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 The aim of this study was to investigate the influencing factors of disease control after ultrasound-guided 125I radioactive seed implantation for patients with hepatocellular carcinoma (HCC). Methods 84 patients with HCC were admitted to our hospital betweenJuly 2017 and August 2021, and all patients received ultrasound-guided intrahepatic 125I radioactive seed implantation with particle activity of 0.6-0.8 mCi and the tumor matched peripheral dose (MPD) of 110-160 Gy. The CT or MRI scan was performed 2 months after the operation and the short-term efficacy was evaluated according to RECIST standard version 1.1. The multivariate Logistic regression analysis was applied to screen for independent factors impacting disease control (the sum of complete response, partial response and disease stable). Results The intratumorous implantation of radioactive125I seeds was successfully finished in our 84 patients with HCC; at the end of two months after surgery, the imaging showed disease control in 69 cases (82.1%), including complete remission in 15 cases (17.9%), partial remission in 47 cases (56.0%) and disease stable in 7 cases (8.3%), with disease progression in 15 cases (17.9%); the univariate Logistic regression analysis showed that the proportions of Child-Pugh class B, BCLC stage C, tumor diameter > 5 cm and the received irradiation dose of 90% target volume (D90 dose) < 110 Gy in thedisease control group were 40.0%, 43.5%, 40.9% and 28.6%, all significantly lower than 60.0%, 56.5%, 59.1% and 71.4% in the disease progression group (P<0.05); the multivariate Logistic regression analysis showed that the D90 dose was an independent factor impacting disease control in patients with HCC after ultrasound-guided radioactive125I seed implantation (OR=344.350, P<0.05). Conclusion The sufficient irradiation dose is necessary in patients with unresectable HCC receiving intratumorous radioactive125I seed implantation in order to gain therapeutic efficacy, which needs further clinical investigation.

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

Objective The purpose of this study was to observe the effect of Mongolian medicine Erligen II on carbon tetrachloride-induced liver fibrosis in rats and explore its possible acting mechanism. Method 58 male SD rats were randomly divided into control, model, low-, moderate- and large-dose of Mongolian medicine Erligen II-intervened groups, and the fibrosis model was established by 40% CCl₄ olive oil solution injection for 8 weeks. Four weeks after modeling, the rats in model group were given intragastrically once daily at different dose of Erligen- II , and in the control group were given the same dose of normal saline for 5 weeks. The pathological changes were observed by HE and Masson staining of liver tissue, and the expression of α-SMA, collagen I and collagen III in liver tissue were detected by immunohistochemistry.Results Serum levels of ALT, AST and HA in moderate dose of Erligen- II-intervened group decreased greatly compared to those in model (P <0.05) , and serum levels of ALT, AST, bilirubin, HA, PIIINP and CIV in large dose of Erligen- II-intervened group decreased significantly compared to those in the model (P<0.05) ; the hepatic expression of α-SMA in control, moderate and large dose of Erligen- II were (0.0±0.0), (4.9±1.0) and (3.4±0.9),significantly weaker than 【(6.1±1.2),P＜0.05】 in model, and that of collagen III were (2.4±1.3), (5.0±2.4) and (3.7±1.8), significantly weaker than 【(6.4±2.4), P＜0.05】 in the model; the hepatic expression of collagen I in the control and in large dose of Erligen- II were (2.1±0.2) and (3.3±1.0), significantly weaker than 【(6.0±2.5), P＜0.05】 in the model; the hepatic fibrosis improved greatly in moderate and large dose Erligen- II groups compared to in the model.Conclusions Mongolian medicine Erligen II has a protective effect on CCl₄-induced liver fibrosis in rats, which might be related to the inhibition of HSC activation and reduction of ECM synthesis.

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 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 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 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 purpose of this study was to explore the clinical implications of magnetic resonance imaging multi-echo dixon technique in diagnosing hepatic steatosis in patients with metabolic associated fatty liver disease (MAFLD). Methods 97 MAFLD patients and 46 healthy persons were enrolled in this study between June 2018 and October 2019, and the proton density fat fraction (PDFF) was detected by MRI ME Dixon technique. All patients with MAFLD underwent routine liver biopsies. The diagnostic efficacy of MRI-PDFF for severity of liver steatosis was analyzed by receiver operating characteristic (ROC) curves. Results The BMI, serum ALT, AST, TG and TC levels as well as fat fraction (FF) in patients with MAFLD were (26.3±3.1)kg/m², (85.6±5.4)U/L, (76.5±4.9)U/L, (3.2±1.0)mmol/L, (7.4±1.2)mmol/L and (23.7±5.3)%, all significantly higher than 【(23.2±2.2) kg/m²,(28.3±3.5) U/L,(26.5±4.1)U/L,(1.5±0.4)mmol/L,(3.9±0.8)mmol/L and (10.3±3.9)%, respectively, P<0.05】 in the control; the FF in 28 patients with moderate and in 18 patients with severe hepatic steatosis were (25.3±5.5)% and (44.7±6.7)%, both significantly higher than 【(15.5±4.0)%, P<0.05】 in 51 patients with mild hepatic steatosis; the area under receiver operating characteristic curve (AUC) of FF in diagnosing mild, moderate and severe hepatic steatosis were0.728(95%CI:0.628-0.829), 0.870(95%CI:0.784-0.957) and 0.996(95%CI:0.985-1.000), when 16.4%, 26.4% and 44.6% was set as the cut-off-value.Conclusion MRI multi-echo dixon technique is of importance in diagnosing hepatic steatosis in patients with MAFLD, which warrants further investigation.

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.

There are normal physiological changes in the liver functions during pregnancy. Nevertheless, 3% of pregnant women have liver dysfunction. Pregnancy-specific liver disease is the main cause of abnormal liver function. About 0% to 25% of pregnant women die from pregnancy-specific liver disease. It is particularly important to improve clinician’s recognition of this entity. We reviewed the literature on pregnancy-specific liver disease in recent years and the progress in the pathogenesis, diagnosis and treatment of some pregnancy-specific liver diseases was summarized in this paper, in order to provide reference for its diagnosis and treatment.

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

Objective The aim of this study was to investigate oral maintaining treatment of propranolol after endoscopic variceal ligation (EVL) and somatostatin combination for emergent hemostasis in patients with esophagogastric variceal bleeding (EVB). Methods 116 cirrhotics with EVB were admitted to our hospital between January 2021 and December 2023, and were randomly divided into control (n=57) and observation (n=59) groups. All patients in the two groups underwent EVL and intravenous administration of octreotide for emergent hemostasis, and those in the observation received oral propranolol for maintaining treatment after operation. Portal vein flow (PVF) and splenic vein flow (SVF) were detected by ultrasonography, and hepatic venous pressure gradient (HVPG) was calculated after transjugular vein intubation. Plasma prothrombin time (PT) and fibrinogen (FIB) levels were routinely obtained. Results One week after treatment, the hemostasis rate in observation and control group were 94.9% and 96.5% (P>0.05), and three patients died in the observation and 2 died in the control; there were no significant differences as respect to bleeding cessation times [(63.5±2.1)vs. (62.3±3.6)h], blood transfusion [(3.9±0.8)U vs. (4.1±1.2)U], hospital stay [(10.4±1.7)d vs. (10.5±2.9)d] and medical costs [(10.8±2.0)thousand yuan vs. (10.8±2.0)thousand yuan] between the two groups (P>0.05); after treatment, PVF, SVF and HVPG in the observation were (541.5±108.6)ml/min, (289.7±53.4)ml/min and (13.5±3.1)mmHg, all significantly lower than [(616.4±112.7)ml/min, (306.4±56.3) ml/min and (14.6±3.8)mmHg, respectively, P＜0.05] in the control; plasma PT was (14.1±1.1)s and FIB levels was (2.7±0.8)g/L, both not much different as compared to [(14.0±1.2)s and (2.8±0.6)g/L] in the control (P＜0.05); the 3-month and 6-month re-bleeding rates in the observation group were 5.4% and 10.7%, both not significantly different compared to 7.3% and 14.6% in the control group (P>0.05). Conclusion Oral maintaining treatment of propranolol after emergent hemostasis in patients with EVB could reduce portal hypertension, which might reduce re-bleeding and needs long-term investigation.

Objective This study aimed to explore qualitative judgement of focal liver lesions (FLL) by quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Methods 107 patients with FLL were encountered in our hospital between January 2022 and January 2025, and all patients underwent DCE-MRI examination to record initial area under enhancement curve (IAUC), maximum slope of increase (MSI), maximum slope of decrease (MSD), mean enhancement time (MET) and positive enhancement integral (PEI). Golden diagnosis was proven by histo-pathological examination. Receiver operating characteristic (ROC) curves was applied to validate the diagnostic efficacy. Results Of the 107 patients with FLL in our series, pathological exam found benign lesions in 37 cases, hepatocellular carcinoma (HCC) in 56 cases and intrahepatic cholangiocarcinoma (ICC) in 9 cases; IAUC and MSD in benign lesions were (21.5±3.5) and (83.2±9.5), both much smaller than(P＜0.05), while MSI, MET and PEI were (283.2±26.6), (552.4±68.6) and (249.9±24.5), all much greater than in malignant lesions (P＜0.05); MSI, MET and PEI in HCC foci were (93.3±11.3), (486.5±61.4) and (32.5±6.6), all significantly smaller than [(103.3±10.3), (515.4±51.3) and (41.5±7.8), respectively, P＜0.05] in ICC foci; the AUC was 0.906, when IAUC, MSI, MSD, MET and PEI were combined to predict malignant lesions, and the AUC was 0.856, when MSI, MET and PEI were combined to differentiate HCC from ICC, both had to some extent implications of clinical practice. Conclusion DCE-MRI quantitative parameters could help clinicians differentiate base on imaging benign from malignant intrahepatic lesions, which warrants further clinical investigation.

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

Objective This study aimed to assess disease burden of nonalcoholic fatty liver disease (NAFLD) in China from 1990 to 2021 and to predict its trends from 2020 to 2040. Methods This study retrieved database from the Global Burden of Disease (GBD) and Excel software was applied toillustrate the incidence, mortality, prevalence and disability-adjusted life years (DALYS) burden of NAFLD during 1990 to 2021 period. R software was used to predict burden trends of the disease, and a Bayesian age-period-cohort model (BAPC) was constructed to predict the incidence of the disease between 2020 and 2040. Results From 1990 to 2021, the overall burden of NAFLD demonstrated a rising trend, the standardized prevalence rate increased by 22.0% (AAPC = 0.6%, P< 0.01), and the standardized incidence rate increased by 18.3% (AAPC = 0.7%, P< 0.01);the BAPC model predicted that the disease burden of NAFLD would continue to rise over the next 20 years; by 2040, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) were expected to reach 780.0, 17706.9, 11306.1, and 8.2 per 100,000, respectively, representing increases of 25.6%, 13.5%, 78.9%, and 7.8%, respectivley compared to in 2021. Conclusion The disease burden of NAFLD in Chinese population increasesgreatly from 1990 to 2021, with younger men being at higher risk. Tailored prevention and treatment strategies should be developed based on the current disease burden characteristics to effectively reduce the negative impact on human health.

Objective The aim of this study was to 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.

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 value of total liver volume (TLV)/spleen volume (SV) ratio by multislice CT calculation in diagnosis ofpatients with liver cirrhosis (LC). Methods 138 cirrhotic patients and 130 patients with benign liver diseases or healthy persons were admitted to our hospital between October 2016 and October 2019, and all underwent dynamic contrast-enhanced multi-slice spiral CT scan. The TLV, right liver volume (RV), left inner lobe volume(LMV), left outer lobe volume (LLV), cauda lobe volume (CV), SV as well as TLV/RV ratio, TLV/LMV ratio, TLV/LLV ratio, TLV/CV ratio and TLV/SV ratio were calculated by software. Results The TLV, RV and LMV of liver in patients with LC were (1078.2±315.7) cm³, (543.8±186.5) cm³ and (163.6±73.7) cm³, significantly smaller than [(1470.4±199.7) cm³, (933.3±174.1) cm³ and (216.2±40.1) cm³, respectively, P<0.05], while the LLV and SV were (327.8±121.9) cm³ and (863.4±396.8) cm³, both significantly larger than [(275.9±65.7) cm³ and (256.3±81.7) cm³, respectively,P<0.05] in the control; the TLV / RV ratio in patients with LC was 2.0±0.9, significantly higher than [1.6±0.7, P<0.05], while the TLV / LLV ratio, TLV / CV ratio and TLV / SV ratio were (3.3±1.5), (25.3±12.4) and (1.3±0.6), all significantly lower than [(5.3±2.5),( 32.8±16.1) and (5.7±2.4), respectively, P<0.05] in the control; there were no significant differences in CV and TLV/LMV ratio between the two groups (P>0.05). Conclusion The calculation of TLV/SV by multislice spiral CT scan might help diagnose LC in clinical practice.

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.