Objective This experiment aimed to investigate the effects of extracellular histones and heparin intervention on cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway in mice with lipopolysaccharide (LPS)/D-galactosamine(D-gal)-induced acute liver failure (ALF). Methods Forty mice were randomly divided into control, model, extracellular histones -intervened and extracellular histones/ heparin-intervened groups , with 10 mice in each. ALF model was established in mice by using LPS/D-gal intraperitoneal injection. Hepatic protein expression of cGAS and STING were detected by Western blotting, and hepatic homogenate tumor necrosis factor-α(TNF-α),interleukin ( IL)-1β and IL-18 levers were measured by using ELISA. Results Histopathological examination of liver tissue confirmed the successful establishment of ALF model in mice, liver tissue damage in the extracellular histones-intervened group was similar to that in the model group, whereas it was significantly milder in the extracellular histones/heparin-intervened group; serum ALT and AST levels in the model group and extracellular histones group were significantly higher than those in the control group (P<0.05), while they decreased greatly in the extracellular histones/heparin-intervened group (P<0.05); hepatic cGAS and STING expression, and liver tissue homogenate TNF-α, IL-1β and IL-18 levels in the model group and extracellular histones group were significantly intensified and elevated as compared to in the control group (P<0.05), however,the expression or levels of these molecules in the extracellular histones/heparin group were significantly weaken or reduced compared to both in the model group or in the extracellular histones group (P<0.05). Conclusion Extracellular histones could induce ALF, probably by activating the cGAS-STING pathway,while heparin might inhibit extracellular histone expression and block the cGAS-STING pathway and thereby exerting a protective effect.

Objective This experiment aimed to investigate the protective effect of Qingchang Ligan Formula(QCLGF), a herbal medicine, against α-naphthyl isothiocyanate(ANIT)-induced cholestatic liver injury(CLI)in mice and its possible mechanism. Methods Twelve mice were randomly divided into control, model and QCLGF intervention group, with 4 mice in each group. A mouse model of CLI was established by intragastric administration of ANIT, and mice in the intervention group were treated with QCLGF. Western blotting was conducted to detect expression of autophagy-related proteins in mouse liver tissues, including coiled-coil myosin-like BCL2-interacting protein(Beclin-1), selective autophagy receptor p62/SQSTM1 and microtubule-associated protein 1 light chain 3 beta(LC3B). Expression change of p62/SQSTM1 was further observed by immunofluorescence staining, and hepatocyte apoptosis was detected by TUNEL assay. Results Hepatocyte swelling and degeneration, inflammatory cell infiltration and bile duct epithelial cell proliferation were observed and serum ALT, AST, ALP, TBA and TBIL levels increased in the ANIT model group, suggesting model successfully established; in the QCLGF intervention group, liver pathological injury was markedly alleviated, and serum biochemical parameters reduced greatly compared to in the model group(P<0.05); hepatic Beclin-1 expression increased, p62/SQSTM1 expression decreased and conversion of LC3B-I to LC3B-II promoted in QCLGF intervention group; in addition, p62/SQSTM1 immunofluorescence intensity was reduced, and percentage of TUNEL-positive cells was decreased after QCLGF intervention. Conclusions QCLGF markedly alleviates ANIT-induced CLI in mice, and the possible protective mechanism might be associated with regulation of Beclin-1, p62/SQSTM1 and LC3B expression, as well as reduction of apoptosis in liver tissues.

Objective This experiment aimed to investigate mechanism by which Qiyin granules (QY), a herbal medicine, improve hepatic lipid metabolism in high-fat diet (HFD)–induced metabolic-associated fatty liver disease (MAFLD). Methods 60 C57BL/6J mice were randomly divided into control, model, pioglitazone /metformin-intervened, low, medium and high-dose Qiyin granules-intervened group, with 10 in each. Model was establish by HFD feeding, and interventions began at seven weeks for six weeks. Liver histopathological study was routinely conducted, and hepatic SIRT1/LXRα signaling pathway genes and their proteins were detected by Western blotting and qRT-PCR, respectively. Results Serum and hepatic triglycerides and total cholesterol levels in model group increased greatly as compared to in the control(P<0.05), while they decreased obviously in pioglitazone /metformin-intervened, and low, medium and high-dose Qiyin granules-intervened group(P<0.05);hepatic SIRT1 protein in pioglitazone /metformin-intervened, and low, medium and high-dose Qiyin granules-intervened group upregulated(P<0.05),while hepatic LXRα, SREBP-1c and FASN protein expression down-regulated greatly as compared to in the model (P<0.05); hepatic SIRT1 mRNA levels in pioglitazone /metformin-intervened, and low, medium and high-dose Qiyin granules-intervened group increased in a dose-dependent manner(P<0.05),while hepatic LXRα, SREBP-1c and FASN mRNA levels decreased obviously (P<0.05), as compared to in the model. Conclusions Qiyin granules could ameliorate HFD-induced MAFLD, maybe via modulating the SIRT1/LXRα signaling pathway, which might suppress de novo lipogenesis and attenuate inflammation.

Objective The aim of this study was to observe antiviral efficacy and impacts on bone mineral density and renal functions of tenofovir alafenamide fumarate (TAF) and tenofovir disoproxil fumarate (TDF) in the treatment of patients with chronic hepatitis B (CHB). Methods A total of 202 patients with CHB were enrolled in our health management center between January 2022 and January 2024, and were randomly assigned to receive oral TAF in 101 cases or TDF in another 101 cases. Observation lasted for 12 months. Serum HBeAg, HBsAg, and hyaluronic acid (HA), IV collagen (IV-C), type III procollagen peptide (PC-III) and laminin (LN) levels were detected by ELISA. Serum HBV DNA loads were detected by real-time fluorescence quantitative PCR. Bone mineral density was determined by dual-energy X-ray absorptiometry scanner, and glomerular filtration rate (GFR) was calculated based on CKD-EPI formula. Results By the end of 12 months of treatment, serum HBV DNA turned to undetectable, and serum AST and ALT levels normalized in the two groups; there were no significant differences as respect to serum HA, IV-C, PC-III and LN levels in the two groups (P>0.05); incidence of decreased bone mineral density and GFR in TAF-treated patients was 2.0%, much lower than 10.9% (P<0.05) in TDF-treated patients. Conclusion The antiviral efficacy of TAF and TDF is parallel in the treatment of patients with CHB, and their impact on bone mineral density and GFR needs long-term clinical observation.

Objective This study was aimed to investigate serum HBsAg clearance and its influencing factors in patients with chronic hepatitis B (CHB) undergoing pegylated interferon α-2b (Peg-IFNα-2b) and nucleos(t)ide analogue (NAs) combination treatment. Methods A total of 246 patients with CHB, including naÏve in 119 cases and previously NAs-treated in 127 cases, were enrolled in our hospital between January 2018 and August 2024, and all received Peg-IFNα-2b in combination with NAs therapy for 48 weeks. Binary Logistic regression analysis was applied to identify factors impacting serum HBsAg clearance, and receiver operating characteristic curve (ROC) with the area under the curve (AUC) was drawn to evaluate predicting efficacy. Results By end of 48 week treatment, serum HBsAg clearance was obtained in 55 cases (22.4%) in our series; serum HBsAg clearance rate in NAs-treated patients was 70.9%,much higher than 29.1%(P＜0.05) in naive patients; baseline serum HBsAg level and HBV DNA load in HBsAg clearance group were (2.6±0.6)lg IU/mL and (2.1±1.0)lg IU/mL,both much lower than[(3.3±0.7)lg IU/mL and (2.7±1.4)lg IU/mL,respectively, P＜0.05] in those without HBsAg clearance; by end of 24 week antiviral treatment, incidence of decreased serum HBsAg level(＞1 lg IU/mL)in those with HBsAg clearance was 81.8%,much higher than 17.8%(P＜0.05)in those without serum HBsAg clearance; multivariate Logistic regression analysis showed that baseline serum HBsAg level, decreased serum HBsAg at 24 week antiviral treatment and NAs-treated were all the independent impacting factors for serum HBsAg clearance (P＜0.05);ROC analysis demonstrated that the AUC was 0.748,with sensitivity of 73.3% and specificity of 78.2%, when baseline serum HBsAg＜537.77 IU/mL was set as the cut-off-value in predicting serum HBsAg clearance. Conclusion The optimal alleged patients with CHB might be those with low serum HBsAg levels and low serum HBV DNA loads with long-term NAs treatment for Peg-IFNα-2b and NAs combination antiviral treatment, who will obtain functional cure.

Objective The aim of this study was to explore the correlation between intestinal flora changes and the severity of hepatic steatosis in patients with non-alcoholic fatty liver disease (NAFLD). Methods A cohort of 50 patients with NAFLD and 38 healthy individuals were recruited in our hospital between July 2024 and July 2025, and all patients with NAFLD underwent FibroScan for controlled attenuation parameter (CAP), by which hepatic steatosis was stratified as mild, moderate and severe degree. The composition of intestinal microbiota was analyzed by utilizing 16S rRNA gene high-throughput sequencing. Results Of the 50 patients with NAFLD, mild liver steatosis was found in 16 cases, moderate in 19 cases and severe in 15 cases; the abundances of Firmicutes, Faecalibacterium prausnitzii, Bifidobacterium, Anaerorhabdus and Blautia in patients with NAFLD were (5.1±1.2) %, (6.5±1.3) %, (7.1±1.9) %, (9.2±2.1) % and (11.8±2.9) %, all significantly lower than [(7.4±1.5) %, (10.4±2.1) %, (9.6±2.0) %, (12.3±2.6) % and (15.7±3.1) %, respectively, P<0.05], while abundances of Bacteroidetes and Proteobacteria were (40.3±3.2) % and (7.4±1.5) %, both significantly higher than [(33.5±2.8) % and (4.6±1.1) %, respectively, P<0.05] in healthy controls; the abundances of Firmicutes, Faecalibacterium prausnitzii, Bifidobacterium, Anaerorhabdus and Blautia in patients with severe NAFLD were (3.1±0.9) %, (5.1±1.0) %, (5.6±1.7) %, (7.4±1.5) % and (8.8±2.3) %, all significantly lower than [(5.3±1.3) %, (6.4±1.2) %, (7.1±1.9) %, (9.3±2.2) % and (12.1±3.1) %, respectively, P<0.05] in those with moderate NAFLD or [(6.7±1.4) %, (7.9±1.7) %, (8.5±2.1) %, (10.8±2.5) % and (14.3±3.2) %, respectively, P<0.05] in those with mild NAFLD, while abundances of Bacteroidetes and Proteobacteria were (44.4±3.2) % and (9.7±1.7) %, both significantly higher than [(41.2±3.3) % and (7.2±1.6) %, P<0.05] in those with moderate NAFLD or [(35.4±3.1) % and (5.5±1.2) %, P<0.05] in mild NAFLD. Conclusion There is a significant imbalance of intestinal flora in patients with NAFLD, which is manifested as decreased abundances of Firmicutes, Faecalibacterium prausnitzii, Bifidobacterium, Anaerorhabdus and Blautia, and increased abundances of Bacteroides and Proteobacteria, which needs further clarification.

Objective The purpose of this study was to investigate clinical efficacy of glucagon-like peptide-1 receptor agonist (GLP-1RA) in the treatment of patients with type 2 diabetes mellitus (T2DM) and concomitant non-alcoholic steatohepatitis (NASH). Methods 83 patients with T2DM and NASH were encountered in our hospital between May 2021 and December 2024, and were randomly assigned to receive metformin in 41 cases in control, or to receive semaglutide at base of metformin treatment in another 42 cases in observation for 24 weeks. Glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2-hour postprandial glucose (2hPG), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels were routinely detected. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were assayed by ELISA. Controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were determined by Fibrotouch. Results By end of six-month treatment, FPG, 2hPG, HbA1c and insulin resistance index (HOMA-IR) in the observation group were (6.1±0.8)mmol/L, (7.6±1.7)mmol/L, (6.1±0.7)% and (3.5±0.7), all much lower than [(7.1±1.0)mmol/L, (9.2±1.9)mmol/L, (6.8±0.8)% and (4.6±0.9), respectively, P<0.05] in the control; CAP and LSM were (288.5±20.7)dB/m and (9.1±1.3)kPa, both significantly lower than [(324.6±26.8)dB/m and (11.5±1.5)kPa, respectively, P<0.05] in the control; serum TG, TC and LDL-C levels were (2.4±0.8)mmol/L, (4.6±0.8)mmol/L and (3.0±0.5)mmol/L, all much lower than [(2.9±0.7)mmol/L, (5.1±0.8)mmol/L and (3.4±0.5)mmol/L, respectively, P<0.05] in the control; serum TNF-α, IL-6 and CRP levels were (9.1±1.9)pg/mL, (6.3±1.3)pg/mL and (3.6±0.9)mg/L, all much lower than [(14.1±2.6)pg/mL, (10.2±1.8)pg/mL and (6.3±1.3)mg/L, respectively, P<0.05] in the control group. Conclusion GLP-1RA, semaglutide, in treatment of patients with T2DM and NASH could remarkably improve glucose and lipid metabolism, which might be due to inhibition of body inflammatory reactions.

Objective The aim of this study was to investigate implication of serum albumin/alkaline phosphatase ratio (AAPR) , leukocyte-derived chemokine 2 (LECT2) and interleukin-21 (IL-21) levels in patients with autoimmune hepatitis (AIH). Methods 58 patients with AIH were encountered in our hospital between May 2023 and May 2025, and all received standardized first-line treatment regimen, e.g., prednisone and azathioprine combination. Serum LECT2 and IL-21 levels were assayed by ELISA, and laboratory tests were obtained and AAPR was calculated. A binary Logistic regression model was constructed to analyze the risk factors influencing response to treatment, and receiver operating characteristic curve (ROC) was applied toevaluate predicting efficacy. Results By end of six month treatment, 35 patients(60.3%) obtained complete response (CR) and 23 patients(39.7%)didn’t; serum LECT2, IL-21 and IgG levels in patients with non-CR (NCR) were (28.5±5.3)ng/mL, (263.5±25.6)pg/mL and (29.7±2.4) g/L, all much higher than [((20.4±4.1)ng/mL, (174.5±21.9)pg/mL and (23.1±2.1)g/L, respectively, P<0.05], while AAPR was (0.3±0.1), much lower than [(0.4±0.1), P<0.05] in those with CR; binary Logistic regression analysis showed that AAPR, serum IgG, LECT2 and IL-21 levels were all the independent risk factors for incomplete response to immunosuppressive therapy(P<0.05); ROC analysis demonstrated that the AUC was 0.891, with relatively low sensitivity of 73.1%, but a relatively high specificity of 97.1%, when serum IgG level was combined with any two of serum AAPR, LECT2 or IL-21 levels in predicting response to immunosuppressive treatment. Conclusion Surveillance of serum AAPR, LECT2 and IL-21 level changes might help clinicians predict response to immunosuppressive therapy in patients with AIH, which warrants further clinical investigation.

Objective The aim of this study was to investigate prediction of significant liver fibrosis (SLF) by FibroTouch detection in combination with aspartate aminotransferase-to-platelet ratio index (APRI) score in patients with primary biliary cholangitis (PBC). Methods A total of 110 patients with PBC were encountered in out hospital between June 2021 and June 2025, all underwent FibroTouch detection for liver stiffness measurement (LSM), and APRI was calculated based clinical materials. Liver biopsies were performed and liver fibrosis was determined by Ludwig staging system. Predicting efficacy was evaluated by receiver operating characteristic (ROC) curves. Results Of the 110 patients with PBC, liver histopathological examination found liver fibrosis S0 in 18 cases, S1 in 25 cases, S2 in 32 cases, S3 in 21 cases and S4 in 14 cases, e.g., SLF in 67 cases and non-SLF (NSLF) in 43 cases; with the progression of liver fibrosis staging, LSM and APRI score increased gradually in PBC patients, e.g., LSM and APRI scores in S0, S1, S2, S3 and S4 were [(5.0±1.1) kPa and (0.3±0.1)], [(6.8±1.3) kPa and (0.5±0.2)], [(9.2±2.0) kPa and (0.8±0.3)], [(12.4±2.7) kPa and (1.4±0.5)] and [(15.8±3.6) kPa and (2.1±0.6)], respectively, with statistically significantly different among different stage groups (P<0.05); ROC analysis showed that the specificity (Sp) was 94.4% by LSM alone in predicting SLF in patients with PBC, while sensitivity was 81.5% and Sp was 83.7% by combination of LSM and APRI score. Conclusion FibroTouch technology in combination with APRI score could preliminarily evaluate SLF in patients with PBC, which might guide clinicians for further interventions.

Objective The aim of this study was to investigate clinical feature, serum autoantibody profiles and prognosis of patients with primary biliary cholangitis (PBC). Methods 60 patients with PBC were encountered in our hospital between March 2020 and December 2024, and all received long-term oral ursodeoxycholic acid (UDCA) treatment. Serum IgM, autoantibody profiles were detected routinely, and liver stiffness measurement (LSM) was measured by Fibroscan. Results As for initial symptoms in our 60 patients with PBC, fatigue accounted for 46.7%, itching for 31.7%, jaundice for 21.7%, right upper quadrant discomfort for 11.7%, ascites for 5.0%, splenomegaly for 3.3% and gastrointestinal symptoms for 5.0%, and concomitant with SjÏgren's syndrome for 23.3%, systemic lupus erythematosus for 6.7% and rheumatoid arthritis for 5.0%; serum AMA-M2 positive rate accounted for 91.7%, AMA for 81.7%, anti-SLA/LP for 3.3%, anti-LKM-1 for 1.7%, anti-gp210 for 26.7%, anti-Sp100 for 15.0% and anti-LC-1 for 3.3%; serum ALP, total serum bilibubin, IgM, LSM and Mayo’s score in 16 patients with serum anti-gp210 positive were (295.0±82.5)U/L, (24.5±10.3)μmol/L, (4.2±1.1)g/L, (14.1±3.8)kPa and (5.9±1.2), all significantly higher than [(210.5±65.8)U/L, (15.7±7.6)μmol/L, (3.7±1.0)g/L, (10.8±3.0)kPa and (4.7±1.0), respectively, P<0.05], while complete response rate to UDCA therapy was 43.7%, significantly lower than 77.3%(P<0.05) in 44 patients with serum anti-gp210 negative; by end of medium 26 month of follow-up, the incidences of liver cirrhosis, decompensated liver functions and liver transplantation/death in patients with serum anti-gp210 positive were 43.7%, 37.5% and 18.7%, all much higher than 20.4%, 11.4% and 4.5%(P<0.05) in those with serum anti-gp210 negative. Conclusion Serum anti-gp210 antibody positive might hints even more clinical severity of disease, and clinicians should take more attention to them.

Objective The aim of this study was to summarize clinical and pathological features of a series of patients with drug-induced liver injury (DILI). Methods 113 patients with DILI were encountered in our hospital between January 2022 and December 2024, and all patients underwent liver biopsies. Types and degrees of liver injury were classified based on clinical materials. Results Of the 113 patients with DILI, there were 58 cases (51.3%) with hepatocyte injury type, 20 cases (17.7%) with cholestasis type and 35 cases (31.0%) with mixed type; proportion of jaundice in patients with mixed was 71.4%,much higher than 55.0%(P<0.05) in those with and cholestasis types, proportions of ≥class 3 liver injury in patients with mixed and cholestasis types were 54.2% and 55.0%,both much higher than 34.5%(P<0.05) in those with hepatocyte injury; serum total bilirubin levels in patients with mixed and cholestasis types were(55.2±12.8)μmol/L and (59.7±14.2)μmol/L, both significantly higher than [(23.5±11.6)μmol/L,P<0.05],and INR were (1.5±0.2) and (1.3±0.2), both much greater than [(1.0±0.2),P<0.05] in those with hepatocyte injury; in terms of pathological manifestations, patients with hepatocyte injury presented with hepatocyte ballooning degeneration and focal necrosis, patients with cholestasis type exhibited with cholestasis and bile duct injury, and patients with mixed type demonstrated with hepatocyte injury and cholestasis; after one to three week treatment, 55 patients (94.8%)with hepatocyte injury, 15 patients (75.0%)with cholestasis type and 28 patients (80.0%)with mixed type recovered. Conclusion The clinical manifestations of patients with DILI are usually nonspecific, and hepatocyte type is the most common clinical classification. The main pathological characteristics of liver include inflammatory cell infiltration, hepatocyte swelling and necrosis. After discontinuing suspected drugs and active liver protection treatment, there is a good prognosis in most patients with DILI.

Objective The aim of this study was to investigate the risk factors for drug-induced liver injury (DILI) in critically ill patients with severe infections during tigecycline antimicrobial therapy, and to provide evidence for safe clinical use. Methods 67 patients with severe bacterial infection were encountered in our hospital between January 2023 and December 202, and all received tigecycline with or without other antibiotic treatment for severe infections. Univariate and multivariate Logistic regression analysis were applied to determine independent risk factors for DILI occurrence. Results Of the 67 patients with severe infections, DILI was diagnosed in 32 cases (47.8%) during tigecycline treatment; ages, concomitant diabetes, liver cirrhosis and sepsis, ICU stay and SOFA score in DILI group were much greater or higher than in those without DILI(P<0.05); doses and course of tigecycline, other antibiotic combination, anti-fungus and steroid therapy in DILI group were(143.8±48.5)mg·d^-1, (10.5±4.2)d, 53.1%, 40.6% and 84.4%, all significantly greater or higher than [(118.6±36.2)mg·d^-1, (7.8±3.6)d, 28.6%, 14.3% and 25.7%, respectively, P<0.05] in those without DILI; liver injuries, decreased serum albumin level, increased INR, C-reactive protein (CRP), procalcitonin (PCT) and lactic acid levels were common in DILI group (P<0.05); multivariate Logistic regression analysis showed that liver cirrhosis, dose and course of tigecycline, combination of anti-fungus medicine and steroid, increased serum CRP and PCT levels were all the independent risk factors for DILI occurrence(P<0.05). Conclusion In critically ill patients with severe bacterial infections, DILI could happen easily during tigecycline antimicrobial therapy, and appropriate prevention and managements should be given to improve the prognosis of patients in this setting.

Objective The purpose of this study was to investigate ultrasound attenuation coefficient imaging (ATI) in the evaluation of liver damage in children and adolescents with hepatolenticular degeneration (HLD). Methods Sixty children and adolescents with HLD, including Child class A in 38 cases, Child class B in 13 cases and Child class C in 9 cases, were encountered in our hospital between February 2021 and February 2024, and all underwent ultrasound attenuation coefficient and elastography imaging for ATI and liver stiffness measurement (LSM). The receiver operating characteristic (ROC) curve was applied to assess diagnostic performance of liver damage. Results LSM, ATI, Fib-4 and APRI in patients with Child-Pugh class C were (16.6±3.3)kPa, (0.8±0.3)dB/cm/MHz, (1.4±0.6) and (0.4±0.2), all significantly higher than [(11.0±2.2)kPa, (0.6±0.2)dB/cm/MHz, (1.0±0.5) and (0.3±0.1), respectively, P<0.05] in those with Child class B or [(7.1±1.2)kPa, (0.4±0.1)dB/cm/MHz, (0.7±0.3) and (0.2±0.1), respectively, P<0.05] in those with Child class A; ROC analysis showed that the AUCs were 0.88 and 0.90, respectively, when ATI and LSM were applied to predict severe liver injuries of Child-Pugh class B/C in patients with HLD, both much superior to 0.74 by Fib-4 or 0.72 by APRI. Conclusion ATI and LSM have a high diagnostic efficacy in the evaluation of liver damage in children and adolescents with HLD, and clinicians might select one of them to assess.

Objective The aim of this study was to investigate endoscopic glue injection and/or esophageal variceal ligation (EVL) in the treatment of patients with liver cirrhosis complicated with esophageal and gastric variceal bleeding (EGVB). Methods 86 patients with liver cirrhosis complicated with EGVB were encountered in our hospital between December 2021 and December 2024, and all were treated with endoscopic tissue glue injection and/or EVL. After 1 year of follow-up, the rebleeding was recorded. Routine clinical tests and examinations were performed to calculate fibrinogen-to-albumin ratio (FAR), neutrophil-to-lymphocyte ratio (NLR) and platelet count/spleen length diameter ratio (PC/SD). Results By end of 12 months of follow-up, rebleeding occurred in 37 cases (43.0%) in the 86 patients with liver cirrhosis after endoscopic treatment; percentage of Child-Pugh class C, INR, FAR and NLR in patients with re-bleeding were 100.0%, (1.4±0.2), (0.05±0.01) and 3.8(2.6,7.4), all significantly higher or greater than [42.9%, (1.2±0.1), (0.03±0.01) and 2.2(1.6,5.3),respectively, P<0.05],while PC/SD ratio was 428.3(338.4,568.5),significantly lower than [786.3(382.5,1028.8),P<0.05] in those without re-bleeding;multivariate Logistic regression analysis showed that PC/SD ratio (OR=0.532,95%CI:0.369-0.765) was protective factor for(P<0.05),while Child-Pugh class (OR=3.710,95%CI:1.267-10.860), INR(OR=5.631,95%CI:2.088-15.185), FAR(OR=2.358,95%CI:1.262-4.407) and NLR(OR=1.619,95%CI:1.167-2.246) were independent risk factors for re-bleeding in patients with EGVB after endoscopic treatment (P<0.05);ROC analysis demonstrated that the AUC was 0.929(95%CI:0.869-0.989), with sensitivity of 89.2% and specificity of 89.8%, when FAR was combined with NLR and PC/SD ratio in predicting re-bleeding. Conclusion Utility of FAR, NLR and PC/SD ratio combination has to some extent clinical value in predicting rebleeding in patients with liver cirrhosis complicated with EGVB after endoscopic treatment, which needs further investigation.

Objective The aim of this study was to investigate clinical efficacy of enteral nutrition preparations in the treatment of patients with decompensated hepatitis B-induced liver cirrhosis (LC). Methods 80 patients with decompensated hepatitis B-induced LC were encountered in Sanshui District People's Hospital, Foshan City between January 2023 and May 2024, all patients were carefully managed with comprehensive internal medication, and were randomly assigned to receive general whole-protein enteral nutrition preparations in 40 cases in control group, or to receive enteral special nutrition preparations in another 40 cases in observation group for six months. Blood, biochemical and serum liver fibrosis markers were routinely screened. Results By end of six-month treatment, two patients in the control and one patient in the observation died; serum albumin level in the observation survivals was (35.7±5.4)g/L, much higher than [(31.1±4.6)g/L, P＜0.05], while total serum bilirubin level was (22.6±8.1)μmol/L, much lower than [(28.9±9.7)μmol/L, P＜0.05] in control survivals; red blood cell count and hemoglobin level were (4.1±1.4)×10¹²/L and (108.5±6.9)g/L, both significantly higher than [(3.8±1.6)×10¹²/L and (98.2±5.8)g/L, respectively, P＜0.05] in the control; serum hyaluronic acid and type IV collagen levels were (123.6±15.0)μg/L and (135.0±47.8)μg/L, both significantly lower than [(151.4±16.0)μg/L and (158.7±46.1)μg/L, respectively, P＜0.05] in the control group. Conclusion The additional oral supplement with liver disease-special enteral nutrition preparations in dealing with patients with decompensated hepatitis B-induced LC could ameliorate anemia and hypoproteinemia, which merits further clinical investigation.

Objective The aim of this study was to explore the application of MR liver diffusion-weighted imaging (DWI) parameters in predicting patients with liver cirrhosis (LC) and high-risk esophageal varices (HREV). Methods The clinical data were collected from 94 patients with hepatitis B-induced LC in our hospital between August 2023 and August 2025, and all underwent gastroscopy and MR DWI to measure and record apparent diffusion coefficient (ADC), true diffusion coefficient (D), perfusion-related diffusion coefficient (D^*) and perfusion fraction (f). The diagnostic efficacy was evaluated by receiver operating characteristic (ROC) curves. Results Of the 94 patients with LC, gastroscopy found mild EV in 35 cases, moderate in 33 cases and severe in 26 cases, and HREV in 46 cases (48.9%) and non-HREV(NHREV) in 48 cases (51.1%); DWI parameters differed significantly among patients with different Child-Pugh classes and with different degrees of EV(P＜0.05); ADC and D in patients with HREV were (1.1±0.2)×10^-3mm²/s and (1.0±0.1)×10^-3mm²/s,both much smaller than [(1.4±0.3)×10^-3mm²/s and (1.3±0.2)×10^-3mm²/s, respectively, P＜0.05],while D^* and f were (45.7±12.4)×10^-3mm²/s and (28.6±6.4)%,both much greater than [(32.6±10.8)×10^-3mm²/s and (21.8±5.7)%,respectively, P＜0.05] in patients with NHREV; ROC analysis showed that the sensitivity was 92.3% while the specificity was 70.8%(P＜0.05), when combination DWI parameters, e.g., ADC, D, D^* and f, any three of them reaching to cut-off-value was set to predict HREV in patients with LC. Conclusion Application of MR DWI parameters of the liver could be useful in predicting HREV in patients with LC, which might help clinicians make further decisions of interventions.

Objective The aim of this study was to investigate the clinical efficacy of partial splenic embolization (PSE) based on highly selective catheterization of splenic artery in the treatment of patients with liver cirrhosis. Methods 96 patients with hepatitis B- or C-induced liver cirrhosis were encountered in our hospital between February 2023 and May 2025, and splenectomy and pericardial devascularization were conducted in 42 cases and PSE supported by highly selective catheterization of splenic artery was performed in another 54 cases. Portal vein diameter (PVD) and portal vein flow (PVF) were measured by Doppler ultrasonic diagnosis apparatus. Results By end of three-month after operation, platelet and red blood cell counts in PSE-treated patients were (108.6±32.4)×10⁹/L and (3.6±0.8)×10¹²/L,both much lower than [(126.9±28.7)×10⁹/L and (4.2±0.8)×10¹²/L,respectively, P<0.05] in splenectomy-treated patients; there were no significant differences as respect to liver function tests, PVD and PVF changes between the two groups (P>0.05); post-operationally, incidences of complications in PSE-treated patients was 16.7%,much lower than 33.3%(P<0.05) in splenectomy-treated patients,and portal thrombosis occurred in four cases (9.5%) in the latter group. Conclusion PSE based on highly selective catheterization of splenic artery in the treatment of patients with liver cirrhosis also oculd ameliorate hypersplenism to some intent, with less severe adverse effects and warrants further clinical investigation.

Objective The aim of this study was to investigate the feasibility of color Doppler ultrasound and contrast-enhanced ultrasound (CEUS) in evaluating stent function after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatitis B-induced liver cirrhosis (LC). Methods A total of 111 consecutive patients with hepatitis B-induced LC were encountered in our hospital between January 2021 and September 2024, portal hypertension (PH) was found in 53 cases (47.7%) based on hepatic venous pressure gradient(HVPG) measurement, and TIPS was conducted in 44 cases. Color Doppler ultrasonography was performed to record portal vein blood flow velocity (PVV), portal vein diameter (PVD) and portal vein blood flow (PVF), and CEUS was done to record time-intensity curve (TIC) for time to arrival (TOA), time to peak (TTP) and peak intensity(PI). Results PVV in patients with PH was (13.2±3.1)cm/s, much lower than [(15.9±3.5)cm/s, P<0.05], while PVD and PVF were (1.5±0.4)cm and (605.2±74.3)ml/min, both much wider or greater than [(1.3±0.2)cm and (502.0±47.1)ml/min, respectively, P<0.05] in those without PH; the portal parameters improved in PH patients after TIPS; TOA and TTP in PH group were (15.2±4.7)s and (35.7±6.4)s, both much quicker than [(13.7±3.5)s and (29.0±5.1)s, respectively, P<0.05], while the PI was (17.3±4.1)dB, much lower than [(23.1±4.6)dB, P<0.05] in those without PH; the TIC parameters improved in PH group after TIPS, not significantly different compared to patients without PH (P>0.05); six months after TIPS, stent dysfunction proven by digital subtraction angiography (DSA) was found in 7 cases (15.9%) out of 44 patients receiving TIPS, and the diagnostic consistence was satisfactory by ultrasonography and CEUS, with the sensitivity of 85.7%, specificity of 89.2% and accuracy of 88.6%. Conclusion Combination of color Doppler ultrasound and CEUS provides a reliable clinical tools for evaluating post-TIPS stent function in patients with hepatitis B-induced LC, and is worthy of widespread clinical application.

Objective The aim of this study was to investigate the efficacy and safety of lenvatinib plus camrelizumab at base of transarterial chemoembolization (TACE) in dealing with patients with unresectable hepatocellular carcinoma (HCC). Methods 90 consecutive patients with unresectable HCC were encountered at Second Affiliated Hospital, Xi’an Jiaotong University between March 2019 and March 2022, 32 patients underwent TACE (T group), 30 received TACE in combination with Lenvatinib (T-L group), and 28 received TACE in combination with lenvatinib and camrelizumab (T-L-P group) therapy. Overall survival (OS), progression-free survival (PFS), Objective response rate (ORR), disease control rate (DCR) and adverse reactions (AEs) were compared, and factors affecting OS and PFS were evaluated by multivariate Logistic regression analysis. Results DCRs in T-L-P and T-L groups were 82.1% and 80.0%,both significantly higher than 50.0%(P<0.05)in T group, while ORRs in the three groups were 57.1%, 50.0% and 31.3%, without significant differences (P>0.05);median overall survival (mOS) in T-L-P group, T-L group and T group were 41.6 mon, 30.5 mon and 21.3 mon (P=0.002);mPFS in the three groups were 14.5 mon, 12.4 mon and 8.2 mon (P=0.001);multivariate Logistic regression analysis showed that T-L-P combination therapy was a factor which could prolong OS and PFS, while remote metastasis and vascular invasion were the risk factors impacting OS and PFS prolongation; there was no significant differences as respect to incidence of AEs in the three groups (P>0.05). Conclusion T-L-P combination is short-termly efficacious in dealing with patients with unrecectable HCC, with relatively safe in clinical practice.

Objective This study aimed to analyze clinical clues of microvessel density (MVD) exhibited by MSCT perfusion imaging parameters in patients with hepatocellular carcinoma (HCC). Methods A total of 128 patients with HCC were encountered in Fourth Medical Center, PLA General Hospital, between October 2023 and October 2025, and all underwent MSCT perfusion imaging to measure perfusion imaging parameters, such as blood flow (BF), mean transit time (MTT), permeability surface (PS) and hepatic artery perfusion (HAP) at focal lesions pre-operationally. Tissue MVD formation was detected by immunohistochemistry. Multivariate Logistic regression analysis was applied to find impacting factors for MVD formation. Results Of the 128 patients with HCC, MVD was found positive in 102 cases (79.7%); size of tumors, percentage of low differentiation, BF, PS and HAP in patients with positive MVD were (7.8±1.2)cm, 60.8%, (108.5±20.8)mL/(100 mL·min^-1), (25.5±4.8)mL/(100mL·min^-1) and (50.5±7.3)mL/(100 mL·min^-1), all significantly greater than [(5.5±1.0)cm, 30.8%, (84.5±10.1)mL/(100 mL·min^-1), (20.7±3.4)mL/(100mL·min^-1) and (42.2±8.2)mL/(100 mL·min^-1), respectively, P＜0.05], while MTT was (15.9±7.1)s, significantly less than [(19.4±6.1)s, P＜0.05] in those with MVD negative; multivariate Logistic regression analysis showed that tumor size, low differentiation, BF≥99.8 mL/(100 mL·min^-1), MTT≤17.4 s, PS≥22.3 mL/(100 mL·min^-1) and HAP≥43.3 mL/(100 mL·min^-1) were all the independent risk factors for MVD formation (P＜0.05)in patients with HCC. Conclusion MSCT perfusion imaging parameters could hint MVD existence in patients with HCC, which might help clinicians make appropriate management strategy, and improve prognosis of patients with HCC.

Objective The aim of this study was toinvestigate theefficacy of sintilimab in combination with lenvatinib in treatment ofpatients with advanced primary liver cancer (aPLC). Methods A total of 95 patients with aPLC were encountered in our hospital between July 2022 and December 2024, and were randomly assigned to receivelenvatinibin 47 cases in control or receive lenvatinib and sintilimab combination in another 48 cases in observation for 4 cycles of the regimen. Patients were followed-up for one to two and half years. Serum alpha fetoprotein (AFP), protein induced by vitamin K absence or antagonist-II ( PIVKA-II) and lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3) levels were measured by using ELISA, and peripheral blood Tlymphocyte subsets were detected by flow cytometry. Results Objective remission rate and disease control rate in the observation group were 45.8% and 87.2%, both significantly higher than 23.4% and 70.2% (P<0.05)in the control group; after treatment, serum PIVKA-II, AFP and AFP-L3 levels in the observation group were all much lower than in the control (P＜0.05); percentage of CD4⁺ cells and CD4⁺/CD8⁺ cell ratio were both significantly higher than in the control group (P＜0.05); by end of follow-up, 35 patients (72.9%)in the observation and25 patients (53.2%) in the control survived (P＜0.05), with mean progress-free survival of 16.5 mon, much longer than 9.4 mon (P＜0.05) in the control; one-year survival rate in the observation was 89.6%, much higher than 72.3%(P＜0.05) in the control group. Conclusion Combination of sintilimaband lenvatinibin dealing with patients with aPLC could obtain promising clinical benefits, with prolonged short-term survival rate, which might related to improved body immune functions and inhibition of tumor growth.

Objective The aim of this study was to explore assessment of therapeutic effectiveness by contrast-enhanced CT scan in patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) therapy. Methods 80 patients with HCC were encountered in our hospital between May 2023 and May 2025, and all underwent TACE therapy for two times at one-month interval. All patients received contrast-enhanced CT scan to record CT value of lesions and enhancement index was calculated. Receiver operating characteristic (ROC) curve was drawn to evaluate predicting efficacy of CT parameters. Results Of 80 patients with HCC in our series, Objective remission (OR) was obtained in 46 cases(57.5%)and didn’t (NOR) obtain in 34 cases (42.5%) based on mRECIST criteria; after treatment, CT values of lesions at plain scan, contrast-enhanced scans at arterial phase, portal vein phase and delayed phase in OR group were (45.3±4.6)HU, (93.3±8.7)HU, (71.1±9.3)HU and (65.8±9.1)HU, all much greater than [(38.3±2.4)HU, (70.1±8.3)HU, (62.8±7.6)HU and (62.3±8.2)HU, respectively, P＜0.05] in NOR group; enhancement indexes at arterial phase, portal vein phase and delayed phase were(0.6±0.2), (0.9±0.1) and (0.9±0.2), all much greater than [(0.5±0.1), (0.8±0.2) and (0.8±0.1), respectively, P＜0.05] in NOR group; ROC analysis showed that the AUC was 0.839 (95%CI:0.658-0.874), with sensitivity of 82.5% and specificity of 83.9%, when CT value of cancerous lesions was combined with enhancement index in predicting good efficacy of TACE. Conclusion The quantitative parameters of contrast-enhanced CT scan could relatively correctly predict therapeutic effect of TACE in patients with HCC, which might guide clinicians make further interventional strategy.

Objective The aim of this clinical trial was to compare efficacy of drug-eluting beads transarterial chemoembolization (D-TACE) and conventional transarterial chemoembolization (C-TACE) in the treatment of patients with hepatocellular carcinoma (HCC). Methods A total of 104 patients with HCC were encountered in our hospital between January 2020 and February 2023, were assigned to receive D-TACE in 56 cases, or to receive C-TACE in 48 cases, and all were followed-up for two years. Serum alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) levels were routinely detected. Results A comparatively higher disease control rate (DCR) was observed in D-TACE group than in C-TACE group (85.7% vs. 66.7%, respectively, P＜0.05); after treatment, serum AFP and PIVKA-II levels in D-TACE group were (90.4±16.7)μg/L and (361.0±41.9)μg/L, both much lower than [(154.1±20.5)μg/L and (421.4±48.7)μg/L, respectively, P＜0.05] in C-TACE group; incidence of adverse effects, such as nausea, granulocytopenia and serum ALT level elevation in D-TACE group were 7.1%, 16.1% and 12.5%, all much lower than 22.9%, 35.4% and 31.3%(P＜0.05) in C-TACE group; one- and two-year survival rates in D-TACE group were 84.9%(45/53) and 69.8%(37/53), both much higher than 68.3%(28/41, P<0.05) and 51.2%(21/41, P<0.05) in C-TACE group. Conclusion D-TACE therapy is efficacious in treatment of patients with HCC, which might improve disease control rate, reduce postoperative adverse reactions, and prolong overall survival.

Objective The aim of this study was to investigate impact of preoperative sarcopenia on postoperative outcomes in patients with end-stage liver disease undergoing liver transplantation (LT). Methods A single-center retrospective cohort study was conducted, enrolling 321 adult patients who underwent allogeneic LT at Beijing You’an Hospital, Capital Medical University, between January 2015 and September 2022. The third lumbar skeletal muscle area (L3-SMA), third lumbar skeletal muscle index (L3-SMI) and skeletal muscle radiation attenuation (SM-RA) were measured by using abdominal CT scans and sarcopenia was diagnosed based on CT results. Binary Logistic regression analysis was applied to reveal risk factors. Results Of the 321 patients receiving LT, preoperative sarcopenia was found in 85 cases (26.5%); sarcopenia was more common in male than in female (29.2% vs. 14.0%,P＜0.01); elderly age, decreased BMI, concomitant liver cirrhosis and severe anemia were frequent in patients with sarcopenia (P＜0.01); L3-SMA, L3-SMI and SM-RA in patients with sarcopenia were (101.5±17.0)cm², (34.0±4.8)cm²/m² and (35.2±7.5)Hu, all much lower than [(136.2±25.0)cm², (46.6±7.1)cm²/m² and (38.9±6.7)Hu, respectively, P＜0.01] in those without sarcopenia; survival at 28 days in patients with sarcopenia was much lower than in those without (80.0% vs. 91.1%, P=0.006), and survival at one year was also significantly lower than in without(75.3% vs. 87.3%, P=0.008); binary Logistic regression analysis showed that sarcopenia, age, hepatic encephalopathy and end-stage liver disease-sodium (MELD-Na) score were all the independent risk factors for poor prognosis at day 28, and age and MELD-Na score were the independent risk factors for poor prognosis at one-year. Conclusion Preoperative sarcopenia could lead to poor short-term postoperative outcomes in patients undergoing LT, and CT-based assessment of L3-SMI and SM-RA could provide evidence for diagnosis of sarcopenia.

Objective This study aimed to construct and validate a predicting model by combination of serum IL-34 (IL-34), alanine aminotransferase/direct bilirubin ratio (ADR) and model for end -stage liver disease (MELD) score in recipients with liver transplant (LT)for early allograft dysfunction (EAD). Methods A total of 156 patients were encountered in our hospital between January 2020 and December 2024, and all underwent allogeneic liver transplantation (ALT). Serum IL-34 level was assayed by ELISA, routine biochemical parameters were detected, and ADR and MELD score were calculated. Multivariate Logistic regression analysis was performed to identify independent predictors for EAD occurrence, predicting models were established and predicting performance were evaluated by receiver operating characteristic (ROC) curve analysis. Results By end of seven days after LT, EAD occurred in 27 cases (17.3%) and didn’t in 129 cases (82.7%) in our series; baseline percentage of Child-Pugh class C and MELD score in patients with EAD were much higher than in those without EAD(P＜0.05); serum IL-34, ALT, direct bilirumin levels and ADR in patients with EAD were (87.6±15.3)pg/mL, (1865.4±320.8)U/L, (58.3±12.4)μmol/L and(31.9±7.8), all significantly higher than [(45.2±10.7)pg/mL, (642.3±185.6)U/L, (23.7±8.9)μmol/L and (27.0±6.5), respectively, P<0.001] in those without EAD; multivariate Logistic regression analysis showed that baseline MELD score, Child-Pugh classification, serum IL-34 level and ADR were all the independent risk factors for EAD occurrence after LT (OR>1,all P<0.05); the AUC was 0.913(95%CI:0.865-0.961), with sensitivity of 88.9% and specificity of 85.3%, when MELD, Child-Pugh classification, serum IL-34 level were combined with ADR to predict EAD happening after LT. Conclusion Combination of serum IL-34 and ADR with liver reservoir index has a promising efficacy in predicting EAD after LT, which warrants further clinical verification.

Objective This study was aimed to compare the efficacy of three different minimally invasive treatments for patients with simple hepatic cysts(SHC). Methods 97 patients with SHC were admitted to our hospital between March 2021 and March 2024, and were divided into group A(n=29), B(n=33) and C(n=35), receiving intra-cystic absolute ethanol sclerotherapy, radiofrequency ablation (RFA) or polidocanol foam sclerotherapy all under ultrasound (US) guidance. Serum Golgi protein 73 (GP73), protein disulfide isomerase A3 (PDIA3) and chitinase-3-like protein 1 (CHI3L1) levels were measured by using an automatic immunoassay analyzer. Results After treatment, serum GP73, PDIA3 and CHI3L1 levels in group C were (24.4±3.6)pg/L, (67.7±5.2)ng/mL and (46.4±5.8)ng/L, all significantly lower than [(31.4±4.3)pg/L, (82.7±5.4)ng/mL and (61.8±6.4)ng/L, respectively, P<0.05] in group B or [(34.2±4.4)pg/L, (89.8±6.7)ng/mL and (66.3±6.8)ng/L, respectively, P<0.05] in group A; by end of three-month after treatment, cyst disappearance and total effectiveness rates in group C were 85.7% and 97.1%, both much higher than 58.6% and 86.2%(P<0.05) in group A, and they were 75.8% and 93.9% in group B; by end of six-month after treatment, cyst relapse in group C was 5.7%, much lower than 27.6%(P<0.05) in group A, and that was 15.2% in group B; incidence of intoxication-like reaction after alcohol injection in group A was 34.5%, while adverse effects in group B and C were much lower than in group A(P<0.05). Conclusion We strongly recommend polidocanol sclerotherapy under US guidance in dealing with patients with SHC, which could provide a best therapeutic efficacy, with higher safety.

Objective The aim of this study was to summarize the efficacy of auxiliary contrast-enhanced ultrasound (CEUS) and percutaneous catheter drainage (PCD) under ultrasound (US) guidance in the treatment of patients with pyogenic liver abscess(PLA). Methods 91 patients with PLA were admitted to our hospital between January 2020 and January 2025, and were randomly divided into control (n=45) and observation group (n=46), underwent PCD under US guidance or underwent PCD under US guidance with CEUS assistance. Serum interleukin-6 (IL-6) and C-reactive protein (CRP) levels were detected by ELISA, and serum procalcitonin (PCT) level was assayed by fluorescence immunoassay. Results In our series, the fever remission time was(2.7±0.6)d, drainage tube removal time was (6.1±1.3)d, disappearance of abscess cavity was (9.5±3.0)d and all patients recovered; Escherichia coli was separated in 26 cases, Klebsiella pneumonia in 19 cases, Staphylococcus aureus in 4 cases and Pseudomonas aeruginosa in 1 case; after treatment, white blood cell count, percentage of neutrophil, serum interleukin-6, C-reactive protein and PCT levels in the observation were (8.6±3.3)×10⁹/L, (71.3±5.7)%, (55.3±8.3)pg/mL, (4.9±4.3)mg/L and (0.4±0.1)ng/mL, all not significantly different as compared to [(8.2±2.5)×10⁹/L, (70.3±5.2)%, (54.3±6.7)pg/mL, (5.6±3.1)mg/L and (0.3±0.1)ng/mL, respectively, P>0.05] in the control group. Conclusion Auxiliary CEUS scan might help judge liquefaction of liver abscess, which could guide clinicians to take measures as early as possible.

Objective The purpose of this study was to observe improvement of enhanced recovery after laparoscopic cholecystectomy (LC) by intraoperative infusion of esketamine in patients with gallstones. Methods A total of 98 patients with gallstones were encountered in our hospital between October 2024 and October 2025, randomly divided into two groups, and all underwent LC. At anesthesia maintaining stage, normal saline was given in control group, and intraoperative intravenous infusion of esketamine was given until discontinuation of surgery. Visual analog scale (VAS) was used to assess pain degree, and 15-item quality of recovery (QoR-15) scale was applied to evaluate recovery quality. Serum interleukin-6 (IL-6) , IL-8 and tumor necrosis factor-alpha (TNF-α) levels were measured by ELISA. Results By one hour and twelve hours after operation, resting VAS scores in the observation group were(2.6±0.3) and (2.7±0.4), both much lower than [(3.3±0.5) and (3.4±0.3), respectively, P<0.05],and motion VAS scores were (2.9±0.3) and (2.8±0.2), both much lower than [(3.6±0.4) and (3.5±0.4), respectively, P<0.05] in the control group; by twelve and twenty-fours, QoR-15 scores in the observation were (114.3±10.2) and (120.0±11.3), both significantly greater than [(101.6±7.1) and (109.4±8.8), respectively, P<0.05] in the control; by end of twenty-four after surgery, serum IL-6, IL-8 and TNF-α levels in the observation were (82.3±9.7)pg/L, (51.3±9.0)pg/L and (16.5±1.9)pg/L, all much lower than [(105.8±10.5)pg/L, (83.7±11.3)pg/L and (22.8±2.3)pg/L,respectively, P<0.05] in the control group. Conclusion Boosting intravenous infusion of esketamine once before discontinuation of LC could improve enhanced recovery after surgery (ERAS) in patients with gallstones, and warrants further clinical investigation.

Objective This study aimed to identify the major factors influencing postoperative residual or recurrent stones in patients with intrahepatic bile duct stones (IHBDS) after partial hepatectomy (PH) and biliary-enteric anastomosis (BEA). Methods 65 patients with IHBDS were encountered in our hospital between January 2022 and December 2024, and all underwent PH and BEA combination operation. Patients were followed-up for six months. Multivariate Logistic regression analysis was applied to reveal impacting factors for postoperative residual or recurrent stones. Results By end of six-month of follow-up, residual or recurrent stones were found in 14 cases(21.5%)by ultrasonography; age older, disease duration longer, percentages of right and left lobe stone distribution, biliary operation history and concomitant diabetes higher in patients with residual or recurrent stones than in without residual or recurrent stones(P<0.05); operative times, intraoperative blood loss, incidences of failed choledochoscopic stone removal and biliary stricture were (252.1±44.6)min, (502.9±162.7)ml, 42.9% and 50.0%, all much longer/greater/higher than [(210.8±33.9)min, (356.2±125.4)ml, 9.8% and 13.7%, respectively, P<0.05] in those without residual or recurrent stones; post-operationally, adverse events, such as bile leakage, cholangitis, delayed recovery of liver function tests and reoperation were 28.6%, 35.7%, 35.7% and 28.6%, all much higher than 3.9%, 11.8%, 17.6% and 5.9%(P<0.05), respectively, in those without residual or recurrent stones; multivariate Logistic regression analysis showed that disease duration longer than 5 yrs(OR=2.61, P=0.032), right and left lobe stones (OR=3.36, P=0.017), biliary operation history (OR=3.83, P=0.026), operational bleeding volume ≥400 mL(OR=3.16, P=0.037), biliary stricture (OR=4.34, P=0.014), postoperative bile leakage (OR=5.36,P=0.013) and postoperative cholangitis(OR=3.56, P=0.045) were all the independent impacting factors for residual or recurrent stones after surgery. Conclusion Surgeons should take impacting factors on stone residue or recurrence into consideration in clinical practice, and take measures to prevent and deal with it.

Objective The aim of this study was to investigate the short-term effects of early oral administration of dietary fiber containing enteral nutrition preparations on postoperative gastrointestinal functions and serum inflammatory factors in patients with gallbladder stones after laparoscopic cholecystectomy (LC). Methods 120 patients with gallbladder stones were encountered in our hospital between May 2023 and April 2025, and all underwent LC operation. After surgery, patients were randomly assigned to receive enteral nutrition containing dietary fiber in 61 cases, or receive conventional parenteral nutrition in another 59 cases for three days. Serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), gastrin (GAS), motilin (MTL) and vasoactive intestinal peptide (VIP) levels were detected by ELISA. Results Bowel sound recovery, anal exhaust, defecation time and hospital stay in the enteral nutrition group were(9.3±1.7)h, (28.4±3.5)h, (33.4±3.7)h and (5.8±1.2)d,all significantly shorter than [(13.7±2.3)h, (37.8±4.3)h, (41.3±4.7)h and (7.6±1.5)d,respectively, P＜0.01],while medical cost was (20.3±4.0) thousand yuan, significantly less than [(29.0±5.0)thousand yuan, P＜0.01] in the parenteral nutrition group;by 72 h,serum IL-6, TNF-α and CRP levels were (15.8±3.3)ng/L, (18.5±3.8)ng/L and (28.5±5.7)mg/L,all much lower than [(21.3±4.2)ng/L, (24.7±4.4)ng/L and (36.8±6.9)mg/L,respectively, P＜0.01] in the parenteral nutrition group;serum GAS and MTL levels were (105.7±15.8)ng/L and (285.7±42.4)ng/L,both much higher than [(92.3±14.6)ng/L and (245.8±40.1)ng/L,respectively, P＜0.01],while serum VIP level was (42.3±9.2)ng/L,much lower than [(48.7±10.2)ng/L,P<0.01] in the parenteral nutrition group. Conclusion Early oral administration of enteral nutrition, including dietary fiber preparations after LC could effectively promote gastrointestinal function recovery and reduce inflammatory reactions.

Objective The aim of this study was to investigate sedation of dexmedetomidine and propofol combination for target-controlled infusion (TCI) in patients with common bile duct stones (CBDS) undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods 102 patients with CBDS were encountered in our hospital between January 2023 and May 2025, and they all underwent selective ERCP. For sedation, they were randomly divided into control (n=51) and observation group (n=51), receiving sufentanil and propofol combination for TCI or dexmedetomidine and propofol combination for TCI, respectively. Anesthesia time, recovery time and anesthesia recovery time were recorded. Heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO₂) were monitored by a monitor at time of entering operating room (T₀), induction completion (T₁), endoscope insertion (T₂), 10 min after endoscope insertion (T₃), discontinuation of drug administration (T₄) and at 5 min after entering the recovery room (T₅). Ramsay sedation scale (RSS) score was evaluated, and visual analogue scale (VAS) was used to evaluate pain. Plasma cortisol (Cor), adrenocorticotropic hormone (ACTH) and tumor necrosis factor-α (TNF-α) levels were detected by ELISA. Results At T₂ to T₅, HR and MAP in the observation group were significantly lower than in the control group (P<0.05), and at T₁ to T₄, the RSS scores in the observation group were significantly higher than in the control group (P<0.05); after surgery, serum Cor, ACTH and TNF-α levels in the observation group were (228.6±34.6) mmol/L, (18.5±3.6) pmol/L and (30.1±3.5) pg/mL, all significantly lower than [(269.0±33.9) mmol/L, (25.4±4.3) pmol/L and (41.8±5.9) pg/mL, respectively, P<0.05) in the control group. Conclusion TCI by dexmedetomidine in combination with propofol has a satisfactory sedation in patients with CBDS undergoing ERCP, which might relieve postoperative body stress.

Objective The aim of this study was to investigate the efficacy of endoscopic nasobiliary drainage (ENBD) in combination with endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) in the treatment of patients with common bile duct stones (CBDS) and moderate-to-severe acute cholangitis (AC). Methods 63 patients with CBDS complicated with moderate-to-severe AC were enrolled in our hospital between January 2023 and January 2025, and were randomly assigned to underwent ERCP/EST in 31 cases in control, or underwent ENBD in combination with ERCP/EST in another 32 cases in observation. All patients were followed-up for six months. Serum procalcitonin (PCT) and C-reactive protein (CRP) levels were determined by fluorescence immunochromatography. Results After surgery, ambulation and hospital stay in the observation were (16.5±3.5)h and (5.1±1.6)d, both much shorter than [(25.4±4.2)h and (7.3±2.1)d, respectively, P<0.05] in the control; there was no significant difference as respect to complete stone clearance(93.8% vs. 93.5%, P>0.05); by three days after operation, serum bilirubin, ALT and AST levels in the observation group were (15.8±3.8)μmol/L, (88.6±10.5)U/L and (71.4±7.6)U/L, all significantly lower than [(33.5±6.5)μmol/L, (112.5±14.2)U/L and (97.5±8.9)U/L, respectively, P<0.05], while serum albumin level was (37.2±6.1)g/L, significantly higher than [(34.1±5.9)g/L, P<0.05] in the control; WBC count, serum PCT and CRP levels were (10.5±2.4)×10⁹/L, (1.0±0.5)ng/mL and (42.8±5.9)mg/L, all much lower than [(12.2±2.8)×10⁹/L, (2.8±0.6)ng/mL and (65.4±7.2)mg/L, respectively, P<0.05] in the control; by end of six-month follow-up, incidence of adverse effects in the two groups was not significant different (12.5% vs. 12.9%, P>0.05). Conclusion ERCP/EST plus ENBD is efficacious in dealing with patients with CBDS and AC, with rapid improvement of postoperative recovery.

Objective The purpose of this study was to investigate the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of patients with acute obstructive suppurative cholangitis (AOSC). Methods A total of 106 patients with AOSC were encountered in our hospital between March 2021 and September 2024, and were randomly assigned to receive ERCP in 55 cases in observation or receive open surgery in another 51 cases in the control. Bile pathogens were separated and characterized routinely. Serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were detected by ELISA. Serum C-reactive protein (CRP) and endotoxin levels were routinely obtained, and pain was assessed by visual analogue score. Results Intraoperative bleeding, operation time, VAS scores 6 hours after surgery and hospital stay in the observation were(35.4±7.5)ml, (68.5±7.0)min, (3.2±0.8) and (6.5±1.5)d, all much less or lower than [(75.0±14.0)ml, (104.0±12.5)min, (4.5±1.1) and (12.2±2.2)d, respectively, P<0.05] in the control; after operation, serum IL-6, TNF-α, CRP and endotoxin levels in the observation were (75.6±9.4)ng/L, (16.1±3.7)ng/L, (17.7±1.3)mg/L and (14.1±2.0)pg/mL, all significantly lower than [(94.1±10.2)ng/L, (22.2±4.3)ng/L, (25.7±1.7)mg/L and (21.0±3.0)pg/mL, respectively, P<0.05] in the control group; bacterial culture of bile was positive in 66 cases (62.3%), yielding 81 pathogenic strains, including Gram-positive in 29 strains (35.8%) and Gram-negative bacteria in 52 strains (64.2%), and Staphylococcus aureus accounted for 19.7% and Escherichia coli for 39.5%. Conclusion The common infected pathogens in patients with AOSC are E. coli and S. aureus, and the ERCP offers a satisfactory clinical efficacy.

Objective The aim of this study was to investigate diagnostic efficacy of computed tomography (CT) and magnetic resonance imaging (MRI) enhanced scans, including magnetic resonance cholangiopancreatography (MRCP), in clinical staging of patients with cholangiocarcinoma (CC). Methods 61 patients with CC were encountered in our hospital between October 2023 and June 2025, and they all received enhanced CT, MRI and MRCP examination before surgery. The diagnosis and tumor staging were proven by histopathological study. Diagnostic consistence was analyzed by Kappa. Results Of the 61 patients with CC, liver histopathological examination found clinical stage Ⅰ in 10 cases, stage Ⅱ in 15 cases, stage Ⅲ in 19 cases and stage Ⅳ in 17 cases; accuracy rate of CT combined with MRI and MRCP in the diagnosis of clinical stage II was 93.3%, much higher than 53.3%(P<0.05) by CT scan; accuracy rate of the three combination in the diagnosis of clinical stage Ⅲ was 94.7%, much higher than 63.2%, 68.4% and 63.2% (P<0.05) by CT, or MRI or MRCP alone; accuracy rate of the three combination in the diagnosis of clinical stage Ⅳ was 94.1%, much higher than 52.9%, 64.7% and 58.8% (P<0.05) by CT, or MRI or MRCP alone; of 41 patients with hilar CC, accuracy of MRCP in diagnosis of Bismuth-Corlette Ⅰ, Ⅱ, Ⅲa, Ⅲb and Ⅳ was 70.7%(29/41). Conclusion Clinical staging of patients with CC by enhanced CT, MRI and MRCP combination has a high diagnostic performance, which could provide a imaging basis for preoperative accurate tumor staging, surgical resectability assessment and individualized treatment strategy.

Objective The aim of this study was to summarize Bismuth-Corlette typing of patients with hilar cholangiocarcinoma (HCCA) by CT multimodal reconstruction. Methods 37 patients with HCCA were admitted to our hospital between January 2023 and January 2025, all underwent multi-slice spiral CT scan and multiplanar reconstruction (MPR), three-dimensional volume rendering (VR) and maximum intensity projection (MIP) were reconstructed. Taking Results of surgical tissue pathological examination as the golden standard, diagnostic efficacy for Bismuth-Corlette classifications and lymph node metastasis by CT scan was evaluated. Results Of the 37 patients with HCCA, surgical tissue histopathological examination found Bismuth-Corlette type I in 5 cases, type II in 9 cases, type IIIa in 7 cases, type IIIb in 7 cases and type IV in 9 cases, and the overall diagnostic accuracy rate by CT multimodal reconstruction for Bismuth-Corlette classifications was 83.8% (31/37), with Kappa of 0.795 (P<0.001), and especially, the diagnostic accuracy for type Ⅱ and Ⅲa were 88.9% (8/9) and 85.7% (6/7), respectively; liver histopathological examination found lymph node metastasis in 17 cases (45.9%), and CT multimodal reconstruction diagnosed in 14 cases, with sensitivity of 82.4%, specificity of 80.0%, accuracy of 81.1%, positive predictive value of 77.8%, negative predictive value of 84.2% and Kappa of 0.621, suggesting good consistency(P<0.001). Conclusion CT multimodal reconstruction could clearly depict lesion boundary, involved vessels and lymph node metastasis in patients with HCCA, with perfect evaluation of tumor staging and lymph node metastasis, which might help make subsequent surgical planning and predict prognosis.

Objective This study aimed to retrospectively compare clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) vs. percutaneous transhepatic cholangial drainage (PTCD in dealing with patients with hilar cholangiocarcinoma (HiCC) and obstructive jaundice. Methods 56 patients with unresectable HiCC with hyperbilirubinemia were encountered in our hospital between January 2022 and December 2024, of them, ERCP was conducted in 30 cases and PTCD in 26 cases. Serum C-reactive protein (CRP) and interleukin-6 (IL-6) levels were detected by ELISA, and peripheral blood lymphocyte subsets were determined by FCM. Short-term quality of life was assessed by KPS score. Results By end of 7 days after operation, drainage tube patency in ERCP group was 93.3%,much higher than 76.9%(P<0.05), total serum bilirubin level was (79.3±23.5)μmol/L, much lower than [(98.6±26.7)μmol/L,P<0.05],while serum albumin level was (37.8±5.9)g/L, much higher than [(34.3±6.1)g/L,P<0.05] in PTCD group; incidence of post-operational complications was 20.0%,much lower than 46.2%(P<0.05) in PTCD group; by end of 14 days after surgery, serum CRP and IL-6 levels were both significantly lower than, while peripheral blood CD4⁺ cell percentage and CD4⁺/CD8⁺ cell ratio were both significantly higher than in PTCD group(P<0.05);KPS score and improvement of appetite were much higher than in PTCD group(P<0.05);median overall survival and 12 m survival rate were 9.8(8.4,11.3)mon and 43.3%,both much longer or higher than [7.2(6.1,8.4)mon and 26.9%,P<0.05] in PTCD group. Conclusion Both ERCP and PTCD could effectively relieve malignant obstructive jaundice in patients with HiCC, but we recommend ERCP preferentially as it seems more efficacious.

Liver diseases can lead to ocular abnormalities through diverse mechanisms, including metabolic disturbances, viral infections and immune dysregulation. These ocular manifestations are closely correlated with hepatic pathological changes and may serve as an important auxiliary indicator for early diagnosis and disease monitoring of liver diseases. This review systematically searches literature in PubMed database, with a focus on characterizing the ocular features associated with different types of liver diseases, analyzing their pathogenic mechanisms, and summarizing the clinical implication of ocular signs in hepatological diagnosis.