Objective This study aimed to explore the mechanism of miR-556-3p in the development of hepatocellular carcinogenesis. Methods The miR-556-3p level in cancerous and its adjacent non-cancerous tissues from patients with hepatocellular carcinoma was detected by real-time fluorescence quantitative PCR, and the phosphatase and tensin homolog (PTEN) expression was revealed by immunohistochemistry. The expression patterns of PTEN/ protein kinase B(Akt) signaling pathway-related proteins were detected by Western blotting after transfection of HepG2 cells with miR-556-3p mimic, miR-556-3p NC, PTEN cDNA and PTEN siRNA. The proliferation ability of HepG2 cells was studied by CCK-8 method, the invasion ability of cells was determined by Transwell method, and the apoptosis was detected by flow cytometry. The regulatory roles of miR-556-3p on PTEN/AKT pathway in HepG2 cells were evaluated by bioinformatics. Results The miR-556-3p loads in cancerous tissues was significantly lower than that in para-neoplastic tissues (P<0.05), and the miR-556-3p loads in HepG2 cells was also significantly lower than that in LO2 cells (P<0.05); the luciferase analysis showed that PTEN was a direct target of miR-556-3p; the proliferation rate, invasion rate and apoptosis rate in miR-556-3p-transfected HepG2 cells decreased significantly than in miR NC-transfected cells (P<0.05); the PTEN overexpression reversed the growth inhibition and apoptosis induction of miR-556-3p in HepG2 cells; the miR-556-3p inhibited PTEN/AKT activation by targeting PTEN. Conclusions The miR-556-3p loads decrease in hepatocellular carcinoma tissues, and the miR-556-3p inhibits the proliferation and invasion, and induce apoptosis in HepG2 cells. The PTEN is regulated by miR-556-3p in HepG2 cells. These findings above suggest that miR-556-3p is closely related to the transformation of liver cells, which needs further verification.

Objective This study was conducted to observe the virologic and biochemical response to entecavir and interferon-α(IFN-α) combination therapy in patients with chronic hepatitis B (CHB). Methods 69 patients with CHB were enrolled in our hospital between May 2019 and March 2022, and they were divided randomly into group A (n=35) and group B (n=34), receiving entecavir and FN-α combination or entecavir alone therapy for 12 months. Serum HBV DNA loads were detected by fluorescence quantitative PCR, and serum hyaluronic acid (HA), laminin (LN), collagen IV (CIV) and procollagen III (PIIIP) levels were detected by radioimmunoassay. Serum human pygopus homolog 2 (Pygo2), nuclear transcription factor κB (NF-κB), transforming growth factor-β (TGF-β), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were detected by enzyme-linked immunosorbent assay. Results At the end of six and twelve month treatment, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) normalization rates in group A were 88.6% and 94.3%, both significantly higher than 67.6% and 73.5%(P＜0.05) in group B, while there was no significant difference as respect to serum HBV DNA loss (91.4% vs. 91.2, and 97.1% vs. 91.2%, respectively, P>0.05) between the two groups; at the end of twelve month treatment, serum ALT and AST levels in group A were (51.4±6.4)U/L and (47.5±5.2)U/L, significantly lower than [(67.7±7.4)U/L and (61.9±6.7)U/L, respectively, P＜0.05] in group B; serum HA and PC-Ⅲ levels in group A were (93.9±21.4)ng/mL and (87.3±15.8)ng/mL, significantly lower than [(125.3±24.3)ng/mL and (108.9±14.7) ng/mL, respectively, P＜0.05] in group B; serum NF-kB, TGF-β and Pygo2 levels in group A were (1.1±0.3)pg/mL, (3.4±1.1)pg/mL and (41.9±4.6)μg/L, all significantly lower than [(1.6±0.4)pg/mL,(4.3±1.3)pg/mL and (54.6±5.2)μg/L, respectively, P<0.05] in group B. Conclusion In clinical practice, the combination of entecavir and IFN-α treatment in dealing with patients with CHB could alleviate liver function injury, decrease serum liver fibrosis index and reduce inflammatory reaction, and have a good short-term efficacy.

Objective The aim of this study was to compare the antiviral efficacy of tenofovir amibufenamide to tenofovir disoproxil fumarate (TDF) in the treatment of patients with chronic hepatitis B (CHB). Methods 62 patients with CHB were enrolled in our hospital between August 2021 and February 2022, and were randomly divided into group A and group B, with 31 cases in each group, receiving tenofovir amibufenamide or TDF for 48 weeks. Serum HBV DNA loads were detected by real-time fluorescence quantitative PCR, serum HBsAg and HBeAg levels were detected by ELISA, and blood routine and serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were obtained to calculate fibrosis index based on 4 factor (FIB-4) and estimated glomerular filtration rate (eGFR). The liver stiffness measurement (LSM) was determined by liver transient elastography. Results At 24 weeks of treatment, serum ALT, AST levels and serum HBV DNA load in group A were (64.3±13.6)IU/L, (61.5±4.0)IU/L and (1.2±0.2)Ig IU/mL, and at the end of 48 week treatment, they were (40.1±3.8)IU/L, (39.4±3.3)IU/L and (0.9±0.2)In IU/mL, all not significantly different compared to [(67.2±3.8)IU/L, (65.3±4.2)IU/L and (1.2±0.3)Ig IU/mL, and (38.4±4.1)IU/L, (42.8±3.9)IU/L and (0.9±0.2)Ig IU/mL, respectively, P<0.05] in group B; the LSM, FIB-4 and eGFR in group A were (7.1±1.7)kPa, (2.0±0.4) and (101.3±7.9)mL/min/1.73 m², and (7.2±1.5)kPa, (1.6±0.3) and (100.9±8.2)mL/min/1.73 m², and they were (7.3±1.6)kPa, (2.2±0.5) and (95.6±8.0)mL/min/1.73 m²(P<0.05), and (7.1±1.6)kPa, (1.6±0.4) and (94.0±7.6)mL/min/1.73 m²(P<0.05), not but eGFR, significantly different compared to in group B. Conclusion The oral administration of tenofovir amibufenamide in the treatment of patients with CHB could obtain the same good antiviral efficacy, but might has less untoward impact on renal functions, and warrants further clinical investigation.

Objective The aim of this study was to investigate the efficacy of entecavir in treatment of patients with chronic hepatitis B (CHB) and concomitant non-alcoholic fatty liver diseases (NAFLD). Methods 63 patients with CHB and 43 patients with CHB and NAFLD were recruited in this study between June 2019 and August 2021, and all patients received entecavir for anti-viral treatment for 12 months. The controlled attenuation parameter (CAP) of livers was detected byFibroscan-502. Serum HBV DNA loads were detected by fluorescence quantitative polymerase chain reaction. Serum alanine aminotransferase (ALT) levels were determined by automatic biochemical analyzer. Serum HBeAg and HBsAg were assayed by chemiluminescence method. Serum reactive oxide (ROS), adiponectin (ADPN) and tumor necrosis factor-α (TNF-α) levels were determined by ELISA. Results At the end of 6 month and 12 month anti-viral treatment, serum ALT normalization rates in patients with CHB were 69.8% and 92.1%, both significantly higher than 41.9% and 74.4% (P<0.05) in patients with CHB and NAFLD, while there were no significant differences respect to serum HBV DNA loss in the two groups (88.9% and 98.4% vs. 81.4% and 93.0%, respectively, P>0.05); at the end of 12 month treatment, serum ALT level in patients with CHB was (41.9±6.5)U/L, much lower than [(71.5±8.4)U/L, P<0.05] in patients with CHB and NAFLD, and the CAP of liver was (211.8±50.1)dB/m, much lower than [(288.0±13.4)dB/m, P<0.05] in patients with CHB and NAFLD; serum ROS and TNF-α levels in patients with CHB were (403.6±70.2)U/mL and (15.5±5.6)ng/L, both significantly lower than [(628.7±67.5)U/mL and (31.7±6.0)ng/L, respectively, P<0.05], while serum ADPN level was (17.7±1.2)ng/mL, much higher than [(11.5±1.8)ng/mL, P<0.05] in patients with CHB and NAFLD. Conclusion The existence of hepatic steatosis in patient with CHB and NAFLD might reduce the biochemical response to entecavir anti-viral therapy, which needs further investigation when the antiviral regimen is made in this setting.

Objective This study was conducted to report the 120-week prognosis of serum HBsAg positive patients with chronic renal failure (CRF) after renal transplantation (RT). Methods The clinical data of 69 patients with serum HBsAg positive and CRF were retrieved. The patients were encountered in our hospital between January 2018 and September 2021, and all underwent RT, 26 of whom receiving liver from serum HBsAg positive donors, and followed-up for 196 weeks (with mean of 120 weeks). After RT, all patients took entecavir for antiviral treatment and standardized immunosuppression therapy. Results The incidence of delayed graft function recovery (DGF) occurred in 3 cases(4.4%) after RT in our series, and at the end of follow-up, 67 patients (97.1%) survived; at follow-up 24 week, 48 week, 96 week and 168 week, there were no significant differences as respect to serum ALT, AST and creatinine levels between 26 patients receiving livers from serum HBsAg positive and 43 patients receiving liver from serum HBsAg negative donors, or between 17 recipients with baseline serum HBV DNA positive and 52 recipients with HBV DNA negative (P＞0.05). Conclusion Under the protection of regular antiviral therapy, the recipients with serum HBsAg-positive might survive long-termly with relatively normal liver and renal function tests, even with livers from serum HBsAg-positive donors. The baseline serum HBV DNA loads of the recipients, the donor's serum HBsAg status, and the immunosuppressants administered after RT might not impact the outcomes of recipients in this setting.

Objective This clinical trial was conducted to evaluate the efficacy and safety of glecaprevir/pibrentasvir in treatment of patients with HCV mono-infection and HIV/HCV co-infection. Methods 25 patients with hepatitis C virus infection, including chronic hepatitis C (CHC) in 22 cases and compensated liver cirrhosis (CLC) in 3 cases, and 27 patients with HIV and HCV co-infection, including CHC in 25 cases and CLC in 2 cases, were enrolled in this study between April 2021 and December 2021, and all received glecaprevir/pibrentasvir antiviral therapy for eight to twelve weeks. All patients were followed-up for 12 weeks. Results The percentages of intravenous drug users in the two groups were 60.0% and 63.0%; the sustained virological response (SVR) at 12 weeks after treatment(SVR 12) in patients with HCV infection was 92.0%, not significantly different compared to 88.9% (P=1.000) in patients with HIV/HCV co-infection; the glecaprevir/pibrentasvir therapy was well tolerated in the two groups, and there was no severe adverse events leading to the adjustment or suspension of the anti-viral therapy regimen. Conclusion The administration of glecaprevir/pibrentasvir anti-viral therapy has a promising short-term efficacy and safety in the treatment of patients with HCV mono-infection and HIV/HCV co-infection.

Objective The aim of this study was to investigate the efficacy of triglyceride glucose index (TyG)in predicting severity of patients with non-alcoholic fatty liver diseases(NAFLD). Methods 44913 individuals who participated in health examinations at the Health Management Center, Hunan Provincial People's Hospital between January 2020 and December 2022 were enrolled. The diagnosis of NAFLD was made by ultrasonography, and the TyG index was calculated according to literature report. The univariate and multivariate Logistic regression analysis were applied to reveal the risk factors, and the area under receiver operating characteristic curve(AUC) was used to predict the diagnostic efficacy. Results Out of our 44913 participants, there were 15901 patients (35.4%) with NAFLD confirmed; the age, BMI, systolic blood pressure, diastolic blood pressure, serum triglyceride(TG), low density cholesterol(LDL-C), total cholesterol(TC), fasting plasma glucose(FPG), ALT levels and TyG index in patients with NAFLD were(45.9±13.6)years old, (26.5±3.0)kg/m², (129.9±15.9)mm Hg, (78.7±11.2)mm Hg, (2.5±2.4)mmol/L, (3.2±0.9)mmol/L, (5.2±1.0)mmol/L, (5.7±1.6)mmol/L, (38.6±36.1)U/L and (9.1±0.7), all significantly higher than [(40.9±13.8)years old, (22.3±2.7)kg/m², (119.0±15.9)mm Hg, (70.7±10.4)mm Hg, (1.3±1.0)mmol/L, (3.0±0.8)mmol/L, (4.9±0.9)mmol/L, (5.2±0.9)mmol/L, (21.0±19.4)U/L and (8.4±0.5), respectively, P＜0.001], while serum high density cholesterol(HDL-C) levels was (1.1±0.2)mmol/L, significantly lower than [(1.3±1.0)mmol/L, P＜0.001] in individuals without NAFLD; in patients with NAFLD, the systolic blood pressure,diastolic blood pressure,TG,ALT and TyG index in obese group were (133.3±15.3)mm Hg,(82.0±11.3)mm Hg,(2.7±2.5)mmol/L,(46.2±31.5)U/L and (9.2±0.7),all significantly higher than [(129.5±15.7)mm Hg, (78.2±10.9)mm Hg, (2.5±2.4)mmol/L, (37.7±41.0)U/L and (9.1±0.6), P＜0.05] in overweight group and [(125.9±16.4)mm Hg, (74.9±10.7)mm Hg, (2.2±2.3)mmol/L, (30.0±22.2)U/L and (9.0±0.6), P＜0.05] in normal body weight group; the age and serum HDL-C level in the obese group were (42.9±12.8)years old and (1.0±0.2)mmol/L,significantly lower than [(46.6±13.6)years old and (1.1±0.2)mmol/L,P＜0.05] in the overweight group and [(48.3±13.9)years old and (1.2±0.3)mmol/L,P＜0.05] in the normal body weight group; the systolic blood pressure,diastolic blood pressure,blood TG,ALT and TyG index in the overweight group were significantly higher than in the normal body weight group(P＜0.05),and the age and blood HDL-C level in the overweight group were significantly lower than in the normal body weitht group(P＜0.05); the FPG in the obese group was (5.8±1.6)mmol/L,significantly higher than [(5.7±1.5)mmol/L, P＜0.05] in the overweight group; the multivariate Logistic regression analysis showed that the older age, increased BMI, diastolic blood pressure, serum TG, FPG, TyG index, ALT and reduced HDL-C levels were the independent risk factors for NAFLD(P＜0.05), the OR= 1.023, 1.521, 1.014, 0.873, 0.972, 3.992, 1.019 and 0.404, respectively,with the TyG index having the highest OR value; the area under the ROC curve(AUC) by the TyG index for predicting NAFLD was 0.814[95%CI(0.810-0.817), P＜0.001], with an optimal cut-off value of 8.67, the sensitivity of 76.1%, and the specificity of 71.4%, respectively; the AUC by the TyG index combined with BMI and ALT in predicting NAFLD was 0.899[95%CI(0.896-0.901), P＜0.001]. Conclusion The TyG index is an independent risk factor for NAFLD,which has good predictive efficacy for NAFLD,and the predictive performance is enhanced when it combine with BMI and ALT levels. The TyG index might helpful for early diagnosis of NAFLD in outpatient and grassroots hospitals as it is economical,practical,and easy to calculate.

Objective The aim of this study was to investigate the diagnosis of coronary atherosclerotic heart disease (CHD) in patients with nonalcoholic fatty liver disease (NAFLD) by coronary artery CT angiography (CCTA) and ¹⁸F-FDG positron emission computed tomography (PET/CT). Methods 120 patients with NAFLD were recruited in our hospital between January 2020 and December 2021, and all underwent CCTA and PET/CT scan. The myocardial and liver standard uptake values (SUV) were obtained and recorded as SUVmyo, SUVliv and SUVmyo/SUVliv ratio(SUVratio). Results Out of the 120 patients with NAFLD, the CCTA found CHD in 28 cases (23.3%); the body mass index, fasting blood glucose, total cholesterol and triglyceride levels in patients with NAFLD and CHD were(28.6±2.2)kg/m²,(6.9±2.1)mmol/L, (6.3±0.9)mmol/L and (3.7±0.4)mmol/L, all significantly higher than[(25.1±2.3)kg/m², (5.2±1.5)mmol/L, (4.4±0.5)mmol/L and (1.6±0.2)mmol/L, P<0.05], and the concomitant proportions of metabolic syndrome, hypertension and diabetes were 28.6%, 32.1% and 28.6%, all much higher than 2.1%, 10.8% and 4.3%(P<0.05) in patients with NAFLD; the CCTA scan showed the non-calcified plaque and non-calcified plaque stenosis in coronary arteries in patients with CHD were 28.6% and 25.0%, both much higher than 4.3% and 2.2%(P<0.05) in patients with NAFLD; the ¹⁸F-FDG PET/CT scan demonstrated that the SUVmyo and the SUVratio in patients with CHD were (3.8±1.1) and (1.6±0.3), both significantly lower than[(6.8±1.6) and (3.1±0.9), respectively, P<0.05] in patients with NAFLD alone. Conclusion The screening of CHD in patients with NAFLD by CCTA and PET/CT scan is convenient and safe, which might be verified by coronary angiography.

Objective The study was conducted to assess the prediction of non-alcoholic fatty liver diseases (NAFLD) in patients with type 2 diabetes mellitus (T2DM) by neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte ratio(PLR) . Methods 110 patients with T2DM and 121 patients with T2DM and NAFLD were included in the Department of Endocrinology, Second Provincial People's Hospital between January 2021 and October 2022, and the NAFLD was proven by ultrasonography. The blood routine was checked-up. The risk factors of T2DM with NAFLD were assessed by multivariate Logistic analysis, and predictive efficacy was evaluated by ROC curve. Results The body mass index in patients with T2DM and concomitant NAFLD was (25.4±3.5)kg/m², much greater than [(23.2±3.1)kg/m², P<0.05], while the course of disease was 5.0(2.0, 8.0)yr, significantly shorter than [8.0(3.0, 13.0)yr, P<0.05] in patients with T2DM; serum alanine aminotransferase, aspartate aminotransferase, glutamyl transpeptidase, uric acid, triglyceride and total cholesterol levels in patients with T2DM and NAFLD were all significantly greater than in patients with T2DM, while serum high density lipoprotein cholesterol level was much lower than in patients with T2DM (P＜0.05); the blood lymphocyte count in patients with T2DM and NAFLD was (1.7±0.4)×10⁹/L, much lower than [(2.2±0.6)×10⁹/L, P<0.05], while the NLR and PLR were (2.4(1.8, 3.2)) and (126.1(93.3, 157.8)), both significantly greater than [1.5(1.2, 2.3) and 89.6(66.9, 116.5), respectively, P<0.05] in patients with T2DM; the Logistic analysis showed that the BMI, NLR and PLR were the risk factors for coincidence of NAFLD in patients with T2DM (P＜0.05); the ROC analysis demonstrated that the sensitivities and the specificities by NLR and PLR in prediction of NAFLD in patients with T2DM were 64.5% and 75.0%, and 71.9% and 65.4%, respectively. Conclusion The surveillance of NLR and PLR, easily accessible, in patients with T2DM might help screen preliminarily NAFLD, and warrants further clinical investigation.

Objective The purpose of this study was to explore the changes of intestinal flora as well as serum interleukin-17 (IL-17) and interferon-gamma (INF-γ) levels in patients with nonalcoholic fatty liver diseases (NAFLD). Methods 102 patients with NAFLD, including simple fatty liver (SFL) in 64 cases and non-alcoholic steatohepatitis (NASH) in 38 cases, and 48 healthy individuals were encountered in our hospital between January 2019 and January 2022. The intestinal flora and serum IL-17 and INF-γ levels were determined and compared. Results The fecal lactobacilli, bifidobacteria numbers and the bifidobacteria/ enterococcus (B/E) ratio in patients with NAFLD were (8.9±0.3)lg CFU/g,(8.6±0.3)lg CFU/g and (0.9±0.2), all significantly lower than [(9.9±0.4)lg CFU/g, (9.7±0.4)lg CFU/g and (1.1±0.3), respectively, P<0.05], while the fecal enterococcus and enterobacter numbers were (8.2±0.3)lg CFU/g and (9.3±0.4)lg CFU/g, both significantly higher than [(7.4±0.2)lg CFU/g and (8.4±0.3)lg CFU/g, respectively, P<0.05] in healthy persons; serum INF-γ level was (172.6±28.7)ng/L, much lower than [(293.7±48.5)ng/L, P<0.05], while serum IL-17 level was (46.9±8.2)ng/L, much higher than [(13.0±2.4)ng/L, P<0.05] in healthy individuals; the fecal lactobacilli, bifidobacteria numbers and the B/E ratio in patients with NASH were (8.2±0.3)lg CFU/g,(7.9±0.3)lg CFU/g and (0.9±0.2), all significantly lower than [(9.3±0.4)lg CFU/g, (8.9±0.4)lg CFU/g and (1.1±0.3), respectively, P<0.05], while the fecal enterococcus and enterobacter numbers were(8.6±0.3)lg CFU/g and (9.5±0.4)lg CFU/g, both significantly higher than [(7.7±0.2)lg CFU/g and (8.4±0.3)lg CFU/g, respectively, P<0.05] in patients with SFL; serum IL-17 level was (55.4±9.7)ng/L, much higher than [(41.3±7.2)ng/L, P<0.05], while serum INF-γ level was (146.9±21.6)ng/L, much lower than [(212.6±36.4)ng/L, P<0.05] in patients with SFL. Conclusion The intestinal flora, and serum IL-17 and INF-γ levels change abnormally in patients with NAFLD, which might be related to the liver injury, and needs further investigation.

Objective The aim of this study was to investigate the combination therapy of reduced glutathione and herbal medicine compound, Hugan Qingzhi tablet in treatment of patients with non-alcoholic fatty liver diseases (NAFLD). Methods 61 patients with NAFLD were admitted to our hospital between February 2020 and February 2022, and were randomly divided into control (n=30) and observation group (n=31), receiving reduced glutathione or reduced glutathione and herbal medicine compound, Hugan Qingzhi tablets therapy for six months. The TCM symptoms were evaluated based on Chinese literature, and serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-8, high sensitivity C-reactive protein (hs-CRP), serine protease inhibitor (vaspin), soluble leukocyte differentiation antigen 163 (sCD163), fibroblast growth factor-21 (FGF21), plasminogen activator inhibitor-1 (PAI-1) and adiponectin (APN) levels were detected by ELISA. Results At the end of six month treatment, the mental fatigue, abdominal distension, right epigastric region discomfort, unsmooth defecation, dark urine, overweight, yallow complexion and tastelessness scores in observation group were(0.6±0.1), (0.9±0.1), (0.8±0.1), (0.6±0.1), (0.8±0.1), (0.8±0.1),(0.7±0.1) and (1.2±0.2), significantly lower than [(1.2±0.1),(1.4±0.2),(1.6±0.2), (1.1±0.1), (1.4±0.2),(1.6±0.2),(1.1±0.2) and (1.9±0.3), P＜0.05] in the control; serum TNF-α, IL-6, IL-8 and hs-CRP levels (20.3±4.1)ng/L, (22.9±3.4)mg/L, (132.9±16.6)ng/L and (12.5±2.1)mg/L, all much lower than [(27.9±3.6)ng/L,(27.5±3.1)mg/L,(167.5±18.2)ng/L and (16.5±2.7)mg/L, P＜0.05] in the control; plasma total cholesterol, triglyceride and low-density lipoprotein cholesterol levels were (4.2±0.4)mmol/L,(1.5±0.2)mmol/L and (2.3±0.4)mmol/L, much lower than [(6.3±0.5)mmol/L, (2.9±0.3)mmol/L and (3.1±0.4)mmol/L, P＜0.05] in the control; serum vaspin, PAI-1 and FGF21 levels sere (1.1±0.2)μg/L, (8.2±1.6)ng/mL and (143.5±16.8)pg/mL, much lower than [(1.5±0.2)μg/L, (10.4±2.3)ng/mL and (181.6±19.7)pg/mL, P＜0.05], while serum APN and sCD163 levels were (15.7±2.4)μg/mL and (76.8±9.1)ng/mL, much higher than [(12.1±3.5)μg/mL and (62.3±7.4)ng/mL, respectively, P＜0.05] in the control. Conclusion The combination of reduced glutathione and herbal medicine compound in treatment of patients with NAFLD could greatly ameliorate TCM symptoms and decrease blood lipid levels, which needs further clinical investigation.

Objective The aim of this study was to investigate the reasons of failed alcohol abstinence in patients with alcoholic liver diseases (ALD). Methods A total of 149 male patients with ALD or ALD with concomitant other liver diseases were admitted to our hospital between February 2021 and June 2022, and all were persuaded and encouraged for alcohol abstinence at first visit. The alcoholic behavior was evaluated by alcohol use disorders identification test (AUDIT), and the univariate and multivariate Logistic analysis was conducted for the factors of alcohol abstinence failure. Results The patients in our series included ALD in 88 cases, with concomitant chronic hepatitis B in 49 cases and with other liver diseases in 12 cases, characterized by mild liver disease in 27 cases, fatty liver in 36 cases, alcoholic hepatitis in 14 cases and liver cirrhosis (LC) or primary liver cancer (PLC) in 72 cases; at the end of three-month of follow-up, the alcohol abstinence failed in 53 cases (35.6%) and succeeded in 96 cases (64.4%); the ages, and the percentages of alcohol abuse longer than 30 yr, with concomitant other liver diseases and alcohol dependence in succeeded patients were (54.8±11.3)yr, 56.3%, 50.0% and 16.7%, significantly different compared to [(49.6±11.5)yr, 28.3%, 24.5% and 60.4%] in failed patients (P＜0.05); the percentages of mild liver diseases, fatty liver, alcoholic hepatitis and LC/PLC in succeeded patients were 17.7%, 15.6%, 6.3% and 60.4%, significantly different compared to 18.9%, 39.6%, 15.1% and 26.4% in failed patients (P＜0.05); the multivariate Logistic analysis showed that the alcohol dependence, simple ALD, mild liver diseases, fatty liver and alcoholic hepatitis were the main risk factors for short-term failed alcohol abstinence (P＜0.05). Conclusion More than one-third (35.6%) of patients with ALD or ALD with other liver diseases fail to abstain from drinking, and the alcohol dependence ALD alone and mild illness are the independent risk factors for abstinence failure.

Objective The aim of this study was conducted to explore the clinical prediction of significant liver fibrosis by transient ultrasound elastography and the aspartate aminotransferase/platelet ratio index (APRI) combination in patients with autoimmune hepatitis (AIH). Methods 67 patients with AIH and 54 healthy individuals at physical examination were enrolled in our hospital between August 2019 and August 2022, and all received FibroScan detection for liver stiffness measurement (LSM) and blood routine for the calculation of APRI. The patients with AIH underwent liver biopsies. The receiver operating characteristic curve (ROC) was applied to analyze the diagnostic performance of APRI and LSM for predicting significant liver fibrosis (SLF, >=S2) in patients with AIH. Results Serum AST level in patients with AIH was (104.3±21.9)U/L, significantly higher than [(30.5±5.1)U/L, P<0.05], the APRI and LSM were (1.4±0.1) and (8.1±1.2)kPa, both significantly greater than [(0.4±0.1) and (4.3±0.7)kPa, P<0.05], while the peripheral blood platelet count was (157.8±23.1)×10⁹/L, significantly less than [(208.5±20.7)×10⁹/L, P<0.05] in the healthy control; the liver histopathological examination showed the liver fibrosis S0 stage in 10 cases, S1 in 17 cases, S2 in 19 cases, S3 in 13 cases and S4 in 8 cases in our series; the APRI and LSM in patients with liver fibrosis S4 were(2.1±0.3) and (13.9±2.8)kPa, in S3 were (1.8±0.2) and (11.2±2.1)kPa, and in S2 were (1.5±0.2) and (7.6±1.5)kPa, all significantly higher than(1.1±0.2) and (6.1±1.2)kPa in S1 (P<0.05) or (0.8±0.1) and (4.0±0.5)kPa in S0 (P<0.05); the ROC analysis showed that the AUC was 0.950, with the sensitivity (Se) of 95.0% and the specificity (Sp) of 85.2%, when the APRI (with the cut-off-value of 1.5) and the LSM (with the cut-off-value of 7.5 kPa) were combined in predicting SLF, much superior to that by APRI(with the Se of 90.0% and the Sp of 81.5%) or by the LSM(with the Se of 75.0% and the Sp of 96.3%)diagnosis. Conclusion The combination of LSM and APRI might a high diagnostic efficacy in predicting SLF in patients with AIH, and warrants further clinical investigation.

Objective The aim of this study was to observe the efficacy and peripheral blood regulatory B cell subset changes in patients with autoimmune hepatitis (AIH) undergoing magnesium isoglycyrrhizinate and standard immunosuppressive therapy. Methods 108 patients with AIH were encountered in our hospital between April 2017 and April 2022, and were randomly divided into control (n=54) and observation (n=54) group, receiving standard immunosuppression treatment or oral magnesium isoglycyrrhizinate at base of it for six month. Serum immunoglobulin levels were detected by immunoturbidimetry, and peripheral blood B cell and regulatory B cell subsets were detected by FCM. Results At the end of six-month treatment, the biochemical response rate in the observation group was 85.2%, much higher than 66.7%(P＜0.05) in the control; serum ALT, AST and ALP level were (51.2±7.6)U/L, (46.2±8.6)U/L and (67.4±2.4)U/L, all significantly lower than[(80.3±8.5)U/L, (75.7±6.4)U/L and (89.7±2.6)U/L, respectively, P<0.05] in the control; there were no significant differences as respect to serum IgG, IgM and globulin levels between the two groups (P>0.05); the percentages of peripheral blood CD19⁺B cell, CD19⁺IL-10⁺B cell, CD19⁺CD24^hiCD38^hi regulatory B cell and CD19⁺CD24^hiCD27⁺ regulatory B cell were (7.1±2.6)%, (0.6±0.2)%, (2.9±1.0)% and (5.7±1.3)%, all significantly higher than [(5.2±1.8)%, (0.4±0.1)%, (2.2±0.9)% and (4.3±1.2)%, respectively, P<0.05], while the percentages of blood CD19⁺CD27⁺CD38⁺⁺ plasma cell and CD19⁺CD27^-CD38^-/+ naïve B cell were (4.2±1.2)% and (56.2±7.9)%, both much lower than [(6.5±1.7)% and (70.5±7.4)%, P<0.05] in the control. Conclusion The administration of standardized immunosuppressant and magnesium isoglycyrrhizinate combination therapy in the treatment of patients with AIH is efficacious, with a promising biochemical response, which might be related to the roles on modulation of peripheral blood regulatory B cells.

Objective The aim of this study was to observe the combination of glutathione and tiopronin in the treatment of patients with drug-induced liver injury (DILI). Methods 72 patients with DILI were enrolled in our hospital between December 2019 and August 2022, and were randomly divided into control (n=36) and observation (n=36) group, receiving tiopronin alone or tiopronin and glutathione combination treatment for two to four weeks. Serum malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were detected by thibabituric acid, xanthine oxidation or dithiobis-nitrobenzoic acid methods, respectively. Serum human heme oxygenase-1 (HO-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), IL-1β and C-reactive protein (CRP) levels were detected by ELISA. Results At the end of treatment, serum ALT and AST levels in the observation group were (40.6±11.5)U/L and (31.0±2.6)U/L, both significantly lower than [(64.6±13.9)U/L and (63.7±15.3)U/L, respectively, P＜0.05] in the control, while there were no significant differences respect to serum bilirubin and GGT levels in the two groups [(16.8±3.9) μmol/L and (59.2±13.3)U/L vs. (20.2±4.2)μmol/L and (60.8±14.7)U/L, respectively, P>0.05]; serum SOD, GSH-Px and HO-1 levels in the observation group were (82.4±12.7)U/L, (99.8±16.6)U/L and (256.7±20.8)U/L, all significantly higher than [(75.6±10.9)U/L, (80.6±15.4)U/L and (197.5±24.9)U/L, respectively, P＜0.05], while serum MDA level was (5.1±0.8)μmol/L, much lower than [(6.2±1.3)μmol/L, P＜0.05] in the control; serum IL-6, TNF-α, IL-1β and CRP levels were (5.1±1.7)pg/mL, (4.4±1.7)pg/mL, (11.2±4.1)ng/mL and (3.9±2.0)mg/L, all significantly lower than [(9.7±1.1)pg/mL, (10.2±1.8)pg/mL, (25.3±4.8)ng/mL and (13.6±2.9)mg/L, respectively, P＜0.05] in the control group. Conclusion The combination of glutathione and tiopronin in the treatment of patients with DILI could effectively improve liver function tests back to normal, which might alleviate body inflammatory and oxidative stress reactions, and warrants further clinical investigation.

Objective This clinical trial was conducted to compare the anticoagulant efficacy and safety of nafmostat mesylate (NM) and heparin (HP) during double plasma molecular absorption system (DPMAS) treatment in patients with liver failure (LF). Methods 49 consecutive patients with LF or hyperbilirubinemia were encountered in You'an Hospital affiliated to Capital Medical University between April 2022 and March 2023, and all underwent at least twice DPMAS treatment. During the procedure, the anticoagulation was crossed by NM or HP once. The prothrombin time activity (PTA) and activated partial thromboplastin time (APTT) were monitored. Results Out of the 98 DPMAS treatment, the procedure successfully completed in 97 (99.0%), only discontinued once because of plugged pipes induced by insufficient anticoagulation of HP; the satisfactory anticoagulation rate in NM-managed group was 75.5%, significantly higher than 28.6%, and the over anticoagulation rate was 2.0%, much lower than 67.3%(P<0.05)in HP-intervened group; after the procedure, the PTA and APTT in NM anticoagulant group were 20.5(13.8, 38.0)% and 83.3(55.9, 138.8)s, significantly different compared to [19.5(14.6, 31.5)% and 400.0(303.3, 400.0)s, P<0.05] in HP anticoagulant group; there were no significant differences as respect to serum bilirubin, albumin levels and platelet counts between the two groups [(279.7±99.5)μmol/L, (24.4±4.2)g/L and 59.5(42.5, 119.0) ×10⁹/L vs. (271.7±98.1)μmol/L, 23.3(21.4, 26.6)g/L and 83.8±65.9×10⁹/L, respectively, P＞0.05]; 24 hours after DPMAS, the puncture skin haemorrhage was found in one case in HP anticoagulant group, and transient increased transmembrane pressure, or venous pressure or coagulation alert by the machine occurred in two cases in NM anticoagulant group. Conclusion The extracorporeal local anticoagulation of NM during DPMAS in patients with LF is efficacious and safer, and warrants further clinical investigation.

Objective The aim of this study was to explore the changes of Golgi protein 73 (GP73), soluble urokinase plasminogen activator receptor (suPAR) and antithrombin-III (AT-III) levels in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods 81 patients with HBV-ACLF, including 29 cases at early stage, 28 cases at middle stage and 24 cases at advanced stage, and 65 patients with chronic hepatitis B (CHB), matched by gender and age, were enrolled in our hospital between November 2019 and October 2022. Serum GP73, suPAR and AT-III levels were detected by ELISA. The patients with HBV-ACLF were carefully managed and followed-up for 3 months. The predicting performance was evaluated by the area under the receiver operating characteristic (ROC) curves. Results Serum GP73 and suPAR levels in patients with HBV-ACLF were(227.4±48.4)ng/mL and (8.3±2.3)ng/mL, much higher than [(126.6±31.6)ng/mL and (5.1±1.6)ng/mL, respectively, P＜0.05], while serum AT-Ⅲ level was (48.2±12.9)%, much lower than [(76.6±18.7)%, P＜0.05] in patients with CHB; serum GP73 and suPAR levels in patients with advanced HBV-ACLF were (265.6±27.1)ng/mL and (9.4±1.2)ng/mL, significantly higher than [(231.7±29.5)ng/mL and (8.4±1.4)ng/mL, P＜0.05] in patients at middle stage or [(191.6±33.5)ng/mL and (7.3±1.6)ng/mL, P＜0.05] in patients at early stage, while serum AT-Ⅲ level was (36.8±9.1)%, significantly lower than [(47.1±10.9)%, P＜0.05] in patients at middle stage or [58.7±11.3)%, P＜0.05] in patients at early stage; at the end of three month treatment, 59 patients(72.8%) survived and 22 patients (27.2%) died in our series; serum GP73 and suPAR levels in dead patients at admission were (270.4±38.3)ng/mL and (9.9±6.2)ng/mL, significantly higher than [(210.9±41.5)ng/mL and (8.0±1.5)ng/mL, P＜0.05], while serum AT-Ⅲ level was (35.4±9.1)%, significantly lower than [(51.1±10.6)%, P＜0.05] in survivals; the AUC was 0.846 by the three combination in predicting the prognosis, much superior to the three parameters alone (the AUCs were 0.703, 0.710 and 0.744, P＜0.05), with the sensitivity of 81.8%, the specificity of 81.4%, and the accuracy of 81.5%. Conclusion The surveillance of serum GP73, suPAR and AT-III levels might help predict the prognosis of patients with HBV-ACLF, and warrants further clinical investigation.

Objective The purpose of this study was to explore clinical implications of peripheral blood mononuclear cell (PBMC) human telomerase reverse transcriptase (hTERT) mRNA and serum angiopoietin-2 (Ang-2) and intercellular adhesion molecuLe-1 (ICAM-1) levels in patients with liver failure (LF). Methods 74 patients with LF, including subacute liver failure (SALF) in 13 cases, acute-on-chronic liver failure (ACLF) in 39 cases and chronic liver failure (CLF) in 22 cases, were admitted to our hospital between January 2019 and May 2021, and 30 healthy individuals who had physical examination in our hospital during the same period were selected as the control group. The PBMC hTERT mRNA was assayed by PCR, and serum Ang-2 and ICAM-1 levels were detected by ELISA. Results The PBMC hTERT mRNA, serum Ang-2 and ICAM-1 levels in patients with LF were (0.9±0.3), (1344.6±55.3)ng/L and (540.2±22.4)ng/ml, significantly higher than [(0.4±0.1), (1062.5±36.2)ng/L and (167.3±15.6)ng/ml, respectively, P<0.05] in the healthy control; the PBMC hTERT mRNA, serum Ang-2 and ICAM-1 levels in patients with SALF were (1.5±0.6), (1507.8±38.2)ng/L and (647.3±26.2)ng/ml, all significantly higher than [(1.2±0.4), (1398.6±35.8)ng/L and (582.7±24.1)ng/ml, respectively, P<0.05] in patients with ACLF or [(0.7±0.2), (1280.5±46.3)ng/L and (468.9±20.3)ng/m, respectively, P<0.05] in patients with CLF; at the end of one to three month treatment, three patients with SALF, five patients with ACLF and four patients with CLF died in our series. Conclusion The PBMC hTERT mRNA as well as serum Ang-2 and ICAM-1 levels in patients with LF increase, which might be helpful in judging the severity of the entity and warrants further clinical investigation.

Objective The purpose of this study was to investigate the implication of peripheral blood mononuclear cell (PBMCs) signal transducer and activator of transcription 3 (STAT3) and serum soluble CD30 (sCD30) levels in patients with chronic hepatitis B (CHB) and hepatitis B cirrhosis. Methods 45 patients with CHB and 38 patients with hepatitis B cirrhosis were encountered in our hospital between December 2019 and December 2021, and 40 healthy volunteers matched by gender and age were selected as control. The PBMCs were separated and the STAT3 mRNA was assayed by RT-PCR. Serum SCD30 level was detected by ELISA. All patients with CHB and hepatitis B cirrhosis received antiviral therapy, and the cirrhotics were also managed by liver-protecting medicines. Results The PBMC STAT3 mRNA load and serum sCD30 level in patients with liver cirrhosis were (1.6±0.4) and (60.3±12.9)U/L, both significantly higher than [(1.3±0.3) and (51.8±10.2)U/L, P＜0.05] in patients with CHB or [(0.5±0.1) and (10.6±2.4)U/L, respectively, P＜0.05] in healthy volunteers; the STAT3 mRNA and sCD30 level in 25 CHB patients with serum HBeAg positive were (1.4±0.3) and (57.2±11.9)U/L, both significantly higher than [(1.2±0.3) and (45.1±8.1), respectively P＜0.05] in 20 CHB patients with serum HBeAg negative, and the STAT3 mRNA and sCD30 level in 16 patients with decompensated cirrhosis were (1.8±0.5) and (70.5±14.3)U/L, both significantly higher than [(1.4±0.3) and (52.9±11.8), respectively, P＜0.05] in 22 patients with compensated cirrhosis; at the end of three-month and six-month treatment, the STAT3 mRNA and sCD30 level in patients with CHB and with hepatitis B cirrhosis decreased gradually, out of which, the STAT3 mRNA and sCD30 levels in patients with cirrhosis were (1.2±0.2) and (43.6±8.3)U/L, and (0.7±0.2) and (21.5±3.7)U/L, all significantly lower than at inclusion (P＜0.05). Conclusion The PBMC STAT3 and serum sCD30 levels in patients with CHB and hepatitis B cirrhosis are up-regulated, which might be related to the deterioration of the disease, and needs further investigation.

Objective The aim of this study was to explore the changes and clinical implications of urine microalbumin (U-mAl), peripheral blood neutrophil/lymphocyte ratio (NLR) and serum neutrophil gelatinase-associated lipocalin (NGAL) level in patients with cirrhosis and complicated hepatorenal syndrome (HRS). Methods 43 patients with cirrhosis and complicated HRS, and 43 patients with decompensated cirrhosis were admitted to our hospital between January 2020 and January 2022, and urine U-mAl level was detected by full-automatic specific protein analyzer. The peripheral blood lymphocyte count and neutrophil count were detected by full-automatic blood cell analyzer, and NLR was calculated. Serum NGAL level was detected by ELISA. The correlation was analyzed by Pearson’ and the diagnostic efficacy was evaluated by receiver operating characteristic (ROC) curves. Results Urine U-mAl level, the NLR and serum NGAL level in patients with cirrhosis and HRS were(25.7±5.3)mg/24 h,(3.8±0.8) and (31.8±6.5) ng/mL, significantly higher than [(18.9±3.4)mg/24 h, (3.1±0.6) and (26.1±4.8) ng/mL, respectively, P＜0.05] in patients with decompensated cirrhosis; urine U-mAl level was positively correlated to NLR or serum NGAL level (r=0.470, r=0.476, both P<0.001), and the NLR was also positively correlated to serum NGAL level (r=0.752, P<0.001) in patients with cirrhosis and HRS; the AUCs were 0.741, 0.733 and 0.734 (P＞0.05), as urine U-mAl equal to 25.0 mg/24 h, the NLR equal to 3.5 and serum NGAL level equal to 29.2 ng/mL were set as the cut-off-value, in predicting HRS in patients with cirrhosis, while the AUC was 0.870, with the sensitivity of 0.973 and the specificity of 0.767 when the three parameters was combined to predict (Z=3.047, Z=3.039, and Z=2.806, all P<0.01). Conclusion The detection of urine U-mAl level, peripheral blood NLR and serum NGAL level might be an easy way to predict the occurrence of HRS in patients decompensated liver cirrhosis, and worthy of further investigation.

Objective The aim of this study was to investigate the modified sandwich endoscopic selective varices devascularization (ESVD) in the treatment of cirrhotics with esophagogastric varices (EGV). Methods A total of 106 patients with liver cirrhosis and EGV were encountered in our hospital between January 2018 and December 2022, and were randomly divided into observation and control group, with 53 cases in each group. All patients in the two groups were treated with anti-viral, non-selective β receptor blockers and supporting therapy, and those in the observation were given modified sandwich ESVD for sclerotherapy to remove EGV. The gastroscopy was conducted three months after for evaluation of the efficacy, and all patients were followed-up for one year. Results After endoscopic sclerotherapy, 5 patients (9.4%)in the observation group had non-disappearance of EGV, which disappeared after second operation; three months after sclerotherapy, the gastroscopy found the disappeared or decreased rate of EGV was 84.9%; serum albumin levels in the two groups increased greatly, and serum bilirubin, albumin and prothrombin time in the observation group were (16.2±1.4)μmol/L, (33.3±1.9)g/L and (11.3±0.4)s, not significantly different as compared to [(16.3±1.5)μmol/L, (33.4±1.8)g/L and (11.2±0.4)s, P>0.05] in the control; the post-operational complications included fever in 3 cases (5.7%), retrosternal pain in 3 cases (5.7%), abdominal pain in 1 case (1.9%), spontaneous bacterial peritonitis in 2 cases (3.8%) and esophageal ulcer in 5 cases (9.4%); at the end of one-year follow-up, the EGV bleeding (EGVB) occurred in 5 cases (9.4%) in the observation group, while it happened in 17 cases (32.1%) in the control, significantly different between the two groups (x²=5.079, P<0.05). Conclusion The modified sandwich ESVD could achieve a promising efficacy in dealing with patients with liver cirrhosis and EGV, which might eliminate the EGV and prevent EGVB.

Objective The aim of this study was to investigate the diagnostic performance of liver stiffness measurement (LSM), platelet count (PLT) / spleen thickness (ST) ratio and splenic vein diameter (SVD) in predicting esophageal varices (EV)in patients with liver cirrhosis (LC). Methods We collected 94 patients with LC, and all patients completed gastroscopy and endoscopic ultrasonography. The EV were divided into non-EV (NEV), mild, moderate, and severe EV, the periesophageal varices (peri ECV) were divided into no peri ECV, mild and severe peri ECV, and the collateral esophageal veins (para-ECV) were divided into non-para-ECV, mild and severe para-ECV. The receiver operating characteristic (ROC) curve was applied to evaluate the predictive performance. Results The ST, SVD and LSM in patients with moderate and severe EV were significantly higher in patients with NEV (P<0.05), and the PLT counts and PLT/ST ratio were significantly lower in with NEV(P<0.05); the PLT and PLT/ST ratio in patients with severe peri-ECV were significantly lower than in patients without or with mild peri-ECV (P<0.05), while the SVD and LSM were significantly higher than in with mild peri-ECV (P<0.05); the PLT counts and PLT/ST ratio in patients with mild and severe para-ECV decreases greatly, while the ST, SVD and LSM increased greatly compared to in patients without para-ECV (P＜0.05); the ROC analysis showed that the AUROC was 0.754 by LSM in predicting EV, much superior to PLT/ST ratio or SVD(the AUROCs were 0.738 and 0.679, respectively); the predictive efficacy of PLT/ST ratio, LSM and SVD for peri-ECV were all poor with the AUROCs<0.600; the predictive efficacy of PLT/ST ratio in judging para-ECV was much superior to LSM or SVD(the AUROC was 0.794 vs. 0.669 or 0.685). Conclusion The LSM has a certain predictive efficacy for EV, and the PLT/ST ratio also has some efficacy for ECV in patients with LC, which might be applied for screening in clinical practice.

Objective The aim of this study was to investigate the diagnostic performance of ultrasound semi-quantitative score and elastography combination in the diagnosis of early cirrhosis in patients with chronic hepatitis B (CHB). Methods 112 patient with CHB were admitted to our hospital between March 2017 and May 2022, and all patients underwent liver biopsies and ultrasonography. The liver stiffness measurement (LSM) and ultrasound semi-quantitative scores were recorded. The diagnostic performance of ultrasound semi-quantitative score and LSM combination for early cirrhosis was evaluated with the area under the receiver operating characteristic (ROC) curve (AUC). Results The liver histopathological examination found early liver cirrhosis in 18 cases; the scores of liver parenchymal echo, liver capsule, hepatic vein clarity, marginal morphology, spleen thickness and the total score by ultrasound semi-quantitation in patients with early cirrhosis were(2.4±0.4), (2.1±0.6), (2.2±0.4), (2.6±0.4), (2.3±0.4) and (11.6±2.4), significantly higher than [(1.7±0.3),(1.5±0.3), (1.7±0.3), (1.5±0.4), (1.7±0.3) and (8.1±1.6), respectively, P<0.05] in patients with CHB; the LSM in patients with cirrhosis was (12.5±2.8)kPa, much greater than [(8.7±2.1)kPa, P<0.05] in patients with CHB; the AUC of ultrasound semi-quantitative score, LSM and combination of the two in the diagnosis of early cirrhosis were 0.826(95% CI:0.747-0.905), 0.863(95% CI:0.794-0.932) and 0.931(95% CI:0.881-0.981), showing the latter greatly superior to the parameter of the two alone (P<0.05); the sensitivity and specificity of the combination prediction were 88.9% and 91.4%, respectively. Conclusion The non-invasive diagnosis of early liver cirrhosis by ultrasound semi-quantitative score elastography in patients with CHB has a high efficacy, and warrants clinical application.

Objective The aim of this study was to investigate the risk factors of re-bleeding in hepatitis B viral infection-induced liver cirrhosis (LC) complicated with esophagogastric varices bleeding (EGVB) within 1 year after gastroscopic sclerotherapy and tissue glue injection therapy. Methods A total of 137 patients with hepatitis B LC and EGVB were enrolled in our hospital between June 2016 and March 2021, and all patients underwent gastroscopic sclerotherapy and tissue glue injection therapy. They were all followed-up for 1 year to observe the occurrence of postoperative re-bleeding. The risk factors of re-bleeding were analyzed by multivariate Logistic regression analysis. Results Among the 137 patients with cirrhosis and EGVB, 28 patients (20.4%) died of emergent bleeding; out of the 109 survivals within 1 year of follow-up, the postoperative re-bleeding occurred in 42 cases (30.7%); there were significant differences between patients with re-bleeding and without re-bleeding as respect to Child-Pugh class (P=0.001), severity of esophageal varices (P=0.027), ascites volume (P=0.016) and malnutrition (P=0.009, P<0.05); the Logistic regression analysis showed that poor Child-Pugh class (OR=1.863), severe esophageal varices (OR=2.028), large volume of ascites (OR=1.797) and moderate to severe malnutrition (OR=1.589) were the independent risk factors for re-bleeding within 1 year after endoscopic therapy. Conclusion The patients with hepatitis B LC and EGVB after gastroscopic therapy could have high risk for re-bleeding within one year, and the careful intervention to these risk factors might decrease the incidence of re-bleeding and increase the survival rates of them.

Objective The aim of this study was to investigate the efficacy of transcatheter arterial chemoembolization (TACE) with CalliSpheres drug-loaded microspheres followed by radiofrequency ablation (RFA) in the treatment of patients with primary liver cancer (PLC). Methods 79 patients with PLC were enrolled in our hospital between January 2019 and January 2021, and were divided into observation (n=43) and control group (n=36), receiving TACE with CalliSpheres drug-loaded microspheres followed by RFA, or the routine TACE followed by RFA. All patients were followed-up for two years. The disease control rate in the two groups after treatment was evaluated according to the Response Evaluation Criteria in Solid Tumors. Serum alpha-fetoprotein (AFP) and human heat shock protein 90α (HSP90α) levels were detected by electrochemiluminescence analyzer. Results At the end of one month after treatment, the complete remission, partial remission, stable disease and the total disease control rate in the observation group were 23.3%, 46.5%, 16.3% and 86.1%, while they were 11.1%, 36.1%, 19.4% and 66.7% in the control, with the latter significantly different (P<0.05) between the two groups; at the end of three months after treatment, serum AFP and HSP90α levels in the observation group were (87.5±14.5)μg/L and (126.1±13.3)ng/mL, both significantly lower than [(164.6±17.2)μg/L and (150.8±19.7)ng/mL, respectively, P<0.05] in the control; during the period of treatment, the incidence of side effects in the two groups were 48.8% and 50.0%, not significantly different (P>0.05); the one-year survival rates in the observation and control groups were 83.7% and 72.2%, not significantly different (P>0.05), while the two-year survival rates were 69.8% and 47.2%, significantly different (P<0.05). Conclusion The TACE with CalliSpheres drug-loaded microspheres followed by RFA has a definite efficacy in the treatment of patients with PLC, which might prolong the survival rates.

Objective The aim of this study was to investigate the clinical implications of cancerous tissue cytokeratin 7 (CK7) and glypican-3 (GPC3) expression in patients with hepatocellular carcinoma (HCC). Methods A total of 219 patients with HCC were enrolled in our hospital between April 2018 and January 2022, and all underwent radical hepatectomy. The patients were followed-up for one year. The expressions of CK7 and GPC3 in cancerous and its adjacent liver tissues were detected by immunohistochemistry. The survival curves were drawn by Kaplain-maier method and the differences of survival rate between patients with CK7 and GPC3 positive and negative were compared by Log Rank test. Results The positive rates of cancerous tissue CK7 and GPC3 expression were 33.3% and 63.5%, significantly higher than 15.5% and 21.9%(P＜0.05) in the adjacent liver tissues; the positive rates of cancerous tissue CK7 expression in low differentiated tumors, BCLC stage C, tumors with vascular invasion, portal cancerous embolus and extrahepatic metastasis were 57.1%, 47.2%, 50.0%, 51.9% and 59.5%, all significantly higher than 16.4%, 20.4%, 24.1%, 22.5% and 28.0%(P＜0.05), and the positive rates of cancerous tissue GPC3 expression were 79.1%, 76.4%, 82.1%, 81.5% and 86.5%, all much higher than 52.3%, 51.3%, 53.2%, 52.9% and 58.8%(P＜0.05) in their surrounding liver tissues; at the end of one-year follow-up, the survival rate in our series was 75.8%; the one-year survival rate in patients with cancerous tissue CK7 negative was 80.1%, much higher than 67.1%(P＜0.05)in those with CK7 positive, and the one-year survival rate of patients with cancerous GPC3 negative was 85.0%, much higher than 70.5%(P＜0.05) in those with GPC3 positive. Conclusion The expressions of CK7 and GPC3 in cancerous tissues are up-regulated in patients with HCC, which might be correlated to tumor malignance and invasiveness.

Objective The purpose of this study was to explore the predictive efficacy of serum interleukin-33 (IL-33) and procalcitonin (PCT) levels for bacterial infection in primary liver cancer (PLC) patients with fever after transcatheter arterial chemoembolization (TACE). Methods A total of 150 patients with PLC were enrolled in our hospital between April 2020 and April 2022, and all patients underwent TACE. The bacterial infection was diagnosed based on blood routine, serology, imaging and bacterial characterization. Serum IL-33 level was detected by ELISA. The receiver operating characteristic (ROC) curves were drawn by SPSS statistical software and the diagnostic performance was analyzed by the area under the ROC curve (AUC). Results Out of the 150 patients with PLC, the bacterial infection was diagnosed in 50 cases(33.3%) after TACE; the incidence of diabetes, tumor in TNM Ⅲ stage, the diameters of tumor greater than 5 cm and the multiple tumors in patients with bacterial infection were much higher than in patients without (P<0.05); serum PCT and IL-33 levels in patients with bacterial infection were (14.91±3.23) ng/mL and (42.2±8.5)pg/mL, significantly higher than [(0.06±0.01)pg/mL and (13.4±4.9)pg/mL, respectively, P<0.05] in patients without; the AUCs were 0.869(95%CI=0.804-0.898, P<0.001), 0.786(95%CI=0.712-0.849, P<0.001) and 0.895(95%CI=0.855-0.912, P<0.001) when serum PCT, IL-33 levels and combination of the two parameters were applied to predict bacterial infection in PLC patients with fever after TACE, suggesting the combination superior to serum PCT or IL-33 alone (Z=1.784, P=0.074) as the combination having the sensitivity of 0.770 and the specificity of 0.930. Conclusion The increased serum IL-33 and PCT levels might hint the bacterial infection in PLC patients with fever after TACE, and warrants further clinical investigation.

Objective The aim of this study was to investigate the efficacy of programmed death 1(PD-1) immunocheckpoint inhibitors (ICIs) and tyrosine kinase inhibitor (TKIs) combination in patients with hepatitis B virus (HBV)-associated advanced hepatocellular carcinoma (aHCC). Methods 44 patients with HBV-related unresectable HCC (normal serum AFP level in 16 cases and elevated in 28 cases) were enrolled in Fifth Medical Center, General Hospital of People's Liberation Army between September 2019 and January 2022, and all received sintilimab, camrelizumab, tirelizhu and lenvatinib combination therapy for 2 to 24 months, with median of 8(6, 26) months. All patients were followed-up for 24(10,36) months. Results Both two patients in groups of normal serum AFP and elevated levels lost in our series; the objective remission rate and disease control rate in patients with normal serum AFP level were 21.4% and 28.6%, both not significantly different as compared to 11.5% and 23.1% in patients with elevated serum AFP level (P>0.05); out of the 14 patients with normal serum AFP level, 4 died, with the median overall survival (mOS)of 17.1(14.0, 24.0)mon, while in those with elevated serum AFP level, 18 died, with the mOS of 8.6(4.8, 18.1)mon(P=0.01). Conclusion The patients with unresectable HBV-related HCC might get benefits from the combination of ICIs and TKIs therapy, and the emphasis should put on those with elevated serum AFP levels.

Objective The aim of this study was to investigate the early evaluation of complete inactivation of tumors by contrast enhanced ultrasound (CEUS) and enhanced magnetic resonance imaging (MRI) scan after radiofrequency ablation (RFA) in patients with primary liver cancer (PLC). Methods 81 patients with PLC were encountered in our hospital between January 2019 and January 2022, and all underwent RFA. One month after the treatment, the CEUS and enhanced MRI scan were performed, and the consistency with digital subtraction angiography (DSA), as the gold standard was compared. Results Out of the 81 patients with PLC, the DSA examination showed the tumor foci was completely inactivated in 61 cases, with tumor residual in 20 cases; the sensitivity (Se), specificity (Sp) and accuracy (Ac) by CEUS evaluation were 91.8%, 85.0% and 90.1%, the Se, Sp and Ac by MRI scan were 96.7%, 95.0% and 96.3%, and the Se, Sp and Ac by CEUS and MRI combination evaluation were 98.4%, 100.0% and 98.8%. Conclusion The early evaluation of tumor inactivation by CEUS and enhanced MRI scan combination after RFA treatment in patients with PLC is efficacious, which might guide the clinicians to make appropriate measures for better outcomes.

Objective The aim of this study was to observe the post-operational analgesia effects of dexmedetomidine (DEX) and butorphanol (BUT) combination in patients with primary liver cancer (PLC) after laparoscopic hepatectomy (LH). Methods 74 patients with PLC were enrolled in our hospital between January 2019 and October 20222, and were randomly divided into control (n=37) and observation group (n=37). All patients underwent selective LH, and post-operationally, the patients in the control and in the observation group were intravenously pumping in sufentanil (SUF) and BUT, and Dex and BUT combination for analgesia. The pain and sedation after surgery were evaluated by visual analogue scale (VAS) and Ramsay sedation. Results The operation times and anesthesia times between the observation and the control group were (210.4±20.2) min and (228.7±30.6) min vs. (208.1±28.3) min and (226.5±32.9) min (P>0.05), while the recovery of spontaneous breathing and awakening time in the observation group were(15.5±3.1) min and (18.2±4.3)min, both significantly shorter than [(20.3±4.9)min and (22.9±4.9)min, P＜0.05] in the control; at 4 h, 24 h and 48 h post-operationally, the VAS scores in the observation group were (2.3±0.5), (1.1±0.3) and (0.9±0.2), not significantly different compared to [(2.5±0.6), (1.2±0.3) and (1.0±0.3), respectively, P＞0.05] in the control; the Ramsay scores in the observation group were (2.4±0.5), (2.8±0.6) and (3.1±0.7), all significantly greater than [(1.5±0.3), (1.9±0.4) and (2.2±0.5), respectively, P＜0.05] in the control; the incidence of untoward effects in the observation group was 5.4%, much lower than 21.6%(P＜0.05) in the control. Conclusion The application of DEX and BUT combination after LH could obviously improve analgesia and relieve pain, which might improve the recovery of patients with PLC.

Objective The aim of this study was to explore the diagnostic performance of contrast-enhanced ultrasound (CEUS) in determining qualitatively intrahepatic space-occupying lesions in patients with hepatitis B liver cirrhosis (LC). Methods 521 patients with hepatitis B LC were admitted to our hospital between January 2020 and January 2022, and all underwent liver biopsy and CEUS. The intrahepatic space-occupying lesions were evaluated by liver imaging reporting and data system (LI-RADS).The diagnostic efficacy of LI-RADS was evaluated by the area under receiver operating characteristic curve (AUROC). Results Out of the 521 patients with LC in our series, the liver histopathological examination showed hepatocellular carcinoma (HCC) in 96 cases, focal nodular hyperplasia of liver (FNHL) in 150 cases, hepatic hemangioma (HH) in 162 cases, hepatic cysts in 63 cases and local fatty liver in 50 cases; the diagnosis of the LI-RADS based on the CEUS evaluation found type I lesions in 248 cases (HH in 145 cases, hepatic cysts in 63 cases and local fatty liver in 40 cases), type II lesions in 140 cases (all was FNHL), type III in 22 cases (FNHL in 18 cases and HCC in 4 cases), type IV lesions in 39 cases (FNHL in 6 cases, HH in 7 cases and HCC in 26 cases), and type V lesions in 72 cases (FNHL in 6 cases and HCC in 66 cases); the AUROC was 0.84(95%CI:0.78-0.89), with the sensitivity (Se), specificity (Sp), positive predicting value (PPV) and negative predicting value (NPV) of 68.8%, 98.6%, 91.7% and 93.3%, respectively, when the type V lesions was determined by LI-RADS, much superior to type IV lesions judged by LI-RADS [0.62(95%CI:0.55-0.69), 27.1%, 96.9%, 66.7% and 85.5%] or to type III lesions judged by LI-RADS [0.50(95%CI:0.44-0.56), 4.2%, 95.8%, 18.2% and 81.6%, P＜0.05]. Conclusion The diagnostic performance on type I, II and V intrahepatic lesions by liver imaging reporting and data system based on the contrast-enhanced ultrasound is excellent, but as for type III and IV lesions, the qualitative diagnosis might be difficult and should be made comprehensively.

Objective The aim of this study was to investigate the expression of fibroblast growth factor receptor 2 (FGFR2) in cancerous tissues and its implication in patients with intrahepatic cholangiocarcinoma (ICC) underwent radical hepatectomy. Methods 56 patients with ICC were encountered in our hospital between March 2017 and April 2022, and all underwent radical hepatectomy. All patients were followed-up for one year. The expression of FGFR2 in cancerous tissues was detected by immunochemical staining. The univariate and multivariate Logistic regression analysis were applied to predict the factors impacting the disease-free survival (DFS). Results The expression of FGFR2 in cancerous tissues was positive in 15 cases(26.8%) and negative in 41 cases (73.2%); the incidence of microvascular invasion in FGFR2 positive group was 66.7%, significantly higher than 29.3% in FGFR2 negative group (P<0.05); serum CEA level in FGFR2 positive group was 5.9(1.3, 55.2)ng/mL, much higher than [2.2(0.5, 26.4)ng/mL, P<0.05] in FGFR2 negative group; at the end of one-year follow-up, the DFS in FGFR2 positive group was 33.3%, much lower than 58.5%(P<0.05) in FGFR2 negative group; the multivariate Logistic regression analysis showed that the tumor diameters, the locations of tumor and the FGFR2 positive expression were the independent risk factors impacting the prognosis of patients with ICC after operation (P<0.05). Conclusion The intensified expression of FGFR2 in cancerous tissues is an independent risk factor for postoperative recurrence of tumor and poor prognosis in patients with ICC, which should be taken into consideration for close surveillance.

Objective The aim of this study was to observe the long-term efficacy of high intensity focused ultrasound (HIFU) ablation and chemotherapy in the treatment of children with advanced hepatoblastoma (HB). Methods 41 children with advanced HB were encountered in our hospital between August 2013 and February 2017, and were divided into control (n=18) and observation group (n=23), receiving CAO chemotherapy, or HIFU ablation after chemotherapy. All the children were followed-up for five years. The percentages of peripheral blood CD3⁺, CD4⁺, CD8⁺ cells were determined by FCM. Results The effective rate and disease control rate in the observation group were 65.2% and 87.0%, both much higher than 33.3% and 55.6%(P＜0.05) in the control; 3 months after treatment, the percentages of CD4⁺ cells and the ratio of CD4⁺/CD8⁺ cells in the observation group were (42.5±3.9)% and (1.6±0.4), both significantly higher than [(39.4±3.5)% and (1.3±0.3), respectively, P＜0.05], while the percentages of CD3⁺ cells and CD8⁺ cells were (55.4±5.2)% and (26.1±2.4)%, both significantly lower than [(60.1±5.9)% and (30.0±2.8)%, respectively, P＜0.05] in the control group; the incidence of untoward effect in the observation group was 34.8%, not significantly different compared to 33.3% in the control (P＞0.05); the one-year, three-year and five-year survival rates in the observation group were 100.0%(21/21), 71.4%(15/21) and 28.6%(6/21) as two lost visit, also not significantly different as compared to 100.0%(17/17), 41.2%(7/17) and 11.8%(2/17) as one lost visit (Log-Rank=3.160, P=0.075) in the control group. Conclusion The HIFU ablation and chemotherapy has a clinical efficacy in the treatment of children with HB, which should be carefully investigated in the future.

Objective The aim of this study was to investigate the efficacy of limited endoscopic sphincterotomy with balloon dilation (ESPBD) and endoscopic sphincterotomy (EST) in the treatment of patients with liver cirrhosis common bile duct stones. Methods 112 patients with compensated liver cirrhosis and choledolithiasis were admitted to our hospital between March 2018 and March 2022, and 56 patients in the control were treated with EST and another 56 in the observation group were treated with ESPBD. Serum cortisol (COR), norepinephrine (NE) and epinephrine (E) levels were detected by ELISA. Results The successful rate of one time stone removal in the observation group was 96.4%, significantly higher than 80.4% in the control group (P <0.05); the intra-operational blood loss, operation time, exhaust time and hospital stay in the observation group were(25.3±3.1)mL, 41.8±5.1)min, (24.3±4.6)h and (8.1±1.6)d, not significantly different compared to [(27.9±2.8)mL, (44.9±4.9)min, (25.7±6.9)h and (7.8±2.1)d] in the control (P>0.05); 7 day after operation, total serum bilirubin, serum alanine aminotransferase, albumin and glutamyl transpeptidease levels in the observation were (15.4±3.6)μmol/L, (29.6±5.7)U/L, (36.3±6.9)g/L and (94.2±5.2)U/L, not significantly different compared to (14.8±2.9)μmol/L, (30.2±6.8)U/L, (37.1±5.8)g/L and (96.1±6.3)U/L in the control (P＞0.05); serum COR, NE and E levels were (129.7±18.2)pg/mL, (415.1±51.6)pg/mL and (24.4±3.9)pg/mL, not significantly different compared to (135.9±21.6)pg/mL,(422.7±53.9)pg/mL and (25.9±4.1)pg/mL in the control (P>0.05); post-operationally, the incidence of complications, such as infection, pancreatitis, intraperitoneal bleeding, bile leak and hyperamylasemia in the observation was 14.3%, much lower than 30.4%(P＜0.05) in the control group. Conclusion Compared with EST treatment, the application of ESPBD in the treatment of patients with liver cirrhosis and choledocholithiasis is efficacious with high one-time successful rate of stone removal and less postoperative complications.

Objective This study was conducted to investigate double endoscopic surgery in the treatment of patients with gallbladder stones (GS) and extrahepatic bile duct stones (EBDS). Methods 76 patients with GS and EBDS were encountered in our hospital between January 2020 and December 2022, 42 patients in the observation group received laparoscopic cholecystectomy (LC) five days after endoscopic retrograde cholangiopancreatography (ERCP) for the removal of common bile duct stones, and 34 patients in the control underwent traditional open surgery. The pain was evaluated by visual analogue scale (VAS), and serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP) and cortisol (Cor) levels were detected by ELISA. The white blood cell counts (WBC) were detected by full-automatic blood cell analyzer. Results The stone clearance rates in the two groups were both 100.0%; the operation time, intraoperative blood loss and VAS score at day 3 after surgery in the observation were(96.8±7.4)min,(25.7±5.3)ml and (2.8±0.7), significantly shorter or less than [(120.1±9.6)min, (46.0±6.8)ml and (3.5±0.6), respectively, P＜0.05] in the control; seven days after operation, serum AST and ALT levels were (40.5±3.9)U/L and (43.1±4.9)U/L, both significantly lower than [(50.2±5.0)U/L and (56.9±6.0)U/L, P＜0.05] in the control; serum TNF-α, IL-6, CRP, Cor levels and WBC counts were (1.5±0.3)ng/L, (10.8±2.0)ng/L, (13.4±2.5)mg/L, (224.7±28.1)mmol/L and (9.8±1.3)×10⁹/L, all significantly lower than [(2.7±0.5)ng/L, (16.1±2.5)ng/L, (22.0±4.9)mg/L, (262.4±31.8)mmol/L and (12.0±1.5)×10⁹/L, respectively, P＜0.05] in the control; post-operationally, the incidence of complications in the observation group was 7.2%, much lower than 23.5%(P＜0.05) in the control. Conclusion The double endoscopic surgery could effectively improve perioperative indexes, promote postoperative recovery, relieve stress response and reduce the complications in patients with GS and EBDS.

Objective The purpose of this study was to explore the clinical efficacy of dynamic magnetic resonance contrast-enhanced imaging (DCE-MRI), diffusion-weighted magnetic resonance imaging (DWI) and magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of patients with extrahepatic cholangiocarcinoma (CC). Methods 64 patients with suspected extrahepatic CC were encountered in our hospital between March 2019 and March 2022, and the histopathological diagnosis was made as the gold standard based on biopsies or post-operational examination. All patients underwent DCE-MRI, DWI scan and MRCP. The consistency of DCE-MRI, DWI, MRCP diagnosis and pathological diagnosis were compared by Kappa tests. Results The histopathological diagnosis showed that among the 64 patients with suspected extrahepatic CC, the final diagnosis of extrahepatic CC was found in 45 cases; the DCE-MRI diagnosis found extrahepatic CC in 46 cases, with 41 positive cases and 14 negative cases consistent with pathological diagnosis(Kappa=0.658, P<0.05); the DWI diagnosis detected 45 cases of extrahepatic CC, with 38 positive cases and 12 negative cases consistent with pathological diagnosis (Kappa=0.476, P<0.05); the MRCP diagnosis determined 44 cases of extrahepatic CC, with 40 positive cases and 15 negative cases consistent with pathological diagnosis (Kappa=0.668, P<0.05); the combined DCE-MRI, DWI and MRCP diagnosis found 45 cases of extrahepatic CC, with 43 positive and 17 negative cases consistent with the pathological diagnosis (Kappa=0.850, P<0.05); the sensitivity, specificity and accuracy of the combined DCE-MRI, DWI and MRCP diagnosis were 95.6%, 89.5% and 93.8%, respectively, much superior to those by anyone of the MRI detection alone. Conclusion The combination of DCE-MRI, DWI, and MRCP scan for the diagnosis of extrahepatic CC is efficacious, which could provide an reliable clue for clinical management.

Objective Nonalcoholic fatty liver diseases (NAFLD) is a kind of liver injury caused by metabolic stress. With the prevalence of obesity and metabolic syndrome (MetS), the NAFLD has become the most popular chronic liver disease in China. Betatrophin is a newly discovered glycoprotein closely related to glucose and lipid metabolism and insulin resistance (IR), which may be closely related to the onset and progression of NAFLD. This article reviewed the role of betatrophin in the process and development of NAFLD.