Objective This experiments aimed to explore the effects of core proteins of different quasispecies of genotype 1b hepatitis C virus (HCV) on the biological behaviors of HepG2 cells in vitro. Methods The eukaryotic plasmids of genotype 1b HCV center strain (T), para-carcinoma strain (NT) and C191 strain (HCV-J6) were constructed, and the HepG2 cells were transfected by them, e.g., pcEGFP-T, pcEGFP-NT and pcEGFP-C191 group by Lipofectamine 2000. The cells proliferation was detected by plate clone method, and the relative levels of cell proliferation related genes, such as PCNA, Ki67, Cyclin B and CDK1 mNRA were detected by fluorescent quantitative PCR. The cells were treated with tumor necrosis factor-α (TNF-α) at dose of 50 ng/mL for 8 h. The apoptosis was detected by flow cytometry. The expressions of apoptosis-related proteins Bax/Bcl-2, Caspase-3 and Caspase-9 and invasion-related proteins of MMP-3, MMP-9 and Snail were detected by Western blot. Results The clone formation rates in pcEGFP-NT-, pcEGFP-T- and pcEGFP-C191-transfected HepG2 cells were (57.3±4.2)%, (64.5±3.8)% and (49.8±3.2)%, significantly higher than [(44.3±3.4)%, P<0.05] in empty plasmid-transfected cells, while the apoptosis was significantly weaker than that in empty plasmid group; the relative levels of PCNA, Ki67, Cyclin B and CDK1 mNRA in pcEGFP-NT group were (1.5±0.0), (1.7±0.1), (1.6±0.0) and (1.8±0.1), significantly higher than [(1.0±0.1), (1.0±0.1), (1.0±0.1) and (1.0±0.1), respectively, P<0.05] in empty plasmid group, those in pcEGFP-T group were (1.9±0.1), (2.1±0.1), (2.3±0.1) and (2.6±0.1), significantly higher than in empty plasmid group (P<0.05) and those in pcEGFP-C191 group were (1.2±0.1), (1.4±0.1), (1.4±0.0) and (1.5±0.0), significantly higher than those in empty plasmid group (P<0.05); the expression levels of Bax/Bcl-2, Caspase-3 and Caspase-9 in pcEGFP-NT group, pcEGFP-T group and pcEGFP-C191 group were significantly weaker than those in empty plasmid group, while the expression levels of MMP-3, MMP-9 and Snai proteins were significantly stronger than those in empty plasmid group. Conclusion The intensified expression of HCV core protein by special quasispecies of HCV infection might improve the proliferation and anti-apoptosis abilities of HepG2 cells in intro.

Objective The paper aimed to investigate the effect of ultrasound-mediated miR-16-5p loaded microbubbles and dendritic cell (DC) vaccine on subcutaneous transplanted tumor growth in mice. Methods The polymer microbubbles loaded with miR-16-5p were prepared and their general properties were detected. The subcutaneous transplanted tumors by HepG2 cell injection were established in thirty mice, and were randomly divided into control, vacuous microbubble, miR-16-5p microbubble, DC vaccine, and miR-16-5p microbubble and DC vaccine combination intervention groups, with six mice in each group. The tumor growth of mice in each group was observed, the tumor growth curve was drawn and the tumor inhibition rate was calculated. The miR-16-5p levels in tumorous tissues were detected by real-time RT-PCR. Serum levels of IgG, IFN-γ, TGF-β, IL-2, and IL-10 were measured by ELISA. Results The prepared polymer microbubbles were spherical with an average particle size of 1.31 μm; the tumor volumes in control, vacuous microbubble, miR-16-5p microbubble, DC vaccine, and miR-16-5p microbubble and DC vaccine combination-intervened groups were(5973.2±257.4)mm³, (5912.3±248.3)mm³, (4873.7±281.5)mm³, (4954.9±276.3)mm³ and (2225.8±201.4)mm³, and the tumor mass were (4.4±0.4)g, (4.2±0.3)g, (2.8±0.2)g, (2.7±0.2)g and (0.9±0.2)g, significantly different among them(P<0.05); the tumorous miR-16-5p levels were (1.02±0.06), (1.05± 0.03), (7.81±0.97), (1.08±0.07) and (8.08± 1.06), suggesting that those in miR-16-5p microbubble- and DC vaccine combination-intervened groups were significantly higher than in other three groups (P<0.05); serum IgG, IFN-γ and IL-2 levels significantly increased, while serum TGF-β and IL-10 levels greatly decrease in miR-16-5p microbubble, DC vaccine, and miR-16-5p microbubble and DC vaccine combination intervention groups as compared to those in control or vacuous microbubble-intervened groups (P<0.05). Conclusion The administration of ultrasound-mediated miR-16-5p microbubbles and DC vaccine has a synergistic inhibitory effect on the growth of subcutaneous transplanted hepatoma in mice, which might be related to the enhancement immune functions.

Objective The aim of this study was to explore the predictive value of antiviral response by serum hepatitis B virus (HBV) pregenomic RNA (pgRNA) levels in naïve patients with hepatitis B receiving nucleos(t)ide analogues treatment. Methods 107 naïve patients with chronic hepatitis B (CHB) were enrolled in our hospital between August 2015 and December 2019, and all were treated with nucleos(t)ide analogues, e.g. entecarvir, tenofovir, or telbivodine, for 12 months. Serum HBV pgRNA loads was assayed by real-time fluorescent quantitative PCR, serum HBsAg and HBeAg were detected by ELISA, the multivariate Logistic regression model was applied to analyze the influencing factors of response in CHB patients to nucleos(t)ide analogue treatment, and the area under the receiver operating characteristic curve (AUROC) was applied to predict the antiviral response by serum HBV pgRNA levels in CHB patients receiving nucleos(t)ide analogue treatment. Results At the end of 48 week observation, 27 patients (25.2%) didn't response to antiviral therapy, but 80 patients(74.8%) obtained complete or partial response; serum HBV DNA loads in patients with CR and PR was (6.1±1.0)lg copies/mL, significantly lower than [(7.2±1.2) lg copies/mL, P<0.05], peripheral blood 血CD4^＋/CD8^＋ cell ratio was (0.7±0.2), significantly higher than [(0.6±0.1), P<0.05], serum HBeAg positive rate was 41.3%, significantly lower than (70.4%, P<0.05),and serum HBV pgRNA level was (5.3±0.8)lg copies/mL, significantly lower than [(6.5±1.1)lg copies/mL, P<0.05] in non-responders; the multivariate Logistic regression analysis showed that baseline serum HBV DNA loads, serum HBeAg state and serum HBV pgRNA levels were the independent influencing factors for antiviral response in CHB patients receiving nucleos(t)ide analogue treatment(OR=2.793, OR=3.827, OR=4.035, all P<0.05); the ROC analysis demonstrated that the optimal cut-off-value of serum HBV pgRNA level in predicting response of antiviral therapy in CHB patients was 5.89 lg copies/mL, with the AUC of 0.865(95%CI:0.816-0.905), the sensitivity of 74.1%(20/27) and the specificity of 88.8%(71/80). Conclusion Serum HBV pgRNA levels could be assayed in sera of patients with CHB, and it might be used to predict the antiviral response and warrants further clinical investigation.

Objective The purpose of this study was to investigate the efficacy of sofosbuvir (SOF) and ledipasvir (LDV) in patients with chronic hepatitis C (CHC). Methods 116 patients with CHC were recruited in our hospital, and all were treated with SOF and LDV without ribavirin for three months. The four indexes of liver fibrosis (FIB-4) was calculated and serum HCV RNA loads were detected by RT-PCR. The univariate and multivariate Logistic regression analyses were applied to screenthe independent impacting factors for sustained virological response (SVR) the patients got after antiviral treatment. The receiver operating characteristic (ROC) curve was applied to analyze the predictive efficacy of parameters for SVR. Results At the end of six month followed-up after the discontinuation of the regimen, serum ALT, AST levels and platelet counts in 116 patients with CHC were (32.4±6.8)U/L,(36.5±9.2)U/L and (224.6±31.9)×10⁹/L, all significantly lower than [(56.6±11.7)U/L, (64.7±11.8)U/L and (262.3±41.7)×10⁹/L, respectively, P＜0.05] at the end of treatment or [(204.3±41.6)U/L, (131.2±26.5)U/L and (313.7±53.6)×10⁹/L, respectively, P＜0.05] before treatment; the FIB-4 and serum HCV RNA load were (0.9±0.1) and (1.1±1.2)lgU/mL, both significantly lower than [(1.2±0.2) and (1.9±1.1)lgU/mL, respectively, P＜0.05] at the end of the treatment or [(1.4±0.2) and (6.4±1.3)lgU/mL, respectively, P＜0.05] before treatment; the rapid virologic response, the end of treatment virologic response and SVR in our series were 75.0%, 89.7% and 82.0%; the multivariate Logistic regression analysis showed that the FIB-4 and serum HCV RNA loads were the impacting factors for SVR (P＜0.05); the AUC was 0.875 with the sensitivity of 83.2% and the specificity of 90.5% when the combination of FIB-4＜1.65 and serum HCV RNA load equal to (6.6±0.8)lgU/mL before treatment were set as the cut-off-value. Conclusion The combination of SOF and LDV in treating patients with CHC is efficacious, and the patients at presentation with low FIB-4 and serum HCV RNA might obtain a better efficacy.

Objective The aim of this study was to investigate the efficacy and safety of sofosbuvir/velpatasvir (SOF/VEL) in treatment of patients with chronic hepatitis C (CHC) and hepatitis C precipitated liver cirrhosis in real-world study (RWS) in a single centre. Method This RWS included naïve or PR-treated patients with CHC, some concomitant with blood hypertension, diabetes, tumor or hepatitis, between May 2018 and April 2020. 32 patients with CHC and 36 patients with compensated hepatitis C -induced liver cirrhosis (CHC-CLC) received SOF/VEL for 12 weeks, and 31 patients with decompensated hepatitis C liver cirrhosis (CHC-DLC) or hepatocellular carcinoma received SOF/VEL and ribavirin (RBV) for 12 weeks. The HCV genotypes (GTs) were determined by RT-PCR. Results The prevalence of GT 2a(55.6%) and GT1b(34.3%) was dominant in our series; the early virological response (EVR4)in patients with CHC, CHC-CLC and CHC-DLC were 90.6%, 86.1% and 83.9%, the end of treatment (EOT) virologic response were 100.0% in the three groups, the sustained virological response (SVR) 12 and SVR24 in patients with CHC and CHC-CLC were 100.0% and 100.0% and both the SVR12 and SVR24 in patients with CHC-DLC were 93.5%, not significantly different among the three groups(P>0.05); both the SVR12 and SVR24 in our series was 97.8%, and they reached 100.0% when the patients with GT3b infection were excluded; the biochemical responses rates in the three groups were 87.5%, 83.3% and 74.2%, and the incidence of adverse event (AE) in our series was 12.1%, no severe AE or discontinuation of therapy owning to AE occurred. Conclusion The efficacy of SOF/VEL and/or with RBV in treating patients with CHC and CHC-precipitated liver diseases is good and promising, without severe untoward effects.

Objective The aim of this study was to investigate the clinical implication of peripheral blood T lymphocyte subset changes in patients with syphilis and hepatitis B or hepatitis C coinfection. Methods 93 patients with treponema pallidum (TP) syphilis were admitted to our hospital between January 2016 and June 2020, including syphilis infection in 61 cases, syphilis with hepatitis B virus infection in 21 cases and syphilis with hepatitis C virus infection in 11 cases. 84 healthy persons were selected as the control. The peripheral blood T lymphocyte subsets was assayed by FCM. Results The percentages of peripheral blood CD3⁺, CD4⁺, CD4⁺CD45RO⁺ and CD8⁺CD45RA⁺ cells as well as the ratio of CD4⁺/CD8⁺ cells in patients with syphilis were(52.2±8.5)%,(40.3±5.7)%,(18.1±3.9)%, (12.4±3.7)% and (1.2±0.3), all significantly lower than [(69.1±7.6)%,(50.7±6.9)%,(20.6±4.7)%,(16.2±4.3)% and (1.9±0.5), respectively, P＜0.05], while the percentages of peripheral blood CD8⁺, CD4⁺CD45RA⁺ and CD8⁺CD45RO⁺ cells were all significantly higher than those in healthy control [(32.4±7.3)%, (24.7±6.5)% and (8.7±1.5)% vs. (26.2±5.4)%, (21.8±6.2)% and (5.4±1.1)%, respectively, P＜0.05]; there were significant differences as respect to the percentages of peripheral blood CD8⁺, CD4⁺CD45RA⁺, CD4⁺CD45RO⁺, CD8⁺CD45RA⁺, CD8⁺CD45RO⁺ cells and the ratio of CD4⁺/CD8⁺ cells among patients with TP, with TP and chronic hepatitis B (CHB), and with TP and chronic hepatitis C (CHC, P＜0.05), the percentages of CD8⁺, CD4⁺CD45RA⁺ and CD8⁺CD45RO⁺ cells in patients with TP and CHB and patients with TP and CHC were all significantly higher than those in patients with TP(P＜0.05), while the ratio of CD4⁺/CD8⁺ cells, and the percentages of blood CD4⁺CD45RO⁺ and CD8⁺CD45RA⁺ cells were all significantly lower than those in patients with TP (P＜0.05); there were no significant differences respect to the percentage of blood CD8⁺, CD4⁺CD45RA⁺, CD4⁺CD45RO⁺, CD8⁺CD45RA⁺ and CD8⁺CD45RO⁺ cells and the ratio of CD4⁺/CD8⁺ cells between patients with TP and CHB, and those with TP and CHC (P＞0.05). Conclusion The percentages of peripheral blood CD3⁺, CD4⁺, CD8⁺, CD4⁺CD45RA⁺, CD8⁺CD45RO⁺, CD4⁺CD45RO⁺, CD8⁺CD45RA⁺ and the ratio of CD4⁺/CD8⁺ cells in patients with TP change greatly, and those in patients with TP and HBV or HCV mixed infection change even significantly, which needs further clinical investigation.

Objective The purpose of this study was to investigate the diagnostic value of liver biopsy under the guidance of ultrasound for patients with liver injury of unknown origin (LIUO). Methods A retrospective analysis was performed on 71 patients with LIUO who underwent liver biopsy in our hospital. The clinical data and pathological reports were summarized for further investigation. Results Out of the 71 patients with LIUO, 53(76.4%) presented with elevated serum ALT levels, 6(8.5%) with elevated serum bilirubin levels, 8 (11.3%) with liver cirrhosis of unknown origin, 2(2.8%) with portal hypertension of unknown origin, and 2 (2.8%) with bile duct dilatation; on the basis of clinical materials, the liver histopathological examination showed autoimmune liver diseases in 13 cases(18.3%), and out of them, primary biliary cholangitis in 8 cases, autoimmune hepatitis in 2 cases, over-lapping syndrome in 2 cases, and IgG4-related cholangitis in one case; non-alcoholic fatty liver diseases in 18 (25.4%), 14 out of them were non-alcoholic steatohepatitis; drug-induced liver injury in 17(23.9%), chemical liver injury in 4 (5.6%), alcoholic hepatitis in 2(2.8%), Gilbert syndrome in 2, Dubin-Johnson syndrome in one, Caroli's disease in one, idiopathic portal hypertension in one, glycogen storage disease-induced liver cirrhosis in one, non-A, non-B hepatitis in one, damaged bile duct in one case, left 9 cases(12.7%) still having non-specific liver inflammation undiagnosed. Conclusion On the basis of clinical materials, the liver histopathological examination could help diagnosis of patients with LIUO, which warrants further clinical investigations.

Objective The aim of this study was to investigate the coincidence of autoimmune thyroid diseases (AITD) in patients with autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC). Methods A total of 41 patients with AIH and 45 patients with PBC were recruited in this study between June 2018 and December 2020, and serum anti-nuclear antibody (ANA), anti-mitochondrial antibody (AMA) and/or anti-mitochondrial antibody M2 (AMA-M2), anti-smooth muscle antibody (ASMA), anti-double-stranded DNA antibody (anti-dsDNA) and anti-centromere antibody (ACA) were detected. Results Out of 41 patients with AIH in our series, 12 patients had Hashimoto's thyroiditis (HT), and 6 had Grave's disease (GD), and out of 45 patients with PBC, 8 had HT, and 7 had GD; serum IgG level in patients with AIH was 17.5(14.8,19.8)g/L, significantly lower than [21.6(17.5, 29.0)g/L, P<0.05] in patients with AIH and HT or [22.4(20.2, 26.4)g/L, P<0.05] in patients with AIH and GD, serum γ-globulin level was 22.2(19.3, 25.6)%, significantly lower than [26.5(22.2, 32.2)%, P<0.05] in patients with AIH and HT or [27.1(24.3, 32.0)%, P<0.05] in patients with AIH and GD; the age of patients with PBC was (55.2±1.1)yr old, significantly younger than [(62.4±1.6) yr old, P<0.05] in patients with PBC and HT or [(62.2±1.5)yr old, P<0.05] in patients with PBC and GD, serum IgG level was 15.4(12.2, 18.0)g/L, significantly lower than [20.3(16.8, 24.7)g/L, P<0.05] in patients with PBC and HT or [21.3(16.8, 25.6)g/L, P<0.05] in patients with PBC and GD, serum γ-globulin level was 21.2(17.8, 25.6)%, significantly lower than [26.7(21.7, 30.4)%, P<0.05] in PBC patients with HT or [25.4(22.2, 29.4)%, P<0.05] in patients with PBC and GD. Conclusion The coincidence of AITD in patients with AILD is common, and serum IgG and γ-globulin levels increase in patients with AIH or PBC with concomitant AITD, which needs further investigation.

Objective The paper aimed to investigate the changes of serum thyroid hormone levels and serum positive rate of anti-thyroid antibody in patients with primary biliary cholangitis (PBC). Methods A total of 94 patients with PBC including 50 cases of cirrhosis (Child-Pugh class A in 29 cases, class B in 15 cases, and class C in 6 cases) and 44 cases of cholangitis were enrolled in our hospital between January 2018 and January 2020, and another 60 healthy volunteers in physical examination in our hospital during the same period were included for control in the study. 5 mL of peripheral venous blood under the morning fasting state was taken to determine serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (thyroid stimulating hormone, TSH) by chemiluminescence immunoassay, and thyroid peroxidase antibody (TPOAB) and thyroglobulin antibody (TGAB) were assayed. Results Serum levels of FT3, FT4 and TSH in patients with cholangitis were (2.4±0.5) ng/L, (1.4±0.2) ng/L and (8.9±2.3) ng/L, and serum positive rates of TPOAb and TGAb were 77.3% and 81.8%, serum levels of FT3, FT4 and TSH in patients with liver cirrhosis were (1.9±0.3) ng/L, (1.0±0.1) ng/L and (19.7±4.9) ng/L, and serum positive rates of TPOAb and TGAb were 70.0% and 64.0%, while serum levels of FT3, FT4 and TSH in healthy subjects were (2.8±0.8) ng/L, (1.8±0.3) ng/L and (3.4±1.2) ng/L, and serum positive rates of TPOAb and TgAb were 0.0% and 0.0%, respectively, suggesting serum FT3 and FT4 levels in patients with cirrhosis and cholangitis significantly lower, serum TSH level was significantly higher than those in healthy persons (P < 0.05), while serum FT3 and FT4 levels in patients with cirrhosis were significantly lower, serum TSH level was significantly higher than those in patients with cholangitis (P < 0.05); there was no significant difference in the positive rates of TPOAb and TgAb between patients with liver cirrhosis and with cholangitis (P > 0.05); serum levels of FT3, FT4 and TSH in cirrhotics with Child-Pugh class A were (2.2±0.4) ng/L, (1.2±0.2) ng/L and (12.2±2.8) ng/L, serum positive rates of TPOAb and TgAb were 69.0% and 48.3%, serum FT3, FT4 and TSH in patients with Child-Pugh class B were (1.8±0.3) ng/L, (0.9±0.1) ng/L and (16.5±3.3) ng/L, serum positive rates of TPOAb and TGAB were 66.7% and 60.0%, and serum FT3, FT4 and TSH levels in patients with Child-Pugh class C were (1.3±0.1) ng/L, (0.6±0.1) ng/L and (20.7±4.6) ng/L, and serum positive rates of TPOAb and TGAB were 66.7% and 50.0%, respectively, suggesting serum levels of FT3 and FT4 significantly different among them, while serum positive rates of TPOAb and TgAb in cirrhotics were not (P > 0.05). Conclusion Serum levels of FT3, FT4 and TSH in patients with cirrhosis and cholangitis change greatly, and serum positive rates of TPOAb and TgAb are significantly high, what it implicate needs further investigation.

Objective The aim of this study was to investigate the short-term impact of metformin and simvastatin combination therapy on blood glucose and lipid parameters in patients with nonalcoholic fatty liver disease (NAFLD) with concomitant diabetes mellitus type 2 (T2DM). Methods 168 patients with NAFLD and T2DM were encountered in our hospital between January 2018 and June 2020, and 75 patients were treated with metformin and another 93 patients received metformin and simvastatin combination therapy. The observation lasted for three months. Blood biochemical parameters, glycosylated hemoglobin (HbA1c) and fasting insulin (FINS) were detected, and the homeostasis model assessment of insulin resistance index (HOMA—IR) was calculated. Results There were no significant differences as respect to baseline materials such as age, gender, body mass index, serum FINS levels, concomitant hypertension, metabolic syndrome, or nonalcoholic steatohepatitis between the two groups(P>0.05); at the end of three month observation, the HOMA—IR in the combination group was 1.8(1.0, 2.7), significantly lower than [2.1(1.3, 3.5), P<0.05] in metformin-treated group, and there were no significant differences in blood HbA1c and FINS levels [(6.4(6.0,7.0)% vs.(6.5(6.2,7.5)%, and (5.5(2.2,7.6)μU/ml vs. (5.7(2.9,8.5))μU/ml,P>0.05] between the two groups; the blood triglyceride level in the combination group was 2.1(1.9,3.3)mmol/l, significantly lower than [(2.7(2.1, 3.5))mmol/l, P<0.05], and blood total cholesterol level was 4.3(3.7, 5.0)mmol/l, significantly lower than [5.4(5.0, 6.2)mmol/l, P<0.05], while blood high-density lipoprotein cholesterol level was 1.7(1.5,2.6)mmol/l, significantly higher than [1.4(1.0,1.7)mmol/l, P<0.05] in metformin-treated patients, and there were no significant differences respect to serum alanine aminotransferase levels [54(26, 62)U/L vs. 55(32, 65)U/L, P>0.05], serum aspartate aminotransferase levels [57(47, 72)U/L vs. 57(46, 64)U/L, P>0.05] and serum low-density Lipoprotein cholesterol levels [2.5(2.2, 3.3)mmol/l vs. 2.6(2.1, 3.4)mmol/l, P>0.05] between the two groups. Conclusion The combination of metformin and simvastatin in treatment of patients with NAFLD and T2DM could improve blood glucose and lipid metabolism, and what it impact on liver steatosis needs further investigation.

Objective The aim of this study was to investigate the structure of intestinal flora changes in patients with non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus type 2(T2DM). Methods 58 patients with NAFLD and T2DM, 66 patients with NAFLD and 60 healthy volunteers were encountered in our hospital between June 2018 and July 2020. The intestinal flora structure, the homeostasis model assessment-insulin resistance steady state model insulin resistance (HOMA-IR) and serum tumor necrosis factor-α(TNF-α) and high-sensitivity C-reactive protein levels were detected. Results The fecal phylum of Bacteroides in patients with NAFLD and T2DM was significantly higher than that in patients with NAFLD or in healthy control (P＜0.05), and the phylum of Bacteroides in patients with NAFLD was significantly higher than that in healthy control (P＜0.05); the abundances of fecal Firmicutes, Clostridium tenuis, Anaerobic Streptomyces and Blautella in patients with NAFLD and T2DM were significantly lower than those in patients with NAFLD or in healthy individuals (P＜0.05), and the abundances of Firmicutes, Clostridium tenuis, Anaerobic bacillus, and Blautella in patients with NAFLD were all significantly lower than those in the healthy control (P<0.05); the HOMA-IR index, serum TNF-α and hs-CRP levels in patients with NAFLD and T2DM were (2.8±1.3), (52.3±11.7)ng/mL and (2.3±1.1)mg/L, significantly higher than [(1.6±0.7), (48.7±10.2)ng/mL and (1.6±0.9)mg/L, respectively, P<0.05] in patients with NAFLD or [(1.3±0.3), (33.2±8.4)ng/mL and (1.2±0.4)mg/L, respectively, P<0.05] in healthy individuals. Conclusion The patients with NAFLD and T2DM have insulin resistance and serum inflammatory factor disorders, as well as the structure changes of intestinal flora, which needs further investigation for its clinical implications.

Objective The aim of this study was to investigate serum interleukin-17 (IL-17) levels and the single nucleotide polymorphism (SNP) of its gene at -197A/G locus in patients with alcoholic liver diseases (ALD). Methods 44 patients with alcoholic fatty liver, 40 with alcoholic hepatitis, 34 with alcoholic cirrhosis and 18 with ALD-related liver cancer were recruited in this study between October 2015 and October 2020, and serum IL-17 level was detected by ELISA. The gene polymorphisms at -197A/G locus were detected by single nucleotide test kits. Results Serum IL-17 level in patients with liver cancer was (8.7±1.4) pg/mL, significantly higher than [(3.7±0.3) pg/mL, (4.0±0.6) pg/mL and (6.9±0.8) pg/mL, respectively, P<0.05] in patients with alcoholic fatty liver, alcoholic hepatitis and alcoholic cirrhosis; serum ALT, AST, GGT and ALB levels in patients with liver cancer were (54.3±13.3)U/L,(53.8±13.7)U/L,(262.2±17.9)U/L and (33.9±13.8)g/L, those in patients with alcoholic liver cirrhosis were (39.8±8.8)U/L,(40.1±7.2)U/L, (251.1±7.9)U/L and (31.1±2.6)g/L, in alcoholic hepatitis were (84.0±7.5)U/L,(75.4±6.8)U/L, (245.1±5.6)U/L and (43.1±5.7)g/L, all significantly different compared to(29.5±5.2)U/L,(30.5±7.8)U/L, (142.7±5.2)U/L and (42.7±3.2)g/L, respectively, P<0.05] in patients with alcoholic fatty liver; the distribution frequencies of AA genotype of IL-17 gene at -197A/G locus in patients with liver cancer and alcoholic cirrhosis were 77.9% and 64.7%, significantly higher than 22.7% and 27.5% (P<0.05) in patients with alcoholic fatty liver and alcoholic hepatitis, and the distribution frequencies of A allele in patients with liver cancer and alcoholic cirrhosis were 83.3% and 75.0%, significantly higher than 26.1% and 33.8% (P<0.05) in patients with alcoholic fatty liver and alcoholic hepatitis. Conclusion High serum level of IL-17 might be related with the progression of ALDs and the AA genotype and A allele of IL-17 at -197A/G locus could be the susceptibility genes of patients with ALD, which might increase the risk of alcoholic liver cirrhosis and even liver cancer.

Objective The aim of this study was to investigate the prevention of drug-induced liver injury(DILI) by orally diammonium glycyrrhetate in naïve patients with pulmonary tuberculosis (PT). Methods A multi-centered, open, randomized, parallel controlled clinical trial was conducted in 14 specialized tuberculosis hospitals in China, and 933 patients with PT were recruited and randomly divided into observation (n=495) and control (n=438), receiving six month 2HREZ/4HR regimen. The patients in the observation received diammonium glycyrrhetate enteric-coated capsules during anti-tuberculosis chemotherapy, whilethose in the control group didn't receive any hepatoprotectants. Results During the anti－tuberculosis therapy, the incidence of DILI in our series of 933 patients was 31.9%, and of which, that was 27.7% in the observation, significantly lower than36.8%(P<0.05) in the control; the incidence of regimen change owing to DILI in the observation was 3.2%, significantly lower than 7.8%(P<0.05) in the control; at the end of six month therapy, thesputum smear negative rates were 91.8% and 92.2%(P>0.05) in the two groups; the incidences of side effects other than DILI were 25.4% and 30.7%(P=0.054) in the two groups. Conclusion Our findings suggest that the preventive administration ofdiammonium glycyrrhetate could reduce the incidence of DILI during anti-tuberculosis treatment, which might keep the regimen going smoothly.

Objective The aim of this study was to observe the clinical efficacy of adenosylmethionine and reduced glutathione in treating patients with drug-induced liver injury (DILI). Methods 90 patients with DILI were enrolled in our hospital between October 2017 and October 2020, and were randomly divided into control and observation group, with 45 cases in each group. The patients in the control group was treated with reduced glutathione, while those in the observation group was additionally treated with adenosylmethionine at base of reduced glutathione. Serum malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were routinely detected. Results After two to six (3.1±1.4) week treatment, serum ALT, AST and bilirubin levels in the observation group were (61.2±8.3)U/L, (54.5±7.4)U/L and (14.4±4.1)μmol/L, all significantly lower than [(86.5±11.5)U/L, (63.1±8.0)U/L and (21.5±5.4)μmol/L, respectively, P<0.05] in the control; serum prealbumin and cholinesterase levels were (205.5±1.9)mg/L and (5224.1±589.9)u/L, both significantly higher than [(188.5±34.2)mg/L and (4933.9±602.2)u/L, respectively, P<0.05], while serum total bile acids was (7.1±1.7)μmol/L, significantly lower than [(9.5±2.1)μmol/L, P<0.05] in the control; serum MDA level was (4.5±0.7)μmol/L, significantly lower than [(6.5±0.9)μmol/L, P<0.05], while serum SOD and GSH-Px levels were (83.1±7.9)U/L and (125.1±13.7)u/L, both significantly higher than [(75.9±7.2)U/L and (105.5±11.1) u/L, respectively, P<0.05] in the control group. Conclusion The short-term clinical efficacy of adenosylmethionine and reduced glutathione combination in treatment of patients with DILI is good, which could effectively inhibit inflammatory reactions and oxidative stress, and protect the liver functions.

Objective The aim of this study was to summarize the clinical features and gene mutation in patients with inherited metabolic liver diseases (IMLD). Methods 16 patients with IMLD were encountered in five tertiary hospital in Luoyang between 2000 and 2021, and the clinical materials and gene sequencing were reviewed retrospectively. Results Out of the 16 patients with IMLD, 10 were male and 6 were female, with the average age of(26±15)yr at presentation, including metal metabolic disorders in 8 cases (Wilson's disease in 7, hereditary haemochromatosis in 1), hereditary hyperbilirubinemias in 3 (Gilbert syndrome in 2, Dubin-Johnson syndrome in 1), hereditary cholestasis in 4 [benign recurrent intrahepatic cholestasis (BRIC) in 2, Alagille syndrome in 1 and Citrin deficiency 1 case) and glycogen storage disease in 1 case; 7 patients with Wilson's disease were from 4 families mainly with ATP7B mutation and the patients with hereditary haemochromatosis had HFE mutation, Gilbert syndrome had UGT1A1 mutation, Dubin-Johnson syndrome had ABCC2 mutation, BRIC had ATP8B1 mutation, Alagille syndrome had JAG1 mutation, Citrin deficiency had SLC25A13 mutation and glycogen storage disease had G6Pase mutation. Conclusion The Wilson's disease is common in patients with IMLD, and the diagnosis depends greatly on the clinical materials and gene sequencing.

Objective The aim of this study was to investigate serum ammonia level changes and itscorrelation to cognitive impairment (CI) in patients with hepatitis B cirrhosis and hepatic encephalopathy (HE). Methods There were 94 patients with hepatitis B liver cirrhosis and HE encountered in our hospital between March 2018 and September 2020, the cognitive impairment was estimated by Montreal cognitive assessment scale (MoCA) and homeostasis model assessment-insulin resistance (HOMA-IR) wascalculated. The Logistic regression model was applied to analyze the risk factors impacting cognitive impairment, and the area under receiver operating characteristic (AUC) was used to predict the occurrence of hepatic coma. Results There were 32 cases of hepatic coma out of 94 patients (34.0%) in our series; the blood ammonia level in patients with hepatic coma was (120.7±18.2) μmol/L, significantly higher than [(76.4±18.3)μmol/L,P<0.05], and the total score of MoCA was (13.7±1.2), significantly lower than [(18.2±2.9), P<0.05] in patients with mild to moderate CI; the scores of visuospatial executive ability, naming, attention, language, abstraction, delayed memory and orientation were (1.5±0.6),(1.6±0.7),(2.1±1.0),(1.7±0.6),(0.9±0.3),(2.0±0.8)and (4.9±0.8), all significantly lower than [(2.7±1.0),(2.2±0.9),(3.4±1.2),(2.5±0.7),(1.5±0.4),(4.4±1.1) and (5.4±1.0),respectively, P<0.05] in patients with mild to moderate CI; there was a significant negative correlation between serum ammonia levels and total MoCA scores in patients with hepatitis B cirrhosis and HE (r=-0.511, P<0.001); the Logistic multivariate analysis showed that blood ammonia (β=-0.529,95% CI=0.432-0.803, P<0.001), serum high sensitivity C-reactive protein levels (β= -0.345,95% CI=0.518-0.968,P =0.030) and HOMA-IR (β=-0.761,95% CI=0.289-0.755, P=0.002) were the independent influencing factors for patients with hepatic coma; the performance of our established prediction model: P=1/[1+e^{(0.242+0.980X1+0.529X2+0.345X3+0.761X4)}] was excellent with the AUC of 0.843 (SE=0.042,95%CI=0.760-0.926,P<0.001), and the sensitivity and specificity of 0.806 and 0.781, respectively in predicting the occurrence of hepatic coma. Conclusion The cognitive functions of patients with hepatitis B cirrhosis and HE is closely related to blood ammonialevels, and it might be helpful to predict the risk of hepatic coma by monitoring blood ammonia levels.

Objective The aim of this study was to explore the correlation of blood cluster differentiation (CD) antigen 64 (CD64) index, serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and interleukin-6 (IL-6) levels to intestinal mucosal barrier functions in patients with hepatitis B liver cirrhosis (LC) and spontaneous bacterial peritonitis (SBP). Methods Eighty-six cirrhotics were admitted to our hospital between October 2015 and February 2020, and fifty-four had SBP. The peripheral blood CD64 positive polymorphonuclear neutrophils, lymphocytes and monocytes were detected by flow cytometry and CD64 index was calculated automatically. Serum sTREM-1 and IL-6 levels were detected by ELISA. Blood endotoxin (ETX) and urine lactulose/mannitol (L/M) ratio were detected and calculated to determine intestinal mucosal barrier functions. Results At presentation, serum IL-6, sTREM-1, D-Lac, DAO, EXT as well as blood CD64 index and urine L/M ratio in patients with SBP were(122.1±37.9)ng/L,(60.3±12.4)μg/mL, (5.1±1.6)μg/mL, (14.2±2.2)μg/mL, (0.2±0.0)U/mL as well as (12314.3±324.3)mol/cell and (0.2±0.1), all significantly higher than [(78.6±28.2)ng/L,(51.4±10.6)μg/mL,(2.5±0.8)μg/mL,(9.8±1.6)μg/mL,(0.1±0.0)U/mL as well as (6376.52.5±0.3)mol/cell and (0.1±0.0), respectively, all P<0.05] in LC patients without SBP; after treatment, serum IL-6, sTREM-1, D-Lac, DAO, EXT as well as CD64 index and urine L/M ratio in patients with SBP were (71.2±23.9)ng/L, (17.5±5.1)μg/mL, (2.9±0.8)μg/mL, (14.2±2.2)μg/mL, (0.1±0.0)U/mL as well as (3398.2±258.2)mol/cell and (0.1±0.0), also all significantly higher than[(52.1±21.6)ng/L,(10.8±2.5)μg/mL,(2.3±0.5)μg/mL,(8.7±1.2)μg/mL,(0.0±0.0)U/mL as well as (2541.0±266.2)mol/cell and (0.0±0.0), respectively, all P<0.05] in cirrhotics without SBP; after treatment, serum IL-6 and sTREM-1 levels as well as blood CD64 index in 33 SBP patients with disabled intestinal mucosal barrier functions were(75.2±24.1)pg/mL and (19.5±4.9)μg/mL as well as (3642.2±242.1)mol/cell, all significantly higher than [(65.2±21.3)pg/mL and (14.8±4.3)μg/mL as well as (3123.2±168.4)mol/cell, respectively, P<0.05] in 21 patients with normal intestinal mucosal barrier functions. Conclusion The LC patients with SBP have abnormal intestinal mucosal barrier functions, which might take part in the pathogenesis of bacterial translocation.

Objective The aim of this study was to investigate the cancerous expression and functional relations of glypican3 (GPC3) and sonic Hedgehog (Shh) proteins in patients with hepatocellular carcinoma (HCC) and hepatoma cell lines in vitro. Methods The expression of GPC3 and Shh in cancerous and adjacent noncancerous tissues in 96 patients with HCC, and in HepG2, MHCC97H, Huh7 and SMMC7721 cells was assayed by immunochemical staining or by immunofluorescence staining and Western blotting. Results The positive rates of GPC3 and Shh protein expression were 77.1% and 68.8%, and the strong expression were 60.4% and 53.1% in our 96 patients with HCC; the positive rate of GPC3 protein in well-differentiated cancerous tissues was significantly higher than that in poorly-differentiated HCC (85.7% vs. 50.0%, P<0.05), and the positive rate of Shh protein was significantly higher than that in poorly-differentiated HCC (81.0% vs. 40.0%, P<0.05); the positive rate of GPC3 protein in cancerous tissues in patients with microvascular invasion (MVI) was significantly higher than that in those without (72.7% vs. 50.0%, P<0.05), and the positive rate of Shh protein was significantly higher than that in those without (65.9% vs. 42.3%, P<0.05); the GPC3 and Shh proteins were consistently co-expressed in the cytoplasm of hepatoma cells in vitro. Conclusion The GPC3 and Shh proteins might affect the differentiation of hepatoma cells and or the MVI formation, and the two proteins might interact each other in the carcinogenesis.

Objective The aim of this study was to investigate the diagnostic value of magnetic resonance imaging (MRI)and serum glypican 3 (GPC3) levels in patients with nodular regenerative hyperplasia (NRH). Methods A total of 79 patients with NRH were admitted to our hospital between March 2016 and August 2019. Serum GPC3 levels were detected by ELISA, and all patients underwent MRI scan. After finishing the check-up, all patients received hepatectomy. The differential value of MRI and serum GPC3 levels for the four types of hepatic lesions was analyzed by receiver operating characteristic (ROC) curves. Results The post-operational histopathological examination showed focal nodular hyperplasia (FNH) in 25 cases, liver cell adenoma (LCA) in 18 cases, dysplasia nodule(DN) in 20 cases and hepatocellular carcinoma (HCC) in 16 cases; serum GPC3 level in patients with HCC was (2.2±0.4) ng/ml, significantly higher than (1.0±0.2) ng/ml in patients with FNH, or (1.2±0.2) ng/ml in patients with LCA (P<0.05), while serum GPC3 level in patients with DN was (1.8±0.3) ng/ml, not significantly different compared to that in patients with HCC (P>0.05); the accuracy by MRI in diagnosing HCC, DN, FNH and LCA were 88.0%(22/25), 88.9%(16/18), 70.0%(14/20) and 75.0%(12/16), not significantly different (P>0.05); the AUC of MRI and serum GPC3 level combination in diagnosing HCC was 0.760, significantly higher than in other three hepatic lesions (0.610, 0.611 and 0.614, respectively, P<0.05). Conclusion MRI and serum GPC3 level combination in distinguishing hepatic NRH is promising and efficacious, which warrants further clinical investigations.

Objective The aim of this study was to explore the application of contrast-enhanced ultrasound (CEUS) parameters in the quantitative diagnosis of patients with hepatocellular carcinoma (HCC). Methods 50 patients with HCC and 5o patients with liver cirrhosis were admitted to our hospital between January 2018 and May 2021, and the diagnoses in all patients were confirmed by pathological examination after liver biopsies. The CEUS was conducted to obtain the peak intensity (PI), the time to peak (TTP), mean trasit time (mTT), the rise time (RT), and the blood perfusion feature was recorded. Results The local blood volume and local blood flow during arterial phase in patients with HCC were (3399.7±783.7) rBV and (64.1±18.7) rBF, significantly higher than [(1363.8±773.5) rBV and (41.9±10.6) rBF, respectively, P<0.05] in patients with cirrhosis, and the local blood volume during venous and delayed phases were (1325.8±546.3) rBV and (463.2±143.2) rBF, significantly lower than [(1775.4±541.3) rBV and (721.2±242.5) rBF, P<0.05] in patients with cirrhosis; the RT, TTP and mTT in cancerous foci were (15.7±8.3) s, (22.6±5.4) s and (133.5±92.3)s, significantly lower than [(26.3±6.4)s, (32.3±7.6)s and (160.4±112.8)s, respectively, P<0.05], while the PI was (85.2±48.2)dB, significantly higher than [(31.5±3.5)dB, P<0.05] in patients with cirrhosis; at the base of histopathological diagnosis as the gold criteria, the sensitivity, specificity and accuracy by CEUS diagnosis were 92.0%, 92.0% and 80.0%. Conclusion The CEUS quantitative parameters could help the diagnosis of patients with HCC, which is of great clinical application.

Objective The purpose of this study was to investigate the application of three-dimensional (3D) computed tomography (CT) reconstruction in the evaluation of resectability of giant intrahepatic tumors in patients with primary liver cancer (PLC). Methods 68 PLC patients with giant intrahepatic tumors were encountered in our hospital between January 2018 and January 2020, and all patients underwent CT scan and 3D reconstruction with 3d visualization software -MI-3DVS before hepatectomy. The tumor size, morphology, blood supply and its relationship with surrounding tissues, the hepatic artery and portal vein involvement, as well as lymph node metastasis were observed, and the resectability of tumors was determined. Results The reconstruction was finished in all the patients, which could clearly show the tumor size, morphology, blood supply and its relationship with surrounding tissues, demonstrating hepatic artery involvement in 18 cases, portal vein involvement in 20 cases, and the lymph node metastasis in 12 cases; the resectability was made in 42 cases (61.8%) based on the 3D reconstruction of CT scan, while the hepatectomy was successfully carried out in 45 cases(66.2%); the consistency analysis showed that the sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Kappa value of CT scan 3d reconstruction in the evaluation of hepatic artery involvement were 84.2%, 95.9%, 92.6%, 88.9%, 94.0% and 0.814, those of in the evaluation of portal vain involvement were 86.4%, 97.8%, 94.1%, 95.0%, 93.8% and 0.862, in the evaluation of lymph node metastasis were 84.6%, 98.2%, 95.6%, 91.7%, 96.4% and 0.853, and in the evaluation of resectability of tumors were 91.1%, 95.7%, 92.6%, 97.6%, 86.4% and 0.841. Conclusion The CT scan 3D reconstruction technology could demonstrate the intrahepatic tumor involvement of blood vessels and lymph node metastasis in PLC patients with massive tumor mass, which could tell the surgeons what tumor resectable and guide the hepatectomy in clinical practice.

Objective The aim of this study was to summarize the clinical features of patients with biliary liver injury (BLI) and observe the magnetic resonance cholangiopancreatography(MRCP)and endoscopic retrograde cholangiopancreatography(ERCP) results. Methods 77 patients with BLI were recruited in our hospital between January 2018 and December 2019, and all underwent MRCP and ERCP, and endoscopic sphincterotomy (EST) when necessary. Result Among the 77 patients, the clinical symptoms and sign included jaundice in 70 cases (90.9%), abdominal pain in 65 cases (84.4%), and fever in 27 cases (35.1%), and the MRCP found negative in 34 and positive in 43 cases; the ultrasound examination showed cholelithiasis in 48 cases(62.3%), and cholecystectomy history in 14 cases (18.2%); 71 cases (92.2%) were diagnosed as choledocholithiasis by ERCP, and the percentage of mud-like stones in common bile duct in MRCP negative group was 91.2%, significantly higher than 9.3% in MRCP positive group; there was no significant differences respect to age, gender, incidence of abdominal pain and jaundice between the two groups(P＞0.05); the incidence of fever in the MRCP negative group was 20.6%, significantly lower than 46.5% in MRCP positive group (P＜0.05); the percentage of neutrophils in MRCP negative group was (66.6±14.4)%, significantly lower than (74.6±14.8)% in MRCP positive group (P＜0.05); there were no significant differences respect to blood biochemical parameters between the two groups (P>0.05); the success rates and the complication rates of ERCP in the two groups were not significantly different(P＞0.05). Conclusion The mud-like stones in common bile duct are the most common cause of BLI in MRCP negative patients, and the ERCP is a safe and effective treatment for the patients with BLI when the MRCP examination is negative.

Objective The aim of this study was to investigate the changes and clinical implication of serum procalcitonin (PCT) and interleukin-6 (IL-6) levels in patients with biliary tract stone after stone removal under endoscopic retrograde cholangiopancreatography (ERCP). Methods 142 patients with common bile duct stones and 120 healthy persons were enrolled in this study between July 2010 and July 2020, and all patients underwent stone removal under ERCP. Serum PCT and IL-6 were detected by enzyme-linked immunosorbent assay and double-antibody sandwich immunoluminescence assay. The forecasting value of serum parameters was evaluated by area under receiver operating characteristic curve (AUC). Results Before operation under ERCP, serum PCT, IL-6 levels, peripheral blood white blood cell (WBC) counts, serum ALT, bilirubin and GGT levels in 142 patients with biliary tract stone were (5.1±1.8)μg/L, (63.8±18.3)pg/mL, (13.7±2.8)×10⁹/L, (86.8±8.8)U/L, (49.4±16.6)μmol/L and (89.5±22.7)U/L, they decreased to (2.5±1.9)μg/L, (31.9±12.2)pg/mL, (6.5±3.1)×10⁹/L, (79.2±5.3)U/L, (13.0±3.3)μmol/L and (56.8±14.8)U/L three days after operation, but all significantly higher than [(0.3±0.1)μg/L, (25.0±8.2)pg/mL, (5.2±0.8)×10⁹/L, (18.7±6.8)U/L, (8.3±2.7)μmol/L and (24.2±6.1)U/L, respectively, P＜0.05] in control; the post-operational biliary infections occurred in 18 cases(12.7%) out of our series, and the Gram-negative and Gram-positive bacteria accounted for 83.3% and 16.7%, respectively; serum PCT, IL-6 and peripheral blood WBC counts in patients with biliary infection were (4.9±1.1)μg/L, (52.3±10.6)pg/mL and (11.4±1.3)×10⁹/L, all significantly higher than [(0.1±0.0)μg/L, (28.9±8.2)pg/mL and (5.8±2.1)×10⁹/L, respectively, P＜0.05] in those without infection; the ROC analysis showed that the sensitivity (Se) and specificity (Sp) were 91.8% and 74.3% by serum PCT, 95.4% and 80.5% by serum IL-6, and 94.1% and 78.1% by WBC counts, but they increased to 93.2% and 91.1% by the three combination, significantly higher than anyone alone (P＜0.05) in predicting biliary infection after the stone removal under ERCP. Conclusion The surveillance of serum PCT and IL-6 levels might help predict the biliary infection in patients with cholelithiasis after stone removal under ERCP, and guide clinical management early and appropriately.

Objective The aim of this clinical observation was to investigate the efficacy and safety of CT-guided percutaneous transhepatic choledochoscopic lithoteipsy (PTCSL) and dual-frequency laser lithotripsy (DFLL) combination in the treatment of patients with recurrent hepatolithiasis. Methods A total of 60 patients with recurrent hepatolithiasis were admitted to our hospital between September 2017 and February 2020, and 31 patients in group A received CT-guided PTCSL and DFLL and 29 patients in group B underwent open choledochofiberscope and DFLL. Serum cortisol (COR) and epinephrine (EP) were detected. Results The operation time, exhaust time, first defecation time and postoperative hospitalization stay in group A were(89.7±10.1)min, (30.3±3.6)h, (2.3±0.3)d and (6.9±1.1)d, all significantly shorter than [(101.9±12.2)min, (34.7±4.1)h, (2.7±0.4)d and (11.8±1.6)d, respectively, P＜0.05], while blood loss was (40.2±8.8)ml, much less than [(97.4±10.6)ml, P＜0.05] in group B; at the end of seven days after operation, the white blood cell counts, neutrophil percentage, serum COR and EP levels were (9.7±1.0)×10⁹/L, (67.8±5.9)%, (310.1±30.7)mmol/L and (210.7±22.8)pg/mL, significantly lower than [(11.8±1.3)×10⁹/L, (76.4±7.1)%, (385.5±34.4)mmol/L and (247.3±23.1), respectively, P＜0.05] in group B; serum ALT, AST, ALP and bilirubin level were (39.7±3.7)U/L, (39.9±4.1)U/L, (80.1±8.5) and (19.4±1.8)μmol/L, significantly lower than [(45.6±5.1)U/L, (45.5±5.1)U/L, (85.9±6.8) and (23.0±3.4), respectively, P＜0.05] in group B; the incidence of postoperative complications was 9.7%, significantly lower than 41.4% (P<0.05) and the stone residual rate was 6.5%, significantly lower than 31.0% in group B(P＜0.05). Conclusion CT-guided (PTCSL) and DFLL combination could reduce surgical damage, accelerate postoperative recovery of gastrointestinal functions with low stone residual rate, which might be related to less oxidative stress and inflammatory reaction.

Objective The aim of this study was to observe the clinical efficacy of partial hepatectomy and choledochojejunostomy in treatment of patients with hepatolithiasis. Methods 68 patients with hepatolithiasis were admitted to our hospital between February 2017 and February 2020, and 38 patients in the observation group underwent partial hepatectomy and choledochojejunostomy., and 30 cases in the control underwent partial hepatectomy only. All patients were followed-up for 12 months after surgery. Serum interleukin-6 (IL-6) and C-reactive protein (CRP) were detected by ELISA or by double-antibody sandwich immunoluminescence method. Results The operation time, intraoperative blood loss and hospitalization stay in observation group were(106.7±29.8)min,(261.7±64.2)mL and (15.5±3.5)d, significantly longer or greater than [(64.3±27.7)min,(190.3±49.0)mL and (10.2±2.3)d, respectively, P＜0.05] in the control; seven days after operation, serum CRP and IL-6 levels in the observation group were (38.0±5.9)mg/L and (99.6±10.7)μg/L, significantly higher than [(25.2±5.1)mg/L and (83.6±9.8)μg/L, respectively, P＜0.05] in the control; there were no significant differences respect to serum hepatic function tests before and after operation between the two groups (P>0.05); at the end of three month followed-up, the incidences of incisional infection, bile leak, biliary bleeding and pleural-peritoneal effusion in the two groups were not significantly different (13.2% vs. 13.3%, P＞0.05); the sonography check-up six weeks after surgery showed that the stone residual rate in the observation group was 5.3% (2/38), significantly lower than 23.3% (7/30, P<0.05) in the control, and at the end of 12-month followed-up, the stone recurrence in the observation group was 13.2%, significantly lower than 33.3%(P＜0.05) in the control. Conclusion The application of partial hepatectomy and choledochojejunostomy in the treatment of patients with hepatolithiasis might reduce stone residuals and recurrence, and needs to be further verified.

Objective The aim of this study was to summarize the ultrasonographic features in patients with acute purulent cholecystitis (APC). Methods 50 patients with simple cholecystitis (SC) and 41 patients with APC were encountered in our hospital between April 2019 and April 2021, and all received sonography, and laparoscopic cholecystectomy. The diagnosis was proven by post-operational histopathological examination. Results The positive rates of poor bile acoustic transmission, gallbladder enlargement, thickened or rough gallbladder wall and positive Murphy sign in patients with APC were 85.4%, 92.7%, 82.9% and 90.2%, all significantly higher than 52.0%, 60.0%, 62.0% and 28.0%, respectively (P＜0.05) in patients with SC; out of 41 patients with APC, the color ultrasonographic examination misdiagnosed as cholestasis in 1 case (2.4%), as simple gallstones in one case(2.4%), and as SC in three cases(7.3%); at presentation, the white blood cell counts in patients with APC was (15.1±3.5)×10⁹/L, significantly higher than [(9.8±4.9)×10⁹/L, P＜0.05], total serum bilirubin level was (25.3±2.7)μmol/L, significantly higher than [17.1±3.1μmol/L, P＜0.05], and serum AST level was (97.1±5.6)U/L, significantly higher than [(36.7±4.7)U/L, P＜0.05] in patients with SC; after surgery, serum AST level was (50.3±4.3)U/L, still significantly higher than [(29.8±4.6)U/L, P＜0.05] in patients with SC. Conclusion Doppler ultrasonography could evaluate gallbladder morphology, gallbladder wall thickness, bile acoustic transmission and Murphy sign in patients with APC, which could provide a reliable imaging feature for the diagnosis of patients with acute purulent cholecystitis.

Objective The aim of this study was to compare the efficacy and safety of laparoscopic common bile duct exploration (LCBDE) or endoscopic sphincterotomy (EST) and laparoscopic cholecystectomy (LC) combination in the treatment of patients with gallbladder stone and choledocholithiasis. Methods 150 patients with gallbladder stones and choledocholithiasis were admitted to our hospital between April 2017 and April 2020, and 77 patients in observation group underwent LCBDE and LC, and 73 patients in control underwent EST and LC combination surgery. They were followed-up for 12 months after surgery. Serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were detected by ELISA. Results The operation time and intraoperative blood loss in observation group were (143.3±17.7) min and (24.3±13.0) mL, significantly longer or much more than [(96.7±10.8) min and (16.7±7.2) mL, P<0.05], the postoperative hospitalization stay and medical cost were (6.2±1.3) d and (3.2±1.0) ten thousands yuan, significantly shorter or less or than [(7.1±1.5) d and (4.3±1.1) ten thousands yuan, P<0.05] in the control; at day five after surgery, serum IL-6 level and peripheral white blood cell count were (27.7±6.2) μg/L and (9.1±1.1)×10⁹/L, significantly lower than [(30.5±7.7) μg/L and (10.5±1.6)×10⁹/L, P<0.05] in the control group; no stone residual in the two groups was found by sonography three months after surgery, and at 12 months of follow-up, the stone recurrence in the observation was 7.8%, not significantly different compared to 11.0% in the control (P＞0.05); two weeks after surgery, the incidence of bile fistula in the observation was 10.4%, significantly higher than 1.4%(P＜0.05), while the incidences of pancreatitis and hyperamylasemia were 2.6% and 1.3%, significantly lower than 13.7% and 16.4% (P＜0.05) in the control. Conclusion The application of LCBDE and LC combination in the treatment of patients with gallbladder stone and choledocholithiasis could shorten hospitalization stay and reduce medical cost, while the stone clearance by the two surgical methods is similar, and the appropriate surgical choice could be made by clinicians.

Objective The aim of this study was to compare the efficacy and safety of early and late sequential percutaneous trans-hepatic gallbladder drainage (PTGBD) and laparoscopic cholecystectomy (LC) for the treatment of patients with acute cholecystitis. Methods 145 patients with acute cholecystitis were admitted to our hospital between March 2019 and June 2020, 70 patients received PTGBD within seven days after onset of the disease and sequential LC (early PTGBD), and other 75 patients received PTGBD seven days after onset of the disease and sequential LC (lately PTGBD). Serum C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels were detected by ELISA. Results During LC, the blood loss in the lately PTGBD group was (26.8±9.3) mL, significantly less than [(46.12±16.3) mL, P<0.05] in the early PTGBD group, the operation time was (67.3±9.2) min, significantly shorter than [(83.2) ±8.3) min, P<0.05], the anal exhaust time was (22.5±5.9) h, significantly shorter than [(28.2±6.2)h, P<0.05], and the abdominal drainage time was (3.3±1.1) d, significantly shorter than [(6.6±1.3) d, P<0.05] in the early PTGBD group; serum aspartate aminotransferase and alanine aminotransferase levels in the lately PTGBD group were significantly lower than those in the early PTGBD group (P＜0.05), and serum CRP, IL-6 and TNF-α levels in the lately PTGBD group were significantly lower than those in the early PTGBD group (P＜0.05); the incidence of postoperative complications, such as bile leak and infections in the lately PTGBD was 5.3%, significantly lower than 20.0% in the early PTGBD group (P<0.05). Conclusion The late PTGBD and sequential LC in dealing with patients with acute cholecystitis is efficacious and safe, with less post-operational complications.

Objective The aim of this study was to investigate the short-term efficacy of lateral lobe hepatectomy in treatment of patients with hepatolithiasis and biliary stricture. Methods 72 patients with hepatolithiasis and biliary stricture were enrolled in our hospital between January 2015 and January 2020, and 38 patients in the observation group received lateral lobe hepatectomy, and 34 in the control group underwent conventional surgery. All patients were followed-up for 12 months. Results The operation time, intraoperative blood loss and post-operational hospitalization stay in the observation were (177.4±20.7)min, (220.6±22.5) ml and (7.1±1.5)d, not significantly different compared to [(185.6±25.3)min, (226.2±23.7) ml and (7.5±2.0)d, P>0.05] in the control group; at the end of seven days after operation, serum ALT, AST and ALP levels in the observation were (35.5±4.2)U/L, (52.4±6.9)U/L and (61.5±6.2)U/L, all significantly lower than [(50.6±5.3)U/L, (79.8±7.2)U/L and (87.6±7.3)U/L, respectively, P<0.05] in the control; the stone clearance rate in the observation group was 100.0%, not significantly different compared to 97.1%(P>0.05) in the control; post-operationally, the complications, such as infection of incisional wound, Acute obstructive suppurative cholangitis, subphrenic abscess and bile leakage in the observation was 7.9%, significantly lower than 26.5%(P<0.05) in control; during followed-up period, the incidence of stone residual rate, stone recurrence rate and the need for re-surgery in the observation group were 0.0%, 2.6% and 2.6%, all significantly lower than 14.7%, 20.6% and 20.6%, respectively, in the control group (P<0.05). Conclusion The short-term efficacy of lateral lobe hepatectomy in treatment of patients with hepatolithiasis and biliary stricture in good, with lower incidence of postoperative complications, lower stone residual and stone recurrence, which warrants further clinical verification.

Objective The aim of this study was to compare the curative efficacy of laparoscopic-choledochoscopic cholelithotomy and laparoscopic cholecystectomy (LC) in patients with gallbladder stones. Methods 78 patients with gallbladder stones were admitted to our hospital between February 2015 and February 2020, and out of them, 36 patients underwent laparoscopic-choledochoscopic cholelithotomy and 42 patients underwent LC. They were followed up for 12 months after surgery. Serum cortisol and C-reactive protein (CRP) levels were detected by ELISA or double-antibody sandwich immunoluminescence assay. Results The operation time and hospitalization cost in observation group were (53.3±17.7) min and (3.2±0.5) ten thousand yuan, significantly longer or higher than [(36.7±10.8) min and (2.3±0.4) ten thousand yuan, P<0.05], and the postoperative eating time and anal exhaust time were (2.8±0.9) h and (14.9±3.2) h, significantly shorter than [(3.3±0.7) h and (19.3±4.1) h, respectively, P<0.05] in the control; 3 days after surgery, serum CRP and COR levels in the observation group were (11.2±3.1) mg/L and (195.6±30.8) ng/mL, significantly lower than [(19.0±4.9) mg/L and (211.6±32.7) ng/mL, respectively, P<0.05] in the control; the ultrasonography 2 weeks after surgery showed that there were no residual stones in the observation group, and the gallbladder function was intact; at 3 months of follow-up, the incidence of complications, such as incision infection, abdominal distension and diarrhea, reflux gastritis, biliary hemorrhage and acute pancreatitis in the observation group was significantly lower than that in the control group (11.1% vs. 31.0%, P<0.05); at the end of 12-month follow-up, one patient (2.8%) had stone recurrence. Conclusion The application of laparoscopic-choledochoscopic cholelithotomy in the treatment of patients with gallbladder stone might be more beneficial to the recovery of gastrointestinal functions with less postoperative complications.

Objective The aim of this study was to observe the curative effect of CT-guided one-step percutaneous transhepatic cholangial drainage (PTCD) in the treatment of patients with malignant obstructive jaundice (MOJ). Methods 60 patients with MOJ were enrolled in our hospital between January 2017 and December 2019, and they were divided randomly into control (n=30) and observation group (n=30). The patients were given PTCD under the guidance of X-ray fluoroscopy in the control or CT-guided one-step puncture in the observation. Results During the operation, the one-time success rate of puncture in the observation group was significantly higher than that in the control group (96.7% vs. 43.3%, P<0.05), the fluoroscopy time was significantly shorter than that in the control group [(13.6±2.1) s vs. (32.6±4.1) s, P<0.05], the total puncture time was significantly shorter than that in the control group [(48.9±10.3) s vs. (92.3±13.6) s, P<0.05], and the radiation exposure dose was significantly less than that in the control group [(2.5±0.3) mGy vs. (5.8±1.1) mGy, P<0.05]; at the end of two weeks after the surgery, total serum bilirubin level in the observation group decreased from (241.8±83.6) μmol/L to (109.8±45.6) μmol/L, that in the control decreased from (242.4±91.2)μmol/L to (108.4±61.9)μmol/L, and there were no significant differences respect to other liver function tests between the two groups (P>0.05); at the end of three month, the post-operational complications such as biliary infection, bleeding, liver abscess and peritonitis in the observation was 3.3%, significantly lower than 26.6% in the control(P<0.05). Conclusion CT-guided one-step PTCD in dealing with patient with malignant obstructive jaundice could improve the puncture successfully, which might be applied in clinical practice overwhelmingly.

Objective The aim of this study was to summarize the imaging features of multi-slice spiral CT (MSCT) in patients with gallbladder adenomyosis and in patients with gallbladder carcinoma. Methods 113 patients with gallbladder adenomyosis and 78 with gallbladder carcinoma were enrolled in our hospital between September 2015 and September 2020, and all patients underwent MSCT and ultrasonography. The histophthological examination was performed after surgery. Results The consistency of diagnosis by MSCT based on postoperative histopathological examination (Kappa=0.749) was stronger than that by ultrasonography (Kappa=0.577); the accuracy rate by MSCT scan in the diagnosis of patients with gallbladder adenomyosis was higher than that by ultrasonography(88.0% vs. 79.6%, P<0.05); the diagnosis of special, local gallbladder adenomyosis, by MSCT was also higher than that by ultrasonography (97.1% vs. 82.9%, P<0.05); the CT scan showed that the percentages of smooth gallbladder walls, RAS sinus display and clear boundary between liver and gallbladder in patients with gallbladder adenomyosis were 36.3%, 36.3% and 69.0%, all significantly higher than 9.0%, 6.4% and 38.5% in patients with gallbladder carcinoma (P<0.05). Conclusion The diagnostic accuracy of patients with gallbladder adenomyosis by MSCT is relatively high, and its imaging feature might help discriminate gallbladder adenomyosis from cancer.

Objective The liver cirrhosis (LC) is the consequence of various chronic liver diseases, with liver function abnormality and portal hypertension occurring in the decompensatory stage. The non-selective beta-blockers (NSBB) has been one of the main medicine for patients with portal hypertension in almost 3 decades, inasmuch as its capacity in reducing portal pressure, though, at the same time, the hemodynamic effects of NSBB can influence the circulatory function of patients. When and how to prescribe NSBB depends on patients' conditions. We aimed to review the reasonable application and controversy of NSBB treatment in cirrhotic patients.

Objective Dietary copper restriction has long been considered an important treatment for patients with hepatolenticular degeneration (HLD). However, evidence supporting this approach is limited. There are no published randomised controlled trials for the recommendation due to rarity of the disease and variable presentation. This review summarized current knowledge on the absorption and regulation of copper in humans and its relevance to patients with HLD. Studies have demonstrated that as the level of dietary copper increases, the proportion absorbed decreases. This observation implies that ‘high copper' foods that HLD patients are generally advised to avoid would need to be consumed in large amounts to impact markedly on the quantity absorbed. Dietary copper restriction is unlikely to reduce the amount absorbed significantly and is not only difficult to manage but restricts food supply unnecessarily, detracting from the provision of substrates essential for improving nutritional status in a nutritionally compromised group. Medical management for HLD is effective in compliant patients, allowing stabilization of the liver disease. Based on current evidence, dietary copper restrictions in stable HLD patients who are adherent to medical therapy are unnecessary with two food exceptions (shellfish and liver organ).