Objective The aim of this study was to investigate the protective effect of compound 38, a selective bromodomain and extra-terminal (BET) inhibitor, on CCl₄-induced acute liver injury (ALI) in mice. Methods The Raw264.7 cells was stimulated by LPS with or without compound 38 co-culture, and the Raw264.7 cells with no stimulation served as control. The cell RNA was extracted by Trizol, and the cell inflammation-related genes were detected by RT-qPCR. Twenty-four mice were divided randomly into control, model and compound 38-intervened group, and the model was established by CCl₄ administration intraperitoneally. Serum ALT and AST level was measured, and the pathological changes of liver tissues were observed. The intrahepatic neutrophil and macrophage was detected by immunohistochemistry. Results In model cells, the IL-1βmRNA, IL-6 mRNA and TNF-αmRNA levels were (23246.0±1185.0), (7740.0±322.2) and (132.2±2.7), significantly higher than [(1.1±0.1), (1.1±0.4) and (1.0±0), P＜0.05], while in the compound 38-intervened cells were all greatly dose-dependently decreased as compared to those in the model (all P＜0.05); serum ALT and AST levels in mice with ALI were (8281.0±2710.0)U/L and (5330.0±2435.0)U/L, significantly higher than [(51.5±7.0)U/L) and (215.3±12.4)U/L, respectively, P＜0.05] in the control, while in the compound 38-intervended cells were (3634.0±713.9.0) U/L and (2876.0±667.1)U/L, greatly decreased compared to in the model (P＜0.05); the histopathological examination showed that the liver tissue structure was disordered with obvious inflammatory response, such as hepatocyte necrosis, destruction of normal lobule structure and aggregation of a large number of inflammatory cells in the model group, while the above pathological changes were alleviated in the intervention group. Conclusion The copound 38, a selective BET inhibitor, could alleviate CCl₄-induced acute liver injury in mice, and the mechanism might be related to the inhibition of inflammation-related cytokine expression and decreased infiltration of macrophages.

Objective The aim of this experiment was to observe the protective effect of oxymatrine (OMT) on liver steatosis in rats with high-fat-induced non-alcoholic fatty liver diseases (NAFLD). Methods 40 SD rats were randomly divided into control, model, OMT –intervened and simvastatin-intervened groups, with 10 rats in each. The NAFLD model was established by high-fat diet feeding. Since 9^th week, the normal saline, OMT or simvastatin was given by gavage, and the management continued to 16^th week. Serum interleukin-1β (IL-1β), IL-6, IL-10 and tumor necrosis factor-α (TNF-α), and liver homogenate superoxide dismutase (SOD), reduced glutathione (GSH) and malondialdehyde (MDA) levels were detected. Results The body mass and liver mass in OMT-intervened group were(610.3±9.4)g and (11.6±0.7)g, significantly lower than [(631.8±13.9)g and (13.9±0.6)g, respectively, P<0.05] in the model; serum ALT and AST levels were(78.9±7.0)U/L and (120.4±11.3)U/L, significantly lower than [(96.7±11.4)U/L and (183.1±25.9)U/L, respectively, P<0.05] in the model; serum TC, TG and LDL levels were (2.0±0.2)mmo/L, (2.2±0.1)mmo/L and (1.0±0.1)mmo/L, significantly lower than [(2.4±0.2)mmo/L, (2.8±0.2)mmo/L and (1.2±0.2)mmo/L, respectively, P<0.05] in the model group; serum IL-1β, IL-6 and TNF-α levels were (6.4±1.8)pg/ml, (63.7±8.5)pg/ml and (13.9±1.9)pg/ml, significantly lower than [(13.9±8.4)pg/ml, (149.8±12.0)pg/ml and (36.5±2.9)pg/ml, respectively, P<0.05], while serum IL-10 level was (42.3±2.0) pg/ml, significantly higher than [(18.9±1.9)pg/ml, P<0.05] in the model; the liver homogenate SOD and GSH levels were (22.3±2.1)μg/mg and (26.0±2.1)U/mg, significantly higher than [(17.5±1.9)μg/mg and (15.8±1.8)U/mg, respectively, P<0.05] while MDA level was (17.9±2.2)nmol/mg, significantly lower than [(23.8±2.7)nmol/mg, P<0.05] in the model. Conclusion Oxymatrine could protect the liver function of rats with NAFLD and reduce blood lipids levels, which might be related to its anti-inflammatory and anti-oxidative stress effects.

Objective The purpose of this study was to investigate the potential mechanism of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection promoting the proliferation of hepatocellular carcinoma cells. Methods The proliferation of HepG2 and Huh7 cells after HBV or HCV infection was detected by MTT. The key genes that affected the proliferation of hepatoma cells after HBV or HCV infection were assayed by high-throughput transcriptome sequencing and small interfering ribonucleic acid genetic screening. After overexpression or knockdown of these genes, their functions were analyzed by high-throughput sequencing and pathway enrichment. Results After HBV transinfection, the proliferation of HepG2 and Huh7 cells were (1.01±0.09)and(0.97±0.09), significantly higher than [(0.61±0.12)and(0.60±0.12), respectively, P<0.05] before transinfection; the proliferation activities of HepG2 and Huh7 cells after HCV transinfection were (1.10±0.09)and(1.03±0.08), significantly higher than [(0.65±0.13)and(0.52±0.11), respectively, P<0.05] before transinfection; when the LSM11 was knocked down, the proliferation of HepG2 and Huh7 cells were (0.39±0.06)and(0.34±0.04), significantly lower than [(0.49±0.02)and (0.50±0.06), respectively, P<0.05] without knock-down; the proliferation of HepG2 and Huh7 cells when overexpression of LSM11 were (1.04±0.07)and(1.02±0.08), significantly higher than [(0.54±0.11)and(0.50±0.12), P<0.05] without overexpression; the high-throughput sequencing and pathway enrichment analysis of the regulated genes after LSM11 knockdown or overexpression showed that LSM11 could significantly affect the product expression of Wnt/β-catenin pathway; after LSM11 knockeddown, the β-catenin activity in HepG2 and Huh7 cells were(1235±69)and(884±95), significantly lower than [(23645±256)and(19482±119), P<0.05] without knocked-down; the activity of β-catenin after LSM11 overexpression in HepG2 and Huh7 cells were (43999±2345)and(39572±3912), significantly higher than [(25281±281)and(2004±145), P<0.05] without overexpression; in addition, the interaction between LSM11 and β-catenin was observed by immunoprecipitation. Conclusion After HBV or HCV transinfection, the expression of LSM11 in hepatocellular carcinoma cells is increased, and LSM11 could bind to β-catenin, a key transcription factor in Wnt/β-catenin signaling pathway, and enhance the functional activity of β-catenin.

Objective The aim of this study was to investigate the efficacy of switching from entecavir(ETV) or tenofovir(TDF) to other different antiviral therapy in ETV- or TDF-treated chronic hepatitis B (CHB) patients with low-level viraemia (LLV). Methods A total of 197 patients with CHB who had been treated with ETV or TDF were enrolled in this study and were divided into group A (n=74) continuing ETV or TDF treatment, group B( n=63) switching to TAF therapy and group C (n= 60) switching to ETV or TDF and peg-IFNα-2b combination therapy. The regimen lasted for (48±2) weeks. Results At the end of 48 week treatment, the complete virologic response and serum HBeAg negative rates in group C were 90.0% and 41.7%, significantly higher than 16.2% and 5.4%(P<0.05) in group A or 66.7% and 9.5%(P<0.05) in group B, and serum ALT normalization rates in group B and group C were 20.6% and 23.3%, significantly higher than 8.1%(P<0.05) in group A; serum HBsAg level in group C was 3.0(2.8, 3.4)lgIU/ml, significantly lower than [3.3(2.9, 3.9)lgIU/ml, P<0.05] in group A or [3.4(3.3, 3.8)lgIU/ml, P<0.05] in group B, serum HBeAg level was 0.1(-0.7, 0.0)lgIU/ml, significantly lower than [0.6(-0.6, 1.8) lgIU/ml, P<0.05] in group A or [0.6(-0.3, 1.8)lgIU/ml, P<0.05] in group B, and serum HBV DNA load was 1.3(1.3, 1.3)lgIU/ml, significantly lower than [1.7(1.3, 2.0)lgIU/ml, P<0.05] in group A or [1.6(1.3, 1.4)lgIU/ml, P<0.05] in group B; the LSMs in group B and group C were 6.4(4.3, 8.4) kPa and 6.2(4.2, 7.7) kPa, both significantly lower than [8.6(5.2, 10.7) kPa, P<0.05] in group A, and serum ALT levels in the three groups were not significantly different (P＞0.05). Conclusion The switch to TAF or combined with peg-IFNα-2b therapy in ETV- or TDF-treated patients with LLV might benefit for further virologic and even serologic response, and warrants clinical investigation.

Objective The aim of this study was to investigate the antiviral response and changes of Toll-like receptor 4 (TLR4) and costimulatory molecule B7-H1 ( B7-H1) in peripheral blood mononuclear cells (PBMCs) by peginterferon α-2a (peg-IFN α-2a) and entecavir combination therapy in patients with chronic hepatitis B (CHB). Methods A total of 96 patients with CHB were enrolled in our hospital between July 2019 and July 2021, and were divided into control group (n=48) and observation group (n=48), receiving entecavir or entecavir and peg-IFN α-2a combination treatment for 48 weeks. Serum collagen type IV (IV-C), laminin (LN), procollagen type III (PG III) and hyaluronic acid (HA) levels, and serum interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) and IL-6 levels were detected by ELISA. The percentages of TLR4 and B7-H1 on the surface of PBMCs were detected by flow cytometry. Results At the end 48 weeks of treatment, the negative conversion rate of serum HBeAg in the observation group was 37.5%, significantly higher than 14.6%(P＜0.05), and HBeAg seroconversion rate was 25.0%, significantly higher than 0.0%(P＜0.05) in the control group; serum ALT and AST levels in the two groups were back to normal and there was no significant differences between them(P>0.05); serum Ⅳ-C level in the observation was (83.9±17.7)μg/L, serum LN level was (89.2±25.5)μg/L and serum HA level was (124.9±22.7)μg/L, all significantly lower than [(106.5±20.3)μg/L, (124.1±32.7)μg/L and (179.2±38.4)μg/L, respectively, P＜0.05] in the control; serum IL-10 level in the observation was (30.6±5.7)pg/mL, significantly higher than [(20.4±8.6)pg/mL, P＜0.05], while serum TNF-α level was (28.8±7.4)mg/L, significantly lower than [(39.1±9.7)mg/L, P＜0.05], and serum IL-6 level was (19.1±3.8)pg/mL, significantly lower than [(27.5±5.4)pg/mL, P＜0.05] in the control; the percentage of TLR4 expression in the surfaces of PBMCs was (10.2±3.1)%, significantly lower than [(15.8±4.6)%, P＜0.05] and the percentage of B7-H1 expression was (8.9±1.5)%, significantly lower than [(11.6±2.2)%, P＜0.05] in the control group. Conclusion The efficacy of peg-IFN α-2a and entecavir combination in the treatment of patients with CHB is promising, which might inhibit HBV replication, promote the recovery of liver function tests, alleviate the process of liver fibrosis, and improve inflammatory response.

Objective The aim of this study was to investigate the clinical implication of serum HBV covalently closed circular DNA (HBV cccDNA) and HBV pregenomic RNA (HBV pgRNA) in patients with chronic hepatitis B (HBV) undergoing entecavir therapy. Methods A total of 89 patients with serum HBeAg-positive CHB were admitted to our hospital between January 2018 and January 2020, and all received entecavir therapy for 48 weeks. Serum HBV cccDNA, HBV pgRNA and HBV DNA loads were detected by fluorescent quantitative PCR under COOBAS TAQMAN and COBAS Amliprep systems. Serum HBsAg and HBeAg levels were detected by chemiluminescence method. The predicting performance of each parameter was analyzed by receiver operating characteristic (ROC) curve. Results At the end of 48 week observation, the virologic response was obtained in 85 cases(95.5%), biochemical response was obtained in 80 cases (89.9%), and serologic response in 9 cases (10.1%); the complete response (CR) as defined by both virologic and biochemical responses was gained in 75 cases(84.3%); at presentation, serum ALT, HBsAg, HBeAg, HBV DNA, HBV cccDNA and HBV pgRNA levels in patients with CR were (228.3±34.9)U/L, (2.5±0.4)lg IU/mL, (18.6±1.9)S/CO, (6.1±0.6)lg IU/mL, (2.2±0.2)cps/mL and (4.5±0.6)cps/mL, significantly different compared to [(69.5±17.1)U/L, (3.7±0.7)lg IU/mL, (163.2±16.3)S/CO,(6.8±0.7)lg IU/mL, (3.9±0.4)cps/mL and (7.0±0.7)cps/mL, respectively, P<0.05]; the area under ROC of serum HBV cccDNA and HBV pgRNA combination in predicting CR in patients with CHB receiving entecavir treatment was 0.892, with the sensitivity of 81.6% and specificity of 89.5%. Conclusion The combined detection of serum HBV cccDNA and HBV pgRNA is of high predictive value in patients with HBeAg-positive CHB before antiviral therapy, which needs further clinical investigation.

Objective The aim of this study was to summarize the clinical features of patients with Dengue fever (DF), especially in those with liver injuries. Methods 70 patients with DF were encountered in our hospital from January to December 2020, and were carefully managed by supporting treatment. The patients with liver injuries were dealt with liver-protecting medicines. The clinical feature, including blood and biochemical parameters was collected. Results Out of 70 patients with DF, the main symptoms included fever, arthralgia, rash, abdominal pain, diarrhea, respiratory and urinary tract infections, and the leukopenia in 34 cases, thrombocytopenia in 35 cases and abnormal liver function tests in 33 cases; the hospital stay in 33 patients with liver injuries was (7.1±2.2) d, significantly longer than [(5.8±2.0), P<0.05] in 37 patients without liver injuries; all the 70 patients recovered; there was no significant difference as respect to peripheral white blood cell counts between patients with and without liver injuries (P>0.05), while the platelet counts in patients with liver injuries was (105.0±48.6)×10⁹/L, significantly lower than [(156.2±88.7)×10⁹/L, P<0.05] in those without liver injuries; serum ALT, AST, GGT, C-reactive protein and MB isoenzyme of creatine kinase levels slightly increased in patients with liver injuries and the outcomes was good. Conclusions The patients with Dengue fever could have complicated slight liver injuries, and the liver-protecting management could improve the recovery.

Objective The purpose of this study was to collect and summarize the clinical feature of patients with drug-induced liver injury (DILI), and to analyze the suspected medicines, clinical characteristics and clinical outcome of patients with DILI. Methods 60 patients with DILI were encountered in our hospital between August 2018 and December 2021,and we collect the clinical materials, including the suspected medicines, episode times, disease severities and treatment periods. The clinical categories and disease grades were determined. The outcomes included recovery, with clinical symptoms and signs disappeared and liver function tests back to normal, and non-recovery. Results The main medicines in the 60 patients with DILI were chemical medicines in 16 cases(26.7%), Chinese herbal medicine in 13 cases(21.7%), antibiotics in 8 cases(13.3%), antithyroid medicines in 7 cases(11.7%), hypolipidemic drugs in 5 cases (8.3%), anti-tuberculosis drugs in 4 cases (6.7%), psychotropic drugs in 3 cases (5.0%), antihypertensive drugs in 2 cases (3.3%) and health products in 2 cases (3.3%); the episode time ranged from 2 to 118 days, and within one week in 19 cases (31.7%), one week to three months in 24 cases (40.0%) and longer than three months in 17 cases(28.3%); the clinical manifestations included anorexia in 13 cases (21.7%), nausea and vomiting in 13 cases (21.7%), fatigue in 12 cases (20.0%), jaundice in 13 cases (21.7%), abdominal pain and diarrhea in 8 cases (13.3%), pruritus in 2 cases (11.7%), and without obvious symptoms in 25 cases (41.7%); the disease severities included grade one in 42 cases (70.0%), grade two in 7 cases(11.7%), grade three in 6 cases (10.0%) and grade four in 5 cases (8.3%), without grade five in our series; the ages and gender between 49 patients with ≤grade 2 and 11 patients with ≥ grade 3 were not significantly different (P>0.05), while the episode time in patients with ≥grade 3 were shorter and the hospitalization stay longer (P<0.05); 54 patients recovered and 6 patients didn’t in our series. Conclusion The most common clinical symptoms in our patients with DILI are digestive system-related, and the common medicines which lead to DILI include chemical medicines, Chinese herbal medicines, antibiotics, antithyroid drugs, hypolipidemic drugs and so on. The patients with poor clinical outcome tend to have severe liver function injuries with coagulation function tests deteriorated, and need careful management in clinical practice.

Objective The aim of this study was to analyze the blood lipid changes in patients with metabolism-related fatty liver disease (MAFLD). Methods A total of 2210 patients with MAFLD were found in Physical Examination Center, Affiliated Hospital, Liaoning University of Chinese Traditional Medicine, from January to October 2021, including 418 individuals with normal blood lipids, and 1792 cases with abnormal blood lipids. The receiver operating characteristic curve (ROC) was established to evaluate the diagnostic efficacy of blood lipids in predicting steatosis severity of patients with MAFLD. Results The body mass index (BMI) in MAFLD patients with abnormal blood lipids was (32.8±10.8 )kg/m², significantly higher than [(28.4±11.2) kg/m², P＜0.05], the systolic blood pressure was (146.2±21.2 )mmHg, significantly higher than [(106.3±7.3)mmHg, P＜0.05], the diastolic blood pressure was (107.3±11.6 )mmHg, significantly higher than [(88.6±5.2)mmHg, P＜0.05], the fasting plasma glucose was (6.4±1.9)mmol/L, significantly higher than [(6.0±1.5)mmol/L, P＜0.05], serum ALT and GGT levels were (42.2±23.8)U/L and (42.5±30.9 )U/L, both significantly higher than [(38.3±13.7) U/L and (39.3±18.3 )U/L, P＜0.05] in those with normal blood lipids; serum TG, TC and LDL-C levels in mild, moderate and severe MAFLD patients with abnormal blood lipids were significantly higher than, while serum HDL-C level was significantly lower than in those with normal blood lipids (P＜0.05); when blood HDL-C=0.84 mmol/L was set as the cut-off-value, the area under ROC curve (AUC) was 0.72(P＜0.001) in predicting mild MAFLD, with the sensitivity (Se) of 84.8% and the specificity (Sp) of 52.8%; when blood TG=2.71 mmol/L was set as the cut-off-value, the AUC was 0.79(P＜0.001) in predicting moderate MAFLD, with the Se of 75.7% and the Sp of 74.4%; when blood TG=3.35 mmol/L was set as the cut-off-value, the AUC was 0.86(P＜0.001) in predicting severe MAFLD, with the Se of 90.4% and the Sp of 73.9%. Conclusion The MAFLD progression is closely related to blood lipid metabolism disorders, and has influence on blood glucose, BMI and blood pressure. The comprehensive check-up, such as blood biochemical tests and ultrasonography could find MAFLD patients with abnormal blood lipids. The early appropriate intervention might help improve the outcomes of patients with MAFLD.

Objective The aim of this study was to investigate the short-term efficacy of Heye Tiaozhi Shugan, a kind of herbal medicine, decoction in dealing with patients with nonalcoholic fatty liver diseases(NAFLD). Methods 56 patients with NAFLD were recruited in our hospital between April 2019 and April 2021, and were randomly divided into control and observation group, with 28 patients in each group. All patients were supervised for health education, like exercise and diet guidance. The patients in the control group were treated with polyene phosphatidylcholine and glycyrrhizinic acid tables, and those in the observation group were treated with the herbal medicine at base of medication in the control. The regimen lasted for 12 weeks. The TCM syndrome scores were evaluated, and serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) levels were assayed. Results At the end of three month treatment, the hypochondriac pain, depression, poor appetite, abdominal distension and loose stool scores as obtained by TCM evaluation were (1.0±0.3), (0.8±0.2), (0.7±0.2), (0.7±0.2) and (1.0±0.1), significantly lower than [(1.4±0.7), (1.3±0.3), (1.3±0.3), (1.2±0.3) and (1.4±0.3), P < 0.05] in the control; serum TG and LDL-C levels in the observation group were(1.8±0.5)mmol/L and(2.7±0.6)mmol/L, significantly lower than [(2.4±0.8)mmol/L and (3.9±0.8)mmol/L, respectively, P＜0.05], while serum HDL-C level was (1.8±0.6)mmol/L, significantly higher than [(1.1±0.4)mmol/L, P＜0.05] in the control; serum alanine aminotransferase, aspartate aminotransferase, gamma glutamine transferase and alkaline phosphatase levels in the observation group were(46.1±8.9)U/L, (31.9±9.0)U/L,(38.7±11.2)U/L and (66.1±12.2)U/L, all significantly lower than [(55.7±9.4)U/L,(44.3±10.7)U/L,(49.7±12.5)U/L and (74.4±14.7)U/L, respectively, P＜0.05]. Conclusion The Heye Tiaozhi Shugan decoction, a herbal medicine compound, in treatment of NAFLD patients with special TCM syndrome, could improve blood lipid metabolism, and needs further investigation.

Objective The aim of this study was to explore the evaluation of left ventricular functions by three-dimensional speckle tracking imaging (3D-STI) in patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). Methods 60 patients with NAFLD and T2DM (mild NAFLD in 30 and severe in 30) and 30 patients with T2DM were admitted in our hospital between June 2019 and June 2021. Serum fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were detected. The left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs) and ratio of peak systolic velocity to end-diastolic velocity (E/A) were measured by routine two-dimensional ultrasound. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF) and left ventricular mass index (LVMI) were measured by real-time three-dimensional ultrasound. The left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and global area strain (GAS) were detected by 3D-STI. Results Serum HbA1c, ALT and AST levels in patients with severe NAFLD and T2DM were (8.9±2.4)%,(127.2±16.9)U/L and (91.2±11.5)U/L, significantly higher than[(7.2±2.9)%, (61.6±10.4)U/L and (60.7±9.6)U/L, respectively, P<0.05] in patients with mild NAFLD and T2DM or [(7.0±2.5)%, (31.7±5.5)U/L and (33.5±4.8)U/L, respectively, P<0.05] in patients with T2DM; there were no significant differences in LVDd, LVDs, ratio of E/A, LVEF, LVEDV, LVESV and LVMI among the three groups (P＞0.05); the GLS, GCS, GRS and GAS in patients with severe NAFLD and T2DM were (14.3±3.9)%, (17.3±3.3)%, (40.6±6.2)% and (24.1±4.6)%, significantly lower than [(17.7±2.8)%, (19.4±2.7)%, (44.9±8.7)% and (27.0±4.4)%, respectively, P<0.05] in patients with mild NAFLD and T2DM or [(18.9±2.4)%, (19.6±3.1)%, (45.5±6.4)% and (28.8±3.6)%, respectively, P<0.05] in patients with T2DM. Conclusion The 3D-STI detection could sensitively reflect changes of left ventricular functions in patients with NAFLD and T2DM, which is beneficial to correctly evaluate impairment of cardiac functions in this setting.

Objective The aim of this study was to investigate the short-term efficacy of different statins in treatment of patients with nonalcoholic fatty liver disease (NAFLD) and hyperlipidaemia. Methods 52 patients with NAFLD and hyperlipidaemia were encountered in our hospital between September 2019 and May 2021, and were divided into two groups, with 26 cases in each group, receiving pitavastatin or atorvastatin treatment for six months. The homeostasis model assessment-insulin resistance index (HOMA－IR) were obtained, and serum tumor necrosis factor-α ( TNF-α) , interleukin-6 (IL－6) , IL-8 and high-sensitivity C-reactive protein (hs-CRP) were detected by ELISA. The controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were recorded by FibroTouch. Results At the end of 6 months of treatment, the HOMA-IR, total cholesterol (TC), triglyceride (TG) and low density lipoprotein cholesterol (LDL- C ) levels in the pitavastatin-treated patients were (2.1±0.5), (3.5±0.4)mmol/L, (2.4±0.3)mmol/L and (2.2±0.5)mmol/L, significantly lower than [(2.5±0.4), (4.2±1.0)mmol/L, (2.9±0.4)mmol/L and (2.9±0.7)mmol/L, respectively, P＜0.05], while serum high density lipoprotein cholesterol (HDL－C) level was (1.6±0.4)mmol/L, significantly higher than [(1.3±0.3)mmol/L, P＜0.05] in atorvastatin-treated patients; there were no significant differences respect to serum cytokine levels between the two groups(P＞0.05); the CAP in the pitavastatin-treated patients was (258.4±6.3)dB/m, much lower than [(267.7±10.2)dB/m, P＜0.05] in atorvastatin-treated patients; there was no significant difference as respect to liver parenchymal echo manifestations (P＞0.05). Conclusion The statins could alleviate insulin resistance, reduce blood lipid levels and inhibit inflammatory reactions in patients with NAFLD and hyperlipidaemia, and the administration ofpitavastatinseems promising, and warrants further investigation.

Objective The purpose of this study was to compare the metabolic characteristics and liver steatosis in non-obese and obese patients with nonalcoholic fatty liver diseases (NAFLD). Methods 274 patients with NAFLD were recruited in our hospital between January 2015 and June 2021, and were divided into non-obese (n=66) and obese (n=208) groups based on basic mass index equal to 25 kg/m². The liver fat content (LFC) and abdominal subcutaneous fat thickness (ASFT) were obtained by MR scan. The controlled attenuation parameter (CAP) was detected by FibroTouch check-up and the carotid intima-media thickness (CIMT) was assessed by ultrasonography. Results In patients with non-obese NAFLD, the BMI was (23.4±1.4)kg/m², serum alanine aminotransferase level was 24.2(19.6,35.8)U/L, aspartate aminotransferase level was 25.0(18.7, 32.3)U/L, triglyceride level was (1.9±0.4)mmol/L, high-density lipoprotein cholesterol level was (1.3±0.4)mmol/L, fasting blood glucose level was (5.0±0.7)mmol/L, fasting insulin level was 7.0(4.8, 9.4)μU/mL, the HOMA-IR was 1.6(1.1, 2.3) and uric acid level was 376.5(294.3, 430.5)μmol/L, significantly different as compared to [(28.6±3.0)kg/m², 88.4(55.4, 160.5)U/L, 71.5(64.4, 141.6)U/L, (2.8±0.6)mmol/L, (1.1±0.3)mmol/L, (5.8±0.8)mmol/L, 10.4(7.7, 14.2)μU/mL, 2.5(1.8, 3.4) and 442.3(346.4, 484.5)μmol/L, respectively, P<0.05] in obese patients; the LFC was 8.2(6.2, 13.4)%, the ASFT was 为(19.2±5.7)mm, the CAP was (233.2±40.5)dB/m and the CIMT was 0.6(0.6, 0.7)mm, significantly different compared to [14.6(10.0, 18.6)%, (24.6±8.2) mm, (284.6±46.0) dB/m and 0.8(0.6, 0.9)mm, respectively, P<0.05] in obese patients; the incidence of liver steatosis grade Ⅰ was 43.9%, significantly higher than 26.0%, while the incidence of liver steatosis grade Ⅲ was 22.7%, significantly lower than 40.4%(P<0.05) in obese patients. Conclusion The metabolic disorders and liver steatosis in non-obese patients with NAFLD are mild, and how to monitor them is really a challenge in clinical practice.

Objective The aim of this study was to explore the diagnostic efficacy of peripheral blood regulatory T cells (Treg)/helper T cells 17 (Th17) and theirrelated cytokines in predicting significant liver fibrosis in patients with primary biliary cholangitis (PBC). Methods 59 patients with PBC and 59 healthy persons were encountered in our hospital between January 2019 and December 2021. All PBC patients underwent routine liver biopsy. The percentages of peripheral blood Treg/Th17 cells were detected by flow cytometry. Serum IL-10, IL-6 and IL-17 levels were detected by ELISA. The receiver operating characteristic (ROC) curves were drawn by SPSS 20.0 software, and the diagnostic performance of peripheral blood Treg/Th17 cell’s parameters in predicting significant liver fibrosis was evaluated by area under the curve (AUC). Results The percentages of peripheral blood Treg and Th17 cells, and Th17/Treg cell ratio in patients with PBC were(3.1±0.5)%, (5.9±0.9)% and (1.9±0.3), all significantly higher than [(1.6±0.3)%, (2.3±0.5)% and (1.4±0.1), respectively, P＜0.05] in healthy persons; serum IL-10, IL-6 and IL-17 levels in patients with PBC were (19.5±3.4)ng/L, (10.3±2.2)ng/L and (21.2±3.1)ng/L, all significantly higher than [(13.9±2.7)ng/L, (6.4±1.5)ng/L and (5.1±0.9)ng/L, respectively, P＜0.05] in healthy persons; the liver histopathological examination showed non-significant liver fibrosis in 20 cases, and significant liver fibrosis in 39 cases in our series; the percentages of cells and their related serum cytokine levels in patients with significant liver fibrosis were much higher than in those with non-significant liver fibrosis(P＜0.05); the ROC analysis demonstrated that the AUC was 0.956 when all the six parameter combination in predicting significant liver fibrosis in patients with PBC, much higher than 0.760, 0.746, 0.776, 0.747, 0.736 and 0.769 (P＜0.05) by any one of them. Conclusion The percentages of peripheral blood Treg and Th17 cells, and their related serum cytokine levels increase in patients with PBC, which might be related to liver fibrosis, and needs further investigation.

Objective This study aimed to explore serum clusterin level changes in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF)and its correlation with short-term prognosis. Methods 48 hospitalized patients with HBV-ACLF and 60 patients with chronic hepatitis B (CHB) were enrolled in our hospital between January 2019 and January 2021, and the patients with HBV-ACLF were classified into early stage with 30% < prothrombin time activity (PTA)<40%, middle stage with 20%<PTA<30% and late stage with PTA<20%. Serum clusterin levels were assayed by ELISA. Results The peripheral white blood cell counts, serum alanine aminotransferase, aspartate aminotransferase, bilirubin levels and model for the end-stage liver diseases (MELD) in patients with HBV-ACLF were(8.0±2.8)×10⁹/L, (418.2±163.5)U/L, (386.1±139.2)U/L, (226.6±74.4)μmol/L and (23.2±5.3), significantly higher than [(6.0±2.3)×10⁹/L, (163.8±75.7)U/L, (118.7±73.3)U/L, (25.6±12.4)μmol/L and (9.6±3.6), respectively, P<0.05], while peripheral platelet counts was (101.8±42.0)×10⁹/L, serum albumin level was (32.6±7.6)g/L, PTA was (35.3±5.3)%, serum clusterin level was (51.0±5.9)μg/mL, all significantly lower than [(128.5±54.4)×10⁹/L, (38.1±8.5)g/L, (77.4±9.3)% and (185.9±13.5)μg/mL, respectively, P<0.05] in patients with CHB; serum clusterin level in 9 patients with HBV-ACLF late stage was (28.5±3.8)μg/mL, significantly lower than [(72.6±7.2)μg/mL, P<0.05] in 20 patients with HBV-ACLF early stage or [(46.0±5.2)μg/mL, P<0.05] in 19 patients with HBV-ACLF middle stage, serum clusterin level in 13 HBV-ACLF patients with bacterial infections was (36.6±4.6)μg/mL, significantly lower than [(56.6±6.1)μg/mL, P<0.05] in 35 HBV-ACLF patients without infections, and serum clusterin level in 15 dead HBV-ACLF patients was (39.8±4.3)μg/mL, significantly lower than [(72.3±7.6)μg/mL, P<0.05] in 33 survivals; the dead patients with HBV-ACLF had even more higher total serum bilirubin levels, elevated MELD scores, more lower PTA, and more the incidence of complications, such as hepatic encephalopathy of 46.7% and hepatorenal syndrome of 40.0%. Conclusion The patients with HBV-ACLF has increased serum clusterin levels, which is a potential biomarker for the evaluation of disease severity and prognosis of patients.

Objective The aim of this study was to explore the diagnostic efficacy of urine microalbumin (UM-Alb), β2-microglobulin (Uβ2-MG) and N-acetyl-beta-glucosaminidase (NAG-U) levels for renal injury in patients with decompensated liver cirrhosis (LC). Methods A total of 135 patients with decompensated LC cirrhosis were enrolled in our hospital between September 2016 and April 2021. Urine UM-Alb and Uβ2-MG levels were detected by immune scatter turbidity, and NAG-U level was assayed by p-nitrophenol colorimetry. The diagnostic efficacy of urine parameters was evaluated by receiver operating characteristic curve (ROC). Results Out of our series, the renal injury was found based on KDIGO clinical practice guidelines for acute kidney injury in 75 patients (stage I in 41 cases, stage II in 19 cases and stage III in 15 cases); the UM-Alb, Uβ2-MG and NAG-U levels in patients with renal injury were (34.4±10.6) mg/L, (3.4±0.6) mg/L and (14.7±3.6) U/L, all significantly higher than (15.8±4.1) mg/L, (1.1±0.3) mg/L and (9.9±2.7) U/L, respectively, P<0.05] in those without; the UM-Alb, Uβ2-MG and NAG-U levels in patients with renal injury stage III were (49.1±9.3) mg/L, (4.9±0.7) mg/L and (21.9±4.9) U/L, all significantly higher than [(27.9 ±7.6) mg/L, (2.6±0.5) mg/L and (11.2±3.1) U/L, respectively, P<0.05] in patients with renal injury stage I or [(36.8±8.4) mg/L, (3.9±0.4) mg/L and (16.6±3.4) U/L, respectively, P<0.05] in patients with renal injury stage II; the area under the curve (AUC) of UM-Alb, Uβ2-MG and NAG-U combination with the cut-off-value of >26.6 mg/L, >2.5 mg/L and >11.3 U/L, respectively, for diagnosing renal injury was 0.908, significantly greater than 0.793, 0.809 and 0.787 by any one parameter alone (P<0.05), which had a higher sensitivity, specificity and accuracy of 86.7%, 85.0% and 85.9%, respectively. Conclusion The patients with decompensated LC is prone to renal injury, and the detection of UM-Alb, Uβ2-MG and NAG-U levels might help diagnose in time, which warrants further clinical investigation.

Objective The purpose of this study was to compare the incidence of portal vein thrombosis (PVT) after splenectomy or transjugular portal systemic shunt(TIPS)in patients with cirrhosis and hypersplenism. Methods 96 patients with cirrhosis and hypersplenism were enrolled and underwent splenectomy (n=45) or TIPS (n=51) in the Second Hospital, Lanzhou University, between January 2017 and December 2018, and all the patients were followed-up for one years. The PVT was diagnosed on ultrasonography, CT or CTA. The cumulative incidences between the two groups were compared by Kaplan-Meier method. Results At 1 month, 3 months, 6 months and 12 months after operation, the cumulative incidences of PVT in patients receiving splenectomy were 40.0%, 46.7%, 48.9% and 48.9%, significantly higher than 7.8%, 9.8%, 15.7% and 21.6% (P<0.05) in patients underwent TIPS; in patients receiving splenectomy, the baseline material analysis showed that the diameter of portal vain in 22 patients with PVT was significantly wider than in 23 patients without(P<0.05); one-year after TIPS, the incidence of PVT was 21.6%, and there were no significant differences as respect to baseline materials between patients with and those without PVT(P>0.05). Conclusion The cumulative incidence of PVT in patients with cirrhosis after splenectomy is relatively higher than that after TIPS. Therefore, the clinicians should carefully evaluate patient's condition before operation, strictly meeting the indications of splenectomy or TIPS, and make the appropriate choice in this setting.

Objective The aim of this study was to analyze the magnetic resonance imaging (MRI) with accelerated volume acquisition (LAVA) technology in evaluating collateral circulation in patients with Budd-Chiari syndrome (BCS). Methods 47 patients with BCS were admitted to our hospital between March 2017 and March 2022, and all underwent digital subtraction angiography (DSA) and MRI scan. The DSA results acted as the "gold standard" to determine the accuracy(Ac) of MRI LAVA on BCS typing and the collateral circulation. Results Among the 47 patients with BCS, the DSA showed hepatic vein occlusion in 18 cases, inferior vena cava occlusion in 21 cases, and mixed type in 8 cases, and the MRI LAVA found hepaticvein occlusion in 16 cases, inferior vena cava occlusion in 21 cases, and mixed occlusion in 10 cases,with the Ac of 95.7%; the MRI LAVA also showed inferior phrenic vein dilatation in 9 cases(19.1%), the intrahepatic communicating branch in 12 cases (25.5%), the superficial abdominal vein dilatation in 26 cases(55.3%), the accessory hepatic vein in 26 cases(55.3%), the azygos/hemiazygos vein in 39 cases(83.0%); the Ac in demonstrating accessory hepatic vein by MRI LAVA was 100%, as compared to by DSA. Conclusion The MRI LAVA scanning could accurately determine the classification of BCS and the collateral circulation establishment, which might   guide the clinicians for appropriate management.

Objective Based on the cancer genome atlas (TCGA) database, we conducted a systematic bioinformatics analysis of abnormal cancerous RNA binding proteins (RBPs) in patients with hepatocellular carcinoma (HCC), with the aim of identifying the prognostic markers and potential therapeutic targets. Methods The cancerous and adjacent liver tissue HCC RNA sequencing data was downloaded from TCGA database, and the functional enrichment analysis and visualization of interaction relationships among them were performed. The univariate and multivariate Cox regression analyses were subsequently applied to identify RBPs that were significantly related to the prognosis and a prognostic model was constructed. The predictive performance of the prognostic model was evaluated by survival analysis and receiver operating characteristic (ROC) curve and was verified in the test cohort. The human protein atlas online database was applied to verify the RBP levels in the prognostic model. Results A total of 82 differentially expressed RBPs were identified, including 55 up-regulated and 27 down-regulated (FDR< 0.05 and |log2 FC|>1); the further functional enrichment and interaction analyses showed that the differentially expressed RBPs were mainly related to regulation of mRNA metabolic process, RNA catabolic, mRNA catabolic process, and macromolecule methylation; five RBP genes, e.g., the LIN28B, SMG5, PPARGC1A, LARP1B, and ANG were identified as prognostic-related genes and were used to construct the prognostic model; the predictive ability of the prognostic model was verified in the test cohort; the ROC curve analysis showed that the prognostic model had good sensitivity and specificity; the independent prognostic analysis showed that the risk score could be an independent prognostic factor for patients with HCC. Conclusion The constructed prognostic prediction model by analyzing the differentially expressed RBPs in cancerous tissues in patients with HCC is reliable, which might be served as a prognostic biomarkers and therapeutic targets.

Objective The aim of this study was to investigate the short-term clinical efficacy of microwave ablation (MWA) under the guidance of ultrasound fusion imaging in the treatment of patients with small primary liver cancer (sPLC). Methods 80 patients with sPLC were admitted to our hospital between January 2018 and January 2022,and were divided into two groups,with 40 cases in each group. The patients in the observation group received MWA treatment under the ultrasound fusion imaging guidance, and those in the control group received transcatheter arterial chemoembolization (TACE). Serum alpha-fetoprotein (AFP) and hot-shock protein-90 (HSP-90) levels were assayed by ELISA. Results At the end of one month treatment, the complete response rate in MWA-treated patients was 82.5%, much higher than 37.5% in TACE-treated patients (P<0.05); at the end of three month treatment, serum AFP and HSP-90 levels in MWA-treated patients were (15.2±9.3)μg/L and (63.5±7.8)ng/ml, significantly lower than [(32.6±10.2)μg/L and (88.4±9.1)ng/ml, respectively, P﹤0.05] in TACE-treated patients; after operation, the incidence of local pain in MWA-treated patients was 47.5%, much lower than 82.5% in TACE-treated patients (P<0.05). Conclusions The application of MWA under the guidance of ultrasound fusion imaging in the treatment of patients with sPLC is efficacious, which could improve the complete ablation rate of lesions, and worthy of clinical verification.

Objective The aim of this study was to investigate different dosage of sevoflurane and propofol combination venous-inhalation anesthesia in patients with primary liver cancer (PLC) undergoing radical hepatectomy. Methods A total of 110 patients with PLC were recruited in our hospital between November 2019 and November 2021, and all underwent radical hepatectomy. During anesthesia, the patients were divided into group A (n=54) and group B (n=56), receiving 0.5 minimum alveolar concentration (MAC) or 1.0 MAC sevoflurane and propofol combination intravenous- inhalation anesthesia. The Ramsay sedation, Aldrete scores and mini-mental state examination (MMSE) scores were evaluated. The heart rhythm (HR), mean arterial pressure (MAP) and peripheral oxygen saturation (SpO₂) were recorded. Results The Ramsay sedation scores in group B immediately after extubation was (4.2±0.5), significantly higher than[(3.7±0.4), P＜0.05] in group A, while 5 minutes and 30 minutes after extubation, there were no significant differences respect to Ramsay and Aldrete scores between the two groups (P>0.05); at 6 h, 24 h and 72 h after operation, the MMSE scores in group B were (25.7±2.8), (27.6±1.4) and (28.4±1.1), all significantly higher than[(22.2±3.6), (25.4±2.2) and (27.8±1.2), respectively, P＜0.05] in group A; during operation, the HR in group B was (79.5±11.6)beats/min, faster than[(74.1±12.4)beats/min, P＜0.05] in group A, while before induction of and 6 hr after anesthesia, there were no significant differences respect to the HR, MAP and SpO₂ between the two groups (P＞0.05); the total incidence of adverse reactions in group B was (23.2%, much higher than 7.4%(P＜0.05) in group A. Conclusion The sevoflurane and propofol combination venous-inhalation anesthesia has a good anesthetic effect in the radical surgery of patients with PLC, and as compared with small dose, the administration of large dose of sevoflurane could obtain a better postoperative consciousness recovery, with a little more untoward reactions, which should be carefully evaluated before the operation.

Objective The aim of this study was to explore the implication of cysteinyl aspartate specific protease-3(caspase-3), decoy receptor 3 (DcR3) expression and small nucleolar host gene 12 (SNHG12) mRNA level in cancerous tissues of patients with hepatocellular carcinoma (HCC). Methods 68 patients with HCC were enrolled in our hospital between May 2016 and May 2019, and all underwent hepatectomy. The expressions of caspase-3 and DcR3 proteins in cancerous and adjacent liver tissues were detected by EnVision, and the SNHG12 mRNA level was assayed by RT-qPCR. The risk factors impacting prognosis of patients with HCC was analyzed by multivariate Logistic regression. Results The positive rate of caspase-3 in cancerous tissues of patients with HCC was significantly lower than that in adjacent liver tissues (47.1% vs. 77.9%, P<0.05), while the positive rate of DcR3 was 61.8%, the SNHG12 mRNA load was (2.9±0.8), significantly higher than [33.8% and (1.6±0.5), P<0.05] in adjacent tissues; the cancerous caspase-3 positive rate in 18 patients with lymph node metastasis was 33.3%, significantly lower than 62.0%(P＜0.05)in 50 patients without, while the DcR3 positive rate was 88.9%, significantly higher than 50.0% in patients without, the SNHG12 mRNA load was (2.6±0.4), significantly higher than [(1.5±0.3), P＜0.05] in patients without, and the SNHG12 mRNA level in 45 patients with greater than 5 cm tumor was (2.7±0.4), significantly higher than [(1.4±0.3), P＜0.05] in 23 patients with tumor less than 5 cm; at the end of follow-up, 30(44.1%) patients survived and 38 patients(55.9%) died; the multivariate Logistic regression analysis showed that large tumor mass, with underlying liver cirrhosis, lymph node metastasis, with caspase-3 weak expression, DcR3 strong expression and high SNHG12 mRNA load were the risk factors impacting the prognosis of patients with HCC after hepatectomy. Conclusion The down-regulated expression of caspase-3 and the intensified expression of DcR3 protein in cancerous tissues of patients with HCC hint the carcinogenesis, which might provide some clues for the prevention and management of the tumor.

Objective The aim of this study was to investigate the survival of patients with primary liver cancer (PLC) and different gross tumor volume (GTV) after radiotherapy three-dimensional conformal radiotherapy (3DCRT). Methods 75 patients with PLC were encountered in our hospital between January 2018 and December 2020, and were divided into group A (n=20,< 125 cm³), group B (n=37,126-999 cm³) and group C (n=18,>1000 cm³) based on different GTV. All patients received 3DCRT. Serum alpha-fetoprotein (AFP), alpha-fetoprotein heterogeneity L3 (AFP-L3), Golgi protein 73 (GP73), vascular endothelial growth factor (VEGF) and matrix metalloproteinase (MMP) levels were detected by ELISA. Results At the end of 4 weeks after treatment, the objective response rate (ORR) in group A was 70.0%, significantly higher than 51.4% in group B or 33.3% in group C(P＜0.05); serum AFP, AFP-L3, GP73, VEGF and MMP levels in group A were (121.0±20.8)ng/mL, (5.9±0.9)ng/mL, (62.8±3.5)ng/mL, (265.3±20.4)pg/mL and (60.2±11.7)ng/L, significantly lower than [(133.0±18.1)ng/mL, (6.5±0.7)ng/mL,(71.4±3.2)ng/mL,(296.1±30.9)pg/mL and (72.5±7.3)ng/L, respectively, P＜0.05] in group B or [(143.0±15.3)ng/mL, (6.9±0.8)ng/mL,(78.3±3.7)ng/mL,(320.5±32.7)pg/mL and (85.5±15.6)ng/L, respectively, P＜0.05] in group C; the one-year cumulative survival rate in group A was 72.2%(13/18), significantlyhigher than 52.9%(18/34) in group B or 41.2%(7/17, P＜0.05) ingroup C. Conclusion The short-term efficacy of patients with PLC after 3DCRT treatmentmight be related to the GTV, and needs further clinical investigation.

Objective The purpose of this study was to explore the short-term efficacy of transcatheter arterial chemoembolization (TACE), radiofrequency ablation (RFA) and immune targeted therapy combination in the treatment of patients with postoperative recurrent hepatocellular carcinoma (HCC). Methods A total of 150 patients with postoperative recurrent HCC were enrolled in our hospital between August 2014 and April 2018, and were divided randomly into control and obserbation group, with 75 cases in each group. The patients in the control group underwent TACE and RFA, while those in the observation group were treated with anti-programmed cell death protein 1 (PD-1) and angiogenesis inhibitors, apatinib, combination on the basis in control group. The clinical efficacy was evaluated by solid tumor mRESIST standards. The peripheral blood T cell subsets were detected by flow cytometry. The survival in the two groups after surgery was analyzed by Kaplan-Meier method. Results At the end of three months after treatment, the total response rate in the observation group was significantly higher than that in the control group (81.3% vs. 53.3%, P<0.05); the percentages of peripheral blood CD3⁺ and CD4⁺ cells and CD4⁺/CD8⁺ cell ratio were (68.2±6.8)%, (45.9±4.7)% and (1.8±0.3), significantly higher than [(56.5±6.1)%, (33.3±4.5)% and (1.3±0.2), respectively, P<0.05], while the percentage of CD8⁺ cells was (22.5±1.8)%, significantly lower than [(28.3±1.4)%, P<0.05] in the control; the incidence of untoward effects grade I/II in the observation group was 73.3%, significantly higher than 32.0%(P<0.05) in the control; the 1-year survival in the observation group was 49.3%, significantly higher than 30.7%(P<0.05) in the control. Conclusion The combination of TACE, RFA and immune targeted therapy could effectively improve short-term clinical efficacy in patients with postoperative recurrent HCC, which might be related to the up-regulation of cellular immune functions.

Objective The aim of this study was to investigate the short-term efficacy of radiofrequency ablation (RFA) in treatment of patients with primary liver cancer (PLC). Methods 62 patients with PLC were enrolled in our hospital between June 2017 and August 2020, and all underwent RFA therapy. The short-term efficacy was evaluated by MRI comparison. Serum alpha-fetoprotein (AFP), human heat shock protein-90α(HSP90α), carbohydrate antigen 125 (CA125) and carbohydrate antigen 199 (CA199) were assayed. Results At the end of one-month treatment, the complete remission (CR) was obtained in 12 cases(19.4%), partial remission (PR) in 21 cases (33.9%) and non-remission (NR) in 29 cases (46.8%); serum AFP, HSP90α and CA199 levels in patients with CR were (85.6±5.2)ng/mL,(112.3±29.2)ng/mL and (32.3±12.4)U/mL, significantly higher than [(334.2±42.3)ng/mL,(124.2±19.6)ng/mL and (45.3±12.5)U/mL, respectively, P<0.05] in patients with PR or [(679.5±48.4)ng/mL, (143.9±33.5)ng/mL and (64.6±16.1)U/mL, respectively, P<0.05] in patients with NR; at presentation, the apparent diffusion coefficient (ADC) of cancerous foci in patients with CR, PR and NR were(1.23±0.47)mm²/s, (1.21±0.57)mm²/s and (1.22±0.31)mm²/s(P>0.05), while after treatment, they were (1.72±0.25)mm²/s,(1.63±0.14)mm²/s and (1.34±0.22)mm²/s, significantly different (P<0.05). Conclusion The RFA therapy in dealing with patients with PLC could gain a good short-term efficacy, and the MR scan could help evaluate the clinical response objectively.

Objective The aim of this study was to explore the diagnostic performance of multimodal magnetic resonance imaging (MRI) in differentiating dysplastic nodules (DN) and small hepatocellular carcinoma (sHCC) in patients with liver cirrhosis (LC). Methods 71 patients with LC with intrahepatic nodules were encountered in our hospital between December 2016 and December 2021, and all underwent multimodal MRI, with the dynamic enhancement (DCE-MRI) parameters, the apparent diffusion coefficient (ADC), pure diffusion coefficient (D) and pseudo diffusion coefficient (D*) recorded. The golden diagnosis was based on fine needle aspiration or post-operational histopathological examination. Results Among the 71 patients, the sHCC was diagnosed in 45 cases (63.4%), and the DN was found in 26 cases (36.6%); the ADC, D and D * in sHCC foci were (0.81±0.19)×10^-3mm² / s, (0.91±0.21)×10^-3mm² / s and (46.26±10.13)×10^-3mm² / s, significantly lower than [(1.34±0.33)×10^-3mm² / s, (1.22±0.24)×10^-3mm² / s and (80.69±13.24)×10^-3mm²/s, respectively, P＜0.05 ] in DN lesions; the ROC analysis showed that when the cut-off values of D, D * and ADC in diagnosing sHCC were set as 1.14×10^-3mm² / s, 62.40×10^-3mm² / s and 0.96×10^-3mm²/s, the AUC were 0.911 (95% CI: 0.820-0.966), 0.809 (95% CI: 0.699-0.893) and 0.984 (95% CI: 0.920-0.999). Conclusion The multimodal MRI has high diagnostic efficacy in differentiating DN and sHCC in patients with LC, which might provide evidence for appropriate management for the patients.

Objective The purpose of this study was to compare the short-term efficacy of intratumor blood aspiration and radiofrequency ablation (RFA), and transcatheter arterial embolization (TAE) in the treatment of patients with hepatic hemangioma (HCH). Methods 102 patients with HCH were encountered in our hospital between October 2018 and October 2020, and the RFA after intratumor blood aspiration was conducted in 46 patients and the TAE was performed in 56 patients. All patients were followed-up for three months. Results The operative time, intraoperative blood loss and hospital stay in patients with TAE operation were (49.2±14.6) min, (13.4±3.7) mL and (3.4±1.6) days, significantly different compared to (57.5±18.9)min, (7.5±1.9)mL and (1.5±0.5)days, respectively, in patients receiving RFA after intratumor blood aspiration (P＜0.05); at the moment immediately after operation and the end of three months, the tumor volumes in TAE-treated patients were (49.2±22.5) mL and (31.4±15.7) mL, not significantly different as compared to (49.1±22.3)mL and (31.2±15.5)mL in RFA-treated patients (P>0.05), and so were the tumor shrinkage rates in the two groups (P>0.05); after operation, the complications in TAE-treated patients was 17.9%, much higher than 6.5%(P＜0.05) in RFA-treated patients. Conclusion The short-term efficacy of RFA after intratumor blood aspiration or TAE in the treatment of patients with HCH is good, and the RFA treatment has less post-operationally complications.

Objective The aim of this study was to investigate the efficacy of step by step three-endoscope surgery in the treatment of patients with calculous biliary obstruction and acute cholangitis. Method In our series, 75 elderly patients with common bile duct stones and gallbladder stones and acute cholangitis were recruited in our hospital, and the emergent endoscopic retrograde cholangiopancreatography (ERCP) was performed and the elective laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) were completed thereafter in 35 patients in observation group and the emergent LC and LCBDE were done in 40 patients in control. Result The operation time in the observation group was much longer than in the control(P＜0.05), while the intraoperative bleeding was significantly less than in the control group(P<0.05); the white blood cell counts, the percentage of neutrophils, serum C-reactive protein and procalcitonin levels in the observation group were much lower than in the control (P＜0.05); 3 days after operation, serum brain natriuretic peptide(BNP) and creatine kinase in the observation were (427.0±327.0)pg/ml and (95.0±30.0)U/L, significantly lower than [(944.0±648.0)pg/ml and (149.0±67.0)U/L, respectively, P<0.05], while serum troponin T(TNT) and lactate dehydrogenase(LDH) levels were (62.8±54.5)pg/ml and (272.0±48.0)U/L, both significantly higher than [(30.5±17.1)pg/ml and (229.0±32.0)U/L, respectively, P＜0.05] in the control group. Conclusion The emergent ERCP could quickly get rid of biliary obstruction and make it possible for elective LC and LCBDE in patients with common bile duct stones and gallbladder stones and acute cholangitis, which warrants further clinical investigation.

Objective The aim of this study was to investigate the efficacy of indwelling subcutaneous jejunal blind loop and Roux-en-Y choledochojejunostomy in treatment of patients with hepatolithiasis. Methods 74 patients with hepatolithiasis were admitted to our hospital between September 2017 and September 2020, andwere randomly divided into control and observation group, with 37 cases in each, receiving Roux-en-Y choledochojejunostomy or Roux-en-Y choledochojejunostomy and indwelling subcutaneous jejunal blind loop thereafter. Serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were detected by ELISA. Results The operation time in the observation group was (265.4±27.1) min, significantly longer than [(243.5±25.6) min, P<0.05] in the control group; after the operation, total serum bilirubin, alanine aminotransferase and gamma-glutamyltransferase levels in the two groups decreased greatly, and no significant differences among them between the two groups (P>0.05); the white blood cell counts, serum IL-6 and TNF-α levels decreased greatly, and no significant differences among them between the two groups (P>0.05); during the follow-up periods, 14 patients out of our series had second or more time operations to remove the stones, of which 3 cases(8.1%) from the observation and 11 cases (29.7%, P＜0.05) from the control. Conclusion The procedure of indwelling subcutaneous jejunal blind loop after Roux-en-Y choledochojejunostomy is beneficial to repeated removing stones from intrahepatic bile ducts, which warrants further investigation.

Objective The aim of this study was to investigate the short-term efficacy of biliary-enteric Roux-en-Y anastomosis and indwelling subcutaneous jejunal blind loop combination in the treatment of patients with intrahepatic bile duct stones (IHS). Methods 71 patients with IHS were enrolled in our hospital between September 2018 and June 2021, and 33 patients in control group were treated by conventional biliary-enteric Roux-en-Y anastomosis, and another 38 patients in observation group were treated with biliary-enteric Roux-en-Y anastomosis and indwelling subcutaneous jejunal blind loop combination. Serum total bilirubin (TBIL), alkaline phosphatase (ALP), alanine aminotransferase (ALT) and glutamyltransferase (GGT) levels were obtained. Serum C-reactive protein (CRP) and interleukin-6 (IL-6) levels were detected by ELISA, and serum procalcitonin (PCT) level was assayed by automatic fluorescent immunoquantitative analyzer. Results At the end of one month after surgery, the clinically total effective rate in the observation group was 94.7%, significantly higher than 75.8%(P<0.05) in the control group; serum GGT and ALT levels in the observation groups were (71.9±6.2)U/L and (38.7±5.9)U/L, significantly lower than [(95.8±6.9)U/L and (62.6±6.8)U/L, respectively, P<0.05] in the control; serum CRP and IL-6 levels were (60.8±8.1)mg/L and (89.8±20.1)pg/mL, significantly higher than [(38.3±9.2)mg/L and (65.7±23.5)pg/mL, respectively, P<0.05] in the control; the postoperative residual of stones in the observation group was significantly less than that in the control group (7.9% vs. 21.2%, P<0.05). Conclusion The combination of iliary-enteric Roux-en-Y anastomosis and indwelling subcutaneous jejunal blind loop in the treatment of patients with IHS has a good clinical efficacy, which might prevent the postoperative reflux infection and reduce the occurrence of postoperative stone residual, providing a permanent access to the intrahepatic bile duct for recurrent stones.

Objective The aim of this study was to investigate the clinical efficacy of complete laparoscopic choledochal cyst resection followed by different biliary tract reconstructions. Methods 81 children with congenital choledochal cyst (CCC) were encountered in our hospital between January 2016 and May 2020, and all underwent complete laparoscopic choledochal cyst resection. As for biliary tract reconstruction, the hepaticoduodenostomy (HA) was done in 28 cases (group A), the hepatojejunal Roux-en-Y anastomosis (HR)was adopted in 30 cases (group B), and the modified cholangio-intestinal loop anastomosis (MCL)was performed in 23 cases (group C). Results At the end of 3 month followed-up after surgery, the clinically markedly effective rate in group C was 69.6%, significantly higher than 35.7% in group A or 43.3% in group B (P<0.05); at day three after operation, serum C-reactive protein level in group C was (12.9±2.4)mg/L, significantly lower than (14.6±2.9)mg/L in group A (P<0.05) or (16.7±2.8)mg/L in group B (P<0.05); the incidences of post-operational complications, such as bile leak, pancreatic leak, biliary bleeding, acute cholangitis and ascites in the three groups were 21.4%, 16.7% and 8.7%, not significantly different among them(P>0.05). Conclusion The application of modified cholangio-intestinal loop anastomosis in the treatment of children with CCC has a better overall clinical efficacy among others, which might be related to relatively easy complete operation under laparoscopy without dissociation of jejunum and little inflammatory reactions.

Objective This study aimed to investigate serum vascular endothelial growth factor C (sVEGF-C) levels in predicting the prognosis of patients with gallbladder cancer (GC). Methods 58 patients with GC and 42 patients with chronic cholecystitis (CC) were enrolled in our hospital between March 2019 and March 2021. They all received ultrasonography, and the patients with GC underwent surgical resection of tumors. Serum sVEGF-C levels were detected by ELISA, and serum CA153 levels were detected by radioimmunoassay. The efficacy of parameters in diagnosing GC was assessed by area under the receiver operator characteristic curve (AUC), and the risk factors of prognosis after operation in patients with GC were analyzed by multivariate Logistic regression analysis. Results Serum CA153 and sVEGF-C levels in patients with GC were (60.6±11.0)U/ml and (72.4±18.5)pg/ml, significantly higher than [(27.5±8.1)U/ml and (37.8±10.3)pg/ml, respectively, P＜0.05] in patients with CC; the gallbladder wall was (29.1±10.4)mm, significantly greater than [(14.7±2.3)mm, P＜0.05] in patients with CC, the percentage of gallbladder wall uneven rigidity and diffusive incrassation were 72.4% and 39.7%, significantly higher than (21.4% and 19.0%, respectively, P＜0.05) in patients with CC; the diagnostic efficacy by the combination of sonography as well as serum CA153 and sVEGF-C levels was the highest with the AUC of 0.872, the sensitivity of 89.5% and the accuracy of 91.8%; at the end of six-month follow-up, the mortality was 34.5% in our series; the univariate Logistic analysis showed that the prognosis was significantly different between patients with different tumor location at gallbladder, TNM stages, and serum sVEGF-C and CA153 levels (P＜0.05), and the multivariate Logistic analysis demonstrated that the TNM states (OR=3.622, 95%CI=1.106-8.856) and serum sVEGF-C levels (OR=2.237, 95%CI=1.126-4.442) were the independent risk factors impacting on the prognosis of patients with GC after tumor resection (P＜0.05). Conclusion Serum sVEGF-C levels increase in patients with GC, and serum CA153 and sVEGF-C level based on ultrasonography could be helpful in diagnosing patients with GC. The GC patients with high serum sVEGF-C levels might have a poor prognosis.

Objective There is a dense collagen deposition in hepatic sinusoide in patients with severe acute alcoholic hepatitis (SAAH), which increase the sinusoidal resistance with increased pressure and block blood flow through hepatic sinusoids. The portal vein blood flow is compromised in a retrograde manner with obviously reduced portal venous perfusion. Consequently, the hepatic artery buffering response (HABR) is triggered to counteract the decreased blood flow from hepatic artery or portal vein to maintain a physiological requirement and restore the hepatic perfusion, e.g., the sum of hepatic artery and portal vein blood flow. The hepatic hemodynamics and quantitative HABR can be assessed by Duplex Doppler ultrasonography, and the latter could be a noninvasive approach for the diagnosis of SAAH.

Objective Alcoholic liver disease (ALD) is one of the major causes of death related to liver disease over the world. The alcohol consumption and the related diseases have become a global health burden. There is growing evidence of strong correlation of intestinal microbiome disorders to liver diseases. The translocation of bacteria and their products caused by the destruction of the intestinal barrier is the key factor to lead to complications of liver diseases. In recent years, many new biomarkers and therapeutic targets are the hotspots in the field of ALD studies.

In view of the high prevalence of diabetes mellitus in patients with liver cirrhosis and the increasing trend of non?alcoholic fatty liver disease?associated cirrhosis, the diagnosis and treatment of diabetes mellitus in patients with liver cirrhosis are becoming widespread concerns. Therefore, the Chronic Disease Management Branch, China Pharmaceutical Biotechnology Association, organized multidisciplinary experts from gastroenterology, infective disease, endocrinology, etc, to draw up expert consensus on the management of diabetes mellitus in patients with liver cirrhosis, with focusing on the classification and management of hyperglycemia in cirrhotic patients. The consensus summarizes the prevalence, pathogenesis, clinical setting and prognosis of the concomitant diabetes mellitus in patients with liver cirrhosis, and definitely puts forward a proposal regarding "hepatogenous diabetes" as one of the four subtypes of diabetes mellitus in cirrhotic patients, and further recommends the basic principles for diagnosing and monitoring diabetes mellitus and the selection of antidiabetic drugs based on liver functions in patients with liver cirrhosis.