Objective The aim of this study was to compare the effects of exosomes derived from rat liver cancer cells with different lung metastasis potentials on the transcriptome of macrophages.Methods The transcriptome sequencing technology was applied to compare the differences on transcriptome between macrophages stimulated by exosomes derived from two rat liver cancer cells (WB1 and WN1) with different lung metastasis potentials and to explore the potential mechanism of lung metastasis promoted by macrophages treated with exosomes. The KEGG pathway analysis, GO and protein protein interaction network analysis were performed on differentially expressed genes.Results There were 318 differentially expressed genes [log2(FC)≥1, P≤0.05] between the transcriptome of macrophages treated with exosomes derived from WN1 (liver cancer cells with high lung metastasis potential) and WB1(liver cancer cells with low lung metastasis potential), among which 296 being up-regulated and 22 down-regulated; the KEGG analysis found that up-regulated differential genes were mainly enriched in PI3K-Akt signaling pathway, IL-17 signaling pathway, TNF signaling pathway and other inflammatory molecule-related signaling pathways as well as in cell adhesion-related signaling pathways; the GO analysis demonstrated that up-regulated differential genes were mainly enriched in terms of angiogenesis, epithelial-mesenchymal transition and metallopeptidase activity; furthermore, the hub genes screened by protein protein interaction network analysis, such as Vegfa, Il6 and Mmp3, were also located in the enrichment pathways mentioned above. Conclusion The transcriptome expression of macrophages stimulated by rat liver cancer cell exosomes with different lung metastasis potentials is significantly different. The exosomes derived from liver cancer cells with high lung metastasis potential might regulate multiple signaling pathways in macrophage to promote lung metastasis of tumor cells.

Objective The aim of this experiment was to explore the changes of NADPH oxidase 4 (NOX4) gene and its protein in liver tissues of mice with carbon tetrachloride (CCl₄)-induced liver fibrosis and hepatic stellate HSC-T6 cells.Methods The liver fibrosis model was established by intraperitoneal injection of CCl₄ in ten mice, and the NOX4 mRNA and its protein in liver tissues were detected by qRT-PCR and Western bloting. The HSC-T6 cells were normally cultured and divided into blank, nonsense and NOX4-siRNA-intervened groups, which were transfected by liposome 2000-coated meaningless sequence or NOX4-siRNA in the two latter groups. The expression ofNOX4, α-smooth muscle actin (α-SMA), type I collagen (Col1a I), tissue inhibitor of metalloproteinase-1 (TIMP-1), matrix metalloproteinase-2 (MMP-2), transforming growth factor-β1 (TGF-β1), Smad2 and Smad3 in HSC-T6 cells was detected by qRT-PCR and Western bloting. The intracellular reactive oxygen species (ROS) content was detected by DCFH-DA fluorescent probe, the cell proliferation was detected by MTT assay, and the cell cycles and apoptosis were detected by flow cytometry.Results There was a significant pathological damage, with a large amount of collagen fiber deposition in liver tissues of mice in model; the NOX4 mRNA level in liver tissues of mice in model was significantly higher than that in control group (P<0.05); the NOX4 mRNA and its protein, ROS, proliferation activity, percentage of cells in S phase, the α-SMA, Col1a I, TIMP-1, MMP-2, TGF-β1, p-Smad2/Smad2 and p-Smad3/Smad3 expression were significantly decreased, while the percentage of cells in G0/G1 phase, and apoptosis rate were significantly increased (P<0.05) in NOX4-siRNA-intervened group. Conclusion The NOX4 is highly expressed in liver fibrotic tissues, and the down-regulation of NOX4 could inhibit proliferation and activation of HSCs, and promote their apoptosis, which mmight be related to the inhibition of TGF-β/Smad signaling pathway.

Objective The aim of this study was to investigate the effects of protocatechuic acid (PA) on hepatic malondialdehyde (MDA), nitric oxide (NO), superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) activities in mice with concanavalin A (ConA)-induced immune liver injury.Methods 60 Kunming mice were randomly divided into control, model, low-dose, middle-dose and high-dose (2.5 mg.kg^-1.d^-1、5 mg.kg^-1.d^-1、10 mg.kg^-1.d^-1) of PA-intervened and 0.2 g.kg^-1.d^-1 of bifendate-intervened group, with 10 in each. The mice in control group and in model group were intragastricly given normal saline for 10 days, and in other groups were intragastricly given PA or bifendate for 10 days. One hour after the last administration, the ConA were injected through tail vein once to induce immune liver injury models. Serum interleukin-4 (IL-4), IL-6, tumor necrosis factor-α (TNF-α) and the MDA, NO, SOD and GSH-PX activities in hepatic homogenate were assayed.Results The liver indexes, spleen indexed, serum ALT and AST, serum IL-4, IL-6 and TNF-α in any dose of PA-intervened groups decreased significantly compared to those in the model (P<0.05); the hepatic MDA and NO activities in model group were (5.2±0.5)nmol/mg and (8.0±0.9)μmol/L, while they both decreased to [(4.7±0.4)nmol/mg, (4.3±0.3)nmol/mg and (3.9±0.3)nmol/mg or (6.8±0.8)μmol/L,(6.2±0.7)μmol/L and(5.8±0.7)μmol/L, respectively, P<0.05] in low-dose, middle-dose and large-dose of PA-intervened groups; the hepatic SOD and GSH-PX activities in model were (59.4±3.6)U/mg and(85.2±9.6)U/mg, while they both increased to [(74.2±4.4)U/mg,(85.2±5.3)U/mg and (99.2±5.9)U/mg or(107.3±13.4)U/mg,(115.2±12.8)U/mg and (139.3±12.9)U/mg, respectively, P<0.05] in low-dose, middle-dose and large-dose of PA-intervened groups.Conclusion PA could alleviate ConA-induced liver injury in mice, which might be related to the increased activity of endogenous antioxidant enzymes in liver tissues.

Objective The aim of this study was to study the changes of histone deacetylase mRNA levels after histone acetylation (HDAC) inhibitor intervention in liver tissue of mice with acute-on-chronic liver failure (ACLF).Methods 28 mice were randomly divided into seven group, with four in each, and the liver failure was induced in mice by lipopolysaccharide (LPS) and D-Gal injection. The mice in group A (control), B (model), C, D, E, F and G were intervened by normal saline, normal saline, trichostatin A(TSA), large dose of sodium butyrate, low dose of sodium butyrate, large dose of pyrrolidine dithiocarbarmate (PDTC) and low dose of PDTC, respectively. The hepatic HDAC mRNA was assayed by Q-PCR.Results The hepatic HDAC1mRNA, HDAC2mRNA, HDAC3mRNA and HDAC8mRNA in group B were (1.7±0.2), (1.7±0.3), (1.9±0.6) and (2.6±0.7), while all of them in group C, group D, group E, group F and group G decreased greatly (P<0.05); the hepatic HDAC4mRNA, HDAC5mRNA, HDAC6mRNA, HDAC7mRNA, HDAC9mRNA and HDAC10mRNA in group B were (0.6±0.2),(6.3±0.9),(3.4±0.8),(2.8±1.0),(6.5±1.1) and (0.4±0.1), while all of them in group C, group D, group E, group F and group G decreased significantly as compared to those in group B(P<0.05).Conclusion The hepatic HDAC mRNA levels is related to the acetylation of proteins, which might reinforce the theoretical basis for the application of histone acetylation regulation in Dealing withliver failure in mice.

Objective The purpose of this study was to observe the efficacy of tenofovir disoproxil fumarate and dual immunization regimen in blocking mother-to-child hepatitis B viral transmission in pregnant women with hepatitis B virus (HBV) carrier.Methods 120 HBV carrying pregnant women were admitted to our hospital between December 2016 and September 2019,and were randomly divided into control and observation group. The pregnant women in the control group didn’t receive any antiviral treatment, while those in the observation group were treated with tenofovir disoproxil fumarate at gestational week 26 to 28 until delivery. The newborns were inoculated with dual immunization regimen, e.g. hepatitis B vaccine and hepatitis B immunoglobulin immediately after birth. Serum HBV DNA loads were detected by PCR, and serum HBsAg and HBeAg were assayed by colloidal gold method.Results At delivery, serum ALT level in the observation women was (23.2±3.6)IU/L, not significantly different compared to [(26.9±4.0)IU/L, P>0.05] in the control, serum HBV DNA loads was (3.1±0.7) lg copies/mL, significantly lower than [(5.9±0.8) lg copies/mL, P<0.05] in the control; the Apgar score in the observation new infants was (9.7±0.3), not significantly different compared to [(9.9±0.5), P>0.05] in the control, and the lengths, body masses and head circumferences in the two group newborns were not significantly different (P>0.05); at delivery, six months and twelve months after delivery, the positive HBV infection in the observation infants were 1.7%, 1.7% and 1.7%, not significantly lower than 11.7%, 11.7% and 13.3% (P>0.05) in the control.Conclusion The management of pregnant women with HBV carrier with oral tenofovir disoproxil fumarate and double immunization program in time for newborns could significantly reduce serum HBV loads, and therefore might decrease mother to infant HBV transmission, which needs multi-center investigation.

Objective The aim of this study was to investigate the efficacy of tenofovir rescue therapy for patients with chronic hepatitis B (CHB) and rtM204 mutation.Methods 94 patients with CHB who had failed to adefovir or lamivudine therapy with confirmed rtM204 mutation were enrolled in our hospital between April 2016 and February 2019, and were randomly divided into two groups, receiving tenofovir in 47 cases, or entecavir in 47 cases for rescue therapy for 18 months. Serum HBV DNA, HBsAg and HBeAg, and creatinine clearance (Crcl) were obtained. The peripheral blood CD3⁺ and CD4⁺ cell percentages were detected by FCM.Results At the end of 6, 12 and 18 month observation, serum HBV DNA loss in tenofovir-treated patients were 66.0%, 76.6% and 93.6%, all significantly higher than 38.3%, 55.3% and 78.7%(all P＜0.05) in entecavir-treated patients; at the end of 18 month, serum HBeAg negative rate in tenofovir-treated patients was 12.8%, much higher than that in entecavir-treated patients (0.0%, P＜0.05); at the end of 6 month and 18 month, serum AST levels in tenofovir-treated patients were (50.2±8.1)U/L and (31.7±6.9)U/L, significantly lower than [(57.7±8.3)U/L and (38.4±7.1)U/L, P＜0.05] in entecavir-treated patients; at 6 month, 12 month and 18 month observation, the percentages of CD3⁺ cells in tenofovir-treated patients were (31.6±5.2)%, (38.1±5.7)% and (40.2±6.2)%, not significantly different compared to [(32.1±5.5)%, (37.6±5.8)% and (39.1±5.9)%, P＞0.05], that of CD4⁺ cells were(28.6±3.9)%, (31.2±5.3)% and (36.1±5.7)%, not significantly different compared to [(29.3±3.7)%, (32.4±5.9)% and (34.5±5.3)%, P＞0.05], and Crcl were (103.4±39.3)mL/min, (101.2±30.2)mL/min and (97.6±23.8)mL/min, not significantly different compared to [(106.7±40.1)mL/min, (103.5±31.6)mL/min and (99.5±25.4)mL/min, respectively, P＞0.05] in entecavir-treated patients.Conclusion The administration of tenofovir for rescue therapy of patients with rtM204 mutation thanks to failed antiviral treatment might have a better efficacy, superior to entecavir, and warrants further and long-term investigation.

Objective The aim of this study was to investigate the balance of peripheral blood regulatory T lymphocytes (Treg)/helper T cell 17 (Th17) in patients with chronic hepatitis B (CHB) and its impact on response to telbivudine treatment.Methods 123 patients with CHB, 112 hepatitis B viral carriers and 95 healthy persons were recruited in this study in our hospital between February 2019 and March 2020, and all CHB patients received telbivudine treatment for 48 weeks. Peripheral blood Treg and Th17 cell percentages were detected by FCM. The multivariate Logistic regression was applied to analyze the impacting factors of non-response to nucleotide analogue treatment in patients with CHB. The area under the receiver operating characteristic curve (AUROC) was applied to analyze the efficacy of Treg/Th17 ratio in predicting the response to antiviral treatment.Results The percentages of Treg cells and Th17 cells as well as Treg/Th17 ratio in patients with CHB were (4.8±1.1)%, (6.1±1.7)% and (0.8 ± 0.1)], significantly higher than [(1.1±0.3)%, (2.5±0.8)% and (0.4±0.0), P<0.05] in HBV carriers, or [(0.9±0.2)%, (2.1±0.6)% and (0.4±0.0), P<0.05] in healthy persons; at the end of week 12, week 24 and week 48, the normalization rates of serum ALT levels were 65.9%, 77.2% and 93.5%, serum HBV DNA loss were 61.8%, 72.3% and 82.9%; at the end of week 48, 21 patients (17.1%) failed to response to antiviral treatment; the percentages of re-treated patients, poor medication compliance, low baseline serum ALT and HBV DNA loads, Treg cells and Treg/Th17 ratios in non-responders were significantly different as compared to those in response group (all P<0.05); the Logistic regression analysis showed that re-treatment, baseline HBV DNA load and ALT levels, and Treg/Th17 ratio were the independent factors for non-response to nucleotide analog treatment in patients with CHC (OR=3.695, OR=3.232, OR=3.866, OR=4.039, all P<0.05); the ROC analysis showed that the optimal cut-off value of blood Treg/Th17 ratio for predicting non-response to nucleotide analogues treatment in patients with CHB was 0.83, with the AUC of 0.923 (95% CI: 0.860-0.963), ant its sensitivity of 81.0%, the specificity of 87.3%, and the accuracy of 91.1%.Conclusion The percentages of peripheral blood Treg cells increase in patients with CHB, which might impact on the response to antiviral therapy and need further investigation.

Objective The aim of this study was to investigate the impact of antiviral therapy efficacy of entecavir in patients with chronic hepatitis B (CHB)and concomitant nonalcoholic fatty liver diseases (NAFLD).Methods 289 naïve serum HBeAg positive patients with CHB were enrolled in this study between January 2015 and January 2019, including 102 patients out of them with concomitant US-confirmed NAFLD. All patients received entecavir therapy and followed-up for 96 weeks. The biochemical, serologic and virological response were observed.Results The body mass index in patients with CHB and NAFLD was (26.1±2.7)kg/m², significantly higher than [(22.5±2.4)kg/m², P<0.05] in patients with CHB, serum uric acid l level was (405.1±125.8)μmol/L, significantly higher than [(324.6±96.8)μmol/L, P<0.05] in patients with CHB, serum total cholesterol level was (5.3±0.9 mmol/l, significantly higher than [(4.2±0.9)mmol/l, P<0.05] in patients with CHB, serum triglyceride level was (3.5±0.7)mmol/l, significantly higher than [(1.9±0.5) mmol/l, P<0.05] in patients with CHB, serum low density lipoprotein level was (3.4±1.0 mmol/l, significantly higher than [(2.3±0.8)mmol/l, P<0.05] in patients with CHB, and fasting blood glucose level was (5.9±1.5)mmol/l, significantly higher than [(4.6±0.6) mmol/l, P<0.05] in patients with CHB, while there were no significant differences respect to serum alanine aminotransferase levels (ALT, 250.8±110.5 U/L vs. 287.2±125.8 U/L), serum aspartate aminotransferase level (149.1±62.8 U/L vs. (168.7±70.8) U/L), serum high density lipoprotein level (1.2±0.5 mmol/l vs. 1.4±0.4mmol/l) and serum HBV DNA load (6.8±1.2 lg copies/ml vs. 6.9±1.1lg copies/ml) between the two groups (P>0.05); at the end of 48 week and 96 week treatment, serum ALT normalization rate in CHB patients with concomitant NAFLD were 69.6% and 81.4%, significantly lower than in patients with CHB(80.2% and 90.9%, respectively, P<0.05), while there were no significant differences respect to serum HBV DNA loss (79.4% and 87.3% vs. 84.0% and 90.9%, respectively), and serum HBeAg negative rates (7.8% and 7.8% vs. 5.3% and 5.9%) between the two groups (P>0.05).Conclusion The patients with CHB and concomitant NAFLD could poorly respond to entecavir antiviral therapy biochemically, and the impact on histological and long-term responses needs further investigation.

Objective The aim of this study was to explore the correlation of serum adipocyte type fatty acid binding protein (A-FABP) levels to glucose-lipid metabolism in patients with chronic hepatitis C (CHC) and non-alcoholic fatty liver diseases (NAFLD). Methods During the period from April 2017 to April 2020, 85 patients with CHC and 85 healthy persons were recruited in this study, and all patients with CHC underwent liver biopsies. The levels of serum A-FABP was detected by enzyme-linked immunosorbent assay. The liver function and glucose-lipid metabolism indexes such as serum alanine aminotransferase (ALT), total bilirubin (TBIL), aspartate aminotransferase (AST), fasting blood glucose (FPG),fasting serum insulin (FIN), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triacylglycerol (TG)] were detected by full-automatic biochemical analyzer. The homeostasis model assessment of insulin resistance (HOMA-IR) was evaluated by homeostasis model. The viral load of hepatitis C virus (HCV) was detected by fluorescent quantitative PCR. The correlation between serum A-FABP level and viral and glucose-lipid metabolism index in patients with CHC was analyzed. Results Out of 85 patients with CHC, 42 cases were found having NAFLD; serum A-FABP, ALT and AST levels in 43 patients with CHC were (13.1±2.9)μg/L, (74.8±14.8)U/L and (56.6±9.4)U/L, and they were(27.6±4.2)μg/L, (81.7±12.2)U/L and (58.2±8.1)U/L in 42 patients with CHC and NAFLD, all significantly higher than [(3.1±1.1)μg/L, (19.7±1.6)U/L and (27.8±3.5)U/L, respectively, P<0.05] in 85 healthy persons; blood FIN, FPG and HOMA-IR in patients with CHC were (12.1±1.6)mIU/L, (6.0±1.3) mmol/L and (4.1±0.5), and they were (17.5±2.5)mIU/L, (6.2±1.3)mmol/L and (5.2±0.4) in patients with CHC and NAFLD, all significantly higher than [(4.2±0.9)mIU/L,(4.5±0.6)mmol/L and (1.6±0.2), respectively, P<0.05] in healthy persons; blood TC, TG and LDL-C levels in patients with CHC were (3.4±0.2)mmol/L, (1.0±0.2)mmol/L and (2.4±0.8)mmol/L, and they were (4.1±0.3)mmol/L, (1.9±0.2)mmol/L and (2.6±0.6)mmol/L in patients with CHC and NAFLD, all significantly higher than [(2.5±0.3)mmol/L, (0.6±0.1)mmol/L and (1.7±0.2)mmol/L, P<0.05] in healthy persons. Conclusion Serum A-FABP levels increase in patients with CHC and NAFLD, which might be related to the imbalance of glucose-lipid metabolism.

Objective The aim of this study was to analyze the changes of serum liver and kidney function tests and cardiac muscle enzymes in patients with coronavirus-19 (covid-19) pneumonia.Methods The clinical materials in 112 patients with covid-19 pneumonia were retrospectively analyzed and it included typical type in 68, severe type in 22 and critical type in 22. Serum liver and kidney function tests and myocardial enzyme cardiac troponin Test (cTnT), myohemoglobin (Myo)and creatine kinase Isoenzyme-MB (CK-MB) levels were determined routinely.Results There was no significant difference as respect to serum renal function tests in the three groups (P>0.05); the abnormal incidences of serum ALT and AST in critical patients were 31.8% and 45.5%, much higher than 4.6% and 13.6% (P<0.05)in severe ones or 0.0% and 2.9% (P<0.05) in patients with typical ones; the abnormal elevated incidences of serum cTnT, Myo and CK-MB in critical patients were 72.7%, 45.5% and 27.3%, significantly higher than 22.7%, 16.6% and 9.1%, respectively (P<0.05) in severe patients or 4.4%, 1.5% and 1.5%, respectively (P<0.05) in typical patients; out of 24 patients with abnormal serum myocardial enzyme, the fatality rate was 25%, much higher than 1.1%(P<0.05) in 88 patients with normal serum myocardial enzyme.Conclusion The results from a single-centered retrospective study suggest that the patients with covid-19 pneumonia could have serum myocardial enzyme elevation, which might hint the critical clinical type and poor prognosis.

Objective The aim of this study was to investigate the clinical efficacy of Xiaozhi Quzhuo decoction, herbal medicine, in the treatment of patients with nonalcoholic simple fatty liver (NAFL). Methods A total of 70 patients with NAFL were enrolled in our hospital for treatment between November 2017 and May 2019, and 34 patients (control) were guided for controlled dieting and exercise, while another 36 patients (observation) took Chinese herbal medicine, Xiaozhi Quzhuo decoction, at the base of dieting and exercise for 12 weeks. Blood biochemical indicators were routinely detected, including fasting plasma glucose (FPG), total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). The controlled attenuation parameter (CAP) was determined by transient elastography, and the homeostasis model assessment of insulin resistance (HOMA-IR), fatty liver index (FLI), body mass index (BMI) and waist-hip ratio (WHR) were calculated.Results At presentation, there were no significant differences in FBG, HOMA-IR, TC, TG, LDL-C and HDL-C between the two groups (P>0.05), while at the end of 12 week treatment, the FBG,HOMA-IR,TC,TG and LDL-C levels in the observation group were (6.1±0.9)mmol/L,(5.8±0.7),(5.2±0.8)mmol/L, (2.2±0.1)mmol/L and (3.1±0.3)mmol/L, all significantly lower than [(6.8±1.6)mmol/L, (6.5±1.6), (5.7±0.8)mmol/L,(2.7±0.2)mmol/L and (3.9±0.9)mmol/L, respectively, P<0.05], and the HDL-C level was (1.5±0.2)mmol/L, significantly higher than [(1.0±0.2)mmol/L, P<0.05] in the control; before treatment, there were no significant differences as respect to fatty liver parameters between the two groups (P>0.05), while at the end of 12 week treatment, the CAP, FLI and BMI in the observation group were (238.4±25.3)dB/m, (22.3±5.3) and (25.1±2.0)kg/m², all significantly lower than [(270.3±30.1)dB/m, (29.1±6.3)U/L and (28.1±2.0)kg/m², respectively, P<0.05] in the control. Conclusion The administration of herbal medicine, Xiaozhi Quzhuo decoction, for the treatment of patients with NAFL could effectively improve the glucolipid metabolism, and might have a short-term clinical efficacy, and it is worthy of further clinical verification.

Objective The paper aimed to analyze the clinical implication of magnetic resonance imaging-proton density fat fraction (MRI-PDFF) in patients with nonalcoholic fatty liver diseases (NAFLD).Methods 64 patients with NAFLD were enrolled in our hospital between January 2018 and September 2020, and all underwent sonography, liver biopsies and MRI scan. The MRI-PDFF was obtained.Results Out of the 64 patients with NAFLD, the sonography showed mild, moderate and severe fatty liver in 20 cases, 28 cases and 16 cases, and the body mass index, blood fats, fasting blood glucose levels and MRI-PDFF in patients with severe fatty liver were all significantly higher than those in patients with mild or moderate fatty liver (P<0.05); the liver histopathological examination demonstrated no liver tissue steatosis (S0) , S1, S2 and S3 in 8 cases, 22 cases, 25 cases and 9 cases, with the MRI-PDFF of (3.2±1.4)%, (8.7±6.3)%, (15.4±5.0)% and (22.8±7.4)%, respectively, significantly different among them (P<0.05), the liver active inflammation grading (G)1 , G2 and G3 were in 14 cases, 36 cases and 14 cases, with the MRI-PDFF of (8.6±7.5)%, (10.9±9.8)% and (14.6±11.3)%, significantly different among them (P<0.05), and the liver fibrosis (F)0 in 18 cases, F1 in 24 cases, F2 in 14 cases, F3 in 6 cases and F4 in 2 cases, with the MRI-PDFF of being (4.6±3.2)%, (9.4±8.1)%, (10.6±7.4)%, (11.3±10.6)% and (7.1±3.4)%, significantly different among them (P<0.05).Conclusion The MRI-PDFF changes and significantly different in patients with different degree of fatty liver, which might help the early diagnosis of patients with hepatic steatosis easily.

Objective The aim of this study was to collect the clinical data of middle-aged and elderly patients with non-alcoholic fatty liver disease (NAFLD) to explore the incidence of gallstone disease (GD) and its relation to the metabolic risk factors.Methods The clinical data of middle-aged and elderly patients with NAFLD found by physical examination were analyzed between January 2018 and December 2020, and the diagnosis of NAFLD and GD were based on sonography. The univariate and multivariate Logistic regression analysis were applied to determine the independent risk factors related to the concomitant GD.Results Out the 216 patients with NAFLD found by physical examination, the GD was diagnosed in 52 cases; the age in patients with GD was (62.4±11.3)yr, significantly older than [(54.2±9.0)yr, P<0.05] in patients without GD, the incidence of diabetes in patients with GD was 23.1%, significantly greater than 12.8% in patients without GD (P<0.05), the diastolic blood pressure in patients with GD was (87.5±10.2)mmHg, significantly higher than [(75.5±9.9)mmHg, P<0.05] in patients without GD, and the fasting blood glucose (FBG) and high-density lipoprotein cholesterol (HDL-C) levels in patients with GD were (7.2±1.5)mmol/L and (1.0±0.3)mmol/L, significantly different compared to [(6.0±1.7)mmol/L and (1.3±0.3)mmol/L, respectively, P<0.05] in patients without GD; the incidence of diabetes, high blood pressure, the body mass index and diastolic blood pressure in patients with GD were 23.1%, 61.5%, (26.1±2.3)kg/m² and (87.5±10.2)mmHg, significantly different compared to [9.5%, 41.0%, (23.2±2.7)kg/m² and (72.2±9.8)mmHg] in healthy individuals (P<0.05); the FBG, serum ALT, AST, TG, TC, LDL-C and HDL-C levels in patients with GD were (7.2±1.5)mmol/L,(48.4±8.5)U/L,(54.5±6.3)U/L, (4.9±1.0)mmol/L, (5.2±1.0)mmol/L, (3.5±0.7)mmol/L and (1.0±0.3)mmol/L, significantly different compared to [(5.4±1.3)mmol/L, (17.7±9.6)U/L, (18.5±7.0)U/L, (1.3±0.7)mmol/L, (4.8±1.1)mmol/L, (2.1±0.6)mmol/L and (1.6±0.3)mmol/L, respectively, P<0.05] in healthy persons; the multivariate Logistic regression analysis showed that the ages, FBG, blood TG, LDL-C and HDL-C levels were the independent risk factor for patients with NALFD having concomitant GD (P < 0.05).Conclusion In the middle-aged and elderly patients with NAFLD, the increase of FBG and the decrease of blood HDL-C levels might hint the concomitant existence of GD, and the healthy education should be strengthened for individuals with risk factors for occurrence of GD, and early sonography should be carried out to find it.

Objective The aim of this study was to investigate the prevalence of nonalcoholic fatty liver diseases (NAFLD) in patients with intracerebral hemorrhage (ICH).Methods A total of 146 patients with ICH were treated in our hospital between January 2010 and June 2020, and all underwent sonography for the diagnosis of NAFLD. The univariate and multivariate Logistic regression analysis was applied to confirm the factors for NAFLD coexistence.Results Out of our series, 52 patients (35.6%) were found with underlying NAFLD; the percentage of type two diabetes mellitus (T2DM) in patients with NAFLD was 32.7%, significantly higher than 12.8%(P<0.05) in patients without NAFLD, the body mass index in patients with NAFLD was (25.4±2.4)kg/m², significantly higher than [(23.1±2.7)kg/m², P<0.05] in patients without NAFLD, the blood high-density lipoprotein (HDL) level in patients with NAFLD was (1.4±0.5) mmol/L, significantly lower than (1.8±0.5) mmol/L in patients without NAFLD, the blood triglyceride level was (4.2±1.6)mmol/L, significantly higher than [(2.2±1.1)mmol/L, P<0.05] in patients without NAFLD, the percentage of large intracerebral bleeding volume in patients with NAFLD was 75.0%, significantly higher than 39.4%(P<0.05) in patients without NAFLD, and the percentage of lowGlasgow coma score (GCS) in patients with NAFLD was 67.3%, significantly higher than 37.2%(P<0.05) in patients without NAFLD, while there were not significant differences as respect to the percentages of high blood pressure, smoking, cardiovascular diseases, vascular malformation, increased fasting plasma glucose, serum alanine aminotransferase and aspartate aminotransferase, and infection between the two groups(P>0.05); multivariate Logistic analysis showed that coincidence of T2DM, large intracerebral bleeding and lower GCS were the independent risk factors for underlying NAFLD in this circumstance, and normal blood HDL level was the protective factor for patients without NAFLD(P<0.05). Conclusions The presence of T2DM, intracerebral hematoma volume greater than 30 ml and GCS score less than 10 in patients with ICH might hints the presence of NAFLD, which remind the clinicians dealing appropriately with them in clinical practice.

Objective This study aimed to investigate the impacting factors in response to immunosuppressive therapy in patients with autoimmune hepatitis (AIH).Methods A total of 68 patients with AIH were enrolled in our hospital between January 2015 and October 2018, including 18 males and 50 females, with an average age of (52.8±11.1) years old. All patients with AIH received standardized prednisone and azathioprine therapy for 24 months. All patients underwent twice liver biopsies before and after treatment, and blood mean platelet volume (MPV) and serum globulin level were detected. The univariate and multivariate Logistic regression analysis were applied to analyze the predictive factors that impact the poor response of patients with AIH to immunosuppressive treatment.Results At the end of two year treatment, 42(61.8%)out of the 68 patients with AIH in our series obtained complete response (CR) to immunosuppressive therapy; at presentation, the MPV, serum γ-globulin, albumin (ALB), total serum bilirubin, prothrombin time international normalized ratio (INR) and serum creatinine(sCr) levels were (8.5±2.0)fL, (23.8±5.2)%, (40.0±1.3)g/L, (23.4±3.9)μmol/L, (1.0±0.3) and (80.6±10.3)μmol/L, all significantly different compared to [(10.3±2.3)fL,(33.1±7.1)%, (30.1±0.9)g/L, (36.2±5.3)μmol/L, (1.4±0.7) and (135.0±12.5)μmol/L, respectively, P<0.05], the percentage of liver cirrhosis in patients with CR was 11.9%, much lower than 54.2%(P<0.05) in nonresponders; We took the response of patients with AIH after treatment as dependent variable, assigning 0=CR, 1=poor response, establishing a multivariate Logistic regression analysis model, and included the above-mentioned statistically significant factors such as MPV, γ-globulin, albumin, bilirubin, INR, sCr and liver cirrhosis into the Logistic regression model. The Logistic regression analysis showed that serum γ-globulin, albumin, MPV and liver cirrhosis were the independent predictors of poor response to immunosuppressive therapy in patients with AIH (P<0.05).Conclusion The patients with AIH might failed to immunosuppressive therapy, and elevated MPV, high γ-globulinemia and low serum albumin levels or even liver cirrhosis are the independent predictors of poor response. Further clinical trials are needed for these patients in order to get a best treatment strategy.

Objective The aims of this study was to explore the diagnostic efficacy of significant liver fibrosis by apparent diffusion coefficient (ADC) in patients with primary sclerosing cholangitis (PSC).Methods A total of 68 patients with PSC were included in this study in our hospital between August 2010 and December 2020, and all patients underwent liver biopsies and MR scan. The liver fibrosis was estimated by METAVIR staging scoring system, and the hepatocellular uptake rate (Ki), extracellular volume (Ve), portal venous flow (Fv) and arterial flow (Fa) were obtained from MRI, calculating the total blood flow (Ft), extracellular mean transit time (MTT) and hepatic uptake fraction (Fi). The apparent diffusion coefficient (ADC) was also determined. The univariate and multivariate Logistic regression analysis was applied to reveal the impacting factors of liver fibrosis in PSC patients. The area under the receiver operating characteristic curve (AUROC) was applied to analyze the diagnostic efficacy of each parameter.Results Out the 68 patients with PSC, the liver histopathological examination showed that non-significant liver fibrosis staging F0/F1 was in 24 cases, and significant liver fibrosis staging F2/F3/F4 was in 44 cases; there were significant differences as respect to serum ALT, AST, ALP, GGT, bilirubin, INR, IgG as well as Ki, Fi and ADC (P<0.05); the multivariate Logistic regression analysis demonstrated that serum ALT, AST, ALP, GGT, INR, IgG, and Ki and ADC were the independent impacting factors for liver fibrosis (P<0.05); the ROC analysis showed that the sensitivity and specificity by Ki in diagnosing significant liver fibrosis were 70.5% and 58.3% when the Ki=3.5/100 min was set as the cut-off-value, and those by ADC were 90.9% and 83.3% when it equal to 1.14 s/mm² as the cut-off-value.Conclusion The application of ADC in predicting liver fibrosis in patients with PSC is promising, and warrants further investigation.

Objective The purpose of this study was to summarize serum alanine aminotransferase (ALT)/ alkaline phosphatase (ALP) ratio changes and liver histopathological features of patients with drug-induced liver injury (DILI) acute hepatocellular type.Methods 43 patients with DILI were admitted to Beijing You'an Hospital between August 2018 and August 2019 and diagnosed at presentation as acute hepatocellular type by serum ALT, ALP and R. All patients underwent liver biopsies at the end of two week liver-protecting treatment.Results At the time of liver biopsies, serum ALT, aspartate aminotransferase (AST), total serum bilirubin (TBIL), ALP, γ - glutamyltranspeptidase (GGT) and total bile acid (TBA) levels in 43 clinically diagnosed at admission as hepatocellular type of DILI decreased greatly, and the R also decreased from 19.6±13.6 to 3.29±3.26 (P<0.05); the histopathological examination showed acute inflammation in 21 and inflammatory cholestasis in 22 cases; there were no significant differences as respect to serum ALT, AST, TBIL, ALP and GGT levels at presentation between the two groups(P>0.05), while the R in patients with acute inflammation was much lower than in patients with inflammatory cholestasis(13.8±6.2 vs. 25.5±16.5, P=0.004), and serum TBA level was also significantly lower than in patients with inflammatory cholestasis (61.0±60.8 μmol/L vs. 115.3±80.9μmol/L, P=0.017); only 9 patients accorded with hepatocellular injury at liver biopsies out of the 43 patients with DILI; the area under ROC was 0.708 in diagnosing intrahepatic cholestasis, when the R equalto 14.9 was set as the cut-off-value.Conclusion The clinical type classification of drug-induced liver injury presents as a dynamic changes, and the increased R might help diagnose intrahepatic cholestasis.

Objective The aim of this summarize the clinical feature and prognostic factors of patients with liver failure induced by chemotherapy for lymphoma.Methods The clinical manifestations, laboratory tests and outcomes of liver failure after chemotherapy for lymphoma were analyzed retrospectively.Results 21 patients (15 males and 6 females) were included with the mean age of 55.6±15.2(29-76) years old, having underlying non-Hodgkin’s lymphoma in 20 cases and Hodgkin’s lymphoma in one; the rituximab and conventional chemotherapy were given, and the causes of liver failure were hepatitis B viral reactivation in 12, drug-induced liver injury in 5, hepatic lymphoma infiltration in 2 and hepatitis E infection in 2; all patients received conventional supporting therapy including artificial liver supporting system; 11 patients survived and 10 died with median survival of 14(4 -40) days; univariate analysis showed that serum AST, Cr, INR and MELD score were the risk factors of death, and Cox regression showed that serum Cr and the MELD score were the independent impacting predictors. Conclusions The liver function tests should be closely monitored in patients with lymphoma during chemotherapy, and antiviral therapy should be started prophylactically in patients with underlying HBV infection.

Objective The aim of this study was to investigate the clinical feature and efficacy of different prognostic scoring models in patients with acute-on-chronic liver failure (ACLF) with different underlying liver diseases.Methods The clinical data of 192 patients with ACLF admitted to our hospital between January 2017 and December 2018 were retrospectively analyzed, and out of them, 54 patients had underlying liver disease of chronic hepatitis (group A), 87 had compensated liver cirrhosis (group B) and 51 had decompensated cirrhosis (group C). The Child-Pugh, the model for end-stage liver disease (MELD), the chronic liver failure research group of European society of liver diseases (EASL-CLIF) and Chinese group on the Study of Severe Hepatitis B (COSSH) were applied to predict the prognosis.Results There were no significant differences in gender, age and etiology between the three groups; there were also no significant differences between the three groups as respect to serum total bilirubin and prothrombin time international normalized ratio (INR, P >0.05); the incidence of ascites and bacterial infections in group C were 70.6% and 47.1%, significantly higher than 62.1% and 33.3% in group B or 40.7% and 22.2% in group A (P <0.05); the 28-day and 90-day survival rates in group A were 63.0% and 59.3%, not significantly different as compared to 69.0% and 57.5% in group B or 56.9% and 47.1% in group C (P >0.05); serum bilirubin, creatinine, INR and hepatic encephalopathy were the independent factors impacting the 90 d survival; the performance of MELD, CLIF-C ACLFs and COSSH-ACLFs models in predicting the short-term mortality of patients with ACLF was superior to Child-Pugh score, and the MELD score was the best.Conclusion The clinical features and complications of ACLF patients with different underlying liver diseases are significantly different, and the prognosis of them are also different, which might need long-term observation.

Objective The aim of this study was to explore the risk factors of death and the construct a prognosis prediction model in patients with hepatitis B virus-related acute on chronic liver failure (HBV-ACLF). Methods 126 patients with HBV-ACLF were admitted to our hospital between January 2016 and September 2019,and their clinical materials were recorded. The multivariate Logistic regression was applied to set up a prediction model. The model fit was evaluated by Hosmer-Lemeshow test, and the predictive value of the model was verified by ROC curves. Results At the end of 90 days, 49 patients(38.9%) in our series died; the multivariate Logistic analysis showed that total serum bilirubin levels, red blood cell distribution width (RDW),INR) and with complications were the independent risk factors impacting the prognosis; the Hosmer-Lemeshow test demonstrated the formula, P=1/[1+e^{(1.441×(TBIL)+1.385×(RDW)+0.983×(INR)+1.639×complications-4.449)}] we established, goodness-of-fit (x²=9.055, P=0.338), and the AUC of the model was 0.822, with the 95%CI of 0.749-0.894.Conclusion We successfully set up a formula to predict the prognosis of patients with HBV-ACLF, which might guide the clinicians to make up a correct decision early.

Objective The aim of this study was to explore the clinical feature and impacting factors of esophageal and gastric variceal bleeding in patients with hepatitis B-induced liver cirrhosis (LC).Methods The clinical materials in 90 patients with hepatitis B cirrhosis and esophageal and gastric variceal bleeding and in 90 hepatitis with hepatitis B liver cirrhosis and varices were retrospectively analyzed. The impacting factors of variceal bleeding were analyzed by univariate multivariate Logistic regression.Results The univariate analysis showed that the long course of cirrhosis, history of variceal bleeding, the application of non-steroidal drugs, poor Child-Pugh class, the severity of esophageal varices, the widen diameter of left gastric vein and portal vein, the prolonged PT, ascite and low serum albumin level were significantly different between the two groups (P<0.05); the multivariate Logistic regression analysis showed that the long course of cirrhosis, non-steroidal administration, poor Child-Pugh class, the severity of esophageal varices, the widen diameter of left gastric vein and portal vein, the prolonged PT and ascite were the independent risk factors for esophageal varices bleeding in patients with liver cirrhosis (OR=3.145; 3.171; 2.190; 2.672; 2.363; 3.142; 3.083; 3.062, P<0.05), while .the high serum albumin level was a protective factor for varices bleeding (OR=0.288, P<0.05).Conclusion Some factors might lead to the esophageal and gastric varices bleeding in patients with hepatitis B liver cirrhosis, which should be paid more attention to and dealing with promptly in clinical practice.

Objective The aim of this study was to investigate the efficacy and changes of portal hemodynamics in patients with hepatitis B cirrhosis complicated by portal hypertension (PHT) after transjugular intrahepatic portosystemic stent-shunt (TIPS).Methods A total of 96 patients with cirrhosis and PHT were recruited in our hospital between January 2017 and May 2019, and were divided randomly into two groups, underwent TIPS or laparoscopic splenectomy and esophagogastric devascularization (LSED). Serum hypoxia-inducible factor-1α (HlF-1α), matrix metalloproteinase-2 (MMP-2) and vascular endothelial growth factor (VEGF) were detected by ELISA, and portal vein diameter (PVD), portal vein flow (PVF) and portal vein velocity (PVV)] were determined by sonography.Results After treatment, serum albumin and blood ammonia levels in patients receiving TIPS were (36.3±3.6)g/L and (92.1±4.5) μmmol/L, both significantly higher than [(32.6±3.1)g/L and (54.2±5.6)μmmol/L, respectively, P<0.05] in LSED-treated thePVV was (36.4±3.8)cm/s), significantly quicker than [(32.5±3.1)cm/s), patients; P<0.05] in LSED-treated patients; serum HIF-α level was (0.5±0.3)ng/mL, significantly higher than [(0.4±0.1)ng/mL, P<0.05], whil e serum MMP-2 and VEGF levels were (213.6±30.4)ng/mL and (92.3±9.7)ng/mL, significantly lower than [(244.9±35.3)ng/mL and (112.4±12.8)ng/mL, respectively, P<0.05] in LSED-treated patients; six months after treatment, the incidence of hepatic encephalopathy (HE) in TIPS-treated patients was 22.9%, significantly higher than 8.3% inLSED-treated patients(P<0.05), and there were no significant differences as respect to the incidences of infection, re-bleeding and stable liver function tests in the two groups (P>0.05).Conclusion The application of TIPS could improve the hemodynamics parameters and reduce the risk of gastrointestinal bleeding in patients with hepatitis B liver cirrhosis, with the disadvantage of increased blood ammonia and HE occurrence, which might be taken into consideration when making the therapeutic strategy.

Objective The aim of this study was to observe the efficacy of endoscopic variceal ligation (EVL) and carvedilol maintenance in the treatment of patients with liver cirrhosis and complicated esophagogastric variceal bleeding (EVB). Methods A total of 72 patients with liver cirrhosis and EVB were enrolled in our hospital between December 2017 and December 2019, and were randomly divided into control (n=35) , receiving EVL, and observation group (n=37), receiving carvedilol maintenance after EVL. All patients were followed-up for 12 months. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected by ELISA.Results Two and four patients in the observation and control group respectively in our series died from emergent bleeding (P>0.05); there were no significant differences in the blood transfusion volume and hemostasis time between the two groups (P>0.05), but the hospital stay in observation group was significantly shorter than that in control group [(10.4±2.4)d vs.(12.1±2.2)d, P<0.05]; there were no significant differences as respect to blood routine and liver function tests at presentation and 2 weeks after treatment between the two groups (P>0.05); at admission, there were no significant differences with respect to serum CRP, IL-6 and TNF-α levels between the two groups (P>0.05), while 2 weeks after the treatment, serum CRP, IL-6 and TNF-α levels in the observation group were (4.9±0.32)mg/l, (20.4±9.4)pg/ml and (25.1±8.1)pg/ml, significantly lower than [(6.3±5.5)mg/l, (28.6±7.6)pg/ml and (34.7±9.3)pg/ml, respectively, P<0.05] in the control; there were no significant differences in the incidence of adverse reactions between the two groups (42.9% vs. 48.4%, P>0.05); at the end of 3 months and 6 months of follow-up, the re-bleeding rates were 11.4% and 20.0% in observation group, significantly lower than 29.0% and 45.2% in the control group (P<0.05).Conclusion The carvedilol maintenance after EVL has a good efficacy in the treatment of patients with liver cirrhosis and EVB, which is worthy of further clinical investigation.

Objective The aim of this study was to explore the efficacy of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in evaluating the severity of gastroesophageal varices (GOV) in patients with chronic B cirrhosis. Methods A total of 88 patients with hepatitis B cirrhosis complicated with GOV were admitted to our hospital between June 2014 and June 2020, and all patients underwent gastroscopy for the GOV severity and color Doppler ultrasonography for the measurement of portal vein diameter (PVD), splenic vein diameter (SVD), spleen diameter (SD), and spleen thickness (ST). The severity of GOV in patients with hepatitis B cirrhosis was evaluated by DCE-MRI.Results We found 28 cases of moderate and severe, and 60 cases of mild GOV by gastroscopy in our series; serum albumin level in patients with moderate/severe GOV was (36.0±3.8)g/L, much lower than [(40.1±3.7)g/L, P＜0.05] in those with mild GOV; the white blood cell count was (3.4±0.5)×10⁹/L, and the platelet count was (69.5±7.3)×10⁹/L, both significantly lower than [(4.2±0.3)×10⁹/L and (103.3±16.4)×10⁹/L, respectively, P＜0.05] in patients with mild GOV; the PVD was (15.4±2.0)mm, the SVD was (11.2±2.1)mm, the SD was (155.9±29.8)mm, and the ST was (53.2±9.8)mm, all significantly greater than those in patients with mild GOV [(14.3±2.1)mm, (10.0±2.6)mm, (140.6±30.6)mm, and(47.6±10.1)mm, respectively, P＜0.05]; the percentages of grade 2 and grade 3 GOV determined by DCE-MRI in 28 moderate/severe GOV by gastroscopy were 42.9% and 50.0%, significantly higher than 11.7% and 0.0%(P＜0.05) in those with mild GOV; the sensitivity, specificity and accuracy, positive predicting value and negative predicting value in evaluating the severity of GOV by DCE-MRI were 88.3% (53/60), 92.9% (26/28), 89.8% (79/88), 96.4% and 78.8%, respectively.Conclusion The application of DCE-MRI in diagnosing GOV in patients with liver cirrhosis is feasible and promising, which needs further investigation.

Objective The aim of this study was to summarize the clinical features of patients with alcoholic liver cirrhosis (ALC).Methods A total of 87 patients with ALC and 96 with hepatitis B liver cirrhosis (LC) were admitted to our hospital between June 2016 and June 2019. All patients underwent sonography and peripheral blood neutrophil/lymphocyte count ratio (NLR)] were detected by full-automatic biochemical analyzer.Results The proportion rate of male patients with ALC was 86.2%, significantly higher than 70.8% in patients with LC (P<0.05); the incidences of fatigue and anorexia, ocular spider and facial telanqiectasis in patients with ALC were 79.3%, 43.7% and 28.7%, significantly higher than 56.3%, 25.0% and 3.1% in patients with LC (P<0.05), while the Child-Pugh class was superior to that in patients with LC (P<0.05); the incidences of complications such as GI bleeding and infections in patients with ALC were much lower in patients with LC (P<0.05); the white blood cell count and NLR in patients with ALC were (6.2±1.6)×10⁹/L and NLR为(3.5±2.8), significantly higher than [(4.9±1.3)×10⁹/L and (2.6±1.9), P<0.05] in patients with LC; serum bilirubin and alanine aminotrasaminase levels in patients with ALC were significantly lower than those in patients with LC, while serum glutamyl transpeptidase and alkaline phosphatase levels were (296.5±22.7)U/L and (249.6±48.2)U/L, significantly higher than those in patients with LC [(124.4±25.8)U/L and (116.7±30.2)U/L, respectively, P<0.05]; the proportion of liver enlargement and echo enhancement of liver parenchyma in patients with ALC were 36.8% and 86.2%, significantly higher than 12.5% and 52.1% (P<0.05), while liver capsule serration and heterogeneous echo of liver parenchyma were 26.4% and 19.5%, significantly lower than 75.0% and 55.2% (P<0.05) in patients with LC. Conclusion The patients with ALC has unique clinical feature, which might guide the clinicians to take an appropriate measures dealing with them in clinical practice.

Objective The aim of this study was to summarize the clinical features and hepatic venous pressure gradient (HVPG) changes in patients with noncirrhotic portal hypertension (NCPH).Methods 28 patients with NCPH were admitted to our hospital between January 2017 and December 2019, the HVPG was measured and calculated by Seldinger from right venae jugularis interna, and the liver biopsies were performed.Results The patients with NCPH included 11 cases of idiopathic portal hypertension(IPH) and 17 cases of non-idiopathic portal hypertension (NIPH); the average age in patients with IPH was (40.6±15.8)yr, significantly younger than [(53.0±12.9)yr, P＜0.05] in patients with NIHP; the HVPG in patients with IPH was (9.9±5.2)mmHg, significantly lower than[(14.3±5.1)mmHg, P＜0.05] in patients with NIPH; serum albumin and cholinesterase levels in patients with IPH were (41.4±4.9)g/L and (6411.7±1839.3)U/L, significantly higher than [(33.9±6.1)g/L and (4438.5±1854.0)U/L, respectively, P＜0.05] in patients with NIPH; the incidence of ascites in patients with IPH was much lower than that in patients with NIPH (27.3% vs. 94.1%, P＜0.01); the occurrence of ascites was positively correlated to(r=0.66, P＜0.01), while the gastrointestinal bleeding and varices were not correlated to HVPG level(r=0.193, P=0.324; r=-0.197, P=0.315); the different entities in our series had their unique histopathological manifestations with common pathological features of non-fibrosis.Conclusion The common clinical approaches could differentiate IPH from NIPH in patients with NCPH, and the correct diagnosis might help dealing with them personally and appropriately.

Objective The aim of this study was to investigate the application of Viatorr coated stent during the transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of patients with liver cirrhosis and portal hypertension.Methods 146 patients with liver cirrhosis and portal hypertension were recruited in our hospital between January 2018 and January 2020, and were randomly divided into control (n=73) and observation (n=73) groups.All patients underwent TIPS, while the bare and the Fluency stent were used in patients in the control and the Viatorr stent was used in the observation. All patients were followed-up for 12 months.Results The operation time in the observation group was (99.5±9.8) min, significantly shorter than [(110.0±8.5) min, P<0.05] in the control, and there was no significant difference in portal vein pressure after operation between the two groups (P>0.05); at the end of 3 months after operation, there were no significant differences as respect to serum hepatic function tests between the two groups (P>0.05); at the end of 12 months, the shunt insufficiency rate in the observation group was 1.4%, significantly lower than 23.3% in the control group (P<0.05); five patients (6.8%)in the observation, and six(8.2%, Log-rank=0.099, P=0.753)in the control died.Conclusion The application of Viatorr covered stent during TIPS for treatment of cirrhotic patients with portal hypertension could effectively shorten the operation time and keep the shunt patency, which warrants further investigation.

Objective The aim of this study was to explore the risk factors of liver cancer occurrence in patients with hepatitis B liver cirrhosis receiving long-term nucleot(s)ide antiviral therapy. Methods A total of 417 patients with hepatitis B-induced liver cirrhosis receiving nucleos(t)ide antiviral therapy were followed-up from May 20012 to May 2015, and they underwent imaging check-up regularly for the findings of primary liver cancer (PLC). Multivariate Logistic analysis was applied to find the risk factors of PLC occurrence.Results During the followed-up period, the PLC was found in 57 patients with liver cirrhosis(13.7)%; the univariate Logistic analysis showed that the percentages of family history of liver cancer, long-term alcohol consumption, Child-Pugh class C, non-first line medicine for antiviral therapy and serum HBV DNA greater than 20 IU/ml in patients with PLC were significantly higher than that in cirrhotic patients (P<0.05); the multivariate Logistic analysis demonstrated that family history of liver cancer (OR=1.568, 95%CI:1.074-2.289, P=0.020), long-term alcohol consumption (OR=1.791, 95%CI:1.227-2.615,P=0.003),Child-Pugh class C(OR=1.598,95%CI: 1.095-2.333,P=0.016), non-first line antiviral medicine therapy (OR=1.476,95%CI:0.997-2.168,P=0.047) and still positive serum HBV DNA loads after antiviral therapy (OR=1.480,95%CI:1.014-2.160,P=0.043) were the independent risk factors for liver cancer occurrence.Conclusion We conclude this study with findings of liver cancer family history, long-term drinking, Child-Pugh class C liver functions, not taking first-line antiviral medicines and serum HBV DNA level greater than 20 IU/ml after antiviral therapy being the risk factors of PLC happening, which hints administration of first-line antiviral therapy to obtain sustained virologic response, abstaining drinking and improvement of liver functions appropriately might decrease the liver cancer happening in patients with hepatitis B-induced liver cirrhosis.

Objective The aim of this study was to investigate the diagnostic efficacy of ¹⁸F-FDG PET/CT scan in patients with intrahepatic cholangiocarcinoma (ICC).Methods 107 patients with ICC and 107 healthy persons underwent ¹⁸F-FDG PET/CT scan between January 2017 and January 2020, and the TNM staging of tumor was evaluated and the standard uptake value maximum (SUVmax) was culculated. All patients received tumor resection.Results The SUVmax in patients with ICC stage Ⅰ was (4.1 ± 1.1), in patients with stage Ⅱ was (7.2 ± 1.5), and in patients with stage Ⅲ was (9.3 ± 1.8), all significantly higher than [(2.0 ± 0.9) , P<0.05] in healthy persons; the FDG PET/CT scan showed TNM stage Ⅰ in 35 cases, stage Ⅱ in 47 cases, and stage Ⅲ in 25 cases, and the post-operational histopathological examination demonstrated TNM stage Ⅰ, stage Ⅱ and stage Ⅲ were34 cases, 48 cases and 24 cases, respectively; the sensitivity (Se) of ¹⁸ F - FDG PET/CT scan in the diagnosis of patients with ICC TNM stage Ⅰ was 0.968, the specificity (Sp) was 0.500,the accuracy (Ac) was 0.914, the positive predictive value (PPV) was 0.938, and the negative predictive value (NPV) was 0.667, in the diagnosis of patients with ICC TNM staging Ⅱ, the Se was 0.976, the Sp was 0.667, the Ac was 0.956, the PPV was 0.976, and the NPV was 0.667, and in the diagnosis of patients with ICC TNM staging Ⅲ, the Se was 0.955, the Sp was 0.667, the Ac was 0.920, the PPV was 0.955, and the NPV was 0.667.Conclusion The application of ¹⁸F-FDG PET/CT scan is helpful for the diagnosis and assessment of TNM stage in patients ICC.

Objective The aim of this study was to investigate the clinical efficacy of living donor liver transplantation (LDLT) for treatment of Children with biliary atresia (BA).Methods 74 children with BA were recruited in our hospital between September 2010 and October 2016, and 36 children underwent LDLT, and 38 children received LDLT after Kasai failure. All the children were followed-up for 36 months. The Kaplan-Meier survival analysis was applied to compare the cumulative survival rate between the two groups.Results The median age in children receiving LDLT after Kasai was 12.5(5.8, 72.5) months, significantly older than 7.2(5.8, 36.8) months (P<0.05) in children receiving LDLT directly, the weight was (12.8 5.2) kg, significantly higher than (10.2±6.6) kg (P<0.05) in children receiving LDLT directly, the preoperative serum bilirubin level was 158.4 (20.4,500.8) μ mol/l, significantly lower than 250.9 (60.8,468.0) μ mol/l (P<0.05) in children receiving LDLT directly, the pediatric end-stage liver disease (PELD) score was (12.5±9.6), significantly lower than [(20.8 15.4), P<0.05] in children receiving LDLT directly, while there were no significant differences in graft quality, donor liver weight to recipient weight ratio (GRWR), hot ischemia time, cold ischemia time, intraoperative blood loss and intraoperative blood transfusion between the two groups ((P>0.05); the incidence of post-operative complications in children receiving LDLT was 55.6%(20/36), significantly lower than [68.4%(26/38), P<0.05] in children underwent LDLT after Kasai; the 1-month, 1-year and 3-year cumulative survival rates in children receiving LDLT after Kasai were 97.3%, 94.7% and 89.5%, not significant different as compared to 97.2%, 91.7% and 86.1% in children receiving LDLT directly (P>0.05).Conclusion We recommend based on our results that the LDLT should be directly given in children with BA, which might obtain a better outcomes in future.

Objective The aim of this study was to investigate the efficacy of one-step and step-by-step laparoscopic cholecystectomy (LC) in the treatment of patients with gallbladder stones and common bile duct stones. Methods 152 patients with gallbladder stones and common bile duct stones were admitted to our hospital between January 2016 and June 2019, 87 patients received one-step surgery, e.g., LC and laparoscopic common bile duct exploration (LCBDE), and 65 patients received step-by-step surgery, e.g., endoscopic retrograde cholangiopancreatography/papillary endoscopic sphincterotomy (ERCP/EST) and afterward LC.Results The total surgical time and postoperative catheter placement rate in patients with one-step surgery were (156.3±42.6)min and 98.9%, significantly longer or higher than [(124.4±31.4)min and 15.4%, P<0.05] in patients receiving step-by-step surgery, while the hospital stay and hospitalization cost were (14.4±3.9)d and (27.9±7.0)thousand yuan, significantly shorter or lower than(18.7±4.2)d and(31.24±5.8)thousand yuan (P<0.05) in the latter; there were no statistically significant differences in the surgical success rate and stone clearance rate between the two groups (95.4% vs. 93.1% and 100.0% vs. 96.9%, respectively, P>0.05); the incidence rate of reflux cholangitis in one-step-treated patients was significantly lower than step-by-step surgery-treated patients (0.0% vss 7.7%, P<0.05), while there was no significant difference in the total incidence of complications between the two groups (19.5% vs. 32.1%, P>0.05).Conclusion Both the one-step and step-by-step with patients with gallbladder surgery are efficacious in dealing stones and common bile duct stones, and under some circumstances, the one-step surgery might eradicate the stones rapidly and get a good efficacy.

Objective The aim of this study was to explore the diagnostic efficacy of ultrasonography, CT and magnetic resonance cholangiography (MRCP) in the diagnosis of extrahepatic bile duct stones.Methods A total of 107 patients with extrahepatic biliary obstruction were recruited in our hospital between March 2017 and February 2019, and all of them underwent abdominal ultrasonography, CT scan and MRCP. The diagnosis was confirmed by pathological examination. The diagnostic sensitivity, specificity and accuracy by abdominal ultrasound, CT and MRCP for diagnosis of stones were analyzed by ROC curves and the area under the ROC curve (AUC).Results Out of our 107 patients with extrahepatic biliary obstruction, 59 were diagnosed as with extrahepatic bile duct stones by post-operational pathological examination and the diagnostic rates by ultrasonography, CT and MRCP were 64.4%,67.8% and 84.7%(P<0.05); as to the stones less than 8 mm, the diagnostic rate by MRCP was 80.0%(32/40), significantly higher than 60.0%(24/40) by ultrasonography or 57.5%(23/40) by CT scan, and the accuracy of positioning stones by MRCP was 84.8%(50/59), also much higher than 66.1%(39/59) by sonography or 67.8%(40/59, P<0.05) by CT scan; the diagnostic sensitivity, specificity and accuracy by MRCP were 84.8%(50/59), 89.6%(43/48) and 86.9%(93/107), significantly higher than64.4%(38/59), 83.3%(40/48) and 72.9%(78/107) by sonography (P<0.05) or 67.8%(40/59), 81.3%(39/48) and 73.8%(79/107) by CT scan (P<0.05). Conclusions The diagnostic efficacy of MRCP in detecting extrahepatic bile duct stone is superior to ultrasonography or abdominal CT scan, especially for stones less than 8 mm, which has a very practical roles in clinical practice.

Objective The aim of this study was to investigate the application of preoperative bile CT value in the diagnosis of patients with gallbladder muddy stones.Methods 72 patients with routine imaging false-negative gallbladder muddy stones and 40 patients undergoing gallbladder excision due to liver surgery were enrolled in Hepatobiliary Surgery of PLA General Hospital between September 2018 and September 2020, and all patients underwent abdominal CT scan. Serum interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) levels were obtained. The area under the receiver operating characteristic curve (AUC) was applied to predict the diagnostic value.Results There were no significant differences in changes of liver function tests and blood parameters between the two groups (P>0.05); the bile CT value in gallbladder stone group was significantly higher than that in control group [(66.01±18.24) Hu vs. (25.40±8.23) Hu, P<0.05; there was no significant differences as respect to serum cytokines and PCT levels; the ROC curves analysis showed that the AUC, sensitivity and specificity were 0.954, 92.3% and 91.0%, respectively as the bile CT value greater than 25.60 Hu was set as the cut-off-value for the diagnosis of gallbladder muddy stones.Conclusion The imaging examination shows that bile CT value in patients with false-negative gallbladder muddy stones is significantly higher than that in the subjects with normal gallbladder without stone. The accuracy of bile CT value is relatively higher in the diagnosis of gallbladder muddy stones.

There are normal physiological changes in the liver functions during pregnancy. Nevertheless, 3% of pregnant women have liver dysfunction. Pregnancy-specific liver disease is the main cause of abnormal liver function. About 0% to 25% of pregnant women die from pregnancy-specific liver disease. It is particularly important to improve clinician’s recognition of this entity. We reviewed the literature on pregnancy-specific liver disease in recent years and the progress in the pathogenesis, diagnosis and treatment of some pregnancy-specific liver diseases was summarized in this paper, in order to provide reference for its diagnosis and treatment.

Primary biliary cholangitis (PBC) is a chronic, progressive, non-suppurative inflammation of the small bile ducts in the liver. Ursodeoxycholic acid is the only first-line therapeutic drug at present. New progress has been made in the research on the efficacy of second-line drugs such as obieticholic acid, betts and immunosuppressants. The efficacy and safety of non-drug intervened measure are under investigation. There are also different treatment ways for different extrahepatic manifestations of patients with PBC. In this review, we put focus on the current progress of treatment for PBC patients.