Objective The aim of this experiment was to investigate the effects of hepatocyte-specific cell cycle inhibitor protein P21 (P21) overexpression on transdifferentiation of biliary epithelial cells (BEC) into mature hepatocytes in mice with choline-deficient and ethionine -supplemented (CDE) -induced chronic liver injury. Methods We established a mice with rosa-stop^flox/flox-EGFP by biliary epithelial cells lineage tracing via Krt19-Cre^ERT, and the mice were injected with the adeno-associated virus serotype 8 encoding Cdkn1a under the control of the CAG promoter(AAV-CAG-P21), a virus which infected only hepatocytes. The overexpression of P21 and the bile duct epithelial cell tracing model were determined by Western blot and immunohistochemistry. Then, the male Krt19-Cre^ERT and Rosa-stop^flox/flox-EGFP mice injected with AAV-CAG-P21(experiment group) and AAV-CAG-MCS(control group) were fed with CDE diet for 2 weeks. The liver tissues were collected for liver damage and cell proliferation analysis. The mice received 2 weeks normal diets after CDE diet-induced liver injury to observe biliary epithelial cells transdifferentiation into hepatocytes, and the liver tissues were collected from all mice and analyzed by immunohistochemistry and immunofluorescence. Results The mice with P21 overexpression in hepatocytes from CDE diet-fed mice developed severe liver injury with pale liver surface, decreased significantly the ratio of liver weight/body weight from (4.5±0.1)% to (5.2±0.2)% (P＜0.05) and increased serum AST levels from (175.9±11.4) U/L to (385.4±12.7) U/L (P＜0.05), ALT levels from (214.8±23.5) U/L to (423.8±32.4) U/L (P＜0.05) and bilibubin levels from (10.5±0.9) μmol/L to (21.3±1.4) μmol/L (P＜0.05); the immunohistochemistry results showed an impaired hepatocyte proliferation in mice with P21 overexpression; the hepatocytes were arrested at G1/S transition-phase with decreased Ki67⁺ hepatocytes from (8.2±1.5)% to (0.1±0.1)% , with lower S phase marker CyclinA2 expression from (3.2±0.7)% to (0.1±0.2) and similar CyclinD1 (G1 phase marker) expression level [(43.2±3.5) % to (42.0±2.8)%]; importantly, we observed the differentiation of biliary epithelial cells into hepatocytes as clones in liver parenchyma with 2 weeks' diet recovery; the lineage tracing and immunofluorescence analysis showed the new hepatocytes were derived from cholangiocytes with GFP, and they had all features of mature functional hepatocytes expressing albumin, CYP3A4, CYP2E1, and CYP2D6, and so on. Conclusion During the chronic procedure of liver injury, the overexpression of cell cycle inhibitor P21 in hepatocytes aggravates the liver injury and impaires hepatocyte proliferation, which triggers a stimulus for BECs to differentiate into mature functional hepatocytes.

Objective The aim of this study was to explore the protective effect and possible mechanism of antimicrobial peptide cathelicidin-PY in mice with lipopolysaccharide (LPS)/D-galactosamine (D-GalN)-induced acute liver failure (ALF). Methods 60 C57BL/6 mice were randomly divided into control, model, low-dose cathelicidin-PY (1.0 mg.kg^-1) –intervention and high-dose cathelicidin-PY (3.0 mg.kg^-1) intervention group, with 15 mice in each group. The models of ALF in mice were established by intraperitoneal injection of LPS/D-GalN, and in intervention groups 2 hours before injection of LPS/D-GalN, the mice were injected with cathelicidin-PY via the tail vein. At 5 hours after LPS/D-GalN injection, the blood samples and liver tissues were collected in 5 sacrificed mice in each group, and the survivals within 24 hours of the residual mice was recorded in each group. Serum tumor necrosis factor α (TNF-α) and interleukin-1β (IL-1β) levels were detected by ELISA, and the apoptosis of liver cells was detected by TUENL staining. The expression of cleaved cysteine proteinase 3 (cleaved caspase-3) in liver tissues was detected by Western blot. Results The 24 h survival rates in low-dose and high-dose cathelicidin-PY intervention groups were 40% (4/10) and 60% (6/10), significantly higher than 10.0% (1/10, P<0.05) in the model; serum TNF-α and IL-1β levels in the model group were (1069.4±178.0) pg/mL and (1354.1±162.9) pg/mL, both significantly higher than [ (140.7 ± 33.6) pg/mL and (436.2 ± 46.8) pg/mL, respectively, P<0.05] in the control, while serum TNF-α and IL-1β levels in the low-dose and high-dose cathelicidin-PY intervention groups decreased significantly compared to in model group (P<0.05); the numbers of apoptotic liver cells and expression of cleaved caspase-3 protein in liver tissues in the model group increased significantly (P<0.05) compared to in the control, while the numbers of apoptotic liver cells decreased, and the expression of cleaved caspase-3 protein became weak significantly compared to in the model in the low-dose and in the high-dose cathelicidin-PY intervention group (P<0.05). Conclusion The antimicrobial peptide, the cathelicidin-PY could reduce mortality in mice with LPS/D-GalN-induced ALF, probably by relieving inflammation response and inhibiting apoptosis of liver cells.

Objective The aim of this study was to explore the evaluation of significant liver fibrosis (SLF) by ultrasonic shear wave elastography (SWE) in rats with carbon tetrachloride(CCl₄)-induced liver injury. Methods 52 male SD rats were randomly divided into control group (n=12) and experimental group (n=40). The liver injury model was induced by intraperitoneal injection of carbon tetrachloride for 4, 6, 8 and 10 weeks, with 10 rats sacrificed at each time. At end of each experiment, the rats were anesthetized for liver stiffness measurement (LSMs) by SWE. The blood routine and serum biochemical parameters were obtained for calculation of APRI and FIB-4. The LSM immediately after dead (LSMd) was performed again after execution. The liver fibrosis, steatosis and inflammatory activity were evaluated by pathological examination. The receiver operating characteristic (ROC) curve was applied to evaluate the performance of parameters in the diagnosis of SLF. Results The pathological examination showed F0/F1 non-significant LF(NSLF) in 18 rats, and > F2 SLF in 30 rats; the APRI score in rats with NSLF was (0.051±0.023), significantly lower than [(0.135±0.117), P<0.05], and the FIB-4 score was (0.132^-100±0.088^-100), significantly lower than [(0.245^-100±0.125^-100), P<0.05], the LSMs was(5.2±1.7)kPa, significantly lower than [(9.7±2.8)kPa, P<0.05] and the LSMd was (3.6±0.8) kPa, significantly lower than [(8.8±1.7) kPa, P<0.05] in rats with SLF; the areas under the ROC curve (AUC) by LSMs and LSMd in predicting SLF were 0.91 and 0.93, significantly higher than 0.75 by APRI or 0.69 by FIB-4, with the sensitivities and specificities of 76.7% and 87.5%, and 85.7% and 92.0%, respectively. Conclusion The SWE technique has a high clinical value in evaluating LF in rats with CCl₄-induced liver injury, with the advantages of non-invasive, simple and repeatable feature.

Objective The aim of this study was to explore the evaluation of liver fibrosis by liver stiffness measurement (LSM) and portal vein hemodynamic index combination in patients with chronic hepatitis B (CHB). Methods A total of 96 patients with CHB confirmed by liver biopsy and 74 healthy individuals were enrolled in our hospital between December 2018 and October 2022, the LSM was detected by FibroTouch scan and the portal vein diameter (PVD), maximum flow velocity (Vmax) and average flow velocity (Vmean) of portal veins were detected by ultrasonography. The diagnostic performance was evaluated by the receiver operating characteristic (ROC) curves. Results The LSM, PVD, Vmax and Vmean in patients with CHB were (9.5±1.6) kPa,(12.7±2.1) mm,(35.4±3.1)cm/s and (29.8±2.8) cm/s, all significantly greater than [(4.4±0.5)kPa, (10.7±1.6)mm,(26.1±2.5)cm/s and (21.7±2.2)cm/s, respectively, P<0.05] in healthy persons; the liver histopathological examination showed non-significant liver fibrosis in 32 cases and significant liver fibrosis in 64 cases in our series; the LSM and the PVD in patients with significant liver fibrosis were (14.5±2.6)kPa and (13.3±2.3) mm, both significantly greater than [(5.8±0.8)kPa and (11.2±1.8)mm, respectively, P<0.05], while the Vmax and Vmean of portal vein blood flow were (29.1±2.6)cm/s and (24.2±1.9)cm/s, both significantly slower than [(36.9±3.8)cm/s and (30.6±2.7)cm/s, respectively, P<0.05] in those without significant liver fibrosis; the ROC analysis showed that the diagnostic efficacy was superior to LSM or PVD alone prediction, with the sensitivity of 90.1％ and the specificity of 77.4%, when the two parameters were combined to assess the significant liver fibrosis in patients with CHB, with the LSM equal to 9.5 kPa and the PVD equal to 12.0 mm as the cut-off-value(P<0.05). Conclusion The validation of combination of LSM by FibroTouch and PVD by ultrasonography in assessing significant liver fibrosis in patients with CHB might be helpful in clinical practice.

Objective The aim of this study was to explore the implication of serum soluble vascular adhesion protein-1 (sVAP-1) and serum amyloid A (SAA) levels in patients with chronic hepatitis C (CHC) receiving pegylated interferon α-2a (peg-IFN-α-2a) and ribavirin standardized treatment. Methods 62 patients with CHC and 48 healthy persons were enrolled in our hospital between February 2018 and February 2022, and all patients with CHC were treated with peg-IFN α-2a and ribavirin for 24 weeks. Serum sVAP-1 and SAA levels were detected by ELISA, and serum HCV RNA load was detected by real-time fluorescence quantitative PCR. The virologic response was evaluated by early virologic response (EVR), end treatment virologic response (ETVR) and sustained virologic response (SVR). Results Serum sVAP-1 and SAA levels in patients with CHC were (164.0±29.3)μg/L and (3.0±0.6)mg/L, significantly higher than [(73.7±15.8)μg/L and (0.8±0.2)mg/L, P<0.05] in healthy persons; serum sVAP-1 and SAA levels in 17 CHC patients with high serum viral loads were (225.9±33.7)μg/L and (4.3±0.7) mg/L, significantly higher than [(156.7±28.4)μg/L and (3.0±0.5)mg/L, respectively, P<0.05] in 26 CHC patients with medium viral loads or [(118.7±22.0)μg/L and (1.8±0.3)mg/L, respectively, P<0.05] in 19 CHC patients with low viral loads; serum SAA levels in patients who responded to antiviral therapy were significantly higher than non-responders [EVR:(4.1±0.7)mg/L vs. (2.2±0.5)mg/L; ETVR:(3.2±0.9)mg/L vs. (1.6±0.4)mg/L and SVR:(3.7±0.8)mg/L vs.(1.5±0.4)mg/L, P<0.05], while there were no significant differences as respect to serum sVAP-1 levels between responders and non-responders (P>0.05). Conclusion Serum sVAP-1 and SAA levels in patients with CHC increase, and their changes are related to virus replication. It might be helpful by monitoring serum SAA level changes in predicting the antiviral efficacy in patients with CHC.

Objective The aim of this study was to investigate the diagnostic performance of ultrasound attenuation parameters (UAP) in predicting fatty liver diseases (FLD) in individuals at physical examination. Methods The general data, biochemical indexes, ultrasonography, UAP and liver stiffness measurement (LSM) by iLivTouch in individuals at physical examination were collected in Physical Examination Center, Third Hospital, Hebei Medical University between November and December 2020, and the diagnostic efficacy of UAP was evaluated by the area under the receiver operating characteristic curve (AUC). Results Among the 308 subjects, the FLD was found in 252 cases, with 56 persons without; the male patients with FLD accounted for the most, much greater than female patients (P<0.001), while there was no significant difference as respect to ages between the those with and without FLD (P>0.05); serum HDL level in patients with FLD was significantly lower than, while the BMI, serum TG, TC, LDL, VLDL, ALT, AST, Cr, UA, GLU and UAP were significantly higher than those in healthy persons (P<0.05); the BMI, ALT and UA were the independent predictors for higher UAP, and the cut-off value was 251.35 dB/m, with the AUC of 0.856, the sensitivity of 0.710 and the specificity of 0.839, when the UAP was applied to diagnose the FLD; the diagnostic performance by the combination of UAP, BMI and ALT for FLD with AUC of 0.920 was superior to any parameter done alone. Conclusion The UAP obtained by iLivTouch scam could diagnose the FLD, and it might be helpful to take the BMI and serum ALT into consideration.

Objective This study was conducted to analyze the etiological diagnosis and hepatic histological manifestations of patients with noncausal chronic abnormal liver biochemical tests (NCALBT). Methods We retrieved and retrospectively analyzed clinical materials of a series of 248 patients with NCALBT at presentation. All patients underwent liver biopsies and evaluated according to Scheuer scores. Blood biochemical, serologic and virologic detections were recorded. Results Out of 248 patients with NCALBT, the diagnosis based on comprehensive materials included drug-induced liver injury (DILI) in 89 cases(35.9%), autoimmune liver diseases (AILD) in 67 cases (27.0%), nonalcoholic fatty liver diseases (NAFLD)in 39 cases(15.7%), inherited metabolic liver diseases (IMLD)in 30 cases (12.1%), idiopathic non-cirrhotic portal hypertension (INCPH) in 20 cases (8.1%) and other liver diseases in 3 cases (1.2%); common serum biochemical parameters in patients with DILI and AILD were significantly higher than in patients with NAFLD or INCPH (P<0.05); 67.8% of patients in our series had liver injuries at G_2-4/S_2-4 states, showing definite liver tissue injuries, and 61.8% of DILI, 95.5% of AILD, 56.4% of NAFLD, 65.0% of INCPH and 100.0% of other liver diseases had liver injuries at G_2-4/S_2-4, while the G_2-4/S_2-4 liver tissue activity accounted for 36.7% in patients with IMLD. Conclusion The etiologies of patients with NACLBT is still common diseases, and the diagnosis might be made based on comprehensive biochemical, serologic, virologic and liver tissue examinations.

Objective The purpose of this clinical trial was to investigate the clinical efficacy of polyene phosphatidylcholine and zhibitai, a herbal medicine, combination in the treatment of patients with non-alcoholic fatty liver diseases (NAFLD). Methods A total of 94 patients with NAFLD proven by ultrasonography were encountered in our hospital between June 2019 and December 2021, and were randomly divided into control (n=47) and observation (n=47) groups, receiving polyene phosphatidylcholine or polyene phosphatidylcholine and Zhibitai capsules combination therapy for six 4 months. Serum diamine oxidase (DAO), D-lactic acid (D-LA) , interleukin 6 (IL-6) and tumor necrosis factor α(TNF-α) levels were detected by ELISA. The intestinal flora was routinely obtained. Results At the end of six-month observation, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and glutamyl transpeptidase (GGT) levels in the observation group were (33.4±6.8)U/L, (32.5±7.4)U/L and (62.5±5.7)U/L, all significantly lower than [(52.8±7.3)U/L,(49.6±7.7)U/L and (78.6±7.4)U/L, respectively, P<0.05] in the control; serum total cholesterol (TC), triacylglycerol (TG) and low density lipoprotein (LDL) levels were (4.6±1.5)mmol/L,(2.1±0.5)mmol/L and (2.2±0.3)mmol/L, all significantly lower than [(5.3±1.8)mmol/L,(2.7±0.7)mmol/L and (2.9±0.5)mmol/L, respectively, P<0.05] in the control; the fecal Enterobacter and Enterococcus counts were (7.6±1.3) lgCFU/g and (6.2±1.2) lgCFU/g, both significantly lower than [(8.3±1.5)lgCFU/g and (6.9±1.2)lgCFU/g, P<0.05], while the fecal Bacteroides and Bifidobacterium counts were (10.5±1.4)lgCFU/g and (11.6±1.3) lgCFU/g, both significantly higher than [(9.7±1.3) lgCFU/g and (9.6±1.2)lgCFU/g, respectively, P<0.05] in the control group; serum DAO, D-LA, IL-6 and TNF-α levels were (24.5±4.3)ng/mL, (28.3±3.9)μmol/L, (22.5±4.6)pg/mL and (70.1±7.7) ng/mL, all significantly lower than [(29.8±5.2)ng/mL,(32.9±4.2)μmol/L, (29.8±5.4)pg/mL and (87.6±8.5)ng/mL,P<0.05] in the control. Conclusion The administration of oral polyene phosphatidylcholine and zhibitai capsule in the treatment of patients with NAFLD could effectively improve liver function and blood lipid indexes, regulate the balance of intestinal microecology, and warrants further long-term clinical observation.

Objective This study was aimed at exploring the implication of serum leptin, retinol binding protein-4 (RBP4) and cholinesterase (ChE) levels in patients with non-alcoholic fatty liver diseases (NAFLD) and type 2 diabetes mellitus (T2DM). Methods 74 patients with NAFLD and T2DM , including mild fatty liver in 28 cases, moderate in 25 cases and severe in 21 cases, 30 patients with NAFLD, 30 patients with T2DM and 30 healthy individuals were recruited in our hospital between April 2019 and April 2022. Serum leptin and RBP4 levels were detected by ELISA, and serum ChE level was detected routinely. The diagnostic performance was evaluated by the area under the receiver operating characteristic (AUC) curves. Results The HOMA-IR in patients with NAFLD and T2DM was(5.8±1.7), much higher than (3.9±1.1) in patients with T2DM, or (3.6±0.9) in patients with NAFLD or [(1.9±0.4), P＜0.05] in healthy persons, while the insulin sensitivity index was(-4.4±0.5), much lower than(-4.0±0.4) in patients with T2DM or (-4.0±0.3) in patients with NAFLD or healthy persons [(-3.5±0.3), P＜0.05]; serum leptin and RBP4 levels in patients with NAFLD and T2DM were (17.1±3.1)μg/L and (30.6±2.8)mg/L, significantly higher than [(12.3±2.7)μg/L and (24.1±2.3)mg/L, P＜0.05] in patients with T2DM or [(13.1±2.4)μg/L and (23.9±2.7)mg/L, P＜0.05] in patients with NAFLD or [(9.7±1.9)μg/L and (20.1±1.9)mg/L, P＜0.05] in healthy persons, while serum ChE level was (8337.3±755.9)IU/L, much lower than [(9080.2±684.7)IU/L, P＜0.05] in patients with T2DM or [(9159.9±812.2)IU/L, P＜0.05] in patients with NAFLD or [(9987.4±975.4)IU/L, P＜0.05] in healthy persons; serum leptin and RBP4 levels in NAFLD/T2DM patients with severe hepatic steatosis was much higher than, while serum ChE level was much lower than in those with moderate or mild hepatic steatosis(P＜0.05); the AUC was 0.834, with the sensitivity, specificity and accuracy of 76.2%, 81.1% and 79.7% when serum leptin, RBP4 and ChE level combination was applied to predict severe hepatic steatosis in patients with NAFLD and T2DM, much superior to the three parameters alone evaluation ( with AUCs of 0.727, 0.739 and 0.708, respectively, P＜0.05). Conclusion Serum leptin and RBP4 levels increase, while serum ChE level decrease, in patients with NAFLD and T2DM, which might be correlated to hepatic steatosis severity, and help evaluate the disease progression.

Objective This study aimed to the prevalence of non-alcoholic fatty liver diseases (NAFLD) in patients with hypopituitarism (HP), and to clarify the relationship between thyroid functions and the occurrence of NAFLD. Methods 32 patients with HP and 30 patients with NAFLD were enrolled in our hospital between January 2018 and June 2022, and all underwent ultrasonography to determine the diagnosis of NAFLD. Serum free triiodothyronine (FT₃), free thyroxine (FT4), thyroid-stimulating hormone (TSH), adrenocorticotrophic hormone (ACTH), cortisol (Cor), growth hormone (GH) and insulin-like growth factor -1 (IGF-1) were detected by ELISA. Results Out of 32 patients with HP in our series, the ultrasonography revealed NAFLD in 17 cases; the body mass index, serum ALT, AST, GGT, lactate dehydrogenase and triglyceride levels in patients with HP and NAFLD were(27.4±3.6)kg/m², 76.7(36.3, 328.6) U/L, 65.2(38.5, 335.2)U/L, 68.5(32.2, 82.5)U/L, (313.5 ± 55.3)U/L and (2.1±0.7)mmol/L, all significantly higher than [(23.4±1.5)kg/m², 16.2(10.4, 23.6)U/L, 18.1(14.5, 25.9)U/L, 36.0(12.5, 43.5)U/L, (198.1 ± 47.3)U/L and (1.3±1.2)mmol/L, respectively, P<0.05], while serum high-density lipoprotein level was (0.8±0.6)mmol/L, much lower than [(1.2±0.5)mmol/L, P<0.05] in patients with HP; serum FT₄ and GH levels in patients with HP and NAFLD were 9.4(7.3, 12.7)pmol/L and 0.05(0.04, 0.10) ng/mL, much lower than [12.3(8.8, 15.3)pmol/L and 0.1(0.05, 0.2)ng/mL, P<0.05] in patients with HP, while the FT₃/FT₄ ratio was 0.4(0.3, 0.4), much greater than [0.2(0.2, 0.4), P<0.05] in patients with HP; serum TSH, FT₄ and GH levels were 1.3(0.4, 3.3)μIU/mL, 9.4(7.3, 12.7)pmol/L and 0.05(0.04, 0.10) ng/mL, significantly lower than [2.8(1.4, 4.5)μIU/mL, 16.5(11.6, 24.9)pmol/L and 0.1(0.05, 0.3)ng/mL, P<0.05], while the FT₃/FT₄ ratio was significantly greater than [0.2(0.1, 0.3), P<0.05] in patients with NAFLD. Conclusion The hypothyroidism could disturb systemic lipid metabolism, which might lead to the occurrence of NAFLD.

Objective The aim of this study was to assess the changes of thyroid hormone in patients with autoimmune liver diseases (AILD). Methods 52 patients with autoimmune hepatitis (AIH), 34 patients with primary biliary cholangitis (PBC) and 46 patients with AIH-PBC overlap syndrome (OS) were admitted to the Second Affiliated Hospital, Anhui Medical University between May 2016 and September 2022, and 52 healthy persons were selected as control. Serum free triiodothyronine (FT3), free thyroxine (FT4), T3, T4, thyroid stimulating hormone (TSH), thyrotrophin receptor antibody (TRAb), thyroid peroxidase antibody (TPOAb), anti-thyroglobulin antibody (TgAb), thyroxine-binding globulin (TBG) and thyroglobulin (Tg) were detected. Results Serum FT3 levels in patients with AIH, with PBC and with OS were 4.5(3.9, 5.0)pmol/L, 4.4 (4.0, 4.5)pmol/L and 4.1(3.7, 4.7)pmol/L, serum FT4 levels were 14.8(13.0, 16.5)pmol/L, 14.6(13.0, 16.0) pmol/L and 14.8(13.1, 15.9)pmol/L, all significantly lower than[4.8(4.5, 5.0)pmol/L and 15.7(14.5, 16.9)pmol/L, respectively, P<0.05] in healthy individuals; serum TSH level in patients with OS was 3.4(2.1, 6.4)mIU/L, much higher than[2.8(2.0, 3.3)mIU/L, P<0.05] in healthy control; the positive rates of serum TRAb, TGAb, TPOAb, TBG and Tg in patients with AIH were 5.4%, 21.6%, 29.7%, 8.1% and 0.0%, in patients with PBC were 6.9%, 13.8%, 17.2%, 10.3% and 3.4%, and in patients with OS were 12.5%, 18.8%, 21.9%, 0.0% and 3.1%, all not significantly different among them (P>0.05); the incidences of hypothyroidism and subclinical hypothyroidism in patients with AIH were 9.6% and 13.5%, in patients with PBC were 20.6% and 23.5%, and in those with OS were 6.5% and 30.4%, also not significantly different among them (P>0.05); at the end of six month treatment, 21 patients(41.2%) with AIH, 25 patients (73.5%) with PBC and 12 patients (26.7%) with OS responded to treatment, and there were no significant differences as respect to the response rates between patients with and without thyroid diseases(28.6% vs. 45.9%, 66.7% vs. 81.3% and 38.9% vs. 18.5%, respectively, all P>0.05). Conclusion Serum FT3 and FT4 levels decrease and serum TSH level increase in patients with AIH, PBC and OS, and the implication of concomitant thyroid diseases in this setting needs to be clarified.

Objective The aim of this study was conducted to compare the clinical features of patients with drug-induced autoimmune hepatitis (DI-AIH), autoimmune hepatitis (AIH) and drug-induced liver injury (DILI). Methods 22 patients with DI-AIH, 23 patients with DILI and 23 patients with AIH were encountered in our hospital between January 2017 and December 2021, the patients with AIH and DI-AIH were treated with prednisone and/or azathioprine combination therapy, and those with DILI were dealt with liver-protecting medicines. All patients were followed-up for two years. Results The percentages of definite medicine administered before diagnosis of patients with DILI and DI-AIH were 82.6% and 100.0%, with the alleged Chinese herbal medicine mainly, both significantly higher than 17.4%(P<0.05) in patients with AIH; the incidence of common symptoms, such as anorexia, jaundice and diarrhea in patients with DI-AIH was 81.8%, much higher than 52.2% and 47.8% (P<0.05) in those with AIH or with DILI; serum alanine aminotransaminase, alkaline phosphatase, glutamine transpeptidase and total bile acid levels in patients with DI-AIH were 331.2(116.4, 512.5) U/L, 125.4(91.6, 164.8) U/L, 202.4(98.8, 394.1) U/L and 23.7(13.1, 69.7)μmol/L, all significantly higher than [198.6(94.3, 497.6)U/L, 98.9(67.7, 168.9)U/L, 101.2(49.6, 231.4)U/L and 7.1(2.7, 29.2)μmol/L, respectively, P<0.05] in patients with DILI or [86.7(32.4, 186.3)U/L, 65.8(54.7, 109.8)U/L, 71.6(61.4, 142.5)U/L and 11.5(4.1, 35.6)μmol/L, respectively, P<0.05] in patients with AIH, while serum globulin level in patients with AIH was 35.6(28.7, 41.4) g/L, significantly higher than 28.8(21.2, 34.5) g/L in patients with DILI (P<0.05) or 30.5(24.6, 42.1)g/L in patients with DI-AIH (P<0.05); there were no significant differences as respect to peripheral white blood cell counts among the three groups (P＞0.05). Conclusion The main pathogenic medicines in patients with DILI and DI-AIH are Chinese herbal medicine, and the clinical features of patients with DI-AIH are unique, presenting with highly increased serum biochemical parameters and good prognosis, showing response to immunosuppression and liver-protecting therapy.

Objective The aim of this study was to investigate the preventive effect of entecavir on anti-tuberculosis drug-induced liver injury (DILI) in patients with pulmonary tuberculosis (PTB) and serum HBeAg-positive high HBV loads. Methods A total of 96 HBV carriers with PTB who had high HBV loads with serum HBeAg-positive were encountered in our hospital between January 2019 and January 2022, and were randomly divided into control and observation group, with 48 cases in each group. All the patients were given standardized anti-tuberculosis regimen for six months, and those in the observation group were given entecavir simultaneously. Serum HBV DNA loads was detected by PCR. Results At the end of one, three and six month treatment, the cumulative incidences of DILI in the observation group were 12.5%, 16.7% and 18.8%, all significantly lower than 29.1%, 45.8% and 54.2%(P＜0.05) in the control; at the end of three month treatment, serum ALT, AST and HBV DNA in 8 patients with DILI in the observation group were(67.7±8.5)U/L,(57.1±4.7)U/L and (1.1±0.2)lg IU/mL, all significantly lower than [(104.5±13.9)U/L, (96.9±15.3)U/L and (6.6±1.4)lg IU/mL, respectively, P＜0.05] in 22 patients with DILI in the control; during the anti-tuberculosis treatment, the incidence of complications, such as right epigastric discomfort, nausea and vomiting, elevated serum creatine kinase level, rash and non-planned discontinuation of anti-tuberculosis treatment in the observation group was 10.4%, much lower than 27.1%(P＜0.05) in the control; all patients (100.0%)in the observation group recovered, while the recovery rate in the control was 85.4%(P<0.05), left seven patients recovered after prolongation of anti-tuberculosis therapy. Conclusion The application of entecavir could effectively reduce the incidence of anti-tuberculosis DILI in HBV carriers with PTB, especially in those with serum HBeAg-positive and high HBV DNA loads, which warrants further investigation.

Objective The aim of this study was to retrospectively summarize the clinical feature and prognosis of adolescent and adult patients with Wilson's disease (WD). Methods 79 patients with WD, including 42 children and 37 adult persons, were encountered in Beijing Ditan Hospital, Capital Medical University between 2009 and 2019, and the clinical features, laboratory tests, complications and prognosis were analyzed. Results The age of onset ranged from 2 to 64 years, with an average age of (20.8±15.9) years; abnormal serum liver function tests as the first sign was found in 59.5% of adolescent patients, and the gastrointestinal symptoms was found in 32.4% of adult patients (P<0.05); the incidence of cirrhosis, hypersplenism, ascites, pleural effusion, hepatorenal syndrome and infection in the adult patients were 91.9%, 67.6%, 78.4%, 24.3%, 13.5% and 40.5%, significantly higher than 40%, 19%, 21.4%, 4.8%, 0% and 9.5% (P<0.05) in adolescent patients; serum ceruloplasmin and total bilirubin levels in children patients were significantly lower than in the adults group (P<0.05); the neuropsychiatric abnormality as the most common initial symptom in 13 patients with mixed clinical type was 84.6%, the positive rates of Kayser-Fleischer ring and the incidence of hypersplenism were 92.3% and 76.9%, significantly higher than 54.5% and 34.8% (P<0.05) in 66 patients with hepatic type; the period from disease onset to the end of follow-up or death was 372.0±60.0 mon, and 19 patients lost; out the 60 patients followed-up, 53 patients (83.3%) survived, and the 10-year cumulative survival rate was 94.4±4.0%. Conclusions The onset of WD could occur at any age, and the incidence of cirrhosis increases in adult patients. The early diagnosed patients with WD having long-term standard treatment might have a better prognosis.

Objective This study was aimed to investigate the clinical utility of transient elastic (TE) imaging for the detection and quantification of liver fibrosis (LF) in patients with alcoholic liver cirrhosis diagnosed by histopathology. Methods 68 patients with alcoholic liver diseases (ALD) were encountered in our hospital between January 2019 and January 2022, and all underwent ultrasound-guided liver biopsy and TE imaging detection for liver stiffness measurement (LSM) and spleen stiffness measurement (SSM). The consistency of diagnosis by two methods was evaluated by Kappa. Results Based on the LSM, the patients without or mild LF were found in 28 cases (41.2%), with significant LF in 19 cases (27.9%), with advanced LF in 13 cases (19.1%) and liver cirrhosis (LC) in 8 cases (11.8%); the liver histopathological examination showed LF S0, S1, S2, S3 and S4 in 15 cases(22.1%), 11 cases (16.2%), 20 cases (29.4%), 12 cases (17.6%) and 10 cases (14.7%); the LSM and SSM in 8 patients with LC proven by TE were (18.4±5.6)kPa and (22.6±4.6)kPa, significantly greater than [(10.7±3.3)kPa and (14.9±3.8)kPa, respectively, P<0.05] in 60 patients without LC; based on the gold criteria by histopathology, the sensitivity, specificity and accuracy by TE in predicting LC were 70.0%, 98.3% and 94.1%, with good consistency (Kappa=0.744). Conclusion The TE imaging technique, as a good non-invasive approach, could be utilized in clinical practice for early diagnosis of LF and/or LC, which might be helpful for clinicians making interventional strategy.

Objective The aim of this study was to investigate the changes of hepatic blood flow parametersobtained by ultrasonography and red blood cell distribution width (RDW) to lymphocyteratio (RLR) in patients with liver cirrhosis andesophageal varices (EV). Methods 188 patients with hepatitis B livercirrhosis and EV were encountered in our hospital between April 2018 and March 2021, and all underwent Doppler ultrasonography and contrast-enhanced ultrasonography to obtain hepatic vein damping index (HV-DI), portal vein velocity (PVV), internal diameter of portal vein (PVD) and portal vein congestion index (PV-CI), andgastroscope to determine the severity of EV. Results The gastroscopy found EV in 120 patients; the PVV and HVAT in patients with EV were (15.2±2.3)cm/s and (15.3±2.4)s, much lower than [(18.9±2.4)cm/s and (22.1±3.5)s, P<0.05], while the PVD, PV-CI, HV-DI and RLR were (1.6±0.2)cm, (0.4±0.1)cm/s, (0.8±0.1) and (24.2±3.5), much higher than [(1.3±0.2)cm, (0.2±0.1)cm/s, (0.6±0.1) and (9.2±1.1), respectively, P<0.05] in patients without EV; the PVV and HVAT in 33 patients with severe EV were (12.8±2.5)cm/s and (8.2±0.9)s, much lower than [(14.2±2.1)cm/s and (12.5±3.1)s, P<0.05] in 42 patients with moderate EV or [(17.9±2.1)cm/s and (23.1±3.4)s, P<0.05] in 45 patients with mild EV, while the PVD, PV-CI, HV-DI and RLR were (2.2±0.3)cm, (0.7±0.1)cm/s, (1.5±0.1) and (32.7±4.1), all much higher than [(1.5±0.1)cm, (0.4±0.1)cm/s, (0.7±0.1) and (26.7±2.8), respectively, P<0.05] in patients with moderate EV or [(1.3±0.1)cm, (0.2±0.1)cm/s, (0.4±0.1) and (15.6±1.5), respectively, P<0.05] in patients with mild EV; during the 12-month follow-up, the EV bleeding (EVB) occurred in 72 cases, and the PVV and HVAT in patients with EVB was significantly lower, while the PVD, PV-CI, HV-DI and RLR was significantly higher than in patients without EVB (P<0.05). Conclusion The monitoring of hepatic blood flow parameters by ultrasonography and RLR might provide clues for predicting EVB in patients with liver cirrhosis and EV, which warrants further clinical investigation.

Objective The aim of this study was to summarize the clinical features of patients with cirrhosis-related non-traumatic chylous ascites (CNCA). Methods 12 patients with CNCA were encountered in our Hospital between January 2012 and January 2022, and the medical histories, serum creatinine, liver function tests, ascites, imaging findings, gastroscopic results, therapeutic strategies and prognoses were analyzed retrospectively. Results Out of the 12 patients, 2 patients had experienced esophagogastric variceal bleeding, and 10 patients had ascites before; serum creatinine level was 92.4(79.2,101.7)μmol/L, and Child-Pugh class B was found in 8 cases and Child-Pugh class C in 4 cases; ascitic fluid triglyceride level was(3.9±0.9) mmol/L, and the exudate ascites was found in 9 cases and transudate in 3 cases; the ascites bacteria culture was positive in 2 patients, Escherichia Coli in 1 case and Aeromonas Hydrophila in 1 case, respectively; the ascites cytology showed no malignant; the abdominal CT scan presented with primary liver cancer in 2 cases, portal vein thrombosis in 3 cases, and mild to moderate splenomegaly in 10 cases and megalosplenia in 1 case; the gastroscopy was not performed in 3 persons, and found mild to moderate esophageal varices (EV) in 4 cases and severe EV in 5 cases; the treatment included low-fat diet, combined with conventional therapy such as antibiotics,drainage of ascetic fluid , diuretics in 5 cases, fasting, parenteral nutrition, and somatostatin in 4 cases, fasting, parenteral nutrition, and terlipress in 1 case, and TIPS in 2 cases; the ascites neutrophils count after treatment was (186.9±135.8)/μl, significantly lower than[(377.3±223.5)/μl,P＜0.05] before treatment; the ultrasonography showed the maximum liquid dark area in the abdominal cavities was 2.3(1.4,10.4)cm after therapy, significantly smaller than[(12±2.3)cm,P＜0.05] before therapy; during hospitalizations, there were 9 patients (75.0%) improved, 2 patients (16.7%) didn't respond to therapy, and 1 patients (8.2%)died of liver failure. Conclusion The patients with CNCA should be dealt with appropriately and individually. Under the circumstance of non-responded to conventional therapy, the TIPS might be the alternative.

Objective The aim of this study was to investigate the efficacy and safety of sofosbuvir (SOF) and velpatasvir (VEL) plus or not plus ribavirin in the treatment of patients with chronic hepatitis C-related compensated liver cirrhosis (CHC-CLC) and decompensated liver cirrhosis (CHC-DLC). Methods 36 patients with CHC-CLC and 27 patients with CHC-DLC were enrolled in this study between March 2020 and March 2022, and all patients received SOF and VEL and the patients with CHC-DLC were added with ribavirin for 12 weeks. The patients were followed-up for 48 weeks. The early virological response rate (EVR), the end of treatment response (EOT), the sustained virological response at 24 weeks (SVR24) and the SVR at 48 weeks (SVR48) after the discontinuation of the regimen were recorded. Results The incidences of esophageal varices, hepatic encephalopathy, ascites and hyperbilibubinemia in patients with CHC-CLC were much lower than(P<0.05), while the peripheral white blood cell (WBC) counts, hemoglobin concentration, platelet counts, serum albumin levels and prothrombin time activity were significantly higher than in patients with CHC-DLC(P<0.05); at the end of 48 week follow-up, three patients (11.1%) with CHC-DLC died; the EVR, EOT, SVR24 and SVR48 in patients with CHC-CLC were 94.4%, 100.0%, 100.0% and 100.0%, superior to 83.3%, 100.0%, 83.3% and 75.0%(P<0.05) in patients with CHC-DLC; in patients with CHC-CLC, serum alanine aminotransaminase level was 32(18, 40)U/L, peripheral WBC count was 4.1(3. 2, 7.7)×10⁹/L, platelet count was 104(90, 381)×10⁹/L, all significantly different as compared to [55(35, 62)U/L, 3.0(2.7, 5.0)×10⁹/L and 72(54, 115)×10⁹/L, respectively, P<0.05] in patients with CHC-DLC; during the antiviral treatment period, the untoward reactions were found in 4 patients with CHC-CLC and in 8 patients with CHC-DLC, including abdominal distension, anorexia, fatigue, throbbing headache and transient hypertension, which didn't influence the treatment. Conclusion The oral administration of SOF and VEL plus or not plus ribavirin in treatment of patients with with CHC-CLC and CHC-DLC is efficacious and safety, which warrants further clinical investigations.

Objective The aim of this study was to investigate the risk factors of re-bleeding after endoscopic esophageal varix ligation (EVL) in the treatment of patients with hepatitis B liver cirrhosis (LC) and esophagogastric varices (EV) bleeding (EVB). Methods 122 patients with LC complicated by EVB were encountered in our hospital between March 2018 and March 2021, and they were all treated with EVL. All patients were followed-up for 1 year. The risk factors was analyzed by multivariate Logistic regression, a predictive model for re-bleeding was established and its predictive efficacy was evaluated by the area under the receiver operating characteristic curve (AUROC). Results At the end of one-year follow-up, the re-bleeding rate in the 122 patients was 27.0%; the incidences of ascites, hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), severe EV in patients with re-bleeding were 36.4%, 12.1%, 15.2% and 75.8%, all significantly higher than 16.9%, 2.2%, 4.5% and 48.3%, P<0.05), while the portal vein diameter was (1.5±0.2)cm, much wider than [(1.1±0.2)cm, P<0.05] in patients without re-bleeding; the multivariate Logistic analysis showed that the ascites [OR(95%CI)=1.818(1.193-2.772)], portal vain diameter [OR(95%CI)=2.085(1.207-3.603)], HE [OR(95%CI)=2.264(1.252-4.092)], severe EV[OR(95%CI)=1.863(1.294-2.682)] and SBP [OR(95%CI)=1.784(1.173-2.714)] were the impacting risk factors for re-bleeding (P<0.05); the formula, e.g., P=1/[1+e^{(0.538Xascites+0.735Xportal vain+0.817XHE+0.622XEV+0.579XSBP-1.053)}] was established based on the Logistic analysis, which had a very good R-squared with the observed data by Hosmer-Lemeshow test(x²=8.361, P=0.399); the ROC analysis showed that the AUC was 0.899, 95%CI:0.832-0.967, with the sensitivity of 87.9%, and the specificity of 86.5%, when the formula we established was applied to predict re-bleeding. Conclusion The patients with LC and EVB having complications and severe EV might have a high risk of re-bleeding after EVL, which should be intervened appropriately clinically with endoscopic measures and/or medicines.

Objective The aim of this study was to investigate the changes of peripheral blood natural killer (NK) cell percentages in patients with hepatocellular carcinoma (HCC) after radical hepatectomy. Methods A total of 127 patients with HCC were admitted to our hospital between May 2019 and May 2021, and all underwent radical hepatectomy. All the patients with HCC were followed-up for 24 months. The peripheral blood NK cell percentages were detected by flow cytometry. Based on the imaging, the recurrent tumors were divided into stage Ⅰ, stage Ⅱ and stage Ⅲ. Results Post-operationally, the percentages of peripheral blood CD3^-CD56⁺ and CD3^-CD16⁺CD56⁺ cells in 127 patients with HCC were(27.3±1.6)% and (16.3±1.4)%, both significantly higher than [(16.4±1.4)% and (12.5±1.5)%, P<0.05] before operation; the imaging showed the recurrent tumors in 53 cases during the two-year follow-up, and the percentages of peripheral blood CD3^-CD56⁺, CD3^-CD16⁺CD56⁺ and D3^-CD161⁺NK cells in patients with recurrent tumors were (21.4±2.3)%, (14.8±1.5)% and (19.4±2.6)%, all significantly lower than [(25.4±2.6)%, (17.1±1.6)% and (22.6±2.8)%, respectively, P<0.05] in patients without recurrent tumors; the percentages of peripheral blood CD3^-CD56⁺, CD3^-CD16⁺CD56⁺ and D3^-CD161⁺NK cells in 15 patients with stage Ⅲ recurrent tumors were (15.3±1.6)%, (13.2±1.5)% and (17.3±1.2)%, all significantly lower than [(20.2±1.4)%, (16.7±1.5)% and (20.4±2.5)%, respectively, P<0.05] in 21 patients with stage Ⅱ or [(23.4±2.5)%, (17.1±1.7)% and (21.4±2.4)%, respectively, P<0.05] in 17 patients with stage Ⅰ recurrent tumors. Conclusions The patients with HCC have their cellular immune function deficiency, and the percentages of peripheral blood CD3^-CD56⁺, CD3^-CD16⁺CD56⁺ and CD3^-CD161⁺NK cells increase post-operationally, which might be helpful in preventing tumor recurrence.

Objective The aim of this study was to investigate the impact of low-level viremia (LLV) on prognosis in patients with hepatitis B virus-related hepatocellular carcinoma (HCC)after transarterial chemoembolization (TACE) therapy. Methods 119 patients with HBV-related HCC were admitted to our hospital between January 2016 and December 2020, and all patients received comprehensive anti-tumor therapy based on TACE and nucleoside (acid) analogs(NAs) for antiviral therapy. All patients were followed-up to December 31,2021. Results Among the 119 patients,42(35.3%) had LLV after antiviral therapy; serum HBeAg positive rate in patients with LLV was 64.3%, significantly higher than that in the non-LLV group (27.3%, P＜0.05); at the end of 3 months after TACE treatment, the ORR in patients with LLV was significantly lower than that in the non-LLV group(33.3% vs. 58.4%, P＜0.05); 6 months after treatment, serum ALT, AST, Child-Pugh score and AFP levels in patients with LLV were 35.0(28.6,56.0)U/L, 56.0(43.6, 78.5)U/L, 7.0(6.0, 8.0) and 2732.0(85.7, 17595.0) ng/ml, significantly higher than [29.0(21.0, 43.0)U/L, 40.0(27.0,61.0)U/L, 6.0(5.0,7.0) and 22.5(5.2, 780.6)ng/ml, respectively, P＜0.05] in the non-LLV group; the 2-year survival in patients with LLV was 2.4%, significantly lower than 41.6% (P＜0. 05) in the non-LLV group; the multivariate Logistic analysis showed that with or without LLV [HR (95%CI): 2.1(1.3-3.3)], Barcelona Clinic Liver Cancer(BCLC) stage [HR(95%CI): 1.7(1.2-1.9)] and radiofrequency ablation [HR(95%CI):0.4 (0.2-0.7)] were the independent prognostic factors for patients with HBV-related HCC (P＜0.05). Conclusion Serum HBeAg positive might influence antiviral response to NAs therapy, and the LLV might impact the prognosis of patients with HBV-related HCC after TACE treatment, which warrants concerns clinically.

Objective The aim of this study was to investigate the implications of serum adenosine deaminase (ADA), α-L-fucosidase (AFU) and alpha fetoprotein-L3 levels in patients with chronic hepatitis B (CHB), liver cirrhosis (LC) and primary liver cancer (PLC). Methods 76 patients with CHB, 31 patients with LC and 29 patients with hepatitis B-associated PLC were encountered in our hospital between January 2020 and April 2022, and serum ADA level was detected by enzymatic colorimetry. Serum AFU level was assayed by special kits and serum AFP-L3 level was determined by enzyme linked immunosorbent assay. The liver biopsies were performed in all patients with CHB. The diagnostic performance was evaluated by the area under the receiver operating characteristic curve (AUC). Results Based on the liver histopathologic examination in patients with CHB, the G0, G1, G2, G3 and G4 were found in (12 cases, 18 cases, 26 cases, 16 cases and 4 cases, and the S0, S1, S2, S3 and S4 were found in 14 cases, 7 cases, 14 cases, 20 cases and 21 cases; serum ADA, AFU and AFP-L3 levels in 46 patients with G2-G4 CHB were (29.6±5.1)μ/L, (34.7±5.0)μ/L and (6.9±1.2)%, all significantly higher than [(25.4±3.9)μ/L, (29.5±5.2)μ/L and (5.8±0.8)%, respectively, P<0.05] in 30 patients with G0/G1 CHB, and serum ADA, AFU and AFP-L3 levels in 55 patients with S2-S4 CHB were (43.8±10.1)μ/L, (66.5±18.8)μ/L and (8.3±1.3)%, significantly higher than (28.1±6.0)μ/L, (33.0±8.4)μ/L and (6.4±1.1)%, P<0.05] in 21 patients with S0/S1 CHB; serum ADA, AFU and AFP-L3 levels in patients with PLC were(51.3±5.2)μ/L, (82.0±9.5)μ/L and (9.2±1.3)%, significantly higher than [(38.1±4.6)μ/L, (51.8±5.1)μ/L and (7.8±1.1)%, respectively, P<0.05] in patients with LC or [(26.5±4.6)μ/L, (30.9±5.6)μ/L and (6.1±0.8)%, respectively, P<0.05] in patients with CHB; the AUCs determined by serum AFP-L3 level were 0.857, with the sensitivity (Se) of 86.2% and the specificity of 88.8%, much superior to that by AFU(0.752, 79.3% and 77.6%, respectively) or that by ADA(0.722, 75.8% and 76.6%, respectively, P<0.05), when serum AFP-L3=7.9%, serum AFU=55.1μ/L and serum ADA=46.0μ/L were set as the cut-off-value for predicting the existence of PLC. Conclusion The diagnostic performance of serum AFP-L3 levels in predicting PLC is superior to that of serum ADA or AFU levels, which might under the circumstance of imaging help the clinicians making an appropriate decisions.

Objective The aim of this study was to explore the value of magnetic resonance imaging (MRI) as well as serum alpha fetal protein heteromorphism 3 (AFP-L3) and vascular endothelial growth factor (VEGF) levels as predictors of tumor response in patients with primary liver cancer (PLC) undergoing transcatheter hepatic artery chemoembolization (TACE). Methods 64 patients with PLC were encountered in our hospital between January 2019 and June 2020, and all patients underwent TACE and followed-up for two years. The patients were checked-up by MRI regularly after TACE, and serum AFP-L3 and VEGF levels were detected by ELISA. The routine blood examination was carried out, and the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were collected.The unconditional multivariate Logistic stepwise regression analysis was adopted, and the predictive value of serum AFP-L3, VEGF, and NLR and PLR for prognosis of patients with PLC after TACE was analyzed by receiver operating characteristic curve (ROC). Results Three months after TACE, the MRI scan showed complete remission in 28 cases(43.8%), partial remission in 16 cases (25.0%), stable disease in 12 cases (18.8%) and progressive disease in 8 cases (12.5%), with the disease control rate (DCR) of 87.5% in our series; at the end of two year follow-upperiod, 30 patients (46.9%) died; the tumor diameters, cancerous tissue necrosis, and the DCR were significantly different between deads and survivals (P＜0.05); the multivariate Logistic regression analysis showed that the continuous multi-nodular tumormargin, incomplete tumor envelope, high serum AFP-L3 and VEGF levels, and the increasedNLR and the PLR were the independent risk factors for poor prognosis in patients with PLC after TACE(P＜0.05); the sensitivities and the specificities were 69.1% and 68.2%, 88.2% and 68.2%, 73.5% and 86.4%, and 83.8%and 77.3% when serum AFP-L3 level greater than 80.9μg/mL, serum VEGF level greater than 119.9μmol/L, the NLR greater than 2.3 or the PLR greater than 13.9 were set as the cut-off-value in predicting poor prognosis in patients with PLC after TACE. Conclusion The clinicians should take risk factors for poor prognosis into considerationin in patients with PLC after TACE, and make therapy strategy carefully and appropriately, which might improve the prognosis.

Objective The aim of this study was to investigate the liver function test and hepatic blood flow parameter changes in children with benign liver diseases after living donor liver transplantation (LDLT). Methods 47 patients with benign liver diseases including congenital biliary atresia in 36 cases and glycogenosis in 11 cases, were encountered in our hospital between April 2019 and April 2022, and all underwent left-leaf LDLT. Serum total bilirubin (TBIL), albumin (ALB), international normalized ratio (INR) of prothrombin time and alanine transaminase (ALT) levels were detected routinely. The portal flow volume (PFV), portal flow index (PFI), hepatic flow volume (HFV) and hepatic flow volume index (HFI) were measured by ultrasonography. Results At presentation, serum TBIL, ALB, INR and ALT levels in our series were (226.3±35.8)μmol/L, (32.9±6.1)g/L, (1.2±0.2) and (79.8±25.1)U/L, one day after operation, they changed to (126.3±29.5)μmol/L, (30.1±5.3)g/L, (1.4±0.3) and (427.5±112.6)U/L, and they gradually returned to normal; at admission, the HFV, HFI, PFV and PFI in our series were (81.6±12.5)ml/min, (31.2±10.5) ml/min.100 g, (568.9±126.8)ml/min and (315.6±96.5)ml/min.100 g, one day after surgery, they changed to (134.7±52.8)ml/min, (58.8±24.2)ml/min.100 g, (1128.3±572.6)ml/min and (552.7±242.4)ml/min.100 g, and thereafter, they gradually returned to normal; 13 days and 15 days after operation, two children died of acute liver failure; one month after LDLT, 45 children recovered with normal liver function tests; during the follow-up period, no untoward complications of hepatic vessels was found in the survivals. Conclusion The liver function tests and hepatic vascular parameters could changes regularly, which might help judge the states of transplants, and should carefully surveyed.

Objective This study was to conducted to compare the clinical efficacy of laparoscopic hepatectomy (LH) and traditional open surgery (OS) in the treatment of patients with giant hepatic hemangioma (GHH). Methods 54 patients with GHH were encountered in our hospital between June 2012 and January 2022, and were divided into two groups, receiving LH (n=30) or traditional open surgery (n=24) treatment. The clinical data before and after operation in the two groups were compared. Results The tumor diameter, the percentages of tumors in the left, right and both lobes in LH-surgery-treated patients were (12.2±2.5)cm, 30.0%, 46.7% and 23.3%, all not significantly different compared to [(11.3±1.9)cm, 29.2%, 54.2% and 16.7%, respectively, P>0.05] in open surgery-treated patients; the intra-operational blood loss in LH-treated patients was (188.3±70.5)ml, much less than [(285.6±116.5)ml, P<0.05], while the blocking time of hilus hepatis was (26.2±10.2)min, much longer than [(15.2±9.7)min, P<0.05] in open surgery-treated patients; the drainage volume in LH-treated patients was (180.5±72.6)ml, much less than [(282.3±102.8)ml, P<0.05], the post-operational hospital stay was (8.2±2.8)days, significantly shorter than [(11.6±3.2)days, P<0.05], and serum C-reactive protein and procalcitonin levels were (31.8±14.4)mg/L and (0.1±0.1)ng/ml, significantly lower than [(56.4±20.5)mg/L and (0.2±0.1)ng/ml, respectively, P<0.05] in open surgery-treated patients. Conclusion The application of LH in the treatment of patients with GHH is safe and feasible, which might be lead to mild systemic inflammatory reactions, and relatively faster recovery after operation.

Objective The aim of this study was to explore the shortly or a little longer laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of patients with acute calculous cholecystitis (ACC). Methods 107 patients with ACC were encountered in our hospital between March 2019 and January 2022, and were divided into group A (n=51), receiving LC within two months after PTGD, and group B (n=56), receiving LC two months after PTGD. The thickness of gallbladder wall and diameter of gallbladder were detected by using color Doppler ultrasound. Serum procalcitonin (PCT) level was measured by semi-quantitative solid-phase immunoassay, and serum C-reactive protein (CRP) and norepinephrine (NE) levels were assayed by ELISA. Serum adrenocorticotropic hormone (ACTH) and cortisol (Cor) levels were detected by chemiluminescence. Results The gallbladder wall thickness before LC in group B was (3.8±0.4) mm, significantly thinner than [(4.1±0.5) mm, P<0.05] in group A; the surgical time, total hospital stay, and intraoperative blood loss in group B were(78.2±9.5)min, (7.9±1.3)d and (53.4±6.9)mL, significantly shorter or less than [(98.7±10.8)min, (10.2±2.1)d and (87.5±9.2)mL, respectively, P<0.05] in group A; after LC operation, the white blood cell counts, serum PCT and CRP levels in group B were (6.4±0.7)×10⁹/L,(0.0±0.0)ng/ml and (4.7±1.7)mg/L, all significantly lower than [(7.2±0.8)×10⁹/L,(1.3±0.2)ng/ml and (61.2±5.8)mg/L, respectively, P<0.05] in group A; 72 hours after LC, serum ACTH level in group B was (84.3±2.8)ng/L, much lower than [(110.4±4.1)ng/L, P<0.05] in group A. Conclusion The relatively late LC after PTGD in the treatment of patients with ACC might get a better efficacy, which could shorten the surgical time and relieve the postoperative inflammatory stress response.

Objective The aim of this study was to explore the efficacy of Shuli Tongxie Decoction, herbal medicine, in the treatment of patients with chronic cholecystitis (CC) and cholelithiasis after laparoscopic cholecystectomy (LC). Methods 78 patients with CC and cholelithiasis were enrolled in our hospital between May 2018 and May 2021, and were randomly divided into control group and observation group with 39 cases in each. ALL patients in the series underwent LC, and the patients in the control group were given ursodeoxycholic acid (UDCA), while those in the observation group were treated with UDCA and the herbal medicine combination for 8 weeks. Serum total bile acid (TBA), unconjugated bilirubin (UCB) and calcium ion (Ca²⁺), serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α),adrenocorticotropic hormone (ACTH), malondialdehyde (MDA), superoxide dismutase (SOD), gastrin (GAS), motilin (MOT) and vasoactive intestinal peptide (VIP) levels were routinely detected. Results At the end of the treatment, serum TBA, UCB and Ca²⁺ levels in the combination treatment group were (6.9±1.4)μmol/L, (7.4±1.1)μmol/L and (1.9±0.2) mmol/L, all significantly lower than [(10.7±1.8)μmol/L, (12.6±1.4)μmol/L and (2.2±0.3)mmol/L, respectively, P<0.05]; serum IL-6, TNF-α, ACTH and MDA levels were (4.8±2.7) ng/L, (1.4±0.2)μg/L, (31.4±3.8)ng/mL and (2.2±0.6)nmol/L, significantly lower than [(19.6±4.4)ng/L, (2.6±0.3)μg/L, (42.7±4.9)ng/mL and (4.9±0.7)nmol/L, while serum SOD level was (149.4±7.1)U/mL, significantly higher than [(96.6±6.7)U/mL, P<0.05] in the control; serum GAS and MOT levels were (103.9±7.9)ng/L and (280.5±13.3)ng/L, both much higher than [(93.6±8.1)ng/L and (243.6±14.6)ng/L, P<0.05], while serum VIP level was (35.9±5.3)pg/mL, much lower than [(49.1±5.7)pg/mL, P<0.05] in the control; six months after operation, the stone relapsed in one case in the combination group, and that was three cases in the control (P>0.05). Conclusion The oral administration of herbal medicine, Shuli Tongxie Decoction, after LC in preventing stone relapse might be helpful, and needs further clinical investigation.

Objective The aim of this study was to investigate the immediate laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in treatment of patients with simultaneous cholecystolithiasis and choledocholithiasis. Methods 73 patients with simultaneous cholecystolithiasis and choledocholithiasis were encountered in our hospital between September 2017 and September 2021, and were randomly divided into observation (n=39) and control (n=34) groups. The patients in the observation group received LC and immediate LCBDE, and those in the control received endoscopic sphincterotomy (EST) followed by LC three days later. All patients were followed-up for 12 months after surgery. The pain was evaluated by visual analogue scale (VAS) and serum C-reactive protein (CRP) level was detected by ELISA. The peripheral blood white blood cell (WBC) counts and the percentages of neutrophil cells (NEUT) were routinely obtained. Results There was no significant difference in stone residual rate between the two groups (5.1% vs. 2.9%, P>0.05); the operation time in the observation group was significantly longer than that in the control group [(140.1±35.2) min vs. (119.7±30.4)min, P<0.05], while the hospitalization time was significantly shorter than that in the control group [(10.9±2.1)d vs. (14.5±2.6)d, P<0.05], the VAS score was significantly lower than that in the control group [(2.3±0.4) vs. (3.1±0.7), P<0.05], and the percentages of persistent analgesia pump needed was significantly lower than that in the control group (35.9% vs. 61.8%, P<0.05); at day 5 after surgery, serum CRP level in the observation was(71.5±16.1)mg/L, much lower than [(90.1±20.4) mg/L, P＜0.05], the WBC count was (9.3±1.4)×10⁹/L, much lower than [(11.3±1.8)×10⁹/L, P＜0.05], and the percentage of NEUT cells was (74.5±6.9)%, much lower than [(82.9±7.5)%, P＜0.05] in the control; the incidences of post-operational complications, such as infection, bleeding, pancreatitis, bile leakage and reflux cholangitis in the observation was 18.0%, much lower than 38.2%(P＜0.05) in the control; at the end of 12 month follow-up, there was no significant difference in the recurrence rate of stones between the two groups (5.1% vs. 8.8%, P>0.05). Conclusion The LC and immediate LCBDE in the treatment of patients with simultaneous cholecystolithiasis and choledocholithiasis could shorten hospital stay times, with reduced post-operational complications.

Objective The aim of this study was to compare the advantages of gallbladder posterior triangle approach (GPTA) to triangle approach (TA) during laparoscopic cholecystectomy (LC) in treatment of patients with gallbladder stones and chronic cholecystitis (CC). Methods 62 patients with gallbladder stones and CC were admitted to our hospital between January 2018 and December 2022, and were randomly divided into observation and control group, with 31 cases in each group. The patients in the observation received LC through GPTA, and those through TA. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8) levels were detected by ELISA, and the percentages of peripheral blood lymphocyte subsets were detected by flow cytometry. Results The operation time, intraoperative blood loss, recovery time of gastrointestinal functions and post-operational hospitalization stay in the observation group were(27.5±2.4)min, (27.8±4.3)mL, (20.4±3.2)h and (3.9±0.9)d, all significantly less or shorter than [(32.9±3.8)min, (40.6±6.5)mL, (27.9±4.5)h and (6.2±1.5)d, respectively, P＜0.05] in the control; at day three post-operationally, serum CRP, TNF-α and IL-8 levels in the observation group were (32.7±2.5)mg/L,(16.4±2.6)ng/L and (11.2±2.5)ng/L, all much lower than [(44.5±3.9)mg/L, (20.6±2.9)ng/L and (16.8±2.7)ng/L, respectively, P＜0.05] in the control; the percentages of peripheral blood CD4⁺ and CD8⁺ cells as well as the CD4⁺/CD8⁺ cell ratio in the observation were (50.6±2.3)%,(25.6±3.7)% and (1.9±0.6), not significantly different compared to [(51.2±2.7)%, (26.1±3.4)% and (1.9±0.8)] in the control group (P>0.05); post-operationally, the incidences of complications, such as bile leak and/or bile duct injury, in the observation group was 9.7%, much lower than 32.3%(P＜0.05) in the control. Conclusion The GPTA during LC in treatment of patients with cholecystolithiasis and CC is superior to TA, which might be related to relatively easy manipulation and less complications.

Objective The aim of this study was to observe the efficacy of Roux-en-Y cholangiojejunostomy and subcutaneous buried blind jejunal loop in the treatment of patients with hepatolithiasis. Methods A total of 165 patients with hepatolithiasis were admitted to our hospital between January 2012 and June 2021, and the Roux-en-Y cholangiojejunostomy was performed in 89 cases and the Roux-en-Y cholangiojejunostomy and subcutaneous buried blind jejunal loop was done in 76 cases. Plasma cortisol (COR) level was detected by ELISA, and the peripheral blood T lymphocyte subsets were measured by flow cytometry. Results The operation time in the combination surgery group was (258.5±36.7) min, much longer than [(221.1±32.5)min, P<0.05] in the anastomosis group, while there were no significant differences as respect to the intraoperative blood loss, postoperative exhaust time and hospital stay between the two groups [(270.4±51.4)ml, (3.9±0.7)d and (8.0±1.4) d vs.(278.4±52.3)ml, (3.8±0.7)d and (7.3±0.7)d, respectively, P>0.05]; one week after the operation, serum bilirubin, ALT, GGT and COR levels in the combination group were (16.5±3.8)μmol/L, (54.4±14.1)g/L, (184.3±34.2)U/L and (241.7±43.5)nmol/L, not significantly different compared to [(13.2±4.0)μmol/L, (49.6±12.4)g/L, (179.5±32.5)U/L and (242.7±44.0)nmol/L, respectively, P>0.05] in the control; the percentages of peripheral blood CD3⁺ anc CD4⁺ cells as well as the ratio of CD4⁺/CD8⁺ cells were (58.2±6.5)%, (37.2±4.3)% and (1.2±0.2), not significantly different as compared to [(57.2±6.2)%, (36.4±4.3)% and (1.2±0.3), respectively, P>0.05] in the control group; the incidence of bile leakage in the combination surgery group was 1.3%, much lower than 10.1%(P<0.05) in the control; one year after the operation, the recurrence rate of stone in the control group was 10.1%, and that was 7.9%(P>0.05) in the combination surgery group, and the stone was successfully removed by through the buried blind jejunal loop. Conclusion The Roux-en-Y choledochojejunostomy and subcutaneous buried blind jejunal loop is efficacious in the treatment of patients with hepatolithiasis, which might be convenient for repeated removal of residual stones and recurrent stones.

Objective The aim of this study was to investigate the implication of liver tissue matrix metalloproteinase-2 (MMP-2) and transforming growth factor-β1 (TGF-β1) expression in children with biliary atresia (BA). Methods 49 children with BA and 44 children with choledochal cyst (CCC) were admitted to our hospital between April 2017 and April 2020, and all the children with BA or with CCC underwent Kasai surgery. All the children were followed-up for 2 years. The hepatic MMP-2 and TGF-β1 expression was detected by SP immunohistochemical staining. The Kaplan-Meier was applied to compare the prognosis of children with BA. Results The relative hepatic expression of MMP-2 and TGF-β1 in children with BA were (0.3±0.1) and (3.3±0.5), significantly stronger than [(0.1±0.0) and (1.1±0.2),respectively, P<0.05] in children with CCC; the strong positive rate of hepatic MMP-2 in 8 children with liver fibrosis stage Ⅳ was 62.5% and in another 8 children with stage Ⅲ was also 62.5%, both significantly higher than 14.3% in children with stage Ⅰ or 15.8%(P＜0.05) in children with stage Ⅱ; the strong positive rate of hepatic TGF-β1 in children with stage Ⅳ was 87.5%, and in children with stage Ⅲ was 62.5%, both much higher than 0.0% in with stage Ⅰ or 0.0%(P＜0.05) in with stage Ⅱ; 4 children lost visit at the end of two year follow-up, and 19 children (42.2%)survived in our series; the survival rate in children with weak hepatic MMP-2 positive was 75.0%(9/12), in children with moderate MMP-2 positive was 47.4%(9/19), and in with strong MMP-2 positive was 7.1%(1/14); the survival in children with weak hepatic TGF-β1 positive was 86.7%(13/15), in with moderate TGF-β1 positive was 22.2%(4/18), and in with strong TGF-β1 positive was 16.7%(2/12), suggesting that the survival in child with weak hepatic MMP-2 and TGF-β1 expression was significantly higher than in those with strong expression (Kaplan-Meier analysis, x²=15.357, P=0.000; x²=14.704, P=0.001). Conclusion The expression of MMP-2 and TGF-β1 in liver tissues of children with BA is highly correlated to liver fibrosis, and the children with strong MMP-2 and TGF-β1 expression might have a poor prognosis, which warrants further investigation.

Objective The aim of this study was to summarize the ultrasound imaging features of benign and malignant gallbladder space-occupying lesions. Methods A total of 120 patients with gallbladder space-occupying lesions were encountered in our hospital between June 2020 and June 2022, and all patients underwent color Doppler ultrasonography to measure the maximum velocity (Vmax) and resistance index (RI) of vessels inside the lesions. The laparoscopic cholecystectomy (LC) was performed in all patients and the diagnosis was proven by histopathological examination after operation. Results The postoperative histopathological examinations showed that out of the 120 patients with gallbladder space-occupying lesions, there were 78 cases (65.0%)with benign lesions, including gallbladder polyps in 37 cases, gallbladder adenoma in 23 cases and gallbladder adenomyosis in 18 cases , and gallbladder adenocarcinoma in 42 cases (35.0%) ; the lesion size, Vmax and RI in patients with benign lesions were (1.3±0.3)cm, (19.2±3.8) cm/s and (0.5±0.1), significantly less than [(3.2±0.6)cm, (42.4±8.1)cm/s and (0.8±0.2), respectively, P<0.05] in malignant lesions, and the percentages of wide base, clear boundary with cyst walls and branch vessels with blood flow in benign lesions were 26.9%, 93.6% and 9.0%, significantly different compared to 100.0%, 7.1% and 66.7% (P<0.05) in malignant lesions; the percentage of Adler's blood flow grade 2/3 accounted for 7.7% in benign lesions, much lower than 88.1% in malignant lesions (P＜0.05). Conclusion The ultrasound imaging features are different between benign and malignant gallbladder space-occupying lesions, which could guide the clinicians to make the correct diagnosis.

Objective Most patients with liver cirrhosis (LC) have a certain degree of malnutrition, mainly protein-calorie malnutrition. The portal hypertension in patients with LC can lead to gastrointestinal congestion and edema, ascites, overgrowth of intestinal bacteria, gastrointestinal bleeding, secondary infections, and other complications, resulting in reduced intake, absorption disorders and excessive loss of nutrients. It can also lead to metabolic disorders, with increased incidence of complications and risk of death. Therefore, nutritional support should be take into consideration during the treatment of patients with LC. In this article, we mainly focuses on the nutritional evaluation and diet management for them.

Objective Liver failure (LF) is a serious syndrome with liver function, such as synthesis, detoxification, metabolism and biotransformation damages, caused by various factors. The causes of LF are diverse, the prognosis is extremely poor, and the mortality rate is extremely high. How to evaluate the severity of liver failure objectively and provide a timely and appropriate treatment plan for patients with LF is very important. The pathogenesis of LF is complicated, the disease progresses rapidly, and there are many factors affecting its prognosis. At present, the research on the prognosis has become a hot spot. In addition to the MELD score, CTP score, SOFA score, etc., many prognostic evaluation systems and new prognostic markers have been discovered. In this article, we provide a review of models and scores for prognostic evaluation of patients with LF.