The Chinese Society of Hepatology of the Chinese Medical Association invited relevantexperts to revise and update the Guideline of Prevention and Treatment of Nonalcoholic Fatty Liver Disease(2018Version) and renamed it as (Version 2024) Guideline for the Prevention and Treatment of MetabolicDysfunction-associated (non-alcoholic) Fatty Liver Disease. Herein, the guiding recommendations on clinicalissues such as screening and monitoring, diagnosis and evaluation, treatment and follow-up of metabolicdysfunction-associated fatty liver disease are put forward.

Objective This study was conducted to investigate ultrasonography visibility of a newly knitted catheter. Methods Tube wall structure, reflected acoustic signal intensity and ultrasonography visibility in liquid and living animal liver tissue between conventional plastic catheter (n=10) and newly knitted catheter (n=10) were compared by through electron microscopy, hydrophone acoustic signal detection, flume catheter ring experiment and live pig liver implantation. Results Under electron microscope, interlaced polymer fibers were observed in the wall of the newly knitted tube, whose acoustic impedance values were different from those of the tube body, and microbubbles were also observed around the intersections of fibers; hydrophone detection experiments showed that the fundamental and second harmonic signals received by the newly knitted catheter were more evenly distributed and less angle dependent; in the catheter ring experiment, complete display rate was (91.9±1.2)%, echo loss rate was(4.0±0.7)%) and multiple reflection artifact display rate was(4.3±0.9)%, all much superior to conventional plastic catheter (P<0.01); in live pig liver in vivo, the echo intensity, wall continuity and tip development of the newly knitted catheter were much better than those of conventional plastic catheter. Conclusion The newly knitted catheter has stronger ultrasound visibility, which might be validated in clinical application.

Objective This study was conducted to investigate clinical efficacy of tenofovir disoproxil fumarate (TDF) and entecavir (ETV) in rescue therapy of patients with lamivudine-resistant HBeAg-negative chronic hepatitis B (CHB). Methods Fifty patients with lamivudine-resistant HBeAg-negative CHB were enrolled in our hospital between January 2017 and December 2021, and we randomly assigned them to receive TDF (n=25) or ETV for rescue antiviral therapy for 48 weeks. Multivariate Logistic regression analysis was applied to predict impacting factors for virological response. Results by 4, 12, 24, 36 and 48 weeks of antiviral treatment, serum HBV DNA loss in TDF-treated patients were 32%, 60%, 72%, 80% and 92%, all much higher than 4%, 24%, 32%, 40% and 44% (all P<0.05) in ETV-treated patients; serum ALT normalization rates in TDF-treated patients were 56%, 68%, 80%, 84% and 96%, all much higher than 16%, 32%, 52%, 56% and 72% (P<0.05) in ETV-treated patients; by end of 48 week treatment, serum creatinine level in TDF-treated patients increased greatly as compared to that at presentation (85.4±13.9μmol/L vs. 76.2±17.5μmol/L, P=0.0001), while it didn’t change obviously in ETV-treated patients (76.6±12.9μmol/L vs. 77.3±11.2μmol/L, P=0.769); multivariate Logistic regression analysis showed that administration of TDF and serum HBV DNA loads were independent factors impacting virologcal response to rescue therapy. Conclusion Based on our findings, we recommend TDF rescue antiviral therapy for CHB patients with lamivudine-resistant, and surveillance of renal functions might be important during the antiviral procedure.

Objective The aim of this study was to investigate the antiviral efficacy of tenofovir alafenamide (TAF) in the re-treatment of patients with chronic hepatitis B (CHB) and low-level viremia (LLV) after entecavir (ETV) treatment. Methods 101 patients with CHB were recruited in our hospital between January 2018 and December 2022, and the enrollment included ETV-treated for longer than 48 weeks and LLV was confirmed by serum HBV DNA load detection. 50 patients toke oral ETV continuously for 48 weeks, and other 51 patients switched to TAF re-treatment for 48 weeks. Serum creatinine (sCr), β₂ microglobulin (β2-G) levels and estimated glomerular filtration rate (eGFR) were routinely detected, and the liver stiffness measurement (LSM) was measured by transient elastography. The complete virological response (CVR) was defined as serum HBV DNA negative, and less than 20 IU/mL quantitatively. Results At the end of 48 weeks, the CVR in the TAF-treated patients was 98.0%, much higher than 24.0%(P<0.05) in ETV-treated patients, while there were no significant differences as respect to serum HBeAg negative rates (17.7% vs. 4.0%, P>0.05) and serum ALT normalization rates (96.1% vs. 98.0, P>0.05) in two groups; serum ALT, AST levels and the LSM in patients receiving TAF were (37.7±5.3)U/L, (34.8±5.7)U/L and (7.1±1.0)kPa, all not significantly different compared to [(36.2±4.8)U/L, (35.2±5.3)U/L and (7.8±1.1)kPa, respectively, P>0.05] in patients taking ETV; serum Cr and β₂-MG levels were (70.4±6.5)μmol/L and (1.3±0.3)mg/L, both significantly lower than [(78.5±6.9)μmol/L and (1.6±0.2)mg/L, P<0.05], while the eGFR was (105.9±17.3)mL/min/1.73 m², much higher than [(98.0±16.7)mL/min/1.73 m², P<0.05] in ETV-treated patients. Conclusion We recommend the CHB patients with LLV after ETV treatment switch to TAF therapy, which could elevate virological response rate, and warrants further clinical investigation.

Objective The aim of this study was to investigate the clinical feature and responses to antiviral therapy in patients with hepatitis B virus (HBV) and hepatitis C virus (HCV)co-infection. Methods 40 patients with chronic hepatitis B (CHB), 24 patients with chronic hepatitis C (CHC) and 17 patients with CHB/CHC were enrolled in our hospital between January 2020 and December 2021, receiving entevavir (ETV), sophobuvir/vipatavir or combination of ETV and sophobuvir/vipatavir for 48 weeks or 24 weeks. Entecavir therapy continued after finishing anti-HCV treatment, and all patients were followed-up for 24 weeks. Serum HBV DNA and HCV RNA loads were detected, and peripheral blood T lymphocyte subsets were determined by FCM. Results Of 17 patients with CHB/CHC, there were family HBV infection history in 41.2%, HCV infection history in 23.6%, blood transfusion history in 17.6% and drug abuse in 17.6%, and the clinical phenotypes included CHB in 70.6%, compensated and decompensated liver cirrhosis in 23.6% and 5.8%; at admission, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in patients with CHB/CHC were both significantly greater than in those with CHB or with CHC, while serum HBV DNA load were much lower than in patients with CHB and serum HCV RNA load were much lower than in those with CHC(P＜0.05); at end of 24 week follow-up, serum ALT/AST levels in patients with CHB/CHC were still much higher than in those with CHB or in with CHC(P＜0.05), however, there were no significant differences as respect to serum viral loads among the three groups (P>0.05); before and after antiviral treatment, percentages of peripheral blood CD3⁺ and CD4⁺ cells as well as ratio of CD4⁺/CD8⁺ cells in patients with CHB/CHC were significantly lower than in those with CHB or with CHC(P＜0.05); at end of 24 week follow-up, there were no virological breakthrough, or disease relapse in the three groups. Conclusion The clinical discrepancy in patients with CHB and CHC as compared to those with CHB or CHC might be slight, and response to antiviral therapy is promising. The long-term outcomes need further investigation.

Objective This study was conducted to investigate application of magnetic resonance proton density fat fraction (MRI-PDFF) in predicting nonalcoholic steatohepatitis (NASH) in overweight and obese children with nonalcoholic fatty liver disease (NAFLD). Methods 74 overweight and 28 obese children with NAFLD were enrolled in 903^rd Hospital, Jiangyou, between December 2022 and December 2023, and all underwent liver biopsies for diagnosis of NASH. MRI-PDFF was obtained by MRI scan, liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were determined by Fibroscan and area under receiver operating characteristic (AUC) was applied to predict diagnostic performance. Results Of the 102 overweight/obese children, histo-pathological examination diagnose simple nonalcoholic fatty liver (SNFL) in 75 cases and NASH in 27 cases; basic mass index, serum ALT, AST, TG, MRI-PDFF, LSM and CAP in children with NASH were (32.2±3.4)kg/m², (92.7±31.3)U/L, (96.8±34.1)U/L, (3.1±1.2)mmol/L, (12.5±4.7)%, (11.7±1.4)kPa and (370.4±146.9)dB/m, all significantly different compared to[(26.7±2.2)kg/m², (38.2±4.4)U/L, (33.0±3.4)U/L, (2.3±0.7)mmol/L, (7.7±2.0)%, (6.2±1.0)kPa and (262.3±61.2)dB/m, respectively, P<0.05)] in those with SNFL; percentages of overweight and obese in children with NASH were 37.0% and 63.0%, much different compared to 85.3% and 14.7% in those with SNFL (P<0.05); ROC analysis showed that the AUC was 0.87(95%CI:0.80-0.93), with sensitivity (Se) of 81.5% and specificity (Sp) of 85.3%, when MRI-PDFF was 11.9% as the cut-off-value in predicting NASH, while the AUC was 0.81(95%CI:0.78-0.89), with Se of 85.2% and Sp of 58.7% (P<0.05), when LSM was 10.8 kPa and CAP was 310.5dB/m combination as the cut-off-value. Conclusion The diagnostic performance of MRI-PDFF in predicting NASH in overweight/obese children with NAFLD is satisfactory, and from the economic and convenient point of view, we recommend Fibroscan for screening.

Objective This study summarized research status of clinical trials related to non-alcoholic fatty liver diseases (NAFLD) registered in Chinese Clinical Trials Registry (ChiCTR). Methods The ChiCTR database was searched for clinical trials related to NAFLD up to July 15, 2023. Excel 2019 software was used to analyze the registration time, region and institution, funding source, research type, design scheme, intervention measures, research stage, randomization or blinding method, research centers, sample size and other feature of the included clinical trials. Results A total of 102 clinical trials related to NAFLD study were included, mainly intervention studies, with a total sample of 144694 cases; the registered areas covered 17 provinces and municipalities directly under the Central government, mainly distributed in Shanghai, Guangdong, Zhejiang and other regions; the study design was mainly randomized parallel controlled studies, while there were 37 studies missing blind method or blanks; intervention measures mainly included medicine and lifestyle, modern diagnosis and treatment technology and combined interventions; the research phase mainly included exploratory research/pre-trial, post-marketing drugs/phase 4 trial and phase I clinical trial; there were 88 single-center studies, while multi-center study seldom if ever. Conclusion The numbers of NAFLD related clinical trial registrations in China is increasing, but lack of high-level, well-designed and multi-center studies.

Objective The aim of this study was to investigate diagnostic performance of four noninvasive indexes in predicting liver cirrhosis (LC) in patients with autoimmune liver diseases (AILDs). Methods 130 patients with AILDs, including autoimmune hepatitis (AIH) in 93 cases and autoimmune hepatitis-primary biliary cholangitis overlap syndrome (AIH-PBC OS) in 37 cases, were encountered in our hospital between April 2017 and September 2020, and all underwent liver biopsies. Aspartate aminotransferase to platelet ratio index (APRI), fibrosis index based on the four factors (FIB-4), aspartate aminotransferase to alanine aminotransferase ratio (AAR) and liver stiffness measurement (LSM) were routinely obtained. Diagnostic efficacy was assessed by area under receiver operating characteristic curve (AUROC). Results Liver histopathological examination showed LC in 21 patients (22.6%) from AIH and 6 patients (16.2%) from AIH-PBC OS; no matter in patients with AIH or with AIH-PBC OS, LSM, FIB-4 and AAR in patients with LC were significantly higher than in those without (P＜0.05); the AUCs were 0.876, 0.783 and 0.745 in predicting LC in patients with AIH, when LSM, FIB-4 and AAR greater than 17.7 kPa, 3.6 and 1.1 were set as the cut-off-values, and the AUCs were 0.989, 0.914 and 0.833 in predicting LC in patients with AIH-PBC OS, when LSM, FIB-4 and AAR greater than 22.9 kPa, 7.7 and 1.0 were set as the cut-off-values. Conclusion Noninvasive LSM, FIB-4 and AAR could predict LC in patients with AILDs, which might be helpful for screening and early diagnosis.

Objective This study aims to assess therapeutic efficacy and safety of mycophenolate mofetil (MMF) in rescue treatment of patients with refractory autoimmune hepatitis (rAIH). Methods 23 patients with rAIH were encountered in our hospital between January 2015 and June 2021, all were treated with MMF and methylprednisolone combination, doses were gradually tapped according to the improvement, and the regimen lasted for up to 20 months and followed-up for two years. Liver biopsies were carried out before and after treatment. Univariate and multivariate Logistic regression analysis were applied to predict impacting factors of response. Results By end of treatment, serum ALT, AST and IgG levels in 23 patients with rAIH were (63.7±13.4)U/L,(54.1±14.5)U/L and (13.8±3.5)g/L, all significantly decreased as compared to [(167.3±43.1)U/L, (124.8±22.6)U/L and (17.4±4.4)g/L, respectively, P<0.05] at presentation; liver tissue fibrosis score was (2.0±1.1) and hepatic activity index (HAI) was (1.5±1.3), both much lower than [(2.7±1.6) and (2.4±1.2), P<0.05] before treatment; by end of follow-up, complete clinical remission (CCR) was obtained in 18 cases and incomplete response (IR) in 5 cases; at enrollment, female proportion, serum ALT and IgG levels, liver fibrosis and HAI scores in patients with CCR were significantly lower than in those with IR (P<0.05); multivariate Logistic regression analysis showed that female (OR=1.04, 95%CI=0.9-1.5), serum IgG level (OR =1.17, 95%CI=1.0-2.3) and hepatic fibrosis score (OR =4.4, 95%CI=1.8-9.3) were all the independent factors impacting response to rescue therapy. Conclusion Rescue therapy with MMF is safe, reliable and efficacious in the treatment of patients with rAIH, which is worth further clinical trial to verify.

Objective The aim of this study was to summarize clinical feature of patients with serum anti-nuclear antibody (ANA) positive drug-induced liver injury (DILI). Methods 64 patients with DILI were admitted to the First Affiliated Hospital, Anhui Medical University between December 2019 and April 2023, and all patients underwent liver biopsies to exclude autoimmune hepatitis (AIH). Serum ANA was found positive in 31 patients and negative in 33 patients. Results Of the 64 patients with DILI, the blamed medicines included herbal medicine in 59.4%, antibiotics in 10.9% and nonsteroidal antiinflammatory drugs in 4.7%; the hepatocellular injury type accounted for 65.6%, cholestatic type for 17.2% and mixed type for 17.2%; of patients with serum ANA positive , the hepatocellular injury type, cholestatic type and mixed type accounted for 77.4%, 6.5% and 16.1%, not significantly different as compared to 54.5%, 5.2% and 30.3% in those with serum ANA negative (P>0.05); serum globulin and Ig G levels in DILI patients with serum ANA positive were 26.1(22.2, 29.9)g/L and 13.6(12.1, 17.7)g/L, both significantly higher than [22.9(21.6, 25.2)g/L and 11.5(9.4, 12.9)g/L, respectively, P＜0.05] in those with serum ANA negative; all patients in the two groups recovered, except for one in serum ANA positive group, who ultimately transferred to drug-induced autoimmune hepatitis (DI-AIH) and two also with serum ANA positive, who transferred to immune mediated drug-induced liver injury (IM-DILI), and the three patients got their liver function tests recovered after oral steroid administration. Conclusion DILI patients with serum ANA positive could recover smoothly, some of them might switch to DI-AIH or IM-DILI, and needs steroid therapy.

Objective This study was conducted to summarize clinical feature of elderly patients with drug-induced liver injury (DILI), and to investigate risk factors impacting severity of liver illness. Methods 181 elderly patients with various underlying diseases were encountered in our hospital between December 2018 and February 2024, and DILI was routinely diagnosed, catalogued and liver injury determined. Univariate and multivariate Logistic regression analysis was applied to find risk factors for liver injuries. Results Of 181 elderly patients, DILI was diagnosed in 44 cases(24.3%), including hepatocellular injury in 28 cases, cholestasis in 12 cases and mixed type in 4 cases; there were mild liver injury in 25 cases, moderate in 10 cases, severe in 8 cases and dead in 1 cases; suspected herbal medicines accounted for 27.3%, health care agents for 22.7%, agents for endocrine diseases for 13.6% and medicines for cardiovascular diseases for 11.4%, etc; ages in patients with DILI was 72(66, 76)yr, much greater than [67(65, 69)yr, P<0.05] in patients without DILI, percentages of multiple concurrent underlying diseases, alcohol abuse, fatty liver and hyperlipidemia were 79.6%, 27.3%, 56.8% and 84.1%, all much higher than 11.7%, 3.6%, 12.4% and 8.7% (all P<0.05) in patients without DILI; ages in 9 patients with liver injury grade 3 or more was 73(67, 75) yr, much older than [67(66, 70)yr, P<0.05] in 35 patients with liver injury of grade 2 or less, percentages of ethanol intake, multiple underlying diseases and concurrent fatty liver was 88.9%, 100.0% and 88.9%, all significantly greater than 11.4%, 74.3% and 48.6% (all P<0.05) in patients with grade 2 or less liver injuries; multivariate Logistic regression analysis showed that elderly [OR:1.67, 95%CI:1.26-3.05], alcohol abuse [OR:2.43, 95%CI:1.35-3.17] and fatty liver [OR:2.14, 95%CI:1.50-4.75] were all the risk factors impacting severity of liver injuries in elderly patients with DILI(P<0.05). Conclusion Herbal medicine, health care drugs, agents for endocrine and cardiovascular diseases could lead to DILI occurrence in elderly patients with multiple system diseases, in which drug-drug interactions might involve in this setting, and clinicians should carefully deal with underlying diseases, and prescribe medicines as necessary as possible.

Objective The aim of this study was to explore the predictive efficacy of serum wingless-type MMTV integration site family member 5a (wnt5a) and microtubule-associated protein 1 light chain 3 II (LC3-II) levels and the model of end-stage liver disease (MELD) score for short-term prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods A total of 152 patients with HBV-ACLF were encountered in our hospital between January 2018 and December 2022, and all patients were routinely carefully managed for supporting and anti-viral treatment. The MELD scores were calculated, and serum serum wnt5a and LC3-II levels were detected by ELISA. The influencing factors of short-term prognosis in patients with HBV-ACLF were analyzed by the Logistic regression analysis, and the predictive performance was evaluated by the receiver operating characteristic (ROC) curves. Results At the end of three month treatment, 112 patients survived of liver failure and 40 (26.3%)patients died; the age, incidence of hepatic encephalopathy (HE), INR, total serum bilirubin level, MELD score and serum wnt5a level in dead patients were (51.3±5.1)yr, 70.0%, (3.2±0.9), (441.5±89.7)μmol/L, (28.2±4.3) and (2.8±1.5)ng/mL, all significantly higher or greater than [(45.4±4.6)yr, 20.0%, (1.7±0.3), (280.6±73.1)μmol/L, (19.7±2.8) and (1.3±0.2)ng/mL, respectively, P＜0.05], while blood platelet count and serum LC3-Ⅱ level were (77.8±10.3)×10⁹/L and (20.6±2.1)μg/mL, both significantly lower than [(116.4±11.7)×10⁹/L and (32.5±3.9)μg/mL, respectively, P＜0.05] in the survivals; the multivariate Logistic regression analysis showed that the age, HE, elevated serum wnt5a level or reduced serum LC3-Ⅱ level were all the factors impacting the short-term prognosis (P＜0.05); the sensitivity and the specificity were 80.0% and 92.9%, respectively when the MELD score greater than 26.9 was set as the cut-off-value in predicting the short-term prognosis in patients with HBV-ACLF, and the detection of serum wnt5a and LC3-Ⅱ levels could improve the prediction. Conclusion The combination of serum wnt5a and LC3-II levels and MELD score is efficacious in predicting the short-term prognosis of patients with HBV-ACLF.

Objective The purpose of this study was to investigate the diagnostic efficacy of serum C-reactive protein (CRP) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) levels for secondary infections in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). Methods 96 consecutive patients with HBV-ACLF were encountered in our hospital between February 2020 and February 2023. Serum CRP and sTREM-1 levels were measured by ELISA. The multivariate Logistic regression analysis was conducted to identify the influencing factors for secondary infections in patients with HBV-ACLF. The diagnostic performance of above parameters was evaluated by using the receiver operating characteristic (ROC) curve. Results 67 (69.8%) patients with HBV-ACLF in our series developed secondary infections, and the spontaneous bacterial peritonitis, pulmonary infection, urinary tract infection, biliary tract infection, intestinal infection, and skin and soft tissue infection accounted for 40.3%, 31.3%, 11.9%, 4.5%, 4.5%, and 7.5%, respectively; the model of end-stage liver disease score and chronic liver failure sequential organ failure assessment score in patients with infection were (15.7±3.0) and (8.5±1.1), both significantly greater than [(12.40±3.00) and (6.1±1.0), P<0.05] in patients without infection; serum CRP and sTREM-1 levels in patients with infection were (52.2±4.6)mg/L and (29.9±5.8)pg/mL, both much higher than [(10.1±3.3)mg/L and (13.3±4.1)pg/mL, P<0.05] in those without; the Logistic regression analysis showed that the international normalization ratio, serum CRP, sTREM-1 and procalcitonin levels were all the independent risk factors for secondary infection (P<0.05); the ROC analysis demonstrated that the AUC was 0.906, with the sensitivity of 98.5% and the specificity of 82.8%, when serum CRP and sTREM-1 level combination was applied to predict the existence of infection, much superior to any parameter alone (P<0.05). Conclusion The surveillance of serum CRP and sTREM-1 level could help diagnose the secondary infections in patients with HBV-ACLF, which needs further clinical investigation.

Objective The purpose of this study was to investigate the effect of balloon-compression endoscopic injection sclerotherapy (bc-EIS) in the treatment of patients with decompensated stage of hepatitis B cirrhosis and esophageal varices (EV), and the impact on rebleeding rate. Methods 78 patients with decompensated stage of hepatitis B cirrhosis and EV were diagnosed and treated in our hospital between January 2021 and January 2022. All of them were given conventional treatments such as acid suppression, hemostasis and blood transfusion. Among them, 39 patients received endoscopic variceal ligation (EVL) (control group) and 39 patients received bc-EIS (observation group). All patients were followed up for twelve months. Curative effect, treatment indicators, adverse reactions and prognosis were compared between the groups. Ultrasound was used to measure portal vein diameter (PVD), portal vein velocity (PVV), splenic vein diameter (SVD) and splenic vein velocity (SVV). Results The first variceal eradication rate and esophageal varices eradication rate after 1 to 2 times in the observation group were 87.2% and 100.00%, significantly higher than that in the control group (66.7% and 89.7%, P<0.05). The number of treatments, hospitalization time, and treatment costs for achieving EV eradication in the observation group were (1.6±0.3) times, (7.7±1.0) days and (19±6) thousand yuan, lower than those in the control group[(2.4±0.5) times, (10.1±1.3) days, and (26±7) thousand yuan, P<0.05]. During the 6 months of follow-up, PVV and SVV in the observation group were (19.04±2.12) cm/s and (21.35±2.25) cm/s, significantly higher than those in the control group[(22.49±2.37) cm/s and (19.58±2.61) cm/s, P<0.05)]. The incidence of esophageal ulcers in the observation group was 35.9%, significantly higher than the control group (17.9%, P<0.05). During the 6 months of follow-up, the recurrence rate and rebleeding rate of EV in the observation group were 2.7% and 2.7%, significantly lower than that in the control group (20.0% and 22.9%, P<0.05). During the 12 months of follow-up,the recurrence rate and rebleeding rate of EV in the observation group were 3.0% and 6.1%, significantly lower than that in the control group (26.7% and 33.3%, P<0.05). Conclusion bc-EIS can improve curative effect on hepatitis B cirrhosis with EV, reduce the incidence of EV recurrence and rebleeding by improving portal and splenic venous hemodynamics, and alleviate the economic burden on patients.

Objective The aim of this study was to investigate the changes of serum monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor -α (TNF-α) and interleukin-10 (IL-10) levels in patients with hepatitis B-induced liver cirrhosis (LC) and with complicated spontaneous bacterial peritonitis (SBP). Methods 63 patients with hepatitis B-induced LC and SBP, and 82 patients with hepatitis B-induced LC were enrolled in our hospital between January 2018 and January 2022, and the patients with SBP were treated with antibiotics for two weeks. Serum MCP-1, TNF-α and IL-10 levels were detected by ELISA. The multivariate Logistic regression analysis was applied to reveal the risk factors for the relapse of SBP, and the area under receiver operating characteristic curve (AUROC) was conducted to predict the efficacy of parameters for relapse of SBP. Results At admission, serum MCP-1, TNF-α and IL-10 levels in patients with SBP were (354.7±73.9)pg/mL,(13.4±3.1)pg/mL and (11.4±1.7)pg/mL, all significantly higher than [(193.8±42.3)pg/mL, (8.8±2.4)pg/mL and (8.1±1.2)pg/mL, respectively, P<0.05] in patients with LC, and at the convalescent stage, serum cytokine levels in patients with SBP were still much higher than in patients with LC (P<0.05); during two-year follow-up period, the SBP relapsed in 31 cases (49.2%), and the incidence of esophageal variceal bleeding in relapsed patients was41.9%, much higher than 6.3% in patients without relapsed SBP (P<0.05); serum MCP-1, TNF-α and IL-10 levels in relapsed SBP patients were significantly higher than in those without relapsed SBP (P<0.05); the multivariate Logistic regression analysis showed that serum MCP-1, TNF-α, IL-10 and albumin levels were all the independent risk factors for SBP relapse (P<0.05); the ROC analysis demonstrated that serum MCP-1, TNF-α, IL-10 and albumin levels at the convalescent stage could predict the relapse of SBP, with the AUCs of 0.91, 0.91, 0.92 and 0.76, respectively, suggesting serum cytokine levels superior to albumin (P<0.05). Conclusion The surveillance of serum MCP-1, TNF-α and IL-10 levels might predict the relapse of SBP, which is worthy of further clinical investigation.

Objective The aim of this study was to observe the efficacy of bone marrow mesenchymal stem cell (BMSC) transplantation and herbal medicine in treatment of patients with decompensated cirrhosis. Methods A total of 93 patients with decompensated cirrhosis were encountered in our hospital between June 2017 and October 2022, and were randomly divided into group A, group B and group C. The patients in the group A were dealt with comprehensive internal medicines, and those in the group B received BMSC transplantation and the patients in the group C were treated with BMSC transplantation and thereafter herbal medicine therapy for six months. Serum hyaluronic acid (HA), type-IV collagen (CIV), laminin (LN) and type-III precollagen (PIIIP) levels were detected by radioimmunoassay, and serum interleukin-6 (IL-6) and tumor necrosis factor-α(TNF-α) levels were detected by ELISA. Serum superoxide dismutase (SOD) and malondialdehyde (MDA) levels were detected by xanthine oxidase method and thiobarbituric acid method. Results At the end of 6 month treatment, the Child-Pugh score and liver stiffness measurement (LSM) in group C were(7.2±1.2) and (9.0±0.6)kPa, both significantly lower than [(8.0±1.1) and (9.3±0.5)kPa, P＜0.05] in group B or [(8.9±1.4) and (9.6±0.6)kPa, P＜0.05] in group A, while serum albumin level was (34.6±3.1)g/L, much higher than [(32.0±1.9)g/L, P＜0.05] in group B or [(30.8±2.4)g/L, P＜0.05] in group A; serum HA and LN levels were (123.8±31.8)ng/mL and (112.9±27.5)ng/mL, both significantly lower than [(141.7±29.5)ng/mL and (129.3±30.3)ng/mL, P＜0.05] in group B or [(186.2±36.7)ng/mL and (161.1±36.5)ng/mL, P＜0.05] in group A; serum IL-6, TNF-α and MDA levels were (104.6±16.7)ng/L, (192.7±19.8)ng/L and (4.1±0.9)μmol/L, all significantly lower than [(114.3±15.3)ng/L, (210.9±22.8)ng/L and (5.0±1.3)μmol/L, P＜0.05] in group B or [(132.8±19.5)ng/L, (230.2±27.1)ng/L and (6.2±1.5)μmol/L, P＜0.05] in group A, while serum SOD level was (143.9±14.5) U/mL, significantly higher than [(134.2±13.3)U/mL, P＜0.05] in group B or [(122.1±11.7)U/mL, P＜0.05] in group A. Conclusion The BMSC transplantation followed by herbal medicine in treatment of patients with decompensated liver cirrhosis could alleviate liver fibrosis and improve liver functions, which might be related to the inhibition of inflammatory cytokines and oxidative stress response.

Objective This study aimed to investigate the etiologies and complications in adults with liver cirrhosis (LC) in First Hospital, Peking University (Center A) and Guizhou Provincial People's Hospital (Center B). Methods A total of 1813 patients with LC in Center A, 388 LC patients in Center B were hospitalized between January 2018 and December 2020, and after exclusion, 700 patients (including hepatitis B in 252 cases) in the former and 340 patients (HBV infection in 137 cases) in the latter were enrolled in this study. Results The common causes of LC in the two centers were hepatitis B, hepatitis C, alcoholic liver diseases (ALD), primary biliary cirrhosis and autoimmune hepatitis, with some uncommon etiologies, such as drug-induced liver injury, inherited metabolic liver disease and cryptogenic liver diseases; the ALD accounted for 23.2% and hepatitis B with concomitant ALD for 17.7% in Center B, both significantly higher than 13.0% and 4.1% (P<0.05) in Center A; incidence of hepatocellular carcinoma in Center A was 27.0%, much higher than 14.1%(P<0.05) in Center B, while the percentages of patients with esophagogastric varices, ascites, infections and Child-Pugh class C in Center B were 61.5%, 80.6%, 50.9% and 52.1%, all much higher than 43.4%, 39.3%, 17.4% and 14.1%(P<0.05) in Center A. Conclusion The main causes of LC in China are still HBV infection and ALD, which varied a little in different regions, and patients in some areas might have a poor liver function states, more complications and need more attentions.

Objective The aim of this study was to investigate dezocine anesthesia induction and propofol target-controlled infusion maintaining in patients withliver cirrhosis (LC) and esophageal variceal bleeding (EVB) underwent endoscopic sclerotherapy. Methods 64 hepatitis B-induced LC patients with EVB encountered in our hospital underwent endoscopic lauromacrogol injection, and 32 patients were assigned to control and another 32 to observation group. For anesthesia, the propofol target-controlled infusion was maintained in the two groups, and dezocine induction was given in the observation, additionally. The postoperative pain was evaluated by visual analogue scale (VAS). Serum neuropeptide Y (NPY), substance P (SP), norepinephrine (NE) and dopamine (DA) levels were detected by ELISA, and serum total antioxidant capacity (T-AOC), superoxide dismutase (SOD) and malondialdehyde (MDA) levels were routinely assayed. Results The mean arterial pressure and heart rate at anesthesia induction and endoscopic insertion in the observation were significantly greater or quicker than in the control(P＜0.05); the propofol dosage in the observation was (461.3±14.1)mg, much lower than [(482.9±15.8)mg, P＜0.05], wake-up time was (5.1±1.3)min, much shorter than [(6.7±1.4)min, P＜0.05] in the control, while there was no significant difference in restless scores between the two groups (P>0.05); at 1 hour and 3 hours after operation, the static and dynamic VAS scores in the observation were much lower than in the control (P＜0.05); at the end of six hours after endoscopic sclerotherapy, serum NPY, SP, DA and NE levels in the observation were (155.7±21.9)pg/mL,(2.6±0.6)g/mL, (71.6±11.2)mmol/L and (2.5±0.6)pg/mL, all significantly lower than [(189.3±22.8)pg/mL, (3.8±0.8)g/mL, (84.3±12.7)mmol/L and (3.9±0.5)pg/mL, respectively, P＜0.05] in the control; serum SOD and T-AOC levels were (73.1±6.1)U/mL and (15.2±1.4)U/mL, both significantly higher than [(64.2±5.7)U/mL and (12.0±1.1)U/mL, P＜0.05], while serum MDA level was (3.7±0.6)mmol/L, significantly lower than [(6.2±0.7)mmol/L, P＜0.05] in the control; the incidence of nausea and vomiting in the observation was 3.1%, much lower than 25.0%(P＜0.05) in the control group. Conclusion During endoscopic sclerotherapy, the dezocine induction before propofol maintaining analgesia could improve the analgesic effects and decrease adverse events in patients with EVB, which might be related to the inhibition of oxidative stress.

Objective The purpose of this study was to investigate the diagnostic performance of computed tomography (CT)-detected parameters and fibrosis-4 (FIB-4) and serum vascular endothelial growth factor (VEGF) levels in predicting esophageal varices (EV) in patients with hepatitis B-induced liver cirrhosis (LC). Methods 98 patients hepatitis B-induced LC were admitted to our hospital between March 2020 and April 2023, and all patients underwent gastroscopy to find EV. The CT examination was conducted to measure the liver and spleen volumes, and the main portal vein (MPV), the splenic vein (SPV) and the left gastric vein (LGV) diameters. The FIB-4 was calculated, and serum VEGF levels were measured by ELISA. The receiver operating characteristic (ROC) curve was plotted, and the diagnostic performance was evaluated based on the area under the curve (AUC). Results Out of the 98 patients with LC in our series, the gastroscopy found EV in 48 cases; the volume of spleen, the MPV and the LGV in patients with EV were (581.7±98.6)cm³, (15.2±1.3)mm and (6.1±0.5)mm, all significantly higher than [(452.6±84.9)cm³, (12.1±0.8)mm and (4.2±0.3)mm, respectively, P<0.05] in those without EV; the FIB-4 score and serum VEGF level were (6.0±1.3) and (101.7±28.1)ng/L, both significantly higher than [(4.3±0.9) and (65.7±15.7)ng/L, P<0.05] in patients without EV; the AUC was 0.967(95% CI:0.931-0.997), with sensitivity of 91.8% and the specificity of 90.0%, when the combination of the spleen volume, MPV, LGV, FIB-4 and serum VEGF level was applied to predict the existence of EV. Conclusion The CT measured parameters of portal veins and FIB-4 and serum VEGF levels in predicting EV in patients with LC could achieve a promising diagnosing performance, which might help the clinicians make an appropriate managements.

Objective This study was conducted to investigate the long-term efficacy of combined stents and Viatorr stents in transjugular intrahepatic portosystemic stent shunt (TIPSS) for treatment of patients with liver cirrhosis (LC) and complicated portal hypertension (PH). Methods All patients in our series underwent TIPSS, 29 patients were assigned to combined stents and 22 to Viatorr stents and all were followed-up for five years. The patency of the intrahepatic shunts were check-up by ultrasonography or/and CT scan. The survival was compared by Kaplan-Meier method. Results The operational costs in patients in Viatorr group was 73282.9(68190.6, 81242.2)yuan, much greater than [61912.7(53713.6,67530.3)yuan, P<0.05] in patients in combined stents; at the end of one, two, three, four and five years after TIPSS, the cumulative patency of intrahepatic stents in patients with Viatorr were 90.9%, 77.3%, 72.7%, 71.4% and 68.4%, and they were 86.7%, 80.0%, 76.7%, 73.3% and 70.0% in patients with combined stents, not significantly different between the two groups (P＞0.05); the cumulative survival rates in patients with Viatorr stent were 95.5%, 77.3%, 72.7%, 68.2% and 59.1%, also not significantly different as compared to 93.3%, 86.7%, 83.3%, 83.3% and 79.9% in patients with combined stents (P＞0.05). Conclusion We recommend the choice of combined stents or Viatorr stents for TIPSS surgery as the supply available, as the two have a relatively similar promising efficacy in dealing with cirrhotics with PH.

Objective The aim of this study was to explore the diagnostic performance of contrast-enhanced magnetic resonance imaging (MRI) and intravoxel incoherent motion-diffusion weighted imaging (IVIM-DWI) in patients with small hepatocellular carcinoma (sHCC). Methods 73 patients with focal nodular hyperplasia (FNH ) were enrolled in our hospital between May 2020 and May 2023, and all patients underwent contrast-enhanced MRI and IVIM-DWI, recording the pseudo diffusion coefficient (D^*), true diffusion coefficient (D) and perfusion fraction (f). The fine needle aspiration biopsies or postoperative histopathology were performed for golden diagnosis. The diagnostic efficacy of contrast-enhanced MRI and IVIM-DWI was evaluated by receiver operating characteristic (ROC) curves. Results Among the 73 patients with FNH, the histopathology examination showed sHCC in 49 cases (67.1%) and the dysplastic nodules (DN) in 24 cases(32.9%); the percentages of low signals on T1WI, high signals on T2WI, arterial phase enhancement and low signals during hepatobiliary phase in HCC lesions were 61.2%, 83.7%, 59.2% and 89.8%, all significantly higher than 20.8%, 33.3%, 25.0% and 29.2%(P＜0.05) in DN lesions; the D^* and D in HCC lesions were (50.9±11.6)×10^-3mm²/s and (0.8±0.2)×10^-3mm²/s, both significantly less than [(78.4±15.8)×10^-3mm²/s and (1.2±0.3)×10^-3mm²/s, P＜0.05] in DN lesions, while there was no significant difference as respect to f between the two lesions [(45.6±8.7)% vs.(43.9±9.5)%, P＞0.5]; the ROC analysis showed the AUC was 0.968, with the sensitivity of 100.0% and the specificity of 86.0%, when the T1WI and T2WI signals, arterial phase enhancement, hepatobiliary phase signal, D^* and D was combined for the diagnosis of sHCC. Conclusion The contrast-enhanced MRI and IVIM-DWI are efficacious in the diagnosis of patients with sHCC, which might provide the clinicians a reliably tool for early differentiation of patients with FNH.

Objective The aim of this study was to explore the efficacy of camrelizumab and apatinib combination in the treatment of patients with advanced primary liver cancer (PLC). Methods 62 patients with advanced PLC were enrolled in our hospital between August 2018 and August 2021, and were divided randomly into control group (n=31) and observation group (n=31), receiving apatinib or camrelizumab and apatinib combination therapy for three months. The percentages of peripheral blood T lymphocyte subsets were detected by flow cytometry, and serum alpha-fetoprotein (AFP), heat shock protein 90α (HSP90α) and carcinoembryonic antigen (CEA) levels were detected by electrochemiluminescence. Results At the end of 3 month treatment, the Objective remission rates in the observation and control group were 58.1% and 32.3%, respectively (P<0.05); the percentage of peripheral blood CD4⁺ cells and the ratio of CD4⁺/CD8 ⁺ cells in the observation group were (38.3±2.6)% and (1.3±0.2), both significantly higher than [(34.5±2.9)% and (1.1±0.2), P<0.05] in the control; serum AFP, HSP90α and CEA levels were (143.6±26.5)μg/L, (93.2±22.4)ng/mL and (13.2±4.3)ng/mL, all much lower than [(204.5±29.6)μg/L, (129.1±23.5)ng/mL and (28.6±4.8)ng/mL, respectively, P<0.05] in the control; the mean overall survivals in the two groups were 14 months and 10 months (Log Rank x²=5.033, P=0.025). Conclusion The combination of camrelizumab and apatinib therapy has a certain clinical efficacy in the treatment of patients with advanced PLC, which might slightly safely prolong the survival.

Objective The aim of this study was to explore the efficacy and safety of camrelizumab and lenvatinib combination in the treatment of patients with advanced primary liver cancer (aPLC). Methods 78 patients with aPLC were enrolled in our hospital between April 2019 and April 2021, and were randomly divided into control (n=39) and observation group (n=39), receiving camrelizumab or camrelizumab and lenvatinib combination therapy until progression of the disease or death. The Objective response rate (ORR) and disease control rate (DCR) were recorded. Serum alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and carbohydrate antigen 199 (CA199) levels were detected by chemiluminescence immunoassay. The survival analysis was conducted by Kaplan-Meier method. Results After treatment, the ORR and DCR in the observation group were 56.4% and 92.3%, much higher than 33.3% and 74.4%(P<0.05)in the control; serum AFP level in the observation group was (78.9±17.4) ng/ml, much lower than [(152.6±31.5)ng/ml, P<0.05] in the control; at the end of two-year follow-up, the mean progression free survival(PFS) in the observation and control groups were 16.2 mon and 12.3 mon, the PFS rates were 38.5% and 25.6%(P＞0.05), and the mean overall survival (OS) were 20.3 mon and 16.0 mon, with the OS rates of 61.5% in the observation, much greater than 38.5% (P<0.05) in the control; during the treatment period, the incidence rates of rash, fatigue, anorexia, hypertension and urinary protein positive in the observation group were 12.8%, 17.9%, 10.3%, 7.7% and 7.7%, all not significantly different compared to 10.3%, 20.5%, 7.7%, 7.7% and 5.1% (P＞0.05), while the incidence of reactive capillary hyperplasia in the observation group was 12.8%, which didn’t occurred in the control group. Conclusion The administration of camrelizumab and lenvatinib combination in the treatment of patients with unresectable PLC has to some extent a short-term and long-term efficacy, and the adverse reactions are endurable.

Objective This study was conducted to explore the functional enrichment pathways and key genes in hepatocarcinogenesis. Methods We downloaded liver transcriptome data from the Gene Expression Database (GEO) at different stages of hepatitis B infection to hepatocellular carcinoma occurrence. Genes were categorized into different modules by weighted gene co-expression network analysis (WGCNA), and genes in different modules were enriched and analyzed. Important gene levels were further validated by GEO dataset. Results A total of 6145 differential genes were involved in the construction of WGCNA, which categorized genes into nine modules. The evolutionary trajectory from early liver lesions to tumorigenesis was further analyzed, e.g., a linear activation of pathways related to cell proliferation, DNA damage repair, and cellular senescence during the process from normal tissues to oncogenesis; a gradual suppression of pathways related to liver function, such as lipid metabolism and coagulation was found with disease progression; and activation of immune-related pathways was also revealed during the period of chronic inflammation prior to tumors, with a gradual convergence to an inhibitory state in the later stage; Three important senescence-related genes, e.g., CCNA2, UBE2C and ANAPC1, were identified, and the levels of the 3 genes were validated in an external dataset. Our further analysis demonstrated that the levels of the 3 genes were strongly associated with poor prognosis of patients with hepatocellular carcinoma. Conclusion By through bioinformatics analysis, we identify potential pathways and important genes involved in hepatocarcinogenesis, which might provide potential targets for diagnosis and therapeutic intervention in the future.

Objective This study was conducted to explore the differential diagnosis of hepatocellular carcinoma (HCC) and hepatic hemangioma (HCH) by contrast-enhanced ultrasonography(CEUS). Methods 75 patients with intrahepatic space-occupying lesions were enrolled in our hospital between January 2020 and December 2021, and all underwent CEUS before liver histopathological diagnosis was made. The receiver operating characteristic (ROC) curves was applied to reveal the diagnostic performance of parameters by CEUS in differentiating HCC from HCH. Results The histopathological examination showed HCH in 35 cases and HCC in 40 cases in our series; the percentages of clear boundary, high echo and uniform internal echo in HCC lesions were 17.5%, 22.5% and 12.5%, all significantly lower than 65.7%, 65.7% and 74.3% (P＜0.05) , while the percentage of grade II blood flow signal was 67.5%, much higher than 14.3%(P＜0.05) in HCH lesions; the CEUS demonstrated that the proportions of high enhancement during arterial stage in HCC lesions was 65.0%, much lower than 91.4% in HCH lesions, while the proportions of low enhancement during portal and delayed stage were 70.0% and 90.0%, both significantly higher than 8.6% and 42.8%(P＜0.05) in HCH foci; the starting time of enhancement, time to peak and enhancement rate in HCC lesions were (9.6±1.8)s,(25.8±4.1)s and (0.5±0.1), all significantly quicker than [(13.2±2.5)s, (32.3±6.7)s and (0.9±0.2), respectively, P＜0.05] in HCH foci; the ROC analysis showed the AUC was 0.935, with the sensitivity of 82.8% and the specificity of 90.0%, when the combination of the starting time of enhancement, time to peak and enhancement rate was applied to predict the differentiation of HCC from HCH, much superior to any parameter done alone (P＜0.05). Conclusion The perfusion and echo changes during CEUS could provide reliable ultrasonic imaging basis for the differential diagnosis of HCH from HCC, and warrants further clinical investigation.

Objective The aim of this study was to investigate the qualitative diagnosis of hepatic space-occupying lesions (SOL) by contrast-enhanced ultrasonography (CEUS). Methods 97 patients with hepatic SOL were encountered in our hospital between January 2020 and January 2023, and all underwent fine needle aspiration biopsies, and conventional ultrasonography and CEUS. The CEUS data were analyzed by Tom Tec Sono Liver CAP software and the area under receiver operating characteristic curve (AUC) was applied to evaluate the diagnostic efficacy. Results The pathological examination showed that there were malignant lesions in 41 patients, including cholangiocarcinoma in 5 cases, metastatic liver cancer in 10 cases and hepatocellular carcinoma in 26 cases, and benign lesions in 56 patients, including focal nodular hyperplasia in 29 cases and inflammatory pseudotumors in 27 cases; the regional blood flow (rBF) at arterial phase in malignant foci was (63.9±12.1)mL/min, much greater than [(42.7±8.9)mL/min, P<0.05], while the rBF at delayed phase was (17.6±2.4)mL/min, much smaller than [(19.0±2.7)mL/min, P<0.05] in benign foci; the initial peak time, peak time, ascent time and passage time in malignant lesions were(11.5±2.1)s, (34.1±6.9)s, (25.8±4.3)s and (110.5±20.7)s, significantly shorter than [(14.1±2.3)s, (45.9±6.2)s, (37.6±5.8)s and (149.3±24.1)s, respectively, P<0.05], while the perfusion index was(141.2±20.0), much greater than [(89.7±18.9), P<0.05] in benign lesions; the sensitivity, specificity, accuracy, positive predictive value and negative predictive value by conventional ultrasonography in differentiating benign from malignant lesions were 82.9%, 78.4%, 78.4%, 70.8% and 85.7%, while they were 80.5%, 82.1%, 81.4%, 76.7% and 85.2% by CEUS. Conclusion The CEUS has a high diagnostic performance in qualitative diagnosis in patients with hepatic SOL, which might help clinicians make an appropriate measure to deal with it.

Objective The aim of this study was to investigate the performance of CT quantitative parameters in the differential diagnosis of focal nodular hyperplasia (FNH) and hepatocellular carcinoma (HCC). Methods Fifty-one patients with HCC and forty-one patients with FNH were encountered in our hospital between August 2017 and August 2022, and the diagnosis was proved by histo-pathological examination. All patients underwent CT plain scan and perfusion scan, and the CT quantitative parameters, including hepatic blood volume (HBV), hepatic blood flow (HBF), hepatic artery perfusion (HAP), portal vein perfusion (PVP), total liver perfusion (TLP), hepatic artery perfusion index (HPI) and mean transit time (mTT), were recorded. The diagnostic efficacy was analyzed by ROC curve, and the diagnostic accuracy was analyzed by Kappa consistency. Results The HBV, HBF and PVP in cancerous foci were (31.9±10.1)mL/100mL,(204.7±66.3)mL/(100mL·min) and (22.8±6.4)mL/(100mL·min), all significantly higher than [(21.4±6.8)mL/100mL, (115.7±33.9)mL/(100mL·min) and (9.2±3.0)mL/(100mL·min), P＜0.05], while the HAP, HPI and mTT were (42.8±12.7)mL/(100mL·min), (64.1±10.7)% and (5.3±1.5)s, all significantly lower than [(61.8±20.4)mL/(100mL·min), (87.5±6.1)% and (8.2±2.4)s, respectively, P＜0.05] in foci of FNH; the ROC analysis showed that the AUCs were 0.787, 0.951, 0.811, 0.915, 0.949 and 0.841(all P＜0.05), when the HBV, HBF, HAP, PVP, HPI and mTT were applied to predict HCC; the Kappa consistency demonstrated that the sensitivity, specificity and accuracy were 0.941, 0.976 and 0.957 (Kappa=0.912) when the combination of HBV, HBF, HAP, PVP, HPI and mTT was applied for the diagnosis of HCC. Conclusion The differentiating diagnosis of HCC from FNH by CT quantitative parameters is efficacious, which might greatly help appropriate management in clinical practice.

Objective The aim of this study was to analyze the clinical and imaging feature in patients with focal nodular hyperplasia of the liver (FNH) . Methods A total of 96 patients with FNH were encountered in our hospital between March 2020 and March 2023, and all underwent color Doppler ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI). The diagnosis was made based on histo-pathological examinations. Results Among the 96 patients with FNH, the upper abdominal fullness and discomfort was found in 19 cases (19.8%), hepatitis B carriers in 8 cases (8.3%) , serum alpha-fetoprotein (AFP) negative in 95 cases (99.0%) and slightly elevated in 1 case (1.0%), slight serum alanine aminotransferase and/or aspartate aminotransferase level elevation in 14 cases (14.6%) ; the pathological examination diagnosed typical FNH in 86 cases (89.6%) and non-typical FNH in 10 cases (10.4%); the abdominal color Doppler ultrasonography showed most of the lesions with clear boundaries, low echo area in 79 cases, even echo in 13 cases, high echo in 4 cases, and abundant blood flow signals in 57 cases; the CT imaging showed that there were slightly low-density or isodensity or uniform density nodules, with clear boundary from the surrounding liver parenchyma, and uniform enhancement at arterial phase in 83 cases, and without enhancement in 13 cases; out of the 38 patients underwent upper abdominal MRI scan, showed equal or low signals of the lesions on T1WI, equal or high signals on T2WI, with clear boundaries, and the lesions were obviously enhanced at arterial phase, equal or slightly high signals at portal venous phase and reduced enhancement at delayed phase. Conclusion There is a lack of specific clinical and imaging manifestations in most patients with FNH, and the biopsies or even direct surgery might be the optimal choice at this scenario.

Objective The aim of this study was to observe the alleviative treatment of percutaneous transhepatic biliary drainage (PTBD) and auxiliary bile entering to gut in treatment of patients with malignant obstructive jaundice. Methods A total of 100 patients with malignant obstructive jaundice, including bile duct cancer in 42 cases, pancreatic cancer in 35 cases and gallbladder cancer in 23 cases, were encountered in our hospital between September 2019 and September 2022, and were randomly divided into control group (n=50) and observation group (n=50), receiving PTBD alone, or the auxiliary bile entering to gut at base of PTBD treatment. Blood parameters were detected by PUZS-600A automatic biochemical analyzer. Results At the end of two week treatment, the body mass index, blood sodium, blood potassium and serum albumin levels in the observation group were(20.3±2.2)kg/m², (144.8±14.6)mmol/L, (4.6±0.5)mmol/L and (35.2±4.2)g/L, significantly higher than [(16.9±1.8)kg/m²,(138.2±10.7)mmol/L, (4.3±0.4)mmol/L and (30.1±4.9)g/L, respectively, P＜0.05] in the control; serum bilirubin, aspartate aminotransferase, alanine aminotransferase and glutamyl transpeptidase levels in the observation group were(142.5±34.5)μmol/L, (42.7±18.6)U/L, (45.9±12.9)U/L and (215.2±74.3)U/L, all significantly lower than [(172.3±36.8)μmol/L, (58.4±14.4)U/L, (62.35±17.8)U/L and (271.9±62.1)U/L, respectively, P＜0.05] in the control; post-operationally, there were bile exosmosis in 5 cases, local catheterization site pain in 8 cases, diarrhea in 1 case and biliary peritonitis in 1 case in the observation group, and there were bile exosmosis in 6 cases, local catheterization site pain in 11 cases and biliary peritonitis in 3 cases in the control, without significant difference between the two groups (30.0% vs. 40.0%, P＞0.05). Conclusion The application of PTBD and auxiliary bile entering to gut in the treatment of patients with malignant obstructive jaundice could relief transiently hyperbilirubinemia and improve the nutritional status, which warrants further clinical investigation.

Objective The aim of this study was to summarize the feature of spiral CT multi-phase enhancement of inflammatory pseudotumor of the liver (IPL). Methods 32 patients with IPL were encountered in our hospital between March 2018 and March 2023, and all underwent 64-slice spiral CT multi-phase enhancement scan. The diagnosis was confirmed pathologically from tissues by surgery or fine needle aspiration biopsy. Results The plain CT scan showed intrahepatic lesions in the right lobe in 19 cases, in the left in 8 cases and in caudate lobe in 5 cases; the single lesions was found in 20 cases and multiple lesions in 12 cases, with the diameter of 2.5-5.0 cm; the appearances of the lesions was multiple, roundness, ellipse or ellipse-like; in plain CT scan, the IPL was low-density or equal-density with a vague edges; the enhancement scan showed the lesions were not obviously intensified at arterial phase; in the portal phase, the lesions was totally intensified in 13 cases, the edges mildly to moderately intensified in 7 cases, the central intensified with the stalactite-like edges in 6 cases, and the inhomogeneous lesions intensified in 6 cases; in the delayed phase, most lesions was still mildly intensified; the CT scan also revealed some indirect signs, such as local stricture or dilatation of the bile ducts, lobe atrophy, inhomogeneous wall incrassation, stricture or even obstruction of portal vain. Conclusion The IPLs really have some special CT manifestation feature, which might help differentiate the diagnosis.

Objective This study was conducted to evaluate blood supply and hepatic arterial embolization (HAE) efficacy by enhanced computed tomography (CT) in patients with hepatic hemangioma (HH). Methods 127 consecutive patients with HH were encountered in our hospital between December 2017 and January 2021, and all patients underwent CT plain and enhanced scan to measure arterial phase enhancement ratio and evaluate blood supply of HH. All patients were treated with HAE, followed-up for 3 years, and reduction rate of tumor size and arterial phase enhancement rate of HH were compared. Results Of 127 patients with HH, enhanced CT scan found rich blood supply lesions in 54 cases and poor blood supply lesions in 73 cases; of 54 lesions with rich blood supply, uniform enhancement at arterial stage in 18 cases, uneven enhancement in 25 cases, continuously enhanced at venous and delayed stage, and not enhanced at three-stages in 11 cases; enhancement rate at arterial stage in HH lesions with rich blood supply was(43.1±13.6)%, much higher than [(16.5±3.7)%, P＜0.05] in lesions with poor blood supply, and percentage of greater than 10 cm lesions was 9.3%, much lower than 64.4%(P＜0.05) in lesions with poor blood supply; by two and three years of follow-up, reduction rates of tumors with rich blood supply were(32.6±7.1)% and (53.9±10.2)%, and reduction rates of arterial stage enhancement were (21.8±2.4)% and (27.5±3.1)%, all significantly higher than [(21.5±4.9)% and (34.7±6.9)%, and (14.2±2.5)% and (19.6±2.7)%, P＜0.05] in lesions with poor blood supply. Conclusion Efficacy of HAE in dealing with HH with rich blood supply is better than those with poor blood supply, and evaluation of blood supply of HH by CT enhanced scan before operation might help make choice of measures and warrants further investigation.

Objective The purpose of this study was to investigate the diagnostic performance of magnetic resonance cholangiopancreatography (MRCP) and diffusion-weighted imaging (DWI) in infants with biliary atresia (BA). Methods 40 children with congenital BA were admitted to our hospital between October 2019 and October 2022, and all underwent MRI, MRCP and DWI scan before operation. The imaging manifestations were recorded, and the diagnostic performances of MRI, 3D-MRCP and DWI were compared. Results Out of the 40 children with BA, the 3D-MRCP showed the extrahepatic bile duct undeveloped in 7 cases (17.5%), tiny bile ducts in 24 cases (60.0%), slightly dilated in 8 cases (20.0%) and choledochal cyst in 1 case (2.5%), the sparse intrahepatic bile ducts or not developed bile ducts in 34 cases (85.0%) and developed bile ducts in 6 cases (15.0%), the small gallbladder in 31 cases (77.5%) and normal gallbladder in 9 cases (22.5%); the DWI showed the undeveloped extrahepatic bile duct in 15 cases (37.5%), tiny ducts in 19 cases (47.5%), slightly dilated ducts in 5 cases (12.5%), the choledochal cyst in 1 case (2.5%), the sparse or not developed intrahepatic bile ducts in 31 cases (77.5%), the developed ducts in 9 cases (22.5%), the tiny gallbladders in 29 cases (72.5%) and normal gallbladders in 11 cases (28.5%); the T2-weighted imaging showed intrahepatic triangular shadows in 31 cases (77.5%), and the DWI showed high intrahepatic signals in 33 cases (82.5%), with the high signal intensity of (0.8±0.2) cm in hilar region; the MRI found the enlarged right lobes of liver in 12 cases (30.0%); the intraoperative cholangiography revealed the undeveloped common bile duct, common hepatic duct and intrahepatic bile duct in 29 cases (72.5%), and the cystic dilatation of common bile ducts in 11 cases (28.5%); during the operation, the fibrous mass in the hilar region was found in 36 cases (90.0%), with the average diameters of (1.2±0.5)cm, and we also found gallbladder atrophy in 33 cases (82.5%), the hepatomegaly in 22 cases (55.0%) and liver cirrhosis in 6 cases (15.0%); the diagnosis based on intraoperative examination included BA type ⅰ in 1 case (2.5%) and BA type ⅲ in 39 cases (97.5%); the diagnostic accuracy by MRI, MRCP and DWI combination was 90.5%, much higher than 77.5% by MRI and 3D-MRCP(P＜0.05). Conclusion The MRCP and DWI scan for infantile biliary atresia could display objectively the whole imaging of biliary system, and have a high diagnostic performance.