Objective The purpose of this experiment was to investigate the effect of PAX6 on inhibition of activation and proliferation of hepatic stellate cells (HSCs) by through MEK/ERK signaling pathway. Methods The LX2 HSCs were divided into control, PAX6 inhibitor and PAX6 mimics group and managed accordingly. The cell proliferation was determined by CCK-8 kit, the cell differentiation was detected by oil red O staining, the cell apoptosis was analyzed by flow cytometry, and PAX6, MEK and ERK mRNA and their protein expression were assayed by RT-PCR and Western blotting, respectively. Results The PAX6 mRNA level, apoptosis rate and G1 stage in PAX6 inhibitor-intervened group were (1.49±0.23), (2.70±0.85)% and (59.02±1.25)%, significantly lower than [(1.85± 0.19), (3.40±0.47)% and (64.66±1.41)%, respectively, P<0.05] in LX2 HSCs, and the cell proliferation, survival rate, differentiation rate, MEK and ERK mRNA and their protein expression in PAX6 inhibitor-intervened group were (0.79±0.03), (73.35±9.74)%, (49.37±4.24)%, (2.55±0.43), (3.90±0.49), (0.89±0.15) and (1.17±0.17), significantly higher than [(0.58±0.05), (60.74±9.24)%, (29.35±4.47)%, (2.67±0.47), (4.55±0.50), (0.74±0.14) and (1.35±0.16), respectively, P<0.05] in the control; the PAX6 mRNA level, apoptosis rate and G1 stages in PAX6 mimics-intervened group were (2.67±0.20), (6.70±1.04)% and (66.38±1.35)%, significantly higher than [(1.85± 0.19), (3.40±0.47)% and (64.66±1.41)%, respectively, P<0.05] in the control, and the cell proliferation, survival rate, differentiation rate, MEK and ERK mRNA and their protein expression in PAX6 mimics group were (0.40±0.04), (52.24±5.57)%, (13.85±3.35)%, (1.94±0.53), (1.45±0.42), (0.53±0.15) and (0.53±0.16), significantly lower than [(0.58 ±0.05), (60.74±9.24)%, (29.35±4.47)%, (2.67±0.47), (4.55±0.50), (0.74±0.14) and (1.35±0.16), respectively, P<0.05] in the control. Conclusion The PAX6 overexpression could inhibit the activation and proliferation of hepatic stellate cells, and promote cell apoptosis. The mechanism involved might be related to the inhibition of MEK and ERK expression and MEK/ERK pathway in hepatic stellate cells.

Objective The purpose of this experiment was to investigate hepatitis B whole x (HBwx) gene promotes inflammation reaction of hepatic stellate cells (HSCs) and triggers hepatocyte apoptosis in vitro. Methods The LX2 cells were divided into control, lipopolysaccharide (LPS)-, HBwx transfected and LPS and HBwx transfection combination-intervened groups. The cell p62 and LC3 as well as NOD-like receptor protein 3 (NLRP3) and pro-IL expression were detected by Western blot, and supernatant IL-1β levels were detected by ELISA. The HL7702 hepatocytes were co-cultured by the supernatants of LX2 cells intervened mentioned above. The cell apoptosis was detected by FCM. Results The HBwx protein was clearly expressed in the cytoplasm of transfected LX2 cells; the LC3 expression decreased, while p62 expression increased in LPS-, HBwx- and LPS and HBwx combination-intervened groups as compared to in the control (P<0.05); the NLRP3 and pro-IL expression increased in LPS-, HBwx- and LPS and HBwx combination-intervened groups as compared to in the control (P<0.05); the supernatant IL-1β levels increased in LPS-, HBwx- and LPS and HBwx combination-intervened groups as compared to in the control (P<0.05); the apoptosis of HL-7702 cells significantly increased in LPS-, HBwx- and especially in LPS and HBwx combination-intervened groups as compared to in the control (P<0.05). Conclusions HBwx promotes inflammatory reaction in HSCs by inhibition of cell autophagy and induces hepatocyte apoptosis.

Objective The purpose of this study was to observe the application of entecavir and magnesium isoglycyrrhizinate combination in the treatment of patients with chronic hepatitis B (CHB). Methods A total of 98 patients with CHB were enrolled in our hospital between January 2019 and February 2020, and were randomly divided into control (n=49) and observation group (n=49), receiving entecavir or entecavir and magnesium isoglycyrrhizinate combination therapy for 48 weeks. Serum hyaluronan (HA), laminin (LN), type-IV collagen (CIV) and type-III procollagen (PIIIP) levels were detected by radioimmunoassay. Serum interleukin 2 (IL-2), interleukin 4 (IL-4), interleukin 10 (IL-10) and tumor necrosis factor α (TNF-α) levels were detected by ELISA. The peripheral blood T lymphocyte subsets were detected by flow cytometry. Results At the end of 48 week observation, serum ALT normalization rate in the observation group was 87.8%, significantly higher than 71.4%(P＜0.05) in the control; serum ALT and AST levels in the combination group were (32.3±6.9)U/L and (38.3±4.7)U/L, both significantly lower than [(47.5±7.6)U/L and (52.9±5.1)U/L, respectively, P＜0.05] in the control; serum HA and PⅢP levels were (90.6±9.5)ng/mL and (141.6±32.6)ng/mL, both significantly lower than [(126.8±14.6)ng/mL and (168.2±29.9)ng/mL, respectively, P＜0.05] in the control; serum IL-4 and TNF-α levels were (48.8±7.9)ng/L and (11.3±1.9)ng/L, significantly lower than [(62.6±8.8)ng/L and (18.5±1.7)ng/L, respectively, P＜0.05], while serum IL-10 level was (19.2±2.5)ng/L, significantly higher than [(12.7±3.4)ng/L, P＜0.05] in the control; the percentage of peripheral blood CD4⁺ cells and the ratio of CD4⁺/CD8⁺ cells were (43.5±5.5)% and (1.6±0.2), both significantly higher than [(38.4±4.7)% and(1.4±0.4), respectively, P＜0.05] in the control group. Conclusion The application of entecavir and magnesium isoglycyrrhizinate combination in the treatment of patients with CHB could effectively improve liver function test normal, inhibit the process of liver fibrosis, which might be related to the inhibition of inflammatory reaction and modulation of immune system.

Objective The aim of this study was to investigate the short-term efficacy of adefovir dipivoxil (ADV) and entecavir (ETV) or tenofovir (TDF) combination rescued therapy in patients with chronic hepatitis B and rtA181V/T mutation. Methods Fifty patients with CHB and rtA181V/T mutation were admitted to the Department of Infectious Diseases in our hospital between January 2017 and January 2020, and were divided randomly into two groups, receiving ADV and TDF or ADV and ETV treatment, with 25 cases in each. Serum HBV DNA loads was assayed by real-time fluorescent quantitative PCR. Serum β2-microglobulin (β2-MG), retinol-binding protein (RBP) and serum creatinine (sCr) were detected, and creatinine clearance (Crcl) and estimaated glomerular filtration rate (eGFR) were calculated. Peripheral blood T lymphocytes were performed by flow cytometry. Results At the end of 24-week and 48-week, serum HBV DNA negative rate in patients receiving ADV and TDF combination treatment were 100.0% and 100.0%, not significantly different compared to 96.0% and 96.0%, respectively, in ADV and ETV combination-treated patients (P>0.05); serum AST levels were (49.2±5.5)U/L and (30.4±4.0)U/L, significantly lower than [(55.3±7.0) U/L and (43.2±6.8) U/L, respectively, P<0.05], serum ALT levels were (40.3±6.1) U/L and (39.1±4.3) U/L, significantly lower than [(65.1±7.5)U/L and (45.3±6.1)U/L,P<0.05], and serum HBV DNA loads were (0.8±0.2)lg IU/mL and (2.0±0.4)lg IU/mL, significantly lower than [(2.9±0.3)lg IU/mL and (1.2±0.2) lg IU/mL, respectively, P<0.05] in ADV and ETV combination-treated patients; the percentages of peripheral blood CD4⁺ cells were(45.2±3.6)% and (48.3±4.2)%, and the ratios of CD4⁺/CD8⁺ cells were (1.4±0.2) and (1.8±0.1), significantly higher than [(42.4±3.1)% and (45.0±3.2)%, and (1.2±0.1)and (1.5±0.1), respectively, P<0.05] in ADV and ETV combination-treated patients; there was no significant changes of renal function tests in the two groups. Conclusion The short-term efficacy of ADV and TDF combination therapy in patients with CHB and rtA181V/T mutation is good, with the rapid inhibition of viral replication and stable liver function tests without side effects.

Objective The aim of this study was to explore the predictive value of serum microRNAs (miR)-21 and miR-148b for liver histopathological inflammation grading and fibrosis staging in patients with chronic hepatitis B (CHB). Methods 134 patients with CHB were enrolled in our hospital between July 2016 and June 2021, and all underwent liver biopsy. The liver tissue inflammation grading (G) and fibrosis staging (S) was evaluated. Serum miR-21 and miR-148b levels were detected by real-time quantitative PCR. The diagnostic efficacy of serum miR-21 and miR-148b levels in predicting liver damages was carried out by the area under the receiver operating characteristic curve (AUROC). Results The liver histopathological examination showed G1 in 23 cases, G2 in 39 cases, G3 in 47 cases and G4 in 25 cases, and S1 in 31 cases, S2 in 46 cases, S3 in 28 cases and S4 in 29 cases out of our 134 patients with CHB; serum miR-21 levels in patients with G1, G2, G3 and G4 were (1.1±0.2), (1.5±0.3), (1.8±0.4) and (2.2±0.6), and serum miR-148b levels were (2.4±0.5), (2.0±0.3, (1.6±0.5) and (1.2±0.4), significantly different among them (P＜0.05); serum miR-21 levels in patients with S1, S2, S3 and S4 were (0.9±0.4), (1.4±0.3), (1.9±0.5) and (2.7±0.5), and serum miR-148b levels were (2.8±0.7), (1.9±0.4), (1.4±0.4) and (0.9±0.2), significantly different among them (P＜0.05); the AUC was 0.875 in predicting significant liver inflammatory activities by the combination of serum miR-21 and miR-148b when serum miR-21=1.5 and miR-148b=2.0 were set as the cut-off-value, significantly higher than by any of the two alone (0.769 and 0.781, respectively, P＜0.05), with the sensitivity (Se), specificity (Sp) and accuracy (Ac) of 87.0%, 82.9% and 83.6%; and the AUC was 0.898 by the combination of the two parameters in predicting significant liver fibrosis when serum miR-21 =1.4 and miR-148b=1.9 were set as the cut-off-value, significantly higher than by any one of the two alone (0.782 and 0.770, respectively, P＜0.05), with the Se of 87.1%, Sp of 73.8% and Ac of 76.9%. Conclusion The diagnostic efficacy by serum miR-21 and miR-148b levels in predicting liver histopathogical injuries in patients with CHB might be high, and needs further investigation.

Objective The aim of this study was to investigate entecavir resistance gene mutation in nucleosi(t)de-treated patients with chronic hepatitis B (CHB). Methods 107 nucleosi(t)de-treated patients with CHB and entecavir-resistance mutation were enrolled in our hospital between October 2016 and October 2020. Serum gene amplification of HBV RT was conducted by nested PCR, and the genotypes were identified by MEGA4 software. The HepG2 cells were transfected by liposome in vitro with different HBV mutants, the cells were intervened by lamivudine, adefovir, entecavir and tenofovir, and the supernatant HBV DNA loads were detected by PCR. Results Out of the 107 nucleosi(t)de-treated patients with CHB in our series, the percentages of entecavir resistance gene rtS202G/M204V/L180M was 40.2%, significantly higher than in patients with rtT184A/M204V/L180M(22.2%), rtT184L/M204V/L180M(23.4%), rtS202G/M204i/L180M(3.7%), rtM250V/M204V/L180M(5.6%), rtM250L/M204I/L180M(5.6%) and rtT184I/S202G/M204V/L180M(5.6%) infections (P<0.05); 38.3% patients had received lamivudine, significantly higher than 22.4% receiving adefovir therapy in our series(P<0.05); serum HBV DNA loads in 36 patients with rtT184^sub mutant infection was (3.0±0.5)lgIU/ml, and in 10 with rtT184/S202^sub infection was (4.1±0.8) lgIU/ml, both significantly higher than [(1.9±0.2)lgIU/ml, P<0.05] in 47 patients with rtS202^sub infection or [(2.1±0.2)lgIU/ml, P<0.05] in 14 patients with rtM250^sub infection; the supernatant HBV DNA load in entecavir-intervened cells carrying rtS202G/M204V/L180M mutant was (3.1±0.1)lg IU/ml, significantly higher than [(2.1±0.1 lg IU/ml, P<0.05] in cells carrying rtT184A/M204V/L180M mutants, no significant differences in lamivudine- or adefovir-treated cells(P>0.05), and they both decreased to undetectable in tenofovir-intervened cells. Conclusion The superior entecavir-resistance mutation in nucleosi(t)de-treated patients with CHB is rtS202G/M204V/L180M infection, and they are resistant to lamivudine or adefovir, but fortunately, they still sensitive to tenofovir intervention.

Objective The aim of this study was to summarize the clinical clues for early liver biopsies in chronic hepatitis B viral infected individuals with low serum alanine aminotransferase (ALT) levels. Methods 226 chronic hepatitis B viral infected individuals with low serum ALT levels were admitted to our hospital between January 2017 and March 2021,and all underwent liver biopsies. The liver injuries were evaluated by Scheuer scoring system for liver fibrosis staging and by histological activity index for inflammatory activity grading. The significant liver injuries were defined as the liver fibrosis≥S2 and/or the inflammatory activity≥G2. Results Out of the 226 individuals with HBV infection and low serum ALT levels, the clinical diagnosis was chronic HBV carriers in 125 cases, and chronic hepatitis B (CHB) in 101 cases; the percentages of male, significant liver injury, serum AST >40 U/L, liver fibrosis ≥F2 and liver inflammation ≥G2 in patients with CHB were 77.2%, 61.4%, 49.5%, 36.7% and 52.5%, all significantly higher than 54.4%, 33.6%, 5.6%, 18.4% and 25.6% in HBV carriers(P<0.05); out of the 226 individuals in our series, the liver histopathological examination showed significant liver injuries in 104 cases and non-significant liver injuries in 122 cases; serum HBV DNA load in patients with significant liver injury was(4.6±1.2) lg copies/ml, significantly lower than [(5.2±1.4)lg copies/ml, P<0.05], peripheral blood platelet count was (163.6±49.2)×10⁹/L, significantly lower than [(192.2±54.5)×10⁹/L, P<0.05] in individuals without significant liver injury, and the percentages of serum ALT level greater than 40 U/L, serum AST level greater than 40 U/L, liver fibrosis greater than F2 staging and liver inflammation greater than G2 grading were 60.6%, 39.4%, 57.7% and 81.7%, significantly higher than 31.1%, 13.1%, 0.0% and 0.0%, respectively (P<0.05) in individuals without significant liver injury. Conclusion The clinical feature of individuals with chronic hepatitis B viral infection and low serum ALT levels is subtle, and some clues might hint liver injury and warrant further liver biopsy, which could present the liver histopathological grading and staging and help the clinicians to make decisions.

Objective The aim of this study was to investigate the diagnostic performance of serum fibroblast growth factor 21 (FGF-21), platelet-derived growth factor-BB (PDGF-BB) and peripheral blood mononuclear cell (PBMC) fibrosin (FBRS) levels on significant liver fibrosis in patients with chronic hepatitis B (CHB). Methods 92 patients with CHB were enrolled in our hospital between January 2020 and January 2021, and all underwent liver biopsies and liver stiffness measurement (LSM). Serum FGF-21 and PDGF-BB were measured by ELISA, and PBMCs FBRS mRNA was assayed by real-time fluorescent quantitative PCR. The diagnostic performance was evaluated by the area under the receiver operating characteristic (ROC) curve (AUC). Results The liver histopathologic examination showed non-significant liver fibrosis in 49 cases, and significant liver fibrosis in 43 cases; in patients with significant liver fibrosis, serum FGF-21 level was (228.8±52.6)ng/ml, significantly lower than [(289.3±57.9)ng/ml, P<0.05], serum PDGF-BB level was (84.7±32.9)pg/ml, significantly higher than [(44.7±18.5)pg/ml, P<0.05], PBMCs FBRS mRNA load was (8.7±3.2), significantly higher than [(4.4±1.8), P<0.05], and the LSM was (15.6±3.9)kPa, significantly higher than [(7.6±1.8)kPa, P<0.05] in patients with non-significant liver fibrosis; the AUCs were 0.800, 0.714, 0.690 and 0.960 by the FGF-21, PDGF-BB, FBRS and LSM in predicting significant liver fibrosis when the cut-off-values were set at 249.0(ng/ml), 63.5(pg/ml), 7.4 and 11.2(kPa), respectively, with the sensitivities (Se) and specificities (Sp) of 69.8% and 79.6%, 69.8% and 69.4%, 65.1% and 73.5%, and 93.3% and 98.0%, but the AUC was 0.989 by the combination of the four parameters, with the Se and Sp of 95.3% and 63.3%. Conclusion The combination of serum FGF-21 and PDGF-BB, PBMCs FBRS mRNA and LSM in predicting liver fibrosis in patients with CHB could improve the Se, but the Sp is still not high, which needs further clinical investigation.

Objective The aim of this study was to observe the early impact of first-line nucleos(t)ide analogs (NAs), e.g. entecavir(ETV), tenofovir disoproxil fumarate(TDF) and tenofovir alafenamide(TAF), on renal function tests in patients with chronic hepatitis B (CHB). Methods 68 patients with CHB were encountered in our Hospital between September 2019 and May 2021, and out of them, 22 patients received ETV, 26 patients received TDF and 20 patients took TAF therapy. All the patients were followed-up for six months. Serum creatinine (sCr), estimated glomerular filtration rate (eGFR), urine retinol-binding protein (RBP), urine cystatin C (Cys-C), urine N.acetyl.β.D.glucosidase (NAG), urine α1-microglobulin(α1-MG) and urine β2-microglobulin (β2-MG) levels were observed. Results At the end of 24±2 weeks of treatment, serum alanine aminotransferase levels in ETV-treated, TDF-treated and TAF-treated patients were (33.2±5.4)U/L, (31.4±8.2)U/L and (32.7±6.1)U/L (P>0.05), and serum aspartate aminotransferase levels in the three groups were (23.8±7.6)U/L, (24.3±9.2) U/L and (22.9±7.8)U/L, not significantly different among them (P>0.05); serum HBsAg levels in the three groups were (3.0±0.7) lgIU/ml, (2.9±0.5)lgIU/ml and (2.8±0.6)lgIU/ml, and serum HBV DNA loads in the three groups were (1.9±0.6) lgIU/mL, (1.8±0.5) lgIU/mL and (1.6±0.7) lgIU/mL, not significantly different among them (P>0.05); there were no statistically significantly differences as respect to sCr, eGFR, urinary RBP, urinary Cys-C, urinary NAG and urinary β2-MG levels in the three groups (P>0.05), while urine α1-MG level in TDF-treated patients was (1.4±0.9)ln mg/L, significantly higher than (0.7±1.1) ln mg/L in ETV-treated or (0.7±0.9)ln mg/L in TAF-treated patients (P<0.05). Conclusion Our findings suggests that ETV, TDF and TAF have the same antiviral efficacy in patients with CHB, but the renal function tests should be specially surveyed in patients with TDF treatment.

Objective The purpose of this study was to compare the virologic response in patients with chronic hepatitis C (CHC) and hepatitis C viral genotype 1b infection receiving pan-genotype or precise genotype-specific direct antiviral agent (DAA) therapy. Methods 75 patients with CHC and genotype 1b HCV infection were enrolled in our hospital between January 2018 and June 2020, and were divided into control (n=34) and study group (n=41). The patients in the control group were given the pan-genotype DAAs regimen, e.g., sofibovir/vapatavir in 19 cases and sufosbuvir/ velpatasvir in 15 cases, and the patients in the study group received precise genotype-specific DAAs regimen, e.g., elbasvir/grazoprevir in 23 cases, and ombitasvir/dasabuvir in 18 cases. The antiviral treatment lasted for 12 weeks. The super-rapid virologic response (SRVR), rapid virologic response (RVR), early virologic response (EVR) and sustained virologic response (SVR) were compared between the two groups. Results At the end of 12 week treatment, serum ALT and AST levels in the study group were (31.9±4.1)U/L and (32.5±4.1)U/L, not significantly different compared to (32.7±4.2)U/L and (31.9±3.7)U/L (P＞0.05) in the control group; the SRVR, RVR, EVR and SVR in the study group were 87.8%, 97.6%, 100.0% and 100.0%, all not significantly different compared to 88.2%, 94.1%, 100.0% and 100.0% in the control (P＞0.05); the SRVR, RVR, EVR and SVR in sofibovir/vapatavir-treated patients were 84.2%, 100.0%, 100.0% and 100.0%, those in sufosbuvir/ velpatasvir-treated patients were 86.7%, 93.3%, 100.0% and 100.0%, in elbasvir/grazoprevir-treated patients were 91.3%, 100.0%, 100.0% and 100.0%, and in ombitasvir/dasabuvir-treated patients were 88.9%, 94.4%, 100.0% and 100.0%, all not significantly different among the four groups(P＞0.05); the incidences of complications during the antiviral treatment were 11.8% vs. 12.2% between the two groups (P＞0.05). Conclusion At present, the pan-genotype and precise genotype- specific DAAs regimens both have a very good antiviral efficacy in CHC patients with genotype 1b infection, with a pleasant safety.

Objective The aim of this study was to investigate the efficacy and safety of glecaprevir/pibrentasvir therapy in the treatment of patients with chronic hepatitis C (CHC) and genotype 1b infection. Methods A total of 138 patients with CHC and genotype 1b infection were admitted to the our hospital between July 2019 and August 2020, and were randomly divided into DAA-treated group, receiving glecaprevir/pibrentasvir treatment in 69 cases, and PR-treated group, receiving pegylated interferon alpha-2b and ribavirin combination treatment in another 69 cases. The regimen lasted for 12 weeks in both groups. The biochemical, hematology and virologic parameters were routinely detected. Results At the end of the treatment, serum aspartate aminotransferase and alanine aminotransferase levels in DAA-treated patients were (35.2±6.2)U/L and (30.7±5.4)U/L, both significantly lower than [(48.4±6.9)U/L and (45.4±6.1)U/L, respectively, P＜0.05] in PR-treated patients; the rapid virologic response, virologic response at end of treatment and sustained virologic response in DAA-treated patients were 78.3%, 95.7% and 95.7%, all significantly higher than 65.2%, 76.8% and 76.8%(P＜0.05) in PR-treated patients; during the treatment, the white blood cell counts and platelet counts in PR-treated patients were (3.4±1.4)×10⁹/L and (110.7±30.8)×10⁹/L, both significantly lower than [(6.3±1.3)×10⁹/L and (208.3±30.2)×10⁹/L, P<0.05] in DAA-treated patients; the incidence of untoward effects in patients receiving DAA treatment was 5.8%, very significantly lower than 84.1%(P<0.001) in patients receiving PR treatment. Conclusion The administration of glecaprevir/pibrentasvir in treating patients with genotype 1b-infected CHC is efficacious and safe with promising virologic response and low side effects, which warrants further clinical investigation.

Objective The aim of this study was to explore an non-invasive indicators for the prediction of gastroesophageal varices (GOV) in patients with primary biliary cholangitis (PBC). Methods A total of 67 patients with PBC were encountered in our hospital between January 2016 and December 2020, and all patients underwent esophagogastroduodenoscopy and ultrasonography. 32 patients received liver biopsies (LB) and 33 received liver stiffness measurement (LSM). The platelet count/spleen length ratio (PSR) were calculated. The prediction was carried out based on the area under the receiver operating characteristic curve (AUC). Results Out of the 67 patients with PBC in our series, 27 patients had GOV (mild in 7, moderate in 7 and severe in 13 cases) and 40 hadn’t; in 32 patients underwent LB, the liver fibrosis S_3-4 was found in 9 cases, S_1-2 was found in 23, and the GOV were found 3 cases in the former and in the latter (Fisher’s, P=0.203); in 33 patients with LSM results, the sensitivity (Se),specificity (Sp) and accuracy (Ac) were 100.0%, 54.2% and 66.7% in predicting GOV occurrence when the LSM＞20 kPa was set as the cut-off-value; the multivariate Logistic analysis showed the PSR was an independent risk factor for GOV happening; the AUC was 0.932, with the Se, Sp and Ac of 92.6%, 87.5% and 89.6% in predicting GOV occurrence when the PSR<0.734×10⁹/L/mm was set as the cut-off-value, and preventing 92.5% of patients from EGD examination. Conclusion The predictive efficacy of our established PSR is promising in predicting GOV in patients with PBC, which might be validated in clinical practice.

Objective The aim of this study was investigate the clinical application of blood red blood cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR) in evaluating liver damage in patients with primary biliary cholangitis (PBC). Methods 93 PBC patients, including 30 with severe(stage Ⅲ) and 63 with mild (stage I /Ⅱ) liver injury, were enrolled in our hospital between March 2017 and December 2019. The RDW and NLR were obtained and calculated routinely. The univariate and multivariate Logistic regression analysis was performed to predict the risk factors for severe liver injuries, and the diagnostic efficacy of any parameter was evaluated by area under the receiver operating characteristic curve (AUC). Results The RDW and NLR in patients with severe liver injury were significantly higher than those in patients with mild liver injury [(15.8±3.2)% vs. 13.3±2.9)%, and (2.1±0.4) vs. (1.5±0.3), respectively, P<0.05]; the percentages of alcohol hobby (33.3% vs. 7.9%), serum GGT level [(395.3±6.5)U/L vs. (189.2±6.1)U/L], serum ALP level [(352.1±49.2)U/L vs. (281.0±46.9)U/L], the RDW≥14.8%(70.0% vs. 46.0%) and the NLR≥1.8(76.7% vsl 41.3%)in patients with severe liver injury were significantly higher than in patients with mild liver injury (all P<0.05); the multivariate Logistic regression analysis showed that the alcohol intake [OR(95%CI):1.8(1.1-2.9)], GGT≥293.1 U/L[OR(95%CI):1.7(1.2-2.5)], ALP≥327.6 U/L[OR(95%CI):1.9(1.2-2.8)], the RDW≥14.8%[OR(95%CI):1.9(1.2-2.8)] and NLR≥1.8[OR(95%CI):1.7(1.3-2.2)] were the independent risk factors for PBC patients with severe liver injury; the AUC was 0.854, with the sensitivity of 86.7% and the specificity of 71.4% when the RDW and NLR combination (RDW=14.8% and NLR=1.8 were set as the cut-off-value) was applied to predict severe liver injury in patients with PBC. Conclusion The NLR and RDW are promising index in predicting liver damage in patients with PBC, which is easily obtained, and needs further clinical investigation.

Objective The aim of this study was to compare the therapeutic efficacy of magnesium isoglycyrrhizinate and compound glycyrrhizin monoamine in treatment of patients with drug-induced liver injury (DILI). Methods A total of 102 patients with DILI were enrolled in our hospital between January 2018 and January 2020, and were randomly divided into observation and control group, with 51 cases in each group. The patients in the observation were treated by intravenous administration of magnesium isoglycyrrhizinate, those in the control were treated by intravenous compound glycyrrhizin monoamine, and the regimen lasted for 14 to 28 days. Serum laminin (LN), hyaluronidase (HA), procollagen-III (PC-III) and collage type IV (IV-Col) were detected by radioimmunoassay. Serum superoxide dismutase (SOD), nitric oxide (NO), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected by ELISA. Results At the end of the treatment, serum ALT and AST levels in the observation group were (42.7±12.5)U/L and (38.2±9.4)U/L, both significantly lower than [(64.5±21.9)U/L and (55.6±15.2)U/L, respectively, P＜0.05] in the control; serum HA, PC-III and IV-Col levels were (138.2±21.5)mg/L, (85.6±17.4)μg/L and (141.5±16.4)μg/L, all significantly lower than [(182.1±23.9)mg/L, (123.8±19.4)μg/L and (175.4±18.7)μg/L, respectively, P＜0.05]; serum SOD and NO levels were (90.3±10.1)U/L and (79.8±9.3)μmol/L, both significantly higher than [(74.9±8.6)U/L and (54.0±7.9)μmol/L, respectively, P＜0.05], while serum IL-6 and TNF-α levels were (11.2±2.5)pg/mL and (26.4±3.6)ng/L, both significantly lower than [(16.8±2.7)pg/mL and (41.3±5.9) ng/L, respectively, P＜0.05] in the control. Conclusion The therapeutic efficacy of magnesum isoglycyrrhizinate is promising in dealing with patients with DILI, which could effectively improve serum biochemical indexes normal and alleviate oxidative stress.

Objective The aim of this study was to retrospectively summarize the clinical feature of drug(tigecycline)-induced liver injuries (DILI) in 134 elderly patients with infection and underlying diseases. Methods The clinical materials of 134 elderly patients with DILI caused tigecycline administration between 2018 and 2020 were summarized retrospectively. The underlying diseases, pathogens and liver function tests were analyzed. Results Among the 134 patients, 54.5% were males and 45.5% were females, with 41.8% of them younger than 70 years old and 58.2% older than 70 years old; the patients hospitalized in Intensive Care Unit, Department of Respiratory Diseases and Department of Orthopaedics accounted for 34.3%, 28.4% and 16.4%; as to the underlying diseases, the hypertension accounted for 67.9%, diabetes for 25.4%, malignant tumors for 23.1%, coronary heart disease for 14.2%, chronic obstructive pulmonary disease for 11.2% and bone fracture for 7.5%; the concomitant administration of cefoperazone/sulbactam accounted for 94.8%; the infected sites included pulmonary, bone and joint, and abdominal cavity infection for 49.3%, 23.1% and 13.4%; the Klebsiella Pneumoniae, Acinetobacter Baumannii and Stenotrophomonas Maltophilia infections accounted for 32.8%, 24.6% and 17.2%; the liver function tests were abnormal one week after intravenous tigecycline administration and peaked at two weeks, with serum bilirubin level of(35.2±5.9)μmmol/L, aspartate aminotransferase level of (69.1±11.5)U/L, alanine aminotransferase level of (56.4±9.3)U/L, alkaline phosphatase level of (194.8±29.3)U/L and acyltranspeptidase level of (134.6±18.9)U/L, which decreased to (29.1±5.0)μmmol/L, (57.9±9.6)U/L, (50.2±8.6)U/L, (183.3±27.4)U/L and (126.9±15.4)U/L one week after discontinuation of tigecycline; the liver function tests returned to normal at day 5 to 33 days, with the average time of (14.6±2.3)days; 130 patients recovered, 3 discharged with abnormal liver function tests and 1 died of multi-organ failures in our series. Conclusion The intravenous administration of tigecycline in treating elderly patients with various infections could cause liver damage, and the surveillance of liver function tests is of particularly importance.

Objective The aim of this study was to observe the short-term efficacy of metformin and dapagliflozin combination therapy in the treatment of patients with diabetes mellitus type 2 (T2DM) and non-alcoholic fatty liver diseases (NAFLD) and their impact on serum soluble dipeptidyl peptidase 4 (sDPP-4) and C-peptide levels. Methods 98 patients with T2DM and NAFLD were enrolled in our hospital between September 2018 and September 2021, and were divided randomly into control (n=49) and observation (n=49) group, receiving metformin or metformin and dapagliflozin combination therapy, respectively, for 24 weeks. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FPG) and glycosylated hemoglobin (HbA1c) were routinely detected. Serum fasting insulin (FINS) was detected by electrochemiluminescence, and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Serum fasting C-peptide level was detected by chemiluminescence. Serum sDPP-4 level was detected by ELISA. Results At the end of 24 week treatment, serum GGT level was (61.0±6.4) U/L, significantly lower than [(79.2±6.9) U/L, P<0.05] in the control; the ratio of liver/spleen CT value in the observation group was (0.9±0.2), significantly higher than [(0.7±0.2), P<0.05], serum fasting C-peptide level was (1.6±0.3) ng/ml, significantly lower than [(2.2±0.5) ng/ml, P<0.05], and serum sDPP-4 level was (901.5±228.3) ng/ml, also significantly lower than [(1086.2±275.8) ng/ml, P<0.05] in the control in the control; the FPG level was (6.1±1.2) mmol/L, significantly lower than [(6.9±1.5) mmol/L, P<0.05], the HbA1c level was (7.1±1.3)%, significantly lower than [(7.8±1.0)%, P<0.05], and the HOMA-IR was (2.3±0.5), significantly lower than [(2.8±0.4), P<0.05] in the control; serum TC level was (4.5±0.6) mmol/L, serum TG level was (2.2±0.4) mmol/L, and LDL-C level was (3.1±0.4) mmol/L, all significantly lower than [(5.1±0.6) mmol/L, (2.6±0.5) mmol/L and (3.5±0.5) mmol/L, P<0.05], while serum HDL-C level was (1.8±0.4) mmol/L, significantly higher than [(1.4±0.3) mmol/L, P<0.05] in the control. Conclusion The combination of metformin and dapagliflozin therapy could effectively control blood glucose levels, correct lipid metabolism disorders, and reduce serum sDPP-4 level in patients with T2DM and NAFLD, which might be related to the remission of insulin resistance.

Objective The aim of this study was to explore the implication of hepatic fat fraction (HFF) by CT angiography (CTA) in patients with nonalcoholic Fatty liver diseases (NAFLD) and high-risk coronary plaque (HRP). Methods 168 patients with NAFLD were admitted to our hospital between January 2015 and January 2021, and all underwent CTA check-up. The HFF was automatically given atSyngo.via station. Results Out of the 168 patients with NAFLD, there were no coronary plaque in 76 cases, with coronary plaque but not risk in 48 cases and with HRP in 44 cases; the epicardial adipose tissue volume (EATV) in plaque-free, HRP negative and HRP group were 91.8(82.4, 98.3)cm³, 102.6(87.6, 120.4)cm³ and 136.2(82.4, 98.3)cm³, significantly statistically different (P < 0.05); the CT values of EAT in the three groups were -79.3(-81.2, -76.4) HU, -74.2(-77.3, -70.4)HU and -66.8(-70.5, -63.4) HU, significantly different (P < 0.05); the CT values of pericoronary adipose tissue (PAT) were -79.0(-80.6, -76.3)HU, -73.1(-75.2, -70.2)HU and -66.2(-70.1, -63.0)HU, significantly different (P < 0.05); the PAT volume (PATV) were [17.5(15.5, 18.6)cm³], [17.4(15.7, 21.8)cm³] and [18.9(17.5, 23.1)cm³], significantly different(P<0.05) among the three groups; the HFF were [6.8(5.3, 9.2)%], [8.8(7.0, 12.6)%] and [15.4(12.3, 17.8)%], significantly different(P<0.05); the CT value of liver were [(44.4±4.7)HU], [(43.2±4.6)HU] and [(39.7±4.4)HU], significantly different(P<0.05); there were significant differences in smoking habit, blood hypertension, diabetes, neutrophil/lymphocyte ratio (NLR), HDL, TG, TC and Framingham risk score among the three groups(P<0.05); there were significant differences in coronary artery stenosis degree, low density plaque, punctate calcified plaque, remodeling index and napkin ring sign between patients with HRP negative and with HRP (P<0.05). Conclusion As a new non-invasive imaging marker for liver fat measurement, the HFF has the advantages of simple measurement and good repeatability, which might help optimize the cardiovascular risk stratification in patients with NAFLD.

Objective The aim of this study was to investigate the short-term efficacy of sequential plasma exchange (PE) and dual plasma molecular adsorption system (DPMAS) combination in treatment of patients with hepatitis B virus infection-related acute-on-chronic liver failure (HBV-ACLF). Methods A retrospective analysis was performed on the clinical data of 64 patients with HBV-ACLF admitted to First Affiliated Hospital, Army Medical University and the 923rd Hospital, People's Liberation Army, between May 2018 and May 2020. Out of them, 33 patients received PE and 31 patients received PE and sequential DPMAS treatment. All patients were follow-up for 90 days. The survival rates in the two groups were statistically analyzed by Kaplan-Meier method. Results At the end of day 28 and day 90, total serum bilirubin levels in PE-DPMAS-treated patients were (119.5±19.4)μmol/L and (29.5±10.4)μmol/L, significantly lower than [(149.5±30.5)μmol/L and (52.4±15.9)μmol/L, respectively, P＜0.05] in patients receiving PE; at the end of 90 day treatment, serum c-reactive protein, procalcitonin and interleukin-6 levels were(12.6±3.5)mg/L,(0.5±0.2)ng/L and (13.4±2.7)ng/L, significantly lower than [(19.2±3.3)mg/L, (0.7±0.4)ng/L and (18.2±3.5)ng/L, respectively, P＜0.05] in patients receiving PE alone; at the end of 90 days, the survival rate in patients receiving PE-DPMAS treatment was 83.9%, significantly higher than 57.6% in PE-treated patients (P＜0.05). Conclusion The sequential therapy with PE and DPMAS could improve liver function tests, decrease serum inflammatory factors and elevate the 90 day survivals in patients with HBV-ACLF.

Objective The aim of this study was to investigate the prognostic factors of patients with type B and type C acute-on-chronic liver failure(ACLF) and moderate or severe esophageal varices (EV). Methods The clinical materials in 58 patients with ACLF (type B in 18, and type C in 40) and moderate to severe EV between November 1,2017 and March 31,2020 in our hospital were retrospectively analyzed. All patients were followed-up for 6 months. The Logistic regression analysis was applied to explore the independent risk factors affecting the 6-month survival rate. Results At the end of six month followed-up, 20 patients (34.5%) died, 1 received liver transplantation, 2 lost and 35 (60.3%) survived; there were significant differences respect to ascites volume(P=0.039), esophageal vein sclerotherapy (EVS)(P=0.010), ACLF clinical types (P=0.034), different stages of hepatic encephalopathy(P=0.029) and degree of varices (P=0.046) between dead and survivals; the Logistic regression analysis showed that the ascites (OR=9.76), sclerotherapy during hospitalization (OR=19.28) and hepatic encephalopathy (OR=5.98) were the independent risk factors for 6-month survival rate. Conclusion The ACLF patients with massive ascites, severe hepatic encephalopathy and EVS treatment might have a poor short-term prognosis, and we do not recommend EVS for patients with ACLF at this setting.

Objective The aim of this study was to observe the very short-term efficacy of concentrated ascites reinfusion (CAR) and terlipressin combination therapy in the treatment of patients with liver cirrhosis (LC) and refractory ascites (RA). Methods 62 patients with LC and RA were admitted to our hospital between May 2016 and May 2021, and were randomly divided into control (n=31) and observation group (n=31). The patients in the control group were treated with CAR, and those in the observation group were treated with CAR and terlipressin combination. The regimen lasted for 7 days in the two groups. The blood urea nitrogen (BUN) and serum creatinine (sCr) levels were detected by an automatic biochemical analyzer. The diameter of portal vein (DPV), the diameter of splenic vein (DSV), the velocity of portal vein (VPV) and the velocity of splenic vein (VSV) were measured with ultrasonography. The WHO quality of life (WHOQOL-BREF) questionnaire was applied to evaluate the quality of life (QOL). The abdominal circumference, depth of ascites, 24 hour urine volume and the incidence of adverse reactions were recorded. Results At the end of 7 day treatment, the abdominal circumference was (85.5±4.5)cm, and the depth of ascites was (35.2±3.4)mm, both significantly smaller than [(88.4±4.3)cm and (47.2±5.1)mm, respectively, P<0.05], while the 24 hour urine volume was (1530.8±30.2)ml, significantly greater than [(1248.6±28.4)ml, P<0.05] in the control; the BUN and sCr levels were (6.6±1.5)μmol/L and(104.2±8.7)μmol/L, both significantly lower than [(9.8±2.4)μmol/L and (133.5±11.2)μmol/L, respectively, P<0.05] in the control, while there was no significant difference respect to liver function tests in the two groups (P>0.05); the VPV was (25.7±5.4)cm/s, significantly higher than [(22.5±4.6)cm/s, P<0.05] in the control, while there were no significant differences respect to DPV, DSV and VSV in the two groups(P>0.05); the total WHOQOL-BREF score was (65.6±12.3), significantly higher than [(56.1±9.8), P<0.05] in the control. Conclusion The CAR and terlipressin combination therapy in the treatment of patients with LC and complicated RA is relatively efficacious, from the point of view of the very short-time, which could improve kidney functions and promote ascites subsided, thereby improve the quality of life.

Objective The aim of this study was to explore the quantitative evaluation of hepatic fibrosis in patients with schistosomiasis by acoustic palpation tissue imaging of ultrasound elastography. Methods A total of 110 patients with hepatic schistosomiasis and 110 healthy volunteers were recruited in our hospital between January 2019 and January 2021, and all patients underwent liver biopsies. The shear wave velocities (SWV) of right anterior lobe, right posterior lobe and left lateral lobe of livers were detected by quantitative acoustic palpation tissue imaging of ultrasound elastography in all individuals. The diagnostic value of SWV in predicting significant liver fibrosis (>=S2) was evaluated by ROC analysis. Results The SWVs of right anterior lobe, right posterior lobe and left lateral lobe of livers in patients with hepatic schistosomiasis were (1.4±0.4), (1.4±0.5) and (1.5±0.5), all significantly higher than [(1.1±0.2), (1.2±0.3) and (1.1±0.3), respectively,P＜0.05] in healthy volunteers; the SWVs of right anterior lobe, right posterior lobe and left lateral lobe of livers in 13 patients with S4 liver fibrosis staging were (1.9±0.5), (1.9±0.5) and (2.1±0.6), all significantly higher than [(1.6±0.4), (1.7±0.3) and (1.8±0.4), respectively, P<0.05] in 27 patients with S3 or [(1.4±0.4), (1.5±0.2) and (1.6±0.3), respectively, P<0.05] in 33 patients with S2 or [(1.2±0.3), (1.3±0.2) and (1.4±0.2), respectively, P<0.05] in 37 patients with S1; the ROC analysis showed that the area under ROC of SWV_{right anterior lobe}, SWV _{right posterior lobe} and SWV _{left lateral lobe} in diagnosing significant liver fibrosis were 0.837, 0.733 and 0.807 when the optimal cut-off-values were set at 1.250, 1.350 and 1.350, with the sensitivities of 0.673, 0.545 and 0.636, and the specificities of 0.909, 0.945 and 0.818. Conclusion The detection of SWV by acoustic palpation tissue imaging quantification of ultrasound in patients with hepatic schistosomiasis could help predicting significant liver fibrosis, and warrants further clinical investigation.

Objective The aim of this study was to compare the clinical feature of patients with primary biliary cholangitis and primary biliary cirrhosis. Methods 164 patients, including 70 with primary biliary cholangitis and 94 with primary biliary cirrhosis were encountered in the First Affiliated Hospital, Nanjing Medical University between May 2015 and September 2021, and their clinical materials were reviewed. The Logistic regression analysis was applied to investigate the risk factors for disease progression in this kind of patients. Result The age of the patients with cirrhosis was ( 58.6±13.0) year-old, significantly greater than [( 53.4± 11.1) year-old, P<0.05] in patients without cirrhosis; serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and total bilirubin levels in patients with cirrhosis were 49.7(27.5, 80.2) U/L, 62.6(44.9, 114.7) U/L, 156.8(126.5, 230.5) U/L and 31.5 (17.6, 88.4) μmol/L, significantly higher than [39.3(23.9, 66.0) U/L, 36.4(26.8, 63.4) U/L, 126.5(94.8, 187.3) U/L and 14.6(10.0, 24.3) μmol/L, respectively, P＜0.05] in patients with primary biliary cholangitis; the positive rates of serum anti-nuclear antibody and anti gp210 antibody in patients with primary biliary cirrhosis were 91.5% and 43.6%, significantly higher than 80.0% and 25.7%(P＜0.05) in patients with primary biliary cholangitis; serum IgG, IgA and IgM levels in patients with primary biliary cirrhosis were 17.0(13.2, 20.9) g/L, 3.5(2.5, 4.8) g/L and 2.9(2.0, 4.8) g/L, significantly higher than [14.2(12.7, 15.8) g/L、2.6(2.0, 3.4) g/L and 1.8(1.2, 3.3) g/L, respectively, P＜0.05], while serum C3 and C4 levels were 0.7(0.5, 0.9) g/L and 0.1(0.1, 0.2) g/L, significantly lower than [1.2(1.1, 1.4) g/L and 0.2(0.2, 0.3) g/L, respectively, P＜0.05] in patients with primary biliary cholangitis; the multivariate Logistic analysis showed that increased serum IgM and decreased C4 levels were the independent risk factors for the occurrence of liver cirrhosis (P＜0.05). Conclusion Some feature could hint the liver cirrhosis in patients with primary biliary cholangitis, out of them, higher serum IgM and low serum complement C4 levels might be the easy parameters.

Objective Gastric varices (GV) bleeding is one of the rare types of gastrointestinal bleeding resulting from portal hypertension in patients with liver cirrhosis (LC), but the risk is the highest. The failed endoscopic treatment is common. The purpose of this study was to investigate the safety and short-term efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) in the treatment of patients with LC and GV bleeding. Methods 13 patients with LC and GV were encountered in Nanjing Drum Tower Hospital between November 2018 and January 2020, and all underwent BRTO. The patients were followed-up and the success rate of BRTO procedure, short-term postoperative complications, variceal bleeding and survival were recorded. Results The technical success rate was 92.3%, and there was no serious or fatal complications in our series during two month follow-up period after BRTO; two patients (16.7%) showed new portal vein thrombosis discovered by color Doppler ultrasonography after BRTO, and they disappeared after anticoagulation therapy with low molecular weight heparin; none of the patients suffered from esophageal or gastric variceal bleeding, and one patient died of hepatic failure owing to primary liver cancer; one patient had mild ascites, and one patient with hepatic encephalopathy before BRTO had an obvious decrease of blood ammonia level and remission of clinical symptoms. Conclusion BRTO might be a safe and effective interventional technique, which could prevent gastric variceal bleeding and warrants further investigation.

Objective The aim of this study was to compare the strategy of intermittent total hepatic inflow occlusion (ITHIO) and regional hepatic inflow occlusion (RHIO) during laparoscopic hepatectomy (LH) in patients with primary liver cancer (PLC). Methods 128 patients with PLC were recruited in our hospital between March 2016 and March 2021, and all patients underwent LH. During the operation, the ITHIO was applied in 57 cases and RHIO was carried out in 71 cases. The mean arterial pressure (MAP), heart rate (HR), and portal vein velocity (PVV) were obtained. Results The intraoperative blood loss and hepatic blood occlusion time in patients with RHIO were (305.4±58.6)mL and (0.0±0.0)min, significantly less or shorter than [(382.5±60.3)mL and (24.2±7.5)min, respectively, P＜0.05] in patients with ITHIO; seven days after operation, serum bilirubin level was (16.4±8.5)μmol/L and serum albumin level was (35.6±5.3)g/L in patients with RHIO, significantly different compared to [(25.7±7.2)μmol/L and (32.4±4.9)g/L, respectively, P＜0.05] in patients with ITHIO; the MAP, HR and PVV in patients with RHIO were (85.6±2.3)mmHg, (78.7±8.3)beats/min and (20.3±0.2)cm/s, not significantly different compared to [(86.8±2.5)mmHg,(79.6±8.1)beats/min and (20.1±0.3)cm/s, P＞0.05] in patients with ITHIO; after operation, the incidences of intraabdominal bleeding, bile leakage, pleural effusion and pulmonary infections in patients with RHIO were 1.4%, 8.5%, 14.1% and 5.6%, not significantly different compared to 3.5%, 10.5%, 22.8% and 10.5% in patients with ITHIO (P＞0.05). Conclusion The strategy of RHIO during LH in dealing with patients with PLC is good with less intraoperative blood loss, shortened hepatic blood occlusion time and alleviation of postoperative liver function recovery.

Objective The aim of this study was to investigate pain control by hydromorphone and nalbuphine combination for patient-controlled intravenous analgesia (PCIA) in patients with primary liver cancer (PLC) undergoing laparoscopic hepatectomy (LH). Methods 104 patients with PLC were encountered in our hospital between January 2018 and January 2021, and they were randomly divided into control (n=52) and observation group (n=52). All patients with PLC underwent LH, and the sufentanil and nalbuphine in patients in the control, while the hydromorphone and nalbuphine in patients in the observation for postoperative PCIA were applied. The T cell subsets, such as CD3⁺ cells, CD4⁺ cells, CD8⁺ cells and NK cells, were detected by flow cytometry. The postoperative pain was assessed by visual analogue scale (VAS). Results At 24 h after surgery, the static and dynamic VAS scores in observation group were (2.5±0.8) points and (3.7±1.2) points, significantly lower than [(4.3±1.2) points and (5.8±1.7) points, P<0.05] in the control; at 72 h after surgery, the static and dynamic VAS scores in the observation group were (1.1±0.4) points and (3.2±0.9) points, significantly lower than [(2.6±0.7) points and (5.1±1.3) points, P<0.05] in the control; after surgery, there were no significant differences as respect to common liver function tests (P>0.05); at 7 d after surgery, the percentages of CD3⁺ cells, CD4⁺ cells, CD8⁺ cells and NK cells in the observation group were (76.3±7.5)%,(36.8±4.9)%,(32.5±3.2)% and(16.3±2.9)%, all not significantly different as compared to [(75.2±7.4)%,(37.6±4.4)%,(31.2±3.4)% and (17.4±2.6)%] in the control (P>0.05). Conclusion The application of hydromorphone and nalbuphine combination in patients with PLC for PCIA after LH could effectively alleviate pain.

Objective The aim of this study was to investigate the clinical efficacy of ultrasound-guided microwave ablation (MWA) after transcatheter arterial chemoembolization (TACE)ACE in the treatment of patients with special locations of primary liver cancer (PLC). Methods 72 patients with special locations (adjacent to the top of the diaphragm, gallbladder, gastrointestinal tract, portal vein, hepatic vein, inferior vena cava, right kidney and heart with the shortest distance less than 0.5 cm) of primary liver cancer (observation group) and 60 patients with PLC (control group) were encountered in our hospital between November 2017 and all patients were treated with TACE and thereafter ultrasound-guided MWA combination therapy. The patients were followed-up for 24 months. Serum alpha-fetoprotein (AFP) were detected by chemiluminescence, and serum alpha-fetoprotein heterogeneity L3 (AFP-L3), vascular endothelial growth factor (VEGF) and S100 calcium-binding protein A4 (S100A4) were detected by ELISA. Results At the end of 1 month after treatment, the disease control rate in the observation group was 91.7%, not statistically significantly different as compared to 93.3% in the control (P>0.05); serum AFP, AFP-L3, VEGF and S100A4 levels in the observation group were (123.4±13.7) ng/mL, (82.5±10.7) mg/mL, (250.4±46.8) pg/mL and (52.7±13.4) mg/L, not significantly different as compared to [(120.8±15.6) ng/mL, (80.6±10.1) mg/mL, (248.7±47.3) pg/mL and (50.9±14.5) mg/L, respectively, P>0.05];at 6, 12, 18 and 24 month, the cumulative survival rates in the observation group were 95.8%, 88.9%, 69.4% and 45.8%, not significantly different as compared to 100.0%, 91.7%, 73.3% and 48.3%, respectively, in the control (P>0.05). Conclusion The short-term and long-term efficacy and safety of ultrasound-guided MWA therapy after TACE in the treatment of patients with special locations of liver cancer are similar to those with ordinary liver cancer, which is worthy of clinical verification.

Objective The purpose of this study was to compare the safety of robotic and laparotomy hepatectomy in dealing with patients with intrahepatic cholangiocarcinoma (ICC). Methods A total of 27 patients with ICC were enrolled in the Hepatobiliary and Pancreatic Surgery Center, Drum Tower Hospital between January 2019 and December 2020, and 9 patients received robotic hepatectomy and 18 open surgery. Results The radical surgery was finished in all patients in both groups; there were no significant differences respect to operation time [(198±32)min vs. (215±74) min], intraoperative blood loss [200 (100,250) ml vs.(275(200,300) ml] and intraoperative blood transfusion (0.0% vs. 11.1%, all P>0.05); there were no significant differences as respect to maximal tumor diameter [4.0 (2.5,5.5) cm vs. 6.3 (3.9, 6.5) cm], R0 resection rate (100.0% vs. 88.0%) and lymph node metastasis rate (44.4% vs. 38.9%) between the two groups (P>0.05); the postoperative bed time and hospitalization stay in patients receiving robotic surgery were 2(1, 2.5)d and 7(4, 8)d, significantly shorter than [3(1.8, 3.5)d and 11(8, 12)d, respectively, P<0.05] in patients receiving open surgery, and there was no significant difference respect to medical costs [113.0 (91.0, 135.0) thousands in robotic vs. 101.0(880.0, 115.0) thousands in open surgery, P>0.05); there was no significant difference in post-operational complications (11.1% vs. 27.8%) in the two groups (P>0.05). Conclusion The robotic hepatectomy in dealing with patients with ICC in safe, with a rapid postoperative recovery.

Objective The aim of this study was to summarize the value of three-phase enhancement scan of 64-slice spiral CT in measuring hepatic hemangioma (HH) volume. Methods 88 patients with HH were enrolled in our hospital between June 2020 and March 2021, and all underwent 64-slice spiral CT three-phase enhancement scan. The enhancement volumes in different phases were detected and measured. Results Out of the 88 patients with HH, the CT plain scan showed that there were 122 lesions, including 54 cases (61.4%) with single lesions and 34 cases (38.6%) with multiple lesions; there were 95 lesions (77.9%) in the right lobe of livers and 27 lesions (22.1%) in the left lobe; there were 100 (82.0%) round or quasi-circular lesions, with clear boundaries, and 22 (18.0%) irregular lesions; there were 87 (71.3%) lesions with diameters of 2 to 10 cm and 35 (28.7%) lesions greater than 10 cm; the CT plain scan showed that there were 111 (91.0%) low-density, 7 (5.7%) iso-density and 4 (3.3%) high-density lesions; the enhancement scan showed that there were 102 (83.6%) lesions with marginal nodular and plaque-like enhancement in arterial phase, including 25 (24.5%) with mild, 37 (36.3%) with moderate and 40 (39.2%) with significant enhancement; in portal phase, there were 98 (80.3%) lesions filled with contrast agents, and the density as gradually decreased, and the other 24 (19.7%) lesions were not accompanied with enhancement; after 3D post-processing, the tumor volume and the arterial enhancement volume in lesions greater than 10 cm were(370.1±52.8)cm³ and (50.7±10.9)cm³, both significantly greater than [(118.8±24.6)cm³ and (42.3±10.6)cm³, respectively, P<0.05], while the arterial enhancement ratio of the lesions was (13.7±4.3)%, significantly less than [(35.6±10.2)%, P＜0.05] in lesions less than or equal to 10 cm. Conclusion The 64-slice spiral CT three-phase enhancement scan could determine the morphology, size and density of hepatic hemangioma, and the enhancement ratio of hepatic hemangioma in arterial phase could accurately reflect blood supply of the lesions, which might be beneficial to the subsequent intervention treatment.

Objective The aim of this study was to investigate the impact of combined sevoflurane anesthesia on renal functions in pediatric living donor liver transplantation (LDLT). Methods 54 children with end stage liver diseases (including congenital biliary atresia in 31 cases, hepatolenticular degeneration in 10 cases, hepatic glycogen storage disease in 8 cases and liver failure in 5 cases ) were recruited in our hospital between March 2017 and March 2020, and all received LDLT. The anesthesia included combined sevoflurane in 20 cases (groupA), combined isoflurane in 18 cases (group B) and combined propofol anesthesia in 16 cases (group C). Serum lactate dehydrogenase (LDH), serum creatinine (sCr), and urea nitrogen (BUN) and renal artery resistance index (RI)determined by ultrasonography were obtained. A 1 day before operation (T₁), 1 day after operation (T₂), 3 days after operation (T₃) and 5 days afteroperation (T₄), the mean arterial pressure (MAP), central venous pressure (CVP) and heart rate (HR) were recorded. Results At T₂, T₃ and T₄, serum LDH level in group A were (502.7±114.4)IU/L, (392.8±128.4)IU/L and (340.6±94.3)IU/L, all significantly lower than [(582.0±104.8)IU/L, (511.7±94.5)IU/L and (450.6±80.6)IU/L, respectively, P<0.05] in group B or [(579.6±106.7)IU/L, (498.9±95.2)IU/L and (443.6±82.1)IU/L, respectively, P<0.05] in group C; sCr were (60.8±13.2)μmol/L,(45.4±9.7)μmol/L and (33.2±8.5)μmol/L, all significantly lower than [(71.6±12.8)μmol/L, (58.4±10.3)μmol/L and (49.5±8.9)μmol/L, respectively, P<0.05] in group B or [(69.3±10.0)μmol/L,(62.2±9.7)μmol/L and (50.3±8.6)μmol/L, respectively, P<0.05] in group C; the MAP were (49.3±3.7)mm/Hg, 52.9±4.9)mm/Hg and (55.3±4.6)mm/Hg, all significantly higher than [(45.9±4.3)mm/Hg, (47.7±3.9)mm/Hg and (51.9±4.5)mmHg, respectively, P<0.05] in group B or [(44.9±4.4)mm/Hg,(49.2±4.6)mmHg and (51.8±5.0)mm/Hg, respectively, P<0.05] in group C, the CVP were (6.9±1.4)mm/Hg,(7.8±2.0)mm/Hg and (8.4±1.5)mm/Hg,all significantly higher than [(5.8±1.5)mm/Hg, (6.4±1.7)mm/Hg and (7.4±1.3)mm/Hg, respectively,P<0.05] in group B or [(5.6±1.3)mm/Hg, (6.5±1.2)mm/Hg and 7.4±0.9)mm/Hg, respectively, P<0.05] in group C. Conclusion The combined sevoflurane anesthesia could protect renal functions in children receiving LDLT, which might be related to the less impact on hemodynamics.

Objective The aim of this study was to observe the long-term efficacy of radical surgery for treatment of patients with hepatic alveolus echinococcosis. Methods A total of 60 patients with hepatic alveolus echinococcosis (Child-Pugh class A in 36 cases, and class B in 24 cases) were encountered in our hospital between July 2014 and July 2019, and all underwent radical resection of the diseased foci. The patients were followed-up for 3 years. Results One week after operation, total serum bilirubin and alkalinephosphatase levels in patients with Child-Pugh class A were (17.8±6.6)μmol/L and (80.0±21.5)U/L, both significantly lower than [(21.8±7.4)μmol/L and (97.8±17.9)U/L, respectively, P＜0.05] in patients with Child-Pugh class B; the incidences of post-operational complications such as Incisional infection, pleural effusion, deep venous thrombosis, hepatic encephalopathy, refractory ascites, bile leak and renal deficiency in patients with Child-Pugh class A was 30.6%, significantly lower than 79.2%(P＜0.05) in patients with Child-Pugh class B; during three year follow-up period, three and two patients missed in patients with Child-Pugh class A and class B, respectively; the one-year and three-year survival in patients with Child-Pugh class A were 97.0%(32/33) and 93.9% (31/33), not significantly different compared to 90.9%(20/22) and 86.4%(19/22) in patients with Child-Pugh class B (Log-Rank=8.99, P=0.343); the hepatic foci relapse rate in patients with Child-Pugh class A was 12.1%(4/33), also not significantly different compared to 27.3%(6/22, x²=1.146, P=0.284) in patients with Child-Pugh class B. Conclusion Radical surgery is efficacious in treatment of patients with hepatic alveolus echinococcosis, even though with a relative high relapse post-operationally. The improvement of liver functions before operation is of very importance in order to decrease the post-operational complications.

Objective The aim of this study was to investigate the efficacy of lauromacrogol or anhydrous ethanol sclerotherapy under the guidance of color Doppler ultrasound (US) in patients with liver-kidney cysts. Methods 72 patients with liver-kidney cysts were encountered in our hospital between January 2019 and December 2020, and they all underwent cyst puncture under US guidance and sclerotheray. Out of them, 36 patients had lauromacrogol, and another 36 patients had ethanol sclerotherapy. They all were followed-up for six months. Results At the end of six month follow-up, the disappearance or obvious shrink of liver and kidney cysts in lauromacrogol-treated patients was 94.4%, not significantly different compared to 91.7% in patients with ethanol sclerotherapy(P>0.05); at one, three and six month after operation, the cyst reduction rates in lauromacrogol-treated patients were(67.5±8.1)%, (81.6±5.5)% and (95.2±4.9)%, all significantly lower than [(53.9±6.4)%, (73.2±4.7)% and (85.6±3.5)%, respectively, P＜0.05] in ethanol-treated patients; the incidences of side effects, such as fever, drunkenness-like reaction and nausea in lauromacrogol-treated patients was 8.3%, significantly lower than 27.8%(P＜0.05) in ethanol-treated patients. Conclusion The anhydrous ethanol or lauromacrogol sclerotherapy under US guidance in the treatment of patients with liver-kidney cysts is efficacious, and we recommend lauromacrogol sclerotherapy because of its high reduction rates of cysts and low incidences of adverse reactions.

Objective The aim of this study was to compare the relapse of hepatic cysts (HC) after laparoscopic fenestration drainage (LFD) or ultrasound-guided puncture sclerotherapy (US-GPS) therapy in patients with HC, and the impact on serum myocardial enzymes and platelet parameters. Methods A total of 65 patients with HC were encountered in our hospital between January 2016 and December 2020, and 31 patients received LFD and 34 patients received US-GPS therapy. All patients were followed-up for three months. Serum creatine phosphokinase (CK), myokinase isoenzyme (CK-MB) and lactate dehydrogenase (LDH)] were assayed, and peripheral blood platelet counts (PLT), thrombocytocrit (PCT), platelet distribution width (PDW) and mean platelet volume (MPV) were detected routinely. Results Three days after operation, serum myocardial enzymes increased compared to those at presentation, and there were no significant differences respect to serum CK, CK-MB and LDH levels [(187.4±24.1)U/L, (25.8±8.3)U/L and (189.2±35.3)U/L vs. (188.1±27.2)U/L, (26.9±7.4)U/L and (188.3±33.5)U/L] between patients with LFD- and with US-GPS-treated groups (P>0.05); the peripheral blood PLT, PCT, PDW and MPV in LFD-treated patients were (239.5±24.1)×10⁹/L, (0.1±0.1)%, (16.2±2.3)% and (10.5±3.6)fl, not significantly different compared to [(242.1±26.3)×10⁹/L, (0.1±0.1)%, (17.2±2.6)% and (9.8±3.1)fl] in US-GPS-treated patients (P>0.05); the incidences of fever, abdominal pain and distension, and vomiting in US-GPS-treated patients were 8.8%, 14.7% and 20.6%, all significantly lower than 29.0%, 41.9% and 48.4% (P<0.05) in LFD-treated patients; at the end of three month post-treatment, the relapse of HC in LFD-treated patients was 3.2%, significantly lower than 20.6%(P<0.05) in US-GPS-treated patients. Conclusion The efficacy of laparoscopic fenestration drainage is equivalent to that by ultrasound-guided puncture sclerotherapy in the treatment of patients with HC, with low recurrence of HC by the former, while with low complications by the latter, and the clinicians might make the decision appropriately.

Objective Ferroptosis is a newly discovered mode of cell death, which is caused by the abnormal increase of intracellular iron ion levels, resulting in the imbalance of redox, lipid peroxidation of cell membrane, and finally cell death owing to cell membrane rupture. At present, the central link of ferroptosis is iron metabolism and reactive oxygen metabolism. Ferroptosis can affect the occurrence and development of a variety of diseases, such as neurodegenerative diseases, tumors, ischemia-reperfusion injury, immunoimbalance diseases, etc. Increasing numbers of studies have shown that the characteristics of ferroptosis, such as iron overload and accumulation of lipid reactive oxygen species, occur in the development many liver diseases. Ferroptosis can affect the progression of liver diseases by regulating the intracellular iron ion levels and lipid peroxidation degree.In this review, we put emphasis on the research progress of ferroptosis in liver diseases.

Objective The pandemic of COVID-19 has ravaged all over the world. The respiratory tract is considered to be the main target of SARS-CoV-2 infection.Some COVID-19 patients have different degrees of liver injuries. We reviewed the progress on mechanism of liver injuries, so as to provide a therapeutic strategies for COVID-19 patients with liver injuries.