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 The incidence rate of nonalcoholic fatty liver disease (NAFLD) is increasing. It might progress to the end-stage liver disease. However, there is still no specific treatment for this entity. Therefore, the establishment of representative animal models reflecting disease characteristics has become especially important. Although there are many different disease models, there is still a lack of NAFLD model which could cover the whole spectrum of this entity in human. In this paper, we reviewed the current progress on NAFLD model, focusing on animal model, 2D cell model, 3D liver model and their advantages and disadvantages.

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 explore the efficacy of the gelatin sponge particle and embosphere microsphere embolization for the treatment of patients with hepatocellular carcinoma and tumor rupture. Methods 49 patients with rupture of hepatocellular carcinoma underwent transcatheter arterial embolization by gelatin sponge particle （n=23） or embosphere microsphere（n=26） embolization in recent 5 years,and instant hemostatic and rehaemorrhagia rates were compared. Results There was no difference between gelatin sponge particle and embosphere microsphere embolization on the effects of instant hemostatic（both were 100%）;Seven days after intervention,the rehaemorrhagia rate in gelatin sponge particles was 13.0%（3/23）,one patient was transferred to surgery,one patient was re-intervened and one patient dead because of haemorrhagic shock,respectively;The rehaemorrhagia rate in embosphere microspheres group was 3.8%（1/26,P<0.01）,and the patient received re-intervention and the bleeding was stopped successfully. Conclusion The instant hemostatic effect is the same between the gelatin sponge particle and embosphere microspheres embolization in patients with rupture of hepatocellular carcinoma,however,the embosphere group has much less chance to rebleeding within 7 days.

Objective This paper aimed to investigate the clinical features and influencing factors of invasive fungal infections (IFI) in patients with acute-on-chronic hepatitis B liver failure (HBV-ACLF). Methods The clinical data of 130 patients with HBV-ACLF admitted in our hospital between January 2017 and January 2020 were collected and analyzed retrospectively. The incidence, location and species of IFI in patients with ACLF were documented. The multivariate Logistic regression analysis was applied analyze the risk factors for IFI in patients with ACLF. Results Out of the 130 patients with HBV-ACLF in our series, the incidence of IFI was 38.5%, and the common infection sites were in upper respiratory tract and lung infection in 24 cases(48.0%), gut infection in 14 cases(28.0%), urinary tract infection in 7 cases(14.0%), blood infection in 4 cases (8.0%) and peritoneal infection in 1 case(2.0%); the most common pathogenic bacteria was the Candida albicans in 26 cases(52.0%); the percentages of age older than 40 year and long-term administration of antibiotics in patients with IFI were significantly higher than in patients without (P<0.05), total serum bilirubin and prothrombin time were significantly higher or longer than, while serum albumin level was much lower than in patients without IFI(P<0.05); multivariate Logistic regression analysis showed that older than 40 year (OR=3.332), incredible hyperbilirubinemia (OR=4.525) and long-term intravenous administration of antibiotics(OR=1.576) were the independent risk factors for IFI in patients with ACLF(P<0.05). Conclusion The main sites of invasive fungal infection in patients with HBV-ACLF are upper respiratory tract and lung, and the main common pathogenic bacteria is Candida albicans. The peripheral blood white blood cell counts, serum bilirubin levels, and PT increase or elongated. The patients’ age older than 40 year, intravenous infusion of antibiotics longer than 4 weeks and excessive high serum bilirubin levels are the risk factors for invasive fungal infection in patients with HBV-ACLF. Therefore, targeted preventive measures should be taken to deal with them, which might reduce the complications and improve the prognosis.

Objective To compare the value of contrast-enhanced CT and contrast-enhanced ultrasonography in the diagnosis of patients with focal liver lesions. Methods 81 patients with focal liver lesions were recruited in our hospital between March 2012 and May 2015. All the patients underwent contrast-enhanced CT check-up and contrast-enhanced ultrasonography. The imaging characteristics and the imaging parameters of ultrasonic contrast of benign and malignant liver lesions were recorded. Then，a comparison of the diagnostic efficacy of the two Methods was conducted. Results This study included 41 patients with hepatocellular carcinoma（HCC） and 40 with benign liver lesions. The quantitative analysis of the Results of contrast-enhanced ultrasonography revealed that time to peak，rise time and mean transit time in patients with malignant liver lesions were significantly shorter than those in patients with benign lesions [（33.2±5.8） s vs. （48.6±13.2） s，（24.1±4.9） s vs. （38.7±11.5） s，（108.5±21.3） s vs. （156.7±35.6） s，respectively，P<0.05 for all]，while the perfusion index in patients with malignant liver lesions was significantly higher than that in patients with benign lesions[（145.3±39.2） vs.（83.6±17.9），P<0.05]；The sensitivity，specificity，and accuracy of the contrast-enhanced ultrasonography were 97.1%， 92.3% and 96.3%，while those of contrast-enhanced CT were 80.3%（P<0.05），91.2%（P>0.05）and 85.2%（P<0.05）. Conclusion Contrast-enhanced ultrasonography could provide abundant imaging information of hepatic lesions in terms of morphology and data measurement，with high sensitivity and diagnostic accuracy in diagnosis of patients with liver lesions.

Objective The aim of this study was to observe the combination of glutathione and tiopronin in the treatment of patients with drug-induced liver injury (DILI). Methods 72 patients with DILI were enrolled in our hospital between December 2019 and August 2022, and were randomly divided into control (n=36) and observation (n=36) group, receiving tiopronin alone or tiopronin and glutathione combination treatment for two to four weeks. Serum malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were detected by thibabituric acid, xanthine oxidation or dithiobis-nitrobenzoic acid methods, respectively. Serum human heme oxygenase-1 (HO-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), IL-1β and C-reactive protein (CRP) levels were detected by ELISA. Results At the end of treatment, serum ALT and AST levels in the observation group were (40.6±11.5)U/L and (31.0±2.6)U/L, both significantly lower than [(64.6±13.9)U/L and (63.7±15.3)U/L, respectively, P＜0.05] in the control, while there were no significant differences respect to serum bilirubin and GGT levels in the two groups [(16.8±3.9) μmol/L and (59.2±13.3)U/L vs. (20.2±4.2)μmol/L and (60.8±14.7)U/L, respectively, P>0.05]; serum SOD, GSH-Px and HO-1 levels in the observation group were (82.4±12.7)U/L, (99.8±16.6)U/L and (256.7±20.8)U/L, all significantly higher than [(75.6±10.9)U/L, (80.6±15.4)U/L and (197.5±24.9)U/L, respectively, P＜0.05], while serum MDA level was (5.1±0.8)μmol/L, much lower than [(6.2±1.3)μmol/L, P＜0.05] in the control; serum IL-6, TNF-α, IL-1β and CRP levels were (5.1±1.7)pg/mL, (4.4±1.7)pg/mL, (11.2±4.1)ng/mL and (3.9±2.0)mg/L, all significantly lower than [(9.7±1.1)pg/mL, (10.2±1.8)pg/mL, (25.3±4.8)ng/mL and (13.6±2.9)mg/L, respectively, P＜0.05] in the control group. Conclusion The combination of glutathione and tiopronin in the treatment of patients with DILI could effectively improve liver function tests back to normal, which might alleviate body inflammatory and oxidative stress reactions, and warrants further clinical investigation.

Objective The aim of this experiment was to explore the effect and underlying mechanism of curcumin on oleic acid-induced steatosis of HepG2 cells in vitro. Methods HepG2 cells were treated with or without 1 mmol/L oleic acid (OA) to establish nonalcoholic fatty liver disease (NAFLD) cell model. The HepG2 cells were divided into four groups, e.g. control (con), steatosis model (OA) , curcumin control and curcumin-intervened groups. Bodipy493/503 staining was used to detect the distribution of lipid droplets in the HepG2 cells. The ultrastructure of mitochondria was examined by transmission electron microscopy. Reactive oxygen species (ROS) levels were detected by DCFH-DA. The TNF-α and IL-6 levels in the supernatants were measured by a commercial kit. The apoptosis was determined by Hoechst 33258 staining. Western blott was applied to determine the expression of Bcl-2, Bax, mCytc, NF-κB, and Caspase-3/9 proteins. Results Compared with in the control cells, the cells treated with OA showed significantly increased lipid droplets accumulation, while the cells treated with curcumin showed reduced lipid droplets accumulation; the mitochondrial damage including mitochondrial swelling and vesiculation in OA group was more obvious than that in control group, while the mitochondrial damage treated by curcumin was significantly improved; the TNF-α and IL-6 levels in OA group were much higher than that in the control group , while they decreased greatly in curcumin-inervened group ; the ROS levels was (52.24±5.11)% in OA group, significantly higher than (6.71±2.31)% in the control group, while it decreased to (37.44±7.21)% in curcumin-treated group (P<0.05); the apoptosis rate in OA group was (12.12±0.72)%, significantly higher than (2.04±0.57)% in the control group, while it decreased significantly in curcumin-treated group ; the expressions of Bax, NF-κB and cleaved-Caspase-3/9 intensified, and Bcl-2 and mCytc decreased greatly in OA group as compare to those in the control, while the expressions of Bax, NF-κB and Caspase-3/9 decreased, and Cytc and Bcl-2 increased (P<0.05) in curcumin-intervened group. Conclusion Curcumin effectively prevent oleic acid-induced steatosis in HepG2 cells, which might be related to the alleviation of inflammatory reaction, oxidative stress and inhibition of apoptosis.

Analgesia in postoperation may be accompanied by a series of complications,which prolong postoperative recovery and decrease the quality of patient’s life. Research on effective approachesfor management of postoperative pain has been the topic studies in clinical practice. This paper puts focus on the mechanism of postoperative analgesia and reviews the choice of medicine for preemptive analgesia. We also discuss the controversies about the efficacy of preemptive analgesiain the treatment of postoperative pain and explore its clinical applications in the future.

Objective The aim of this experiment was to investigate the changes of lipid metabolism related genes in liver tissues of mice with nonalcoholic fatty liver diseases (NAFLD). Methods A NAFLD model was established in ten mice by feeding high-fat diet. The histopathological changes of the liver tissues were observed. Blood total cholesterol (TCH) and triglycerides (TG) levels were detected, and sterol regulatory element-binding proteins (SREBPs), acetyl coenzyme carboxylase (ACC) and fatty acid synthase (FAS) mRNA were detected by reverse transcription-polymerase chain reaction. Results The steatosis of liver cells was found in mice in NAFLD model group; blood TG and TCH levels in NAFLD model group were (0.63±0.13) mmol/L and (7.23±0.7) mmol/L, significantly higher than [(0.28± 0.06) mmol/L and (2.78±0.6) mmol/L, P<0.001] in ten mice in the control; at the end of 24 w experiment, hepatic FAS and SREBP-1 mRNA in NAFLD mice were (3.9±1.1) and (1.8±0.7), significantly higher than 【(1.0±0.3) and (1.0±0.4), FAS: t = 6.231, P<0.001; SREBP-1: t = 2.431, P =0.035】, while the ACC mRNA was (1.2±0.5), not significantly different as compared to 【(1.0±0.4), t = 0.765, P =0.462】 in the control. Conclusion The lipid metabolism related genes in liver tissue of mice with NAFLD are significantly up-regulated, which might play a pivotal role in the pathogenesis of NAFLD.

Wilson's disease (WD) is an autosomal recessive genetic disease characterized by abnormal copper metabolism, which can cause secondary damage to pathological organs, mainly liver and brain. The current basic treatment for patients with WD is based on medicines that increase excretion of copper from the body,such as chelators or zinc salts, etc. The choices of these agents should be based on patients' clinical manifestations and tolerance to them owing to side effects, physicians' experience and the cost and availability of them. The treatment of WD remains challenging for its side effects, compliance problems and life-long treatment. The shortage of donor liver, high cost, and the need for sustained immunosuppressive therapy after operation restrict the application of liver transplantation. Therefore, new treatment or methods, especially ones with better safety and permanent cure, are also attracting more and more attention. Therefore, this article systematically reviews the current research progress in treatment of patients with WD.

Objective To study the clinical characteristics of patients with Madelung syndrome （MS） in China. Methods We searched China National Knowledge Internet（CNKI）database （1994-2013）,Wanfang database （2000-2013） and VIP Citation database （2002-2013） for articles about MS; Finally,61 articles with 282 cases of MS were included in this study;SPSS17.0 and Excel software were used to analyze the retrieved data. Results In all 282 cases,there were 264 male （93.62%） and 18 female （6.38%） patients,and the male to female ratio was 14.6:1;Among these patients,62 cases from 41 articles had complete case history and clinical data （60 male and 2 female） and the age of patients ranged from 34 to 79 year-old with a average age of （50.04±8.15） year old;In this 62 cases,the course of disease lasted for 3 months and 20 years and the average disease course was （5.62±4.02） years;Forty-one cases （66.13%） had chronic alcoholism; Eighteen cases showed the symptoms of compression of the upper mediastinum,including oppression of the neck, dyspnea,snoring or sleep apnea syndrome;Symmetry or neck-rounded ring-shaped lumps were found in the parotid area,cervical region,and back at physical examination;Fifty-eight （out of 62） cases underwent surgical excision （include plastic surgery）. Conclusion MS is a kind of concealed and slowly progressing benign tumor,mostly affecting middle-aged men with long-term heavy alcohol intake.

Objective To investigate the dynamic changes of serum anti-HEV IgM, IgG and HEV RNA in patients with acute hepatitis E (AHE). Methord Serum anti-HEV IgM, IgG and HEV RNA loads were detected in a consecutive 217 patient with AHE, who were admitted to our Hospital between January 2016 and March 2018. Results At presentation,serum anti-HEV IgM, anti-HEV IgG and HEV RNA positive in 31 cases(14.3%), anti-HEV IgM and IgG positive in 99 cases (45.5%), anti-HEV IgM positive in 8 cases (3.7%), anti-HEV IgG positive in 72 cases (33.2%), anti-HEV IgM and HEV RNA positive in 3 cases (1.5%), anti-HEV IgG and HEV RNA positive in 2 cases (0.9%), and anti-HEV IgM, IgG and HEV RNA negative in 2 cases(0.9%); in 75 patients with second detection, the results showed that serum anti-HEV IgG positive increased; in 138 patients with accurate onset of the disease, serum HEV RNA positive at week one, two, three, four and after four were 49.0%(25/51), 10.2%(6/59), 3.1%(1/32), 4.0%(1/25) and 0.0%(0/0); serum anti-HEV IgM positive were 70.6%(36/51), 69.5%(41/59), 65.6%(21/32), 48%(12/25) and 56.5%(13/23); serum anti-HEV IgG positive were 90.2%(46/51), 88.1%(52/59), 96.9%(31/32), 100%(25/25) and 100.0%(23/23). Conclusion Serum anti-HEV IgM, IgG and HEV RNA changes regularly in patients with AHE, which might help clinicians to make decisions for diagnosis and management.

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 Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children and adults all over the world. Sarcopenia is a syndrome caused by continuous loss of skeletal muscle mass, strength, and functions. As sarcopenia progresses, lean body mass may decrease while fat mass increases, resulting in sarcopenic obesity. Sarcopenic obesity is associated with NAFLD and its development. Although most of the previous studies have demonstrated the positive correlation between sarcopenia and NAFLD, the difference in diagnostic methods of sarcopenia and NAFLD leads to difficulties in interpretation and application. This review mainly discusses the impact of sarcopenic obesity on NAFLD and the diagnosis and treatment strategies when the two coexist.

Objective This experiment aimed to investigate the protective effects and mechanisms of berberine (BBR) on hepatic steatosis by activation of KLF4 via targeting HDAC/H3K9ac in palmitic acid (PA)-induced HepG2 cells in vitro. Methods HepG2 cells were induced by PA to construct hepatocyte steatosis model. The fat deposition was determined by oil red O staining. The cellular HDAC1, H3K9ac, KLF4, SREBP-1c and PPARγ expression was assayed by Western blot. The H3K9Ac in the KLF4 promoter region was determined by chromatin immunoprecipitation (ChIP). The supernatant cytokine levels were identified by ELISA kits. The KLF4 gene was silenced by siRNA to verify the protective effects of BBR by targeting HDAC/H3K9Ac/KLF4 in PA-induced HepG2 cells. Results The BBR treatment significantly improved lipid deposition in PA-induced HepG2 cells compared to that in model cells, and the supernatant TNF-α, IL-1β and IL-6 levels were (514.7±46.4) pg/ml, (241.5±37.7) pg/ml and (362.7±19.9) pg/ml, significantly lower than [(1162.0±110.8) pg/ml, (635.8±73.4) pg/ml and (1110.0±85.1) pg/ml, respectively, P < 0.001] in the model; the expression of HDAC1 protein in BBR-intervened group decreased by 19.0%, while the expression of H3K9ac and KLF4 protein increased by 1.53 and 1.52 times, the level of H3K9ac in KLF4 promoter region increased by 3.97 times, and the expression of lipid synthesis related gene SREBP-1c protein decreased by 49.1%, the expression of lipid decomposition related gene PPARγ protein increased 1.84 times compared to in the model cells; compared with empty plasmid transfection, the expression level of HDAC1 protein in cells transfected with eukaryotic plasmids was increased by 2.02 times, and the expression level of H3K9Ac protein was decreased by 57.1%; compared with SiRNA-NC transfection, the KLF4 protein expression level in HepG2 cells after SiRNA-KLF4 transfection was significantly decreased (P < 0.01), lipid deposition was significantly increased, the levels of TNF-α, IL-1β and IL-6 were (887.9±89.9) pg/ml, (471.9±38.4) pg/ml and (793.1±59.3) pg/ml, significantly higher than [(534.2±46.1) pg/ml, (260.3±26.9) pg/ml and (372.0±30.6) pg/ml, P < 0.01] in SiRNA-NC transfected cells, and the expression of lipid synthesis related gene SREBP-1c protein was increased by 1.77 times, while the expression of PPARγ protein associated with lipid decomposition decreased by 41.6%. Conclusion Taking together, the findings in the present study indicate that BBR protects from cell steatosis and inflammatory reactions by activation of KLF4 via regulating HDAC1/H3K9ac in PA-induced HepG2 cells, which provides the insight into new therapeutic approaches for patients with non-alcoholic fatty liver disease management.

Objective This study was designed to evaluate of reliability and validity of self-rating anxiety scale（SAS） and self-rating depression scale（SDS） in patients with liver cirrhosis. Methods A total of 138 patients with liver cirrhosis were enrolled in this study. The reliability and validity of the two scales was evaluated by Cronbach’s α co-efficient,intraclass correlation co-efficient （ICC）,Kaiser-Meyer-Olkin （KMO） score and Bartlett’s test of sphericity（BTS）. Results The prevalence of anxiety and depression in this series were 38.2% and 63.1%,respectively;SAS scale’ Cronbach's α coefficient was 0.777 and SDS scale’ was 0.782, indicating better homogeneity reliability; Twenty items of SAS and SDS scales were analyzed by exploratory factors to construct validity and four main factors were extracted from the SAS scale that showed the variances ratio were 15.4%,14.9%,10.6% and 10.2%,respectively,and four factors accounted for 51.1% of the total variance of accumulated explanation;Five main factors were extracted from SDS scales that showed the variance ratio were 14.0%,12.6%,11.9%,10.3% and 8.4%,respectively,with 57.4% of the total variance;The re-measurement analysis of SAS and SDS scale’s items found that the two measurements were highly correlated with each other （P<0.001）. Conclusion SAS and SDS scales have a better reliability and validity in the investigation of psychological and mental impairment in patients with liver cirrhosis.