination (MMSE) scores were evaluated. The heart rhythm (HR), mean arterial pressure (MAP) and peripheral oxygen saturation (SpO₂) were recorded. Results The Ramsay sedation scores in group B immediately after extubation was (4.2±0.5), significantly higher than[(3.7±0.4), P＜0.05] in group A, while 5 minutes and 30 minutes after extubation, there were no significant differences respect to Ramsay and Aldrete scores between the two groups (P>0.05); at 6 h, 24 h and 72 h after operation, the MMSE scores in group B were (25.7±2.8), (27.6±1.4) and (28.4±1.1), all significantly higher than[(22.2±3.6), (25.4±2.2) and (27.8±1.2), respectively, P＜0.05] in group A; during operation, the HR in group B was (79.5±11.6)beats/min, faster than[(74.1±12.4)beats/min, P＜0.05] in group A, while before induction of and 6 hr after anesthesia, there were no significant differences respect to the HR, MAP and SpO₂ between the two groups (P＞0.05); the total incidence of adverse reactions in group B was (23.2%, much higher than 7.4%(P＜0.05) in group A. Conclusion The sevoflurane and propofol combination venous-inhalation anesthesia has a good anesthetic effect in the radical surgery of patients with PLC, and as compared with small dose, the administration of large dose of sevoflurane could obtain a better postoperative consciousness recovery, with a little more untoward reactions, which should be carefully evaluated before the operation.

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 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.

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 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 clinical efficacy of rosiglitazone and metformin combination in the treatment of patients with non-alcoholic fatty liver disease (NAFLD)and type 2 diabetes mellitus(T2DM). Methods A total of 98 patients with NAFLD and T2DMwere enrolled in our hospital between January 2023 and March 2024, and were randomly assigned to receive oral metformin (control, n=49) or combination of metformin and rosiglitazone (observation, n=49) for six months. Serum high density lipoprotein cholesterol(HDL-C), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) levels were routinely detected. Fasting insulin level was detected by radioimmunoassay. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were detected by Fibroscan. Results By end of six-month treatment, serum HDL-C level in the observation group was(1.3±0.3)mmol/L, much higher than [(1.1±0.2)mmol/L, P＜0.05], while serum TG level was(2.0±0.3)mmol/L, much lower than [(2.9±0.5)mmol/L, P＜0.05] in the control; fasting insulin level in the observation was (6.5±1.3)μU/ml, much lower than [(7.4±1.6)μU/ml, P＜0.05] in the control, while there were no significant differences as respect to HbA1c and FBG between the two groups(P>0.05); serum AST and CAP were (38.9±4.3)U/L and (266.1±10.7)dB/m, both much lower than [(45.4±4.8)U/L and (286.0±11.9)dB/m, respectively, P＜0.05]in the control group. Conclusion Rosiglitazone and metformin combination in the treatment of patients with NAFLD and T2DM could improve lipid metabolism disorder, which is worthy of further clinical study.

Objective The aim of this study was to investigate the clinical efficacy of polyene phosphatidylcholine in combination with compound glycyrrhizin in the treatment of patients with drug-induced liver injury (DILI). Methods 122 patients with DILI were encountered in our hospital between January 2023 and December 2024, and were randomly assigned to receive intravenous polyene phosphatidylcholine in control (n=61), or receive intravenous polyene phosphatidylcholine and compound glycyrrhizin combination in observation (n=61) for two to six weeks. Serum superoxide dismutase (SOD) level was measured by radioimmunoassay, serum malondialdehyde (MDA) level was determined by biochemical colorimetry and serum glutathione peroxidase (GSH-Px) level was detected by velocity method. Serum interleukin (IL)-6, IL-1β and tumor necrosis factor-α (TNF-α) levels were measured by ELISA. Cost/efficacy was calculated by medicine cost/effectiveness. Results By end of average four-week treatment, serum ALT, AST and ALP levels in the observation group were (56.2±9.3)U/L, (46.3±9.8)U/L and (90.6±10.2)U/L, all much lower than [(69.1±10.7)U/L, (59.5±10.2)U/L and (109.3±11.3)U/L, respectively, P<0.05] in the control; serum SOD and GSH-Px levels were (95.1±10.4)U/mL and (119.7±13.1)μmol/L, both significantly higher than [(73.4±9.2)U/mL and (95.3±11.9)μmol/L, respectively, P<0.05], while serum MDA level was (2.7±0.6)μmol/L, significantly lower than [(3.8±0.7)μmol/L, P<0.05] in the control; serum IL-6, IL-1β and TNF-α levels were (7.2±1.6)pg/mL, (16.5±3.1)ng/mL and (7.5±1.8)pg/mL, all significantly lower than [(9.8±1.9)pg/mL, (22.4±4.0)ng/mL and (11.3±2.1)pg/mL, respectively, P<0.05] in the control group; medical cost in the observation group was higher than in the control, but the treatment effectiveness rate was 98.4%, much higher than 59.0%(P<0.05) in the control group. Conclusion Combination of polyene phosphatidylcholine and compound glycyrrhizin in dealing with patients with DILI could get a satisfactory effectiveness, which might be related to inhibition of oxidative stress and cytokine reactions.

Objective The purpose of this study was to investigate prediction of esophageal gastric varices (EV/GV) by abdominal CT scan parameters in patients with liver cirrhosis (LC) and portal hypertension. Methods 110 patients with LC and portal hypertension were encountered in our hospital between January 2021 and December 2025, and all patients underwent electronic gastroscopy. Abdominal CT scan was conducted to measure hepatic and splenic parenchyma iodine concentrations, and gastric coronary vein (GCV) diameter. Predicting efficacy was evaluated by receiver operating characteristic (ROC) curve. Results Of the 110 patients with LC, gastroscopy found mild EV in 61 cases, and moderate to severe EV/GV in 49 cases; iodine concentrations in left lobe, right lobe, caudate lobe of the liver, and splenic parenchyma as well as diameter of GCV in patients with moderate to severe EV/GV were (5.9±1.1)mg/ml, (5.6±0.7)mg/ml, (6.1±0.9)mg/ml, (20.4±1.5)mg/ml and (5.5±0.8)mm, all significantly higher or greater than [(5.1±0.7)mg/ml, (5.0±0.4)mg/ml, (5.5±0.5)mg/ml, (17.7±1.2)mg/ml and (3.6±0.5)mm, respectively, P＜0.05] in those with mild EV; the sensitivity, specificity and accuracy were 77.6%, 83.6% and 80.9%, when diameter of GCV≥4.7 mm, iodine concentrations in caudate lobe of liver≥5.8 mg/ml and splenic parenchyma≥19.2 mg/ml were set as the cut-off-value in predicting moderate to severe EV/GV. Conclusion Abdominal CT scan could help judge EV/GV existence in patients with LC.

Objective The aim of this study was to investigate differential diagnosis of dysplastic nodule (DN) and small hepatocellular carcinoma (sHCC) under background of liver cirrhosis (LC) by enhanced magnetic resonance imaging (MRI). Methods A total of 104 patients with LC and intrahepatic nodular lesions were encountered in our hospital between July 2022 and July 2025, and all underwent Gd-EOB-DTPA enhancement of 3.0 T MR. The diagnosis was proven by histo-pathological examination. Results The histo-pathological examination diagnosed DN with dimeter of (0.9±0.2)cm in 46 cases and sHCC with diameter of (1.1±0.2)cm in 58 cases in our series; DN lesions presented with high or equal signals on T1WI mostly, and with low signals on T2WI and DWI mostly, while sHCC lesions showed with low or equal signals on T1WI mostly, and with high signals on T2WI and DWI mostly; sHCC lesions demonstrated with enhancement at arterial phase, clearance at portal vein phase, low signals at hepatobiliary phase and "fast-in and fast-out" mode, and their relative apparent diffusion coefficient (ADC)was much lower than ADC lesions; the differential diagnosis by MRI was excellent with sensitivity of 89.7%, the specificity of 91.3% and the accuracy of 90.4%, and the Kappa was 0.81 as compared to histo-pathological diagnosis. Conclusion MRI by Gd-EOB-DTPA enhancement could provide differential diagnosis of DN and sHCC, and the signal intensity and enhancement mode between the two lesions were mostly different.

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 investigate the modified endoscopic nosal biliary drainage (ENBD) through gallbladder approach in the treatment of patients with small-diameter common bile duct stones (CBDS). Methods A retrospective analysis was conducted, including 54 patients with small-diameter CBDS encountered in the hospital between December 2015 and June 2018 (control group) and other 54 cases presented between July 2018 and December 2020 (observation group). All patients underwent laparoscopic cholecystectomy (LC), followed by common bile duct exploration and ENBD, and the difference was the common nasal biliary drainage (NBD) was applied in the control and the modified NBD in the observation. Serum C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were detected routinely. Results The postoperative drainage volume of bile and extubation time of nasobiliary ducts in the observation were (281.6±52.5)mL and (5.9±1.3)d, significantly greater or longer than [(228.7±53.2)mL and (4.0±1.4)d, respectively, P＜0.05], while the hospital stay was (6.1±1.1)d, significantly shorter than [(8.1±1.3)d, P＜0.05] in the control group; the incidences of post-operational complications, such as pancreatitis, bile leakage and slippage of nasobiliary ducts in the observation was 7.4%, significantly lower than 25.9%(P＜0.05) in the control; one week after operation, serum CRP, IL-6 and TNF-α levels in the observation were (42.8±11.1)mg/L, (3.2±0.8)ng/L and (1.0±0.8)ng/L, significantly lower than [(73.7±17.4)mg/L, (4.9±1.2)ng/L and (1.8±0.9)ng/L, respectively, P＜0.05] in the control group. Conclusion Compared with the ordinary NBD tube, the application of modified NBD tube could reduce the risk of slippage, improve the drainage of bile and shorten the postoperative recovery in patients with small-diameter CBDS.

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 compare the clinical efficacy of complete laparoscopic left hemihepatectomy and traditional open laparotomy with left hepatic pedicle occlusion in treatment of patients with intrahepatic and extrahepatic bile duct stones. Methods A total of 78 patients with intrahepatic and extrahepatic bile duct stones were admitted to our hospital between January 2016 and December 2021, and out of them, 45 patients underwent laparoscopic left hemihepatectomy with left hepatic pedicle occlusion and 33 patients received open laparotomy with left hepatic pedicle occlusion. Results In patients receiving laparoscopic operation, the operation time was (4.6±0.9) h, significantly longer than [(3.6±0.6) h, P<0.05], the postoperative exhaust time and hospitalization time were (22.8±8.4) h and (9.4±2.5) d, significantly shorter than [(44.6±10.5) h and (12.3±3.1) d, P<0.05] in patients with open operation, while the intraoperative blood loss in the two groups was not significantly different [(190.6±45.7)ml vs. (212.5±50.4)ml, P＞0.05]; one week after operation, serum ALT, AST and GGT levels in patients receiving laparoscopic operation were (33.5±6.8)U/L, (43.1±7.4)U/L and (56.0±8.4)U/L, much lower than [(39.7±5.2)U/L, (50.8±8.2)U/L and (64.2±8.8)U/L, respectively, P<0.05] in patients receiving open operation; the incidence of postoperative complications, such as incision or abdominal infection, biliary leakage, ascites and pneumonia between the two groups was not statistically significantly different (4.4% vs. 12.1%, P>0.05). Conclusion The application of complete laparoscopic left hemihepatectomy with left hepatic pedicle occlusion is a safe and feasible operation in the treatment of patients with intrahepatic and extrahepatic bile duct stones.