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 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.

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

Objective To observe the clinical efficacy of Dangfei Liganning combined with lecithin for treating patients with non-alcoholic steatohepatitis（NASH）. Methods 116 patients with NASH were randomly divided into three groups. The combination therapy group（n=45）was treated with Dangfei Liganning and lecithin tablets,and the Dangfei Liganning group （n=38）and lecithin group （n=33）were treated with Dangfei Liganning and lecithin tablets orally,respectively. The regimen lasted for three months.Before and after treatment,clinical data including main symptoms,hepatic function parameters,blood cholesterol and fatty liver image under B ultrasound in the three groups were monitored respectively. Results The rates of symptoms alleviation such as fatigue,anorexia,abdominal discomfort in the combination therapy group were higher than in the lecithin group（x²=3.94,x²=10.63,x²=8.54,P<0.05 or P<0.01）. Fatigue improvement was better in the Dangfei Liganning group than in the lecithin group（x²=3.97 or P<0.05）;The levels of AST and ALT were declined obviously in the combination therapy group and Dangfei Liganning group than in the lecithin group after treatment（P<0.05 or P<0.01）. AST,ALT,TG,TC were also lower in the combination therapy group than in the Dangfei Liganning group （P<0.05 or P<0.01）;Fatty liver under B ultrasound in the combination therapy group and lecithin group were obviously improved after treatment（P<0.05 or P<0.01）; Some patients had abdominal distension,nausea,anorexia and other gastrointestinal reactions after taking Dangfei Liganning. Conclusion Dangfei Liganning combined with lecithin has good clinical efficacy and security for the treatment of patients with NASH.

Objective To evaluate clinical therapeutic effectiveness of stereotactic conformal radiotherapy （body gamma knife）combined with transcatheter arterial chemoembolization（TACE）for primary hepatic carcinoma（PHC）. Methods A total of 120 patients with unresectable PHC were randomly divided into two groups. 58 patients were treated with TACE，while 62 patients with TACE combined with stereotactic conformal radiotherapy. Results There were 7CR，28PR，16NC and 7PD in the group treated with TACE and 10CR，39PR，11NC，2PD in the group treated with TACE combined with stereotactic conformal radiotherapy；The group treated with TACE had a median survival duration of 9.3 months and 12.5 months in the group treated with TACE compared with stereotactic conformal radiotherapy. Conclusion The stereotactic conformal radiotherapy technique combined with transcatheter arterial chemoembolization is a safe and effective treatment for PHC and improve the survival of PHC patients．

Objective To analyze the therapeutic effect of primary liver cancer treated by stereotactic radiotherapy. Methods 266 patients with primary liver cancer were treated with γ ray stereotatic radiotherapy（SRT）. The dose of 3200~4600cGy（300~500cGy/F,6F/w） were delivered to PTVs over 7 to 10 fracions,6 consecutive fractions per week. Results All patients were examined with image of CT or MRI. The total effective rate（CR+PR）,steady diseae（SD）,progressive disease（PD） was 79%,18% and 3%. The 1,2,3-year survival rates of patcents were 71.2%,40.3%,22.8%,respectively. No RILD and serious side effect occurred,and the gastrointestinal complications were uncomfortable in upper abdomen and poor appetite. Conclusions Stereotactic radiotherapy has good effect and little side effect in the treatment of primary liver cancer.

Objective To investigate the counts of natural killer cells and T lymphocytes in patients with chronic hepatitis B. Methods The CD3⁺T cells,CD3⁺CD4⁺T cells,CD3⁺CD8⁺T cells and CD3^-CD16⁺CD56⁺NK cells in peripheral blood were counted by FCM. Results The T lymphocytes and NK cells decreased in 56 patients with hepatitis B-related hepatic failure;the CD3^-CD16⁺CD56⁺ natural killer cells in 49 patients with chronic hepatitis B increased as compared to in 41 chronic hepatitis B viral carriers. Conclusions The T lymphocytes and NK cells in patients with hepatic failure decreased while T lymphocytes in patients with chronic hepatitis B with HbeAg positive increased.

Objective To inhibit the gene expression of connective tissue growth factor （CGTF） by small interfering RNA（siRNA） and observe its influence on downstream gene expression. Methods 293T cells were cotransfected with lent viral transferred plasmid containing siRNA targeted to CTGF,packaging plasmid,and envelope protein plasmid. The lent viral vector was packed to mediate CTGF gene silence and infect hepatic stellate cell line HSC-T6 cells. The lent viral vector with the highest inhibition efficiency was screened by real-time PCR and Western blot. Efficiency of infection was measured by the expression of green fluorescent protein. mRNA levels of tissue inhibitor of metalloproteinase-1 （TIMP-1）,TIMP-2,and collagen I were detected by real-time PCR. Results Efficiency of infection of the packing lent viral vector was more than 50%. After infecting HSC-T6 cells,the expression of CTGF was suppressed on both mRNA and protein level,with the highest inhibition efficiency by TS1. The expressions of mRNA in TIMP-1,TIMP-2,and collagen I were significantly restrained by inhibition of CTGF（P<0.05）. Conclusion The packing lent viral vector in HSC-T6 has a better efficiency of infection and CTGF gene silencing effect. Gene silencing can further inhibit the TIMP-1,TIMP-2 and collagen type I gene expression in HSC-T6 cells. It has an active significance in anti-fibrosis studying.

Objective To investigate the serum levels of extracellular matrix protein 1（ECM1），matrix metalloproteinase-9（MMP-9）and vascular endothelial growth factor（VEGF）in patients with HCC. Methods Serum levels of ECM1，MMP-9 and VEGF were detected by enzyme-linked immunosorbent assay in 40 patients with HCC. Results The serum ECM1，MMP-9 and VEGF levels were 150.01±5.85pg/ml，467±30.81μg/l and 751.29±51.08pg/ml；The serum levels of them were significantly associated with tumor capsula，TNM stage，lymph metastasis and Edmondson grade；ECM1 levels was positively correlated with MMP-9 and VEGF levels（r=0.438，P=0.005；r=0.427，P=0.006）.Conclusion ECM1 may stimulate angiogenesis，metastasis and invasion of HCC via interaction with MMP-9 and VEGF.

Objective To probe the membrane protein changes in rats with hepatic fibrosis after the treatment of Fufang Biejia Ruangan Pian. Method This research set up an rat model with porcine sera-induced hepatic fibrosis and the model rats were treated by intragastric infusion of Fufang Biejia Ruangan Pian solution for 8 weeks. Plasma membrane was purified by density gradient centrifugation,the purity of them was verified by Western blot and differential proteomic analysis of liver plasma membrane was done. Result An animal model of hepatic fibrosis was set up successfully at week 8. After treatment with Fufang Biejia Ruangan Pian for eight weeks,the livers returned to normal levels;Western blot analysis showed that the plasma membrane was enriched while the contamination of other subcellular fractions such as mitochondrion reduced. 22 proteins with more than three-fold differences were found and 9 proteins were successfully identified. Western blotting verified the different expression of keratin 8 and annexin A2. Conclusion Fufang Biejia Ruangan Pian has anti-fibrotic effects by regulating keratin 8 and annexin A2 expression in the plasma membrane during hepatic fibrosis process.

Objective To explore genotype distribution and clinical significance of HCV in Taiyuan region. Methods To amplify 5’ UTR of HCV RNA in 62 patients using RT-nested-PCR,to cut 5’UTR fragment into different length clips by using incision enzyme HaeⅢ and Bsh1236Ⅰ. Results In 62 patients with hepatitis C,43 cases were infected with genotype 1b,9 cases were infected with genotype 2a,5 cases was 1b/2a mixed-type,1 case was type 1a,1 case was type 3a,and 3 cases were not tested. The patients with 1b genotype were more serious than the patients with non-genotype 1b in the hepatic function and liver fatty degeneration. Conclusion In this locality hepatitis C were dominated by genotype 1b，and the pathogenetic condition of genotype 1b patients more serious than non-genotype 1b patients. HCV genotypes 1b accounted for 69.4% of HCV infections in patients from this geographical region. HCV genotype 1b was associated with more serious clinical performance.

Objective To study the therapeutic effects of transcatheter arterial chemoembolization combined with lienalis infusion indirectly to portal vein in treating patients with primary liver cancer. Methods 30 patients with PLC underwent transcatheter arterial chemoembolization treatment,while 40 underwent transcatheter arterial chemoembolization combined with lienalis infusion to portal vein. The serum levels of TNF-α,IL-2,sIL-2R and VEGF were assessed by ELISA. Results The serum levels of TNF-α,sIL-2R as well as the VEGF levels in the two groups decreased（P<0.01）,while IL-2 increased（P<0.01）after treatment;The 1,2 and 3 year survival rates of patients with transcatheter arterial chemoembolization combined with lienalis infusion to portal vein were 72.5%,55% and 25%,higher than that of single TACE therapy group（60%,30% and 6.7%,respectively,P<0.05）. Conclusion Transcatheter arterial chemoembolization combined with lienalis infusion in treating patients with primary liver cancer can improve the immune function and enhance the curative effect.

Objectives To investigate the genotypes of hepatitis C virus in patients with chronic hepatitis C. Method The genotypes of hepatitis C virus was detected by gene chips and serum hepatitis C viral RNA was assayed by RT-PCR. Results Out of 570 sera,552（95%） were positive for HCV RNA,and 1b were positive in 400 （72.4%）,2a in 63（11.4%）,3a in 20（3.6%）,3b in 20 （3.6%）,1b+2a in 12 （2.1%）,1a in 2 （0.4%）,6 in 7（1.26%）,1b+3a in one（0.18%）,2a+1b in 3（0.5%）,and unknown in 24（4.3%）;Serum HCV RNA levels in patients with different hepatitis C viral genotype infection were not significantly different（P>0.05）. Conclusion The hepatitis C virus of genotype 1b dominated,and 2a in the second place in our series; Some mix infection with multiple genotypes needs further investigation.

Objective To analyze the therapeutic effects of 48-week entecavir treatment in patients with decompensated cirrhosis caused by hepatitis B virus（HBV）. Methods In this cohort study,98 patients with liver cirrhosis caused by HBV were divided into three groups randomly: entecavir（ETV） group （n=32）,lamivudine （LAM） group（n=42）,and control group（n=24）:conventional liver protection treatment. The course of treatment lasted 48 weeks. The virological and biochemical parameters,PT,hepatic fibrosis index and Child-Pugh scores were observed at different time points during treatment. Results The HBV DNA levels in entecavir group were significantly decreased. The negative rates of HBV DNA（<500 copies/ml） were correspondingly and significantly higher than those in lamivudine group and control group（P<0.05）. At week 24 and 48,the negative rates of hepatitis B e antigen（HBeAg） and the rates of HBeAg/anti-HBe sero-conversion in entecavir group were higher than those in control group（P<0.05）. ALT,AST,total bilirubin, hepatic fibrosis index and Child-Pugh scores were significantly improved in entecavir group and lamivudine group after treatment（P<0.05）. Conclusion Entecavir can rapidly and effectively inhibit HBV DNA replication and improve liver function,hepatic fibrosis index and Child-Pugh scores in patients with liver cirrhosis caused by HBV.

Objectives In order to know the changes of HBV DNA in patients with chronic hepatitis B. Methods To observe and compare the model for end-stage liver disease（MELD） scores and HBV DNA loads in 51 cases with acute-on-chronic liver failure and 56 with chronic hepatitis B of severe degree. Results MELD scores in peak and convalescent stages in patients with acute-on-chronic liver failure were 20.5±4.4 and 12.2±6.1,and HBV DNA loads were 6.2±1.5 log10 copies/ml and 4.5±1.5 log10 copies/ml,respectively;MELD scores in peak and convalescent stages in patients with chronic hepatitis B were 11.9±3.2 and 6.4±3.1,and HBV DNA loads were 6.5±1.5 log10 copies/ml and 4.9±1.8 log10 copies/ml,respectively（t=6.692~13.215,all P<0.000）. Conclusion No matter in patients with acute-on-chronic liver failure or chronic hepatitis B,their serum HBV DNA loads has spontaneously decreased in convalescent stages.

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 To study the effects of polyene phosphatidylcholine on iron homeostaisis in rats with alcoholic liver disease. Methods Thirty wistar rats were randomly divided into control，model and intervention group. The animals were feeded with or without Lieber Decarli liquid in twenty and polyene phosphatidylcholine was given in ten rats. The serum alanine aminotransferase（ALT），aspartate aminotransferase（AST），malonyldialdehyde（MDA），iron，total iron binding capacity（TIBC），ferritin and hepcidin were examined after 6 weeks. Hepatic tissue was assessed by hematoxylin and eosin staining，prussian blue iron staining and immunohistochemisty staining. Results There were no significant differences in serum concentration of iron and TIBC among the three groups（P>0.05）；the levels of serum ALT，AST and ferritin in the model group were respectively 37.9±14.3 U/L，55.0±18.6 U/L and 337.8±132.8 ng/ml，much higher than that in control group（P<0.05，respectively）；the level of serum hepcidin was 124.1±32.0 ng/ml，much lower than in control（P=0.034）；the level of serum MDA in the intervention group was 3.6±2.4 nmol/ml，much lower than that in the model group（P=0.01）；there was no difference in liver iron content among the three groups. Conclusion Alcohol can lead to liver injury and iron overload，and decrease hepcidin expression in liver. Polyene phosphatidylcholine can protect alcohol liver damage by lipid hydroperoxides.

Objective To study the distribution and expression of β-galactosidase（LacZ） reporter gene mediated by adenovirus vector in the liver of normal mice or mice with fulminant hepatitis, so as to evaluate the efficacy and safety of adenovirus as a gene therapy vector transduction system. Methods The normal Balb/cJ mice were randomly assigned to normal and fulminant hepatitis group. Each mouse was injected with adenovirus at 2×10⁸PFU by tail vein injection,then the normal mice serum was collected to detect ALT and TBil at 24h,48h,72h,96h,120h, and the seventh day,meanwhile,the mice organs including liver,lung,heart,and kidney were collected and stained by X-gal in order to observe the expression of adenovirus vector in mice organ;the expression of adenovirus vector in liver of fulminant hepatitis mice induced by MHV-3 was detected. Results Adenovirus mainly expressed in the livers of mice;In normal group and fulminant hepatitis group,the highest expression efficiency was at 72 hours,reached 55.7% and 25.7%,respectively,then it followed by a gradual reduction of adenovirus expression; The adenovirus infection didn’t show obvious injury in liver function. Conclusions The adenovirus vector is highly expressed in the liver with no significantly liver damage; Adenovirus vector might be as an effective and safe gene delivery system for liver disease gene therapy.

Objective To observe the effects of telbivudine combined with oxymatrine in patients with HBeAg positive chronic hepatitis B. Methods 65 cases of HBeAg positive CHB were randomly divided into two groups. In combined group（33 cases）,telbivudine was given 600 mg once a day and oxymatrine 0.6g/d. In telbivudine group（32 cases）,telbivudine was given alone. Clinical evaluation and laboratory detection were performed at the 12,26,52 weeks of the follow up period. Results At 12 weeks,undetectable rates of serum HBV DNA in combination group and telbivudine group were 45.4% and 31.3% respectively（P>0.05）;at 26 weeks,the rates were 72.7% and 46.9%,respectively（P<0.05）;at 52 weeks,the rates were 81.8% and 59.4%,respectively（P<0.05）. Seroconversion rates of HBeAg/HBeAb in combination group and telbivudine group were 12.1% and 6.3% respectively at 12 weeks（P>0.05）,But the seroconversion rates were 30.3% and 9.38% respectively at 26 weeks（P<0.05）; the seroconversion rates were 45.5% and 21.9% respectively at 52 weeks（P<0.05）. The normalization rates of ALT and TBIL in the two groups had no statistically significant difference（P>0.05）. There were no severe adverse reaction in both groups. Conclusion Telbivudine combined with Oxymatrine could enhance the effect of antivirus therapy for patients with chronic hepatitis B.