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 To study the difference of magnetic resonance imaging（MRI） scan and enhanced features of patients with primary liver cancer （PLC） and focal nodular hyperplasia （FNH）. Methods 26 patients with FNH and 36 patients with PLC between July 2014 and June 2016 were enrolled in this study,and all of them finished MRI check-up. Lesion distribution and imaging manifestation were compared between the two lesions. Results The proportion of lesions in the left lobe and right lobe in FNH foci were 30.8% and 69.2%）,not statistically different as compared with PLC foci（38.9% and 61.1%,P>0.05）,while the foci under hepatic capsule in FNH was 46.2%,much higher than in PLC（16.7%,P<0.05）;the lesion diameters in FNH foci was （4.8±0.8） cm,not statistically different compared to PLC foci[（5.1±0.8）cm,P>0.05];plain scan results showed that the proportion of low and equal signal in T1 in FNH foci were 84.6% and 15.4%,no significant difference compared with PLC foci（88.9% and 11.1%,P>0.05）;the proportion of high and equal signal in T2 in FNH foci were 88.5% and 11.5%,not statistically significantly different as compared with PLC foci（91.7% and 8.3%,respectively,P>0.05）;Tumor lesions often showed long T1 and long T2 signals in necrotic area in PLC foci,while FNH exhibited a central stellate structure and a signal of long T1 and long T2;the proportion of central scar and feeding arteries in FNH foci were radiologically 65.4% and 46.2%,much higher than 8.3% and 8.3% in PLC foci （P<0.05）;the proportion thrombus in portal vein and cirrhosis in FNH foci were 0.0% and 7.7%,much lower than 25.0% and 55.6% in PLC foci（P<0.05）;the proportion of fast-in and fast-out enhancement and swollen lymph nodes in FNH were 88.5% and 0.0%,not significant different as compared with PLC foci （86.1%and 11.1%,respectively,P>0.05）. Conclusion MRI can clearly distinguish PLC and FNH,which can help the diagnosis in clinical practice.

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

Objective The aim of this study was to investigate the clinical implication of peripheral blood T lymphocyte subset changes in patients with syphilis and hepatitis B or hepatitis C coinfection. Methods 93 patients with treponema pallidum (TP) syphilis were admitted to our hospital between January 2016 and June 2020, including syphilis infection in 61 cases, syphilis with hepatitis B virus infection in 21 cases and syphilis with hepatitis C virus infection in 11 cases. 84 healthy persons were selected as the control. The peripheral blood T lymphocyte subsets was assayed by FCM. Results The percentages of peripheral blood CD3⁺, CD4⁺, CD4⁺CD45RO⁺ and CD8⁺CD45RA⁺ cells as well as the ratio of CD4⁺/CD8⁺ cells in patients with syphilis were(52.2±8.5)%,(40.3±5.7)%,(18.1±3.9)%, (12.4±3.7)% and (1.2±0.3), all significantly lower than [(69.1±7.6)%,(50.7±6.9)%,(20.6±4.7)%,(16.2±4.3)% and (1.9±0.5), respectively, P＜0.05], while the percentages of peripheral blood CD8⁺, CD4⁺CD45RA⁺ and CD8⁺CD45RO⁺ cells were all significantly higher than those in healthy control [(32.4±7.3)%, (24.7±6.5)% and (8.7±1.5)% vs. (26.2±5.4)%, (21.8±6.2)% and (5.4±1.1)%, respectively, P＜0.05]; there were significant differences as respect to the percentages of peripheral blood CD8⁺, CD4⁺CD45RA⁺, CD4⁺CD45RO⁺, CD8⁺CD45RA⁺, CD8⁺CD45RO⁺ cells and the ratio of CD4⁺/CD8⁺ cells among patients with TP, with TP and chronic hepatitis B (CHB), and with TP and chronic hepatitis C (CHC, P＜0.05), the percentages of CD8⁺, CD4⁺CD45RA⁺ and CD8⁺CD45RO⁺ cells in patients with TP and CHB and patients with TP and CHC were all significantly higher than those in patients with TP(P＜0.05), while the ratio of CD4⁺/CD8⁺ cells, and the percentages of blood CD4⁺CD45RO⁺ and CD8⁺CD45RA⁺ cells were all significantly lower than those in patients with TP (P＜0.05); there were no significant differences respect to the percentage of blood CD8⁺, CD4⁺CD45RA⁺, CD4⁺CD45RO⁺, CD8⁺CD45RA⁺ and CD8⁺CD45RO⁺ cells and the ratio of CD4⁺/CD8⁺ cells between patients with TP and CHB, and those with TP and CHC (P＞0.05). Conclusion The percentages of peripheral blood CD3⁺, CD4⁺, CD8⁺, CD4⁺CD45RA⁺, CD8⁺CD45RO⁺, CD4⁺CD45RO⁺, CD8⁺CD45RA⁺ and the ratio of CD4⁺/CD8⁺ cells in patients with TP change greatly, and those in patients with TP and HBV or HCV mixed infection change even significantly, which needs further clinical investigation.

Objective The aim of this study was to explore the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) time-intensity curve in patients with liver cirrhosis (LC) and intrahepatic nodules. Methods A total of 108 patients with LC and intrahepatic nodules were encountered in our hospital between February 2019 and December 2020, and all underwent liver punctures or operation for histopathological diagnosis. All patients with LC received CEUS and the peak intensity (PI), rise time (RT) and peak time (PT) were obtained based on the time-intensity curve of CEUS. The malignant nodules diagnosed by time-intensity curve of CEUS was defined referred to literature. The area under receiver operating characteristic curve (AUC) by MedCal 15.2 software was applied to evaluate the diagnostic efficacy of parameters. Results Out of the 108 patients with LC and intrahepatic nodules, the histopathological examination showed hepatocellular carcinoma in 43 cases, and benign nodules in 65 cases; the PI, RT and PT in malignant foci were(214.5±20.8)%, (17.6±3.2)s and (24.3±4.6)s, significantly different as compared to [(117.2±15.7)%,(38.1±6.9)s and (46.8±8.1)s, respectively, P<0.05] in benign nodules or [(115.9±16.1)%, (37.6±6.3)s and (47.4±8.4)s, respectively, P<0.05] in adjacent liver tissues; the sensitivity, specificity and accuracy by CEUS in diagnose malignant nodules were 72.1%, 73.8% and 73.1%, all of them were raised to 97.7%, 87.7% and 91.7% by parameters based on the time-intensity curve of CEUS. Conclusion The diagnosing accuracy of time-intensity curve of CEUS in patients with LC and intrahepatic nodules is efficacious, which might help the clinicians make an appropriate decision for patients and improve the outcomes.

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

Objective The aim of this study was to observe clinical efficacy of human serum albumin in combination with lactulose and ornithine aspartate in treatment of patients with liver cirrhosis (LC) and hepatic encephalopathy (HE). Methods 58 cirrhotics with complicated HE were enrolled in our hospital between January 2022 and April 2025, and were randomly assigned to receive intravenous human albumin 5 g daily in 28 patients in control, or receive intravenous human albumin 10 g daily in 30 patients in observation. All patients were carefully managed by internal treatment for two weeks. Serum interleukin(IL)-6, IL-8 and C-reactive protein (CRP) levels were detected by ELISA, and HE was evaluated by West Haven scoring system. Results By end of two week observation, three patients (10.7%)died in the control, and one died (3.3%, P>0.05)in the observation groups; total serum bilirubin level in 29 survivals in the observation was (38.2±10.6)μmol/L, much lower than [(50.1±12.7)μmol/L, P>0.05],while serum albumin level was (35.1±2.5)g/L, much higher than [(33.5±2.1)g/L, P＜0.05)] in 25 survivals in the control; serumIL-6, IL-8 and CRP levels were (21.2±5.9)pg/mL, (31.4±8.7)pg/mL and(11.5±3.2)mg/L, all significantly lower than [(29.4±6.2)pg/mL, (40.5±10.9)pg/mL and (46.2±4.5)mg/L, respectively, P＜0.05] in the control; proportion of West Haven grade 0 in the observation group was 51.7%, much higher than 28.0%(P＜0.05) in the control group. Conclusion Human serum albumin infusion in dealing with LC patients with HE could improve regaining consciousness, which might be related to increased plasma colloid osmotic pressure and relatively quick liver functioning.

Objective With the wide application of biologics, the hepatitis B virus (HBV) reactivation have been increasingly become a problem. The patients with HBV reactivation may suffer from liver failure, which might lead to death. The screening, prophylactic antiviral therapy and surveillance for the patients at a risk of HBV reactivation have become the consensus of major related guidelines. In this article, we reviewed the population risk stratification, mechanism by which the HBV reactivated, and the prophylactic antiviral agents.

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

Objective This study aimed to investigate and summarize magnetic resonance imaging (MRI) feature in patients with primary liver cancer (PLC) and radiation-induced liver injury RILI) after three-dimensional conformal radiotherapy (3D-CRT). Methods A total of 92 patients with PLC were encountered in our hospital between January 2023 and September 2025, and all received 3D-CRT therapy and underwent gadopentetate dimeglumine (Gd-DTPA)-enhanced MRI scan. MRI signal, dynamic contrast-enhancement patterns, distribution morphology, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values were recorded. Results By end of radiotherapy, RILI occurred in 22 cases (23.9%); tumor volume, doses of radiation, target volume and mean hepatic doses of radiation in patients with RILI were all greater than in those without RILI(P<0.05); percentages of hypointensity on T1-weighted imaging, hyperintensity on T2-weighted imaging, abnormal enhancement at arterial phase, decreased enhancement at portal venous phase and persistent hypointensity at delayed phase in lesions in patients with RILI were 77.3%, 86.4%, 81.8%, 72.7% and 68.2%, all significantly greater than 27.1%, 30.0%, 20.0%, 25.7% and 17.1%(P<0.05) in those without RILI; percentages of wedge-shaped distribution, insistency of enhanced area with radiotherapy dose distribution, distributed along hepatic segments or vascular courses and hyperintensity on DWI in patients with RILI were 86.4%, 90.9%, 68.2% and 81.8%, all much greater than 15.7%, 12.9%, 14.3% and 28.6%(P<0.05) in those without RILI; ADC value in patients with RILI was (1.5±0.2)×10^-3mm²/s, much greater than [(1.2±0.2)×10^-3mm²/s, P<0.05] in those without RILI. Conclusion Patients with PLC and RILI could have special MRI features, which might help clinicians make diagnosis and managements.

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 explore the diagnostic performance of multimodal magnetic resonance imaging (MRI) in differentiating dysplastic nodules (DN) and small hepatocellular carcinoma (sHCC) in patients with liver cirrhosis (LC). Methods 71 patients with LC with intrahepatic nodules were encountered in our hospital between December 2016 and December 2021, and all underwent multimodal MRI, with the dynamic enhancement (DCE-MRI) parameters, the apparent diffusion coefficient (ADC), pure diffusion coefficient (D) and pseudo diffusion coefficient (D*) recorded. The golden diagnosis was based on fine needle aspiration or post-operational histopathological examination. Results Among the 71 patients, the sHCC was diagnosed in 45 cases (63.4%), and the DN was found in 26 cases (36.6%); the ADC, D and D * in sHCC foci were (0.81±0.19)×10^-3mm² / s, (0.91±0.21)×10^-3mm² / s and (46.26±10.13)×10^-3mm² / s, significantly lower than [(1.34±0.33)×10^-3mm² / s, (1.22±0.24)×10^-3mm² / s and (80.69±13.24)×10^-3mm²/s, respectively, P＜0.05 ] in DN lesions; the ROC analysis showed that when the cut-off values of D, D * and ADC in diagnosing sHCC were set as 1.14×10^-3mm² / s, 62.40×10^-3mm² / s and 0.96×10^-3mm²/s, the AUC were 0.911 (95% CI: 0.820-0.966), 0.809 (95% CI: 0.699-0.893) and 0.984 (95% CI: 0.920-0.999). Conclusion The multimodal MRI has high diagnostic efficacy in differentiating DN and sHCC in patients with LC, which might provide evidence for appropriate management for the patients.

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.

Liver cirrhosis is a very serious chronic progressive liver disease caused by one or more pathological factors repeatedly. The hepatic macrophages is regarded as the important cells for liver damage and repair. The different phenotypic liver macrophages on inflammation of liver are discussed, and the liver macrophage polarization is emphasized in this paper.

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

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

Objective The aim of this study was to 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 observe the efficacy of microwave ablation (MWA) under the guidance of real-time contrast-enhanced ultrasound(CEU) and fusion image navigation (FIN) in treatment of patients with small primary liver cancer (PLC).Methods 142 patients with small PLC were admitted to our hospital between December 2013 and December 2016, and were randomly divided into two groups, with 71 cases in each group. The patients in observation group received MWA under the real-time CEU and FIN guidance, and those in the control group received surgical resection. Serum alpha-fetoprotein (AFP),α-L-fucosidase (AFU) and carbohydrate antigen 19-9 (CA19-9)levels were assayed. Results At the end of three months after treatment, the complete ablation rate in the observation group was 93.8%, and the complete removal in the control was 100.0%(P>0.05); there were no significant differences as compared to serum AFP, AFU and CA19-9 levels in the two groups(P＞0.05); the complication occurrence, such as pulmonary infection, bile leak, incision infection,peritoneal or pleural effusion in the observation group was4.2%, significantly lower than 25.3%(P＜0.05) in the control; the patients were followed-up for 3 to 36 months withmedium of 18 months, and the survival rate in the observation was 73.2%(52/71), not significantly different compared to 71.8%(51/71) in the control (Log-rank=0.086,P=0.763).Conclusion The application of MWA under the guidance of real-time CEU and FIN in the treatment of patients with small PLC is efficacious, similar to surgical resection, which is worthy of clinicalverification.

Liver fibrosis (LF) is closely related to poor outcomes in patients with non-alcoholic fatty liver disease (NAFLD), and early intervention is expected to improve prognosis of the disease. Percutaneous liver biopsy is the primary method for the diagnosis and staging of LF, but its wide application is limited as its invasiveness, sampling inconsistency and subjective evaluation. Recently, a lot of new non-invasive techniques have emerged for LF assessment, with advantage of convenience and repeatability. In this article, we provides a review on this topic.

Objective This study was conducted to investigate targeted and immunotherapy plus transarterial chemoembolization (TACE) in the treatment of patient with primary liver cancer (PLC). Methods A total of 100 PLC patients were encountered in our hospital between May 2021 and April 2023, randomly divided into control (n=50) and observation (n=50) groups, and all patients in the two groups underwent TACE for two to five times. Patients in the observation group received target medicine, including apatinib or cangvatinib, and immunomodulators, including carilizumab or trelizumab, etc., combination therapy for three months. Peripheral blood lymphocyte subsets were detected by FCM, serum AFP level were routinely obtained, and serum macrophage metastasis inhibitor (MIF) and vascular endothelial growth factor (VEGF) levels were determined by ELISA. Results By end of three month treatment, Objective response rate (ORR) in the observation group was 62.0%, much higher than 42.0% in the control group (P<0.05); after treatment, percentage of peripheral blood CD4⁺ cells and ratio of CD4⁺/CD8⁺cells in the observation group were (46.8±4.6)% and (1.8±0.3), both much higher than [(37.3±4.2)% and (1.3±0.3), respectively, P＜0.05], while percentage of CD8⁺ cells was (25.1±2.4)%, much lower than [(28.5±2.5)%, P＜0.05] in the control; serum AFP, MIF and VEGF levels were (110.2±27.5)μg/L, (55.8±10.1)ng/mL and (180.1±48.7)pg/mL, all significantly lower than [(288.1±31.5)μg/L, (80.1±11.3)ng/mL and (261.1±54.3)pg/mL, respectively, P＜0.05] in the control; by end of one-year follow-up, survival rate in the observation group was 66.0%, not statistically significantly different as compared to 46.7% in the control group (Log-Rank=2.643, P=0.104). Conclusin Targeted and immunotherapy with combination of TACE in dealing with patients with advanced PLC could get a satisfactory short-term clinical efficacy, which might be related to improvement of body immune functions, but the long-term efficacy should be investigated further.

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 purpose of this study was to compare the incidence of portal vein thrombosis (PVT) after splenectomy or transjugular portal systemic shunt(TIPS)in patients with cirrhosis and hypersplenism. Methods 96 patients with cirrhosis and hypersplenism were enrolled and underwent splenectomy (n=45) or TIPS (n=51) in the Second Hospital, Lanzhou University, between January 2017 and December 2018, and all the patients were followed-up for one years. The PVT was diagnosed on ultrasonography, CT or CTA. The cumulative incidences between the two groups were compared by Kaplan-Meier method. Results At 1 month, 3 months, 6 months and 12 months after operation, the cumulative incidences of PVT in patients receiving splenectomy were 40.0%, 46.7%, 48.9% and 48.9%, significantly higher than 7.8%, 9.8%, 15.7% and 21.6% (P<0.05) in patients underwent TIPS; in patients receiving splenectomy, the baseline material analysis showed that the diameter of portal vain in 22 patients with PVT was significantly wider than in 23 patients without(P<0.05); one-year after TIPS, the incidence of PVT was 21.6%, and there were no significant differences as respect to baseline materials between patients with and those without PVT(P>0.05). Conclusion The cumulative incidence of PVT in patients with cirrhosis after splenectomy is relatively higher than that after TIPS. Therefore, the clinicians should carefully evaluate patient's condition before operation, strictly meeting the indications of splenectomy or TIPS, and make the appropriate choice in this setting.

Objective The purpose of this experiment was to explore the roles of microRNA(miR)-122 in the pathogenesis of liver fibrosis by in vitro and by in vivo. Methods The liver fibrosis model was established in C57BL/6 mice by intraperitoneal injection of carbon tetrachloride and also in HSC-T6 cells in vitro by incubation with 10 ng/ml transforming growth factor-β1 (TGF-β1). The miR-122 agomir and miR-122 mimics were transfected to overexpress miR-122 in mice and in hepatic stellate cells. The total RNA and whole protein were extracted for RT-PCR and Western-blot detection of miR-122, α-smooth muscle actin (α-SMA), type I collagen (Collagen Ⅰ), tissue inhibitor of metalloproteinase 1 (TIMP-1), and platelet-derived growth factor (PDGF). The proliferation of HSC-T6 cells was detected by CCK-8. Results The expression of α-SMA in the liver tissue in the model animal was significantly higher than that in the control group (9.92±2.12 vs. 1.12±0.54, P<0.01), while the miR-122 level was significantly lower than that in the control group (0.95±0.31 vs. 2.07±0.28, P<0.01); in mice with carbon tetrachloride-induced liver fibrosis, the miR-122 level in the miR-122 agomir-transfected group was significantly higher than that in the miR-122 agomir control-transfected group (6.27±1.73 vs. 2.78±0.21, P < 0.01); the α-SMA, type I collagen, TIMP-1 and PDGF protein expression in the miR-122 agomir-transfected group were significantly decreased; in TGF-β1-intervened HST-T6 cells, the α-SMA expression increased as the prolongation of TGF-β1 treatment (0h:0.61±0.02, 12 h:0.69±0.05, 24 h:0.75±0.01, 48 h:1.01±0.03, P＜0.05), while the miR-122 levels decreased (0 h:0.72±0.05, 12 h:0.45±0.01, 24 h:0.37±0.03, 48 h:0.29±0.08, P＜0.05); the miR-122 level in the miR-122 mimics-transfected cells greatly increased as compared with the miR-122 negative control-transfected cells (178.45±30.62 vs. 12.18±2.39, P＜0.01); the Western blot showed that the expression of α-SMA protein was significantly down-regulated in the miR-122 mimics-transfected group; in TGF-β1-intervened HST-T6 cells, the proliferation activity greatly decreased in the miR-122 mimics-transfected group as compared to that in miR-122 negative control-transfected group (P＜0.05). Conclusion The miR-122 levels down-regulate in liver fibrosis, and overexpression of it might inhibit the activation and proliferation of hepatic stellate cells, and probably inhibit the occurrence and development of liver fibrosis.

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

Objective The aim of this study was to summarize magnetic resonance imaging (MRI) manifestation of atypical focal nodular hyperplasia (FNH) of the liver. Methods 116 patients with liver FNH were encountered in our hospital between January 2022 and July 2024, all underwent plain, enhanced MRIscan, including diffusion weighted imaging (DWI), and the diagnosis was confirmed by biopsies or post-operational histo-pathological examinations. Results Of the 116 patients with liver FNHA, all had solitary intrahepatic nodule, located at right and/or left lobe, with diameters of 1.0to 11.2 cm, averaged with (6.1±1.3)cm, including≤2.0 cm in 31 cases, 2.0-5.0 cm in 51 cases and ＞5.0 cm in 34 cases; equal or slightly lower signals on T1WI, equal or slightly higher signals on T2WI, slightly higher signals on DWI, high signals at arterial phase, slightly high or equal signals at portal phase, equal or low signals at delayed phase, and high or equal signals at hepatobiliary phase; without central scar in 49lesions(42.2%),with pseudocapsule in 69lesions(59.5%),with internal bleeding or necrosis in 43lesions (37.1%),with fat infiltration in 37lesions (31.9%) and without significant enhancement at arterial phase in 56lesions(48.3%); percentages of without central scar, pseudocapsule, internal bleeding or necrosis, fat infiltration and non-significant enhancement at arterial phase in lesions >5.0cm were 64.7%, 88.2%, 61.8%, 52.9%and 73.5%, all significantly higher than 41.2%, 56.9%, 35.3%,31.4% and 47.1%(P＜0.05)in lesions of 2.0 to 5.0 cm or 19.4%, 32.3%, 12.9%, 9.7%and 22.6%(P＜0.05)in ≤2.0 cm of lesions. Conclusion Liver FNH, including atypical ones could have specific MRI feature, which might help clinicians make an appropriate measures to deal with.