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

Objective Liver injury is common in many chronic liver disease, and liver disease has a systemic impact, and vice versa. Diagnosis and treatment of patients with liver disease should not only consider the liver disease itself, but also need to clarify patho-physiological mechanisms by which the interaction occur between various systemic diseases and inflammatory liver injury. Therefore, the dealing with liver injury often require multidisciplinary discussions and joint decision-making. One of the important aspects of liver disease treatment is to protect and maintain the stability of liver functions, and how to carry out anti-inflammatory and liver protection involves etiology and liver injuries for appropriate treatment strategies. Bicyclol is a chemical agent independently developed in China and has a widespread administration to treat patients with inflammatory liver injury. Bicyclol has a good preventive and therapeutic efficacy on inflammatory liver injury caused by various etiologies documented in literature, and has been registered and listed in nine countries along the Belt and Road. We have organized domestic experts from relevant disciplines all over the country to summarize multidisciplinary clinical application of bicyclol in the prevention and treatment of inflammatory liver injury abide on liver disease diagnosis and treatment guidelines/consensus/clinical pathways and evidence-based medicine, combined with clinical practice in China. The aim of this consensus is to improve the reasonable and standardized clinical application of bicyclol in the treatment of patients with inflammatory liver injury.

Objective Non-alcoholic fatty liver diseases (NAFLD) is the most prevalent chronic liver disease worldwide at present, and the main mechanisms involved in the pathogenesis include insulin resistance, oxidative stress and so on. Different serum markers are closely related to the pathogenesis of NAFLD, but there is no clear conclusion yet. This article reviewed the important role of different serum markers in patients with NAFLD.

Objective To evaluate the gallbladder contractility of patients with hepatolenticular degeneration （HLD） by cardiac left ventricular volume calculation method （modified Simpson method）. Methods The modified Simpson method was conducted at the long axis view to measure the gallbladder volume of 104 subjects（54 with HLD and 60 normal persons） under fasting conditions and after the administration of lipoid-food,and the gallbladder emptying rates in two groups were calculated and compared. Results Under the fasting state,there was no statistical difference in the volume of gallbladder between the patients with HLD [（27.31±6.90） ml] and the healthy controls [（25.63±4.72） ml];after the conduction of lipoid-food test,the gallbladder volume in patients with HLD was （10.31±4.61）ml,significantly bigger than in the controls [（3.41±2.78）ml,P<0.05],while the gallbladder emptying rate in patients with HLD [（54.85±12.12）%] was significantly lower than that in the controls [（73.48±7.60）%,P<0.01]. ConclusionsThe modified Simpson method is easy to perform and of good repeatability in measurement of gallbladder volume and is helpful in evaluation of gallbladder contractility in patients with HLD.

Objective To explore the efficacy of fenofibrate and bicyclol combination in the treatment of patients with non-alcoholic fatty liver diseases (NAFLD) and its influence on hepatic peroxisome proliferator-activated receptor gammaγ₂ (PPARγ₂) mRNA level. Methods 66 patients with NAFLD were admitted to our hospital between February 2018 and December 2019, and were randomly divided into control group (n=33) and observation group (n=33), receiving bicyclol or bicyclol and fenofibrate combination for three months. The curative effect in the two groups after treatment were compared. The liver biopsies were performed, and hepatic PPARγ₂ messenger ribonucleotide (mRNA) were assayed by PCR. Serum cytokines and peripheral blood T lymphocyte subsets were compared. Results At the end of the treatment, the total effective rate in the observation group was 97.0%, which was much higher than that in the control group (66.7%, P<0.05); the relative level of PPARγ₂ mRNA in liver tissues in the observation group was (1.5±0.1), significantly higher than in the control; serum tumor necrosis factor-α (TNF-α) level was (26.4±3.1) pg/mL, significantly lower than , serum IL-6 level was (35.94.9) ng/L, significantly lower than (46.45.8) ng/L, P<0.05], and serum high-sensitivity C-reactive protein (hs-CRP) level was (5.1±1.4) mg/L, much lower than in the control; the percentage of peripheral blood CD3⁺ cells was (80.2±11.5)%, significantly higher than , the percentage of peripheral blood CD4⁺ cells was (44.7±5.8) %, significantly higher than , and the ratio of CD4⁺/CD8⁺ cells was (1.5±0.4), significantly higher than in the control.Conclusion The oral administration of fenofibrate and bicyclol combination in the treatment of patients with NAFLD has a short-term efficacy, which might be related to the increased hepatic PPARγ2 mRNA levels and the reduction of serum cytokine levels.

Objective To evaluate the efficacy of two domestic kits using different nucleic acid extraction methods for quantitative detection of serum hepatitis B virus（HBV） nucleic acids. Methods Thirty-six serum samples from hepatitis B patients with HBV DNA levels <1x10⁴ IU/ml after antiviral treatment were collected and HBV DNA was detected by kits from two pharmaceutical Co..The quantitative linear range,accuracy,sensitivity and specificity of each kits were evaluated and compared. Results Out of 36 serum samples,the HBV DNA levels in 14 were <500 IU/ml by KELONG reagent,while they were>1.00× 10³ IU/ml by San Xiang reagent;There was a good correlation in 31 samples by the two reagents（r=0.817,P<0.05 ）;The positive rates of serum HBV DNA were 55.6% and 94.4%,respectively,by the two kit detection（x²=12.07,P=0.000）;We detected serum HBV DNA in some strong positive samples after serial dilution and the results showed a good linear correlation （San Xiang: r=0.999,KELONG:r=0.992）;The relative deviations by San Xiang kit repetition was within ±0.3logIU/ml,while it was beyond ±0.3logIU/ml in two detections by KELONG. Conclusions The findings in this study suggests that the San Xiang reagent is more stable as it use nanometer magnetic extraction, which might be superior to boiling method for DNA extraction because the magnetic nanoparticle has wider liner ranger and significantly improves the sensitivity and accuracy of HBV DNA detection.

Objective To observe the clinical efficacy of percutaneous transhepatic gallbladder drainage （PTGBD） and delayed laparoscopic cholecystectomy（LC） combination in the treatment of patients with acute cholecystitis （AC）.Methods A retrospective study was conducted on 94 patients with AC admitted to our hospital between August 2015 and August 2017. 47 patients in observation received PTGBD and delayed LC treatment,and another 47 in the control received emergent LC.Results In the observation group,the operation time was （83.2±34.1） min,significantly shorter than [（119.0±36.4） min,P<0.05] in the control,blood loss was （33.7±15.5） ml,much less than 【（60.4±16.7） ml,P<0.05】 in the control,the postoperative anal exhaust was （23.5±6.6） h,significantly shorter than 【（27.2±5.1） h,P<0.05】 in the control,the postoperative abdominal drainage was （3.4±2.0） d,significantly shorter than 【（9.1±3.1） d,P<0.05】 in the control,while total hospital stay was（11.2±4.7） d,significantly longer than【（8.3±3.0） d,P<0.05】 in the control;the rates of conversion to open surgery and direct open surgery in observation group were 4.3% and 0.0%,significantly lower than 17.0% and 12.8% （P<0.05） in the control;72 hours after operation,the while blood cell counts,serum ALT,AST and bilirubin levels were significantly lower than those in the control （P<0.05）;the incidences of short-term complications in the observation was 8.5%,much lower than 29.8% （P<0.05） in the control. Conclusion The application of PTGBD and thereafter delayed LC in the treatment of patients with AC is definitely efficacious,which might effectively reduce the conversion rate to open surgery and the incidence of post-operational Complications.

Objective To investigate the diagnostic value of color Doppler ultrasound in patients with intrahepatic portosystemic venous shunts （IPSVS）. Methods Philips IE33 and GE LOGIQ9 color Doppler ultrasound was applied for liver examination. Results Fourteen patients（six men and 8 women with age of 43 to 70 yr-old） were recruited in our series. Out of them，one with hepatic metastasis from colon，two with abnormal liver function tests with unknown causes，three with liver cirrhosis， and eight with extrahepatic diseases；IPSVS manifested aneurysmal or tubular communication from portal vein to hepatic veins and 12（85.7%） were found having IPSVS located in right lobe of liver，and 2（14.3%，P＜0.01）in left liver；According to Park classification，typeⅡ were found in 5（35.7%）and type Ⅲ in 9（64.3%，P<0.01）；Color Doppler imaging showed alternating red and blue or circuitous blood flow signals in the shunts. Conclusion Color Doppler ultrasound can sensitively determine the blood flow direction，flow velocity and flow volume of IPSVS.

Objective The purpose of this study was to investigate the prevalence of bacterial infection in patients with hepatitis B viral infection-related acute-on-chronic liver failure (HBV-ACLF). Methods The clinical materials of 214 patients with HBV-ACLF between January 2015 and February 2022 were retrieved from His system in our hospital, and various infections were defined according to related criteria. The multivariate Logistic regression analysis was applied to reveal the impacting factors for infection. Results Out of the 214 patients with HBV-ACLF, the bacteria infection was found in 145 cases(67.7%), involving one organ in 113 cases, two in 28 cases and three in 4 cases, including spontaneous bacterial peritonitis (SBP) in 127 cases (85.2%), pulmonary infection in 41 cases (27.5%), acute cholecystitis in 25 cases(16.8%), urinary tract infection in 4 cases (2.7%) and perianal infection in 2 cases (1.3%); there were significant differences as respect to ages, systemic inflammatory response syndrome (SIRS) score, peripheral white blood cell counts, platelet counts, C-reactive protein, procalcitonin, prothrombin time activity (PTA), serum bilirubin, albumin, the incidence of hepatic encephalopathy (HE) and ascites between patients with and without bacterial infections(P<0.05); the multivariate Logistic analysis showed that the age, SIRS scores, WBC counts, PCT and ascites were the independent risk factors, while the PTA and serum albumin levels were the protective ones for bacterial infection in patients with HBV-ACLF(P<0.05); we set the SIRS score as the basic parameter, and its combination with age in predicting bacterial infection had the sensitivity (Se) and specificity (Sp) of 75.9% and 55.1%, with WBC counts of 77.2% and 62.3%, with PTA of 79.3% and 59.4%, with PCT of 89.7% and 46.4%, with ALB of 80.7% and 63.8%, and with ascites of 67.6% and 72.5%, suggesting a good Se with relatively low Sp. Conclusion The patients with HBV-ACLF are prone to bacterial infection, and some factors, such as elderly persons, hyperbilirubinemia and severe coagulation dysfunction, might trigger the infection, which should be appropriately dealt with as early as possible in clinical practice.

Objective The aim of this study was to investigate the short-term efficacy of dapagliflozin and liraglutide combination in treatment of patients with non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus type 2(T2MD). Methods 60 patients with NAFLD and T2MD were admitted to our hospital between September 2017 and October 2020, and were randomly divided into control and observation group, with 30 cases in each group. All the patients were supervised for routine lifestyle intervention and oral metformin administration for blood glucose control. In addition, the patients in the control group were treated with liraglutide intravenouly, and those in the observation group were treated with dapagliflozin and liraglutide combination. The regimen lasted for 3 months. The fasting plasma glucose (FPG), 2 hour-postprandial plasma glucose (2h PG) and glycated hemoglobin (HbA1c) as well as serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL－C) and high density lipoprotein cholesterol (HDL－C) levels were routinely obtained. Serum fasting insulin(Fins) and 2 h Ins levels were assayed, and the HOMA-IR was calculated. The controlled attenuation parameter (CAP) of livers was detected by FibroTouch. Results At the end of 3 month observation, the FPG, 2hPG and HbA1 levels in the observation group were(5.8±0.7)mmol/L, (6.9±0.8)mmol/L and (6.3±0.9)%, all significantly lower than [(6.6±0.6)mmol/L,(7.7±0.7)mmol/L and (7.2±1.0)%, respectively, P＜0.05] in the control group; serum Fins, 2hIns and HOMA-IR levels were (9.8±1.2)mIU/L, (20.2±1.7)mIU/L and (2.6±0.4)%, significantly lower than [(11.9±1.1)mmol/L, (24.8±1.6) mmol/L and (3.2±0.5)%, respectively, P＜0.05] in the control; serum TG level was (2.6±0.4) mmol/L, significantly lower than [(3.0±0.3)mmol/L, P＜0.05], while serum HDL-C level was (1.6±0.2) mmol/L, significantly higher than [(1.2±0.3)mmol/L, P＜0.05] in the control; the CAP was (249.2±7.5)dB/m, also significantly lower than [(264.7±8.6)dB/m, P＜0.05] in the control; serum AST level was (39.9±3.8)U/L, significantly lower than [(44.9±4.2)U/L, P＜0.05] in the control. Conclusion The application of dapagliflozin and liraglutide combination is efficacious in the treatment of patients with NAFLD and T2MD, which could effectively reduce blood glucose and lipid levels, improve liver function tests back to normal, with the ability of alleviation of insulin resistance.

Objective The purpose of this study was to analyze the clinical features of patients with pyogenic liver abscess (PLA) with different underlying diseases. Methods The adult PLA patients were encountered in our hospital between January 2007 and December 2020, and the clinical materials were collected and analyzed. Results Out of the 1930 patients with PLA in our series, 926 patients (group A) had no underlying diseases, 592 patients (group B) had type two diabetes mellitus (T2DM), 261 patients (group C) had biliary diseases, and 151 patients (group D) had T2DM and biliary diseases; the percentage of neutrophils in group D was (83.6±9.3)％, much higher than in other three groups (P<0.05), serum albumin levels in group B and group D were 30.3(26.1, 35.1)g/L and 30.8(26.9, 34.1)g/L, much lower than [32.3(28.3, 36.8) g/L, P<0.05] in group A; the incidence of jaundice in group C was 11.9％, significantly higher than 5.5％in group A and 2.7％ in group B(P<0.05), the incidence of pulmonary lesions in group D was 39.1％, significantly higher than 28.3％(P<0.05) in group A, the proportions of aerogenic abscess in group B and group D were 15.4％ and 12.6％, significantly higher than 6.6％(P<0.05) in group A, and the diameter of hepatic abscess in group D was 68.0(50.0, 87.0)mm, significantly higher than in other three groups (P<0.05); the medical costs in group B, group C and group D were 20000.2(10000.5,30000.3) yuan, 20000.3(10000.5, 30000.4) yuan and 20000.4(10000.5, 40000.2) yuan, significantly higher than [10000.9(10000.2, 20000.9) yuan (P<0.05) in group A. Conclusion The PLA patients with underlying diseases might have a severe disease, and have a relatively high hospitalization costs.

Objective To investigate the efficacy of laparoscopic cholecystectomy (LC) in the treatment of patients with gallstones and chronic cholecystitis.Methods 70 patients with gallstones and chronic cholecystitis were enrolled in our hospital between March 2018 and March 2020, and were randomly divided into control group (n=35) and observation group (n=35). The patients in the control group were treated with open cholecystectomy with small incision, and those in the observation group were treated with LC. Serum gastrin (GAS), vactive intestinal peptide (VIP) and motilin (MOT) levels were detected by ELISA.Results The operationtime in the observation group was (60.6 ±6.5) min, which was significantly shorter than that in the control group [(95.4±7.2) min, P<0.05], the postoperative hospital stay was (5.3±1.4) d, which was significantly shorter than that in the control group [(7.7±2.5) d, P<0.05], and the intraoperative blood loss was (42.3±12.4) mL, which was significantly less than that in the control group [(124.5±21.7) mL, P <0.05]; serum glutamyl transferase (GGT) level in the observation group was (41.4±9.3) U/L, which was significantly lower than in the control group [(65.1±10.5) U/L, P<0.05], serum aspartate aminotransferase (AST) level was (45.3±17.5) U/L, which was significantly lower than in the control group [(71.2±19.7)U/L, P<0.05], and serum alanine aminotransferase (ALT) level was (28.0±20.5) U/L, which was significantly lower than in the control group [ (59.5±22.8) U/L, P<0.05]; serum C-reactive protein (CRP) level was (28.4±8.3) ng/L, which was significantly lower than in the control group [(35.7±8.7) ng/L, P<0.05], serum interleukin-6 (IL-6) level was (42.4±5.3) ng/L, which was significantly lower than that in the control group [(47.7±6.7) ng/L, P<0.05], serum tumor necrosis factor-ɑ (TNF-ɑ) level was (1.9±0.5) μg/L, which was significantly lower than that in the control group [(4.7±0.9) μg/L, P<0.05]; serum GAS level was (129.5±12.4) ng/L, which was significantly higher than that in the control group [(112.7±10.6) ng/L, P<0.05], serum MOT level was (242.4±38.7) ng/L, which was significantly higher than that in the control group [(197.6±42.4) ng/L, P<0.05], and serum VIP level was (18.2±3.7) pg/mL, which was significantly lower than that in the control group [(22.8±5.3) pg/mL, P<0.05]; after operation, the incidence of complications in the observation group was 8.6%, significantly lower than that in the control group (20.0%, P<0.05).Conclusion The application of laparoscopic cholecystectomy for treatment of patients with gallstones and chronic cholecystitis is efficacious, which might significantly decrease serum VIP level and increase serum GAS and MOT levels, improve gastrointestinal function restoration, and relieve inflammation reaction.

Objective The aim of this study was to investigate the clinical implications of cancerous tissue cytokeratin 7 (CK7) and glypican-3 (GPC3) expression in patients with hepatocellular carcinoma (HCC). Methods A total of 219 patients with HCC were enrolled in our hospital between April 2018 and January 2022, and all underwent radical hepatectomy. The patients were followed-up for one year. The expressions of CK7 and GPC3 in cancerous and its adjacent liver tissues were detected by immunohistochemistry. The survival curves were drawn by Kaplain-maier method and the differences of survival rate between patients with CK7 and GPC3 positive and negative were compared by Log Rank test. Results The positive rates of cancerous tissue CK7 and GPC3 expression were 33.3% and 63.5%, significantly higher than 15.5% and 21.9%(P＜0.05) in the adjacent liver tissues; the positive rates of cancerous tissue CK7 expression in low differentiated tumors, BCLC stage C, tumors with vascular invasion, portal cancerous embolus and extrahepatic metastasis were 57.1%, 47.2%, 50.0%, 51.9% and 59.5%, all significantly higher than 16.4%, 20.4%, 24.1%, 22.5% and 28.0%(P＜0.05), and the positive rates of cancerous tissue GPC3 expression were 79.1%, 76.4%, 82.1%, 81.5% and 86.5%, all much higher than 52.3%, 51.3%, 53.2%, 52.9% and 58.8%(P＜0.05) in their surrounding liver tissues; at the end of one-year follow-up, the survival rate in our series was 75.8%; the one-year survival rate in patients with cancerous tissue CK7 negative was 80.1%, much higher than 67.1%(P＜0.05)in those with CK7 positive, and the one-year survival rate of patients with cancerous GPC3 negative was 85.0%, much higher than 70.5%(P＜0.05) in those with GPC3 positive. Conclusion The expressions of CK7 and GPC3 in cancerous tissues are up-regulated in patients with HCC, which might be correlated to tumor malignance and invasiveness.

Objective The purpose of this study was to investigate the clinical efficacy of transhepatic arterial chemoembolization (TACE) with sequential microwave ablation (MWA) followed by oral sorafenib maintenance in treatment of patients with large hepatocellular carcinoma (HCC). Methods A total of 144 patients with large HCC were encountered in our hospital between April 2017 and April 2019, and 74 patients were treated by TACE with sequential MWA followed by oral sorafenib maintenance and another 70 patients received TACE and oral sorafenib. All patients were followed-up for two years. Results At the end of three month, the objective remission rate and disease control rate in the combination group were 73.0% and 98.6%, both significantly higher than 47.1% and 88.6%(P＜0.05) in TACE-treated patients; serum AFP level was (128.0±14.4)μg/L, significantly lower than [(208.7±27.3)μg/L, P＜0.05], and KPS's score was (88.7±8.2), significantly higher than [(79.4±7.9), P＜0.05] in TACE-treated patients; the incidence of post-operational complications was 39.2%, not significantly different compared to 34.3% in TACE-treated patients (P＞0.05); the incidence of diarrhea, anorexia, alopecia, nausea and vomiting, and skin reactions were 24.3%, 27.0%, 20.3%, 13.5% and 18.9%, not significantly different compared to 24.3%, 30.0%, 24.3%, 17.1% and 18.6% in TACE-treated patients (P＞0.05); at the end of two-year followed-up, 5 cases and 2 cases were lost in the two groups respectively, and the one-year survival rate in the combination group was 97.1%(67/69) and the two-year survival rate was 73.9%(51/69), both significantly higher than 79.4%(54/68) and 52.9%(36/68) in TACE-treated patients (Log-Rank=11.857, P=0.001). Conclusion The strategy of TACE with sequential MWA and oral sorafenib maintenance in treating patients with large-volume HCC is encouraging, which warrants further clinical investigation.

The hepatolenticular degeneration (HLD), also known as Wilson's disease, is an entity of disordered copper metabolism caused by ATP7B gene mutation, which leads to intracellular copper transport dysfunction and excessive accumulation of copper in various organs. The early diagnosis and treatment can improve the prognosis of patients with HLD and reduce disability and early death. The current treatments include a diet with low copper, medical intervention and liver transplantation. However, the low copper diet could not significantly reduce the amount of copper absorption in intestinal epithelial cells, and excessive restriction of it will cause nutrient absorption disorders in normal tissue cells. The present treatment regimens often face problems such as poor adherence and worsening neurological symptoms. The application of liver transplantation is often limited by the shortage of donor organs and the need for lifelong immunosuppression. The new therapies, such as new medicine preparations, cell and gene therapy have brought new hopes for patients with HLD.

Objective Hepatocellular carcinoma (HCC) is one of the most common liver malignancies in the world. The etiology and molecular events HCC are still unclear. We tried to identify the key pathogenic gene, the cell division cycle 20 (CDC20) by comprehensive bioinformatics, which was related to the pathogenesis of HCC with certain underlying molecular mechanism. Methods We downloaded GSE36376 gene expression profile from Gene Expression Omnibus (GEO) database, found 433 samples, of which 240 HCC tissues and 193 of normal liver tissues, and were analyzed by comprehensive bioinformatics. The R software in RStudio was applied to screen the differential gene expression (DEG) in HCC and normal liver tissues, and the protein-protein interaction (PPI) network of DEG was constructed from the STRING database. The Metascape online tool was applied to carry out enrichment analysis, at the same time, the MCODE was used to identify Hub gene. Results The GSE36376 data was screened to get 706 DEGs, among them, a total of 554 down-regulated genes and 152 up-regulated genes were identified; the significant up-regulated genes were UBE2C, CDC20, COL4A1, NUSAP1, HSP90AB1, and CDKN3 from the PPI network; the Metascape enrichment analysis showed that in the GO biological process, it was mainly concentrated in the small molecule catabolism, the monocarboxylic acid metabolism, the steroid metabolism, the cofactor metabolism, the drug catabolism, the primary alcohol metabolism, and the effects of toxic substances; it also involved the organic anion transport, monosaccharide metabolism, aromatic amino acid family metabolism, detoxification, primary alcohol catabolism, and organic cyclic compound catabolism, etc; as for the KEGG signal pathway, it was mainly focused on carbon metabolism, fatty acid degradation, complement and coagulation cascade, tryptophan metabolism and peroxisomes, etc; the Hub genes were UBE2C, CDC20 and HSP90AB1 from MCODE. Conclusion The CDC20 gene obtained by comprehensive bioinformatics is a key gene for pathogenesis of HCC, which might be important for early diagnosis and therapeutic target.

Objectiv To explore the impact of nutrition support and medusa administration on liver function, erythrocyte and platelet parameters in patients with alcoholic liver diseases（ALD）. Methods 90 patients with ALD were recruited in our hospital between May 2015 and October 2017,and they were divided into two groups with 45 cases in each group. All the patients were given glutathione,portuguese aldehyde lactone intravenously and 45 patients were treated with metadoxine,while another 45 were treated with combination of metadoxine and nutritional support at 35~40 kcat·kg^-1·d^-1. The regimen lasted for four weeks. Results At presentation,serum liver function and blood coagulation function index in the two groups were not statistically significantly different （P>0.05）,while serum ALT,GGT and bilirubin levels at the end of the treatment in the two groups significantly decreased and coagulation function improved;before the treatment,the red blood cell parameters,including RBC counts,HBG levels,HCT,RDW and MCV in the two groups had no statistically significantly different（P>0.05）,while at the end of the treatment,the RBC counts,HBG and HCT in the two groups were significantly increased,e.g.（3.45±0.46）×10¹²/L vs. （5.32±0.51）×10¹²/L,（90.12±3.67） g/L vs. （140.92±6.02） g/L,（0.32±0.12）% vs. （0.46±0.11） % in the combination group,and（3.44±0.42）×10¹²/L vs. （4.96±0.48）×10¹²/L,（89.92±3.54）g/L vs. （135.67±6.23） g/L,（0.32±0.10）% vs. （0.41±0.10） % in metadoxine-treated group,and MCV and RDW decreased,e.g. （19.34±1.92）% vs. （12.43±1.21）% and（109.24±6.34）fL vs. （95.19±5.92） fL in the combination,and （19.15±1.89）% vs. （14.91±1.19）% and （109.01±6.45）fL vs. （99.43±6.42）fL in the metadoxine-treated group （P<0.05）;Before the treatment,the platelet parameters,such as PLT counts,MPV and PDW had no statistically significantly different （P>0.05）,and at the end of the treatment,the platelet counts significantly increased in the two groups,e.g. （98.43±10.02）×10⁹/L vs. （219.04±9.78）×10⁹/L in the combination group,an （98.68±10.13）×10⁹/L vs. （200.43±10.24）×10⁹/L in metadoxine-treated group（P<0.05）,while the MPV and PDW decreased obviously,e.g.（12.74±2.02） fL vs.（10.76±1.13） fL and （17.93±2.01） fL vs. （14.28±1.45） fL in the combination group,and（12.84±2.11） fL vs.（11.63±1.02） fL,and （17.87±1.98） fL vs. （15.89±1.51） fL in metadoxine-treated group （P<0.05）;All the improvements above in combination group were significantly superior to those in metadoxine-treated group （P<0.05）. Conclusion The metadoxine combined with nutrition support in treatment of patients with ALD might significantly improve the liver function,erythrocyte and platelet parameters,which needs further and long-term investigation.

Objective The aim of this study was to analyze the clinical features and risk factors of acute kidney injury (AKI) in patients with viral hepatitis B-induced liver cirrhosis (LC). Methods A total of 223 patients with hepatitis B cirrhosis were admitted to our hospital between April 2015 and February 2020, and the AKI incidence was found. Serum hydroxybutyrate-dehydrogenase (HBDH) and indocyanine green (ICG) were detected. The estimated glomerular filtration rate (eGFR) was calculated. The independent risk factors for occurrence AKI were analyzed by multivariate Logistic regression analysis. Results Out of the 223 patients with LC, 41 patients(18.4%) were found having AKI, and we selected 82 patients without AKI based on age and gender pair for control; the results showed that the percentages of aged≥50 yr, with diabetes, hyperuricemia, ascites, infection and Child-Pugh class C in patients with AKI were 39.0%,26.8%,29.3%,80.5%,36.6% and 53.7%, all significantly higher than (20.7%, 12.2%, 13.4%, 59.8%, 17.1% and 17.1%, respectively, P<0.05); serum HBDH and ICG levels in patients with AKI were (184.2±21.3)U/L and (31.4±3.6)%, both significantly higher than [(141.0±13.8)U/L and (15.6±1.9)%, respectively, P<0.05], while the eGFR was (71.6±11.3)mL/min·(1.73 m²)^-1, significantly lower than [(113.8±13.4)mL/min·(1.73 m²)^-1, P<0.05] in patients without AKI; the multivariate Logistic regression analysis demonstrated that aged ≥50 yr[OR(95%CI):3.0(1.1-8.6)], complicated by diabetes [OR(95%CI):1.9(1.1-3.3)], with hyperuricemia [OR(95%CI):2.8(1.1-7.3)], with ascites [OR(95%CI):2.6(1.0-6.6)], with infection [OR(95%CI):5.1(1.2-22.6)], Child-Pugh class C [OR(95%CI):3.6(1.5-8.9)], high serum HBDH level [OR(95%CI):2.8(1.2-6.3)] and lower eGFR [OR(95%CI):2.4(1.3-4.4)] were all the independent risk factors for occurrence of AKI in patients with LC induced by CHB(P<0.05). Conclusion AKI is more prone to patients with hepatitis B-induced liver cirrhosis, and some risk factors, such as eldly patients, with concomitant diabetes, hyperuricemia, ascites, infection, and poor liver functions, should be taken into consideration clinically, which means early diagnosis and appropriate management might improve the prognosis.

Objective The aim of this study was to investigate the efficacy of cetylcysteine combined with magnesium isoglycyrrhizinate in treatment of patients with drug-induced liver injuries (DILI). Methods 100 patients with DILI were randomly divided into observation (n=50) and control group (n=50) in this study. The patients in the control group were treated with magnesium isoglycyrrhizinate, and those in the observation group received acetylcysteine and magnesium isoglycyrrhizinate combination for 4 weeks. Serum malonaldehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), interleukin-6 (IL-6) and procalcitonin (PCT) levels were assayed in all the patients. Results At the end on the observation, serum bilirubin, aspartate aminotransferase, alanine aminotransferase and glutamic transpeptidase levels in the combination group were(14.2±4.6)μmol/L,(62.9±6.8)U/L,(67.5±6.9) and (54.9±8.9)U/L, significantly lower than 【(21.4±7.3)μmol/L, (90.3±8.4)U/L, (86.4±7.5)U/L and (63.6±6.4), respectively, P<0.05】 in the control; serum MDA level was (4.8±0.7)μmol/L, much lower than 【(6.2±1.1)μmol/L, P<0.05】, serum SOD and GSH-Px levels were (81.5±7.9)U/L and (124.7±9.9)U/L, significantly higher than 【(75.5±8.3)U/L and (92.6±8.7)U/L, respectively, P<0.05】, serum IL-6 and PCT levels were (4.2±0.7)pg/L and (0.3±0.1)ng/L, significantly lower than 【(6.6±1.2)pg/L and (0.5±0.1)ng/L, respectively, P<0.05】 in the control. Conclusion The combination of magnesium isoglycyrrhizinate and acetylcysteine in treatment of patients with DILI is efficacious for short-term observation, which might be related to the inhibition of inflammatory reaction and oxidative stress.

Fitz-Hugh-Curtis syndrome (FHCS) has been reported for almost 100 years since 1919, but the definition and etiology of it became a topic of debate among scholars and clinicians since the first discovery of a male patient in 1970 .In this paper, based on documented literatures, we puts forward that FHCS might be defined in a narrow or broad way, and reviews the progress of generalized FHCS in etiology , pathogenesis, clinical features, complications, diagnosis and therapy.

Portopulmonary hypertension （PPHTN） is defined as the development of pulmonary arterial hypertension associated with increased pulmonary vascular resistance complicating portal hypertension, with or without advanced liver disease. The presence of PPHTN markedly increases mortality. No effective medical therapies are currently available and liver transplantation is the only accepted treatment at the time. This review stresses on the epidemiology, pathophysiology, clinical presentation, diagnosis, treatment and the prognosis of PPHTN.