Objective The aim of this study was to investigate the possible mechanism of hepatitis B virus X protein (HBx) affecting cytokine signal transduction inhibitor-1 (SOCS-1) gene in vitro. Methods The expressions of HBx, DNA methyltransferase (DNMT)3A/3B and SOCS-1 in cancerous and paracancerous tissues of 22 patients with HBV-related hepatocellular carcinoma (HCC) were detected by real-time PCR. The HBx expression plasmid (pcDNA-X) or an empty plasmid (pcDNA3. 0) were transfected in L02 cells by liposome infection. The effect of 5-aza-2′-deoxycytidine(5-Aza-C) on the survival rate of L02 cells was detected by CCK8. The HBx, DNMT3A/3B and SOCS-1 mRNA as well their protein expression were assayed by real-time PCR and Western blot. Results The HBx and DNMT3A mRNA level in cancerous tissues were(65.2±3.5)and (77.2 ± 3.8), much higher than [(22.5±4.0)and(42.1± 2.9), respectively, P<0. 05], while the expression of SOCS-1 was (33.1±3.0), significantly lower than [(75.6 ±2.6),P<0. 05] in adjacent liver tissues; the activity of L02 cells expressing HBx decreased with the increase of 5-Aza-C concentration (P<0. 05); the DNMT3A mRNA level and its protein expression in L02 cells with overexpression of HBx were significantly higher than in empty plasmid-transfected cells (P< 0.05); the SOCS-1 mRNA level and its protein expression were significantly lower than in the empty plasmid-transfected cells (P< 0.05); the DNMT3A mRNA level and its protein expression in L02 cells expressing HBx after 5-Aza-C intervention were significantly lower than in the control cells (P < 0.05), while the SOCS-1 mRNA level and its protein expression were significantly higher than in the control (P < 0.05). Conclusions The present study indicates that HBx induces epigenetic down-regulation of SOCS-1 by increasing the expression of DNMT3A,which might be reversed with DNA methyltransferase inhibitor 5-Aza-C.

Objective The aim of this study was to observe the efficacy of entecavir in treatment of patients with chronic hepatitis B (CHB) and non-alcoholic fatty liver diseases (NAFLD). Methods A total of 118 patients with CHB were enrolled in our hospital between March 2018 and October 2020, and out of them, the concomitant NAFLD was found in 42 cases. All the patients with CHB were treated with oral entecavir for 12 months. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyl transpeptidase (GGT) levels were detected. Serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were also assayed. The controlled attenuation parameter (CAP) was measured by FibroScan 502. The peripheral blood lymphocyte subsets were detected by FCM. Results At the end of 12-month treatment, serum AST, ALT, GGT and the CAP in CHB patients with NAFLD were(72.3±8.9)U/L,(63.3±9.2)U/L,(76.2±9.8)U/L and (301.1±10.7)dB/m, all significantly higher than [(43.2±7.6)U/L, (45.1±8.3)U/L, (48.8±7.7)U/L and (262.7±7.6)dB/m, respectively, P＜0.05] in patients with CHB; serum TG, TC and LDL-C levels in patient with CHB and NAFLD were (3.5±0.7)mmol/L, (6.1±1.0)mmol/L and (2.7±0.3)mmol/L, all significantly higher than [(1.8±0.5)mmol/L, (4.7±0.9)mmol/L and (1.9±0.4)mmol/L, respectively, P<0.05], while serum HDL-C level was (1.2±0.4) mmol/L, significantly lower than [(1.6±0.3)mmol/L, P<0.05] in patients with CHB; the serum ALT normalization rate in patients with CHB and NAFLD was 66.7%, much lower than 82.9%(P＜0.05) in patients with CHB, while there were no significant differences as respect to serum HBeAg or HBsAg negative or HBV DNA loss rates between the two groups (P＞0.05); the percentage of peripheral blood CD4⁺ cells and the ratio of CD4⁺/CD8⁺ cells in patients with CHB and NAFLD were (32.6±4.9)% and (1.1±0.2), both significantly lower than [(36.4±5.2)% and (1.4±0.3), respectively, P＜0.05], while the percentage of CD8⁺ cells was (29.1±3.6)%, much higher than [(26.9±3.1)%, P＜0.05] in patients with CHB. Conclusion The antiviral efficacy of entecavir is good even in patients with CHB and concomitant NAFLD, but the hepatic steatosis might intervene with biochemical response in this scenario, which needs further clinical investigation.

Objective The aim of this study was to investigate serum B-cell activating factor (BAFF) levels in predicting antiviral response of pegylated interferon alpha (Peg-IFN-α) in inactive HBsAg carriers(IHCs). Methods 54 IHCs were recruited in our hospital between January 2018 and August 2020,and all were treated with Peg-IFN-α for 48 weeks and followed-up for 24 weeks. Serum BAFF levels were measured by ELISA. The Logistic regression analysis was applied to analyze the factors affecting antiviral response, and the area under the receiver-operating characteristic curve (AUC) were applied to evaluate the performance of serum BAFF levels in predicting antiviral response. Results At the end of 72 weeks, the complete response (CR) was obtained in 24 cases (44.4%), and were not obtained in 30 cases (55.6%); there was no significant difference as respect to baseline serum BAFF levels [(670.9±105.9) pg/mL vs. (612.7±183.8)pg/mL, P>0.05] between the two groups; at the end of 12 weeks and 24 weeks, serum BAFF levels in responders were (805.8±197.6)pg/mL and (895.3±227.4)pg/mL, both significantly higher than [(675.3±190.8)pg/mL and (724.4±218.0)pg/mL, respectively, P<0.05] in non-responders; the multivariate Logistic regression analysis showed that baseline serum HBsAg, HBV DNA<20 IU/mL, serum BAFF levels at week 12 and week 24 were the independent factors impacting the antiviral response; the ROC analysis demonstrated that the AUC=0.722, with the sensitivity (Se) of 79.2% and specificity (Sp) of 66.7%, when serum BAFF level greater than 704.3 pg/mL at week 12 was set as the cut-off-value, and the AUC=0.725, with Se of 75.0% and Sp of 70.0%, when serum BAFF level greater than 741.9 pg/mL at week 24 was set as the cut-off-value in predicting antiviral response in patients receiving Peg-IFN-α treatment. Conclusion The CR is nearly 40% in IHCs receiving Peg-IFN-α treatment, and the surveillance of serum BAFF levels might guide the regimen going or stopping.

Objective The aim of this study was to explore the correlation of polymorphisms of calcitonin gene-related peptide (CGRP) and interferon-λ4 (IFNL4) genes to response toα-interferon therapy in patients with chronic hepatitis B (CHB). Methods A total of 92 patients with CHB were enrolled in our hospital between September 2018 and February 2021, and all were treated with α-interferon for 1 year. The polymorphisms of CGRP gene at rs155209 locus, and IFNL4 gene at rs368234815 and rs12979860 loci were detected by polymerase chain reaction-restriction fragment length polymorphism. The Logistic regression analysis was applied to reveal the correlation of polymorphisms of genes to response of antiviral therapy. Results At the end of 1-year antiviral therapy, the complete response (CR) was obtained in 67 cases(72.8%) anddidn’t obtained in 25 cases (27.2%); the proportions of CC genotype and C allele at CGRP-rs155209 locus in patients without CR were 36.0% and 56.0%, significantly higher than 16.4% and 32.8% in patients who got CR (P<0.05); the frequencies of TT/TT genotype and TT gene at IFNL4-rs368234815 locus in non-response patients were 76.0% and 86.0%, significantly lower than 92.5% and 95.5% (P<0.05) in responded ones; the proportions of CC, CT and TT genotypes at IFNL4-rs12979860 loci in non-response patients were 44.0%, 44.0% and 12.0%, not significantly different compared with 40.3%, 46.3% and 13.4% (P>0.05) in responded ones; the unconditional Logistic regression analysis with corrected gender and age showed that CC genotype at CGRP-rs155209 locus was a risk genotype for poor response to α-interferon therapy [OR=1.489 (95%CI: 1.103-2.009)], while TT/TT genotype at IFNL4-rs368234815 locus was a protective genotype [OR=0.652 (95%CI: 0.477-0.893)]. Conclusion The CC genotype at CGRP-rs155209 locus is a risk genotype for poor response to α-interferon therapy in patients with chronic hepatitis B, while the TT/TT genotype at IFNL4-rs368234815 locus is a protective one, which both might impact the biochemical and virological responses to α-interferon therapy, and needs further investigation.

Objective This study was aimed at exploring the response to elbavir/glarevir antiviral therapy in patients with genotype 1b chronic hepatitis C (CHC). Methods 68 patients with genotype 1b CHC were recruited in our hospital and were divided into observation (n=34) and control (n=34) group, receiving elbavir/glarevir or ribavirin and peg-interferonα-2a combination therapy for 24 weeks. All the patients were followed-up for 24 weeks. Serum L-selectin, C-reactive protein (CRP), interleukin- 6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were detected by ELISA. Results The rapid virological response, early virological response, end-of-treatment response and sustained virological response in the observation group were 70.6%, 91.2%, 97.1% and 94.1%, all much higher than 41.2%, 55.9%, 64.7% and 55.9%(P＜0.05) in the control; at the end of 4, 12, 24 week treatment and 24 week follow-up, serum HCV RNA loads in the observation group were (1.5±0.9)lgIU/mL,(1.6±0.7)lgIU/mL, (1.2±0.6)lgIU/mL and (1.2±0.4)lgIU/mL, significantly lower than [(4.3±0.8)lgIU/mL, (4.7±0.9)lgIU/mL, (3.2±0.5)lgIU/mL and (3.2±0.5)lgIU/mL, respectively, P＜0.05] in the control; at the end of 24 week treatment, serum L-selectin, CRP, IL-6 and TNF-α levels in the observation group were (816.3±161.4)ng/mL, (13.7±1.9)ng/L, (84.4±18.8)pg/mL and (1.2±0.3) ng/mL, all significantly lower than [(1157.4±192.3)ng/mL, (16.3±2.0)ng/L, (115.9±20.5)pg/mL and (1.6±0.3)ng/mL, respectively, P＜0.05] in the control group; the white blood cell counts, platelet counts and hemoglobin level in the observation were (5.4±1.1)×10⁹/L, (101.3±17.3)×10⁹/L and (120.8±19.5)g/L, all significantly higher than [(3.2±0.8)×10⁹/L, (86.9±16.6)×10⁹/L and (101.6±16.2)g/L, respectively, P＜0.05] in the control. Conclusion The application of elbavir/glarevir in the treatment of CHC patients with genotype 1b infection is efficacious, with low untoward effects, which might be related to the low body response of inflammatory reactions.

Objective The aim of this study was to explore the supplement of human blood albumin products in reducing the incidence of drug-induced liver injury (DILI) in patients with pulmonary tuberculosis ans hypoproteinemia. Methods 56 patients with pulmonary tuberculosis and hypoproteinemia were encountered in the Department of Infectious Diseases, Shantou Central Hospital between March 2019 and March 2021, and were divided into control (n=28) and observation (n=28) groups. All patients were treated with the anti-tuberculosis regimen, e.g. 2HRZE/4HR, and those in the observation group was additionally given human blood albumin product infusion. The anti-tuberculosis treatment lasted for six months, and the patients with DILI received liver-protecting medicine appropriately. Serum albumin (ALB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and total bilirubin (TBIL) levels were detected by fully automated biochemical Analyzer, and serum total bile acid (TBA) level was detected by chemiluminescence. The clinical outcomes were evaluated by CT scan and sputum specimen culture and the incidence of DILI was recorded. Results The total effective rate in the observation group was 92.9%, significantly higher than 71.4% (P<0.05) in the control group; the negative rate of sputum bacteria in the observation group was 91.3%, significantly higher than 66.7% (P<0.05) and the absorption of lung lesions was 89.3%, significantly higher than 64.3%(P<0.05) in the control; during the period of anti-tuberculosis, the incidence of DILI in the observation group was 25.0%, significantly lower than 53.6%(P<0.05) in the control; when the DILI occurred, serum ALB level in the 7 patients in the observation group was (35.2±4.9)g/L, significantly higher than [(29.6±4.9)g/L, P<0.05], while serum bilirubin level was (33.6±5.2)μmol/L, significantly lower than [(45.7±16.6)μmol/L, P<0.05] in 15 patients in the control; after the liver-protecting treatment, serum AST, ALT, ALP, TBIL and TBA levels in the observation were (39.4±9.8)U/L, (35.1±10.8)U/L, (98.6±16.2)U/L, (17.4±4.6)μmol/L and (81.3±13.7)μmol/L, all significantly lower than [(64.8±9.9)U/L, (78.0±13.8)U/L, (133.7±22.9)U/L, (26.5±6.8)μmol/L and (96.9±16.4)μmol/L, respectively, P<0.05] in the control. Conclusion Our observation suggest that the infusion of human blood albumin product in time to correct hypoalbuminemia in patients with pulmonary tuberculosis could reduce the incidence of DILI, and improve the recovery of tuberculosis.

Objective The aim of this study was to investigate the short-term efficacy of dapagliflozin and liraglutide combination in treatment of patients with non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus type 2(T2MD). Methods 60 patients with NAFLD and T2MD were admitted to our hospital between September 2017 and October 2020, and were randomly divided into control and observation group, with 30 cases in each group. All the patients were supervised for routine lifestyle intervention and oral metformin administration for blood glucose control. In addition, the patients in the control group were treated with liraglutide intravenouly, and those in the observation group were treated with dapagliflozin and liraglutide combination. The regimen lasted for 3 months. The fasting plasma glucose (FPG), 2 hour-postprandial plasma glucose (2h PG) and glycated hemoglobin (HbA1c) as well as serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL－C) and high density lipoprotein cholesterol (HDL－C) levels were routinely obtained. Serum fasting insulin(Fins) and 2 h Ins levels were assayed, and the HOMA-IR was calculated. The controlled attenuation parameter (CAP) of livers was detected by FibroTouch. Results At the end of 3 month observation, the FPG, 2hPG and HbA1 levels in the observation group were(5.8±0.7)mmol/L, (6.9±0.8)mmol/L and (6.3±0.9)%, all significantly lower than [(6.6±0.6)mmol/L,(7.7±0.7)mmol/L and (7.2±1.0)%, respectively, P＜0.05] in the control group; serum Fins, 2hIns and HOMA-IR levels were (9.8±1.2)mIU/L, (20.2±1.7)mIU/L and (2.6±0.4)%, significantly lower than [(11.9±1.1)mmol/L, (24.8±1.6) mmol/L and (3.2±0.5)%, respectively, P＜0.05] in the control; serum TG level was (2.6±0.4) mmol/L, significantly lower than [(3.0±0.3)mmol/L, P＜0.05], while serum HDL-C level was (1.6±0.2) mmol/L, significantly higher than [(1.2±0.3)mmol/L, P＜0.05] in the control; the CAP was (249.2±7.5)dB/m, also significantly lower than [(264.7±8.6)dB/m, P＜0.05] in the control; serum AST level was (39.9±3.8)U/L, significantly lower than [(44.9±4.2)U/L, P＜0.05] in the control. Conclusion The application of dapagliflozin and liraglutide combination is efficacious in the treatment of patients with NAFLD and T2MD, which could effectively reduce blood glucose and lipid levels, improve liver function tests back to normal, with the ability of alleviation of insulin resistance.

Objective The aim of this study was to explore the implications of serum omentin, retinol-binding protein-4 (RBP-4) and propeptide of type I procollagen (PINP) in patients with diabetes mellitus type 2 (T2DM) and non-alcoholic fatty liver diseases (NAFLD). Methods A total of 102 patients with T2DM and NAFLD (with mild steatosis in 39 cases, moderate in 34 cases and severe in 29 cases) and 98 patients with T2DM were enrolled in our hospital between June 2019 and December 2021. The hepatic steatosis was evaluated by ultrasonography, and serum omentin, RBP4 and PINP levels were detected by ELISA. The diagnostic performance was evaluated by the area under the receiver operating characteristic curve (AUC). Results Serum omentin and PINP levels in patients with T2DM and NAFLD were (45.4±12.4) ng/mL and (29.6±6.2) ng/mL, significantly lower than [(68.3±15.6) ng/mL and (35.8±7.3) ng/mL, respectively, P<0.05], while serum RBP4 level was(26.6±5.1)mg/L, significantly higher than [(20.1±4.6)mg/L, P＜0.05] in patients with T2DM; serum omentin and PINP levels in patients with severe NAFLD were (40.7±4.9)ng/mL and (25.8±3.7)ng/mL, significantly lower than [(45.2±5.6)ng/mL and (29.9±4.0)ng/mL, respectively, P＜0.05] in patients with moderate NAFLD or [(49.1±6.2)ng/mL and (32.2±3.3)ng/mL, respectively, P＜0.05] in patients with mild NAFLD, while serum RBP4 level was (30.3±3.0)mg/L, significantly higher than [(26.5±2.8)mg/L, P＜0.05] in patients with moderate NAFLD or [(23.9±3.1)mg/L, P＜0.05] in patients with mild NAFLD; the AUC was 0.856 by serum omentin, RBP4 and PINP level combination in predicting severe NAFLD in patients with T2DM and NAFLD, with the sensitivity, specificity and accuracy of 86.2%, 79.5% and 81.4%. Conclusion Serum omentin and PINP levels decrease and serum RBP4 level increase in patients with T2DM and NAFLD, which might help predicting hepatic steatosis and needs further clinical investigation.

Objective The aim of this clinical trial was to observe the short-term observation of metformin and pioglitazone combination in treatment of patients with non-alcoholic fatty liver diseases (NAFLD) and diabetes mellitus type 2 (T2DM). Methods 86 patients with NAFLD and T2DM were enrolled in our hospital between October 2018 and October 2020, and were divided randomly into control (n=43) and observation group (n=43). The patients in the control received metformin therapy and those in the observation were treated by metformin and pioglitazone combination therapy. The regimen lasted for 24 weeks. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), 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 detected. Serum fasting insulin (FINS) level was detected by electrochemiluminescence method, and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Results At the end of 24 week treatment and in the observation group, serum AST level was significantly lower than that in the control group [(37.9±4.2) U/L vs. (50.7±3.8) U/L, P<0.05], and serum GGT level was significantly lower than that in control group [(64.1±6.2) U/L vs. (73.1±7.0) U/L, P<0.05]; FPG level in observation group was significantly lower than that in control group [(6.0±1.2) mmol/L vs. (6.8± 1.5) mmol/L, P<0.05], HbA1c level was significantly lower than that in control group [(7.2±1.1)% vs. (7.7±1.3)%, P<0.05], and HOMA-IR level was significantly lower than that in control group [(2.4±0.5) vs. (2.9±0.5), P<0.05]; serum TG level was significantly lower than that in control group [(2.2±0.5) mmol/L vs. (2.6±0.4) mmol/L, P<0.05], LDL-C level was significantly lower than that in control group [(3.1±0.6) mmol/L vs. (3.5±0.8) mmol/L, P<0.05], while serum HDL-C level was significantly higher than that in control group [(1.5±0.3) mmol/L vs. (1.2±0.2) mmol/L, P<0.05]. Conclusion The application of metformin and pioglitazone combination in the treatment of patients with NAFLD and T2DM could effectively decrease blood glucose and insulin resistance levels, correct lipid metabolism disorders, which warrants further clinical investigation.

Objective The purpose of this study was to investigate the prevalence and clues for non-alcoholic steatohepatitis (NASH) in obese children/ adolescents. Methods 117 obese children and adolescents, including 78 males and 39 females with the average age of (10.0±2.4) year old, were enrolled in our hospital between July 2015 and January 2021. Serum interleukin-2 (IL-2), IL-4, IL-6, IL-10, tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) levels were detected by ELISA, and thehomeostasis model of assessment for insulin resistance index (HOMA-IR) were obtained by fasting blood glucose (FBG) and fasting insulin (FINS) calculation. The liver stiffness measurement (LSM) and the controlled attenuation parameter (CAP) were detected by FibroScan 502. Results 27 cases of NASH and 90 simple fatty liver (SFL) were diagnosed in our 117 obese children/ adolescents; serum FINS, HOMA-IR, ALT, AST, LSM and CAP in patients with NASH were(20.2±3.2)pmol/L, (5.2±0.4), (70.8±12.8)U/L, (57.3±12.0)U/L, (9.2±2.7)kPa and (255.6±33.7)dB/m, all significantly higher than [(17.8±3.0)pmol/L, (4.0±0.3), (33.8±7.5)U/L, (25.2±8.0)U/L, (7.8±2.4)kPa and (290.8±28.1)dB/m, respectively,P<0.05] in children and adolescents with SFL; serum IL-6 and IL-10 levels in patients with NASH were (4.0±0.8)pg/ml and (3.2±0.5)pg/ml, both significantly higher than [(3.3±0.6)pg/ml and (2.4±0.4)pg/ml, respectively, P<0.05] in those with SFL, while there were no significant differences as respect to serum IL-2, IL-4, TNF-α and INF-γ levels between the twogroups (P>0.05); the multivariate Logistic regression analysis showed that the HOMA-IR, serum IL-10 and liver CAP were the independent clues for NASH existence (P<0.05). Conclusion The prevalence of NASH in Children and adolescents with obesityis a severe public health problem, and some clinical clues might hints the disease existence. The clinicians, including paediatricians, should give them appropriate advice and managements.

Objective The aim of this study was to analyze the impact of impaired fasting glucose (IFG) and insulin resistance (IR) on liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Methods A total of 110 patients with NAFLD were encountered in the Health Management Clinic between May 2020 and May 2021. All individuals underwent oral glucose tolerance test (OGTT), and the homeostasis model insulin resistance index (HOMA-IR) was calculated. Serum type IV collagen, type III procollagen (PCIII), laminin (LN) and hyaluronic acid (HA) levels were detected by radioimmunoassay. The NAFLD fibrosis score (NFS) was calculated and the progressive liver fibrosis (PLF) was defined as the NFS﹥0.676. The multivariate Logistic regression analysis was applied to reveal the risk factors for PLF occurrence. Results Based on the OGTT results, the normal glucose tolerance (NGT) was found in 43 cases, the impaired glucose tolerance (IGT) in 35 cases and the IFG in 32 cases; the fasting plasma glucose, insulin and HOMA-IR in patients with IFG were (6.6±0.3) mmol/L, (10.9±2.4) μU/mL and 3.2±0.9, significantly higher than [(5.6±0.7) mmol/L, (8.5±2.2) μU/mL and 2.4±0.5, P<0.05] in patients with IGT or [(5.5±0.6) mmol/L, (7.4±1.9) μU/mL and 1.8±0.4, P<0.05] in patients with NGT; serum collagen IV, PCIII, LN and HA levels in patients with IFG were (75.7±9.6) ng/mL, (146.3±13.1) ng/mL, (132.7±15.2) ng/mL and (189.6±17.5) ng/mL, significantly higher than [(63.9 ± 8.4) ng/mL, (133.3 ± 10.7) ng/mL, (122.4 ± 13.4) ng/mL and (163.9 ± 18.6) ng/mL, P<0.05] in patients with IGT or [(59.4 ± 7.4) ng/mL, (128.6 ± 11.6) ng/mL, (109.4 ± 8.9) ng/mL and (150.2 ± 13.2) ng/mL, P<0.05] in patients with NGT; the PLF was found in 18 patients in our series, and the multivariate Logistic regression analysis showed that the IFG (OR=1.528) and IR (OR=1.714) were the independent risk factors for PLF in patients with NAFLD (P<0.05). Conclusion When the IFG occurs in patients with NAFLD hint the IR, which might promote liver fibrosis progression.

Objective The aim of this study was to explore the changes of serum cystatin C (CysC), lipoprotein α (Lp-α) and human new satiety molecule protein 1 (nesfatin-1) levels in patients with non-alcoholic fatty liver diseases (NAFLD). Methods A total of 119 patients with NAFLD and 65 healthy individuals with matched age and gender were enrolled in our hospital between July 2019 and November 2021. Serum CysC, Lp-α and nesfatin-1 levels were detected by enzyme-linked immunosorbent assay. The area under the receiver operating characteristic curve (AUROC) was applied to evaluate the diagnostic efficacy of serum parameters. Results Serum CysC level in patients with NAFLD was (1.5±0.4)mg/L, much higher than [(0.8±0.2)mg/L, P＜0.05], while serum Lp-α and nesfatin-1 levels were (88.5±18.6)mg/L and (0.9±0.2)ng/mL, much lower than [(140.3±29.5)mg/L and (1.6±0.3)ng/mL, respectively, P＜0.05] in the healthy persons; serum CysC level in patients with severe fatty liver was (1.9±0.3)mg/L, much higher than [(1.6±0.3)mg/L, P＜0.05] in patients with moderate fatty liver or [(1.2±0.2)mg/L, P＜0.05] in patients with mild fatty liver, while serum Lp-α and nesfatin-1 levels were (63.6±15.9)mg/L and (0.4±0.1)ng/mL, significantly lower than [(88.2±14.3)mg/L and (0.9±0.2)ng/mL, P＜0.05] in patients with moderate fatty liver or [(104.3±17.8)mg/L and (1.2±0.3)ng/mL, P＜0.05] in patients with mild fatty liver; the Logistic regression analysis showed that increased serum CysC, fasting plasma glucose, TC and LDL-C levels or decreased serum Lp-α and nesfatin-1 levels were all the independent risk factors for severe fatty liver (P＜0.05); the AUROC was 0.887, with the sensitivity of 86.7%, the specificity of 80.9% and the accuracy of 82.4%, when the combination of the three serum parameters was applied in predicting severe fatty liver, much superior to 0.738, 0.773 and 0.776(P＜0.05) by any serum parameter alone. Conclusion Serum CysC level increases, while serum Lp-α and nesfatin-1 levels decrease in patients with NAFLD, which warrants further investigation for clinical application.

Objective The aim of this study was to explore the implications of peripheral blood mononuclear lymphocyte (PBMC) thioredoxin-interacting protein (TXNIP)/nod-like receptor family pyrin domain-containing protein 3 (NLRP3) in patients with nonalcoholic steatohepatitis (NASH). Methods A total of 150 patients with NASH and 45 persons with simple fatty liver (SFL) were recruited in our hospital between January 2019 and January 2021, and all had their PBMCs being separated to detect the TXNIP/NLRP3 mRNA. All patients with NASH had liver biopsies at presentation for determination of liver tissues injury degrees as mild, moderate and severe, and had a second time liver biopsies a year after recruitment as for determination of progressive or non-progressive diseases. Results Serum ALT and AST levels in patients with NASH were (72.2±6.9)U/L and (61.8±5.1)U/L, both significantly higher than [(33.4±4.0)U/L and (31.3±3.1)U/L, respectively, P＜0.05] in patients with SFL; the PBMCs TXNIP mRNA, NLRP3 mRNA and the ratio of TXNIP/NLRP3 in patients with NASH were (1.9±0.1), (1.5±0.1) and (1.3±0.1), all significantly higher than [(0.7±0.1), (0.6±0.1) and (1.1±0.1), respectively, P＜0.05] in patients with SFL; the PBMCs TXNIP mRNA, NLRP3 mRNA and the ratio of TXNIP/NLRP3 in 33 patients with severe NASH were (2.4±0.2), (1.9±0.2) and (1.6±0.1), significantly higher than [(1.5±0.1), (1.2±0.1) and (1.0±0.1), respectively, P＜0.05] in 49 patients with mild NASH or [(2.0±0.2), (1.5±0.1) and (1.4±0.1), respectively, P＜0.05] in 68 patients with moderate NASH; the PBMCs TXNIP mRNA, NLRP3 mRNA and the ratio of TXNIP/NLRP3 in 31 patients with progressive NASH were (2.1±0.2), (1.7±0.2) and (1.5±0.1), all significantly higher than [(1.8±0.1), (1.4±0.1) and (1.2±0.1), respectively, P＜0.05] in 119 patients without progressive NASH. Conclusion The PBMC TXNIP/NLRP3 mRNA in patients with NASH significantly increase, seemingly have some correlation to the liver tissue injuries, and needs further investigation.

Objective The purpose of this study was to investigate serum peripheral blood leukocyte differentiation antigen 38 (CD38) and interleukin 21 (IL-21) level changes and their implications in patients with autoimmune hepatitis (AIH). Methods 53 patients with AIH were admitted to our hospital between October 2018 and October 2021, and all underwent liver biopsies. The patients were clinically defined to mild or moderate and severe degree of the disease. Serum CD38 and IL-21 levels were determined by enzyme-linked immunosorbent assay. The univariate and multivariate Logistic regression analysis were applied to analyze the factors affecting the intrahepatic tissue inflammatory activity, and the area under the receiver operating characteristic curve (AUROC) was applied to judge the diagnostic efficacy. Results Serum bilirubin, ALT, AST, CD38, IL-21 levels, the incidence of liver cirrhosis and the percentage of intrahepatic lymphocyte infiltration in portal area in 19 patients with severe degree of AIH were(89.4±15.2)μmol/L,(179.3±36.5)U/L,(216.1±37.6)U/L, (19.0±4.5)pg/mL, (367.8±62.0)pg/mL, 36.8% and 84.2%, all significantly higher than [(36.5±6.8)μmol/L, (61.2±25.9)U/L, (78.7±33.8)U/L, (11.1±2.3)pg/mL, (209.5±46.2)pg/mL, 8.8% and 5.9%, respectively, P<0.05] in 34 patients with mild/moderate AIH; serum CD38 and IL-21 levels in 23 patients with G3-G4 AIH were (21.8±4.4)pg/mL and (387.1±59.7)pg/mL, both significantly higher than [(12.4±2.3)pg/mL and (194.6±45.5)pg/mL, respectively, P<0.05] in 30 patients with G1-G2; the multivariate Logistic regression analysis showed that serum bilirubin, CD38 and IL-21 levels and intrahepatic lymphocyte infiltration in portal area were all the independent risk factors for severe liver tissue injury (P<0.05); the ROC analysis showed that the AUC was 0.939, with the sensitivity of 82.6% and specificity of 96.7% when the combination of serum CD38 (20.4 pg/mL as the cut-off-value ) and IL-21 (379.3 pg/mL as the cut-off-value) was applied to predict the intrahepatic inflammatory activity, superior to any one of the two parameter. Conclusion Serum CD38 and IL-21 levels increase in patients with autoimmune hepatitis, as the disease deteriorate, and the clinicians might predict the disease severity based on this phenomenon.

Objective The aim of this study was to investigate vasovagal reaction (VVR) in patients with liver failure (LF) during double plasma molecular adsorption system (DPMAS) treatment. Methods 82 patients with LF and 17 patients with pre-LF were encountered in our hospital between January 2021 and March 2022, and all underwent DPMAS treatment. The VVR was defined as decreased blood pressure and slowed heart beats with concomitant symptoms. Results Out of the 99 patients with LF or pre-LF, the incidence of VVR was 3.1% in 417 times of DPMAS from 8 patients; before the DPMAS treatment, the systolic blood pressure, heart beats and venous pressure in patients with VVR were (105.7±8.7) mmHg, (71.3±11.2) bpm and (3.5±7.3)mmHg, all significantly lower or slower than [(114.6±14.7) mmHg, (82.7±15.0)bpm and (14.7±16.5)mmHg, respectively, P＜0.05] in patients without VVR, while there were no significant differences as respect to the diastolic pressure, mean arterial pressure, arterial pressure and transmembrane pressure between the two groups(P>0.05); the incidence of VVR was 5.7% in patients with SBP≤110 mmHg before DPMAS, accounting for 76.9% of all, while the VVR was 1.2% in patients with SBP＞110 mmHg, accounting for 23.1% of all; in all patients with VVR, the DPMAS was discontinued, administered with hydroxyethyl starch sodium chloride intravenously, and all recovered; the prophylactic infusion of hydroxyethyl starch sodium chloride intravenously in patients with SBP≤110 mmHg before DPMAS decreased the incidence of VVR. Conclusions The DPMAS treatment-related VVR is a relatively rare complication, and the decreased SBP and slow HR before treatment are the important factors impacting the occurrence of VVR. The intravenous infusion of hydroxyethyl starch sodium chloride is the main measure to prevent the occurrence of VVR.

Objective The aim of this study was to analyze the triggering factors and impacting factors of prognosis in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). Methods A retrospective analysis was performed on 96 patients with HBV-ACLF between January 2019 and December 2021, and all patients received comprehensive internal medicine supporting therapy at base of entevavir antiviral treatment. The patients were followed-up for 90 days. The univariate and multivariate Logistic regression analysis were applied to reveal the risk factors that impacted the prognosis. Results The triggering factors in our series included self-discontinuation of antiviral therapy in 53 cases (55.2%), hepatitis H or hepatitis E co-infection in 11 cases (11.4%), complicated bacterium infection in 9 cases (9.4%), exhausted in 7 case (7.3%), binge in 6 case (6.2%), drug-induced liver injuries in 5 cases (5.2%) and cryptogenic in 5 cases (5.2%); at the end of 90 day observation, 69 patients survived and 27 patients died; the median ages in dead patients was 50(41, 69)yr, significantly older than [39(33, 58) yr, P<0.05] in survived patients, the incidences of complication, such as gastrointestinal bleeding (GIB), hepatic encephalapathy (HE) and acute kidney injury (AKI), were 14.8%, 29.6% and 44.4%, significantly higher than 1.4%, 5.8% and 14.5% (P<0.05) in the survivals, and serum bilirubin level was 532(204, 780)μmol/L, significantly higher than [302(80, 416)μmol/L, P<0.05], the INR was 3.0(2.0, 3.4), significantly higher than [2.1(1.5, 2.6), P<0.05] and the MELD score was 26(18, 37), significantly higher than [20(10, 29), P<0.05] in the survivals; the multivariate Logistic regression analysis showed that the ages [OR=1.04(95%CI:1.02-1.08)], GIB[OR=1.51(95%CI:1.23-0.79)], HE [OR=0.50(95%CI:0.22-0.78)], INR[OR=1.52(95%CI:1.22-0.73)] and the MELD score [OR=2.44(95%CI:1.63-3.75)] were the independent risk factors for poor prognosis in patients with HBV-ACLF. Conclusion The predisposing factors of patients with HBV-ACLF mainly include inappropriate discontinuation of nucleos(t)ide , other heparnavirus infections and bacterial infections. The clinicians should take the risk factors ,such as elderly age, GIB, HE, and MELD scores into consideration and deal with them carefully to improve the prognosis.

Objective The purpose of this study was to explore the qualitative evaluation of intrahepatic nodules in patients with liver cirrhosis. Methods A retrospective analysis was performed on 124 cirrhotics with liver imaging reporting and data system (LI-RADS) 3 intrahepatic nodules. All, but fourpatients were followed-up for 60-78 (mean 74) months, and the MRI was conducted regularly. The fine needle aspiration liver biopsies werecarried out when necessary. The multivariate Logistic analysis was performed to reveal the risk factors. Results At the end of follow-up, 4 patients lost, and the cancerous foci were found in 24 cases (20.0%); the percentages of alcohol-taking, cigarettes smoking, concomitant diabetes, hepatitis B viral infections and alcoholic hepatitis in patients with intrahepatic cancerous lesions were 91.7%, 87.5%, 75.0%, 100.0% and 41.7%, allsignificantly higher than 45.8%, 52.1%, 41.7%, 58.3% and 20.8% (P<0.05) in patients without cancerous lesions; the Cox analysis showed that the alcohol-taking(HR=2.264, 95%CI=1.597-3.210, P<0.001), diabetes (HR=1.294, 95%CI=1.107-1.513, P=0.001), hepatitis B (HR=1.795, 95%CI=1.329- 2.561, P<0.001) and alcoholic hepatitis (HR=0.658, 95%CI=0.552-0.784, P<0.001) were the independent risk factors for patients with LR-3 intrahepatic foci; the formula was established based on the Cox analysis results, e.g.,Y=0.817X₁+0.258X₂+0.585X₃-0.419X₄(X₁=alcohol-taking, X₂=diabetes, X₃=hepatitis B, X₄=alcoholic hepatitis), and the ROC analysis demonstrated that the AUC was 0.812(SE=0.064, 95%CI=0.687-0.936, P<0.001), with the sensitivity of 0.833 and the specificityof 0.673, for liver cirrhotics with intrahepatic LR-3 nodules. Conclusion It might be important to follow-up liver cirrhosis patients with intrahepatic LR-3 nodules, especially in those with risk factors for malignant transformation, which could find cancerous lesions as soon as possible.

Objective The aim of this study was to construct a risk prediction model for nosocomial death in cirrhotics with portal hypertension and esophagogastric variceal bleeding (EVB). Methods A retrospective cohort study was conducted on the clinical data of 107 patients with cirrhotic portal hypertension and EVB who were admitted to our hospital between June 2018 and June 2020. All patients received transjugular intrahepatic portosystemic shunt (TIPS) therapy. The Logistic regression analysis was performed to screenindependent risk factors influencing the prognosis of patients with cirrhotic portal hypertension and EVB. A risk prediction model for nosocomial death was constructed based on these independent factors, and its predictive efficacy was verified by the area under receiver operating characteristic curve (AUC). Results 25 patients (23.4%) died and 82 patients survived in our series; the univariate Logistic regression analysis showed that Child class, portal vein diameter, the sites of bleeding, the incidence rates of hepatic encephalopathy and hemorrhagic shock in died patients were significantly different compared to in survivals (P<0.05), and the multivariate Logistic regression analysis demonstrated that the portal vein diameter (OR=2.201, 95%CI: 1.544-3.139), hepatic encephalopathy (OR=3.093, 95%CI: 1.731-5.524) and hemorrhagic shock (OR=1.101, 95%CI: 1.040-1.165) were the independent risk factors for nosocomial death (P<0.05); the C-index of the constructed nomogram model we built up by internal verification for predicting nosocomial death of patients with cirrhotic portal hypertension and EVB was 0.937 (95%CI: 0.734-0.879), witha good discrimination, and the AUC was 0.896 (95%CI: 0.796-0.958, P<0.001), with the sensitivity and specificity of the prediction model were 91.3% and 88.1%, respectively. Conclusion The early recognition of risk factors of nosocomial death in patients with cirrhotic portal hypertension and EVB is important for appropriate management of patients, and the risk prediction model we constructed might have a good predictive efficacy.

Objective The aim of this study was to explore the polymorphisms of patatin-like phospholipase domain-containing protein 3 (PNPLA3) and protein kinase AMP-activated catalytic subunitα1 (PRKAA1) genes and their correlation to liver cirrhosis in patients with hepatitis B viral infection. Methods A total of 101 patients with hepatitis B-induced liver cirrhosis and 90 asymptomatic HBV carriers were enrolled in our hospital between January 2016 and July 2021. The polymorphisms of PNPLA3 gene at rs738409, rs139047 and rs2294919 loci, and PRKAA1 gene at rs3792822, rs10036575 and rs154268 loci were detected by polymerase chain reaction-restriction fragment length polymorphism. The correlation of suspected genes and tendency of cirrhosis was explored by Logistic regression analysis. Results The percentages of AA, GA and GA genotypes of gene PNPLA3 at rs139047 locus in patients with cirrhosis were 18.8%, 51.5% and 29.7%, not statistically significantly different compared with 16.7%, 51.1% and 32.2% in HBV carriers (P>0.05); the percentages of CC, TC and TT genotypes of gene PNPLA3 at rs2294919 locus in patients with cirrhosis were 41.6%, 45.5% and 12.9%, not significantly different compared with 38.9%, 50.0% and 11.1% in HBV carriers (P>0.05); the percentages of GG, GA and AA genotypes of gene PRKAA1 at rs3792822 locus in patients with cirrhosis were 54.5%, 38.6% and 6.9%, not statistically significant compared with 55.6%, 37.8% and 6.7% in HBV carriers (P>0.05); the percentages of CC, CT and TT genotypes of gene PRKAA1 at rs154268 locus in patients with cirrhosis were 5.0%, 35.6% and 59.4%, not statistically significant compared with 4.4%, 34.4% and 61.1% in HBV carriers (P>0.05); the percentage of GG genotype and allele G of PNPLA3 gene at rs738409 locus in patients with cirrhosis were 19.8% and 44.6%, significantly higher than 8.9% and 29.4%, respectively, in HBV carriers (P<0.05), and the percentage of CC genotype and allele C of PRKAA1 gene at rs10036575 locus were 38.6% and 63.9%, significantly higher than 23.3% and 45.5%, respectively, in HBV carriers (P<0.05); the unconditional Logistic regression model analysis showed that the GG genotype of PNPLA3 gene at rs738409 locus [OR=1.605 (95%CI: 1.150-2.239)] and CC genotype of PRKAA1 gene at rs10036575 locus [OR=1.507 ((95%CI: 1.097-2.070)] were the risk genotype for cirrhosis occurrence. Conclusion The individuals with HBV infections and susceptible genes might have a high tendency of liver cirrhosis, and the polymorphism of PNPLA3 and PRKAA1 genes might have a correlation to the involved pathogenesis.

Objective The aim of this study was to establish a nomogram for predicting portal venous thrombosis (PVT) in patients with liver cirrhosis (LC). Method 1000 patients with LC were enrolled in our hospital between January 2010 and October 2021, and the clinical materials, including general data, serological indicators, ultrasonography and CT imaging were collected. A nomogram model was established by Lasso and multivariate Logistic regression analysis. Results The risk factours included splenectomy, widened portal vain diameters and splenic vain diameters in patients with liver cirrhosis complicated by PVT (P＜0.05); in the external validation population, the AUC of the nomogram prediction model was 0.751 (95%CI:0.6740-0.827) with a good discrimination (P=0.170, by Hosmer-Lemeshow test) , suggesting a high reliability of the model. Conclusion We establish an easy-to-use nomogram to predict the PVT formation in patients with cirrhosis. This nomogram might help clinicians screen patients at high risk of PVT, make in timely and individualized clinical decisions to improve outcomes of them.

Objective The aim of this study was to observe the efficacy of transjugular intrahepatic portosystemie stent (TIPS) and gastric coronary vein embolization (GCVE) in treatment of patients with liver cirrhosis and esophageal varices (EV). Methods 62 patients with decompensated cirrhosis were encountered in our hospital between January 2018 and December 2020, and 33 patients in group A underwent TIPS and GCVE and 29 patients in group B underwent TIPS and endoscopic esophageal varices ligation (EVL). The portal vein blood flow velocity (PVFV), portal venous pressure (PVP) and portal vein pressure gradient (PPG) were detected by ultrasonography. Results At the end of one month after surgery, the PVFV in group A was (15.9±1.8)cm/s, significantly more rapid than [(14.1±1.9)cm/s, P＜0.05] in group B, while the PVP and PPG were (20.3±2.7)mmHg and (9.7±1.2)mmHg, significantly lower than [(22.8±2.9)mmHg and (11.4±0.9)mmHg, respectively, P＜0.05] in group B; at the end of twelve month, the incidence of EV re-bleeding in group A was 6.0%, significantly lower than 31.0%(P＜0.05) in group B, while there were no significant differences as respect to incidences of shunt patency and hepatic encephalopathy (93.9% and 9.1% vs. 93.1% and 6.9%, P>0.05) between the two groups; the fatality in group A was 15.1%, significantly lower than 41.3%(P＜0.05) in group B. Conclusion The efficacy of TIPS and GCVE in dealing with patients with liver cirrhosis and EV is efficacious, which might accelerate the blood flow velocity of portal vein, reduce re-bleeding and improve survivals.

Objective The aim of this study was to explore the application of semi-quantitative scoring (SQS) based on ultrasonography in evaluating the severity of esophageal varices (EV) in patients with hepatitis B cirrhosis. Methods 124 patients with hepatitis B cirrhosis underwent gastroscopy in our hospital between June 2020 and January 2022. The routine liver ultrasonography and semi-quantitative scoring were conducted. Based on blood biochemical index and demographic data, the fibrosis index based on the four factors (FIB-4) and aspartate aminotransferase/platelet index (APRI) were calculated. The evaluation efficacy of each index for moderate to severe EV was assessed by receiver operating characteristic (ROC) curves. Results The gastroscopy showed that among the 124 patients with hepatitis B cirrhosis, there were 46 cases (37.1%) in stage G0, 30 cases (24.2%) in stage G1, 28 cases (22.6%) in stage G2 and 20 cases (16.1%) in stage G3 of EV, e.g. 48 cases (38.7%) with moderate to severe EV (G2-G3); the SQS, FIB-4 and APRI scores in patients at stages G2-G3 were (13.1±1.9), (5.7±1.1) and (1.7±0.3), significantly higher than [(11.8±1.5) , (4.2±0.7) and (1.1±0.2), P<0.05] in patient with stage G1 or [(10.8±1.7) , (2.7±0.5) and (0.7±0.2), respectively, P<0.05] in those with stage G0; the cut-off values of SQS, FIB-4 and APRI for assessing moderate to severe EV were 12.7, 5.0 and 1.4, respectively, and their sensitivity and specificity were 91.7% and 73.7%, 89.6% and 67.1%, and 87.5% and 72.4%, without significant differences as respect to the diagnostic performance among them (P>0.05). Conclusion As a non-invasive approach, the application of semi-quantitative scoring based on ultrasonography is practical in evaluating moderate to severe EV in patients with hepatitis B cirrhosis.

Objective The aim of this study was to explore the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) time-intensity curve in patients with liver cirrhosis (LC) and intrahepatic nodules. Methods A total of 108 patients with LC and intrahepatic nodules were encountered in our hospital between February 2019 and December 2020, and all underwent liver punctures or operation for histopathological diagnosis. All patients with LC received CEUS and the peak intensity (PI), rise time (RT) and peak time (PT) were obtained based on the time-intensity curve of CEUS. The malignant nodules diagnosed by time-intensity curve of CEUS was defined referred to literature. The area under receiver operating characteristic curve (AUC) by MedCal 15.2 software was applied to evaluate the diagnostic efficacy of parameters. Results Out of the 108 patients with LC and intrahepatic nodules, the histopathological examination showed hepatocellular carcinoma in 43 cases, and benign nodules in 65 cases; the PI, RT and PT in malignant foci were(214.5±20.8)%, (17.6±3.2)s and (24.3±4.6)s, significantly different as compared to [(117.2±15.7)%,(38.1±6.9)s and (46.8±8.1)s, respectively, P<0.05] in benign nodules or [(115.9±16.1)%, (37.6±6.3)s and (47.4±8.4)s, respectively, P<0.05] in adjacent liver tissues; the sensitivity, specificity and accuracy by CEUS in diagnose malignant nodules were 72.1%, 73.8% and 73.1%, all of them were raised to 97.7%, 87.7% and 91.7% by parameters based on the time-intensity curve of CEUS. Conclusion The diagnosing accuracy of time-intensity curve of CEUS in patients with LC and intrahepatic nodules is efficacious, which might help the clinicians make an appropriate decision for patients and improve the outcomes.

Objective The aim of this study was to investigate the short-term hemostatic effect of endoscopic variceal ligation (EVL) and omeprazole and octreotide combination in the treatment of cirrhotics with first esophageal varices bleeding (EVB). Methods 60 patients with cirrhosis and EVB were enrolled in this study between January 2018 and January 2021, and 30 patients in the control were treated with omeprazole and octreotide, while another 30 patients in the observation group were treated with EVL on the basis of medicines in the control group. The diameters, mean flow velocities and blood flows of portal vein and splenic vein were detected by color Doppler ultrasound. Serum gastrin (GAS) and glucagon (GLC) levels were detected by ELISA, and serum procollagen type III N-terminal peptide (PIIINP) level was detected by radioimmunoassay. Results 1 week after treatment, the total efficient rate in the observation group was significantly higher than that in the control group (96.7% vs. 76.8%, P<0.05), and the emergent hemostasis rate in the observation group was also higher than that in the control group (93.3% vs. 73.3%, P<0.05); the early re-bleeding rate and the delayed re-bleeding rate in the observation group were 10.0% and 3.3%, both significantly lower than 33.3% and 20.0% (P<0.05) in the control; the mean flow velocity and blood flow of portal vein in the observation group were (14.2±2.3) cm/s and (1224.6±173.2) mL/min, significantly higher than [(12.1±1.6) cm/s and (1030.7±164.5) mL/min, P<0.05], the mean flow velocity and blood flow of splenic vein in the observation group were (14.4±1.9)cm/s and (934.6±185.3)mL/min, both significantly higher than [(12.3±1.7)cm/s and (731.3±172.4)mL/min, respectively, P<0.05] in the control; serum PIIINP, GAS and GLC levels in the observation group were (173.6±19.5) μg/L, (69.7±9.6) ng/L and (52.3±7.1) ng/L, significantly lower than [(202.8±23.1) μg/L, (91.4±12.3) ng/L and (62.4±8.3) ng/L, respectively, P<0.05] in the control group; the total incidence of post-EVL complications, such as sore throat, retrosternal pain, dysphagia, abdominal distension, nausea and vomiting was 53.3%. Conclusion The short-term clinical hemostatic effect of EVL at base of omeprazole and octreotide combination is good in patients with liver cirrhosis and first EVB, which could improve hemodynamic states of portal system, with a relative safety.

Objective The purpose of this study was to investigate the impact of cell necrosis-related genes on prognosis of patients with hepatocellular carcinoma (HCC). Methods The mRNA data of patients with HCC and the clinical data of corresponding patients were downloaded from the Cancer Genome Atlas TCGA database. The polynecrosis-related gene prognostic models were constructed in TCGA files by using LASSO Cox regression. Results by univariate Cox regression analysis, 23 cell necrosis-related differentially expressed genes were associated with prognostic survival (P < 0.05); in this protocol, a significantly correlated prognostic model of 6 cell necrosis-related genes was constructed; the patients were divided into two groups according to the threshold of risk, and the overall survival in patients with high risk was significantly reduced as compared to in those with low risk (P<0.01); meanwhile, by multivariate Cox regression analysis, the risk score met the criteria for independent prognostic factors (P<0.01); the enrichment analysis (GO/KEGG) and one-sample gene set enrichment analysis (ssGSEA) were performed based on differentially gene levels, and the differential genes were found to be correlated to immune pathways (P<0.05). Conclusion The prognostic model we constructed by 6 cell necrosis-related genes could be applied to predict independently the prognosis of patients with HCC and provide a reference for the clinical management appropriately.

Objective The aim of this study was to investigate the short-term efficacy of auxiliary DutanyuPixu Formulae, herbal medicine compound, therapy after transcatheter arterial chemoembolization (TACE) in the treatment of patients with primary liver cancer(PLC) and to observe the changes of serum vascular endothelial growth factor (VEGF), basic fibroblast growth factor (b-FGF) and thrombospondin-1 (TSP-1) levels. Methods 68 patients with PLC were encountered in our hospital between June 2020 and January 2022, and were randomly divided into control and observation group, with 34 cases in each group. The patients in the control group was treated with TACE, with cisplatin, epirubicin and fluorouracil infusion, and those in the observation group was treated with DutanyuPixu Formulae after TACE. The percentages of peripheral blood lymphocyte subsets were detected by FCM, serum AFP, CEA, CA19-9 and CA125 were assayed. Serum VEGF, b-FGF and TSP-1 levels were detected by ELISA. Results At the end of three month treatment, the partial remission, stable disease and disease progression rates in the observation group were 14.7%, 61.7% and 23.5%, not significantly different compared to 11.7%, 52.9% and 35.2% in the control(P＞0.05); the percentages of CD3⁺, CD4⁺, NK and ratio of CD4⁺/ CD8⁺ were (66.1±5.4)%,(39.8±4.2)%, (14.7±2.8)% and (1.5±0.2), not significantly different compared to [(60.2±5.3)%, (35.5±3.4)%, (10.2±2.4)% and (1.4±0.2), respectively, P＞0.05]; serum AFP, CEA, CA19-9 and CA125 levels were (284.7±29.4)μg/L, (13.2±3.4)ng/mL, (36.1±10.7)U/mL and (26.4±13.7)U/mL, all significantly lower than [(334.4±27.6)μg/L, (17.7±3.4)ng/mL, (44.6±11.2)U/mL and (35.8±14.4)U/mL, respectively, P<0.05] in the control; the improvement of liver function tests was also superior to that in the control(P<0.05); serum VEGF, b-FGF and TSP-1 levels were (126.3±52.1)pg/mL, (32.1±8.3)pg/mL and (68.3±31.2)μg/mL, all significantly lower than [(194.3±62.2)pg/mL, (44.7±9.5)pg/mL and (91.9±32.4)μg/mL, respectively, P＜0.05] in the control group. Conclusion The auxiliary DutanyuPixu Formulae therapy after TACE in treatment of patients with PLC do not improve the short-term clinical efficacy, but it seems to improve the liver function tests and tumor indicators, which might inhibit the tumor progression by reducing serum angiogenic factor levels.

Objective The aim of this study was to analyze the metabolic syndrome (MetS) relevant risk factors for disease progression in patients with hepatocellular carcinoma (HCC). Methods A retrospective study was performed on the clinical data of 203 patients with HCC admitted to the Department of Hepatobiliary Pancreatic Surgery, Eighth Hospital Affiliated to Sun Yat-sen University between January 2013 and December 2021, and out of them, the concomitant MetS was found in 89 cases, and wasn’t in 114 cases. The disease progression was defined as intrahepatic tumor metastasis, blood vessel invasion, tumor diameter larger than 5 cm, lymph node metastasis and remote metastasis. The multivariate Logistic regression analysis was applied to reveal the risk factors. Results The fasting plasma glucose (FPG), serum bilirubin, high-density lipoprotein (HDL) and triglyceride levels in patients with MetS were (6.6±1.4)mmol/L, (48.3±16.2)μmol/L, (0.9±0.3)mmol/L and (1.5±0.8)mmol/L, significantly different as compared to [(5.4±1.9)mmol/L, (22.9±7.2)μmol/L, (1.2±0.3) mmol/L and (1.0±0.5)mmol/L, respectively, P<0.05] in HCC patients without; the incidences of hepatitis B viral infection, intrahepatic tumor metastasis, lymph node metastasis, central obesity and blood hypertension in patients with MetS were 73.0%, 52.8%, 32.6%, 78.7% and 69.7%, significantly different compared to 86.8%, 29.8%, 20.2%, 39.5% and 29.8% (P＜0.05) in patients without; the HCC patients with MetS were prone to having disease progression (P<0.05), and the multivariate Logistic analysis showed that decreased serum HDL, increased FPG, and hypertension were the independent risk factors for disease progression in patients with HCC(P<0.05). Conclusion The MetS components could promote intrahepatic and lymph node tumor metastasis, leading to disease progression in patients with HCC, which warrants further investigation.

Objective The aim of this study was to investigate the performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in diagnosis andevaluation of transcatheter arterial chemoembolization (TACE) efficacy in patients with primary liver cancer (PLC). Methods 68 patients with intrahepatic spaceoccupying lesions were encountered in our hospital between January 2017 and June 2021, and all patients underwent DCE-MRI and fine needle aspiration biopsies. The patients with PLC were treated by TACE. The clinical epidemiology analysis skills was applied toevaluate the performance of DCE-MRI in diagnosing PLC. Results The DCE-MRI showed that the intrahepatic malignant lesions had some special feature, such as low frequency signal in T1WI, high frequency signal in T2WI, arterial enhancement, rapid disappeared in portal stage; the cytolgical examination demonstrated the PLC in 64 cases, and non-cancerous foci in 4 cases out of our series; the sensitivity, specificity, accuracy, positive and negative predictive values by DCE-MRI diagnosis were 95.2%,75.0%, 89.7%, 93.8%, and 25.0%; after TACE treatment, the DCE-MRI scan showed complete remission in 18 cases (28.1%), partial remission in 25 cases (39.1%), stable disease in 15 case (23.4%) and disease progression in 6 cases (9.3%). Conclusion The DCE-MRI is a great importance in preoperative diagnosis and postoperative efficacy evaluation in patients with PLC, which could guide clinicians to make appropriate decisions for management.

Objective This study was to explore the prognosis of patients with hepatocellular carcinoma (HCC) after hepatectomy and sorafenib therapy by cancerous N⁶-methylpurine (M6A) methyltransferase-like protein 3 (METTL3) levels. Methods A total of 62 patients with HCC were enrolled in our hospital between August 2016 and August 2019, and all patients underwent hepatectomy, receiving sorafenib therapy after operation and followed-up for two years. The cancerous and non-cancerous tissue METL3 mRNA levels were detected by qRT-PCR. The prognostic value of cancerous METL3 mRNA was analyzed by area under the receiver operating characteristic (ROC) curves (AUC). Results The cancerous METL3 mRNA level was significantly higher than that in adjacent tissues [(7.7±1.4) vs. (5.3±1.1), P<0.05]; the cancerous METL3 mRNA levels in patients with tumor diameter ≥5 cm, TNM stage Ⅲ and with extrahepatic metastasis were (8.1±1.1), (8.2±1.4)and (8.6±0.8), all significantly higher than [(7.0±0.9), (7.3±0.7)and (7.4±1.2), P<0.05] in patients with tumor diameter <5 cm, TNM staging stage Ⅰ-Ⅱ and without extrahepatic metastasis (P＜0.05); at the end of two-year follow-up, 27 patients survived and 35 died; the cancerous METTL3 mRNA level in survived patients was (7.0±1.0), significantly lower than [(8.2±1.1), P＜0.05] in died ones; the AUC was 0.712 [95%CI(0.584-00.839)] when the optimal cut-off-value of cancerous METTL3 mRNA level was set at 7.6, with the sensitivity, specificity and accuracy of 71.4%, 66.7% and 69.4%; the total survival in patients with lower cancerous METTL3 mRNA levels was 64.3%, significantly higher than 26.5%(P＜0.05) in those with high cancerous METTL3 mRNA levels. Conclusion The cancerous METTL3 mRNA levels in patients with HCC is up-regulated, and the cancerous METTL3 mRNA level is correlated to tumor diameter, TNM staging and extrahepatic metastasis. The surveillance of cancerous METTL3 mRNA levels might help predict the prognosis of HCC patients receiving sorafenib therapy after hepatectomy.

Objective The aim of this study was to investigate the guidance of real-time contrast-enhanced ultrasonography and 3D ultrasound fusion imaging for ablation area in patients with primary liver cancer(PLC)during microwave ablation (MWA) therapy. Methods A total of 102 patients with PLC were encountered in Meizhou People's Hospital between February 2017 and February 2021, and were randomly divided into observation (n=51) and control group (n=51). They were all treated with MVA. In the control group, the conventional contrast-enhanced ultrasonography was applied to evaluate the ablation area, while in the observation group was evaluated by real-time contrast-enhanced ultrasonography and 3D ultrasound fusion imaging navigation combination. All patients were followed-up for one year, and the one-year overall survival rate in the two groups were recorded and compared. Results The complete ablation rate and supplemental ablation rate in the observation group were 94.1% and 19.6%, significantly higher than 78.4% and 3.9% in the control (P<0.05); after MWA, theincidence of ablation-related complications, such as bleeding, infection, adjacent organ injuries, bile leakage and pleural effusion or ascites in the observation was 17.7%, not significantly different compared to 21.6% in the control (P＞0.05); at the end of one-year follow-up, therecurrence of intrahepatic tumor in the observation was 10.0%, significantly lower than 28.0% in the control group (x²=5.26, P=0.02); the one-year overall survival rate in the observation was 96.0%,significantly higher than 84.0%(Log-Rank x²=22.159, P＜0.001) in the control. Conclusion The guidance of ablation area by real-time contrast-enhanced ultrasonography and 3D ultrasound fusion imaging navigation combination could help evaluate the ablation efficacy of MWA in patients with PLC, and warrants further clinical investigation.

Objective The purpose of this study was to investigate the short-term efficacy of high intensity focused ultrasound (HIFU) with auxiliary artificial plethorax (AAP) in the treatment of children with unresectable hepatoblastoma (HB). Methods 48 children with unresectable HB were admitted to our hospital between June 2018 and June 2020, and the children were randomly divided into control and observation group, with 24 cases in each, receiving HIFU or HIFU with AAP therapy. All patients were followed-up for 12 weeks. Serum immunoglobulin M (IgM), IgG and IgA were detected by immunoturbidimetry, and serum complement C3 and C4 levels were detected by scattering turbidimetry. Results At the end of 12 weeks of treatment, the effective rate in the observation group was 87.5%, significantly higher than 62.5% in the control group (P<0.05); serum ALT, AST and AFP levels in the observation group were(72.6±26.1)U/L, (61.0±30.3)U/L and(43.1±5.3)μg/L, significantly lower than [(117.5±30.2)U/L, (116.6±37.8)U/L and (155.2±6.1)μg/L, respectively, P＜0.05], while hemoglobin level was (96.4±26.1)g/L, significantly higher than [(90.7±23.6)g/L, P＜0.05] in the control; there were no significant differences respect of serum IgM, IgG, IgA, complement C3 and C4 levels between the two groups (P＞0.05); during the treatment, the incidences of complications, such as fever, skin burning, ascites and traumatic wet lung in the observation group was 4.2%, significantly lower than 29.2%(P＜0.05) in the control. Conclusion The HIFU with AAP in the treatment of children with unresectable HB is short-termly efficacious, which could effectively reduce the incidence of complications, and worthy of clinical verification.

Objective The purpose of this study was to investigate the impact of fatty liver on the diagnosis of contrast-enhanced ultrasound (CEUS) in patients with inflammatory pseudotumor of liver (IPL). Methods 28 patients with IPL were encountered in Kailuan General Hospital, North China University of Science and Technology between January 2016 and January 2021, and out of them, 12 patients with underlying fatty liver. The diagnosis was made by fine needle aspiration biopsies or post-operational histopathologic examination. All patients underwent CEUS, and the blood supply status, contrast-enhanced modes and quantitative parameters were compared between the two groups. Results In patients with IPL and underlying fatty liver, there were 1 cases (8.3%) with arterial blood supply, 11 cases (91.7%) with venous blood supply, 3 cases (25.0%) presenting with rich blood supply, and 9 cases (75.0%) with poor blood supply, while in patients with IPL and normal liver, there were 7 cases (43.8%) with arterial blood supply, 9 cases (56.3%, P<0.05) with venous blood supply, 5 cases (31.3%) presenting with rich blood supply and 11 cases(68.8)with poor blood supply (P>0.05); there were no significant differences in blood supply type and blood supply richness between the two groups (P>0.05); In patients with fatty liver, there were no significant enhancement of foci under CEUS in 1 cases, enhancement with rapid clearance in 5 cases, equal enhancement in 3 cases, and low enhancement in 3 cases, while in patients with IPL, there were no significant enhancement in 2 cases, enhancement with rapid clearance in 5 cases, equal enhancement in 7 cases, and low enhancement in 2 cases, not significantly different between the two groups in contrast enhancement mode ( P=0.661); in patients with IPL and fatty liver, the contrast agent arrival time was (8.9±1.3) s, significantly slower than [((8.0±0.9)s, P<0.05], and the peak intensity was (53.2±7.8)dB, significantly weaker than [((61.1±9.7)dB, P<0.05] in patients with IPL, while there were no significant differences as respect to the peak time, the curve sharpness and the area under curve between the two groups (P> 0.05). Conclusion The IPL foci in patients with fatty liver are mainly having venous blood supply, and the underlying fatty liver might interfere with the imaging diagnosis, which should be carefully identified.

Objective The aim of this study was to evaluate the efficacy and safety of percutaneous transhepatic biliary drainage (PTBD) and secondary percutaneous transhepatic choledochoscopic lithotomy (PTCSL) in the treatment of patients with acute cholangitis with choledocholithiasis. Methods 75 patients with acute cholangitis and choledocholithiasis were admitted to Changzhou Seventh People's Hospital between May 2017 and May 2020, and were divided into observation (n=39) and control group (n=36). All patients underwent emergency PTBD, and the patients in the observation group received second phase PTCSL and those in the control received laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE). All patients were followed-up for 12 months. Results The postoperative anal exhaust time and drainage tube indwelling time in the observation group were(19.6±3.3)h and (7.8±1.2) h, not significantly different compared to (20.4±3.5) h and (8.1±1.3) h in the control (P>0.05), while the operation time and hospital stay were (86.9±14.1)min and (9.5±1.5)d, both significantly shorter than [(124.6±19.8)min and (11.4±1.9)d, respectively, P<0.05] in the control group; 24 hours after operation, the visual analogue scale score in the observation group was (2.1±0.3), significantly lower than [(3.6±0.6), P<0.05] in the control; after operation, the incidence of complications, such as incision infection, bile leakage, pancreatitis and biliary bleeding in the observation group was 15.4%, not significantly different compared to 13.9% in the control (P>0.05); at the end of one-year follow-up, the incidences of residual stones and stone recurrence rates in the observation were 7.7% and 15.4%, not significantly different compared to 8.3% and 11.1% in the control (P>0.05). Conclusion PTBD combined with the second-stage PTCSL for the treatment of patients with acute cholangitis and common bile duct stones can shorten the operation time and hospital stay, reduce the amount of bleeding, and can reduce the postoperative pain response of the patient, which is safe and reliable.

Objective Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection leads to a new type of coronavirus disease (COVID-19), which is still rampant in the world. It is reported that about 2% to 11% of SARS-CoV-2 infected patients have underlying chronic liver disease, and the impact of liver diseases on the susceptibility and severity of patients with COVID-19 infection, and whether the SARS-CoV-2 infection will deteriorate the progression of chronic liver diseases is still unclear. In this article, we mainly focus on the influence of different basic liver diseases on the outcomes of patients with COVID-19 infection.

Objective The spontaneous bacterial peritonitis (SBP) is one of the most common complications in patients with cirrhosis, with high clinical incidence, rapid disease development and high mortality. The clinical manifestations of SBP are often not very typical, and the diagnosis of celiac infection is mainly based on the white blood cell counts in celiac fluid. The treatment is mainly empirical antibiotic administration and intestinal flora modulation. Early diagnosis and active intervention are of great importance to improve the prognosis and reduce the mortality, but there are still some great challenges in the diagnosis, treatment and prevention of the entity, which require in-depth study to further solve the relevant problems, so as to guide the clinical practice and improve the patient's prognosis.