Objective This experiment was performed to investigate protective effects of silencing information regulator 2 related enzyme 1 (SIRT1) agonist CAY10602 on liver injuries in mice with acute liver failure (ALF). Methods Forty mice were randomly divided into 5 groups, e.g., control, model, CAY10602-intervend, glycyrrhizin (GLY)-intervened and CAY10602 and GLY combination-intervened group, with 8 mice in each group. A model of ALF was established by intraperitoneal injection of lipopolysaccharide and D-galactosamine (LPS/D-Gal). SIRT1 agonist CAY10602 and high mobility group box-1 protein (HMGB1) inhibitor glycyrrhizin (GLY) were used for intervention. Hepatic expression of SIRT1, HMGB1, and ferroptosis-related protein glutathione peroxidase 4 (GPX4), and Acyl-CoA synthetase long-chain family member 4 (ACSL4) was detected by Western blot. Results Liver tissue structure of mice in LPS/D-Gal model group was seriously disordered, necrosis of hepatocytes was found, and liver tissue congestion was serious; However, SIRT1 agonist CAY10602 intervention could significantly ameliorate liver tissue injuries; serum ALT, AST and bilirubin levels in LPS/D-Gal model group mice were (3278.3±520.8) U/L, (2457.0±545.5) U/L and (96.4±16.5) μmol/L, significantly higher than in control group [(32.1±10.3) U/L, (67.8±12.8) U/L and (4.7±2.3) μmol/L, P<0.05]; serum ALT, AST and bilirubin levels in LPS-Gal/D/CAY10602-intervened group mice were significantly lower than in the model group; compared with in the model group, CAY10602 significantly decreased hepatic expression of HMGB1 (P <0.05), while promoted ferroptosis-related protein GPX4 expression, and decreased expression of ACSL4 (P<0.05), suggesting that SIRT1 agonist CAY10602 might alleviate liver injuries by inhibiting HMGB1 expression and reducing ferroptosis in liver tissues. Conclusions SIRT1 agonist CAY10602 can protect liver tissue injuries, and the mechanism might be involved inhibition of hepatic HMGB1 release and ferroptosis occurrence.

Objective This experiment aimed to investigate effect of Yiqi Huoxue Tongluo compound, herbal medicine, intervention on portal vein recanalization in rats with surgery-induced portal vein thrombosis (PVT). Method 45 rats were randomly divided into experimental (n=40) and control (n=5) group. The PVT model was established by intermittent portal vein ligation and clamping, and monitored by ultrasonography. Rats with PVT were randomly divided into model (n=6), model control (n=6), rivaroxaban-intervened (n=12) and herbal medicine-intervened (n=12) group. Result Ultrasonography showed PVT was successfully established; 2 weeks after intervention, the reperfusion rate in rivaroxaban group was 44.4% (4/9), and it was 90.9% (10/11, P<0.05) in herbal medicine-intervened group; pathologically, vascular intima injury, media edema and thickening, and collagenous fiber adhesion in model, model control and rivaroxaban group, while vascular intima basically intact with slightly thicken media and much less collagenous fiber adhesion in herbal medicine-intervened group; serum D-dimer levels in herbal and rivaroxaban-intervened groups were (170.7±6.7)ng/mL and (176.8±7.3)ng/mL, both significantly lower than [(211.3±12.4)ng/mL, P<0.05] in model or [(205.1±12.7)ng/mL, P<0.05] in model control group. Conclusion A stable rat PVT model is successfully established by using intermittent ligation and clamping. Both rivaroxaban and herbal medicine, Yiqi Huoxue Tongluo Formula are effective in promoting PVT recanalization, which needs further investigation.

Objective The aim of this study was to explore gene polymorphisms of human leukocyte antigen (HLA) and apolipoprotein E (ApoE)in pathogenesis of chronic hepatitis B (CHB) . Methods 79 patients with CHB and 100 chronic HBV carriers were enrolled in our hospital between April 2021 and April 2024, and peripheral bloodgene polymorphisms of HLA (HLA-DQA1, HLA-DQB1, HLA-DRB1)and ApoE were detected by direct gene sequencing. Results The frequencies of HLA-DQA1*0102 and HLA-DRB1*15 allelesin patients with CHB were 13.9% and 5.7%, significantly lower than 25.0% and 14.5% (P<0.05), while the frequencies of HLA-DQA1*0501, HLA-DQB1*0301, HLA-DRB1*03 and HLA-DRB1*07 alleleswere 20.3%, 31.7%, 9.5% and 15.8%, significantly higher than 12.5%, 20.5%, 4.0% and 7.5% in HBV carriers (P<0.05); the frequencies of ε2/3 genotype and ε2 allele of ApoE gene in patients with CHB were 15.2% and 8.2%, significantly higherthan 5.0% and 3.0% in HBV carriers (P<0.05). Conclusion The gene polymorphisms of HLA and ApoE are related to pathogenesis of chronic hepatitis B. Individuals carrying HLA-DQA1*0102 and HLA-DRB1*15 alleles might protect the infection from episode, while carrying HLA-DQA1*0501, HLA-DQB1*0301, HLA-DRB1*03 and HLA-DRB1*07 allelesand/or ApoE ε2 allele might have more chances to breakout.

Objective The aim of this study was to investigate diagnosis of liver fibrosis by shear wave elastography (SWE) in combination with aspartate aminotransferase to alanine aminotransferase ratio (AAR), aspartate aminotransferase to platelet ratio index (APRI) and fibrosis index based on 4 factors (FIB-4) in patients with chronic hepatitis B (CHB). Methods 121 patients with CHB were enrolled in our hospital between January 2022 and June 2024, and all received liver biopsies and SWE examination for Young’ s modulus. AAR, APRI and FIB-4 were calculated, routinely. Multivariate Logistic regression analysis was applied to analyze factors affecting significant liver fibrosis (SLF) in patients with CHB. Receiver operating characteristic curve (ROC) with the area under the curve (AUC)was performed to assess diagnostic performance. Results Of the 121 patients with CHB, liver histo-pathological examination showed liver fibrosis F0 stage in 11 cases and F1 stage in 36 cases (non-SLF in 47 cases),F2 stage in 40 cases and F3 stage in 19 cases (SLF in 59 cases) and F4 stage in 15 cases; the Young’ s modulus, AAR, APRI and FIB-4 in patients with SLF were (11.5±3.1)kPa, (1.4±0.5),(1.1±0.5) and (2.2±0.8), all significantly greater than [(6.8±2.8)kPa, (1.0±0.3),(0.6±0.2) and (1.5±0.6), respectively, P<0.05] in those with non-SLF; multivariate Logistic regression analysis showed that Young’ s modulus(OR=4.389, 95% CI:2.059-9.352),AAR(OR=2.342, 95% CI:1.355-4.046),APRI(OR=3.916, 95% CI:1.892-8.102) and FIB-4(OR=1.306, 95% CI:1.042-1.636) were all the independent impacting factors for SLF in patients with CHB ; ROC analysis demonstrated that the AUC was 0.950(95% CI:0.916-0.984), with sensitivity of 90.5% and specificity of 80.9%, when combination of Young’ s modulus, AAR, APRI and FIB-4 were applied to predict SLF in patients with CHB, much superior to any one index did(P<0.05). Conclusion Application of SWE in combined with other non-invasive parameters could helpscreen and assessment liver fibrosis in patients with CHB, which needs further clinical investigation.

Objective The purpose of this study was to investigate diagnostic performance of combination of sound palpation tissue quantification (SPTQ) and FIB-4 index and AST/ALT ratio in evaluation of liver fibrosis in patients with hepatitis B (CHB). Methods 82 naïve patients with CHB were encountered in our hospital between March 2019 and March 2024, and all underwent liver biopsy for liver fibrosis staging. Shear wave velocity (SWV) was obtained by SPTQ, and FIB-4 index and AST/ALT ratio were calculated routinely. Multivariate Logistic regression analysis was conducted and receiver operating characteristic curve (ROC) and its area under curve (AUC) were applied to evaluate liver fibrosis in patients with CHB. Results Liver histo-pathological examination showed S1 in 7 cases, S2, e.g., significant fibrosis (SF) in 47 cases, S3 in 23 cases and S4 in 5 cases, e.g., advanced fibrosis (AF) in 28 cases; SWV, FIB-4 and ratio of AST/ALT in patients with AF were (1.5±0.2)m/s, (2.0±0.3) and (1.5±0.3), all significantly higher than [(0.9±0.2)m/s, (1.0±0.1) and (0.8±0.2), respectively, P＜0.05] in those with SF; percentages of hypertension and family history of hepatitis B were 32.1% and 75.0%, both much higher than 17.0% and 19.2% (P＜0.05), total serum bilirubin, serum GGT levels and HBV DNA loads were (24.6±5.3)μmol/L, (78.4±6.3)U/L and (5.8±1.1)lg U/ml, all much higher than [(15.5±3.2)μmol/L, (45.7±14.0)U/L and (3.7±1.0)lg U/ml, respectively, P＜0.05] in patients with SF; multivariate Logistic regression analysis showed that SWV, FIB-4 and ratio of AST/ALT were independent risk factors for occurrence of AF in patients with CHB(all P＜0.05); ROC analysis demonstrated that the AUC was 0.938(95%CI:0.862-0.979), with sensitivity of 92.4% and specificity of 86.2%, when combination of SWV, FIB-4 and ratio of AST/ALT was applied to predict AF. Conclusion Combination of SWV, FIB-4 and AST/ALT ratio could predict AF existence in nave patients with CHB, which is worthy of further study.

Objective The purpose of this study was to investigate the antiviral efficacy of pegylated interferon α-2a and albavir/granrivir combination in the treatment of patients with chronic hepatitis C (CHC). Methods 74 patients with CHC were encountered in our hospital between January 2018 and January 2022, and were randomly divided into control (n=37) and observation (n=37) group, receiving pegylated interferon α-2a and ribavirin therapy for 24 weeks, or pegylated interferon α-2a and albavir/granrivir combination therapy for 12 weeks. All patients were followed-up for 24 weeks after discontinuation of the antiviral treatment. Results The rapid virological response, early virological response, end of treatment virological response and sustained virological response in the observation were 70.3%, 89.2%, 89.2% and 94.6%, all significantly higher than 37.8%, 54.1%, 62.2% and 54.1%(P<0.05) in the control; at treatment week 4, week 12, week 24 and at follow-up 24 week, serum HCV RAN loads in the observation were (1.6±0.8)lg copies/L, (1.2±0.4)lg copies/L, (1.2±0.4)lg copies/L and (1.2±0.3)lg copies/L, all significantly lower than [(4.3±0.9) lg copies/L, (4.5±0.8)lg copies/L, (3.2±0.5)lg copies/L and (3.2±0.5)lg copies/L, respectively, P<0.05] in the control group; at the end of antiviral treatment, serum ALT and AST levels in the observation were (34.6±5.8)U/L and 36.4±6.9)U/L, both much lower than [(46.3±6.9)U/L and (49.1±7.5)U/L, respectively, P<0.05] in the control, while white blood cell counts, platelet counts and hemoglobin concentration in the two groups decreased obviously, without significant differences (P>0.05). Conclusion The combination of pegylated interferon α-2a and albavir/graniclovir therapy in the treatment of patients with CHC has a high virological response rate, which is beneficial to the recovery of liver function tests, showing a promising therapeutic outcomes.

Objective The aim of this study was to explore the implication of serum ferritin (SF) levels in patients with Dengue fever. Methods 65 patients with Dengue fever at acute fever phase, including typical patients in 43 cases, severe type in 22 cases and with liver injury in 31 cases, were encountered in our hospital between October 2021 and October 2022. Serum SF and C-reactive protein (CRP) levels were routinely detected. The patients with liver injury were carefully managed with liver-protecting medicines. The multivariate Logistic regression analysis was applied to reveal the risk factors for the occurrence of severe type of the entity. Results Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), SF, CRP levels and platelet (PLT) count in patients with severe Dengue fever were (113.3±36.1)U/L, (93.2±22.4)U/L, (2214.4±519.3)ng/mL, (54.7±1.6)mg/L and (33.1±10.9)×10⁹/L, and in patients with liver injury were (86.3±7.1)U/L, (74.2±7.9)U/L,(1935.4±568.2)ng/mL, (33.2±3.2)mg/L and (55.4±11.7)×10⁹/L, they all decreased or got back to normal at the convalescent stage; the multivariate Logistic regression analysis showed that the greatly increased serum SF levels and the decreased PLT counts were the risk factors for the occurrence of severe Dengue fever(P<0.05); serum AST and ALT levels peaked at one week of onset of the disease, and gradually returned to normal, without liver failure happening. Conclusion Serum SF level increase in patients with Dengue fever, which might hint liver injury or even deterioration of the disease, and needs carefully monitored.

Objective This study was conducted to investigate steatosis-activity-fibrosis-based SAF score and fatty liver inhibition of progression (FLIP) algorithm in evaluation of liver fibrosis in patients with metabolic associated fatty liver disease (MAFLD). Methods This study recruited 113 individuals with MAFLD in our hospital between August 2020 and March 2021, and all underwent liver biopsies. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were detected by FibroScan. Compensated progressive chronic liver disease (cACLD) was determined by Baveno VII consensus. Results Of 113 patients with MAFLD, liver histo-pathological examination showed F0-F2 liver fibrosis (non-cACLD) in 91 cases and F3-F4(cACLD) in 22 cases; there were significant differences as respect to percentages of concomitant type 2 diabetes, etiologies and alcohol intake between patients with and without cACLD (P<0.05); CAP and LSM in patients with cACLD were 247.5(230.0-301.5) dB/m and (22.0±16.2)kPa, much different as compared to [299.0(260.2-325.2)dB/m and (9.6±4.4)kPa] in non-cACLD (P<0.05); platelet count, total serum bilirubin, uric acid and LDL-C levels in cACLD were all significantly different compared to in non-cACLD (P<0.05); SAF score in cACLD was(8.4±1.1), much higher than [(5.7±1.8), P<0.05] in non-cACLD; FLIP algorithm found nonalcoholic steatohepatitis (NASH) accounted for 86.4% and no fatty liver disease for 13.6% in cACLD, while found NASH for 40.7%, nonalcoholic simple fatty liver for 53.8% and no fatty liver disease for 5.5% in non-cACLD. Conclusion MAFLD could include multiple etiologies, SAF score could diagnose cACLD and FLIP algorithm could help screen existence of NASH, which warrants further clinical investigation.

Objective The aim of this study was to investigate changes of serum arginase-1 (Arg-1) levels and apolipoprotein B/apolipoprotein A1 ((ApoB/ApoA1) ratio in patients with non-alcoholic fatty liver disease (NAFLD). Methods 69 patients with NAFLD and 50 healthy volunteers were recruited in Gaochun Hospital, affiliated to Jiangsu University between February 2021 and December 2023, all patients with NAFLD underwent liver biopsies, and nonalcoholic steatohepatitis (NASH) and liver fibrosis were diagnosed based on NAFLD activity score (NAS). Serum Arg-1 levels were detected by ELISA, and serum ApoB/ApoA1 ratio was calculated. Receiver operating characteristic curve (ROC) was drawn and area under the curve (AUC) was obtained to predict NASH with liver fibrosis. Results Of 69 patients with NAFLD, liver histo-pathological examination showed simple fatty liver(SFL) in 23 cases, NASH in 32 cases [including significant liver fibrosis (SLF) in 18 cases] and NASH-related liver cirrhosis in 14 cases; serum Arg-1 level and ApoB/ApoA1 ratio in patients with liver cirrhosis were (5.7±1.4)ng/ml and (1.0±0.2), both significantly higher than [(4.6±1.2)ng/ml and (0.8±0.1), P<0.05] in patients with NASH or [(3.1±1.0)ng/ml and (0.7±0.1), P<0.05] in patients with SFL or [(1.5±0.4)ng/ml and (0.5±0.1), P<0.05] in healthy control; serum Arg-1 level and ApoB/ApoA1 ration in patients with NASH and SLF were (5.5±1.2)ng/ml and (0.9±0.2), both significantly higher than [(3.4±1.0)ng/ml and (0.7±0.1), respectively, P<0.05] in patients with NASH; ROC analysis showed that the AUC was 0.960(95%CI:0.893-1.000), with sensitivity of 94.4% and specificity of 92.9%, when serum Arg-1 levels and ApoB/ApoA1 ratio combination was applied to predict NASH with SLF, much superior to any parameters did alone (P<0.05). Conclusion Serum Arg-1 levels and ApoB/ApoA1 ratio significantly elevate, which might hint existence of NASH or even SLF, and need carefully concerned.

Objective The aim of this study was to explore implications of serum interleukin-17 (IL-17), γ-interferon (IFN-γ) and interleukin-6 (IL-6) level changes in patients with nonalcoholic fatty liver disease (NAFLD) and carotid atherosclerosis (CAS). Methods A total of 122 patients with NAFLD were enrolled in our hospital between September 2022 and August 2024. Serum IL-17, IL-6 and IFN-γ levels were detected by flow fluorescent luminescence, and CAS was testified by ultrasonography. The influencing factors of CAS occurrence were analyzed by binary Logistic regression analysis. Results Prevalence of CAS in our series was 46.7%; there were significant differences as respect to blood pressure, body mass index, concomitant diabetes, coronary heart disease, fasting plasma glucose and uric acid between patients with and without CAS(P<0.05); serum IL-17 and IL-6 levels in patients with NAFLD and CAS were (51.2±8.6)pg/ml and (17.9±6.5)ng/ml, both significantly higher than [(42.1±7.3)pg/ml and (12.1±3.2)ng/ml, respectively, P＜0.05], while serum IFN-γ level was (171.0±23.4)ng/L, significantly lower than [(220.0±33.2)ng/L, P＜0.05] in those without CAS; there was also a significant difference respect to blood fat levels between the two groups (P＜0.05); multivariate Logistic regression analysis showed that serum IL-17(OR=1.530, 95%CI:1.133-2.064), IFN-γ(OR=1.489,95%CI:1.170-1.895), IL-6(OR=1.511, 95%CI:1.144-1.996), hyperlipidemia(OR=1.578, 95%CI:1.160-2.146) and diabetes (OR=1.611, 95%CI:1.112-2.334) were all the independent risk factors for CAS occurrence (P＜0.05). Conclusion NAFLD patients could have more probability of CAS, which might be related to hyperlipidemia and cytokine involvement.

Objective The aim of this study was to explore diagnostic performance of FibroTouch parameters in the diagnosis of non-alcoholic steatohepatitis (NASH) from individuals with non-alcoholic fatty liver diseases (NAFLD). Methods 149 patients with NAFLD were encountered in our hospital between March 2022 and March 2023, and all underwent liver biopsies. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were obtained by FibroTouch detection. Multivariate Logistic regression analysis was applied to find risk factors, and the area under the receiver operating characteristic curve (AUC) was used to analyze diagnostic efficacy of above parameters for NASH occurrence. Results Histo-pathological examination diagnosed NASH in 45 cases (30.2%) and simple fatty liver (SFL) in 104 cases (69.8%) in our series; body mass index (BMI), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and low density lipoprotein levels in patients with NASH were (29.7±1.8)kg/m², (82.6±25.7)U/L, (107.4±10.5)U/L, (74.2±16.0)U/L, (65.6±11.1)U/L and (4.2±0.9)mmol/L, all significantly higher than【 (25.6±1.5)kg/m², (50.3±19.4)U/L, (82.5±8.5)U/L, (28.9±15.2)U/L, (21.2±12.4)U/L and (3.1±0.8)mmol/L, respectively, P<0.05] in patients with SFL; CAP and LSM in NASH patients were (304.0±19.6)db/m and (13.1±2.1)kPa, both much higher than [(263.9±15.4)db/m and (8.2±1.6)kPa, respectively, P＜0.05] in SFL patients; multivariate Logistics regression analysis showed that CAP and LSM were independent risk factors for NASH occurrence (P＜0.05); the AUC was 0.901, with sensitivity of 96.8% and specificity of 82.5%, when CAP=303.7 db/m and LSM=12.9 kPa were set as cut-off-value in predicting NASH existence in individuals with NAFLD. Conclusion FibroTouch-detected LSM and CAP could help screen NASH preliminarily in individuals with NAFLD, which might guide appropriate management in clinical practice.

Objective The aim of this study was to investigate clinical implications of peripheral blood leukocyte differentiation antigen 34 (CD34) positive mononuclear cell and interleukin-3 (IL-3) level changes in patients with autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC) and AIH-PBC overlap syndrome (AIH-PBC OS). Methods 40 patients with AIH, 35 patients with PBC and 25 patients with AIH-PBC OS were admitted to our hospital between June 2019 and December 2022, and they received prednisolone, ursodeoxycholic acid (UDCA) or combination of them therapy for 12 months. Percentage of peripheral blood CD34⁺ cells was detected by FCM, serum IL-3 level was measured by ELISA, and serum anti-gp210 antibody, anti-SP100 antibody, anti-mitochondrial M2 antibody (AMA-M2), anti-liver and kidney microsomal type I antibody (LKM-I) were detected by Western blot. Results At presentation, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in patients with AIH were (136.8±9.8)U/l and (116.3±28.1)U/l, while by end of 12 month treatment, they returned to (36.8±4.8)U/l and (46.3±8.1)U/l, respectively (P<0.05); serum total bilirubin (TBIL), alkaline phosphatase (ALP) and glutamyl transferase (GGT) levels in patients with PBC were (51.4±5.7)μmol/l, (321.1±30.0)U/l and (471.5±58.8)U/l, and they decreased to (31.2±4.6)μmol/l, (224.8±29.0)U/l and (271.7±48.9)U/l, respectively by end of 12-month treatment (P<0.05); serum TBIL, ALT, AST, ALP and GGT levels in patients with AIH-PBC OS were (28.3±5.7)μmol/l, (90.6±12.3)U/l, (89.6±11.9)U/l, (252.3±23.6)U/l and (323.6±46.3)U/l, and they all decreased to (20.4±4.6)μmol/l, (50.7±11.4)U/l, (39.4±10.1)U/l, (157.6±21.4)U/l and (228.8±41.8)U/l, respectively by end of 12-month treatment (P<0.05); percentages of peripheral blood CD34⁺ cells in patients with AIH, PBC and AIH-PBC OS were (8.8±2.1)%, (10.2±2.4)% and (12.6±3.2)%, and they decreased to (4.7±1.2)%, (5.1±1.3)% and (5.0±1.2)%(all P<0.05), and serum IL-3 levels were (46.3±7.8)pg/ml, (50.7±8.4)pg/ml and (58.2±9.7)pg/ml, and they all decreased to (32.7±5.4)pg/ml, (33.5±5.6)pg/ml and (30.9±5.2)pg/ml, respectively, by end of 12-month treatment (P<0.05). Conclusion Serum CD34 and IL-3 levels in patients with AIH, PBC and AIH-PBC OS increase, which might be surveillance parameters for assessment of the entity.

Objective The aim of this study was to analyze the factors influencing the occurrence of hepatitis B viral reactivation (HBV-RA) and drug-induced liver injury (DILI) during anti-tuberculosis treatment in patients with serum HBsAg-positive pulmonary tuberculosis (PT). Methods 120 patients with serum HBsAg-positive PT were encountered in our hospital between January 2021 and December 2022, and all received standardized anti-tuberculosis treatment. The preventive entecavir antiviral treatment was given in 45 patients. The influencing factors for HBV-RA and DILI occurrence were analyzed by multivariate Logistic regression. Results The HBV-RA occurred in 30 cases (25.0%)during anti-tuberculosis treatment and all of them didn’t received entecavir antiviral treatment; the age, percentages of drinking hobby, hypoalbuminemia and administration of steroid in patients with HBV-RA were(43.5±6.2)yr, 60.0%, 66.6% and 36.7%, all significantly greater or higher than [(36.2±5.0)yr, 17.7%, 20.0% and 11.1%, respectively, P＜0.05] in those without HBV-RA, all of whom received entecavir therapy; during anti-tuberculosis treatment, the DILI occurred in 45 cases (37.5%); the percentages of drinking hobby and hypoalbuminemia in patients with DILI were 55.6% and 62.2%, much higher than 12.0% and 13.3%, respectively, P＜0.05), while the percentage of persons receiving antiviral therapy was 22.2%, much lower than 46.7%(P＜0.05)in those without DILI; the multivariate Logistic regression analysis showed that no antiviral treatment, drinking hobby and hypoalbuminemia were the independent risk factors for the HBV-RA (P＜0.05) and the drinking hobby and hypoalbuminemia were the independent risk factors for DILI occurrence in patients with serum HBsAg positive PT(P＜0.05). Conclusion The HBV-RA and DILI could occur during antituberculosis treatment in patients with serum HBsAg positive PT, which might be carefully prevented and managed appropriately in clinical practice.

Objective The aim of this study was to summarize clinical feature and outcomes of 80 patients with drug-induced liver injury (DILI). Methods The clinical data of 80 patients with DILI were retrospectively analyzed in our hospital between January 2021 and December 2023, the alleged medicines were discontinued and liver-protecting agents were given for one to three weeks. The outcomes was recorded. Results As for clinical catalogue in 80 patients with DILI, hepatocellular type was found in 41 cases (51.3%), cholestatic type in 14 cases (17.5%) and mixed type in 25 cases (31.2%); gastrointestinal symptoms was found in 51.2% of patients with hepatocellular type, much higher than 21.4% of patients with cholestatic type or 24.0% of those with mixed type; serum ALT level in patients with hepatocellular type was (646.2±177.5) U/L, much higher than [(91.4±28.9)U/L, P<0.05] in with cholestatic type or [(140.8±42.4)U/L, P<0.05] in with mixed type, AST level was 430.7±123.9)U/L, much higher than [(111.4±42.6)U/L, P<0.05] in cholestatic type or [(129.1±60.7)U/L, P<0.05] in mixed type, ALP level was (90.6±19.4)U/L, much lower than [(258.1±83.3)U/L, P<0.05] in with cholestatic type or [(191.4±50.8)U/L, P<0.05] in mixed type, and GGT level was (263.9±100.7)U/L, much lower than [(881.4±350.2)U/L, P<0.05] in with cholestatic type or [(475.1±192.3)U/L, P<0.05] in mixed type; 69 patients (86.3%) in our series recovered and 11 patients (13.7%) didn’t, without significant differences among patients with different clinical catalogue (P>0.05). Conclusion The most common clinicaltype of patients with DILI is hepatocellular, with digestive symptoms more common. Most DILI patients have good prognosis, while liver injury caused by herbal medicines cannot be ignored.

Objective The aim of this study was to investigate clinical feature and risk factors of sepsis-related liver injury (SRLI). Methods A total of 175 patients with sepsis were enrolled in this studybetween January 2021 and April 2024, and out of them, 32 patients were found having SRLI. Patients were treated with antibiotics and/or liver-protecting medicines. Serum C-reactive protein (CRP), interleukin-6 (IL-6) and procalcitonin (PCT) levels were assayed by ELISA. Multivariate Logistic regression analysis was applied to reveal risk factors.Results Concomitant diabetes, chronic nephropathy, mechanical ventilation, respiratory and biliary tract infection, SOFA and APACHE Ⅱ scores, positive blood bacteria culture, septic shock and multi-organ functional failure (MOFF) in patients with SRLI were all significantly higher than in those without liver injury (P<0.05); serum ALT, AST, total bilirubin, CRP, IL-6 and PCT levels in patients with SRLI were (92.5±9.7)U/L, (87.5±9.9)U/L, 31.4(17.9, 56.2)μmol/L, (56.3±12.6)mg/L, 130.2(95.2, 162.3)pg/L and 23.6(11.9, 35.0)μg/L, all much higher than [(36.2±3.5)U/L, (31.5±2.9)U/L, 14.0(9.3, 22.4)μmol/L, (9.7±1.7)mg/L, 102.4(74.2, 139.7)pg/L and 11.0(7.7, 17.9)μg/L, respectively, P<0.05], while peripheral platelet count and serum albumin level were 59.1(46.2, 83.4)×10⁹/L and (30.4±2.8)g/L, both significantly lower than [95.6(60.3, 141.8)×10⁹/L and (33.6±2.5)g/L, respectively, P<0.05] in those without liver injury; multivariate Logistic regression analysis showed that serum IL-6 level, septic shock and MOFF were all the risk factors for occurrence of liver injury (all P<0.05). Conclusion SRLI could occur in patients with sepsis, especially in those with septic shock and MOFF, which might be related to inflammatory reactions, and early active antimicrobial therapy is essential in reducing liver injury.

Objective The aim of this study was to explore implications of serum human beta-defensin 1 (HBD-1), Golgi protein 73 (GP73) and interleukin-33 (IL-33) levels in patients with hepatitis B viral infection-related acute-on-chronic liver failure (HBV-ACLF), with emphasis on 28-day and 90-day prognosis. Methods 156 patients with HBV-ACLF, 60 patients with HBV-related liver cirrhosis (LC) and 60 healthy individuals were encountered in our hospital between April 2020 and March 2023. Serum HBD-1, GP73 and IL-33 levels were assayed by ELISA, and univariate and multivariate Logistic regression analysis were applied to reveal risk factors for poor prognosis, and receiver operating characteristic curve (ROC) was drawn for evaluation of diagnostic performance. Results By admission, serum HBD-1 level in patients with ACLF was (314.9±47.3)ng/mL, much higher than [(256.5±42.6)ng/mL, P＜0.05] in patients with LC or [(43.1±11.3)ng/mL, P＜0.05] in healthy persons, serum GP73 level was (285.4±68.4)ng/mL, much higher than [(142.4±51.6)ng/mL, P＜0.05] in LC group or [(44.6±12.0)ng/mL, P＜0.05] in healthy group, and serum IL-33 level was (1.7±0.4)pg/mL, significantly higher than [(1.3±0.2)pg/mL, P＜0.05] in LC or [(0.5±0.1)pg/mL, P＜0.05] in control group; 28 day- and 90 day-survival rates in our series were 76.3% and 43.6%; serum HBD-1, GP73 and IL-33 levels in 28 d survivals were significantly lower than in dead patients (P＜0.05), and serum HBD-1 and IL-33 levels in 90 d survivals were much lower than in dead (P＜0.05); multivariate Logistic regression analysis showed that total serum bilirubin (TSB), INR, HBD-1, GP73 and IL-33 levels were risk factors for 28 d survivals (P＜0.05), and serum TSB, INR, HBD-1 and IL-33 levels were risk factors for 90 d survivals (P＜0.05); ROC analysis showed the AUC as 0.902(95%CI:0.846-0.961), with sensitivity (Se) of 85.7% and specificity (Sp) of 80.9%, when HBD-1, GP73 and IL-33 levels (265.6 ng/mL, 266.3 ng/mL and 1.4 pg/mL were set as cut-off-value) were combined to predict 28 day survival, and the AUC was 0.879(95%CI:0.805-0.979), with Se of 83.6% and Sp of 78.4%, when serum HBD-1 and IL-33 levels (277.7 ng/mL and 1.4 pg/mL were set as cu-off-value) were combined to predict 90 day prognosis. Conclusion Besides TSB and INR, detection of serum HBD-1, IL-33 and/or GP73 levels could predict prognosis of patients with HBV-ACLF, which might help clinicians make appropriate measure for management of patients with ACLF in this setting.

Objective The aim of this study was to investigate prevalence and risk factors of pulmonary infection in patients with acute-on-chronic liver failure (ACLF). Methods 89 patients with ACLF were enrolled in our hospital between January 2020 and January 2024, and their clinical materials were retrospectively analyzed. The occurrence of pulmonary infection and short-term prognosis were recorded. Model for end-stage liver disease and serum sodium (MELD-Na) was calculated, multivariate Logistic regression analysis was applied to evaluate risk factors of pulmonary infection, and receiver operating characteristic (ROC) was used to predict prognosis. Results 31 patients (34.8%) had pulmonary infection among 89 patients with ACLF. In our series; the proportion of age older than 65 years, concomitant diabetes mellitus, invasive operation rate and long-term antibiotic use in patients with pulmonary infection group were 61.3%, 19.4%, 61.3% and 32.3%, all significantly higher than 32.8%, 1.7%, 34.5% and 10.3% (P<0.05), while serum albumin level was (29.3±4.2)g/L, much lower than [(33.8±4.9)g/L, P<0.05] and MELD-Na score was (30.5±2.5)points, much higher than [(27.1±2.0)points, P<0.05] in those without pulmonary infection; hospital stay, 28 d and 90 d mortality were (29.8±3.1)d, 41.9% and 51.6%, all much longer or greater than [(21.2±2.7)d, 12.1% and 15.5%, respectively, P<0.05] in those without pulmonary infection; Logistic regression analysis revealed that age older than 65 years [OR=2.457, 95%CI (1.283-4.707), P<0.05], diabetes mellitus [OR=2.807, 95%CI (1.579-4.990), P<0.05], invasive operation [OR=3.071, 95%CI (1.776-5.311), P<0.05], long-term antibiotic administration [OR=2.983, 95%CI (1.727-5.154), P<0.05], serum albumin level lower than 31.2 g/L [OR=4.289, 95%CI (2.779-6.619), P<0.05] and MELD-Na score greater than 29.0 points [OR=3.927, 95%CI (2.487-6.203), P<0.05] were all the independent risk factors for pulmonary infection; ROC analysis showed that serum albumin and MELD-Na score had statistical implication in predicting pulmonary infection in ACLF patients (AUC=0.949, AUC=0.912, P<0.05). Conclusion The risk of pulmonary infection is higher in ACLF patients. Surveillance of serum albumin levels and MELD-Na score might help clinicians take an appropriate measures to deal with it.

Objective The aim of this study was to investigate the prevalence of third-generation cephalosporin resistance in patients with decompensated hepatitis B liver cirrhosis (LC) and spontaneous bacterial peritonitis (SBP). Methods 117 patients with decompensated hepatitis B-induced LC and SBP who had ascites culture bacterial positive were encountered in our hospital between March 2020 and March 2023, and all received one of third generation cephalosporin treatment for 7 to 14 days. The univariate and multivariate Logistic regression were analyzed for the factors of third-generation cephalosporin resistance. Results Out of the 117 cirrhotics with SBP, we separated 143 strains of bacteria, including Gram-positive bacteria in 54 strains (18 Streptococcus, 11 Enterococcus and 25 Staphylococcus) and Gram-negative bacteria in 89 strains (43 strains of Escherichia Coli, 22 strains of other Enterobacter, 10 strains of Acinetobacter and 14 strains of Pseudomonas Aeruginosa); 47 patients received ceftriaxone, 26 patients received cefepime, 19 patients received ceftazidime and 25 patients received cefoperazone treatment with the effective rates of 78.7%, 73.1%, 78.9% and 80.0%, respectively; the resistant rates of Streptococcus to ceftriaxone, cefepime, ceftazidime and cefoperazone were 68.0%, 52.0%, 40.0% and 56.0%, and the resistant rates of Escherichia Coli to ceftriaxone, cefepime, ceftazidime and cefoperazone were 62.8%, 39.5%, 25.6% and 32.6%; the percentages of previous SBP episode history and broad-spectrum antibiotic exposure history in 47 patients with resistance to cephalosporin treatment were 23.4% and 27.7%, much higher than 7.1% and 10.0%(P＜0.05) in patients who sensitive to the therapy; the multivariate Logistic regression analysis showed that the previous SBP episode(OR:2.673,95%CI:1.556-4.592) and broad-spectrum antibiotic exposure history(OR:2.295,95%CI:1.309-4.024) were both the independent risk factors for resistance to cephalosporin (P＜0.05). Conclusion The cirrhotics with complicated SBP is commonly infected by Gram-negative bacteria, Escherichia Coli, for example, and is usually resistant to cephalosporins, and the clinicians should deal with it appropriately.

Objective The aim of this study was to investigate the diagnostic efficacy of dynamic enhanced magnetic resonance imaging (DCE-MRI) functional parameters in the diagnosis of decompensated liver functions in patients with hepatitis B-induced liver cirrhosis (LC). Methods 143 consecutive patients with hepatitis B-induced LC were encountered in our hospital between February 2020 and February 2022, including compensated in 76 cases and decompensated LC in 67 cases based on guideline criteria diagnosis. 60 healthy individuals during the same period were included, and all subjects underwent liver DCE-MRI scanning, and the functional imaging parameters were obtained by using Extended Tofts hemodynamic model. The kappa test was used to verify diagnostic consistency. Results Hepatic artery perfusion(HAP), hepatic perfusion index(HPI), mean transit time (MTT)and time to peak (TTP) in patients with decompensated LC were(38.6±14.7)ml·min^-1·100 g^-1, (0.8±0.2), (57.5±16.6)s and (13.7±3.4)s, all significantly higher than [(28.8±15.3)ml·min^-1·100 g^-1, (0.5±0.1), (34.3±11.4)s and (8.4±1.3)s, respectively, P＜0.05] in patients with compensated LC or [(23.6±12.6)ml·min^-1·100 g^-1, (0.3±0.1), (17.4±14.2)s and (5.6±1.2)s, respectively, P＜0.05] in control, while portal vein perfusion(PVP) and full perfusion (FP) were (45.6±17.5)ml·min^-1·100 g^-1 and (63.5±23.4)ml·min^-1·100 g^-1, significantly lower than [(72.4±21.8)ml·min^-1·100 g^-1 and (109.7±18.8)ml·min^-1·100 g^-1, P＜0.05] in compensated LC or [(101.5±24.6)ml·min^-1·100 g^-1 and (128.5±21.9)ml·min^-1·100 g^-1, P＜0.05] in healthy individuals; the diagnosis of decompensated LC by MRI functional parameters was well consistent to that based on guideline (kappa=0.790), with the sensitivity of89.5%, specificity of 89.6%, accuracy of 89.5%, positive predictive value of 90.7% and negative predictive value of 88.2%. Conclusion The DCE-MRI functional parameters could help early diagnosis of decompensated liver functions in patients with hepatitis B-induced LC, which might guide clinical decision-making.

Objective The aim of this study was to investigate liver histological reversal in patients with hepatitis B-induced compensated liver cirrhosis (LC) after long-term treatment with entecavir (ETV). Methods 58 naïve patients with compensated hepatitis B cirrhosis were enrolled in our hospital between March 2015 and March 2019, and all received initial treatment with ETV for 5 to 9 years. Double liver biopsies at presentation and at time for follow-up were performed, and independent influencing factors on long-term histological improvement were analyzed by univariate and multivariate Logistic regression analysis. Results Of the 58 naïve patients with hepatitis B-induced LC, 35 individuals (60.3%) had liver histological improvement after 5 to 9 year antiviral treatment; percentages of alcohol intake and hepatitis B family history in those with histological reversal were 14.3% and 5.7%, both much lower than 52.2% and 39.1%(both P<0.05), age at enrollment was (41.8±9.3)yr, body mass index was (22.2±1.6)kg/m², both much younger or less than [(48.8±8.5) yr and (26.6±1.8)kg/m², P<0.05], serum HBV DNA load and antiviral treatment period were 5.6(4.1, 6.9)Ig IU/ml and 7.1(5.7, 9.1)yrs, significantly lower or longer than [7.8(6.1, 8.4)Ig IU/ml and 5.6(4.7, 6.1)yrs, P<0.05], LSM was 12.8(10.3, 15.1)kPa, much lower than [14.5(12.7, 20.3)kPa, P<0.05], and percentage of histological activity index (HAI) >G3 was 14.3%, much lower than 69.6%(P<0.05) in patients without histological reversal; multivariate Logistic regression analysis showed that age, serum HBV DNA loads at baseline, antiviral therapy period, LSM and HAI were all the independent impacting factors for long-term histological improvement (P＜0.05). Conclusion Early initiation and enough times of ETV antiviral treatment could improve liver histological injuries, and might obtain satisfactory outcomes in patients with compensated hepatitis B cirrhosis.

Objective The aim of this study was to investigate diagnostic performance of ultrasonography and shear wave elastography (SWE) in predicting high risk esophageal varices (HREV) in patients with liver cirrhosis (LC). Methods 92 patients with LC and cirrhotic portal hypertension were admitted to our hospital between January 2022 and April 2024, and all underwent ultrasonography for portal vein diameter (PVD), splenic vein diameter (SVD), portal vein maximum velocity (PVVmax) and splenic vein maximum velocity (SVVmax). Liver stiffness measurement (LSM) and splenic stiffness measurement (SSM) were measured by using SWE mode. Multivariate Logistic regression analysis was applied to reveal impacting factors, and receiver operating characteristic (ROC) curve was used to evaluate diagnostic efficacy. Results Endoscopy found HREV in 35 cases (38.0%) in 92 patients with cirrhotic portal hypertension in our series; there were significant differences as respect to percentages of Child-Pugh class B/C and blood platelet counts between HREV and non-HREV groups (P＜0.05); PVD and SVD in HREV group were (16.7±3.1)mm and (11.2±2.1)mm, both significantly greater than [(13.4±1.7) mm and (8.6±1.7)mm, respectively, P＜0.05], while PVVmax and SVVmax were (12.6±2.4)cm/s and (14.3±3.0) cm/s, both significantly less than [(15.7±1.9)cm/s and (17.2±2.1)cm/s, respectively, P＜0.05] in non-HREV group; LSM and SSM were (18.4±3.8)kPa and (31.5±6.4)kPa, both much greater than [(12.3±2.4)kPa and (25.7±5.8)kPa, respectively, P＜0.05] in non-HREV group; multivariate Logistic regression analysis showed that PVD and LSM were independent risk factors impacting occurrence of HREV, while the PVVmax was a protecting factor (all P＜0.05); ROC analysis demonstrated that PVD, PVVmax and LSM had a diagnostic efficacy in predicting existence of HREV (Z=2.87, P=0.13; Z=2.74, P=0.15; Z=2.35, P=0.37), while combination of the three parameters could improve specificity with a slight reduction of sensitivity. Conclusion Ultrasonography and SWE have a certain clinical implication in predicting occurrence of HREV in cirrhotics with portal hypertension, which warrants further investigation.

Objective The aim of this study was to investigate clinical efficacy of endoscopic tissue gel injection (ETGI) and endoscopic variceal ligation (EVL) in treatment of cirrhotics with esophagogastric variceal bleeding (EVB). Methods 89 patients with liver cirrhosis (LC) and complicated EVB were encountered in our hospital between January 2017 and November 2023, and were divided into control (n=45) and observation group (n=44). All patients were well treated by internal comprehensive supporting measurement, including hemostasis, blood transfusion and intravenous somatostatin administration, and patients in the observation group received ETGI and/or EVL at base of supporting treatment. Portal vein diameter (PVD), portal vein velocity (PVV) and splenic vein velocity (SVV) were detected by ultrasonography, and serum lipid peroxide (LPO), motilin (MTL) and gastrin (GAS) levels were assayed by ELISA. Results Successful hemostasis rate in the observation group was 97.7%, much higher than 88.9%(P<0.05) in the control; blood transfusion was (1.8±0.4)u, much less than [(4.2±2.0)u, P<0.05], hemostasis time was (0.8±0.2) day, much shorter than [(3.1±1.1)day, P<0.05] in the control, and disappearance of EV at re-gastroscopy in 9 cases (20.9%) in the observation group; there were no significant differences as respect to PVD, PVV and SVV in the two groups (P>0.05); after treatment, serum LPO, MTL and GAS levels in the observation group were (4.3±1.1)U/L, (193.6±20.4)ng/L and (85.5±9.2)μg/mL, all much lower than [(7.1±1.6)U/L, (254.9±24.9)ng/L and (112.4±10.3)μg/mL, respectively, P<0.05] in the control; by end of six-month follow-up, re-bleeding was found in 3 cases (7.0%) in the observation group, and they recovered after ETGI and/or EVL, while re-bleeding occurred in 17 cases (42.5%, P<0.05) in the control, and 5 (29.4%)of them died. Conclusion ETGI and/or EVL at supporting measures in dealing with emergent patients with EVB is efficacious in saving patient’s lives, which might be carried out by qualified clinicians.

Objective The aim of this study was to investigate oral maintaining treatment of propranolol after endoscopic variceal ligation (EVL) and somatostatin combination for emergent hemostasis in patients with esophagogastric variceal bleeding (EVB). Methods 116 cirrhotics with EVB were admitted to our hospital between January 2021 and December 2023, and were randomly divided into control (n=57) and observation (n=59) groups. All patients in the two groups underwent EVL and intravenous administration of octreotide for emergent hemostasis, and those in the observation received oral propranolol for maintaining treatment after operation. Portal vein flow (PVF) and splenic vein flow (SVF) were detected by ultrasonography, and hepatic venous pressure gradient (HVPG) was calculated after transjugular vein intubation. Plasma prothrombin time (PT) and fibrinogen (FIB) levels were routinely obtained. Results One week after treatment, the hemostasis rate in observation and control group were 94.9% and 96.5% (P>0.05), and three patients died in the observation and 2 died in the control; there were no significant differences as respect to bleeding cessation times [(63.5±2.1)vs. (62.3±3.6)h], blood transfusion [(3.9±0.8)U vs. (4.1±1.2)U], hospital stay [(10.4±1.7)d vs. (10.5±2.9)d] and medical costs [(10.8±2.0)thousand yuan vs. (10.8±2.0)thousand yuan] between the two groups (P>0.05); after treatment, PVF, SVF and HVPG in the observation were (541.5±108.6)ml/min, (289.7±53.4)ml/min and (13.5±3.1)mmHg, all significantly lower than [(616.4±112.7)ml/min, (306.4±56.3) ml/min and (14.6±3.8)mmHg, respectively, P＜0.05] in the control; plasma PT was (14.1±1.1)s and FIB levels was (2.7±0.8)g/L, both not much different as compared to [(14.0±1.2)s and (2.8±0.6)g/L] in the control (P＜0.05); the 3-month and 6-month re-bleeding rates in the observation group were 5.4% and 10.7%, both not significantly different compared to 7.3% and 14.6% in the control group (P>0.05). Conclusion Oral maintaining treatment of propranolol after emergent hemostasis in patients with EVB could reduce portal hypertension, which might reduce re-bleeding and needs long-term investigation.

Objective The purpose of this study was to investigate measurement of liver volumes by computed tomography (CT) scans in patients with hepatitis B-induced liver cirrhosis of different Child-Pugh class. Methods A total of 126 patients with hepatitis B liver cirrhosis, including Child-Pugh class A in 37 cases, class B in 58 cases and class C in 31 cases, and 50 healthy individuals for physical examination were encountered in our hospital between October 2020 and October 2022, and all underwent enhanced CT scans. Liver volumes were measured by software Volume at Syngo Acquisition station. Results Total liver volumes in patients with Child-Pugh class A, B and C were (1101.3±285.2) m³, (984.7±240.1) m³ and (875.9±228.7) m³, left inner lobe volumes were (142.8±39.1) m³, (133.9±26.8) m³ and (117.2±32.6) m³, right anterior lobe volumes were (305.2±84.5) m³, (323.6±71.9) m³ and (281.3±60.2) m³, and right posterior lobe volumes were (242.3±74.2) m³ , (236.5±58.6) m³ and (213.7±56.8) m³, all significantly smaller than [(1227.5±267.6) m³, (182.5±47.3) m³ , (468.3±82.6) m³ and (349.7±81.2) m³, P<0.05] in healthy persons; left lateral lobe volumes in patients with Child-Pugh class A, B, and C were (362.7±75.8) m³, (248.4±72.3) m³ and (225.6±68.2) m³, caudate lobe volumes were (48.3±11.6) m³, (42.3±10.5) m³ and (38.1±10.9) m³, all significantly larger than [194.6±45.9) m³ and (32.4±10.6) m³, P<0.05] in healthy persons; proportions of left lateral lobe to whole liver volumes in patients with Child-Pugh class A, B and C were (30.2±6.3)%, (29.3±6.1)% and (28.9±5.3)%, proportions of caudate lobe were (3.5±1.1)%, (3.3±0.9)% and (2.8±0.6)%, all significantly greater than [19.3±2.5)% and (1.8±0.3)%, P<0.05] in healthy control; proportions of right anterior lobes in patients with Child-Pugh class A, B and C were (30.2±4.3)%, (28.7±4.8)% and (29.3±5.1)%, while the proportions of right posterior lobes were (20.8±3.7)%, (23.7±2.1)% and (23.3±2.4)%, all significantly lower than (35.5±5.4)% and (27.1±2.5)%, respectively, P<0.05) in healthy individuals; by Spearman rank correlation coefficient analysis, there was a negative correlation between Child-Pugh classification and total liver volumes in patients with hepatitis B-induced liver cirrhosis (r=-0.562, P<0.05). Conclusion The total liver volumes measured by CT scan in patients with hepatitis B-induced liver cirrhosis decrease as compared to in healthy individuals, which means a reduced liver function reservoir.

Objective The aim of this study was to compare indirect calorimetry and Harris-Benedict (H-B) formulain measuring resting energy expenditure (REE) in patients with decompensated hepatitis B-induced liver cirrhosis (DHBC), and to provide reference for nutritional intervention and health management of DHBC patients. Methods 112 patients with DHBC were admitted to our hospital between June 2020 and June 2023,and their REE was measured by indirect calorimetry or calculated by Harris-Benedict formula. All patients were followed-up for one year. Body fat, visceral fat area, subcutaneous fat area, body fat rate, fat-free weight and basal metabolic rate were obtained. Results REE of 112 patients with DHBC detected by indirect calorimetry and H-B formula were (1753.1±150.8)kcal/d/d and (1476.1±141.7)kcal/d/d, respectively, and the difference was statistically significant (P<0.05); there were significant differences in REE obtained by the two methods in different gender, ages and body mass index(P<0.05); the REE in different body fat, visceral fat areas, subcutaneous fat areas, body fat rates, fat-removed body weights and basal metabolic rates measured by indirect calorimetry were significantly higher than those by H-B formula calculation(P<0.05); there were no significant differences as respect to REE in different total water volume, intracellular fluid and extracellular fluid subgroups (P>0.05); by end of one-year follow-up, 21 patients (18.8%) with DHBC dies, and body fat, visceral fat areas, body fat rates and basal metabolic rates markedly influenced outcomes of the patients with DHBC(P<0.05). Conclusion Indirect calorimetry is more accurate in measuring REE in patients with DHBC, and the results calculated by H-B formula could be underestimated. When using indirect calorimetry to determine REE, it is necessary to consider the impact of different individual body composition indexes on the results, including body fat, visceral fat area, subcutaneous fat area, body fat rate, fat-free weight and basal metabolic rate. At the same time, the patients with DHBC with high body fat, large visceral fat area, high body fat rate and high basal metabolic rate might have a poor prognosis and needs careful management.

Objective The aim of this study was to investigate portal vein hemodynamic changes in patients with liver cirrhosis (LC) and portal hypertension (PH) after transjugular intrahepatic portal shunting (TIPS) and partial splenic artery embolization (PSE). Methods 100 patients with LC complicated with PH were encountered in First Affiliated Hospital, Guangdong Medical University and Comprehensive Interventional Department, Henan Provincial People's Hospital between January 2021 and December 2023, and were randomly divided into control (n=47) and observation group (n=53), and all patients in the two groups underwent TIPS and those in the observation received PSE after TIPS. All patients were followed-up for one year. Plasma endothelin (ET), angiotensin II (AT II) and renin activity (PRA) levels were assayed by ELISA, and portal vein diameter ( PVD), portal venous flow (PVF), splenic vein diameter(SVD) and splenic vein flow (SVF) were detected by ultrasonography. Results After treatment, peripheral white blood cell, platelet and red blood cell counts in the observation group were (5.9±0.8)×10⁹/L, (93.7±14.0)×10⁹/L and (3.5±0.6)×10¹²/L, all significantly higher than [(3.4±0.4)×10⁹/L, (64.9±11.2)×10⁹/L and (3.1±0.2)×10¹²/L, respectively, P＜0.05] in the control; plasma ET, ATⅡ and PRA levels were (54.9±5.8)ng/L, (113.7±1.0)ng/L and (69.5±6.1)ng/L, all significantly lower than [(79.4±6.4)ng/L, (144.9±1.2)ng/L and (98.2±7.0)ng/L, respectively, P＜0.05] in the control; PVD, SVD and SVF in the observation were (12.1±3.0)mm,(9.4±0.6)mm and (275.9±37.6)ml/min, all significantly smaller or lower than [(13.5±2.2)mm, (10.5±0.4)mm and (301.1±43.8)ml/min, respectively, P＜0.05] in the control; by end of one-year follow-up, incidences of shunt stenosis or occlusion, esophageal varice bleeding (EVB) and hepatic encephalopathy in the control group were 19.2%, 2.1% and 25.5%, and they were 17.0%, 0.0% and 15.1% in the observation group. Conclusion Combination of TIPS and PSE in dealing with patients with LC-induced PH could improve hypersplenism and reduce the risk of EVB, and we remind importance of surveillance of shunt patency.

Objective The aim of this study was to investigate diagnostic performance of ultrasound virtual touch tissue quantification ((VTQ)) and serum liver fibrosis markers in predicting liver fibrosis in patients with hepatic schistosomiasis. Methods 87 patients with hepatic schistosomiasis were admitted to our hospital between February 2022 and April 2024, and all of them underwent liver biopsy to determine the stage of liver fibrosis. Ultrasonography was conducted to measure shear wave velocity (SWV). Serum laminin (LN), type III procollagen (PC-III), type IV collagen (IV-C)and hyaluronic acid (HA)levels were measured rountinely. Receiver operating characteristic (ROC) curves were drawn to evaluate diagnostic efficacy for significant liver fibrosis (SLF) in patients with hepatic schistosomiasis. Results Of 87 patients with hepatic schistosomiasis, liver histo-pathological examination showed liver fibrosis stage (S)0 in 14 cases, S1 in 21 cases, S2 in 20 cases, S3 in 17 cases and S4 in 15 cases; SWV in patients with S0, S1, S2, S3 and S4 were (1.1±0.1) m/s, (1.2±0.1)m/s, (1.6±0.1)m/s, (1.8±0.2)m/s and (2.1±0.2)m/s, significantly different among different liver fibrosis group (P＜0.05); serum LN, PC-Ⅲ,Ⅳ-C and HA levels in S2 group were (125.8±16.6)ng/L, (98.4±12.6)ng/L, (67.3±14.9)ng/L and (110.8±20.6)ng/L, all much higher than [(107.3±22.9)ng/L, (85.6±11.2)ng/L, (55.9±12.6)ng/L and (95.1±16.5)ng/L, respectively, P＜0.05] in S1 group;diagnostic efficacy was much superior to any single marker when combination of SWV (with cut-off-value of 1.51 m/s)and any two of four serum liver fibrosis markers (cut-off-value:LN=125 ng/L, PC-Ⅲ=98 ng/L, Ⅳ-C=68 ng/L and HA=109 ng/L)was assumed to predict SLF (>=S2), with the sensitivity of 89.0% and specificity of 100.0%. Conclusion The combination of VTQ and serum liver fibrosis markers has a satisfactory diagnostic performance in predicting SLF in patients with hepatic schistosomiasis, which is worthy of further clinical investigation.

Objective The aim of this study was to identify characterization of disulfidptosis-related long non-coding RNAs (DRLs) and investigate their prognostic features in patients with hepatocellular carcinoma (HCC). Methods Materials of patients with HCC were retrieve from cancer genome atlas database (TCGA), and feature of DRLs was analyzed by univariate Cox regression, least absolute shrinkage and selection operator (LASSO) regression, and multivariate Cox regression. We establish an HCC prognostic model, and the model's performance was validated. The HCC patients were divided into high-risk and low-risk groups based on the median of the risk score. Molecular subtypes of HCC were identified through cluster analysis based on DRLs characteristics. Survival analysis was conducted based on different risk groups and clustering of molecular subtypes. Results A total of 3002 DRLs were identified, among which 345 DRLs were found to be related to prognosis by univariate COX regression(P＜0.05); further selection by LASSO regression reduced the number of DRLs to 7, and finally, 3 DRLs were selected by multivariate COX regression to be believed to participate in the model construction; the risk score was calculated as follows: risk score=0.9478 × AC026412.3 expression level + 0.5511 × RNF216P1 expression level + 0.5367 × TMCC1-AS1 expression level; the overall survival (OS) in the high-risk group was significantly lower than that in the low-risk group(P＜0.05); the cluster analysis categorized HCC samples into three molecular subtypes: e.g., cluster 1(C1), cluster 2(C2), and cluster 3(C3); survival analysis indicated that patients in group C2 had the best prognosis, followed by group C1, and patients in group C3 had the worst prognosis(P＜0.001). Conclusion The HCC prognostic model based on 3 DRLs could provide guidance for personalized management and treatment in patients with HCC.

Objective This study was conducted to analyze influencing factors of delayed postoperative intestinal paralysis (DPOI) in patients with primary liver cancer (PLC) after radical hepatectomy and to construct and validate a nomogram prediction model based on risk factors for prediction. Method A total of 135 patients with PLC were encountered in our hospital between January 2022 and October 2023, and 51 patients received open surgery and 84 patients received laparoscopic hepatectomy. Systemic immune inflammation index (SII), and C-reactive protein/albumin ratio (CAR) were calculated. Univariate and multivariate Logistic regression analysis were applied to reveal risk factors, and receiver operating characteristic (ROC) curve was drawn for prediction efficacy. Result Of 135 patients with PLC in our series, DPOI occurred in 38 cases (28.2%) after hepatectomy; univariate Logistic regression analysis showed that ages, China liver cancer staging scheme (CNLC), operation, opioid use, SII and CAR were all related to DPOI happening (P＜0.05), and multivariate Logistic regression analysis demonstrated that CNLC(OR=5.273, 95%CI:2.195-12.663), operation (OR=3.046, 95%CI:1.721-5.388), opioid use (OR=4.457, 95%CI:2.166-9.168) and CAR (OR=5.856, 95%CI: 3.177-10.793) were all the independent risk factors for DPOI occurrence (P＜0.05); ROC analysis showed the AUC was 0.894(95%CI: 0.813-0.974, P＜0.05), with sensitivity of 89.5% and specificity of 90.7%, when the nomogram prediction model based on risk factors was applied for predicting DPOI occurrence. Conclusion Postoperative DPOI could occur in patients with PLC after radical resection of liver cancer, and early warning and intervention might improve the recovery.

Objective The aim of this study was to observe effects of dexmedetomidine (DEX) for anesthesia induction on hepatic ischemia-reperfusion injury (HIRI) in patients with primary liver cancer (PLC) undergoing hepatectomy. Methods A total of 81 patients with PLC were encountered in our hospital between June 2021 and January 2023, and were randomly divided into control (n=41) and observation (n=40) groups. All patients in the two groups underwent hepatectomy, and for anesthesia induction, all patients received intravenous fentanyl, cisatracurium and propofol, and patients in the observation received additional DEX administration, then, all patients received intravenous drip of DEX, remifentanil and propofol for anesthesia untill the end of surgery. Serum malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH), tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and IL-8 levels were detected by ELISA. Results At inflow occlusion, one hour, six hours and twenty-four hours after anesthesia, serum ALT levels in the control group were(98.1±10.8)U/L, (168.5±13.2)U/L, (196.7±14.9)U/L and (179.1±13.7)U/L, all significantly higher than [(86.6±10.1)U/L, (124.3±11.3) U/L, (143.8±12.4) U/L and (121.3±11.5)U/L, respectively, P<0.05], serum AST levels were (118.4±11.7)U/L, (186.3±14.0)U/L, (226.3±16.5)U/L and (192.3±15.4)U/L, all significantly higher than [(92.3±12.1) U/L, (133.6±13.4) U/L, (161.8±15.3)U/L and (136.8±14.0) U/L, respectively, P<0.05] in the observation group, and six hours and twenty-four hours after anesthesia, serum bilirubin levels in the control group were (26.4±5.1)μmol/L and (31.5±4.8)μmol/L, both significantly higher than [(18.2±4.8)μmol/L and (22.4±5.0)μmol/L, respectively, P<0.05] in the observation group; one hour, six hours and twenty-four hours after anesthesia, serum MDA level in the observation group was much lower than in the control (P<0.05), while serum SOD and GSH levels were much higher than in the control group (P<0.05); serum TNF-α, IL-6 and IL-8 levels in the observation group were much lower than in the control group (P<0.05). Conclusion DEX administration for anesthesia induction with combination of others in patients with PLC undergoing hepatectomy could alleviate HIRI, which might be related to inhibition of perioperative oxidative stress and cytokine release, and needs further clinical investigation.

Objective This study was conducted to explore the qualitative diagnostic efficacy of focal nodular lesions of liver (FNLL) by magnetic resonance imaging (MRI) in patients with nonalcoholic fatty liver diseases(NAFLD). Methods A total of 113 patients with FNLL under the background of NAFLD were enrolled in our hospital between December 2019 and December 2022, and all patients were examined by diffusion-weighted magnetic resonance imaging (MRI-DWI) and dynamic enhanced magnetic resonance imaging (DCE-MRI), with the time-signal curve types recorded. The fine needle aspiration biopsy was performed for pathological diagnosis as the gold standard. The consistency of diagnoses by MRI-DWI and DCE-MRI with the gold standard was compared by Kappa test. Results Out the 113 patients with FNLL and NAFLD, the pathological examination showed focal nodular hyperplasia (FNH) in 69 cases and hepatocellular carcinoma (HCC) in 44 cases; the percentages of typeⅠ, type Ⅱ and type Ⅲ of time-signal curve in malignant lesions were 38.6%, 52.3% and 9.1%, significantly different compared to 2.9%, 20.3% and 76.8% in benign lesions (P＜0.05); the sensitivity, specificity and accuracy were 93.2%,100.0% and 97.3% when the qualitative diagnosis was made by the combination of MRI-DWI and DCE-MRI, much superior to 90.9%, 88.4% and 89.4% by DCE-MRI alone or 90.9%,91.3% and 91.2% by MRI-DWI alone (P＜0.05). Conclusion Theapplication of MRI, especially with DCE-MRI and MRI-DWI models, in the qualitative diagnosis of FNLL under the background of NAFLD is efficacious, which might help the clinicians make a correct diagnosis and deal with appropriately.

Objective The aim of this study was to summarize morphology and enhancement feature of hepatic hemangioma (HH)by multi-slice spiral CT (MSCT). Methods A total of 110 patients with HH were encountered in our hospital between January 2021 and December 2023, and all patients underwent MSCT scan. The morphology and blood supply was analyzed by 3D software. Results Of the 110 patients with HH, MSCT plain scan showed 152 lesions, including 68 (61.8%) single lesions and 42 (38.2%) multiple lesions; there were 104 (68.4%) lesions in right lobe of liver and 48 (31.6%) in left lobe; there were 122 lesions (80.3%) with circular or circular-like shape with edges clear and 30 lesions (19.7%) with irregular edges; 128 (84.2%) lesions were smaller than 10 cm and 24 (15.8%) were larger than 10 cm; 144 (94.7%) lesions were with low density shadow and 8 (5.3%) lesions with high density shadow; with spotty or nodular enhancement at edge or in center of lesions at arterial stage accounted for 83.6%, and no enhancement for 16.4%; there were 118 (77.6%) lesions with reduced enhancement and 34 (22.8%) lesions without enhancement at portal stage; of 34 lesions without enhancement at portal stage, 18 lesions(52.9%) presented with enhancement and 16 lesions(47.1%) left still without enhancement; tumor volume and enhancement volume in large HH lesions were (318.4±53.1) cm³ and (52.0±9.1) cm³, both significantly larger than [(131.7±25.8) cm³ and (38.4±7.9) cm³,P<0.05], while enhancement ratio was (16.3±4.6) %, significantly lower than (29.1±12.0) % (P<0.05) in small lesions. Conclusion MSCT scan could show HH morphology and enhancement feature, which might help clinicians determine the quality of intrahepatic lesions and make appropriate diagnostic and therapeutic measures.

Objective The aim of this study was to investigate patient controlled epidural analgesia (CEA) in patients with hepatolithiasis after laparoscopic hepatectomy (LH). Methods A total of 78 patients with hepatolithiasis were encountered in our hospital between January 2020 and July 2024, and all underwent LH. On support of induction and maintenance anesthesia, the operation was finished. After completion of surgery, patients were assigned to receive CEA (n=40) or patient controlled intravenous analgesia (CIA, n=38) for post-operational analgesia. Numerical rating scale (NRS) was evaluated, serum interleukin (IL)-6, IL-8 and IL-10 levels were detected by ELISA, and serum cortisol (Cor), adrenocorticotropic hormore (ACTH) and malondialdehyde (MDA) levels were assayed by ELISA. Results At 6 h, 12 h, 24 h and 48 h after surgery, dynamic NRS scores in CEA group were(3.8±1.2), (3.5±1.), (3.1±0.9) and (2.5±0.7), all significantly lower than(4.1±1.2), (4.4±1.2), (3.9±1.0) and (3.2±0.8), respectively, ,P＜0.05] in CIA group; within 48 h since termination of operation, total compression on analgesic pumps in CEA group was(8.5±2.2)times, and effective compression was o(7.3±1.7)times, both much less than [(10.7±3.4)times and (10.0±2.2)times, respectively, P＜0.05] in CIA group; serum IL-6 and IL-8 levels in CEA group were (26.4±4.9)ng/ml and (25.5±5.4)ng/ml, both significantly lower than [(42.6±5.2)ng/ml and (35.1±5.6)ng/ml, respectively, P＜0.05], while serum IL-10 level was (44.1±3.9)pg/ml, much higher than [(27.6±4.0)pg/ml, P＜0.05] in CIA group; serum Cor, ACTH and MDA levels in CEA group were (318.5±58.3)mmol/L, (19.6±4.3)pmol/L and (3.4±0.8)mmol/mL, all significantly lower than [(375.9±66.4)mmol/L, (25.9±5.6)pmol/L and (4.3±1.0)mmol/mL, respectively, P＜0.05] in CIA group. Conclusion CEA has a satisfactory analgesic effect in patients with hepatolithiasis after LH, which might be related to inhibition of stress inflammatory reactions, with less cytokine secretion.

The application of immune checkpoint inhibitors is becoming more and more extensive,which plays an important role in the treatment of patients with malignant neoplasmas,and the adverse events are more common.Bile duct injury is rare, but once happening, the immunosuppressive therapy tends to be insensitive in most patients,so individualized management is recommended. In this article, we review the epidemiology,pathogenesis,biochemical indexes,clinical and pathological manifestations,imaging and treatment of patients with immune checkpoint inhibitors-associated bile duct injury.

Primary biliary cholangitis (PBC), also known as primary biliary cirrhosis, is a chronic intrahepatic autoimmune cholestatic disease. Ursodeoxycholic acid (UDCA) is first line of treatment for PBC, which can improve biochemical indicators and slow down disease progress, while 30% to 40% of patients with PBC still have poor response to UDCA therapy, which is called refractory PBC. These patients have a higher incidence of cirrhosis and related complications, and early warning, institution treatment and prognosis evaluation for these patients remain a major challenge. The aim of this review is to present the latest research on the clinical features, influencing factors, therapeutic medicines and prognosis of patients with refractory PBC.