Objective The aim of this experiment was to investigate the inhibitory effect of apoptosis stimulating protein 2 of P53 (ASPP2) recombinant adenovirus (ASPP2-ad) on hepatocellular carcinogenesis induced by diethylnitrosamine (DEN) in mice. Methods The mouse liver cancer model was established by intraperitoneal injection of DEN at dose of 25 mg·kg^-1 and drinking water with 0.005% of DEN. The experiment was divided into two groups with 10 mice in each group, receiving DEN or DEN and ASPP2-ad combination intervention. The formation of liver cancer in mice was observed by ultrasonography. The number of liver tumors was recorded, and the expression of Ki67 was detected by immunohistochemistry. Serum IL-1β, IL-6, KC, IL-2 and TNFα levels were detected by flow multiprotein quantification technology. The protein expressions of AFP, caspase3, cyclin D1, PCNA, p-IKK, IKK, p-IκB, IκB, p-p65 and p65 were observed by Western blot, and the Nfatc1 mRNA level was assayed by real-time quantitative PCR. Results After 24 weeks of DEN induction, the number of liver tumors in DEN-intervened group was (9.9±1.9), significantly greater than in the DEN and ASPP2-ad combination intervened group; the number of Ki67 positive cells in DEN-intervened group was (91.4±9.1), significantly greater than in DEN/ASPP2-ad-intervened group; the survival rate in the DEN-intervened group was 65.2%, significantly lower than 90.0%(P <0.05)in DEN/ASPP2-ad-intervend group (P <0.05); serum ALT and AST levels were (271.5±143.8)U/L and (299.3±221.4)U/L, both significantly higher than in DEN/ASPP2-ad-intervend group; serum IL-6 and TNFα levels in DEN/ASPP2-ad-intervend group were (8.1±1.6)MFI and (8.1±1.0)MFI, both much lower than in DEN-intervened group; the cancerous AFP, Cyclin D1 and PCNA expression became weaker, the p-IKK, p-IκB and p-p65 expression down-regulated, the p-IKK/IKKα, p-IκB/IκB and p-p65/p65 ratio down-regulated, the Nfatc1 expression weaker, while the caspase-3 expression intensified (P<0.05) in DEN/ASPP2-ad-intervend group. Conclusion The ASPP2-ad could remarkably inhibit DEN-induced inflammatory proliferation reaction and the occurrence of liver cancer, which might be related to the regulation of NF-κB signal pathway, and warrants further investigation.

Objective The aim of this study was to summarize the etiology and clinical feature in 230 children with abnormal liver function tests. Methods The clinical data of 230 children with abnormal liver function tests, who were encountered in our hospital between October 2020 and October 2022, were retrospectively analyzed. The clinical materials were retrieved and analyzed. Results Out of the 230 children with abnormal liver function tests, the infants accounted for 53.0%, the young children for 24.8%, the preschool children for 12.6% and the school-aged for 9.6%; the clinical manifestations included fever in 156 cases(67.8%), rash in 78 cases(33.9%), cough in 66 cases(28.7%), diarrhea in 33 cases (14.3%), anorexia in 17 cases (7.4%), nausea and vomiting in 13 cases (5.7%), jaundice in 4 cases (1.7%), fatigue in 4 cases (1.7%) and without symptoms in 15 cases (6.5%); the CMV infection in 42 cases (53.2%), the EB viral infection in 22 cases(27.9%), the rotavirus infection in 7 cases (8.9%), the enterovirus infection in 4 cases (5.1%), the respiratory syncytial virus infection in 3 cases(3.8%) and the herpes simplex virus infection in 1 case (1.3%); the septicemia in 4 case, the bronchitis in 4 cases, the pharyngitis caused by Hemolytic streptococcus in 2 cases, the Neissria meningitidis meningitis in 1 case, the enteritis in 3 case; the upper respiratory mycoplasma infection in 13 cases (5.7%); the mixed virus, bacteria and mycoplasma infection in 43 cases (18.7%); the drug-induced liver injury in 33 cases (14.3%); the autoimmune hepatitis in 3 cases (1.3%); the Wilson’s disease in 7 cases, the glycogen storage disease in 3 cases; the cryptogenic liver injury in 35 cases (15.2%); serum ALT and AST levels in 22 school-aged children were(140.5±37.2)U/L and (131.3±29.7)U/L, significantly higher than in 29 preschool children or in 57 young children or [(59.4±14.8)U/L and (57.1±14.5)U/L, P<0.05] in 122 infants. Conclusion The pulmonary and gut infections could lead to transient liver injuries, with good prognosis, and needs careful screening and management.

Objective The aim of this study was to investigate the virological response of patients with genotype 1b infected chronic hepatitis C (CHC) to combination of ombitasvir and dasabuvir antiviral therapy. Methods A total of 106 patients with genotype 1b infected CHC were enrolled in our hospital between January 2020 and January 2022, 53 patients in the observation group were treated with ombitasvir and dasabuvir combination and other 53 patients in the control group were treated with dasabuvir alone. The antiviral regimen lasted for 12 weeks in the two groups. Serum HCV RNA load was detected by real-time fluorescence quantitative PCR, and the super rapid virological response (SRVR), rapid virological response (RVR), end of treatment virological response (ETVR) and sustained virological response (SVR) were recorded. Results The SRVR, RVR, ETVR and SVR in the observation group were 88.7%, 94.3%, 100.0% and 100.0%, all significantly higher than 67.9%, 75.4%, 83.0% and 90.5% (P<0.05) in the control; at the end of 12 week treatment, serum ALT and AST levels in the observation group were (30.8±4.6)U/L and (29.7±2.4)U/L, both significantly lower than in the control group; during the period of antiviral treatment, the incidence of untoward effects in the observation group was 18.7%, much higher than 9.4%(P＜0.05) in the control group. Conclusion The combination of ombitasvir and dasabuvir in the treatment of patients with genotype 1b infected CHC is efficacious, with high virological response and improved liver function tests and relatively good safety.

Objective The aim of this study was to observe the virological response to half-dose of sofosbuvir and full-dose of daclatasvir therapy in patients with end-stage renal disease (ESRD) and acute hepatitis C (AHC). Methods 49 patients with ESRD and AHC who underwent long-term hemodialysis in our hospital were enrolled between June 2020 and January 2022, and were randomly divided into observation (n=25) and control (n=24) groups, receiving half-dose of sofosbuvir and full-dose of daclatasvir or full-dose of sofosbuvir and full-dose of daclatasvir antiviral therapy for 12 weeks. Serum HCV RNA load was detected by RT-PCR, and the peripheral blood T lymphocyte subsets were detected by flow cytometry. Results The rapid virological response, end-of-treatment virological response, 12-week sustained virological response (SVR12) and SVR24 in the observation group were 72.0%, 96.0%, 88.0% and 88.0%, not significantly different compared to 70.8%, 95.8%, 87.5% and 87.5% in the control group (P>0.05); at the end of antiviral treatment, the estimated glomerular filtration ratein the observation group was (12.5±1.0)ml/min·1.73m², much higher than , while serum creatinine level was (448.5±11.7)μmol/L, much lower than in the control; there were no significant differences as respect to the percentages of peripheral blood CD₄⁺cells and CD₈⁺cell as well as the CD₄⁺/CD₈⁺cell ratio between the two groups at the end of antiviral treatment or of the follow-up (P>0.05);the incidence of untoward effects in the observation group during the antiviral therapy was 4.0%, much lower than 25.0%(P<0.05)in the control group. Conclusion The modified half-dose of sofosbuvir and full-dose of daclatasvirin treating patients with ESRD and AHC is relatively efficacious, which might meet the request of antiviral therapy and the reduction of renal function injury, and needs multi-central verification.

Objective The aim of this study was to explore the clinical implications of serum interleukin-1 receptor antagonist (IL-1RA), complement C1q tumor necrosis factor related protein 13 (CTRP13) and cytokeratin 18 (CK-18) levels in patients with non-alcoholic fatty liver diseases (NAFLD). Methods 67 patients with NAFLD and 55 healthy individuals at physical examination were enrolled in our hospital between January 2021 and January 2023, and all patients received liver biopsies for hepatic steatosis classification. Serum IL-1RA, CTRP13 and CK-18 levels were detected by ELISA, and the risk factors for severe liver steatosis was determined by multivariate Logistic regression analysis. Results Serum IL-1RA and CTRP13 levels in patients with NAFLD were (328.6±54.3)pg/ml and (2634.2±397.5)pg/ml, both significantly lower than [(673.1±125.4)pg/ml and (3425.7±423.8)pg/ml, P<0.05], while serum CK-18 level was (15.2±3.1)ng/ml, significantly higher than in healthy persons; serum IL-1RA and CTRP13 levels in 17 patients with severe liver steatosis of F3 were (256.3±47.6)pg/ml and (2056.3±308.4) pg/ml, significantly lower than [(388.3±59.4) pg/ml and (3071.5±409.3)pg/ml, P<0.05] in 29 patients with F1 steatosis or in 21 patients with F2 steatosis, while serum CK-18 level was (23.4±4.7)ng/ml, significantly higher than in patients with F1 or in patients with F2 steatosis; the percentages of concomitant obesity, diabetes mellitus, hyperlipidemia, family history of metabolic syndromes, low serum IL-1RA and CTRP13, and high serum CK-18 levels in patients F3 steatosis were 70.6%, 76.5%, 88.2%, 70.6%, 35.3%, 35.3% and 70.6%, significantly different compared to 38.0%, 42.0%, 40.0%, 30.0%, 92.0%, 80.0% and 10.0% in 50 patients with F1/F2 steatosis (P<0.05); the multivariate Logistic regression analysis showed that the obesity , diabetes , hyperlipidemia , low serum IL-1RA and CTRP13 and high serum CK-18 were the risk factors for severe liver steatosis in patients with NAFLD (P<0.05). Conclusion The abnormal changes of serum IL-1RA, CTRP13 and CK-18 levels in patients with NAFLD might help evaluate hepatic steatosis, and warrants further clinical investigation.

Objective The aim of this study was to investigate the evaluation of hepatic steatosis by controlled attenuation parameter (CAP) of ultrasonic transient elastography in patients with nonalcoholic fatty liver diseases (NAFLD). Methods 78 patients with NAFLD were enrolled in our hospital between May 2020 and May 2022, and they all received liver ultrasonography and ultrasonic transient elastography for CAP. The receiver operating characteristic curve (ROC) was plotted and the area under the curve (AUC) was calculated to evaluate the efficacy of CAP in predicting the degree of hepatic steatosis in patients with NAFLD. Results The liver ultrasonography showed that out of the 78 patients with NAFLD in our series, there were mild hepatic steatosis in 41 cases, moderate hepatic steatosis in 23 cases and severe hepatic steatosis in 14 cases; serum ALT and AST levels in patients with severe liver steatosis were (77.2±14.9) U/L and (59.1±11.7)U/L, significantly higher than in patients with moderate or in patients with mild liver steatosis; serum triglyceride level and the CAP in patients with severe liver steatosis were (3.5±0.7)mmol/L and (317.7±27.6)dB/m, both significantly higher than in patients with mild or in patients with moderate, while serum high-density lipoprotein cholesterol level was (0.8±0.4)mmol/L, much lower than in patients with mild or in patients with moderate liver steatosis; with the CAP>280.4dB/m as the cut-off value for the diagnosis of moderate hepatic steatosis in patients with NAFLD, the AUC, sensitivity (Se) and specificity (Sp) were 0.783 (95%CI: 0.669-0.896), 78.3% and 75.6%, and with the CAP>309.1 dB/m as the cut-off value for the diagnosis of severe hepatic steatosis, the AUC was 0.696 (95% CI: 0.515-0.876), with the Se of 78.6% and the Sp of 69.6% (P<0.05). Conclusion The application of CAP obtained by ultrasonic transient elastography might help assess more accurately the severity of liver steatosis in patients with NAFLD.

Objective The aim of this study was to investigate the risk factors for liver fibrosis (LF) in patients with diabetes mellitus type 2 (T2DM) and non-alcoholic fatty liver diseases(NAFLD). Methods 482 patients with T2DM were recruited in our hospital between April 2020 and April 2022, and the NAFLD was diagnosed based on ultrasonography and the LF was determined by the Young's modulus. The Lasso regression model and ordinal multicategory Logistic regression were applied to reveal the risk factors for LF, and the receiver operating characteristic curves(ROC) was drawn to assess the predictive efficacy of risk factors for LF in patients with NAFLD. Results Out of the 482 patients with T2DM in our series, the concomitant NAFLD was found in 276 cases(57.3%), including LF in 58 cases(12.0%) in the latter; the age, incidence of peripheral neuropathy (PN), body mass index and Young's modulus in patients with T2DM/NAFLD/LF were (46.0±4.2)yr, 82.8%, (28.3±3.2)kg/m² and (10.8±2.2)kPa, all significantly higher than in patients with T2DM/NAFLD or in patients with T2DM; blood TG, UA, HOMA-IR, ratio of triglyceride glucose/body mass index (TyG-BMI), serum TNF-α and IL-6 level in patients with T2DM/NAFLD/LF were(2.6±0.8)mmol/L, (355.2±24.6)μmol/L, (2.6±0.4), (270.8±18.5), (8.2±2.3)pg/ml and (13.6±2.4)pg/ml, all significantly higher than in patients with T2DM/NAFLD or in patients with T2DM; the LASSO and multivariate Logistic regression analysis showed that the ratio of TyG-BMI(OR=1.012, P=0.000), IL-6(OR=2.782, P=0.000), TNF-α(OR=1.008, P=0.026), UA(OR=1.530, P=0.000) and PN (OR=1.855, P=0.010) were the independent risk factors for the severe NAFLD in patients with T2DM; the ROC analysis demonstrated that the AUCs were 0.897, 0.928, 0.840 and 0.762, when the ratio of TyG-BMI, IL-6, TNF-α and UA were applied to predict LF in patients with T2DM/NAFLD. Conclusions The LF could deteriorate the disease in patients with T2DM/NAFLD, and the clinicians should take the risk factors into consideration and the early intervention might improve the prognosis.

Objective The aim of this study was to investigate the changes of serum hypoxia inducible factor-1α (HIF-1α), high-mobility group box 1 (HMGB1) and adiponectin (APN) levels in patients with non-alcoholic fatty liver diseases (NAFLD) and their correlation to carotid atherosclerosis (CAS). Methods 158 patients with NAFLD, including concomitant CAS in 71 cases, were encountered in our hospital between May 2018 and March 2023, and the NAFLD was diagnosed based on Fibrotouch detection and the CAS was determined by ultrasonography. Serum HIF-1α, HMGB1 and APN levels were assayed by ELISA, the risk factors was revealed by multivariate Logistic regression analysis and predicting performance was evaluated by the area under the receiver operating characteristic curve (AUC). Results The systolic blood pressure in patients NAFLD and concomitant CAS was(137.1±10.3)mmHg, much higher than in NAFLD patients without CAS; serum TC, LDL-C, HIF-1α and HMGB1 levels were (6.5±2.3)mmol/L, (3.7±0.6)mmol/L, (25.7±6.5)pg/L and (9.4±2.3)ng/ml, all significantly higher than , while serum APN level was (7.5±3.0)mg/L, much lower than in those without CAS; the multivariate Logistic regression analysis showed that serum TC(OR=1.411, 95%CI:1.133-1.757), LDL-C(OR=1.419, 95%CI:1.128-1.785), HIF-1α(OR=1.504, 95%CI:1.182-1.914), HMGB1(OR=1.520, 95%CI:1.206-1.916) and APN(OR=1.530, 95%CI:1.226-1.909) were all the risk factors impacting CAS occurrence in patient with NAFLD (P<0.05); the ROC analysis demonstrated that the AUC was 0.863, with the sensitivity of 94.5% and the specificity of 75.0% when the combination of serum HIF-1α, HMGB1 and APN levels was applied to predict the CAS existence, much superior to any single parameter did (P<0.05). Conclusion The elevated serum HIF-1α and HMGB1 levels and the decreased serum APN level are all risk factors for the occurrence of CAS in patients with NAFLD, which might be intervened as sooner as possible.

Objective The aim of this study was to explore the diagnostic performance of serum proneurotensin (Pro-NT), a adipose cytokine level and micro RNA (miRNA) load in patients with nonalcoholic steatohepatitis (NASH). Methods 159 patients with nonalcoholic fatty liver diseases (NAFLD) and 90 healthy persons were recruited in our hospital between January 2017 and June 2022, and the NAFLD was diagnosed by ultrasonography. Serum Pro-NT level was detected by ELISA, and serum miRNA load was assayed by RT-PCR. All patients with NAFLD received liver biopsies and the NASH was determined by histopathological examination. The area under the receiver operating characteristic curve (AUC) was applied to assess the diagnostic efficacy of serum parameters. Results Out of the 159 patients with NAFLD, the liver tissue examination found NASH in 49 cases (30.8%) and simple NAFLD in 110 cases (69.2%); the body mass index in patients with NASH was (28.4±1.2)kg/m², much greater than in patients with NAFLD; serum ALT, AST, fasting blood glucose, insulin, HOMA-IR and uric acid levels in patients with NASH were 62(48, 96)U/L, 56(47, 85)U/L, (5.9±0.6)mmol/L, 10.2(8.8, 13.4)μU/mL, 2.6(1.8, 3.4) and 496(392, 515)μmol/L, all significantly higher than 38(25, 53)U/L, 32(21, 49)U/L, (5.3±0.6)mmol/L, 9.0(7.2, 12.6)μU/mL, 2.2(1.3, 2.7) and 446(351, 495)μmol/L, respectively, P<0.05] in patients with NAFLD; serum Pro-NT level and miRNA-122 load were 167(148.4, 186.9)pmol/L and 8.2(2.0, 29.3), much higher than in patients with NAFLD; all the parameters in patients with NAFLD were much higher than in healthy persons (P<0.05); the diagnostic performance by serum Pro-NT level (≥112 pmol/L as the cut-off-value) was much superior to serum miRNA-122 (≥7.08 as the cut-off-value) by Delongin test in predicting the existence of NASH, with the AUC of 0.824, the sensitivity of 80.0%, the specificity of 80.0%, the positive predictive value of 84.9% and the negative predictive value of 82.3%, to 0.637, 56.0%, 70.0%, 76.5% and 56.8% (P<0.05) by serum miRNA-122. Conclusion Serum Pro-NT level might be acted as a non-invasive parameter for surveillance and screening of NASH in patients with NAFLD, and warrants further clinical investigation.

Objective The aim of this study was to compare the clinical characteristics of patients with autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) with concomitant Sjogren's syndrome (SS). Methods A retrospective study was conducted to summarize 200 patients with autoimmune liver diseases (AILD) admitted to our hospital between June 2015 and June 2023, including 50 cases of AIH, 20 cases of AIH with SS, 85 cases of PBC, and 45 cases of PBC concomitant with SS. The clinical manifestations, laboratory tests, positive rates of serum autoantibodies, and histopathology characteristics of liver were compared. Results The incidence of dry mouth/dry eye in patients with AIH /SS was 95.0%, significantly higher than 10.0% in patients with AIH (P<0.05), the incidence of dry mouth/dry eye in patients with PBC/SS was 97.8%, much higher than 12.9%(P<0.05), while the incidences of itching and jaundice were 37.8% and 40.0%, much lower than 67.1% and 60.6%(P<0.05)in patients with PBC; total serum bilirubin level (TSB) in patients with AIH/SS was (14.4±3.1)μmol/L, much lower than in patients with AIH; serum bilirubin and ALP levels in patients with PBC/SS were(26.7±6.6)μmol/L and (159.1±14.3)U/L, significantly lower than , while serum IgG level was (20.6±3.6)g/L, much higher than in patients with PBC; the positive rate of serum anti- Ro-52 in patients with AIH/SS was 55.0%, much higher than 16.0%(P<0.05) in patients with AIH, and that was 53.3% in patients with PBC/SS, much higher than 25.9%(P<0.05) in patients with PBC; there were no significant differences respect to liver histopathological features among patients with AIH/SS or with PBC/SS, as compared to in patients with AIH or with PBC(P＞0.05). Conclusion There are some differences in clinical manifestations and laboratory results between patients with AIH and with PBC with or without concomitant SS, the internists should take care of them and deal with appropriately in clinical practice.

Objective The purpose of this study was to summarize the clinical features and prognosis of patients with drug-induced liver injury(DILI). Methods The clinical data of 219 hospitalized patients with DILI was analyzed, who were encountered in First Affiliated Hospital, Guangxi Medical University between January 2012 and December 2020. The diagnosis was made by the RUCAM score ≥6. The suspect medicines, clinical features, disease severity and outcomes were retrospectively analyzed, and the disease severity was classified as mild, moderate and severe. Results In our series of 219 patients with DILI, the top five suspected medicines that most frequently caused DILI were Chinese herbal medicine (30.1%), anti-tuberculosis agents (12.3%), antibiotics (11.9%), anti-tumor and immunosuppressive medicines (7.8%) and antipyretic analgesics (6.4%); the clinical types included hepatocyte injury type in 160 cases, cholestasis type in 42 cases and mixed type in 17 cases; there was no significant differences in gender and age distribution among the three types of clinical types (P>0.05); there were 100 patients with disease severity of grade 1, 32 patients with grade 2 and 87 patients with grade 3 or above; the percentages of severe type in patients with cholestasis type and mixed type were 57.1% and 53.0%, both significantly higher than 33.7%(P＜0.05) in patients with hepatocyte injury; the recovery rate in patients with hepatocyte injury was 93.8%, much higher than 61.9% in patients with cholestasis type or 70.6% in patients with mixed type (P＜0.01). Conclusion The common suspected medicines which could lead to DILI in clinical practice are mainly traditional Chinese herbal medicines, anti-tuberculosis agents and antibiotics. The clinical classification is mainly hepatocellular injury type, and the proportions of severe liver injury in patients with cholestasis and mixed type are significantly higher than that in those with hepatocyte injury type. The outcomes of patients with hepatocyte injury is relatively promising.

Objective The aim of this study was to analyze the clinical features and influencing factors of drug-induced liver injury (DILI) in patients with severe infection receiving tigecycline therapy. Methods 74 patients with severe infection were encountered in the intensive care unit of our hospital between January and December 2022, and all were treated with tigecycline at 50 mg(n=27) or 100 mg(n=47), intravenously, q12h, for 7-14 days. The multivariate Logistic regression analysis were applied to reveal the risk factors of DILI occurrence, and the receiver operating characteristic curve (ROC) was applied to predict the efficacy. Results During the antibacterial treatment period, the DILI was found in 36 cases (48.6%); the incidence of concomitant diabetes, hypertension and malignant tumors in patients with DILI were 50.0%, 47.2% and 33.3%, all significantly higher than 18.4%, 23.7% and 13.2% (P<0.05) in patients without DILI; the AUC_0-24h of blood tigecycline concentration in patients with DILI was (17.6±6.6) mg·h·L^-1, much higher than in patients without DILI; the multivariate Logistic regression analysis showed that the concomitant diabetes, malignant tumors and AUC_0-24h were all the independent risk factors for the occurrence of DILI (P<0. 05); the ROC analysis showed that when serum tigecycline’s AUC_0-24h=14.78 mg·h·L^-1 was set as the cut-off-value in predicting DILI occurrence, the sensitivity and specificity were 66.7% and 65.8%, respectively. Conclusion The clinicians should take the precipitating factors of DILI into consideration in critically infected patients when the tigecycline is used, and we recommend monitoring blood drug concentration for making a personalized therapeutic plan to reduce DILI occurrence.

Objective The aim of this study was to investigate the clinical phenotypes and blood ATP7B gene mutation profile changes in children with Wilson's disease (WD). Methods 62 children with WD including hepatic phenotype in 41 cases (clinical phenotypes in 11 cases and subclinical phenotypes in 30 cases) and neuropathy in 21 cases (clinical phenotypes in 6 cases and subclinical phenotypes in 15 cases) were admitted to our hospital between January 2020 and January 2023. The blood ATP7B gene mutation profile was obtained by gene sequencing and the results were compared in ATP7B mutation data bank. 24 hour-urine copper and serum ceruloplasmin levels were assayed by flame atomic absorption spectrometry. Results The onset age, incidence of corneal K-F ring, serum alanine aminotransferase (ALT) and 24-hour urinary copper levels in children with hepatic phenotype were(6.1±2.5)yr, 17.0%, (149.6±51.3)U/L and (157.0±25.7)μg, significantly different compared to in those with neuropathy(P<0.05); the onset age, incidence of corneal K-F ring, bile acid, serum ALT and 24-hour urinary copper levels in children with clinical phenotype of liver disease were(6.8±1.9)yr, 54.5%, (158.5±23.6)μmol/L, (279.6±17.5)U/L and (196.6±62.8)μg, significantly different compared to in those with subclinical phenotype of liver diseases (P<0.05), and the incidence of corneal K-F ring, bile acid, serum ALT and 24-hour urinary copper levels in children with clinical neuropathy were 100.0%, (26.8±5.8)μmol/L, (96.7±10.1)U/L and (376.5±48.9)μg, significantly different compared to in those with subclinical neuropathy (P<0.05); as for the ATP7B gene mutation spectrum, the c.2333G>T (Arg778Leu) was found in 41 alleles, with 33.1% of allele frequency, the c.2975G>T (Pro992Leu) was found in 10 alleles, with 8.1% of allele frequency, and the C.2621C>T (Ala874Val), c.1708-5t>g (Ala874Val) and c.994G >T (Glu332stop) were found with 4.8%, 3.2% and 3.2% allelic frequencies; 34 missense mutations, 15 insertion mutations, 8 shear mutations and 5 nonsense mutations were detected in our series and there were compound heterozygosity in 45 cases, heterozygosity mutation in 7 cases and homozygous mutation in 10 cases; there was no statistical differences as respect to the mutation frequencies of the top five pathogenic mutation genes, e.g., p.Arg778Le, p.Pro992Leu, p.Ala874Val, IvS4-5: t>g and p.Glu332stop between children with liver illness and neuropathy phenotypes (P>0.05). Conclusion The common clinical phenotype of children with WD is liver involvement, and the top five pathogenic gene variants are Arg778Leu, Pro992Leu, Ala874Val, Ala874Val and Glu332stop, which might be firstly sequenced for early diagnosis, but the gene screening probably hard to predict the clinical phenotypes.

Objective This study was conducted to analyze the prevalence of acute kidney injury (AKI) and its impact on prognosis in patients with acute/subacute liver failure (ALF/SALF). Methods The patients with ALF/SALF were encountered in our hospital between January 2016 and July 2021, and the AKI was diagnosed based on the criteria proposed by International Club of Ascites in 2015. The multivariate COX survival regression analysis was applied to predict the prognostic factors. Results Out of 378 patients with liver failure, the ALF was diagnosed in 77 cases and SALF in 301 cases; the incidence of AKI in patients with ALF was 42.9%, significantly higher than 19.3% in patients with SALF (P<0.05); among the 91 patients with AKI, the prerenal azotemia (PRA) was found in 4 cases (4.4%), the hepatorenal syndrome (HRS) in 54 (59.3%), the acute tubular necrosis (ATN) in 22 (24.2%) and other types of renal injuries in 11 cases (12.1%); the 28-day and 90-day fatality rates in patients with ALF without AKI were 45.5% and 47.7%, much lower than 78.8% and 90.9%(P<0.05) in patients with AKI, and the 28-day and 90-day fatality rates in patients with SALF without AKI were 23.0% and 26.7%, much lower than 69.0% and 74.1%(P<0.05) in those with AKI; the multivariate COX survival regression analysis showed that the occurrence of ALF, complicated AKI and high level of INR were the independent risk factors for 28-day and 90-day survival in patients with ALF/SALF. Conclusion The complicated AKI in patients with liver failure is common, especially in those with ALF, which hints poor prognosis, and needs urgent management properly.

Objective The aim of this study was to investigate the short-term efficacy of entecavir (ETV) and peginterferon-α 2b (Peg-IFN-α 2b) combination in treatment of patients with hepatitis B-induced liver cirrhosis (LC). Methods 40 patients with compensated hepatitis B-induced LC were randomly assigned to the ETV group (control) and 38 to the combination group (observation) between March 2019 and March 2021. After 24 week treatment, all patients in the two groups received ETV continuously and were followed-up for another 24 weeks. The liver function indexes, liver fibrosis indexes, serum HBsAg and HbeAg quantification and HBV DNA loads were routinely measured. Results At the end of 24 week follow-up, serum albumin level in the observation group was (45.7±3.2)g/L, significantly higher than in the control; serum collagen type IV, hyaluronic acid, procollagen Ⅲ peptide and laminin levels in the observation were (154.3±11.7)μg/L, (130.9±17.5)μg/L, (110.6±16.2)μg/L and (152.7±14.3)μg/L, all significantly lower than[(200.7±12.4)μg/L, (161.8±18.7)μg/L, (157.4±17.3)μg/L and (200.9±16.3)μg/L, respectively, P＜0.05] in the control; serum HBsAg level was 1363.8(623.1, 2767.6) IU/ml, much lower than , while serum HBsAg negative rate was 15.8%, much higher than 0.0%(P＜0.05) in the control group. Conclusion The combination of ETV and Peg-IFN-α 2b in the treatment of patients with compensated hepatitis B LC could decrease serum liver fibrosis markers and increase serum HBsAg negative rates, which might delay the progression of the entity.

Objective The aim of this study was to explore the anesthesia of different concentrations of oxycodone and target-controlled infusion of propofol combination in patients with hepatitis B liver cirrhosis (LC) and esophageal variceal bleeding (EVB) undergoing endoscopic sclerotherapy (EIS). Methods 87 patients with hepatitis B viral infection-induced LC and EVB were enrolled in our hospital between May 2021 and March 2023, and all patients underwent EIS. The patients were randomly divided into group A, B and C, receiving oxycodone at doses of 0.04 mg·kg^-1, 0.08 mg·kg^-1 and 0.12 mg·kg^-1 for induction of anesthesia, and the combination of target-controlled infusion of propofol was continued. The parameters at immediately after disappearance of eyelash reflection (T1), at 1 min after endoscope placement (T2) and immediately after endoscope removal (T3) were recorded. The postoperative recovery quality and pain were evaluated by Stward’s scores and the visual analogue scale (VAS). Serum interleukin (IL-6) and tumor necrosis factor α (TNF-α) levels were detected by ELISA. Results At T1, T2 and T3, the effect compartment concentrations of propofol in group C were (3.0±0.2)μg/mL, (3.5±0.2)μg/mL and (3.1±0.6)μg/mL, all much lower than in group B or in group A; the dosage of propofol, the awakening time and the Stward’s socre in group C (388.3±27.1)mg, (11.8±2.0)min and (4.0±0.9), significantly different as compared to in group B or in group A; at 1 hour and 2 hours after EIS, the VAS scores in group C or group B were much lower than in group A(P＜0.05); at 6 hours after operation, serum IL-6 and TNF-α levels in group B were (30.5±4.4)pg/mL and (16.3±1.9)pg/mL, both much lower than in group A or in group C; the incidences of nausea and vomiting, and respiratory depression in group C were 27.6% and 20.7%, much higher than 10.3% and 3.5% in group A (P＜0.05) or 3.5% and 0.0% in group B(P＜0.05). Conclusion We recommend oxycodone at dose of 0.08 mg·kg^-1 for induction of anesthesia, and target-controlled infusion of propofol in patients with EVB during EIS, which might guarantee an relatively good anesthetic effect, and less complications.

Objective The aim of this study was to investigate the efficacy of entecavir and Fuzheng Jiedu Sanjie Decoction, a herbal compound, combination in the treatment of patients with hepatitis B-induced liver cirrhosis (LC). Methods A total of 112 patients with hepatitis B-induced LC were enrolled in our hospital between September 2020 and September 2022, and were divided randomly into control (n=56) and observation group (n=56), receiving entecavir or combination of entecavir and the herbal compound treatment for 24 weeks. Serum type-III procollagen (P-Ⅲ), laminin (LN), hyaluronic acid (HA) and type-IV collagen (Ⅳ-C) levels were detected by radioimmunoassay, the thickness of spleen, diameters of splenic vein and portal vein were detected by color Doppler ultrasonography and the liver stiffness measurement (LSM) was detected by FibroScan. Results At the end of 24 week treatment, the normalization rate of serum ALT level in the observation group was 92.9%, much higher than 75.0%(P<0.05) in the control; the traditional Chinese medicine (TCM) syndrome scores in the observation group decreased greatly, much superior to that in the control (P＜0.05); serum ALT level in the observation group was (41.6±9.0)U/L, significantly lower than in the control; serum PC-Ⅲ and HA levels were (106.4±17.9)μg/L and (122.3±15.6)μg/L, both significantly lower than in the control; the spleen thickness and LSM were (43.8±3.5)mm and (11.0±1.6)kPa, both much lower than in the control group. Conclusion The combination of a herbal medicine compound at base of entecavir antiviral therapy could improve liver function test normal and ameliorate liver fibrosis, and warrants further clinical investigation.

Objective This clinical trial was conducted to investigate the efficacy of endoscopic variceal ligation (EVL) and transjugular intrahepatic portal vein shunt (TIPS) in the treatment of patients with liver cirrhosis (LC) and complicated esophagogastric variceal bleeding (EVB) . Methods 85 patients with LC and complicated EVB were enrolled in this study between March 2019 and January 2022, and 42 patients in control group received EVL and 43 patients in observation group received TIPS after EVL. All patients were followed-up for 6 months. The portal vein pressure gradient (PPG), portal vein pressure (PVP) and portal vein flow velocity (PVFV) were detected by ultrasonography, and serum lipid peroxide (LPO), motilin (MTL) and gastrin (GAS) levels were determined by ELISA. Results The fatality rates after first bleeding were 9.3% and 9.5%(P>0.05) in the observation and control groups; there was no significant differences as respect to the hemostasis time and blood transfusion volume between the two groups (P>0.05), while the hospital stay in the observation group was(12.8±2.6)d, much longer than in the control; one month after operation, the PVFV in the observation group was (16.7±3.8)cm/s, much faster than , while the PPG and PVP were (9.1±1.4)mmHg and (19.6±2.3)mmHg, both significantly lower than in the control; serum LPO, MTL and GAS levels in the observation were (4.1±2.2)U/L, (202.4±22.7)ng/L and (76.3±8.4)μg/mL, all much lower than [(7.9±1.6)U/L, (256.8±26.1)ng/L and (115.6±10.9)μg/mL, respectively, P＜0.05) in the control; at the end of six-month follow-up, the incidence of re-bleeding in the observation groups was 7.7%, much lower than 31.6%(P＜0.05) in the control. Conclusion The patients with decompensated LC receive TIPS after EVL is efficacious in preventing re-bleeding after first EVB, which is worthy of further investigation.

Objective The aim of this study was to explore serum N-terminal pro-brain natriuretic peptide (NT-ProBNP) and troponin I (TnI) level changes in patients with liver cirrhosis for early diagnosis of cirrhotic cardiomyopathy (CCM). Methods 93 patients with liver cirrhosis and 49 healthy persons at physical examination were enrolled in our hospital between January 2020 and March 2023, and all underwent electrocardiography (EKG). Serum TnI level was detected by chemiluminescence immunoassay and serum NT-ProBNP level was measured by ELISA. The diagnostic performance was evaluated by the area under the receiver operating characteristic curve (AUROC) analysis. Results Out of our series, the CCM was found in 51 cases, including NYHA classⅠ in 18 cases, class Ⅱ in 20 cases and class Ⅲ in 13 cases based on cardiac Doppler ultrasonography; serum NT-ProBNP and TnI levels in patients with CCM were (41.5±7.9)pmol/L and (0.6±0.2)μg/mL, significantly higher than in cirrhotics without CCM or in healthy individuals; the abnormal EKG manifestation in patients with CCM accounted for 98.0%, much higher than 71.4% in patients with liver cirrhosis or 2.0%(P<0.05) in healthy persons; serum NT-ProBNP and TnI levels in patients with CCM class Ⅲ were (48.3±8.5)pmol/L and (0.8±0.2)pmol/L, significantly higher than in patients with CCM class Ⅱ or in patients with CCM class Ⅰ; the AUC was 0.923, with the sensitivities of 94.1% and the specificities of 78.6% when serum NT-ProBNP level equal to 40.4 pmol/L and serum TnI level equal to 0.5μg/mL were set as the cut-off-value, and with abnormal EKG combination in predicting CCM, much superior to any of the parameters did alone (P<0.05). Conclusion The elevated serum NT-ProBNP and TnI levels in patients with decompensated liver cirrhosis might hint the existence of CCM, which occurs early before abnormal EKG manifestations loom.

Objective The aim of this study was to investigate the etiology and diagnostic roadmap in patients with non-cirrhotic portal hypertension (NCPH). Methods 105 patients with NCPH were encountered in the First Affiliated Hospital, Guangxi Medical University between September 2020 and March 2022, and the etiologies and the main diagnostic methods were summarized retrospectively. Results The etiologies of NCPH in our series included prehepatic, hepatic and posthepatic entities; the common diseases were found with prehepatic portal hypertension (PH) in 69 cases (65.7%), the hepatic PH in 21 cases (20.0%) and the posthepatic PH in 4 cases (3.8%); the common diseases in patients with prehepatic ph were pancreaticogenic diseases in 22 cases (31.9%), portal vein obstruction in 15 cases (21.7%), and hematologic diseases in 15 cases (21.7%); the main diagnostic methods were imaging examination in 28 cases (40.6%), gastrointestinal endoscopy in 14 cases (20.3%) and bone marrow biopsies in 12 cases (17.4%); the top three methods for the etiological diagnosis in patients with NCPH were imaging examination (33.3%), comprehensive analysis (18.1%) and gastrointestinal endoscopy (13.9%). Conclusion The prehepatic PH should be considered firstly in patients with NCPH presentation, the laboratory and imaging examinations should be performed routinely, and the gastrointestinal endoscopy and bone marrow biopsy might be performed if necessary. For those without clear diagnosis after routine examination, the hepatic and posthepatic PH must be considered, and liver biopsy and inferior vena cava puncture angiography should be done for further validation of diagnosis.

Objective The purpose of this study was to investigate the qualitative diagnosis by multi-slice spiral CT (MSCT) and serum alpha-fetoprotein (AFP) and vascular endothelial growth factor (VEGF) detection combination in patients with intrahepatic space-occupying lesions (SOL). Methods 82 patients with intrahepatic SOL were encountered in our hospital between January 2021 and December 2022, and all patients underwent MSCT plain and contrast-enhanced scans. Serum AFP level was detected by chemiluminescence, and serum VEGF level was detected by ELISA. The diagnostic performance was evaluated by the area under the receiver operating characteristic (AUROC) curves. Results Out of the 82 patients with intrahepatic SOL, the pathological examination showed hepatocellular carcinoma (HCC) in 43 cases, and focal proliferative nodules (FPN) in 39 cases, while the MSCT scan diagnosed primary liver cancer (PLC)in 36 cases and benign lesions in 46 cases; the CT value at plain, contrast-enhanced arterial, portal and delayed phases in HCC lesions were (33.2±1.7), (68.2±2.4), (61.5±1.2) and (31.9±1.6), all significantly lower than in FPN lesions; serum AFP and VEGF levels in patients with HCC were (310.5±25.3)ng/mL and (97.6±62.1)ng/L, both significantly higher than in patients with FPN; the sensitivity (Se) and specificity (Sp) by MSCT in determining malignant lesions were 81.4% and 97.4%, while they both increased to 97.4% when the CT scan was combined with these two serum parameters. Conclusion The combination of contrast-enhanced MSCT scan and serum AFP and VEGF detection could help determine the quality of intrahepatic SOL, which has a great implications in clinical practice.

Objective The aim of this study was to explore the preoperative determination of China liver cancer staging (CNLC) by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative parameters in patients with primary liver cancer (PLC). Methods 69 patients with PLC were enrolled in our hospital between January 2021 and January 2023, and all received DCE-MRI examination pre-operationally. The perfusion parameters, such as the transfer constant (K^Trans), rate constant (K_ep) and extravascular extracellular space volume fraction (V_e), were calculated. The CNLC of patients was determined by fine needle aspiration biopsy or postoperative pathology. The receiver operating characteristic curve (ROC) was plotted and the area under the curve (AUC) was calculated to evaluate the efficacy of DCE-MRI quantitative parameters in diagnosing the preoperative staging of patients with PLC. Results The 69 patients with PLC were all diagnosed pathologically as hepatocellular carcinoma (HCC), and the DCE-MRI scan found the CNLC stageⅠ in 17 cases, stage Ⅱ in 21 cases, stage Ⅲa in 29 cases and stage Ⅲb in 2 cases; the K^Trans and K_ep in patients with stage Ⅲ were (0.4±0.1)min^-1 and (1.2±0.6)min^-1, both significantly higher than , while the V_e was (0.4±0.2), significantly less than in patients with stage Ⅰ/Ⅱ; the AUC was 0.812(95% CI:0.706-0.918), with the sensitivity of 80.6% and the specificity of 65.8%, when the K^Trans and K_ep were combined with the V_e in predicting the CNLC staging in patients with PLC, much superior to any parameter doing alone(P<0.05). Conclusion The quantitative parameters of DCE-MRI scan could to certain extent decide pre-operationally the clinical staging in patients with PLC, which might be a great help for appropriate management in this circumstance.

Objective The purpose of this study was to investigate the efficacy of microwave ablation (MWA) and anti-programmed death receptor-1 (PD-1) antibody therapy in patients with primary liver cancer (PLC). Methods A total of 102 patients with PLC were encountered in our hospital between June 2019 and December 2020, and were randomly divided into control (n=51) and observation group (n=51), receiving MWA or sintilimab immediately after MWA for six months. The quality of life was evaluated by 36-item shot-form health status survey (SF-36). The peripheral blood lymphocyte subsets was analyzed by FCM. All patients after therapy was followed-up for one year. Results The objective remission rate (ORR) in the observation group was much higher than in the control group (51.% vs. 29.4%, P<0.05); at the end of six-month therapy, the physical function, physiological role, body pain, overall health, energy, social function, role limitation and mental health scores in the observation were significantly higher than in the control(P<0.05); the percentage of peripheral blood CD4⁺ cells and the CD4⁺/CD8⁺ cell ratio in the observation were much higher than in the control (P<0.05), while the percentage of CD4⁺CD25⁺FOXP3⁺Treg cells and CD8⁺ cells were much lower than in the control (P<0.05); the Kaplan-Meier analysis showed that the median progression-free survival (PFS) in the observation group was 9.7(95%CI:7.971-11.429)mon, much longer than 7.8(95%CI:5.931-9.729)mon, and the one-year survival rate was 58.8%, also much higher than 37.3%(P<0.05)in the control group. Conclusion The administration of sintilimab immediately after MWA in treatment of patients with PLC is efficacious, which might be related to modulation of disturbed immune functions.

Objective This clinical trial was conducted to investigate the efficacy of venous administration of vitamin B6 sodium cantharidate after transhepatic arterial chemoembolization (TACE) in the treatment of patients with primary liver cancer (PLC). Methods 84 patients with PLC were encountered in our hospital between January 2019 and January 2022, and 42 patients in the control received TACE and another 42 patients in the observation were treated by TACE followed by venous administration of vitamin B6 sodium cantharidate for three weeks. All patients in the two groups were followed-up for one year. Serum alpha-fetoprotein (AFP) levels were detected by chemical fluorescence assay, serum carbohydrate antigen 125 (CA125) levels were detected by chemiluminescence immunoassay, and serum carbohydrate antigen 199 (CA199) levels were detected by direct chemiluminescence assay. Serum homocysteine (Hcy) levels were detected by enzymatic method, serum nitric oxide (NO) levels were assayed by nitrate reduction method, and serum endothelin (ET-1) levels were determined by enhanced chemiluminescence immunoassay. Results The CR, PR, SD and PD in the observation were 7.1%, 42.9%, 38.1% (P＜0.05) and 4.8%, while those in the control were 7.1%, 40.5%, 19.1% and 26.2%, with the SD significantly different between the two groups; after treatment, serum AFP, CA125 and CA199 levels in the observation group were (540.4±87.1)μg/L, (28.1±9.1)kU/L and (18.0±4.8)kU/L, all significantly lower than in the control; serum Hcy and ET-1 levels were (14.1±3.6)μmol/L and (66.1±10.3)ng/L, both much lower than [(18.4±4.3)μmol/L and (80.2±12.1)ng/L, respectively, P＜0.05] in the control; the incidence of gastrointestinal reaction in the observation was 16.7%, much lower than 40.5%(P＜0.05) in the control; there was no significant difference as respect to the one-year survival in the two groups (84.2% vs.76.9%, P>0.05). Conclusion The venous administration of vitamin B6 sodium cantharidate after TACE in the treatment of patients with PLC could ameliorate gastrointestinal reactions and improve the vascular endothelial functions.

Objective The aim of this study was to observe the clinical efficacy of dexmedetomidine and sevoflurane combination anesthesia in patients with primary liver cancer (PLC) undergoing hepatectomy. Methods 57 patients with PLC were enrolled in our hospital between January 2019 and December 2022, and were randomly divided into control (n=28) and observation group (n=29) during hepatectomy, receiving sevoflurane anesthesia or dexmedetomidine and sevoflurane combination anesthesia, respectively. The heart rate (HR) and mean arterial pressure (MAP) were routinely monitored before anesthesia (T0), immediately after surgery (T1), 12 h after surgery (T2) and 24 h after surgery (T3). The pain was evaluated by visual analogue scale (VAS), and serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), cortisol (Cor) and adrenocorticotropic hormone (ACTH) levels were detected by ELISA. Results At T0, T1, T2 and T3, there was no significant differences as respect to HR or MAP between the two groups (P>0.05); at T1, T2 and T3, the VAS scores in combination group were (2.1±0.5), (1.6±0.4) and (1.1±0.2), all significantly lower than in the control group; at T0, serum IL-6, TNF-α, Cor and ACTH levels in the combination group were (5.2±1.1)ng/L, (26.9±4.3)μg/L, (185.6±28.4)mmol/L and (10.6±2.1)pmol/L, not significantly different compared to in the control (P>0.05), while at T3, serum IL-6, TNF-α, Cor and ACTH levels were (9.7±2.6)ng/L, (31.3±4.8)μg/L, (219.7±32.5)mmol/L and (14.8±3.5) pmol/L, all significantly lower than in the control group. Conclusion The dexmedetomidine and sevoflurane combination anesthesia in patients with PLC during hepatectomy could alleviate perioperative pain and relieve perioperative body inflammatory and oxidative stress reactions, which is worthy of further clinical investigation.

Objective This study was conducted to investigate the efficacy of ultrasound(US)-guided radiofrequency ablation ( RFA ) in the treatment of patients with small hepatocellular carcinoma (sHCC), and analyze the risk factors affecting the survivals. Methods 102 patients with sHCC were encountered in our hospital between December 2019 and January 2021, and all underwent US-guided RFA. The patients in our series were followed-up for two years. The univariate and multivariate Logistic regression analysis were applied to analyze the factors affecting the survivals of patients after RFA treatment. Results One-month observation showed progression diseases in 6 cases, stable diseases in 21 cases, partial remission in 52 cases and complete remission in 23 cases, with the objective response rate of 73.5%; the one-year and two-year survival rates were 90.2% and 77.5%; there were no significant differences respect to the ages, gender, history of alcohol abuse, underlying hepatitis B viral infection as well as plasma prothrombin time international normalized ratio and blood platelet counts between died and survived patients (P>0.05), while the percentages of Child-Pugh class C, low differentiation of tumor cells, lesions adjacent to vessels, without antiviral therapy of nucleos(t)des and serum AFP level in dead patients at admission were 43.5%, 34.8%, 69.6%, 69.6% and (292.4±28.5) ug/L, all significantly higher than , and serum albumin level was (32.2±4.5) g/L, much lower than in survivors; the Logistic analysis showed that high serum AFP levels, Child-Pugh class C, foci adjacent to blood vessels and without antiviral therapy were all the independent risk factors (P<0.05) impacting the long-term survival of patients with HCC after RFA therapy . Conclusion The RFA under US-guidance in managing patients with sHCC is definitely efficacious, and take the risk factors affecting the survival into consideration and intervenes with them in time might prolong the survivals of patients with sHCC.

Objective The aim of this study was to investigate the differentiation of hepatocellular carcinoma (HCC) from hepatic hemangioma (HH) by using contrast-enhanced energy spectrum CT parameters. Methods 78 patients with primary intrahepatic space-occupying lesions were encountered in our hospital between January 2021 and December 2022, and all patients underwent hepatectomy. The postoperative histopathological examination revealed 46 patients with HH and 32 patients with HCC. At presentation, all patients received plain and enhanced energy spectrum CT scanning, and the iodine (water) concentration (IC), water (iodine) concentration (WC), iodine uptake ratio (IUR) of lesions, and slope of energy spectrum curve of lesions at 50, 60, 70, 80 and 90 keV single-energy CT values were recorded. The kappa coefficient test was applied to analyze the diagnostic performance of CT parameters. Results The foci CT values at 5 single energy levels of arterial phase in patients with HCC were (152.3±48.5), (117.5±41.6), (95.2±34.3), (83.1±29.8) and (70.5±25.3), all significantly higher than , and the foci CT values at 5 single energy levels of portal phase were (177.5±51.2), (130.9±35.9), (106.8±22.8), (85.9±20.3) and (74.6±19.8), all significantly higher than in HH foci; the arterial IC, IUR and energy spectrum curve in patients with HCC were (2.0±0.6), (2.7±0.5) and (2.8±0.9), significantly higher than , and the portal IC, IUR and energy spectrum curve were (2.6±0.8), (0.9±0.3) and (3.5±1.1), significantly higher than in HH foci; the sensitivity, specificity and accuracy were 90.6%, 89.1% and 89.7% when the arterial and portal CT parameter were combined for the prediction of HCC, which was much consistent with histopathological examination (Kappa=0.790). Conclusion The energy spectrum CT enhanced scanning might help differentiate the HCC from HH, and needs further clinical investigation.

Objective The aim of this study was to compare the diagnostic efficacy of CT and magnetic resonance imaging (MRI) in the differential diagnosis of patients with hepatic hemangioma (HH) and hepatocellular carcinoma (HCC). Methods 69 patients with intrahepatic space-occupying lesions were encountered in Huai 'an First People's Hospital between June 2020 and June 2022, all patients received enhanced CT and MRI scanning, and underwent liver biopsies or hepatectomy. The Kappa test was used to analyze the agreement between CT and MRI diagnosis based on histopathological diagnosis. The area under the receiver operating characteristic curve (AUC) was applied to determine the diagnostic efficacy. Results Based on histopathological examination, the CT scan found primary liver cancer (PLC) in 29 cases (78.4%) and HH in 24 cases(75.0%), while the MRI diagnose correctly PLC in 35 cases (94.6%) and HH in 29 cases; the enhanced CT and MRI scan were consistent with the pathological diagnosis as respect to the diagnosis of HH and HCC by Kappa test (Kappa=0.532, P<0.05 and Kappa=0.749, P<0.05); the sensitivity (Se), the specificity (Sp) and the accuracy by MRI scan in diagnosing the intrahepatic occupying lesions were 94.6%, 90.6% and 92.8%, much superior to 78.4%, 75.0% and 76.8% by CT scan, while the combination of the two didn’t improve the diagnostic efficacy (90.6%, 90.6% and 92.8%, respectively). Conclusion The optimal check-up might be the MRI scan in determining the quality of intrahepatic occupying lesions.

Objective The purpose of this study was to investigate the clinical efficacy of drug-eluting bead transcatheter arterial chemoembolization (DEB-TACE) followed by microwave ablation (MWA) in dealing with patients with large primary liver cancer (PLC). Method 50 consecutive patients with large PLC were encountered in our hospital between May 2018 and May 2021, and were randomly divided into control and observation group, with 25 cases in each group. The patients in the control group was treated with conventional TACE and thereafter MWA, and the patients in the observation received DEB-TACE followed by MWA. All patients were followed-up and the efficacy was evaluated by complete remission (CR), partial remission (PR), stable disease (SD), progressive disease (PD), objective remission rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS). Results After treatment, the CR, PR, SD, ORR and CDR in the observation group were 44.0%, 48.0%, 4.0%, 92.0% and 96.0%, much superior to 36.0%, 24.0%, 16.0%, 60.0% and 76.0% (P<0.05) in the control; serum AFP and AFP-L3 levels in the observation were (121.5±63.7) ng/mL and (7.1±0.2)%, both much lower than in the control; after (18.3±6.7) month of follow-up after treatment, the fatality rate in the observation group was 24.0%, not significantly different compared to 48.0% in the control (x²=3.125, P=0.077); the median PFS in the observation and in the control were 8.3 mon and 5.3 mon (t=3.172, P=0.075), and the median OS in the two groups were 14.5 mon and 9.4 mon (t=2.432, P=0.082), not significantly different. Conclusion The short-term efficacy of DEB-TACE and MWA combination in treatment of patients with large PLC is definite, while the long-term efficacy should investigate further in the future.

Objective This study was conducted to observe the efficacy of laparoscopic assisted hemangioma removal and anatomical hepatectomy in the treatment of patients with huge hepatic hemangioma (HH). Methods 68 patients with huge HH were encountered in our hospital between January 2020 and June 2022, and the enrolled patients had HH with diameter ≥ 10 cm. They were divided into two groups, with 34 cases in each, receiving laparoscopic peeling off tumors or anatomical hepatectomy for removal of the tumors. The BK-200 automatic biochemical analyzer was used to detect the liver function tests. Results The operation time, intraoperative blood loss, peritoneal drainage and hospitalization cost in patients with peeling off tumor treatment were (144.6±37.2)min, (402.3±132.5)mL, (257.2±48.6)mL and (32000±700) yuan, all significantly shorter or less than in patients receiving anatomical hepatectomy; at day three after operation, serum alanine aminotransferase and aspartate aminotransferase levels in patients receiving peeling off tumors were (71.6±14.8)U/L and (48.8±9.2)U/L, both significantly lower than in patients underwent anatomical hepatectomy; post-operationally, the incidence of complications, such as pleural effusion, incision liquefaction or infection and biliary leakage in patients receiving peeling off tumors was 17.6%, not significantly different compared to 26.5% in patients underwent anatomical hepatectomy (P＞0.05). Conclusion The laparoscopic assisted hemangioma peeling and anatomical hepatectomy in treatment of patients with giant HH are both efficacious, and we recommend the peeling off operation, which might shorten the operation time, reduce blood loss with less liver injury.

Objective The aim of this study was to compare the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) and open surgery in the treatment of patients with acute obstructive suppurative cholangitis (AOSC). Methods A total of 103 patients with AOSC were encountered in our hospital between January 2020 and January 2023, and 58 patients in observation group received ERCP therapy and 45 patients in control group received open laparotomy. The pain was evaluated by visual analogue scale (VAS), and serum interleukin(IL)-6, IL-1, tumor necrosis factor (TNF)-α and C-reactive protein (CRP) levels were detected by ELISA. Results The intraoperative blood loss, operation time, VAS score at day three after surgery and hospitalization stay in the observation group were(30.7±4.6)mL, (74.3±8.8)min, (3.1±0.8) and (7.2±1.4)d, all significantly less or shorter than in the control; at day five after surgery, serum ALT and GGT levels in the observation group were (48.2±4.1)U/L and (163.9±17.2)U/L, both significantly lower than in the control; serum IL-6, IL-1, TNF-α and CRP levels in the observation were (82.6±8.3)ng/L, (20.9±4.0)ng/L, (16.2±3.5)ng/L and (18.1±2.2)mg/L, all significantly lower than in the control; the incidence of post-operational complications in the observation group was significantly lower than that in the control group (5.1% vs. 17.8%, P<0.05). Conclusion The ERCP therapy was successfully completed in our series, and it could deal emergently or urgently with patients with AOSC, which warrants further clinical investigation.

Objective The aim of this study was to compare the T-tube drainage through rectus abdominis and right midclavicular line after laparoscopic common bile duct exploration (LCBDE) in dealing with patients with common bile duct stones (CBDS). Methods A total of 198 patients with CBDS were admitted to our hospital between January 2021 and December 2022, all patients underwent LCBDE) operation, 125 cases in group A having T-tube drainage through rectus abdominis and 73 cases in group B having T-tube drainage through right midclavicular line. The perioperative indexes and complications in the two groups were recorded. The liver function tests were routinely detected. The gastrointestinal quality of life index (GIQLI) score, the self-rating depression scale (SDS) score and the self-rating anxiety scale (SAS) score were evaluated. Results The operation time, intra-operational blood loss, extubation time and hospital stay in group A were (52.9±3.1)min, (40.2±14.5)ml, (4.1±0.5)d and (7.2±1.1)d, all not significantly different compared to in group B; 5 days after operation, serum bilirubin, ALT, AST and albumin levels in group A were (12.4±2.7)μmol/L, (51.8±4.2)U/L, (36.2±3.4)U/L and (37.9±1.5)g/L, all not significantly different compared to in group B; the GIQLI score in group A was (129.4±10.3), much higher than (105.7±9.9), while the SDS score and the SAS score were (30.2±1.7) and (30.7±1.9), much lower than in group B; post-operationally, the incidence of complications, such as bleeding, infection, biliary leakage and cholangiostenosis in group A was 9.6%, much lower than 20.5%(P＜0.05) in group B; at the end of one-year follow-up, the recurrence of biliary stones revealed by ultrasonography in group A was 3.2%, not significantly different compared to 4.1% in group B (P＞0.05). Conclusion The T-tube drainage through rectus abdominis after LCBDE might ameliorate the mental strain in patients with CBDS, and reduce the incidence of postoperative complications.

Objective The aim of this study was to investigate re-operation of percutaneous transhepatic one-step biliary fistulation (PTOBF) and percutaneous transhepatic choledochoscope lithotomy (PTCSL) in treatment of patients with recurrent hepatolithiasis after Roux-en-Y cholangiojejunostomy. Methods 83 patients with relapsed hepatolithiasis after Roux-en-Y cholangiojejunostomy were enrolled in our hospital between January 2020 and December 2022, and 31 cases in control group received PTCSL and 52 cases in observation group underwent PTOBF and PTCSL combination surgery. All patients in the two groups were followed-up by ultrasonography check-up. Results The operation time and post-operational hospital stay in the observation group were (136.3±29.5)min and 6.1(4.7, 7.8)d, much longer than in the control; the success rates of one-time puncture and one-time fistula dilation in the observation group were 76.9% and 94.2%, much higher than 54.8% and 67.7%(P＜0.05) in the control; there were no significant differences as respect to liver function tests in the two groups before and after operation(P>0.05); post-operationally, the shedding incidence of drainage tubes in the observation was 1.9%, much lower than 25.8%(P＜0.05) in the control, while there were no significant differences respect to the incidences of biliary bleeding and pleural effusion(1.9% vs. 3.2% and 3.9% vs. 3.2%, respectively, P>0.05) between the two groups; the post-operational follow-up showed the re-occurrence of intrahepatic stones in the observation was 3.9%, much lower than 16.1%(P＜0.05) in the control group. Conclusion The application of PTOBF and PTCSL combination in dealing with patients with recurrent hepatolithiasis after Roux-en-Y cholangiojejunostomy is efficacious, with a good success rates of one-time puncture and one-time fistula dilation, and relatively low stone recurrence rates.

Objective This study was to explore the clinical efficacy of laparoscopic hepatectomy (LH) in treating patients with cholangiolithiasis and underlying liver cirrhosis. Methods 59 patients with cholangiolithiasis were recruited in Jingzhou Hospital Affiliated to Yangtze University between June 2018 and June 2023, and all the patients enrolled had underlying compensated liver cirrhosis. 20 patients underwent open hepatectomy (OH), and other 20 patients selected by propensity score matching underwent LH. Results The patients in the two groups were matched successfully on body mass index, the etiologies of liver cirrhosis and surgery history, and all operations were successfully completed without switch to OH in LH-treated patients; the surgery time in patients receiving LH was (182.6±97.2)min, much longer than , while the intraoperative blood loss and the hepatic inflow occlusion time were(203.5±186.6)ml and (32.3±21.4)min, significantly less or shorter than in patients receiving OH operation; the post-operational hospital stay in patient receiving LH was(8.6±5.7)d, much shorter than in patients underwent OH, while the daily T-tube drainage volumes, postoperative feeding times and mobilization times in the two groups were not significantly different(P>0.05); the incidence of post-operational complications in patients receiving LH was 15.0%, not significantly different compared to 30.0%(P>0.05) in patients receiving OH. Conclusion The laparoscopic hepatectomy in the treatment of patients with cholangiolithiasis and underlying liver cirrhosis is as efficacious as traditional open surgery, with minimally invasive operation virtue, and warrants further clinical verification.

Objective The aim of this study was to investigate the high-frequency and low-frequency ultrasound in the diagnosis of polypoid lesions of gallbladder (PLG). Methods 64 patients with PLG were enrolled in our hospital between May 2020 and April 2023, and they all underwent low-frequency and high-frequency ultrasonography and thereafter laparoscopic cholecystectomy (LC). The histo-pathological examination was routinely performed, and the diagnosis by ultrasonography was evaluated by Kappa coefficient. Results Among the 64 patients with PLG, the histopathological examination found benign lesions in 59 cases and malignant lesions in 5 cases; the ultrasonic features included the single lesion, wide substrate and lesions with blood signals in malignant lesions; the low-frequency ultrasound found malignant lesions in 9 cases (14.1) and benign lesions in 55 cases(85.9%), the high-frequency ultrasound found malignant lesions in 8 cases (12.5%) and benign lesions in 56 cases (87.5%) and the low- and high-frequency ultrasound combination diagnosed malignant lesions in 7 cases (10.9%) and benign lesions in 57 cases (89.1%), without significant differences among them (P>0.05); the sensitivity, specificity and accuracy by the high-frequency and low-frequency ultrasound combination in judging the quality of PLG were 100.0%, 96.6% and 71.4%, which had a high consistency with histopathological diagnosis (kappa=0.817). Conclusion The combination of high-frequency and low-frequency ultrasound in the diagnosis of PLG is efficacious, which might guide the clinical strategy for management of PLG.

The Epstein-Barr virus (EBV) is one of the members of the human herpesvirus family, which might cause many diseases. The children with EBV infection often have liver injury, which is usually manifested as mild to moderate liver dysfunctions. In severe cases, it can develop into liver failure and even lead to death. Most children with acute EB viral infection recover after supportive treatment. However, in cases of chronic infection or post-transplant infection, the immunomodulatory therapy, chemotherapy, and even bone marrow transplantation may be required in addition to actively management of the underlying diseases. In this review, we describes the comprehensive updates of the epidemiology, pathogenesis, diagnosis, treatment and prognosis of children with liver injury associated with EBV infection.