Objective This experiment aimed to observe improvement of liver steatosis of Coprococcus eutactus (C. eutactus) in mice with methionine-choline-deficent diet (MCD)-induced metabolic-associated fatty liver disease (MAFLD). Methods Two MAFLD mouse models, e.g., in db/db mice and in a MCD-induced mice, were established. The mice were randomly divided into control, model and C. eutactus –intervened (daily oral gavage of C. eutactus at 10⁹ CFU/mouse) groups. After finishing the experiment, serum samples were collected for biochemical analysis, and liver tissues were subjected to Hematoxylin & Eosin staining, oil red O staining and Masson staining. Quantitative real-time PCR and Western blotting were applied to investigate gene and protein expression. Results Pathological examination showed marked improvements in hepatocyte steatosis and inflammatory infiltration; qPCR analysis demonstrated that C. eutactus intervention significantly down-regulated mRNA levels of lipid metabolism-related genes (such as FASN and Fabp5) in mouse liver tissues compared to in the model group (decreased by 44.1% and 52.7%, respectively, P<0.01); furthermore, C. eutactus intervention greatly suppressed protein expression of inflammatory cytokines, such as CCL3, and fibrosis markers, as TGF-β1, in hepatic tissues compared to either in the control or in the model groups. Conclusion This study confirms that C. eutactus could ameliorate liver steatosis by inhibiting lipid synthesis, reducing inflammatory responses, and delaying fibrosis progression.

Objective This study was conducted to observe clinical efficacy of rescue antiviral therapy of tenofovir alafenamide (TMF) in entecavir(ETV)-treated chronic hepatitis B (CHB) patients with low level viremia (LLV). Methods 85 patients with CHB were encountered in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between September 2021 and February 2023, all enrolled patients had been treated by ETV for at least 48 weeks, and LLV was found by quantitatively PCR detection. The patients were divided into group A, B and C, receiving ETV (n=28),TMF (n=26) or ETV and TMF combination (n=31) for 48 weeks. Serum HBsAg level was detected by chemiluminescent immunoassays and serum HBV DNA loads were determined by real-time fluorescent quantitative PCR. Fibrosis factor-4 (FIB-4) and estimated glomerular filtration rate (eGFR) were routinely obtained. Liver stiffness measurement (LSM) was detected by FibroScan. Results By end of 48 week antiviral treatment, serum HBV DNA load in group C was(12.3±3.4)IU/mL, much lower than [(31.3±5.8)IU/mL, P＜0.05] in group B or [(244.1±14.1)IU/mL, P＜0.05] in group A, while there were no significant differences respect to serum HBsAg levels among the three groups [(4322.6±210.2)IU/mL vs.(4323.1±150.2)IU/mL or vs.(4453.5±143.3)IU/mL, P>0.05]; there were no significant differences as respect to serum bilirubin, AST and ALT levels among the three groups (P>0.05); LSM in group C was (6.6±0.5)kPa, and in group B was (6.4±0.8)kPa, both significantly lower than [(7.6±1.2)kPa, P＜0.05] in group A, while FIB-4 and eGFR were not significantly different among the three groups (P>0.05). Conclusion For CHB patients with LLV after ETV treatment, we recommend TMF rescue therapy, while combination of nucleos(t)ide analogue needs further clinical investigation.

Objective The aim of this study was to investigate the safety and efficacy of elbavir/granavir antiviral regimen in the treatment of patients with chronic hepatitis C (CHC) and chronic renal disease (CRD). Methods 56 patients with CHC and CRD undergoing hemodialysis were admitted to our hospital between February 2018 and November 2023, and all received albavir/gravir antiviral treatment for 12 weeks. Serum HCV RNA loads were assayed by RT-PCR, and rapid virologic response (RVR), end treatment of virologic response (ETVR) and sustained virologic response (SVR) were recorded. Results Among 56 patients with CHC and CRD in our series, the infected genotypes of HCV included 1b in 11 cases(19.6%), 2a in 39 cases (69.6%) and 1b/2a in 6 cases (10.7%); the RVR, ETVR and SVR were 73.2%, 91.1% and 85.7%, respectively; by end of antiviral treatment, serum ALT, AST, HCV RNA loads, BUN and sCr levels were 30.6(29.7, 37.5)U/L, 32.7(18.7, 36.4)U/L, 0.8(0.4, 3.1)lg copies/ml, (7.8±1.8)mmol/L and 132.7(85.7, 262.4)μmol/L, all significantly lower than [50.5(40.4, 717.3)U/L, 41.2(29.6, 659.7)U/L, 6.3(3.6, 7.9)lg cps/ml, (11.3±2.4)mmol/L and 261.5(174.6, 349.1)μmol/L, respectively, P<0.05] at presentation; the adverse effects include nausea, fatigue, hyperkalemia, anorexia, constipation, hair loss and joint pains, and no discontinuation of antiviral treatment occurred in our series. Conclusion The albavir/gravir antiviral regimen in the treatment of patients with CHC and CRD is safe and efficacious, which warrants further clinical investigation.

Objective The aim of this study was to investigate the antiviral efficacy of 3D regimen in the treatment of patients with naïve genotype 1b-infected chronic hepatitis C (CHC). Methods A total of 102 patients with genotype 1b-infeced CHC were enrolled in our hospital between January 2020 and December 2024, and all the naïve patients received paritaprevir, ritonavir, ombitasvir and dasabuvir combination antiviral therapy for 12 weeks. Blood, biochemical and virological parameters were routinely detected. Controlled attenuation parameter(CAP) and liver stiffness measurement (LSM) were detected by Fibrotouch. Results Serum HCV RNA load at baseline in the 102 patients with CHC was(6.2±0.7)lg copies/ml, and by end of 2 week, 4 week, 8 week, 12 week of antiviral treatment, and 12 week and 24 week of follow-up, it decreased to (5.1±1.4)lg copies/ml, (3.7±0.9)lg copies/ml, (2.4±0.7)lg copies/ml, (1.1±0.3)lg copies/ml, and (0.7±0.3)lg copies/ml and (0.7±0.3)lg copies/ml, respectively; the end-treatment virological response (VR) was 96.1%, and the sustained virological response (SVR) 12 and SVR 24 w were 93.1% and 93.1%, respectively; serum ALT and AST levels at presentation were (81.3±7.8)U/L and (58.7±6.4)U/L, and after four week antiviral treatment, they turned back to normal gradually; baseline peripheral white blood cell count, platelet count, LSM and CAP in the series were (6.8±1.3)×10⁹/L, (205.4±47.1)×10⁹/L, (8.9±0.6)kPa and (255.4±8.9)dB/m, by end of antiviral treatment, they were (6.7±1.1)×10⁹/L, (213.7±52.9)×10⁹/L, (8.5±0.5)kPa and (253.7±10.1)dB/m, and by end of 24 week follow-up, they changed to (6.9±1.1)×10⁹/L, (215.8±54.3)×10⁹/L, (8.1±0.4)kPa and (256.9±8.4)dB/m, respectively, apart from LSM decreased greatly (P<0.05) at end of 24 week follow-up, all without significant differences (P>0.05). Conclusion Short-term antiviral efficacy of 3D regimen is satisfactory and safe in patients with naïve genotype 1b-infected CHC, which needs long-term clinical observation.

Objective The aim of this study was to investigate the efficacy of liraglutide in the treatment of patients with nonalcoholic fatty liver disease (NAFLD) and concomitant diabetes mellitus type two (T2DM) and its impact on peripheral blood mononuclear cell (PBMC) nucleotide-binding oligomerization domain-like receptor family pyrin containing domain protein 3 (NLRP3), apoptosis-associated speck-like protein containing a CARD (ASC) and cysteine aspartate protease 1 (caspase-1) levels. Methods 106 patients with NAFLD and T2DM were enrolled in our hospital between January 2022 and January 2025, and were randomly assigned to receive oral metformin and acarbose in 53 cases in control, or intravenous liraglutide at base of metformin and acarbose in another 53 cases in observation for six months. PBMC NLRP3, Caspase-1 and ASC mRNA loads were detected by qRT-PCR, and serum malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels were routinely assayed. Results After treatment, serum biochemical parameters in the observation improved much superior to in the control(P<0.05); fasting plasm glucose, 2-hour postprandial blood glucose, glycated hemoglobin, fasting insulin and HOMA-IR were (5.9±1.1)mmol/L, (7.3±1.0)mmol/L, (6.2±0.7)%, (9.2±1.8)μIU/ml and (2.5±0.5), all significantly lower than [(6.5±1.3)mmol/L, (8.7±1.5)mmol/L, (7.0±1.0)%, (13.4±2.3)μIU/ml and (3.1±0.4), respectively, P<0.05] in the control; PBMC NLRP3, Caspase-1 and ASC mRNA loads were (1.1±0.2), (1.2±0.3) and (1.0±0.2), all much lower than [(1.7±0.3), (1.6±0.4) and (1.5±0.3), respectively, P<0.05] in the control; serum MDA level was (7.3±1.5)nmol/mL, much lower than [(10.2±2.1)nmol/mL, P<0.05], while serum SOD and GSH-Px levels were (134.6±7.5)U/L and (153.7±14.0)U/L, both much higher than [(117.2±8.3)U/L and (129.1±13.9)U/L, respectively, P<0.05] in the control group. Conclusion Liraglutide has satisfactory efficacy in the treatment of patients with NAFLD and T2DM, improving glucolipid metabolism, which might be related to decreasing PBMC NLRP3, Caspase-1 and ASC loads.

Objective The aim of this study was to investigate combination of Xuezhikang, a herbal medicine compound, and atorvastatin in treatment of patients with non-alcoholic fatty liver disease (NAFLD) and hyperlipidemia. Methods 124 patients with NAFLD and hyperlipidemia were enrolled in our hospital between January 2022 and July 2024, and were randomly assigned to receive atorvastatin in 63 cases in control, or receive Xuezhikang at base of atorvastatin in another 61 cases in observation for 24 weeks. Fasting insulin was assayed by immunoassay, and HOMA-IR and HOMA-β were calculated. Serum tumor necrosis factor(TNF-α), interleukin -6(IL-6) and IL-8 levels were detected by ELISA. Results By end of 24-week treatment, serum ALT, AST and GGT levels in the observation group were (36.5±3.3)U/L, (32.7±2.8)U/L and (46.4±4.7)U/L, all significantly lower than [(62.8±3.6)U/L, (58.9±3.2)U/L and (64.1±5.3)U/L, respectively, P<0.05] in the control; there were no significant differences as respect to serum TC, TG, LDL-C and HDL-C levels in the two groups (P>0.05); serum FINS and HOMA-IR were (5.3±1.5)μU/ml and (2.7±0.8), both much lower than [(6.4±1.2)μU/ml and (4.1±1.3), respectively, P<0.05], while HOMA-β was (92.3±15.4), much greater than [(77.2±13.7), P<0.05] in the control; serum TNF-α, IL-6 and IL-8 levels were (15.5±6.3)pg/ml, (16.2±5.1)ng/L and (5.5±1.1)μg/L, all significantly lower than [(27.6±6.8)pg/ml, (26.6±5.8)ng/L and (7.2±1.4)μg/L, respectively, P<0.05] in the control group. Conclusion Application of Xuezhikang with combination of atorvastatin in treatment of patients with NAFLD and hyperlipidemia could improve liver function test normal, which might be related to modulation of glycolipid metabolism and inhibition of cytokine reactions.

Objective The aim of this clinical trial was to investigate semaglutide in combination with fenofibrate in the treatment of patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Methods A total of 102 patients with T2DM and NAFLD were encountered in our hospital between January 2022 and January 2024, and were randomly assigned to receive fenofibrate at base of metformin in 51 cases in control, or receive semaglutide at base of treatment as mentioned in the control in another 51 cases in the observation for six months. Fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPBG) and Hemoglobin A1c (HbA1c) levels were routinely detected, and serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were assayed by ELISA. Visceral and subcutaneous fat areas were obtained by special equipment. Results By end of six-month treatment, body mass index, FBG, 2hPBG and HbA1c levels in the observation group were (24.6±2.1)kg/m², (6.0±1.3)mmol/L, (7.0±0.8)mmol/L and (6.3±0.8)%, all significantly lower than [(27.8±5.7)kg/m², (7.8±1.3)mmol/L, (8.5±1.0)mmol/L and (6.9±1.0)%, respectively, P＜0.05] in the control; serum TC, TG and LDL levels were (4.9±0.4)mmol/L, (1.9±0.3)mmol/L and (2.4±0.4)mmol/L, all much lower than [(5.6±0.9)mmol/L, (3.2±0.4)mmol/L and (3.6±0.5)mmol/L, respectively, P＜0.05], while serum HDL level was (1.2±0.5)mmol/L, much higher than [(1.0±0.3)mmol/L, P＜0.05] in the control group; visceral and subcutaneous fat areas were (135.11±14.0)cm² and (202.3±18.4)cm², both significantly lower than [(164.9±18.7)cm² and (240.7±23.3)cm², respectively, P＜0.05], and serum IL-6 and TNF-α levels were (5.7±2.4)pg/mL and (18.9±4.7)pg/mL, both significantly lower than [(19.2±3.0)pg/mL and (46.1±5.5)pg/mL, respectively, P＜0.05] in the control group. Conclusion The regimen with semaglutide, fenofibrate and metformin at base of diet control and exercise in dealing with patients with T2DM and concomitant NAFLD could have a short-term efficacy of weight loss, and needs further clinical investigation.

Objective This study aimed to explore exenatide in combination with metformin in treatment of patients with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) and its impact on blood lipid metabolism, and high mobility group protein B1 (HMGB1) and adiponectin (APN) levels. Methods A total of 156 patients with NAFLD and T2DM were enrolled in our hospital between January 2022 and December 2024, and were randomly divided into control (n=78) and observation (n=78), receiving metformin or exenatide and metformin combination therapy for six months. Fasting insulin level was detected by radioimmunoassay, and serum HMGB1 and APN levels were assayed by ELISA. Results By end of 24-week treatment, fasting insulin and fasting blood glucose levels in the combination group were(7.3±1.1)μU/ml and (5.6±0.7)mmol/L, both much lower than [(8.9±1.8)μU/ml and (6.5±0.8)mmol/L, respectively, P＜0.05] in the metformin-treated patients; serum ALT and AST levels were (45.7±7.4)U/L and (34.9±5.8)U/L, both significantly lower than [(59.6±8.2)U/L and (67.1±6.4)U/L, respectively, P＜0.05] in the metformin-treated patients; serum triglyceride, total cholesterol and low-density lipoprotein cholesterol levels were (1.7±0.5)mmol/L, (5.2±0.6)mmol/L and (2.5±0.6)mmol/L, all much lower than [(3.6±0.4)mmol/L, (5.9±0.7)mmol/L and (3.1±0.7)mmol/L, respectively, P＜0.05], while serum high-density lipoprotein cholesterol level was (1.1±0.3)mmol/L, much higher than [(0.9±0.2)mmol/L, P＜0.05] in the metformin-treated patients; serum HMGB1 level was (4.7±0.9)ng/mL, much lower than [(6.8±1.3)ng/mL, P＜0.05], while serum APN level was (14.8±2.7)mg/L, much higher than [(8.5±2.4)mg/L,P＜0.05] in the metformin-treated patients. Conclusion Exenatide in combination with metformin in dealing with patients with NAFLD and T2DM could improve glucose and lipid metabolism, promote the recovery of liver function tests, which might be related to the regulation of HMGB1 and APN.

Objective The aim of this study was to investigate the clinical efficacy of semaglutide in combination with Huatan Quyu Tongluo, a herbal decoction in the treatment of patients with nonalcoholic fatty liver disease (NAFLD) and concomitant type 2 diabetes mellitus (T2DM) and its influence on serum high mobility group protein 1 (HMGB1) and adiponectin (APN) levels. Methods 120 patients with NAFLD and T2DM were enrolled in our hospital between January 2022 and December 2024, and were randomly assigned to receive subcutaneously semaglutide in control (n=60) or to receive Huatan Quyu Tongluo decoction at basis of semaglutide in combination group (n=60) for 12 weeks. Serum HMGB1 and APN levels were detected by ELISA kit. Results By end of 12-week treatment, serum glutamyltransferase level in combination group was(62.4±9.2)U/L, much lower than [(84.2±12.3)U/L, P<0.05] in the control; type IV collagen, hyaluronic acid and type Ⅲ procollagen were (49.8±0.9)ng/mL, (72.5±11.1)ng/mL and (6.5±0.8)ng/mL, all significantly lower than [(66.6±1.0)ng/mL, (87.4±13.7)ng/mL and (8.1±0.9)ng/mL, respectively, P<0.05] in the control; the homeostasis model assessment of insulin resistance was(2.5±0.4), much lower than [(3.1±0.6), P<0.05] in the control; serum triglyceride, total cholesterol and low-density lipoprotein cholesterol were(1.7±0.4)mmol/L, (4.3±1.0)mmol/L and (2.2±0.7)mmol/L, all much lower than [(2.4±0.5)mmol/L, (5.0±1.1)mmol/L and (2.9±0.8)mmol/L, respectively, P<0.05], while serum high-density lipoprotein cholesterol was (1.2±0.4)mmol/L, much higher than [(1.0±0.3)mmol/L, P<0.05] in the control; serum HMGB1 level was (6.4±1.9)ng/mL, much lower than [(9.2±2.6)ng/mL, P<0.05], while serum APN level was (15.1±5.8)μg/mL, much higher than [(11.9±5.4)μg/mL, P<0.05] in the control group. Conclusion Combination of semaglutide and Huatan Quyu Tongluo decoction could effectively alleviate insulin resistance and correct lipid metabolism disorders in patients with NAFLD and T2DM, which might be related to the inhibition of HMGB1 secretion and increased APN level.

Objective The aim of this study was to investigate the application of multiparametric ultrasound (US) in the assessment of patients with high-risk metabolic associated steatohepatitis (hrMASH). Methods A total of 116 patients with MASH were recruited in our hospital between March 2021 and March 2024, and all underwent liber biopsies and ultrasonography for shear wave elastography (SWE), shear wave dispersion imaging (SWD) and attenuation imaging (ATI) for measurement of liver elasticity modulus, dispersion coefficient and attenuation coefficient. Receiver operating characteristic (ROC) curve was drawn to assess the diagnostic efficacy of the multi-US quantitative parameter combination for hrMASH. Results Of the 116 patients with MASH, liver histo-pathological examination showed that hrMASH in 49 cases (42.2%) and non-hrMASH in 67 cases (57.8%); serum total cholesterol and low-density lipoprotein cholesterol levels in patients with hrMASH were(6.5±1.5)mmol/L and (3.9±0.9)mmol/L, both significantly higher than [(5.8±1.1)mmol/L and (3.1±0.7)mmol/L, respectively, P＜0.05] in those with non-hrMASH; serum alanine aminotransferase and aspartate aminotransferase levels in patients with hrMASH were (60.1±6.8)U/L and (44.6±4.7)U/L, both significantly higher than [(35.5±4.7)U/L and (33.4±3.4)U/L, respectively, P＜0.05] in those with non-hrMASH; liver elastic modulus, frequency dispersion coefficient and attenuation coefficient in patients with hrMASH were (4.8±0.9)kPa, (12.1±2.0)m·s^-1·kHz^-1 and (1.1±0.4)dB·cm^-1·MHz^-1, all much higher than [(4.2±0.5)kPa, (10.4±1.7)m·s^-1·kHz^-1 and (0.8±0.1)dB·cm^-1·MHz^-1, respectively, P＜0.05] in those with non-hrMASH; ROC analysis showed that the AUC was 0.858 (95%CI:0.790-0.927), with sensitivity of 74.6% and specificity of 89.8%, when combination of the three ultrasound parameters was applied for prediction of hrMASH. Conclusion Multiparametric US could help predict hrMASH in specific population, which warrants further clinical investigation.

Objective The aim of this study was to investigate the efficacy of standard immunosuppressive therapy with combination of diammonium glycyrrhizinate in the treatment of patients with autoimmune hepatitis (AIH). Methods 64 patients with AIH were enrolled in our hospital between October 2022 and October 2024, and were randomly assigned to receive standard immunosuppressive therapy in 32 cases for control, or to receive diammonium glycyrrhizinate at base of standard immunosuppressive therapy in another 32 cases in observation, for six months. Serum immunoglobulin G (IgG), IgA and IgM levels were detected by immunoturbidimetry, and serum hyaluronic acid (HA), laminin (LN), type III procollagen (PCIII) and type IV collagen (IV-C) levels were measured by radioimmunoassay. Serum chemokine C-C-motif ligand 2 (CCL2), CCL4, chemokine ligand 8 (CXCL-8) and CXCL10 levels were detected by ELISA. Results By the end of 6 month treatment, serum ALT, AST and ALP levels in the observation group were (48.2±10.4)U/L, (45.4±8.6)U/L and (66.2±5.4)U/L, all significantly lower than [(76.3±13.8)U/L, (71.6±12.6)U/L and (86.8±7.2)U/L, respectively, P<0.05] in the control; serum IgG, IgA and IgM levels were (13.2±2.4)g/L, (2.0±0.4)g/L and (2.6±0.5)g/L, all much lower than [(16.8±2.6)g/L, (2.8±0.6)g/L and (3.7±0.7)g/L, P<0.05] in the control group; serum HA and PCⅢ levels were (113.2±42.6)μg/L and (94.6±37.9)μg/L, both much lower than [(174.8±49.2)μg/L and (132.1±42.6)μg/L, P<0.05] in the control; serum CCL2, CCL4, CXCL-8 and CXCL10 levels were (54.2±5.6)ng/L, (156.8±29.4)ng/L, (21.9±4.2)ng/L and (20.9±3.7)ng/L, all significantly lower than [(60.4±6.2)ng/L, (181.7±24.3)ng/L, (26.5±4.6)ng/L and (27.6±4.9)ng/L, respectively, P<0.05] in the control group. Conclusion Standard immunosuppressive therapy plus oral diammonium glycyrrhizinate has an excellent efficacy in the treatment of patients with AIH, which might be related to further relief of body inflammatory reaction.

Objective The aim of this study was to investigate clinical implications of serum chemokine ligand 10 (CXCL10), interleukin 17A (IL-17A) and cluster of differentiation 38 (CD38) in patients with autoimmune hepatitis (AIH). Methods 62 patients with AIH were admitted to our hospital between January 2022 and October 2024, and were divided into mild (n=42)and moderate-to-severe group (n=20) based on clinical classification by Chinese guidelines. Serum CXCL10, IL-17A and CD38 levels were assayed by ELISA, multivariate Logistic regression was analyzed and receiver operating characteristic (ROC) curves were applied to assess the predictive efficacy of above indicators for the severity of AIH. Results Serum CXCL10, IL-17A and CD38 levels in patients with moderate-to-severe degree of the ailment were (120.8±26.4)pg/mL, (759.8±162.4)ng/L and (18.7±4.1)pg/mL, all significantly higher than [(77.5±18.6)pg/mL, (556.2±124.8)ng/L and (12.1±3.3)pg/mL, respectively, P＜0.05] in mild patients; multivariate Logistic regression analysis showed that serum CXCL10(OR=0.877, 95%CI:0.803-0.959), IL-17A(OR=0.978, 95%CI:0.963-0.993) and CD38(OR=0.478, 95%CI:0.318-0.720) were all the independent risk factors for severe disease in the setting (P＜0.05); ROC analysis demonstrated that the AUCs were 0.926(95%CI:0.803-0.959), 0.831(95%CI:0.762-0.887) and 0.902(95%CI:0.843-0.944) by serum CXCL10, IL-17A and CD38 levels, respectively, in predicting severe ailment, all but serum CXCL10 level superior, with sensitivity of 87.2% and specificity of 81.4%(P＜0.05). Conclusion Serum CXCL10, IL-17A and CD38 levels elevate in patients with AIH, which might hint severe disease, and needs further clinical investigation.

Objective The aim of this study was to investigate the risk factors for immune checkpoint inhibitors (ICIs)-associated liver injury in patients with malignant tumors. Methods A total of 337 consecutive patients with malignant tumors were admitted to our hospital between January and December 2024. All of them received anti-tumor treatment containing ICIs or ICIs with combination of other anti-tumor medicines. Multivariate Logistic regression analysis was applied to identify the risk factors for ICIs-associated liver injury in the patients. Results Of the 337 patients with malignant tumor, 31 (9.2%) patients developed ICIs-associated liver injury during anti-tumor treatment; the proportions of patients at tumor stage IV, the application of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) inhibitor and with a chronic liver disease history in the liver injury group were 67.7%, 25.8% and 32.2%, all significantly higher than 45.1%, 9.2% and 13.1% (P<0.05) in those without iver injury group; multivariate Logistic regression analysis showed that tumor stage (OR=2.700, 95%CI: 1.172-6.223, P<0.05), CTLA-4 inhibitor administration (OR=1.740, 95%CI: 1.052-2.880, P<0.05) and liver disease history (OR=3.619, 95%CI: 1.486-8.815, P<0.05) were the independent risk factors for occurrence of ICIs-associated liver injury in patients with malignant tumors. Conclusion Clinicians should take risk factors into consideration in order to prevent and early management of ICIs-associated liver injury.

Objective The purpose of this study was to investigate the diagnostic efficacy of serum cytokeratin (CK)18-M30, heme oxygenase-1(HO-1), hypoxia-inducible factor 1-alpha (HIF-1α) and nuclear factor erythroid 2-related factor 2(Nrf2) levels in patients with drug-induced liver injury (DILI). Methods 83 patients with DILI and 80 healthy individuals who underwent physical examinations were enrolled in our hospital between March 2021 and March 2024, and serum CK18-M30, HO-1, HIF-1α and Nrf2 levels were detected by using ELISA. Receiver operating characteristic (ROC) curve was constructed to evaluate the diagnostic performance. Results Serum ALT, AST, ALP, GGT and bilirubin levels in patients with DILI were(118.5±36.1)U/L, (91.4±40.3)U/L, (193.5±46.7)U/L, (377.8±86.2)U/L and (49.8±7.3)μmol/L, all significantly higher than in healthy persons (P<0.05); serum CK18-M30 level in healthy control was (4.9±0.2)ng/L, much higher than in those with DILI (P<0.05), while serum HO-1, HIF-1α and Nrf2 levels were (11.8±1.9)U/L, (55.4±16.3)ng/mL and (165.5±31.4)U/L, much lower than in those with DILI(P<0.05); ROC analysis showed that the AUC was 0.978(95%CI:0.952-1.000), with sensitivity of 97.6% and specificity of 93.2%, when any two parameters of the four serum markers reached to diagnostic threshold (cut-off-value:CK18-M30=4.08 ng/L, HO-1=15.40 U/L, HIF-1α=90.53 ng/mL and Nrf2=501.23 U/L) for DILI. Conclusion The detection of serum CK18-M30, HO-1, HIF-1α and Nrf2 levels might help make diagnosis of DILI, which needs further clinical investigation.

Objective The aim of this study was to investigate prevention of drug-induced liver injury (DILI) based on CYP2C19 gene polymorphism in patients with fungal disease of lung (FDL) undergoing voriconazole therapy. Methods 96 patients with FDL were admitted to our hospital between March 2022 and March 2025, and were randomly divided into group A, group B and group C, with 32 cases in each group. CYP2C19 gene polymorphism was detected by PCR-gene chip. All patients received voriconazole antifungal treatment, and simultaneously, no hepatoprotective medicine was given in group A, silybin glucoside was given in group B, and in group C, no hepatoprotective medicine was given in 11 patients with CYP2C19-proven rapid metabolizers, silybin glucoside was given in 11 patients with CYP2C19-proven intermediate metabolizers, and silybin glucoside and phosphatidylcholine capsules were given in 10 patients with chronic metabolizers. Serum liver function tests and high-sensitivity C-reactive protein (hs-CRP) levels and serum interleukin-6 (IL-6) levels were detected routinely, and serum superoxide dismutase (SOD) and malondialdehyde (MDA) levels were detected by using visible spectrophotometry. Results By end of 6 week-treatment, the effective rates of antifungal treatment in group A, group B and group C were 78.1%, 75.0% and 84.4%(P＞0.05); the incidences of DILI in group A, B and C were 21.9%, 6.3% and 3.1%(P＜0.05); serum ALT, AST and bilirubin levels in group B and C were much lower than in group A, and serum ALT and AST level in patients with chronic metabolizers were much lower than in group B(P＜0.05); serum hs-CRP, IL-6 and MDA levels in group B and C were much lower than in group A, and serum MDA level in patients with chronic metabolizers was much lower than in group B (P＜0.05). Conclusion During voriconazole therapy in patients with FDL, a targeted preventive hepatoprotective treatment based on CYP2C19 gene metabolic type could precisely improve liver functions, which might finish anti-fungal treatment relatively safely.

Objective The aim of this study was to explore the predictive efficacy of ascites polymorphonuclear leucocyte (PMN) counts and systemic immune-inflammation index (SII) and serum C-reactive protein (CRP)/albumin (ALB) ratio for spontaneous bacterial peritonitis (SBP) in patients with decompensated liver cirrhosis. Methods 80 patients with decompensated liver cirrhosis were admitted to our hospital between April 2021 and April 2025, blood and ascites routine, blood biochemical and serum CRP levels were obtained clinically, and SII and CRP/ALB ratio were calculated. The predictive efficacy was analyzed by using multivariate Logistic regression and receiver operating characteristic (ROC) curves. Results Of the 80 patients with decompensated liver cirrhosis, SBP was diagnosed in 31 cases(38.8%); percentage of Child-Pugh class C, hepatic encephalopathy and varices bleeding in SBP group were 51.6%, 22.6% and 45.2%, all much higher than 10.2%, 0.0% and 0.0% (P＜0.0) in non-SBP group; prothrombin time, serum albumin levels and peripheral white blood cell counts in SBP group were (14.3±3.1) s, (29.7±0.5) g/L and (9.8±2.6)×10⁹/L, all significantly different as compared to [(12.9±2.9) s,(36.9±8.1) g/L and (7.1±1.9)×10⁹/L, respectively, P＜0.05] in non-SBP group; ascites PMN count, SII and CRP/ALB ratio in patients with SBP were (270.2±70.4)×10⁶/L, (284.1±41.7) and (0.7±0.2), all significantly higher than [(25.6±6.9)×10⁶/L,(221.7±28.9) and (0.4±0.1), respectively, P＜0.05] in those without; Logistic regression analysis showed that ascites PMN, SII and CRP/ALB ratio were all the independent risk factors for SBP occurrence (P＜0.05); ROC analysis demonstrated that the sensitivity was 94.8% and the specificity was 98.0%, when ascites PMN was combined with SII or CRP/ALB ratio in predicting SBP complicated. Conclusion SII and/or CRP/ALB ratio is helpful in preventing underdiagnosis of SBP in patients with decompensated liver cirrhosis, if ascites PMN counts is alone relied on.

Objective The aim of this study was to investigate entecavir (ETV) antiviral treatment with daily outcutaneous irradiation of infrared ray in patients with hepatitis B-induced liver cirrhosis (LC). Methods 84 patients with LC due to hepatitis B viral infection were encountered in our hospital between January 2021 and January 2024, and were randomly assigned to receive oral ETV (control, n＝42) or ETV with daily outcutaneous irradiation of infrared ray by a bio-informational infrared liver disease therapist (observation, n＝42). All patients were followed-up for three months. Serum HBV markers and HBV DNA loads were routinely detected. Serum hyaluronic acid (HA), laminin (LN), type Ⅲ procollagen (PⅢ-P) and collage type Ⅳ(Ⅳ-C) levels were detected by RIA. Serum transforming growth factor beta 1 (TGF-β1) , interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) levels were assayed by ELISA. Splenic vein diameter (SVD) and portal vein diameter (PVD), and portal vein flow velocity (PVFV) were determined by ultrasonography. Results By end of three month observation, serum HA, PⅢ-P and Ⅳ-C levels in the observation group were(102.2±10.3)mg/L, (114.2±11.5)ng/mL and (71.2±7.3)ng/mL, all significantly lower than [(134.0±11.5)mg/L, (152.7±13.8)ng/mL and (89.1±9.2)ng/mL, respectively, P＜0.05] in the control; serum TGF-β1, IL-6 and TNF-α levels were (20.3±3.9)ng/mL, (17.0±2.6)ng/mL and (21.4±3.1)ng/mL, all significantly lower than [(31.4±4.1)ng/mL, (24.3±3.0)ng/mL and (33.5±4.2)ng/mL, respectively, P＜0.05] in the control group; there were no significant differences as respect to liver function index, serum HBsAg and HBeAg, serum HBV DNA loads, and portal vein parameters between the two groups (P>0.05). Conclusion Entecavir antiviral treatment with auxiliary infrared ray irradiation could inhibit liver fibrosis progression, which might be related to modulation of cytokine metabolism.

Objective The aim of this study was to investigate the risk factors influencing portal vein thrombosis (PVT) after splenectomy and portoazygous devascularization in patients with hepatitis B-induced liver cirrhosis (LC). Methods A total of 96 patients with hepatitis B-induced LC were encountered in our hospital between January 2022 and December 2024, and all underwent splenectomy and portoazygous devascularization. General clinical materials were obtained routinely, and multivariate Logistic regression analysis was performed to identify risk factors influencing PVT formation. Results Of 96 patients with LC, ultrasonography found PVT in 34 cases (35.4%) three weeks after surgery; Child-Pugh score at baseline in patients with PVT was (10.0±1.4), significantly higher than [(6.9±1.2) in those without (P<0.05), and percentages of prophylactic intravenous administration of low molecular dextran or low molecular heparin for anticoagulant interventions after operation were 8.8% and 14.7%, both much lower than 27.4% and 33.9% (P<0.05) in those without; pre-operational platelet (PLT) count was (64.2±16.9)×10⁹/L, much lower than [(88.0±14.8)×10⁹/L, P<0.05], while it peaked to (180.5±24.1)×10⁹/L post-operationally, much higher than [(126.8±15.0)×10⁹/L, P<0.05] in those without; portal vein diameter, spleen length and spleen thickness at admission were much greater than, while portal blood flow velocity was much slower than in those without (P<0.05); multivariate Logistic regression analysis demonstrated that pre-operational Child-Pugh score and post-operational PLT counts were the independent risk factors for PVT formation after surgery (P<0.05), while post-operational anticoagulant measures exhibited protective roles(P<0.05). Conclusion The risk factors promoting PVT formation after splenectomy and portoazygos devascularization in patients with LC should be taken into consideration, as appropriate prophylactic interventions might prevent it occurrence and promote prognosis.

Objective The aim of this study was to investigate diagnostic performance of liver shear wave velocity (Vs) and various noninvasive parameter combination in the assessment of liver cirrhosis in patients with primary biliary cholangitis (PBC). Methods 83 patients with PBC were encountered in our hospital between April 2021 and June 2024, all underwent liver biopsy and ultrasound examination to record liver fibrosis index (LFI), fibrosis related index (F Index), inflammation activity index (A Index), and adiposity attenuation coefficient (ATT). Fibrosis index based on factor 4 (FIB-4) and aspartate aminotransferase/platelet ratio index (APRI) were calculated. Receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic efficacy. Results Of the 83 patients with PBC, liver cirrhosis was proven by histo-pathological examination in 22 cases (26.5%), and PBC without liver cirrhosis were found in 61 cases (73.5%); blood PLT counts in cirrhosis patients was 117.5(99.3,139.5)×10⁹/L, significantly lower than that in patients without cirrhosis [174.0(139.0, 216.0)×10⁹/L,P＜0.05]; FIB-4 and APRI socres, Vs, LFI, and F index were 3.4 (2.7, 4.9), 1.2 (0.9, 1.4), (2.7±0.4) m/s, (3.4±0.7) and (2.8±0.4), all significantly higher than [2.2 (1.4, 2.9), 0.8 (0.5, 1.2), (1.7±0.4) m/s, (2.7±1.1) and (1.7±0.7), respectively, P＜0.05] in those without; ROC analysis showed that the AUCs were 0.791, 0.694, 0.955, 0.695 and 0.919, respectively, when FIB-4 score, APRI, Vs, LFI, and F index were applied to evaluate the occurrence of cirrhosis in PBC patients, with Vs having the highest diagnostic efficacy; the AUC was 0.969, when FIB-4 and Vs combination was established, much superior to an parameter did alone. Conclusion The noninvasive assessment of cirrhosis in patients with PBC by using elastography and liver fibrosis model is satisfactory, which needs further clinical investigation.

Objective The purpose of this study was to investigate serumfibroblast growth factor receptor 1 (FGFR1), vascular endothelial growth factor A (VEGFA) and Irx homeobox 5 (IRX5) level changes in patients with hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE). Methods 80 HCC patients were encountered in our hospital between January 2020 and October 2021, and all underwent TACE and followed-up for 36 months. Serum FGFR1, VEGFA and IRX5 levels were measured by using ELISA. Receiver operating characteristic (ROC) curves were applied to assess the predictive performance of postoperative serum biomarker levels for prognosis. Results By three months after treatment, objective remission (OR) was obtained in 45 cases and non-OR was found in 35 cases; serum FGFR1, VEGFA and IRX5 levels in OR group after TACE were (173.2±28.6)pg/ml, (79.3±17.2)pg/mland (47.4±5.6)ng/ml, all significantly lower than [(210.6±33.3)pg/ml, (103.4±19.3)pg/ml and (69.9±6.2)ng/ml, respectively, P<0.05] in non-OR group; ROC analysis showed that the AUC was 0.969(95%CI:0.924-1.000), with the sensitivity of 97.8% and the specificity of 97.1% when the three serum markers combined to predict efficacy after TACE; by end of 36 month, the survival rate was 48.8%, with 80.0% in OR group and 8.6% in non-OR (P<0.05). Conclusion Surveillance of serum FGFR1, VEGFA and IRX5 levels after TACE treatment might help predict efficacy and prognosis of patients with HCC.

Objective The aim of this study was to investigate ¹²⁵I radioactive seed implantation in combination with transcatheter arterial chemoembolization (TACE) in the treatment of patients with primary liver cancer (PLC). Methods 78 patients with PLC were enrolled in our hospital between January 2021 and December 2023, and were divided into two groups, receiving TACE in 39 cases or receiving TACE and ¹²⁵I radioactive seed implantation in another 39 cases. All patients were followed-up until December 2024, and the objective remission rate (ORR) , disease control rate (DCR), overall survival (OS) and progression-free survival (PFS). Results By end of 3 months after operation, the ORR in the combination group was 87.2%, much higher than 66.7%(P<0.05) in the TACE group, while there was no significant difference as respect to DCR (97.4% vs. 89.7) between the groups (P>0.05); after operation, serum AFP level in the combination group was (349.7±111.9)ng/mL, much lower than [(452.0±147.6)ng/mL, P<0.05] in the TACE group; survival rates in the two groups were 53.8% vs. 71.8%, without significant difference (x²=2.690, P>0.05), while the OS in TACE group was 24.0(16.0, 35.0)m and in combination group was 31.0(22.0, 41.0)m, and the PFS was 22.0(12.0, 33.0)m and 28.0(19.0, 39.0)m, both much longer in the combination group than in the TACE group(Log Rank=5.380, and Log Rank=4.963, P<0.05). Conclusion ¹²⁵I radioactive seed implantation in combination with TACE in the treatment of patients with PLC is efficacious, which might improve short-term tumor control and prolong survival.

Objective The aim of this study was to investigate efficacy of local transhepatic arterial chemoembolization (TACE) with combination of immune and targeted therapy in the treatment of patients with advanced primary liver cancer(aPLC). Methods 86 patients with aPLC were encountered in Department of Hepatobiliary Surgery, Xiangxi Autonomous Prefecture People's Hospital affiliated to Jishou University between January 2021 and January 2025, and assigned to undergo TACE in 42 cases in the control, or to receive TACE with combination of lenvatinib and tislelizumab treatment in another 44 cases in the observation for three months. Serum alpha-fetoprotein (AFP) and abnormal prothrombin-II (PIVKA-II) levels were detected routinely, and peripheral blood lymphocyte subsets were determined by FCM. Results By end of three-month treatment, the disease control rate was 70.5% and the objective remission rate was 36.4% in the observation group, both much higher than 47.6% and 16.7% (P＜0.05) in the control group; serum AFP and PIVKA-Ⅱ levels were (653.5±131.5)ng/mL and (864.5±89.6)ng/mL, both much lower than [(965.5±152.2)ng/mL and (1038.4±91.3)ng/mL, respectively, P＜0.05] in the control; percentage of peripheral blood CD⁺₄ cells and CD⁺₄/CD⁺₈ cell ratio were (33.6±3.1) % and (1.2±0.3), both significantly higher than [(29.5±2.7 %) and (0.9±0.2), respectively, P＜0.05] in the control; after treatment, the successful conversion surgery rate in the observation group was 22.7%, not significantly different as compared to 7.1% (P>0.05) in the control group. Conclusion Local TACE in combination with immune and targeted therapy in dealing with patients with aPLC is short-termly efficacious, which might alleviate immune suppression with control of tumor progression.

Objective The aim of this study was to explore multimodal ultrasound in evaluating microvascular invasion (MVI) in patients with primary liver cancer (PLC) receiving transarterial chemoembolization (TACE). Methods 63 patients with hepatocellular carcinoma (HCC) were encountered in our hospital between January 2022 and January 2024, and all of them received TACE and followed-up for 12 months. All patients underwent multimodal ultrasound examination before surgery for intratumorous blood flow signal evaluation. Multivariate Logistic regression analysis was performed to identify the factors hinting MVI existence. Results Liver histo-pathological examination found MVI in 27 cases(42.9%) out of our 63 patients with HCC; the proportions of patients with tumors ≥ 5 cm, incomplete tumor capsule, unsmoothed tumor edges, tumor blood flow signal score, type III blood flow signal, peritumoral enhancement, equal and low enhancement at portal vein phase and at delayed phase in the MVI group were 63.0%, 66.7%, 63.0%, (1.9±0.5), 70.4%, 48.2%, 92.6% and 96.3%, all significantly greater than 36.1%, 38.9%, 36.1%, (1.4±0.3), 42.7%, 19.4%, 69.4% and 77.8% (P＜0.05) in those without MVI, while the clearance time was (60.8±15.5)s, significantly shorter than [(82.7±21.6)s, P＜0.05] in those without MVI; multivariate Logistic regression analysis showed that blood flow signal, enhancement at delayed phase and clearance time were the independent factors indicating MVI occurrence(P＜0.05); by end of 12-month follow-up, the deteriorated tumors was 70.4% in MVI group, much higher than 25.0%(P＜0.05) in tumors without MVI. Conclusion Multimodal ultrasound is helpful in evaluating MVI before TACE operation, which might guide make decisions for appropriate TACE plan.

Objective This study aimed to investigate qualitative diagnosis of focal liver lesions (FLL) by enhanced magnetic resonance imaging (MRI) and enhanced CT. Methods A retrospective analysis was conducted on 96 patients with FLL who admitted to the First People's Hospital of Suqian, Jiangsu Province between January 2022 and December 2024. The final diagnosis was made by histo-pathological examination. All patients underwent MR and CT scan. Results Histo-pathological examination proven benign intrahepatic lesions in 46 cases and malignant ones in 50 cases; MRI found the malignant lesions with diameter of (3.3±1.6)cm, much greater than [(2.6±1.2)cm, P<0.05] in benign ones; percentages of cystic necrosis, circular enhancement and low signal at hepatobiliary phase in malignant lesions were 84.0%, 58.0% and 100.0%, all much higher than 26.1%, 0.0% and 32.6% (P<0.05), respectively, in benign lesions; CT scan demonstrated that percentages of blurred margins, cystic necrosis, circular enhancement and “fast in and fast out” model at enhanced scan in malignant lesions were 80.0%, 88.0%, 56.0% and 80.0%, all significantly higher than 6.5%, 32.6%, 8.7% and 0.0% (P<0.05), respectively, in benign lesions; the AUC was 0.969(95%CI:0.933-1.000), with sensitivity of 98.0% and specificity of 91.3%, when enhanced MRI and CT was combined to made diagnosis, much superior to MR or CT alone (P<0.05). Conclusion Both enhanced MRI and CT are useful tools for differentiating benign and malignant intrahepatic lesions, which might help clinicians make decisions as early as possible.

Objective The aim of this study was to investigate diagnostic performance of sonazoid contrast-enhanced ultrasound (CEUS) and serum alpha fetoprotein(AFP) and prothrombin induced by the absence of vitamin K or antagonist-II (PIVKA II) levels in determining quality of focal liver lesions (FLL). Methods 80 patients with FLL were admitted to our hospital between May 2019 andJuly 2024, and all of them underwent liver biopsies and sonazoid CEUS examination.Serum AFP and PIVKA-II levels were measured by chemiluminescence immunoassay. Receiver operating characteristic (ROC) curves wereplotted to explore the diagnostic efficacy of sonazoid CEUS and serum AFP and PIVKA-II level combination in judging the quality of FLL. Results Of the 80 patients with FLL, liver pathological examination proved hepatocellular carcinoma(HCC)in 43 cases, focal nodular hyperplasia (FNH) in 13 cases, cirrhotic nodule in 19 case and inflammtory pseudotumor in 5 cases; serum AFP and PIVKA-Ⅱ levels in malignant group were (710.1±213.0)ng/ml and (56.0±18.0) mAU/ml, both significantly higher than [(8.4±1.5)ng/ml and (28.3±6.3)mAU/ml, respectively,P＜0.05] in benign group; CEUS diagnosed benign lesions in 29 cases and malignant ones in 51 cases; of51 patients with malignant lesions diagnosed by CEUS, the percentages of fast-in at arterial phase, fast-out at portal phase and complete clearance at delayed phase in malignant group were86.3%, 76.5% and 88.2%, all much higher than 31.0%, 0.0% and 0.0%(P＜0.05) in benign group; the AUC was 0.932(95%CI:0.853-0.976), with sensitivity of 100.0% and specificity of 86.5%, when serum AFP=400 ng/ml and PIVKA-Ⅱ=55 mAU/ml were respectively set as the cut-off-value and combined with CEUS in determining the quality of FLL, much superior to any parameter did alone(P＜0.05). Conclusion Sonazoid CEUS and serum AFP and PIVKA-II level combination isgenerally accuracy in diagnosing quality of focal liver lesions, which might help clinicians make an appropriate intervention as early as possible.

Objective The purpose of this study was to investigate deep learning-based high-resolution magnetic resonance imaging (MRI) in the differential diagnosis of focal liver lesions(FLL). Methods 98 patients with FLL were admitted to Second People's Hospital, Lianyungang City between January 2023 and December 2023, and all underwent hrMRI scan. The imaging was repeatedly read by Residual Network under PyTorch, persons encountered in the first half of the year were selected as training set, and those in the second half of the year were acted as validation set. Tissues obtained by fine needle aspiration biopsies or by surgery were routinely pathologically examined. Area under receiver operating characteristic curve (AUC) was applied to evaluate diagnostic performance. Results The eligible image quality rate for diagnosis by deep learning-based hrMRI was 93.9%, much higher than 84.7% by hrMRI (P＜0.05); of 98 patients with FLL, histo-pathological examination showed malignant lesions in 55 cases (cholangiocarcinoma in 5 and hepatocellular carcinoma in 50), and benign lesions in 43 cases (focal nodular hyperplasia in 25 and cirrhotic nodules in 18); sensitivity, specificity, accuracy, positive predictive value and negative predictive value by deep learning-based hrMRI were 89.1%, 86.1%, 87.8%, 89.1% and 86.0%, much superior to 81.8%, 67.8%, 76.5%, 77.6% and 75.0%(P＜0.05) by hrMRI. Conclusion Efficacy by deep learning-based hrMRI in differentiating quality of intrahepatic lesions is satisfactory, which warrants further investigation.

Objective The aim of this study was to investigate diagnostic performance of ultrasound features in combination with serum reactive oxygen species modulator 1 (ROMO1)and alpha-fetoprotein (AFP) levels in children with hepatoblastoma (HB). Methods 112 children with focal liver lesions (FLL) were encountered in our hospital between January 2022 and January 2025, and they all received ultrasonography. Serum ROMO1 level was detected by ELISA, and serum AFP level was detected by chemiluminescence. Receiver operating characteristic (ROC) curve was applied to evaluate diagnostic efficacy. Results Of the 112 children with FLL, the histo-pathological examination found HB in 78 cases and benign lesions in 34 cases; diameter of tumors, percentages of irregular lesion and local infiltration in children with HB were(9.2±2.3)cm, 51.3% and 35.9%, all significantly greater or higher than [(1.6±0.6)cm, 10.3% and 0.0%, respectively, P<0.05] in benign lesions; serum AFP and ROMO1 levels in patients with HB were (156.4±24.5)ng/mL and (130.1±20.1)ng/mL, both significantly higher than [(7.1±2.4)ng/mL and (19.0±3.7)ng/mL, respectively, P<0.05] in those with benign lesions; ROC analysis showed that the AUC was 0.867, with sensitivity of 96.2% and specificity of 64.7%, when ultrasonic features in combination with serum AFP and ROMO1 levels in diagnosing HB in children. Conclusion Ultrasound features in combination with serum ROMO1 and AFP levels could provide a more reliable auxiliary tool for early accurate identification of HB in children.

Objective The aim of this study was to observe clinical feature, pathogen distribution and prognosis in patients with pyogenic liver abscess (PLA). Methods A total of 122 patients with PLA were admitted to our hospital between April 2022 and April 2025, and all were treated by percutaneous catheter drainage (PCD) and intravenous antibiotics. The pathogens identification was performed by full-automatic microbial identification instrument. Results The diameter of abscess was(4.8±0.9)cm, WBC count was (13.6±2.5)×10⁹/L, serum CRP level was (124.2±26.8)mg/L and serum procalcitonin level was (4.8±1.2)ng/mL; underlying diseases, such as diabetes accounted for 42.6% and biliary tract diseases for 45.9%; abscess located at right lobe accounted for 62.3% and single abscess for 74.6%; main pathogens were Kleebsiella pneumoniae (45.1%), Escherichia coli (17.6%) and Staphylococcus aureus (11.8%); after 2 to 6, with average of (3.5±0.8)week treatment, two patients with PLA died of septic shock or multiple organ failure, and other 120 patients with PLA recovered. Conclusion In patients with PLA, the main underlying diseases are diabetes mellitus and biliary tract diseases, common pathogens are Klebsiella pneumoniae, and the prognosis of patients with PLA are satisfactory.

Objective The purpose of this study was to investigate efficacy of ultrasound (US)-guided catheter drainage in the treatment of patients with pyogenic liver abscess (PLA). Methods 91 patients with PLA were encountered in our hospital between January 2023 and June 2025, and were randomly assigned to underwent catheter drainage (CD) under US guidance in 45 cases or underwent puncture and aspiration (PAA) under US guidance in another 46 cases. Results Fever subsidence and abscess cavity closure times in CD-treated patients were(4.2±1.3)d and (10.7±2.8)d, both significantly shorter than [(5.8±1.6)d and (14.3±3.1)d, respectively, P<0.05], and puncture times, administration of antibiotics and defined daily doses (DDD) of antibiotics were (1.3±0.5)times, (12.1±3.0)d and (30.2±2.8), all significantly shorter or lower than [(3.1±1.0)times, (15.6±3.4)d and (44.8±5.5), respectively, P<0.05] in PAA-treated patients; by 24 hours and 3 days after operation, there were no significant differences as respect to visual analog scale (VAS) scores [(3.8±1.0)vs. (3.6±1.2) and (2.1±0.8)vs.(2.2±1.0)], or to physical performance measure / score by day 7 [(69.2±7.5) vs. (67.5±8.3), P>0.05] between the two groups, while hospital stay in CD-treated patients was (13.5±3.8)d, much shorter than [(15.7±4.6)d, P<0.05], and recurrence of abscess was 2.2%, much lower than 13.0% (P<0.05) in PAA-treated patients. Conclusion Ultrasound-guided puncture and catheter drainage is a safe and effective minimally invasive treatment for patients with PLA, which could significantly improve clinical symptoms subside, accelerate abscess cavity closure, with shorten antibiotic therapy and hospitalization.

Objective The aim of this study was to investigate percutaneous transhepatic one-stage rigid choledochoscopyfollowed by pneumatic lithotripsy (PL) in the treatment of patients with intrahepatic bile duct stones (IBDS). Methods 69 patients with IBDS were encountered in our hospital between October 2022 and October 2024, and 25 patients in control were assigned to undergo open surgery, and 44 patients in observation were assigned to receive percutaneous transhepatic puncture with one-stage rigid choledochoscopy followed by PL for stone removal. All patients were followed-up for six months after operation. Result The operation time, intraoperational blood loss, postoperative ambulation time and hospital stay in the observation group were (132.6±19.8)min, (20.4±4.33)mL, (1.6±0.4)d and (6.6±1.2)d, all significantly less or shorter than [(182.6±19.1)min, (200.6±15.3)mL, (2.5±0.7)d and (9.7±1.4)d, respectively, P＜0.05] in the control group; post-operationally, total serum bilirubin, ALT and AST levels in the observation were (18.6±2.7)μ mol/L, (40.0±3.9)U/L and (38.0±3.7)U/L, all much lower than [(23.6±3.1)μ mol/L, (53.9±4.0)U/L and (49.9±4.0)U/L, respectively, P＜0.05] in the control; incidence of complications, such as incision infection, biliary leakage, biliary bleeding and pleural and peritoneal effusion in the observation group was 13.6%, much lower than 52.0%(P＜0.05) in the control; stone clearance rate was 93.2%, much higher than 60.0%(x²=11.479, P=0.001) in the control ,and six-months after surgery, the stone recurrence rate was 6.8%, much lower than 32.0%(x²=4.899, P=0.027) in the control group. Conclusion Percutaneous transhepatic puncture for one-stage rigid choledochoscopy lithotomy followed by PL in patients with IBDS could significantly improve stone clearance rate and decrease the recurrence rate, which warrants large-scale clinical investigation.

Objective The aim of this study was to investigate the impact of different pneumoperitoneum pressures (PPP) on respiratory and hepato-renal functions in patients with cholecystolithiasis and chronic cholecystitis receiving laparoscopic cholecystectomy (LC). Methods 94 patients with cholecystolithiasis and chronic cholecystitis were enrolled in our hospital between April 2021 and April 2025, and all received LC surgery. During the operation, the patients were randomly divided into two groups, receiving low PPP (8-12 mmHg) in 47 cases and high PPP (13-16 mmHg) in another 47 cases. The peak expiratory flow (PEF), forced vital capacity (FVC) and mid-expiratory flow (FEF_25%-75%) were measured by standardized forced expiratory test. Pain was evaluated by VAS. Results One day after operation, the PEF, FVC and FEF_25%~75% in low PPP group were (62.9±12.9) L, (71.4±13.5)L and (87.1±20.1)L/sec, all much higher than [(41.0±10.2)L, (46.8±11.5)L and (44.8±10.4)L/sec, respectively, P<0.05] in high PPP group; by end of three days after surgery, serum ALT and AST levels in low PPP group were (47.3±11.4)IU/L and (42.9±12.1)IU/L, both much lower than [(75.1±12.6)IU/L and (64.9±14.2)IU/L, respectively, P<0.05] in high PPP group; serum BUN and Cr levels were (4.9±1.0)mmol/L and (90.1±10.3)μmol/L, both significantly lower than [(5.5±1.1)mmol/L and (97.1±11.2)μmol/L, respectively P<0.05] in high PPP group; postoperative bowel sound recovery, anal exhaust and first defecation time in low PPP group were(13.5±2.3) h, (18.9±4.9) h and (27.4±7.4) h, all much shorter than [(18.7±3.6)h, (25.8±5.3)h and (42.1±8.5)h, respectively, P<0.05] in high PPP group; the incidence rate of postoperative shoulder pain in low PPP group was 19.2%, much lower than 45.2%(P<0.05) in high PPP group. Conclusion We recommend relative low pneumoperitoneum pressure at 8-12 mmHg during LC operation in patients with cholecystolithiasis and chronic cholecystitis, which might influence less respiratory and hepato-renal functions.

Objective The aim of this study was to evaluate analgesic effect of fluorobiphenyl ester and fentanyl hydrochloride combination in patients with cholecystolithiasis during laparoscopic cholecystectomy (LC). Methods A total of 104 patients with cholecystolithiasis were encountered in our hospital between April 2022 and November 2024, and all underwent LC. For analgesia, the patients were assigned to receive propofol and sufentanil hydrochloride in 52 cases in control group, or to receive propofol, flurbiprofen axetil and sufentanil hydrochloride combination in other 52 cases in the observation group. Hemodynamic parameters, e.g., heart rate (HR) and mean arterial pressure (MAP) were monitored before anesthesia induction (T0), after loss of consciousness (T1), after skin incision (T2), after extubation (T3) and 10 minutes post-extubation (T4). Postoperative pain was assessed by using the visual analog scale (VAS) at 2 h, 6 h, 12 h and 24 h. Recovery times for spontaneous breathing and awakening were recorded. Serum levels of interleukin-1β (IL-1β), IL-6 and IL-10 were measured by ELISA. Results In combination group, it showed significantly lower HRs and MAPs at T1 to T4 compared to in the control group (P<0.05); recovery times for spontaneous breathing [(8.6±2.5) min] and awakening [(9.1±2.9) min] were much shorter in the combination group than in the control group [(10.9±2.9) min and (12.7±3.0) min, respectively, P<0.05]; postoperative VAS scores at 2 h, 6 h and 12 h were also much lower in the combination group [(1.9±0.5), (2.1±0.7) and (2.9±0.8) points] compared to in the control group [(2.2±0.5), (3.1±0.9) and (3.9±1.1) points, P<0.05]; at 12 hours postoperatively, serum levels of IL-1β and IL-6 in the combination group were (43.5±8.0)pg/mL and (107.1±18.6)pg/mL, both significantly lower than [(49.1±7.5)pg/mL and (126.3±14.6)pg/mL, respectively, P＜0.05] in the control group. Conclusion The combination of sufentanil hydrochloride and flurbiprofen axetil provides an effective postoperative analgesia in patients with cholecystolithiasis during LC, with relatively less impact on hemodynamic parameters and quick consciousness, which might be related to less activation of cytokine reaction.

Objective The purpose of this study was to summarize laparoscopic choledochal cyst resection in children. Methods The clinical materials in 26 children with choledochal cyst (CC) were retrieved and summarized between January 2019 and January 2024, and Todani classification showed type Ia in 16 cases (61.5%), type Ib in 1 case (3.8%), type Ic in 1 case (3.8%) and type VI in 8 cases (30.8%). Opencholedochal cyst resection (OCCR) were performed in 14 cases, and laparoscopic choledochal cyst resection (LCCR) and Roux-en-Y anastomosis of common hepatic duct and jejunum were underwent in 12 cases. All children were followed-up for three months. Results Operation time, recovery time of bowel sounds, first time of anal exhaust and hospital stay in LCCR group were(67.2±11.6)min, (22.0±4.8)h, (42.8±7.0)h and (6.5±1.2)d, all significantly shorter than [(85.4±13.5)min, (30.8±5.5)h, (56.5±7.4)h and (8.5±2.3)d, respectively, P<0.05] in OCCR group; by five days after operation, white blood cell count and serum C-reactive protein (CRP) level in open surgery group were (15.6±4.0)×10⁹/L and (26.8±2.9)mg/L, both much higher than [(12.8±3.7)×10⁹/L and (14.3±2.5)mg/L, respectively, P<0.05] in LCCR group; by three months after surgery, all operations succeeded in the two groups as validated by imaging, and no cysts recurred; post-operationally, bile leakage occurred in one case and pancreatic leakage in one case in LCCR group, and bile leakage occurred in one case and acute cholangitis in one case in OCCR group, no significant differences between the two groups(P>0.05). Conclusion The overall clinical efficacy of LCCR and Roux-en-Y anastomosis of common hepatic duct and jejunum in dealing with children with CC is satisfactory, with similar efficacy of OCCR, but damage less tissue wound, which might shorten operation time and improve recovery.

Objective The aim of this study was to summarize magnetic resonance cholangiopancreatography (MRCP) and multi-slice spiral CT (MSCT) feature in children withcongenital choledochal cysts (CCC). Methods 89 children with CCC were encountered in our Children's Hospital Affiliated to Soochow University between February 2019 and December 2024, and all underwent MRCP and MSCT scan. Results By MRCP, the common bile duct of children with CCC was accompanied by varying degrees of cystic, fusiform or columnar dilation, and Todani type I accounted for 77.5% (type Ⅰa in 63 cases,Ⅰb in 3 cases and Ⅰc in 3 cases, and type Ⅱ in 10 cases(11.2%), type Ⅲ in 2 cases (2.2%) and type Ⅳ in 8 cases (9.0%); MSCT scan diagnosed that Todani typeⅠ in 70 cases(78.7%), Todani typeⅠa in 64 cases, typeⅠb in 3 cases and type Ⅰc in 3 cases), and Todani type Ⅱ in 9 cases (10.1%), Todani type Ⅲ in 3 cases (3.4%) and Todani type Ⅳ in 7 cases(7.9%). Conclusion MRCP and MSCT scan could reveal the location, Morphology and structure of the bile duct system in children with CCC, which provide a basis for the clinical diagnosis and management.

Objective The aim of this study was to explore the hepatic tumor suppressor protein (Tp53) and nucleotide binding oligomeric domain like receptor protein 3 (NLRP3) levels in patients with gallbladder cancer and their impact on tumor metastasis after surgical resection. Methods 60 patients with gallbladder cancer and 50 patients with cholecystitis were encountered in our hospital between January 2020 and January 2024, and all underwent cholecystectomy. Patients with gallbladder cancer were followed-up for 2 years. Hepatic Tp53 and NLRP3 mRNA were detected by PCR. Multivariate Logistic regression analysis was applied to find impacting factors. Results Tp53 and NLRP3 mRNA in cancerous tissues were (1.2±0.2) and (1.0±0.2), both much higher than [(0.8±0.2) and (0.6±0.1), respectively, P<0.05] in gallbladder tissues; by end of two-year follow-up after operation, tumor relapse or remote metastasis was found in 17 cases(28.3%); tumor Tp53 and NLRP3 mRNA level in patients with metastasis were (1.4±0.3) and (1.2±0.2), both significantly higher than [(0.9±0.1) and (0.7±0.1), respectively, P<0.05] in those without tumor metastasis; multivariate Logistic regression analysis showed that high levels of tumor tissue Tp53(OR=3.554) and NLRP3(OR=3.155) were both the independent risk factors for tumor relapse or remote metastasis (P<0.05). Conclusion High tumor tissue Tp53 and NLRP3 levels might hint susceptibility of tumor relapse or remote metastasis after operation in patients with gallbladder cancer, which needs further investigation.

We reported a case of pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS) complicated by portal vein thrombosis (PVT) here, and successfully dealt with transjugular intrahepatic portosystemic shunt (TIPS). The patient had a clear history of ingesting PA-containing herbal medicine (Gynura segetum, commonly known as Tusanqi). Initial anticoagulation therapy proved ineffective, but significant symptomatic improvement was observed following TIPS intervention. This report includes a literature review with an overview and analysis of the pathophysiology, clinical features, diagnostic strategies, and therapeutic options for HSOS complicated by PVT, aiming to enhance clinicians’ understanding and management of this rare but serious entity.

Sarcopenia is a systemic entity in which muscle mass and strength progressively decline. Sarcopenia is associated with poor outcomes and prognosis in patients with chronic liver disease, particularly in those at the end-stage. On the basis of traditional nutritional supplementation and exercise intervention, the existing intervention are extending more to target therapy for signaling pathways. In this review, we summarized the progress of intervention for sarcopenia in patients with chronic liver disease, in order to provide more references for the clinical management of sarcopenia.