Objective The aim of this study was to analyze partial epidemiological characteristics of patients with inherited metabolic liver disease (IMLD) of Beijing You'an Hospital from 1996 to 2020.Methods All patients with IMLD admitted in Beijing You'an Hospital from January 1996 to December 2020 were included, and the prevalence of disease catalogues, gender and ages of patients were analyzed.Results There were 552 cases of IMLD (some admitted more than one time) presented in our hospital during this period, accounting for 3.6 ‰ of inpatients with liver disease; out of the 393 patients with IMLD, the percentage of male patients was higher than that of female, with an average age of 29 years; among all patients with IMLD, 223 (56.7%) had Wilson's disease and 136 (34.6%) had congenital hyperbilirubinemia, both accounting for 91.3%; compared with in the previous 10 years, the number of rare diseases increased in recent 10 years and the age of onset increased slightly from 24.9 years to 31.4 years ( P < 0.01), with middle-aged and elderly patients also increasing.Conclusion Adult inherited metabolic liver disease is not rare, and the disease spectrum is gradually rich, to which should be paid more attention by hepatologists.

Objective The purpose of this study was to observe the shear wave velocity (SWV) by acoustic radiation force impulse (ARFI) in patients with hepatolenticular degeneration (HLD).Methods 38 patients with HLD, 49 with other chronic liver disease (CLD) and 56 healthy persons were recruited in thisstudy between June 2017and June 2019. The ARFI technology was used to measure hepatic SWV. Serum copper ion (Cu²⁺) level was determined by atomic absorption spectrometry, serum ceruloplasmin (CP) level was determined by immunoturbidimetric method, and serum copper oxidase (sCO) were determined by manual method.Serum type III procollagen (PC-III), laminin (LN), type IV collagen (IV-C), and hyaluronic acid (HA) wereassayed by radioimmunoassay.Results Serum Cu^2＋and CP levels in patients with HLD were (6.7±1.5)μmol/L and (88.0±13.2)mg/L, significantly lower than 【(13.2±1.6)μmol/L and (216.6±43.5)mg/L, respectively, P＜0.05】 in patients with CLD, or 【(17.2±6.2)μmol/L and (400.0±150.0)mg/L, respectively, P＜0.05】 in healthy persons, and sCO activity in patients with HLD was (0.02±0.01)U/L, much lower than 【(0.4±0.1)U/L, P＜0.05】 in healthy persons; serum PC-Ⅲ, Ⅳ-C, LN and HA levels in patients with HLD were (11.1±0.3)ng/mL, (95.9±12.4)ng/mL, (43.6±11.4)ng/mL and (88.9±15.8)ng/mL, all significantly lower than 【(48.5±24.2)ng/mL, (140.6±15.3)ng/mL, (847.6±38.5)ng/mL and (261.2±22.8)ng/mL, P＜0.05】 in patients with CLD; the sonogram showed that the liver were fatty liver-like, starlight, dendritic, terraneous or nodular in patients with HLD, and the SWV in patients with HLD was (1.9±0.2)m/s, significantly lower than 【( 2.2±0.3 )m/s,P＜0.05】 in patients with CLD, but much higher than 【(1.1±0.2)m/s, P＜0.05】 in healthy persons.Conclusion The sonogram shows characteristic hepatic changes in patients with HLD, and the SWV might help discriminate with other CLD to some extent.

Objective The aim of this study was to observe the effects of somatostatin (SST) on the inflammatory response and apoptosis in mice with CCl₄-induced liver fibrosis (LF) , and to investigate whether SST can reduce liver injury and alleviate the process of LF by inhibiting the ERS.Methods Forty WT mice were randomly divided into control, model, low-dose SST-intervened and large-dose SST-intervened group, with 10 in each. Except the mice in control, the mice in other groups were injected with 25% CCl₄ and oil mixture intraperitoneally to establish the model of liver injury and the mice in SST-intervened groups were given large or low doses of SST subcutaneously, respectively. Serum ALT and AST were detected, the liver tissues were obtained for pathological examination, and the protein expression of Bcl-2, Bax, Casp-9, BiP and CHOP in liver tissues were detected by Western blot.Results The histological activity index (HAI) score in model group was (12.2±2.7), significantly higher than [(1.8±0.8), P＜0.01] in the control, and the hepatic fibrosis score was (5.4±0.5), significantly higher than [(0.1±0.3),P＜0.01] in control; serum AST and ALT in the model were (194.7±35.2)U/L and (121.8±26.6)U/L], both significantly higher than [(53.8±21.7)U/L and (35.3±12.9)U/L, respectively,P＜0.01] in the control; the HAI scores in low-dose and large-dose SST-intervened groups were (7.7±2.1) and (6.9±2.0), and the hepatic fibrosis scores were (4.3±1.0) and (3.9±0.9), significantly decreased compared to those in the model (P＜0.05); the expression of Bax, Casp-9, BiP and CHOP in hepatic tissues in the model intensified greatly compared to in the control ([P＜0.01), while the hepatic expression of Bax, Casp-9, BiP and CHOP in SST-intervened groups weaken obviously compared to in the model (F=26.36, F=14.81, F=25.11 and F=30.31,P＜0.05).Conclusion SST could alleviate liver inflammation and LF, the mechanism by which might be related to the inhibition of ERS.

Objective To establish a hepatopulmonary syndrome (HPS) model in rats by ligation of common bile duct.Methods 40 SD rats were randomly divided into experimental (n=30) and control group (n=10), and the rats had operation of common bile duct ligation or sham-operated. Two rats in experimental group and control group were sacrificed at 1, 2, 4, 5, 6 weeks after operation, respectively. PaO₂, PaCO₂ and pH were detected by blood gas analysis.Results At one week, the results of abdominal ultrasonography showed that the echo of the livers was coarse, and the bile duct was slightly dilated; at two weeks, the bile duct was obviously enlarged, and at four to six weeks, the surface of the liver was not flat in the experimental group; the histopathological examination showed that the infiltration of inflammatory cells, the formation of fibrous cords and some pseudolobules in liver tissues, and the dilatation of pulmonary microvessels in the lung tissues were observed; At the end of six week experiment, blood gas analysis showed that PaO₂ was (65.5±8.2)mmHg in the experimental group, significantly lower than【(95.5±4.5)mmHg,P<0.05】in the control, serum nitric oxide level in the experimental group was(64.1±4.5)μmol/L, significantly higher than【(32.8±4.3)μmol/L,P<0.05】 in the control.Conclusion The model of hepatopulmonary syndrome is successfully established by ligation of common bile duct in our experiment, which has the advantages of short model formation, high stability, and no toxicity.

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

Objective The aim of this study was to investigate the predictive value of histological activity index and fibrosis by liver stiffness measurement (LSM) and indocyanine green retention at 15 minutes (ICGR15) in patients with chronic hepatitis B (CHB) and normal or minimally elevated serum ALT levels.Methods A total of 309 patients with CHB with normal or minimally elevated serum ALT were recruited in this study, and all of them underwent liver biopsies. LSM and ICGR15 were detected. The area under receiver operating characteristic curve(AUC) was applied to estimate the efficacy of diagnosis.Results Out the 309 patients with CHB, the stable disease was found in 113 patients, and the progressive disease defined as histological activity index being grading 2 or more or fibrosis being staging 2 or more in 196 patients; there were no significant differenceswith respect to age, gender, platelet counts, serum HBeAg positive and serum ALT levels(P>0.05), while there were significant differences as for serum HBV DNA loads, albumin, LSM and ICGR15 comparison between the two groups (P<0.05); the LSM, ICGR15 or LSM/ICGR15 combination was positively correlated to hepatic METAVIR score(P<0.05); the ROC analysis showed that the AUC of LSM, ICGR15 or LSM/ICGR15 combiantion in predicting progressive liver disease were 0.655, 0.617 and 0.686, e.g., when the LSM equal to 7.35 kPa as the cut-off-value, the diagnosic sencitivity was 55.4%, and the specificity was 68.1%, when the ICGR15 equal to 4.15% as the cut-off-value, they were 34.4% and 90.3%, and when the LSM/ICGR15 combined, they were 59.5% and 78.8%.Conclusion The application of LSM and ICGR15 might have a predictive value for prediction of hepatic grading and staging in patients with CHB, especially in those with normal serum ALT levels or mild liver injury, which needs further investigation.

Objective The purpose of this study was to observe the manifestations of small intestinal mucosal lesions in patients with chronic hepatitis B(CHB) and to explore the relationship between small intestinal mucosal lesions and clinical data, biochemical indexes and hepatic fibrosis indexes.Methods 158 patients with CHB were recruited in this study between January 2015 and December 2019, and all of them underwent capsule endoscopy. The intestinal mucosal manifestations were evaluated by Lewis score system. The typical mucosal abnormalities were chorionic edema, increased fragility, necrotizing erosion, mucosal ulcer, mucosal edema with erosion and inflammatory stenosis.Results Out the 158 patients with CHB, 94 patients (59.5%)had normal, and 64 patients (40.5%) had abnormal bowel mucosa; the incidence of bile reflux in patients with abnormal bowel mucosa was 62.5%, significantly higher than 35.1% in those with normal bowel mucosa (P<0.05); the Lewis score in patients with abnormal bowel mucosa was (140.6±80.2), significantly higher than that in patients with normal bowel mucosa 【(0.0±0.0), P<0.05); blood platelet count, serum ALT, AST, GGT, albumin, bilirubin, creatinine, and urea levels in in patients with abnormal bowel mucosa were(208.6±65.2)×10⁹/L, (32.5±10.6)U/L, (35.0±7.8)U/L, (47.9±12.5)U/L, (39.2±4.4)g/L, (18.8±15.2)μmol/L, (89.6±16.8)μmol/L and (6.6±2.7)mmol/L, all significantly different compared to 【(248.2±72.6)×10⁹/L, (16.2±8.2)U/L, (15.8±8.6)U/L, (18.2±14.2)U/L, (43.6±5.2)g/L, (12.7±4.8)μmol/L, (80.4±15.6)μmol/L and (5.2±1.4)mmol/L, respectively, P<0.05】 in patients with normal bowel mucosa, while they were no significant differences with respect to age, gender, smoking alcohol consumption, serum HBV DNA loads, and prothrombin times between the two groups (P>0.05); the APRI, Forns index, S index, FIB-4 and BARD score in patients with abnormal bowel mucosa were (0.35±0.42), (7.52±1.51), (0.08±0.13), (1.80±1.31) and (2.11±0.71), significantly different compared to 【(0.22±0.14), (6.40±1.42), (0.05±0.06), (1.20±0.61) and (1.83±0.72), respectively, P<0.05】 in those with normal bowel mucosa.Conclusion There are some kind of different degrees of intestinal mucosal abnormalities in patients with CHB, and the pathological changes might be related to some extent to the liver function injuries, and warrants further investigation.

Objective The aim of this study was to investigate the efficacy and safety of tenofovir disoproxil fumarate (TDF) and telbivudine (LdT)on blocking mother-to-child transmission of hepatitis B virus infection.Methods A total of 77 pregnant women with chrnonic hepatitis B virus infection were encruited in Tongliao Infectious Disease Hospital between May 2016 and May 2019, and 43 women took TDF and 34 women took LdT from 24th to 28th weeks of gestation to cessation of pregnance. All newborns received hepatitis B immunoglobulin within 6 hours of birth and yeast-derived recombinant hepatitis B vaccine at 0, 1, and 6 months after birth. Mothers and infants were followed for 7 months after infants’ birth.Results Serum HBV DNA load in TDF-treated women decreased from(7.4±1.2)lg copies/mL to (3.6±1.1)lg copies/mL(P＜0.05), and that in LdT-treated women decreased from (7.3±1.1)lg copies/mL to (4.1±1.2)lg copies/mL(P＜0.05) before and after treatment, and there was no significant difference between the two groups; there were no significant differences respect ot serum ALT levels before and after treatment in the two groups; seven months after birth, serum HBsAg were negative and serum HBsAb were positive in all infants in the two groups and there were no significant differences respect to body mass, lengths and circumferences of head of infants in the two groups (P>0.05); we didn’t observe any side effects in the two groups during the treatment.Conclusion The administration fo TDF LdT at the base of basic hepatitis B immunoglobulin and hepatitis B vaccine inoculation might effectively block mother-to-child hepatitis B virus transmission.

Objective The aim of this study was to investigate the diagnostic efficacy of transient elastography in combination with aspartate aminotransferase (AST)/platelet count index (APRI) and AST/ alanine aminotransferase (ALT) ratio(AAR) in evaluating significant liver fibrosis in patients with chronic hepatitis B (CHB). Methods+++++118 patients with CHB were admitted to our hospital between May 2017 and May 2018, all received entecavir for treatment for 12 months, and all underwent liver biopsies. The liver stiffness measurement (LSM) was detected by FibroScan-502 transient elastography scanner. Blood routine and blood biochemical indexes were detected by BX800 full-automatic biochemical analyzer. The predictive value of LSM, evaluated by receiver operatingAPRI and AAR for diagnosing significant liver fibrosis in patients with CHB was characteristic (ROC) curves.Results Out of the 118 patients with CHB in our series, the liver fibrosis stage S_0-1 was found in 65 patients, and the S_2-4 (significant liver fibrosis) was found in 53 patients; serumALT and AST levels, APRI, AAR and LSM in patients with significant liver fibrosis were (128.3±31.4)U/L, (133.7±41.9)U/L, (0.5±0.2), (1.5±0.5) and (9.3±2.7)kPa, all significantly higher than 【(104.6±26.8)U/L, (93.4±40.2)U/L,(0.3±0.1), (1.2±0.3) and (5.6±1.6)kPa, respectively, P<0.05】, while peripheral blood PLC count was (123.4±46.4)×10⁹/L, significantly lower than 【(184.2±42.8)×10⁹/L, P<0.05】 in patients without liver fibrosis; we set the cut-off-value of 7.830(kPa), 0.350 and 1.310, respectively, and the AUC were 0.867(95%CI:0.827-0.947), 0.774(95%CI:0.678-0.861) and 0.687(95%CI:0.500-0.774) for LSM, APRI and AAR in diagnosing significant liver fibrosis, all significantly lower than 0.945(95%CI:0.904-0.986) for the three combination diagnosis (P<0.05); there were no significant changes in LSM, APRI and AAR after 12 month antiviral treatment in 65 patients without significant liver fibrosis, while the LSM was (7.4±1.2)kPa at the end of 12 month observation, significantly decreased as compared to 【(9.3±2.7)kPa, P<0.05】 at presentation in 53 patients with significant liver fibrosis.Conclusion The application of LSM, in combination with APRI and AAR maybe, is of good predictive value in evaluating significant liver fibrosis in patients with CHB, and warrants further investigation.

Objective The aim of this study was to investigate the short-term efficacy of tenofovir dipivoxil and entecavir in treating patients with chronic hepatitis B (CHB) and serum fibroblast growth factor-23 (FGF-23) level changes.Methods 150 patients with CHB were recruited in our hospital between January 2018 and January 2019, and were divided into two groups, with 75 in each, receiving entecavir or tenofovir for 48 weeks. Serum cytokine levels in the two groups before and after 48 weeks of treatment were detected by ELISA.Results At the end of 48-week treatment, serum HBV DNA loss in the tenofovir-treated group was 100.0 %, which was significantly higher than 93.3% (P<0.05) in the entecavir-treated group, However, there were no statistical significant differences as respect to serum HBeAg negative or serum alanine aminotransferase normalization between the two groups (10.1% vs. 8.0% and 96.0% vs. 93.3%, respectively, P>0.05); serum HBV DNA level in tenofovir-treated group was(0.9 ± 0.5)Ig IU/mL, not significantly different compared to(1.3 ± 0.6)Ig IU/mL in entecavir-treated group (P>0.05), and there were no significant differences with respect to serum ALT and AST levels between the two groups (P>0.05); serum β2-microglobulin, FGF-23 and cystatin-C levels in tenofovir-treated group were(1.6 ± 0.5)mg/L, (382.2 ± 61.3)pg/mL and (3.0 ± 0.8)mg/L, all significantly higher than 【(1.4 ± 0.5)mg/L,(363.2 ± 53.3)pg/mL and(2.8 ± 0.8)mg/L, respectively, P<0.05】 in the entecavir-treated group.Conclusion The oral administration of entecavir or tenofovir disoproxil in the treatment of patients with CHB could obtain short-term response as serum HBV DNA loss and serum ALT normalization, while the implication of elevated serum β2-MG, FGF-23 and Cys-C levels needs further investigation.

Objective The aim of this study was to investigate serum reactive oxygen species (ROS) and adiponectin (ADPN) level changes in patients with chronic hepatitis B (CHB) and non-alcoholic fatty liver diseases (NAFLD).Methods 97 patients with CHB and NAFLD and 97 patients with CHB were recruited in our hospital between January 2018 and January 2020, and serum ROS, ADPN and tumor necrosis factor-α (TNF-α) were detected by ELISA. The liver fibrosis was assessed by NAFLD fibrosis scoring (NFS) system. The liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were detected by FibroScan.Results Serum GGT level in patients with CHB and NAFLD was (96.5±13.3)U/L, significantly higher than 【(67.3±12.5)U/L, P<0.05】 in patients with CHB; serum FPG, TC, TG and LDL-C levels in patients with CHB and NAFLD were (5.9±1.0)mmol/L, (5.2±1.1)mmol/L, (2.8±0.4)mmol/L and (2.8±0.4)mmol/L, all significantly higher than 【(4.9±1.0)mmol/L,(4.1±0.8)mmol/L,(1.7±0.3)mmol/L and (2.2±0.3)mmol/L, respectively, P<0.05】, while serum HDL-C was (0.9±0.2)mmol/L, much lower than 【(1.2±0.2)mmol/L, P<0.05】 in patients with CHB; serum ROS and TNF-α levels were (1.7±0.4)U/mL and (32.6±5.4)ng/L, both significantly higher than 【(0.9±0.2)U/mL and (21.5±4.8)ng/L,P＜0.05】, while serum ADPN level was (8.7±1.9)ng/mL, much lower than 【(10.2±2.3)ng/mL, P＜0.05】 in patients with CHB; the NFS score, LSM and CAP were (0.2±0.1), (10.2±1.3)kPa and (287.4±44.3)dB/m, all significantly higher than 【(-1.4±0.1), (9.1±1.2)kPa and (242.5±38.7)dB/m, respectively, P＜0.05】 in patients with CHB.Conclusion Serum ROS level significantly increases, while serum ADPN level greatly decreases in patients with CHB and NAFLD, and the mechanism by which they take part in the pathogenesis of the coexisted entity needs further investigation.

Objective The aim of this study was to investigate the changes of serum interferon-γ (IFN-γ) and interleukin-18 (IL-18) levels in children with cytomegalovirus (CMV) hepatitis and their implications with prognosis.Methods A total of 95 children with CMV hepatitis (including mild hepatitis in 66 and severe hepatitis in 29) and 90 healthy children were recruited in our hospital between January 2017 and June 2019, and children with viral hepatitis were treated with ganciclovir for six weeks. Serum IFN-γ and IL-18 levels were detected by enzyme linked immunosorbent assay. The prognosis of the children with CMV hepatitis was analyzed with the area under ROC (AUC).Results At presentation, serum IFN-γ, IL-18, ALT and bilirubin levels in mild group were(7.7±2.9)mmol/L, (56.9±5.7)pg/L, (69.8±11.3)U/L and (75.4±16.7)μmol/L, and in severe hepatitis children were (16.6±4.1)mmol/L, (89.5±8.3)pg/L, (104.7±13.2)U/L and (235.7±20.4)μmol/L, all significantly higher than 【(2.1±1.1)mmol/L, (33.7±4.9)pg/L, (19.6±3.1)U/L and (8.3±2.7)μmol/L, respectively, P<0.05】 in healthy children; at the end of six week treatment, serum IFN-γ, IL-18, ALT and bilirubin levels in mild hepatitis children were(2.2±0.9)mmol/L, (34.1±5.4)pg/L, (21.2±4.3)U/L and(13.4±4.1)μmol/L, all significantly lower than 【(4.1±0.6)mmol/L, (40.6±7.9)pg/L, (46.5±7.5)U/L and (26.5±3.4)μmol/L, respectively, P<0.05】 in severe group; out of the 95 children with CMV hepatitis, 80 recovered, and 15 didn’t; serum IFN-γ, IL-18, ALT and bilirubin levels in recovered children were significantly lower than those in children with abnormal liver function tests or serum CMV DNA positive (all P<0.05); the sensitivity and specificity of serum IFN-γ level in predicting undesirable outcome of children with CMV hepatitis were 86.7% and 96.3%, and those of serum IL-18 level were 93.3% and 73.8%.Conclusion Serum IFN-γ and IL-18 levels are significantly elevated in children with CMV hepatitis, and the children with CMV hepatitis having an increased serum cytokines might have a bad prognosis.

Objective The purpose of this study was to investigate the early screening of nonalcoholic steatohepatitis (NASH) detected by FibroScan with liver controlled attenuation parameters (CAP) .Methods 142 patients with NASH and 130 healthy individuals were recruited in our hospital between January 2016 and January 2020,and underwent Fibroscan for CAP. All patients received liver biopsies and the nonalcoholic fatty liver disease activity score (NAS) was defined. The area under the receiver operating characteristic curve (AUROC)was obtained for evaluating the diagnostic efficacy of CAP in predicting NASH.Results The cap in patients with NASH was (291.1±94.5) dB / m, which was significantly higher than that in healthy persons [(216.2±43.1) dB/m, P<0.001]; the cap values in 60 patients with NAS of four, 39 patients with NAS of five, 27 patients with NAS of six and 16 patients with NAS of seven were (247.4±20.4)dB/m, (282.4±25.2)dB/m, (352.4±31.4)dB/m and (372.4±27.0)dB/m,P＜0.001】, significantly different among them; the ROC analysis showed that the AUC of CAP was 0.865(SE:0.025, 95%CI=0.815-0.915, P＜0.001), with optimal cut-off-value of 293.7 dB/m, and the sensitivity of 0.831 and specificity of 0.885.Conclusion The CAP might help quantitatively screening Nash in physical examination, and warrants further investigation.

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

Objective The aim of this study was to observe the efficacy of combination of ursodeoxycholic acid (UDCA) and prednisone and azathioprine in the treatment of patients with autoimmune hepatitis (AIH).Methods 120 AIH patients were recruited in the Department of Gastroenterology in our hospital between February 2017 and December 2019, and were randomly divided into control and observation groups with 60 cases in each group. The patients in the control received prednisone and azathioprine, while those in the observation group received UDCA at base of prednisone and azathioprine therapy. The regimen lasted for 21 months. Serum complement 3 (C3), C4, as well as immunoglobulin were detected.Results At the end of the treatment, serum alanine aminotransferase level in the observation group was (55.2±6.9)U/L, significantly lower than 【(91.2±12.8)U/L, P<0.05】, serum aspartate aminotransferase level was (59.7±7.5)U/L, significantly lower than 【(101.5±13.5)U/L, P<0.05】, serum alkaline phosphatase level was (122.4±15.7)U/L, much lower than 【(138.9±15.2)U/L, P<0.05】, and serum glutamyl transpeptidase level was (120.7±10.1)U/L, significantly lower than 【(161.5±20.7)U/L, P<0.05】 in the control; serum C3 level in the observation was (0.6±0.1)g/L, significantly lower than 【(0.8±0.2)g/L,P＜0.05】, and serum C4 level was (0.1±0.1)g/L, significantly lower than 【(0.2±0.1)g/L, P＜0.05】 in the control; serum IgG level in the observation group was (12.5±2.0)g/L, significantly lower than 【(20.4±2.7)g/L, P＜0.05】, and serum IgM level was (2.7±0.9)g/L, significantly lower than 【(3.4±1.1)g/L, P＜0.05】 in the control.Conclusion The administration of ursodeoxycholic acid at base of prednisolone and azathioprine combination in the treatment of patients with AIH could effectively reduce serum C3 and C4 levels, improve immune functions and alleviate liver injury, which needs further investigation.

Objective To investigate the therapeutic efficacy of polyene phosphatidylcholine in patients with anti-tuberculosis agents-induced liver injury and its effect on serum heme oxygenase (HO-1), glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD) levels. Methods 78 patients drug-induced liver injury (DILI) during anti-tuberculosis therapy for pulmonary tuberculosis were enrolled in our hospital between March 2018 and March 2019, and were randomly divided into control and observation group with 39 in each, receiving diammonium glycyrrhizinate or polyene phosphatidylcholine orally for 12 weeks. Serum interleukin-6, IL-1β and tumor necrosis factor-α(TNF-ɑ) as well as serum HO-1, GSH-Px and SOD levels were detected.Results At the end of 12 week observation, serum level of alanine aminotransferase (ALT) in the observation group was (28.1 ± 20.5) U/L, which was significantly lower than that in the control group [(59.4 ± 22.7) U/L, P <0.05], and serum level of aspartate aminotransferase (AST) in the observation group was (345.1 ± 17.3) U/L, which was significantly lower than that in the control group [(45.1 ± 17.3) U/L, P <0.05]; serum TNF-ɑ level inthe observation group was (7.4 ± 1.5) pg/mL, which was significantly lower than that in the control group [(10.3 ± 1.8) pg/mL, P <0.05], and serum IL-1β level in the observation group was (13.7 ± 2.1) ng/mL, which was significantly lower than that in the control group [(34.2 ± 4.8) ng / mL, P <0.05]; serum HO-1 level in the observation group was (294.1 ± 16.9) U/L, which was significantly higher than that in the control group [(198.8 ± 17.2) U/L, P <0.05], and serum level of SOD was (544.2 ± 13.3) U/L, which was significantly higher than that in the control group [(421.0 ± 12.8) U/L, P <0.05]. Conclusion The administration of polyene phosphatidylcholine in the treatment of patients with DILI caused by anti-tuberculosis medicine is efficacious, which could significantly increase serum HO-1 and SOD levels, and reduce oxidative stress response, and needs further clinical investigation.

Objective The aim of this study was to investigate the short-term efficacy of magnesium isoglycyrrhizinate and adenosylmethionine butanedisulfonate combination in treatment of patients with drug-induced liver injury (DILI) and serum heme monooxygenase 1(HO-1), nuclear factor E2 related factor 2(Nrf-2) and glutathione peroxidase (GSH-Px) level changes.Methods 78 patients with DILI were enrolled in this study between January 2018 and December 2019, and were randomly divided into control and combination groups, with 39 cases in each group. The patients in control group received intravenous infusion of adenosylmethionine butanedisulfonate, and those in the combination received intravenous infusion of magnesium isoglycyrrhizinate at the base of medicine in the control for two weeks. Serum Nrf-2, TNF-α, IL-10, NO, NOS, HO-1, GSH-Px and macrophage dectected.Results At the end two week migration inhibitory factor (MIF) were of treatment, serum alanine aminotransaminase level in the combination group was (65.9±7.7)U/L, serum AST level was (58.5±7.3)U/L, and serum total bilirubin level was (20.5±5.3)μmol/L, all significantly lower than 【(93.5±11.2)U/L, (91.3±10.8)U/L and (25.2±7.9)μmol/L, respectively, P<0.05】 in the control; serum NOS level was (47.7±5.8)U/mg, and serum GSH-Px level was (0.8±0.1)ng/mL, both significantly higher than 【(38.5±5.6)U/mg and (0.5±0.1)U/mg, respectively, P<0.05】, while serum HO-1 level was (0.4±0.1)ng/mL, and serum Nrf-2 level was (0.5±0.1)ng/mL, both significantly lower than 【(0.7±0.1)ng/mL and (0.8±0.1)U/mg, respectively, P<0.05】 in the control; serum TNF-α level was (3.0±0.5)ng/mL, and serum MIF level was (8.9±1.1)ng/mL, significantly lower than 【(4.2±0.6)ng/mL and (11.4±1.5)ng/mL, respectively, P<0.05】, while serum IL-10 level was (33.1±4.4)pg/mL, and serum NO level was (66.5±7.3)μmol/L, significantly higher than 【(22.5±2.9)pg/mL and (41.1±5.6)μmol/L, respectively, P<0.05】 in the control. Conclusion The magnesium isoglycyrrhizinate and adenosylmethionine butanedisulfonate combination in the treatment of patients with DILI have a short-term efficacy, which might be related to the inhibition of inflammatory and oxidative stress reactions, and needs further clinical investigation.

Objective The aim of this study was to investigate the clinical value of serum pentraxin 3 (PTX3) and soluble tumor necrosis factor-like weak inducer of apoptosis (TWEAK) levels in predicting death of patients with decompensated hepatitis B cirrhosis.Methods 108 patients with decompensated hepatitis B-induced liver cirrhosis were admitted to our hospital between January 2016 and June 2019, and all were followed-up for 6 months. The protein-energy wasting (PEW) was evaluated, and serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) as well as serum PTX3 and sTWEAK levels were detected.Results 39 patients with decompensated hepatitis B-induced liver cirrhosis out of our series died, and 69 survived during six month follow-up period; serum TNF-α, IL-6, CRP, PTX3 and sTWEAK levels in dead group at presentation were significantly higher than those in the survival group[(68.3±11.2)ng/L vs. (39.8±19.0)ng/L, (918.3±148.7)ng/L vs. (249.6±51.2)ng/L, (5.6±0.3)mg/L vs. (2.4±0.9)mg/L, (19.7±3.3)ng/mL vs. (11.6±0.6)ng/mL, and (1459.0±215.3)ng/L vs. (549.5±23.5)ng/L, respectively, all P<0.05], while the SGNA score in the dead group was significantly lower than that in the survival group[(16.5±8.6) vs. (23.2±7.6), P<0.05]; the multivariate Logistic analysis showed that the SGNA, serum PTX3 and sTWEAK levels were the independent risk factors for death in patients with decompensated hepatitis B cirrhosis (OR=1.366, 95%CI:1.036-1.801; OR=1.939, 95%CI:1.409-2.670, OR=2.891; 95%CI:1.909-4.380, P<0.05); the SGNA, serum PTX3 and sTWEAK levels had predictive value for the death of patients with decompensated hepatitis B cirrhosis with the area under ROC (AUC) of serum PTX3 level the largest(AUC=0.868, 95%CI:0.823-0.912), of serum sTWEAK the relative large(AUC=0.753, 95%CI:0.690-0.816)and the SGNA smallest (AUC=0.675, 95%CI:0.606-0.743), and the sensitivity and specificity of serum PTX3 level were the highest, 83.52% and 74.16%, respectively.Conclusion Serum levels of PTX3 and sTWEAK in dead patients with decompensated cirrhosis elevate early, and the determination of them might help predict the prognosis of patients with decompensated hepatitis B cirrhosis in the early stage, which is worthy of clinical verification.

Objective The aim of this study was to analyze the short-term efficacy of glicladine and insulin aspart 50 in the treatment of patients with non-alcoholic fatty liver diseases (NAFLD) and hepatogenic diabetes and to monitor the changes of homeostasis model assessment for insulin resistance (HOMA-IR) and index of β-cell function in homeostasis model assessment (HOMA-β).Methods 98 patients with NAFLD and hepatogenic diabetes were admitted to our hospital between January 2017 and December 2019 were randomly divided into control group (n=49) and observation group (n=49). The patients in the control group were treated with insulin aspart 50, while those in the observation group were treated with glicladine at the basis of insulin aspart 50. The regimen in both groups lasted for 12 weeks. The fasting blood glucose (FBG) , postprandial 2 hour blood glucose (2 h PG) and serum hemoglobin A1c (HbAlc) level were detected, and the HOMA-IR and HOMA-β were calculated. Serum liver function indexes were detected by automatic biochemical analyzer.Results At the end of 12 week treatment, the FPG level in observation group was (6.3±3.9) mmol/l, significantly lower than [ (7.8 ±1.2) mmol/l, P<0.05] in the control, the 2 h PG level was (8.4±2.6) mmol/l, significantly lower than [(11.5±2.8) mmol/l, P<0.05] in the control, and the HbAlc level was (7.1±1.6)%, significantly lower than [(8.3±1.9)%, P<0.05] in the control; the HOMA-IR in the observation group was (1.5±0.2) , significantly lower than [(2.4±03), P<0.05] in the control, while the HOMA-β was (42.9±8.7), significantly higher than [(33.5±7.2), P<0.05] in the control; serum alanine aminotransferase (ALT) level in the observation group was (53.9±13.7) U/L, significantly lower than [(72.2±19.6) U/L, P<0.05] in the control, and serum aspartate aminotransferase (AST) level was (22.1±6.3) U/L, significantly lower than [(46.4±6.9) U/L, P<0.05] in the control; Serum albumin, total bilirubin and glutamyl transpeptidase levels in the two groups were not significantly different before and after treatment (P>0.05).Conclusion The administration of glicladine and insulin aspart 50 in the treatment of patients with NAFLD and hepatogenic diabetes could significantly improve the blood sugar level recovery, which might related to the improvement of islet β cell functions and reduction of HOMA-IR.

Objective The aim of this study was to investigate serum oncogene and tumor suppressor gene level changes in patients with hepatocellular carcinoma (HCC).Methods 40 patients with chronic hepatitis B (CHB), 25 patients with compensated hepatitis B liver cirrhosis (LC), 31 patients with decompensated hepatitis B LC, 50 patients with HCC and 40 healthy persons were enrolled in our hospital between July 2017 and July 2020, and serum oncogene transformation of participants (N-ras), proliferation related genes (C-myc), fibroblast growth factor (FGF) 2, silk/threonine kinase (PLK) 1 as well as tumor-suppressor genes iron element (hepcidin), scavenger receptors (SCAR) A5, and cell cycle dependent protein kinase inhibitor (P16) protein were detected by ELISA.Results Serum N-ras, C-myc, FGF2 and PLK1 levels in patients with HCC were (17.9±2.4)pg/mL, (16.2±2.0)pg/mL,(19.0±3.2)pg/mL and (15.4±1.9)pg/mL, all significantly higher than 【(10.3±1.4)pg/mL,(10.0±1.2)pg/mL,(10.2±1.4)pg/mL and (9.0±1.1)pg/mL, respectively, P＜0.05】 in patients with decompensated LC or 【(9.9±1.2)pg/mL,(9.9±1.1)pg/mL,(10.0±1.3)pg/mL and (9.1±1.0)pg/mL, respectively,P＜0.05】 in patients with compensated LC or 【(9.8±1.1)pg/mL,(9.7±1.1)pg/mL,(9.9±1.2)pg/mL and (9.0±1.0)pg/mL, respectively, P＜0.05】 in patients with CHB or 【(1.2±0.2)pg/mL, (1.1±0.1)pg/mL, (1.1±0.2)pg/mL and (0.9±0.1)pg/mL, respectively, P＜0.05】 in healthy persons; serum hepcidin, SCARA5 and P16 levels in patients with HCC were (1.1±0.3)pg/mL,(1.3±0.3)pg/mL and (1.7±0.4)pg/mL, all significantly lower than 【(5.3±0.7)pg/mL,(7.2±1.1)pg/mL and (6.4±0.8)pg/mL, respectively, P＜0.05】 in patients with decompensated LC or 【(5.6±0.8)pg/mL,(7.3±1.1)pg/mL and (6.3±0.8)pg/mL, respectively, P＜0.05】 in patients with compensated LC or 【(5.4±0.7)pg/mL,(7.9±1.1)pg/mL and (6.5±1.0)pg/mL, respectively, P＜0.05】 in patients with CHB or 【(12.9±1.2)pg/mL, (14.4±1.3)pg/mL and (11.6±0.9)pg/mL, respectively, P＜0.05】 in healthy individuals.Conclusion The up-regulation of N-ras, c-myc, FGF2 and PLK1 and down-regulation of hepcidin, scara5 and p16 occur in patients with HCC, which might be involved in the hepatocarcinogenesis.

Objective The aim of this study was to explore the impact of peripheral blood mononuclear cell (PBMC) surface Toll-like receptor (TLR) 2/4 expression and small intestinal bacterial overgrowth (SIBO) on survival in patients with hepatocellular carcinoma (HCC) after transcatheter arterial embolization (TACE) therapy.Methods A retrospective clinical analysis was performed in 47 patients with HCC, who received TACE in our hospital between January 2013 and June 2016. 100 healthy persons were recruited for the controls during the same period. The expression intensity (EI) of TLR2 and TLR4 on PBMC surface were detected by flow cytometry, and the SIBO was assessed based on lactulose hydrogen breath test (LHBT). patients with HCC was 66.0%, significantly.Results The SIBO positive rate in higher than 6.0%(P＜0.05) in healthy persons, and the EI of TLR2⁺ cells was (94.7±12.3)geometric mean fluorescence(GMF), significantly higher than 【(26.4±4.2) GMF, P＜0.05】, the EI of TLR4⁺ cells was (43.1±8.7)GMF, significantly higher than 【(16.8±4.5) GMF, P＜0.05】 in healthy persons; the EI of TLR2⁺ cells in 31 HCC patients with SIBO positive was (109.3±16.8) GMF, greater than【(71.5±5.6) GMF, P＜0.05】 in 16 HCC patients with SIBO negative, and the EI of TLR4⁺ cells was (46.7±7.1)GMF, greater than 【(31.5±4.3) GMF, P＜0.05】 in patients with SIBO negative; six month after TACE, the EI of TLR2⁺ cells in 23 but one patients who lost with long survival was (45.7±5.8)GMF, significantly weaker than 【(65.6±12.5)GMF, P＜0.05】, the EI of TLR4⁺ cells was (21.5±4.3)GMF, significantly weaker than 【(30.1±7.4) GMF, P＜0.05】 , and the SIBO positive rate was 4.4%, significantly lower than 62.5%(P＜0.05) in 23 patients with short survival; the 3-year cumulative survival rate and 3-year cumulative event-free survival rate in 23 patients with TLR2 intensified expression were 17.4% and 13.0%, significantly lower than 52.2% and 43.5%(P＜0.05) in 23 patients with weak TLR2 expression, and the 3-year cumulative survival rate and 3-year cumulative event-free survival rate in 23 patients with TLR4 strong expression were 13.0% and 8.7%, also significantly lower than 56.5% and 47.8%(P＜0.05) in 23 patients with weak TLR4 expression, and they were 10.0% and 3.3% in 30 patients with SIBO positive, significantly lower than 81.3% and 75.0%(P＜0.05) in 16 patients with SIBO negative. Conclusion The expression of TLR2 and TLR4 on PBMC surface and SIBO could impact the survival of patients with HCC after TACE, and the mechanism needs further investigation.

Objective The purpose of this study was to explore the short-term and long-term survivals of patients with huge primary liver cancer (PLC) after associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) . Methods The clinical data of 98 patients with PLC including in our hospital between January 2016 and February 2018 were retrospectively analyzed, and 20 patients were treated with ALPPS (group A), 38 patients underwent surgical resection after transcatheter hepatic arterial chemoembolization (TACE) (group B), and 40 patients received direct resection of huge liver cancer (group C). The liver regeneration was estimated by post-operational CT scan, and the total liver volume (TLV),the remnant liver volume ( RLV) and future remnant liver volume at three months ( FRLV) were calculated, and the regenerative volume (RV) and the regeneration rate (RR) were obtained.Results At 3 months after surgery, the FRLV in group A was (366.3±31.7)mL, significantly greater than (185.2±16.4)mL in group B or (181.9±14.2)mL in group C (P＜0.05), and the RR was (68.8±6.4)%, significantly higher than (21.4±2.0)% in group B or (22.6±2.3)% in group C (P＜0.05); fifteen days after operation, serum albumin level in group A was (37.0±2.7)g/L, significantly higher than (34.1±2.9)g/L in group B or (34.0±3.2)g/L in group C (P＜0.05); the two-year total survival and the progress-free survival in group A were 70.0% and 55.0%, and they were 55.3% and 36.8% in group B and 52.5% and 42.5% in group C, not significantly different among them (P＞0.05).Conclusion The surgery of ALPPS could rapidly increase the remnant liver volume in a short time after operation, and accelerate the postoperative liver function recovery in patients with PLC, which warrants further investigation.

Objective The aim of this study was to investigate the clinical efficacy of external local high frequency thermotherapy (ELHFT) and radiotherapy in the treatment of patients with advanced hepatocellular carcinoma (HCC).Methods 66 patients with advanced HCC were enrolled in this study, and were randomly divided into control and observation group, with 33 cases in each group. The patients in the control received three-dimensional conformal therapy/intensity modulated radiation therapy (3D-CRT/IMRT), and those in the observation received ELHFT and 3D-CRT/IMRT. All patients were followed-up for 12 months.Results The Objective remission rate in the observation group was 63.6%, significantly higher than 35.5%(P＜0.05) in the control; after treatment, serum alpha-fetoprotein heterogeneity L3 level was (4.2±1.0)ng/ml, Golgi protein-73 level was (55.1±2.6)ng/ml, and vascular endothelial growth factor level was (200.5±55.7)pg/ml, all significantly lower than [(5.9±0.9)ng/ml, (62.1±3.5)ng/ml and (265.7±60.3)pg/ml, respectively, P＜0.05] in the control; the incidence of radiation- induced liver injury in the observation was 21.2%, much lower than 45.2%(P＜0.05) in the control; the median overall survival (OS) in the observation group was 8(95%CI:7-9)m, and the 1-year cumulative survival rate (CSR) was 14.3%, and the median OS in the control was 6(95%CI:6-7)m and the 1-year CSR was 11.8%(x²=1.674,P=0.171).Conclusion The ELHFT and radiotherapy might improve the survival in patients with advanced HCC, which needs further clinical investigation.

Objective The aim of this study was to investigate the analgesia of dexmedetomidine and morphine in patients with primary liver cancer (PLC) undergoing transcatheter hepatic arterial chemoembolization (TACE) .Methods A total of 125 patients with PLC were enrolled in our hospital between July 2018 and July 2020, and all underwent TACE. During the procedure, the patients with PLC were divided into group A (n=64) receiving dexmedetomidine and morphine for analgesia, and group B (n=61) receiving morphine for analgesia. The treatment was in an intravenous patient-controlled way. The visual analogue scale (VAS) and modified observers assessment of alertness/sedation scale (OAA/S) were applied for assessment of analgesia immediately after embolization (T0), completion of surgery (T1), 12 h (T2) after surgery, and 24 h (T3) after surgery. The mean arterial blood pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were monitored.Results At T0, T1, T2 and T3, the VAS scores in group A were (2.4±1.1), (2.0±0.9), (1.7±0.5) and (1.2±0.3), significantly lower than [(2.9±1.5), (2.5±1.3), (2.0±0.9) and (1.6±0.5), respectively, P < 0.05] in group B; at T0, T1, T2 and T3, the OAA/S scores in group A were (4.6±0.3), (4.5±0.3), (4.7±0.2) and (4.6±0.2), not significantly different compared to [ (4.5±0.3), (4.5±0.2), (4.6±0.4) and (4.6±0.2), respectively, P > 0.05] in group B; there were no significant differences as respect to MAP, SBP, DBP and HR in the two groups at any times (P > 0.05); the overall incidence of adverse reactions in group A was significantly lower than that in group B (12.5% vs. 27.9%, P < 0.05); the effective rate and disease control rate in group A after treatment were 67.2% and 73.4%, not statistically significantly different compared with 68.9% and 75.4%, respectively, in group B (P>0.05).Conclusion The application of dexmedetomidine and morphine combination for analgesia in an intravenous patient-controlled way in patients with PLC underwent TACE is effective and simple, which might relieve pain with less incidence of adverse reactions.

Objective The aim of this study was to investigate the diagnostic efficacy of plasma Ki67 and miRNA-26b levels in patients with hepatocellular carcinoma (HCC).Methods 90 patients with HCC and 60 patients with hepatitis B liver cirrhosis (LC) were admitted to our hospital, and plasma Ki67 and miRNA-26b were detected by RT-qPCR. The ROC curve was applied to analyze the diagnostic efficiency of plasma Ki67 and miRNA-26b levels in patients with HCC.Results The plasma Ki67 level in patients with HCC was 【1.6(1.1-2.2)】, significantly higher than 【0.4(0.1-1.2), P＜0.05】 in patients with LC; plasma miRNA-26b level in patients with HCC was 【0.7(0.3-1.4)】, significantly lower than 【2.0(1.4-3.0), P＜0.05】 in patients with LC; plasma Ki67 and miRNA-26b level distribution in patients with different Edmonson class, early or not relapse and metastasis were significantly different (P＜0.05); The AUC of plasma Ki67 in diagnosing HCC was 0.8(95% CI :0.7-0.9), and that of plasma miRNA-26b was 0.8(95% CI:0.8-0.9).The sensitivities (Se) of plasma Ki67 and miRNA-26b for diagnosing HCC were 55.6% and 70.0%, the specificities (Sp) were 95.0% and 83.3%, and the parallel test of plasma Ki67 and miRNA-26b improved the Sp to 96.7% and the concurrent test improved the Se to 87.8%. The combination the two parameters elevated the accuracy to 85.3%, superior to 71.3% and 75.3% by any one alone.Conclusion The detection of plasma Ki67 and miRNA-26b levels might provide new parameters for the diagnosis of patients with HCC, which warrants further investigation.

Objective The aim of this study was to evaluate the clinical value of diffusion-weighted magnetic resonance imaging (DWI) in diagnosing patients with focal lesions of liver (FLL).Methods A total of 80 patients with FLL were collected and they received MRI and DWI, and all received hepatectomy. The MRI diagnosis was estimated by histopathological examination.Results Out of the 80 patients with FLL, the histopathological examination showed that hepatocellular carcinoma (HCC) in 28 patients, liver metastasis in 24, hepatic hemangioma in 19 and hepatic cyst in 9; When b=50 s/ mm³, the apparent diffusion coefficient (ADC) of region of interest (ROI) in HCC and in liver metastasis were(2.42±0.21) and (2.45±0.35), both significantly lower than 【(2.65±0.37) and (2.71±0.37), respectively, P<0.05】 in patients with hepatic hemangioma and hepatic cyst, when b=400 s/ mm³, the ADC in patients with HCC and liver metastasis were (2.03±0.22) and (2.17±0.23), both significantly lower than 【(2.48±0.34) and (2.49±0.24), respectively, P<0.05】 in patients with hepatic hemangioma and hepatic cyst, and when b=800 s/ mm³, the ADC in patients with HCC and liver metastasis were(1.75±0.26) and (1.82±0.18), also both significantly lower than 【(2.27±0.27) and (2.30±0.16), respectively, P<0.05】 in patients with hepatic hemangioma and hepatic cyst; the diagnostic accuracy of HCC, liver metastasis, hepatic hemangioma and hepatic cyst by MRI and DWI combination were 96.4%, 100.0%, 100.0% and 100.0%, significantly higher than [(71.4%, 75.0%, 68.4% and 66.7%), respectively P<0.05] by intensified MRI or [(53.6%, 45.8%, 57.9% and 55.6%), respectively, P<0.05] by DWI alone.Conclusion The diffusion-weighted magnetic resonance imaging in differentiating benign and malignant focal lesions of liver is promising and practical in clinical practice, which might help the clinicians dealing with the patients with FLL appropriately and improve the prognosis.

Objective The aim of this study was to summarize the conventional and contrast-enhanced ultrasonography (CEUS)manifestations of intrahepatic cholangiocarcinoma (ICC).Methods 52 patients with ICC were recruited in our hospital, and all underwent conventional and CEUS check-up.Results The gray-scale ultrasonography showed than the tumors presented with uniform hypoechoic in 23 cases (44.2%, uneven hypoechoic in 22 cases (42.3%), slightly hyperechoic and hyperechoic in 7(13.5%); the color Doppler flow imaging showed that the blood supply of lesions was in grade 0 in 11 cases (21.2%), in grade 1 in 9 cases (17.3%), in grade 2 in 28 cases (53.8%), and in grade 3 in 4 cases(7.7%); out of 51 eligible cases of ICC, the CEUS demonstrated that the enhancement performance in arterial phase was in typeⅠ, e.g. rapid overall uniform enhancement, in 10 cases (19.6%), and in type Ⅱ, e.g. rapid uneven enhancement, in 41 cases (80.4%), out of which, in subtype Ⅱa, the overall uneven enhancement, in 19 cases (37.3%), in subtype Ⅱb, the dendritic enhancement, in 9 (17.6%), in subtype Ⅱc, thick-walled irregular ring-like enhancement, in 6 (11.8%), and in subtype Ⅱd, ring-like and dendritic enhancement, in 7 (13.7%).Conclusion ICCs have some CEUS characteristic features, which might help for the early diagnosis.

Objective 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 To explore the efficacy of laparoscopic cholecystectomy (LC) and intraoperative choledochoscopy for the treatment of patients with gallbladder stones and extrahepatic bile duct stones.Methods A retrospective study on 105 patients with gallbladder stones and extrahepatic bile duct stones was performed, and 53 patients received LC and intraoperative choledochoscopy and 52 received open surgery. The flow cytometry was applied to detect the percentages of peripheral blood CD4⁺ and CD8⁺ cells and ratio of CD4⁺/CD8⁺ cells, serum immunoglobulin E (IgE), IgG and (IgA levels were assayed by immunoturbidimetry, and serum angiotensin I (AngI), AngⅡ and Ang1-7 levels were detected by ELISA.Results The operation time in the combination group was (98.7±2.8) min, significantly shorter than that in the control group [(123.6±5.3) min, P<0.05], the incision length was (3.0±1.0) cm, significantly shorter than that in the control group [(9.1±1.6) cm, P<0.05], the intraoperative blood loss was (21.8±2.5) mL, significantly less than that in the control group [(43.7±2.9) mL, P<0.05], and the postoperative exhaust time was (25.1±2.1) h, significantly shorter than in the control group [(47.3±3.3) h,P<0.05]; 3 d after operation, serum AngI level in the combination group was ( 10.3±1.8) ng/mL, significantly lower than [(14.9±1.9) ng/mL, P<0.05], serum AngⅡ level was (51.4±5.0) ng/L, significantly lower than [(66.2±7.2) ng/L, P<0.05], and serum Ang1-7 level was (413.5±43.7) ng/L, significantly lower than [(522.7±63.4) ng/L, P<0.05] in the control; the percentage of blood CD4⁺ cells was (32.4±1.1)%, significantly higher than [(28.5±1.2)%, P<0.05], while that of CD8⁺ cells was (22.0±1.2)%, significantly lower than 【(25.9±1.0)%, P<0.05】, and the ratio of CD4⁺/CD8⁺ cells was(1.4±0.1), significantly higher than 【(1.1±0.1), P<0.05】 in the control; serum IgE level was(11.4±0.5)g/L, significantly higher than 【(9.2±0.4)g/L, P<0.05】, serum IgG level was (2.5±0.3)g/L, significantly higher than 【(2.2±0.2)g/L, P<0.05】, and serum IgA level was (1.6±0.2)g/L, significantly higher than 【(1.4±0.1)g/L, P<0.05】 in the control; the incidence of postoperative complications in the combination group was 5.7%, significantly lower than 21.2% in the control (P<0.05).Conclusion The combined application of LC and intraoperative choledochoscopy in the treatment of patients with gallstones and extrahepatic bile duct stones could inhibit the secretion of angiotensin, reduce the body's stress response, and decrease the incidence of postoperative complications.

Objective The aim of this study was to explore the CT imaging manifestation of congenital choledochal cysts (CCC) in children with different Todani classification.Methods 126 children with CCC admitted to our hospital between January 2013 and June 2020 were selected for the study. All children received plain CT scan and enhanced CT scan after admission, then, underwent surgical operation for CCC. The CT imaging manifestations were summarized and its diagnostic efficacy was estimated when the histopathological examination was done as the gold standard.Results Out of the 126 children with CCC, the postoperative histopathologic diagnosis found Todani Ⅰ in 36 cases, Ⅱ in 10 cases, Ⅲ in 11, Ⅳ in 34, and Ⅴ in 35 cases; the preoperative CT feature in Todani Ⅰ was different size of cysts or a cystic masses between the hilar area of liver and pancreatic head; in Todani Ⅱ, the CT showed the cystic low density and smooth edges of lateral wall of common bile duct, with gallbladder and intrahepatic bile duct normal; in Todani Ⅲ, the CT showed the lower part of common bile duct cystic dilatation, with gallbladder and gallbladder tube normal; in Todani Ⅳ, the CT demonstrated the low density of bile duct inside and outside the liver cystic dilatation in multiple sizes; in Todani Ⅴ, the CT found the cyst in the liver, almost watery density; the CT preoperatively diagnosed children with CCC Todani typeⅠ with the sensitivity (Se) of 83.3%, the specificity (Sp) of 93.3%, the accuracy (AC) of 90.5%, the positive predictive value (PPV) of 83.3%, and the negative predictive value (NPV) of 93.3%; in the diagnosis of Todani type Ⅱ, the Se, Sp, Ac, PPV and NPV were 50.0%, 95.7%, 92.1%, 50.0% and 95.7%; in the diagnosis of Todani type Ⅲ, the Se, Sp, Ac, PPV and NPV were 54.5%, 93.9%, 90.5%, 46.2% and 95.6%; in the diagnosis of Todani type Ⅳ, the Se, Sp, Ac, PPV and NPV were 85.3%, 91.3%, 89.7%, 78.4% and 94.3%; in the diagnosis of Todani type Ⅴ, the Se, Sp, Ac, PPV and NPV were 80.0%, 97.8%, 92.9%, 93.3% and 92.7%.Conclusion The CT manifestations of CCC in children with different Todani types are characteristic, which might help the preoperative diagnosis and dealing with it appropriately.

Objective The aim of this study was to investigate the clinical value of three-dimensional magnetic resonance cholangiopancreatography (3D-MRCP) in the diagnosis of infantile biliary atresia (BA).Methods 24 children with suspected BA were admitted to our hospital between April 2016 and April 2020, and all underwent routine MRI and 3D-MRCP examination. The diagnostic efficacy of MRCP was evaluated by histopathological examination as a gold standard.Results 24 children with suspected BA were successfully completed surgery, andthe pathological examination showed BA in 22 (91.7%)children, including BA type Ⅰ in 2 (8.3%), BA type Ⅱ in2(8.3%) and type Ⅲ in 18(75.0%), choledochal cyst in 1 (4.2%) and normal biliary system in 1(4.2%); the 3D-MRCPdiagnosed BA in 21, choledochal cyst in 1, while misdiagnosed BA as choledochal cyst in 1, and misdiagnosed infantile hepatitis syndrome with normal biliary tract system as BA in 1; the sensitivity of 3D-MRCP in the diagnosis of BA was 95.5%, with the specificity of 50.0%, the accuracy of 95.8%,the positive predictive value of 95.5%, the negative predictive value of 50.0%, and the Kappa value of consistency with pathological diagnosis was 0.455 (P<0.05).Conclusion The application of 3D-MRCP has a high diagnostic efficiency for infants with BA, which could guide the clinicians dealing with this entity appropriately early.

Objective The pathogenesis of nonalcoholic fatty liver disease (NAFLD) is related to insulin resistance (IR) and lipid metabolism disorders. Currently, the widely accepted hypothesis of NAFLD is the "multiple hits theory". Studies have reported that inhalation of ambient particular matter (PM) 2.5 could induce oxidative stress and inflammation in liver tissues, impacting liver lipid metabolism and causing liver cell damage. In addition, PM2.5 is also closely related to IR, obesity and fat synthesis signaling pathways. This review will summarize the relationship between IR, obesity, lipid metabolism and PM2.5, and analyze the potential impact of PM2.5 on the pathogenesis of NAFLD, which might have implications for the prevention and treatment of the entity.

Objective Hilar cholangiocarcinoma (HCCA) is one of the common malignant tumors in biliary system. The reported cases of HCCA increases gradually as the intensive application of imaging examination. Due to the lack of specific manifestations in the early stage of the tumor, most patients are found to be with advanced disease, resulting in a low radical resection and poor prognosis. Therefore, early screening and diagnosis is the top priority for individuals with high risk factors. At present, the imaging detection has become an important means of diagnosis and differentiation of HCCA. In this article, we review the early imaging screening and diagnosis of HCCA.