Gastrointestinal symptoms as a common clinical evaluation index require a universal evaluation tool, and the Gastrointestinal Symptom Rating Scale (GSRS) has been widely applicated in domestic studies. However, the versions used are not standardized Chinese versions and their measurement performance has not been reported yet.

To explore the measurement performance of the Chinese version of the GSRS, in order to provide an objective basis for expanding the application of the scale.

From October 2021 to March 2022, patients with irritable bowel syndrome (IBS), chronic enteritis and chronic gastritis who attended outpatient clinics of splenogastroenterology or gastroenterology in 45 hospitals (community health service centers), including Jilin Provincial People's Hospital and Beijing Changping District Urban Community Health Service Center, etc. The Chinese version of GSRS was used to evaluate the gastrointestinal symptoms of the included patients on treatment days 0, 3, 7 and 14. Reliability and validity analyses were conducted on the Chinese version of GSRS, and the paired Wilcoxon signed rank sum test was applied to compare the changes in the scores of patients before and after treatment. Additionally, effect size (ES), standardized response mean (SRM), and score change rate (CR) were used to assess the responsiveness of the scales.

A total of 554 patients were included and followed up, including 127 patients (22.93%) with IBS, 244 (44.04%) patientswith chronic enteritis and 183 (33.03%) patients with chronic gastritis. The Cronbach's alpha coefficient for the Chinese version of GSRS was 0.896, the Guttman Split-half coefficient was 0.920, the Spearman-Brown coefficient was 0.926, the intraclass correlation coefficient (ICC) for the two retest results was 0.589, and the Spearman correlation coefficient was 0.662. The content validity index for each item ranged from 0.78 to 1.00. The content validity index (CVI) for the scale-level universal agreement was 0.73, and the average CVI was 0.96. Exploratory factor analysis extracted a total of three common factors with eigenvalues>1, and the rate of cumulative variance contribution is 60.721%.The validation factor analysis demonstrated that the data samples did not fit the initial model M0 well, and each fit index of model M1 is within the acceptable range after correction according to the modification indicator hints in the acceptable range: χ²/df<3.000, root mean square error of approximation (RMSEA) <0.800, and each fit index >0.900. The total Chinese version of GSRS scores of patients after 14 d of treatment are lower than the total Chinese version of GSRS scores before treatment (P<0.001), with ES=1.03, SRM=1.01, and CR=74.32%.

The Chinese version of GSRS has a high level of measurement performance with good reliability and responsiveness, which is suitable for measuring a general population with gastrointestinal symptoms and evaluating the treatment effectiveness of them.

Primary liver cancer is one of the common cancers in the world and with extremely high morbidity and mortality. This paper details the current epidemiology of primary liver cancer, population attributable fractions and associated risk factors in China. In this paper, we found that hepatitis B virus and hepatitis C virus are still the main risk factors for the development of primary liver cancer by searching the databases such as PubMed, Web of Science, and CNKI. With hepatitis B virus vaccination and antiviral treatment, the incidence of primary liver cancer in China has slightly decreased, but the incidence of primary liver cancer caused by metabolic factors such as diabetes, obesity and non-alcoholic fatty liver disease is gradually increasing; smoking and alcohol consumption are also important risk factors. This article summarizes the epidemiological characteristics and risk factors of primary liver cancer, which can provide practical evidence-based medicine evidence for the development of preventive and control measures for primary liver cancer.

Esophageal and gastric varices bleeding (EGVB) is one of the most common and dangerous complications of liver cirrhosis. However, whether EGVB affects the one-year mortality of patients with liver cirrhosis remains unclear.

To explore the influence of EGVB on one-year mortality and influencing factors in patients with liver cirrhosis, providing guidance for follow-up for these patients.

This study selected liver cirrhosis patients who were admitted to the Affiliated Changsha Central Hospital, University of South China from January 2015 to May 2021. The patients were divided into EGVB group and non-bleeding (control group) by the prevalence of EGVB at the first consultation. One-year routine follow-up was conducted with them until the date of death from liver cirrhosis or the termination follow-up day. Logistic regression analysis was conducted for screening the factors affecting one-year mortality. Furthermore, the covariates between the two groups were matched in a 1∶2 ratio using propensity score matching (PSM) . Then, Logistic regression analyses were applied to identify and compare the influencing factors of one-year mortality in the groups.

Among the 812 patients enrolled, 158 (19.5%) were diagnosed with EGVB, and the other 654 (80.5%) had no EGVB. The one-year mortality of the EGVB and control groups was 13.3% (21/158) and 13.9% (91/654) , respectively, showing no significant difference (P>0.05) . Before PSM, multivariate Logistic regression analysis showed that elevated serum sodium level〔OR=0.95, 95%CI (0.90, 0.99) 〕 and albumin level [OR=0.95, 95%CI (0.91, 0.99) 〕 were associated with a decreased risk of one-year mortality (P<0.05) , while older age〔OR=1.04, 95%CI (1.02, 1.06) 〕 and hepatic encephalopathy (grade Ⅲ or Ⅳ) 〔OR=3.72, 95%CI (1.21, 11.37) 〕were associated with an increased risk (P<0.05) . After PSM, the one-year mortality was the same in EGVB group (n=145) and control group (n=290) 〔12.4% (18/145) vs 12.4% (36/290) 〕, showing no significant difference (P>0.05) . Moreover, elevated blood urea nitrogen (BUN) 〔OR=1.15, 95%CI (1.02, 1.29) 〕 was an independent risk factor for one-year mortality in EGVB group (P<0.05) , while older age〔OR=1.09, 95%CI (1.04, 1.14) 〕 and elevated neutrophil-to-lymphocyte ratio (NLR) 〔OR=1.09, 95%CI (1.00, 1.18) 〕 acted as independent risk factors for one-year mortality in the control group (P<0.05) .

EGVB had no obvious association with one-year mortality in liver cirrhosis patients. But there were considerable discrepancies in the risk factors affecting one-year mortality between the two groups. Elevated BUN was the independent risk factor for one-year mortality in the EGVB group, while older age and elevated NLR were independent risk factors for one-year mortality in the control group. These results provide a new reference for clinical follow-up and treatment of patients with liver cirrhosis.

Non-alcoholic fatty liver disease has showed a high prevalence and a increasing trend especially towards younger age. It is of great public health significance to reduce damage through early detection of NAFLD in physical examination and intervention in time.

To investigate the detection rate of NAFLD in the Beijing physical examination population from 2018 to 2021, and analyze its related influencing factors.

People who received physical examinations at the Beijing Physical Examination Center from 2018-01-01 to 2021-12-31 were selected based on the inclusion criteria, the results of physical examination, laboratory examination, and liver ultrasonography were collected for analysis. Univariate analysis was performed using t-test, Mann-Whitney U test and Chi-square test. Multivariate Logistic regression was used to explore the influencing factors of NAFLD.

A total 325 726 people were included in the study, of which 108 512 cases of NAFLD were detected, with a detection rate of 33.31%. The results of liver ultrasonography revealed that the number of mild, moderate and severe NAFLD detections were 74 062, 33 281 and 1 169 cases, accounting for 68.25%, 30.67% and 1.08% of the detection population, respectively. The detection rate of NAFLD was higher in males than females (χ²=17 518.893, P<0.05). Chi-square test for trend revealed an age-dependent increase detection rate of NAFLD before 70 years old, and a subsequent decline after reaching 70 years old (χ^2trend=14 397.61, P<0.001). Higher detection rate was revealed in males than females among people aged 18-59 years (P<0.05), while lower detection rate in males than females among people aged ≥70 years old (P<0.05). Multivariate Logistic regression results showed that gender (male: OR=1.173), aging (30-39: OR=1.604, 40-49: OR=1.948, 50-59: OR=2.486, 60-69: OR=2.663, 70-79: OR=2.079, ≥80: OR=1.149), BMI (18.5-23.9 kg/m²: OR=2.997, 24.0-27.9 kg/m²: OR=3.911, ≥28.0 kg/m²: OR=11.780), systolic blood pressure (SBP) (≥140 mmHg: OR=1.200), diastolic blood pressure (DBP) (≥90 mmHg: OR=1.177), fasting blood glucose (FBG) (≥6.10 mmol/L: OR=1.934), triacylglycerol (TG) (≥1.70 mmol/L: OR=2.946), total cholesterol (TC) (≥5.20 mmol/L: OR=1.050), high-density lipoprotein cholesterol (HDL-C) (<1.0 mmol/L: OR=1.645), low-density lipoprotein cholesterol (LDL-C) (≥3.4 mmol/L: OR=1.499), serum uric acid (SUA) (SUA_male>420 μmol/L, SUA_female>360 μmol/L: OR=2.067) were influencing factors for NAFLD (P<0.05) .

The detection rate of NAFLD in physical examination population in Beijing was 33.31%, the highest incidence showed in people aged 50 to 69 years. Males, overweight and obese people are the high-risk groups, and abnormalities in blood lipids, blood pressure and blood glucose are also risk factors for NAFLD.

Helicobacter pylori (H. pylori) infection induced precancerous lesions of gastric mucosa mostly in adulthood. However, it is debatable whether these pathological changes could also occur in children.

To investigate the relationship between H. pylori infection and precancerous lesions of gastric mucosa in children hospitalized due to upper gastrointestinal symptoms in central plain area of China.

A total of 1 015 children under the age of 18 years old were enrolled. These children attended the People's Hospital of Zhengzhou University for upper gastrointestinal symptoms such as abdominal pain, bloating, nausea, vomiting, hiccups, and acid reflux from August 2018 to July 2021. All children underwent gastroscopy, from which gastric mucosal biopsy tissues were taken for rapid urease test and histopathological examination. The clinical and pathological data of the patients were collected retrospectively. The children were divided into infected and uninfected groups according to H. pylori infection status. The age, sex, endoscopic diagnosis, and H. pylori infection rate were compared between children in infected and uninfected groups. The incidence of precancerous lesions of gastric mucosa, inflammatory activity and the degree of inflammatory cell infiltration were compared between infected and uninfected groups, meanwhile these tests were also compared in children of different age groups.

Among the 1 015 children, 854 (84.14%) were infected with H. pylori and 161 (15.86%) were not infected. H. pylori-infected children were significantly older than those of non-infected subjects (P<0.05). Endoscopy examination revealed that the proportion of chronic superficial gastritis in H. pylori- infected group was significantly higher than that in uninfected group, while nodular gastritis was more common in H. pylori-uninfected patients (P<0.05). Among the enrolled children, 54 were 1-4 years old, 199 were 5-8 years old, 435 were 9-12 years old, and 327 were 13-18 years old. H. pylori infection rate in groups of 5-8, 9-12 and 13-18 year-old children was significantly higher than that in group of 1-4 year-old children; and the infection rate in groups of 9-12 and 13-18 year-old children was also significantly higher than that in group of 5-8 year-old children (P<0.05). Among H. pylori-infected patients, 37 out of 854 children had precancerous lesions of gastric mucosa (with incidence rate of 4.33%), of which 17 patients had atrophy, 11 patients had intestinal metaplasia and 9 patients had dysplasia, and only one of the 161 H. pylori-uninfected patients (0.62%) had atrophic gastritis. The incidence of precancerous lesions of gastric mucosa in H. pylori-infected patients were significantly more than those uninfected patients (χ²=5.178, P=0.023). The level of active inflammation and inflammatory cell infiltration of gastric mucosa in H. pylori-infected children were higher than that in non-infected children (P<0.05). In groups of 5-8, 9-12 and 13-18 year-old children, the prevalence of active inflammation and neutrophil granulocyte infiltration in gastric mucosa were significantly higher than that in uninfected patients (P<0.05). In H. pylori-infected patients, children in groups of 9-12 and 13-18 years old showed more severe lymphocyte infiltration over the uninfected patients (P<0.05) .

In children, gastric mucosal precancerous lesions occur in 4.33% of H. pylori-infected patients in central China, this include atrophic gastritis, intestinal metaplasia and dysplasia; the data revealed an obvious critical issue requiring future investigation and intervention for this group of population.

Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have proved to have a certain significance in predicting the severity of pancreatitis, however, at present, there are few relevant studies on the diagnostic and predictive value of NLR and PLR for liver injury in biliary acute pancreatitis (BAP) .

To explore the correlation between NLR and PLR in the severity of BAP and the concurrent acute liver injury (ALI) .

A total of 142 patients with BAP admitted to Emergency Department of the Second Affiliated Hospital of Nanchang University from March 2019 to March 2021 were selected and divided into mild (MAP) /moderately (MSAP) group (n=98) and severe (SAP) group (n=44) according to Atlanta classification. According to whether the liver function is damaged or not, they were divided into ALI group (n=92) and non-ALI group (n=50) . The ALI group was further divided into hepatocyte type liver injury subgroup (n=1) , bile duct type liver injury subgroup (n=16) and mixed type liver injury subgroup (n=75) . The general condition and clinical data of patients were collected, and the predictive value of NLR and PLR on the severity of BAP and concurrent ALI was explored by the ROC curve and binary Logistic regression analysis.

The NLR and PLR in MAP/MSAP group were lower than those in SAP group (P<0.05) . The NLR and PLR in ALI group were higher than those in non-ALI group (P<0.05) . There was no significant difference in NLR and PLR between bile duct type liver injury subgroup and mixed type liver injury subgroup (P>0.05) . The area under the ROC curve of NLR, PLR and their joint prediction of SAP was 0.809, 0.667, 0.809, respectively. The area under the ROC curve of NLR, PLR and their joint prediction of ALI in BAP was 0.774, 0.767, 0.806, respectively. The area under the ROC curve of NLR, PLR and their joint prediction of the occurrence of cholangiocytic liver injury in BAP was 0.813, 0.742, 0.861, respectively. The area under ROC curve of NLR, PLR and their joint prediction of mixed liver injury in BAP was 0.763, 0.770 and 0.794 respectively. The results of binary Logistic regression analysis showed that elevated NLR was a risk factor for SAP〔OR=1.184, 95%CI (1.102, 1.271) , P<0.001〕. Elevated NLR and PLR were the risk factors for ALI in BAP〔OR=1.140, 95%CI (1.050, 1.238) , P=0.002; OR=1.007, 95%CI (1.001, 1.013) , P=0.023〕; elevated NLR was a risk factor for bile duct cell liver injury in BAP〔OR=1.184, 95%CI (1.054, 1.331) , P=0.004〕. Elevated NLR and PLR were risk factors for mixed liver injury in BAP〔OR=1.120, 95%CI (1.120, 1.221) , P=0.011; OR=1.007, 95%CI (1.001, 1.013) , P=0.034〕.

Elevated NLR is a risk factor for SAP, elevated NLR and PLR are the risk factors for ALI in BAP. The predictive value of NLR on the severity of BAP and concurrent ALI is better than PLR, and the combined detection effect is better.

Non-alcoholic fatty liver disease (NAFLD) is a common disease of the digestive system. With the improvements of living standards and breakthroughs in viral hepatitis research, NAFLD has replaced viral hepatitis as the most common chronic liver disease. Guidance documents can provide clinical staff with standard and reliable diagnosis and treatment approaches. The screening and development of high-quality guidance documents is of great importance to standardise the clinical practice of NAFLD.

To analyze the methodological quality and reporting quality of guidance documents for NAFLD, summarize and compare the recommendations, so as to provide a reference for the development and report of future guidelines for NAFLD.

PubMed, CNKI, CBM, Wanfang Data Knowledge Service Platform, VIP Database were searched for clinical guidelines and consensuses on NAFLD supplemented by WHO, GIN, NICE, SIGN and Medlive from 2012-01-01 to 2022-01-01. Two researchers in the field of liver disease screened the literature, extracted the data and independently evaluated the methodological quality and reporting quality of the included guideline documents using AGREE Ⅱ and RIGHT, respectively. The recommendations of the higher quality guideline documents were collated and compared by the two researchers.

A total of 19 publications were enrolled, including 12 guidelines and 7 consensuses; 6 in Chinese and 13 in English; 10 of which were developed using an evidence-based approach. The average scores for each domain of AGREE Ⅱ were 42.84% for scope and purpose, 31.43% for participants, 31.25% for rigour, 60.67% for clarity, 32.68% for application and 37.50% for independence. The average scores of RIGHT in each area were 59.65% for basic information, 66.12% for background, 42.11% for evidence, 39.85% for recommendations, 17.11% for review and quality assurance, 18.42% for funding and conflict of interest statement and management, 47.37% for other aspects. The average scores in AGREEⅡ and reporting qualities in RIGHT of evidence-based guidance documents were both higher than non-evidence-based guidance documents. The average scores in AGREEⅡ and reporting qualities in RIGHT of foreign guidance documents were higher than domestic guidance documents. The main recommendations relate to screening and diagnosis, assessment, management (non-pharmacologic and pharmacologic treatment) and surgical treatment.

The methodological quality and reporting quality of the published guidance documents for NAFLD still need to be improved, and there are still gaps between domestic guidance documents and international guidance documents. The development of TCM guidance documents should follow an evidence-based approach. Further reference should be made to international standards such as AGREE Ⅱ and RIGHT in the development and reporting of guidelines. Clinical screening awareness for high-risk population of NAFLD and a comprehensive system for early non-invasive diagnosis and assessment should be established. Multidimensional treatment plans for lifestyle, liver function and metabolic disorders should be provided for patients with NAFLD.

Preoperative frailty is a severely unhealthy status that reflects the reduction of overall physiological reserve, which is highly prevalent in elderly patients with gastric cancer. Understanding the perceived influencing factors of preoperative frailty can provide an important basis for developing individualized intervention plans.

To perform a qualitative descriptive study to identity the perceived influencing factors of preoperative frailty among elderly gastric cancer patients using the theory of health ecology.

A qualitative descriptive study was conducted based on health ecology theory. Purposive sampling method was used to select 29 frail elderly patients who would undergo gastric cancer surgery in the First Affiliated Hospital with Nanjing Medical University from February to June 2021 for semi-structured interview. Directed content analysis was used for data analysis.

Five themes and thirteen sub-themes were extracted: physiological traits, including accumulated aging-related losses, obvious gastrointestinal symptoms, and successive attacks of multiple diseases; behavioral characteristics, including lack of exercise behavior and overexertion; interpersonal networks, including insufficient peer social interaction, lack of parent-child interaction, and lack of communication and self-disclosure between couples; living and working conditions, including heavy individual financial burden, heavy unplanned family care tasks, insufficient information resources for health and disease management; macro factors, including limited medical services and medical insurance support.

This study described the effects of different perceived factors on preoperative frailty among elderly gastric cancer patients from the perspective of health ecology. Medical workers should formulate and implement systematic prehabilitation programs based on the above factors to improve the patients' preoperative anti-stress capacity and postoperative outcomes.

China has a large baseline number of patients with hepatitis B virus (HBV) -related chronic liver disease, and it is urgently to contain HBV infection prevalence. To do this, the issue that needs to be addressed quickly is transforming the hospital-based management into community-, hospital-, patient- and society-based management.

To quantify preferences of health management in patients with HBV-related chronic liver disease from Hubei Province, providing a basis for the development of strategies for containing chronic hepatitis disease and for managing such patients.

From July 2018 to July 2019, a discrete choice experiment survey was carried out with a multistage random sample of 180 patients with HBV-related chronic liver disease recruited from three cities (Wuhan, Shiyan, and Xiangyang) of Hubei Province using a questionnaire for collecting their general information, and preferences related to health management (choice sets in the discrete choice experiment consist of place for regular health checkups, average monthly expense for health management of HBV-related chronic liver disease, followed health management, and ways of accessing health management information of HBV-related chronic liver disease with different options) . The mixed Logit model developed in 15.0 was used for data analysis.

The response rate of the survey was 89.4% (161/180) . Patients were more tended to choose a management pattern with lower average monthly expense, a hospital as the place for regular medical examinations, self-management or accessing health management information using offline approaches (P<0.05) . The amount of an additional monthly expense that the patients were willing to pay was 256.75 yuan if the place for regular health checkups was changed to a hospital from a community, 96.87 yuan if the management pattern was changed to self-management from a patient support group-based management, and 52.94 yuan if the approaches for accessing health management information were changed to offline from online. Compared with other choices, the change in the place for regular health checkups from a community to a hospital was the most popular in the patients (willingness increased by 87.29%) .

Patients with HBV-related chronic liver disease preferred to undergo regular health checkups and access health management information in hospitals, but were less likely to contract a family doctor or invest in health. To improve the containment of chronic liver disease, we put forward the following recommendations: strengthening hospitals' capabilities in treating HBV-related chronic liver disease, and their services delivered by a family doctor team, guiding patients to change the idea of "focusing on treatment rather than prevention", and delivering integrated online and offline services.

The prevalence of metabolic-associated fatty liver disease (MAFLD) has increased rapidly. And there is no conclusion on body fat composition, characteristics of metabolic indicators, and their predictive values for MAFLD in non-obese populations.

To identify the risk factors for MAFLD by comparing body fat composition and key metabolic indicators (blood lipids, blood sugar, uric acid) between obese and non-obese MAFLD patients, and to assess their associations with MAFLD as well as their predictive values for MAFLD in non-obese patients.

Physical examinees with and without liver B-ultrasound-detected fatty liver were recruited from Health Management Center, Nanjing Drum Tower Hospital from January 2018 to January 2019 after excluding those with non-MAFLD, and divided into obese group (including 129 cases with MAFLD, and 129 without fatty liver) and non-obese group (including 129 without fatty liver cases, and 129 with MAFLD) by BMI. The body fat composition and metabolic indices in non-obese MAFLD cases were compared with those of the other three subgroups. The correlation of each index with MAFLD in non-obese cases was analyzed. The independent risk factors of MAFLD in non-obese cases were identified by using Logistic regression. The predictive value of each index for MAFLD in non-obese was assessed using the receiver operating characteristic (ROC) curve.

(1) Comparison of body fat composition and metabolic indicators: compared with non-obese without fatty liver cases, non-obese cases with MAFLD had greater average BMI, body fat (BF), body fat ratio (BFR), visceral fat area (VFA), waist circumference (WC), waist-hip-ratio (WHR), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), uric acid (UA), alanine transaminase (ALT) and gamma-glutamyl transpeptidase (GGT), and lower high-density lipoprotein cholesterol (HDL-C) (P<0.05). In comparison with obese cases with MAFLD, non-obese cases with MAFLD had lower average BMI, BF, VFA, WC, WHR, fasting plasma glucose (FPG), and glycosylated hemoglobin (HbA_1c) (P<0.05). Non-obese cases with MAFLD had lower average BMI, BF and WC, and higher average TG, UA, ALT and GGT than obese cases without fatty liver (P<0.05). Non-obese female cases with MAFLD had greater average age, BF, BFR and VFA and lower WC, VA, GGT than non-obese male cases with MAFLD (P<0.05). (2) Kendall's rank correlation analysis showed that the risk of MAFLD in non-obese cases increased with the growth of BFR, VFA, WHR, TC, TG, LDL-C, UA, ALT, and GGT (r=0.099, 0.092, 0.136, 0.095, 0.176, 0.092, 0.114, 0.125, 0.142, P<0.05), but decreased with the growth of HDL-C (r=-0.112, P<0.05). (3) Multivariate Logistic regression analysis showed that TG, ALT, UA, BFR and VFA were risk factors of MAFLD in non-obese cases. (4) The results of ROC analysis of the performance of five indicators predicting MAFLD in non-obese cases were as follows: BFR had an AUC of 0.853〔95%CI (0.807, 0.898) 〕, with 0.789 sensitivity, 0.770 specificity when 22.30% was chosen as the optimal cut-off value; VFA had an AUC of 0.938〔95%CI (0.906, 0.970) 〕, with 0.852 sensitivity, 0.904 specificity when 61.45 cm² was chosen as the optimal cut-off value; TG had an AUC of 0.807〔95%CI (0.754, 0.860) 〕, with 0.822 sensitivity, 0.713 specificity when 1.02 mmol/L was chosen as the optimal cut-off value; UA had an AUC of 0.665〔95%CI (0.599, 0.731) 〕, with 0.605 sensitivity, 0.682 specificity when 356.00 μmol/L was chosen as the optimal cut-off value; ALT had an AUC of 0.752〔95%CI (0.692, 0.812) 〕, with 0.814 sensitivity, 0.770 specificity when 18.35 U/L was chosen as the optimal cut-off value.

Compared with non-obese people without fatty liver, non-obese people with MAFLD had increased BF and visceral fat, abnormal lipid metabolism, elevated levels of UA and transaminase. The risk of MAFLD in non-obese people increased with the increase in TG, ALT, UA, BFR and VFA, but decreased with the increase in HDL-C. BFR, VFA, TG, UA and ALT could partially predict and diagnose MAFLD in non-obese people, providing evidence for the delivery of interventions as soon as possible.

As the most common chronic liver disease, nonalcoholic fatty liver disease (NAFLD) has been reported to be associated with significant changes in myocardial structure and function, but it is still a controversial issue whether it is an independent risk factor for abnormalities in cardiac structure and function.

To assess the correlation of NAFLD with early left ventricular diastolic dysfunction by comparing left ventricular structure and functional indices between NAFLD and non-NAFLD patients.

A total of 519 inpatients from Geriatric Medicine Unit, Peking University People's Hospital were enrolled during 2018 to 2020, and divided into NAFLD group and non-NAFLD group according to the results of abdominal ultrasound or CT examination. Left ventricular structural and functional indices of two groups were comparatively analyzed. Early left ventricular diastolic dysfunction was defined as the ratio of the peak velocity of the early filling (E) wave to the atrial contraction (A) wave <1. Multivariate Logistic regression was used to assess the correlation between NAFLD and early left ventricular diastolic dysfunction. FIB-4 index was used to assess the risk of liver fibrosis in NAFLD patient〔low risk (<1.30) , medium risk (1.30-3.25) , and high risk (>3.25) 〕. NAFLD patients were divided into low-risk subgroup (n=81) and medium-high risk subgroup (n=100) according to whether FIB-4 index <1.30.

Compared with the non-NAFLD patients (n=338) , NAFLD patients had lower E/A ratio〔 (0.79±0.25) vs (0.87±0.34) , t=2.607, P=0.009) 〕 and greater end-diastolic interventricular septal thickness〔 (0.92±0.13) cm vs (0.89±0.13) cm, t=-2.525, P=0.012〕. Multivariate Logistic regression analysis showed that NAFLD was independently associated with the risk of early left ventricular diastolic dysfunction〔OR=2.941, 95%CI (1.736, 4.981) , P<0.001〕. NAFLD patients with medium-high risk subgroup had lower E/A ratio〔 (0.75±0.21) vs (0.84±0.28) , t=2.275, P=0.024〕 and higher left ventricular mass index than did those with low-risk subgroup〔 (80.22±14.92) g/m² vs (74.72±16.83) g/m², t=-2.327, P=0.021〕.

NAFLD may be an independent risk factor for early left ventricular diastolic dysfunction. The higher risk of advanced fibrosis in NAFLD patients, the worse was the left ventricular diastolic function.

Hepatokines are a variety of proteins secreted by the liver, a key organ involved in systemic metabolism and endocrine, directly affect the liver glycolipid metabolism, and play an important role in the development of nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2DM). Ectodysplasin A (EDA) is a newly discovered hepatokine, which is considered to be strongly related to diabetes, obesity and insulin resistance.

To assess the relationship between serum EDA level and the risk of NAFLD in patients with T2DM.

One hundred and thirty T2DM patients, including 74 males (56.92%) and 56 females (43.08%), with a mean age of (55.6±12.4) years, were recruited from Department of Endocrinology, Affiliated Hospital of Jiangsu University between November 2017 and November 2020. Baseline data, results of glucose tolerance test, insulin response test, C-peptide response to glucagon test, and color Doppler ultrasound of the abdomen were collected. Baseline data were compared between patients with ultrasound-detected NAFLD (n=80) and those without (n=50). Pearson correlation analysis was used to evaluate the correlation between serum EDA and the other clinical and biochemical indices. Multiple linear regression analysis was used to explore the influencing factors of EDA level. Multivariate Logistic regression analysis was used to explore the effect of EDA level on the risk of NAFLD.

Compared with non-NAFLD group, NAFLD group had much younger mean age, shorter mean duration of T2DM, but significantly higher mean levels of BMI, fasting insulin (FIns), 2-hour postprandial insulin responses (2 hIns), fasting C-peptide (FCP), 2-hour postprandial C-peptide (2 hCP), homeostasis model assessment of insulin resistance (HOMA-IR), triacylglycerol (TG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood uric acid (SUA), urea nitrogen (BUN), and EDA level (P<0.05). Pearson correlation analysis showed that the serum EDA level was positively correlated with age, FIns, 2 hIns, HOMA-IR, and AST (r=0.222, 0.186, 0.233, 0.204, 0.189, P<0.05). Multiple linear regression analysis showed that age〔β=1.957, 95%CI (0.412, 3.502), P=0.013〕, WHR〔β=-328.845, 95%CI (-638.903, -18.788), P=0.038〕, 2 hIns〔β=0.523, 95%CI (0.036, 1.011), P=0.036〕 and AST〔β=2.148, 95%CI (0.520, 3.776), P=0.010〕were independently associated with EDA (P<0.05). Multivariate Logistic regression analysis demonstrated that EDA was still associated with NAFLD after adjusting for multiple confounding factors〔OR=1.006, 95%CI (1.002, 1.010), P=0.007〕.

In T2DM patients with NAFLD, the level of serum EDA was significantly increased, and potentially associated with elevated risk of NAFLD, which suggests that serum EDA level may play a role in the development of NAFLD in T2DM. Our study may provide a theoretical basis for early screening or treatment of NAFLD.

Targeted therapies and immunotherapies, represented by programmed cell death protein 1 (PD-1) and programmed cell death-ligand 1 (PD-L1) inhibitors, have demonstrated high efficacies in multiple cancers. China-produced PD-1/PD-L1 inhibitors have been approved for use recently.

To investigate the efficacy and safety of China-produced camrelizumab, a PD-1 inhibitor, in combination with apatinib in the first-line treatment of middle and advanced stages of primary liver cancer.

Eighty-six patients with middle and advanced stages of primary liver cancer were selected from the oncology department of four hospitals in Chizhou (the People's Hospital of Chizhou, Chizhou Second People's Hospital, Dongzhi County People's Hospital, Shitai County People's Hospital) from June 2018 to January 2021. All patients were initially treated with apatinib mesylate tablets and intravenous infusion of China-produced camrelizumab, and followed up till August 31, 2021 with disease progression or all-cause death as the endpoint. Clinical efficacies were assessed at the end of the first and third months of treatment. The treatment-emergent adverse events were counted.

There were no dropouts due to serious treatment-emergent adverse events. The overall response rate (ORR) and disease control rate (DCR) in the patients were 58.14% (50/86) and 65.12% (56/86) , respectively, at the end of the first month of treatment, and were 76.74% (66/86) and 82.56% (68/86) , respectively, at the end of the third month of treatment. The follow-up period for them ranged from four to 26 months, with a mean value follow-up time of (12±6) months. A total of 35 patients died during the follow-up. The median progression-free survival was 8〔95%CI (5.18, 11.89) 〕 months, and the median overall survival was 12〔95%CI (8.97, 15.97) 〕 months in all patients. The major treatment-emergent adverse events included gastrointestinal reactions〔52 (60.47%) 〕, secondary hypertension〔31 (36.05%) 〕, hand-foot syndrome〔18 (20.93%) 〕 and proteinuria〔12 (13.95%) 〕, among which gastrointestinal reactions (6.98%) in six cases, secondary hypertension (2.33%) in two cases and hand-foot syndrome (1.16%) in one case were grade 3-5 adverse events.

For middle and advanced stages of primary liver cancer, China-produced camrelizumab with apatinib as the first-line treatment has good effect with controllable adverse events.

Cirrhosis is a chronic consumption disease, whose impact on patients' physical function and nutritional status has been increasingly valued by the academic community. It is helpful to promote the innovation and development in nutrition for cirrhosis in China by reviewing the hotspots in global research on nutrition for cirrhosis periodically.

To perform a bibliometric and visualized review of the development, hotspots, and trends of studies on nutrition for cirrhosis published from 1991 to 2021, providing a reference for future studies related to nutrition in cirrhosis.

The studies about nutrition in cirrhosis published during 1991-2021 were searched from the database of Web of Science. Collaboration and co-occurrence network analyses supported by CiteSpace were used for data mining and visualization analysis of countries, institutions, authors, keywords, and burst keywords relevant to studies of nutrition in cirrhosis .

A total of 1 520 studies were finally included, the yearly number of these studies demonstrated a wave-like growth during the period of 1991-2021, in particular, it exceeded 100 in 2020 and 2021. The U.S. ranked first in terms of the number of published studies (424) and intermediary centrality value (0.32). As for institutions, Mayo Clinic (the U.S.) ranked first in terms of the number of published studies (25) and intermediary centrality value (0.08), followed by Gifu University (Japan), Cleveland Clinic (the U.S.), and Aarhus University Hospital (Denmark). Inter-institutional collaborative networks were formed in the U.S., with Mayo Clinic and Cleveland Clinic, as the core, and in Europe, with Charite (Germany) and Karolinska Institute (Sweden) as the core. A total of 891 authors were included in the collaborative network, represented by TANDON P and KAWAGUCHI T. High-frequency keywords included nutritional status, liver transplantation, and body composition. Sarcopenia was the keyword with the strongest citation bursts (strength 26.170 9) .

Nutritional assessment, liver transplantation and body composition may be hot topics in research on nutrition in cirrhosis. And the pathophysiological mechanisms of malnutrition and nutritional management in patients with cirrhosis and sarcopenia may be foci of future research.

Due to great differences in physiological reserve, psychological status and social functioning, frailty in elderly patients with gastric cancer may present various subtypes. The relationship between preoperative frailty and postoperative adverse outcomes in them still remains to be further explored.

To explore the relationship between preoperative frailty subtypes and postoperative adverse outcomes〔total complications, prolonged length of stay (PLOS), low quality of life (QOL), and disability〕among elderly patients with gastric cancer.

From March to October 2021, 404 elderly gastric cancer patients were selected from Department of Gastric Surgery, the First Affiliated Hospital with Nanjing Medical University by convenience sampling. The General Demographic Data Questionnaire and Tilburg Frailty Indicator were used to collect demographics and frailty status before surgery. Total complications and PLOS were collected from the electronic medical records, and the status of disability and QOL were obtained using a telephone follow-up at one month after discharge. Univariate Logistic regression was performed to explore the influencing factors of postoperative adverse outcomes. Multivariate Logistic regression analysis was performed to analyze the association of preoperative frailty subtypes with postoperative adverse outcomes, with potential confounders adjusted.

Two hundred and eighty-five cases were found with preoperative frailty, and the frailty subtypes in them were classified into eight classes: exclusive physical frailty〔77 (19.1%) 〕, exclusive psychological frailty〔78 (19.3%) 〕, exclusive social frailty〔23 (5.7%) 〕, physical and psychological frailty〔63 (15.6%) 〕, physical and social frailty〔13 (3.2%) 〕, psychological and social frailty〔16 (4.0%) 〕, multidimensional frailty (physical, psychological, and social frailty) 〔15 (3.7%) 〕. The other 119 (29.5%) cases had no preoperative frailty. In the univariate Logistic regression, age was the factor influencing total complications〔OR=1.063, 95%CI (1.021, 1.106), P=0.003〕. History of pharmacological treatment〔OR=1.549, 95%CI (1.016, 2.362), P=0.042〕and surgical approach〔OR=2.103, 95%CI (1.191, 3.712), P=0.010〕were the factors influencing PLOS. Marital status〔OR=4.611, 95%CI (1.079, 19.706), P=0.039〕, living in an urban area〔OR=1.614, 95%CI (1.009, 2.582), P=0.046〕, having at least two comorbidities〔OR=1.694, 95%CI (1.038, 2.766), P=0.035〕were the factors influencing postoperative low QOL. Living in an urban area〔OR=0.601, 95%CI (0.390, 0.926), P=0.021〕, history of pharmacological treatment〔OR=1.663, 95%CI (1.082, 2.558), P=0.020〕, and advanced TNM stages〔OR=1.659, 95%CI (1.017, 2.706), P=0.043〕were the factors influencing postoperative disability. In the multivariate Logistic regression, the preoperative multidimensional frailty was independently associated with total complications, with age adjusted〔OR=5.344, 95%CI (1.715, 16.656), P=0.004〕. The preoperative physical frailty〔OR=2.048, 95%CI (1.078, 3.891), P=0.029〕, preoperative psychological frailty〔OR=2.077, 95%CI (1.103, 3.913), P=0.024〕and preoperative multidimensional frailty〔OR=8.321, 95%CI (2.400, 28.848), P<0.001〕were independently associated with PLOS, with history of pharmacological treatment and surgical approach adjusted. Preoperative psychological frailty〔OR=2.620, 95%CI (1.267, 5.418), P=0.009〕, preoperative psychological and social frailty〔OR=11.122, 95%CI (3.253, 38.028), P<0.001〕and preoperative multidimensional frailty〔OR=11.579, 95%CI (2.835, 47.302), P<0.001〕were independently associated with postoperative low QOL, with marital status, living in an urban area, and having at least two comorbidities adjusted.

Medical professionals should pay attention to preoperative frailty prevalence in elderly gastric cancer patients, and assess preoperative frailty in these patients using tools with the multidimensional frailty scale included, and attach great importance to those with exclusive physical frailty, exclusive psychological frailty, psychological and social frailty, and multidimensional frailty before surgery. A targeted prerehabilitation intervention program can be delivered to those with preoperative frailty according to their subtypes of frailty to improve postoperative adverse outcomes and QOL.

Nonalcoholic fatty liver disease (NAFLD) is rarely detected at early stage, and often found when merged with metabolic disorders. Currently, the predictive value of noninvasive indicators for NAFLD with metabolic syndrome (MS) has been rarely reported.

To assess the predictive value of monocyte to high-density lipoprotein cholesterol ratio (MHR) for NAFLD with MS in community residents, and to evaluate the associated factors using multivariate regression tree analysis.

From June to December 2020, among 9 812 permanent community residents (>45 years) who underwent physical examination in Songjiang District Sijing Community Health Center, 5 727 eligible individuals were selected, including 4 652 with MS, diabetes, hypertension and dyslipidemia and other metabolic disorders〔1 948 with no NAFLD and MS (controls) , 1 248 with NAFLD (NAFLD cases) , 1 456 with both NAFLD and MS (MAFLD cases) 〕, and 1 075 without metabolic disorders (healthy controls) . General data, anthropometric parameters, blood pressure, biochemical parameters and routine blood test results of all participants were collected. Spearman rank correlation analysis was performed to assess the correlation of MHR and lipid accumulation product (LAP) index with NAFLD and MS. ROC analysis was conducted to analyze the optimal cutoff value of noninvasive indicators〔including neutrophil to lymphocyte ratio (NLR) , platelet to lymphocyte ratio (PLR) , lymphocyte to monocyte ratio (LMR) and MHR〕for NAFLD with MS. Factors associated with the predictive value of above-mentioned noninvasive indicators for NAFLD with MS were identified using multivariate regression tree analysis.

The prevalence rates for metabolic disorders and NAFLD in this group were 76.61% (7 517/9 812) and 27.59% (2 704/9 812) , respectively. The controls, NAFLD cases, MAFLD cases, and healthy controls had significant differences in female ratio, mean age, BMI, waistline, hipline, waist-to-hip ratio, systolic and diastolic blood pressure, fasting blood glucose, total cholesterol, triacylglycerol, low-density lipoprotein cholesterol, HDL-C, total bilirubin, serum uric acid, ALT, AST, ALT/AST ratio, GGT, eGFR, white blood cell count, neutrophil count, monocyte count, lymphocyte count, platelet count, NLR, PLR, LMR, MHR, alcoholic fatty liver disease to NAFLD index, LAP index, and atherogenic index of plasma, and distribution of waistline and BMI, as well as prevalence of hypertension and dyslipidemia (P<0.01) . Spearman rank correlation analysis showed that, MHR was positively correlated with the grouping (r_s=0.342, P<0.001) ; LAP index was also positively correlated with the grouping (r_s=0.580, P<0.001) . ROC analysis found that, in the prediction of NAFLD with MS, the AUC of NLR was 0.528〔95%CI (0.511, 0.545) 〕with 74.66% sensitivity, and 31.52% specificity when the optimal cutoff value was chosen as 2.192, that of PLR was 0.581〔95%CI (0.564, 0.598) 〕with 59.82% sensitivity, and 53.95% specificity when the optimal cut-off value was chosen as 115.470, and that of LMR was 0.546〔95%CI (0.529, 0.563) 〕with 51.79% sensitivity, and 56.62% specificity when the optimal cut-off value was chosen as 0.193, and that of MHR was 0.695〔95%CI (0.679, 0.711) 〕with 69.51% sensitivity, and 60.63% specificity when the optimal cut-off value was chosen as 0.292. Multivariate regression tree analysis revealed that sex, BMI, waistline, triacylglycerol, and fasting blood glucose were associated with the predictive value of MHR for NAFLD with MS.

The value of MHR for predicting NAFLD with MS in physical examinees in the community is relatively high, but it may be significantly influenced by sex, BMI, waistline, triacylglycerol and fasting blood glucose.

The number of researches on the application of artificial intelligence (AI) to diagnosis and treatment of gastric cancer has been increasing in recent years, but no researcher has systematically analyzed it using bibliometric analysis.

To analyze the researches on the application of AI to diagnosis and treatment of gastric cancer, explore the research hotspots and development trends from 2003 to 2022. Methods On November 06, 2022, Web of Science (WOS) core collection database was searched by computer to obtain studies on the application of AI to gastric cancer diagnosis and treatment, and VOSviewer 1.6.18 software was used to visualize and analyze inter-country (region), inter-institution, and inter-author collaborations, co-cited authors, keyword co-occurrences and overlays through bibliometric analysis. CiteSpace 5.7.R5 software was used to perform institutional betweenness centrality analysis, journal biplot overlay, cluster analysis of co-cited literature for the last 6 years, co-cited literature clustering timeline graph analysis and reference bursting analysis. Excel 2019 software was used to plot bar graphs of the volume of publications and descriptive analysis tables of countries (regions), institutions, journals, authors, cited references and keywords.

A total of 703 papers were included, and the annual publication volume of the application of AI to gastric cancer diagnosis and treatment showed an overall increasing trend from 2003-2022, with a rapid increase after 2017 and the most rapid growth from 2019-2021. The top publishing country, institution and author was China, Chinese Academy of Sciences and TADA TOMOHIRO, respectively. The top three co-cited authors of BRAY FREDDIE, HIRASAWA TOSHIAKI and JIANG YUMING had made significant contributions to the field. Frontiers in Oncology was the journal with the highest publication volume, and Gastrointestinal Endoscopy was the most influential journal among the top ten journals for researches related to the application of AI to the diagnosis and treatment of gastric cancer. The citing journals mainly focused on the two fields of "Medicine, Medical, Clinical" and "Molecular, Biology, Immunology". And the cited journals mainly focused on the two fields of "Molecular, Biology, Genetics" and "Health, Nursing, Medicine". The top-ranked literature in terms of total citations titled Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. All keywords were classified into 4 categories based on keyword clustering results, including AI-assisted biological research of gastric cancer, AI-assisted endoscopic diagnosis of gastric cancer, AI-assisted pathological diagnosis of gastric cancer, and AI-assisted non-endoscopic treatment and prognosis prediction of gastric cancer. Deep learning, convolutional neural network, imaging histology, gastrointestinal endoscopy, pathology and immunotherapy were the current research hotspots.

AI has a broad application prospect in gastric cancer diagnosis and treatment, and more and more scholars are devoted to AI in gastric cancer diagnosis and treatment. Currently, AI has been widely studied in the biology, diagnosis, staging, efficacy assessment and prognosis prediction of gastric cancer. The results of this study can provide a reference for scholars engaged in research work related to AI and gastric cancer.

Alpha-fetoprotein (AFP) is a common diagnostic marker for hepatocellular carcinoma (HCC) , a highly malignant cancer, but its sensitivity is only 41%-65%, and the rate of missed diagnosis is relatively high. Therefore, there is an urgent need to develop new diagnostic markers and methods to improve the detection rate of AFP-negative and other types of HCC.

To assess the diagnostic efficacy of muscarinic acetylcholine receptor m3 autoantibody (m3AchR-Ab) in AFP-negative HCC, and to explore the diagnostic value of m3AchR-Ab in HCC.

Participants (n=257) were selected from the First Affiliated Hospital of Xinjiang Medical University, including 90 with confirmed diagnosis of HCC, 89 with liver cirrhosis, hepatic hemangioma or other benign liver diseases, and 78 healthy controls. ELISA was the technique used for measuring the serum m3AchR-Ab level in venous blood samples of all cases stored in the serum repository of the hospital from November 2011 to September 2015. Serum m3AchR-Ab levels were compared in the three groups. The associations of serum m3AchR-Ab level with gender, age, size (the maximum diameter) of HCC, number and TNM stage of HCC, prevalence of lymph node metastasis, distant metastasis and HBsAg positivity in HCC patients were analyzed. The efficacy of m3AchR-Ab in the diagnosis of AFP-negative HCC was evaluated by the receiver operating characteristic (ROC) curve.

HCC patients had higher serum m3AchR-Ab level than benign liver disease patients and healthy controls (P<0.05) . The level of m3AchR-Ab was correlated with the size and TNM stage of HCC, as well as prevalence of lymph node metastasis and HBsAg positivity (P< 0.05) . The area under the ROC curve of serum m3AchR-Ab in the diagnosis of AFP-negative HCC was 0.69〔95%CI (0.54, 0.83) 〕, with 64.00% sensitivity and 91.02% specificity when 74.00 ng/ml was chosen as the optimal cut-off value. The area under the ROC curve of m3AchR-Ab with AFP in serum in diagnosing HCC was 0.90〔95%CI (0.85, 0.95) 〕, with 90.00% sensitivity and 88.02% specificity.

Serum m3AchR-Ab level is a potential diagnostic maker for AFP-negative HCC, and its combination with serum AFP level could produce higher diagnostic efficiency for HCC, which may be a reference for further research on novel diagnostic markers for HCC.

There is no a gold standard examination method for the diagnosis of hiatal hernia in patients with metabolic syndrome. Improving the preoperative detection rate of hiatal hernia is of great significance for formulating an appropriate surgical approach and avoiding severe postoperative complications.

To examine the diagnostic value of gastroscopy, high-resolution esophageal manometry and upper gastrointestinal contrast examination for hiatal hernia in metabolic syndrome.

Fifty-five patients with metabolic syndrome complicated with gastroesophageal reflux who were surgically treated in Department of Minimally Invasive, Hernia and Abdominal Surgery, People's Hospital of Xinjiang Uygur Autonomous Region from September 2021 to April 2022 were retrospectively selected, including 17 with hiatal hernia found intraoperatively (complex group) and 38 without (simple group) . The results of gastroscopy, high-resolution esophageal manometry, acid measurement, upper gastrointestinal contrast tests performed after admission and GERD-Q score were collected. Receiver operating characteristic (ROC) curves of these examination methods were plotted and the area under the ROC curve (AUC) was compared for estimating their diagnostic performance.

Compared with simple group, complex group had higher diagnostic rates of gastroscopy, high-resolution esophageal manometry, greater manometric hiatal hernia diameter and upper gastrointestinal contrast examination, and higher Gerd-Q score (P<0.05) . Complex group also had lower mean resting pressure of lower esophageal sphincter (LESP) and Demeester score (P<0.05) . Multivariate Logistic regression analysis showed that Demeester score and findings upper gastrointestinal angiography were associated with the diagnosis of hiatus hernia in metabolic syndrome (P<0.05) . ROC analysis indicated that all of gastroscopy (AUC=0.728, P=0.007) , LESP (AUC=0.789, P=0.001) , Demeester score (AUC=0.772, P=0.001) , upper gastrointestinal contrast examination (AUC=0.774, P=0.007) , Gerd-Q score (AUC=0.746, P=0.004) had an AUC greater than 0.7, indicating high clinical diagnostic value.

Gastroscopy, LESP, Demeester score, upper gastrointestinal contrast examination, and Gerd-Q score all had high diagnostic value for hiatus hernia in metabolic syndrome.

Hepatocellular carcinoma (HCC) is characterized by high morbidity and mortality. Early diagnosis and timely intervention in the precancerous stage can effectively reduce the incidence of HCC, which is of great significance for its prevention and treatment. Modern medical treatment of precancerous lesions of HCC has problems such as difficulties to grasp the timing of intervention and single treatment method, traditional Chinese medicine (TCM) may be a simple and effective new approach to prevent and treat precancerous lesion of HCC.

To observe the clinical efficacy and safety of Qizhuhuaji formula in the treatment of precancerous lesion of HCC (liver-depression and spleen-deficiency, phlegm and blood stasis syndrome) .

Patients with precancerous lesion of HCC who met the TCM syndrome type "liver-depression and spleen-deficiency, phlegm and blood stasis syndrome" admitted in the hepatology clinic of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Weihai Hospital of Traditional Chinese Medicine and Taian Hospital of Traditional Chinese Medicine from October 2019 to March 2020 were included as the study subjects. General information (gender, age, history of HBV-related cirrhosis, family history of HCC, history of alcohol consumption for more than 10 years), the TCM syndrome score, liver function indicators [alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), albumin (ALB), glutamyl transpeptidase (GGT), alkaline phosphatase (ALP) ], tumor marker indexes [alpha-fetoprotein (AFP), alpha-fetoprotein variants-L3 (AFP-L3), des-γ-carboxy-prothrombin (DCP) ], imaging indexes (lesion type, lesion nature, lesion length diameter), safety indexes and adverse reactions were collected. The 64 patients who met the inclusion criteria and completed the study were divided into the observation group (n=34) and the control group (n=30) using the random number tables. The patients in the control group were treated with conventional therapy such as antiviral, anti-inflammatory and liver-protective therapy; the observation group was treated with conventional therapy combined with Qizhuhuaji formula. The treatment course was 48 weeks, and the follow-up period was 48 weeks after drug withdrawal. The incidence of HCC and complications in the treatment cycle and follow-up period of the two group were observed, and the differences in the improvement indexes of TCM syndrome (TCM syndrome scores, total effective rate), liver function indicators, tumor marker indexes, imaging indexes (lesion length diameter, lesion stability rate, lesion improvement rate), and safety index (safety rate) between the two groups before and after treatment.

After treatment, the TCM syndrome scores, ALT, AST, TBIL, GGT, ALP, and AFP-L3 were lower than those before treatment in both groups, and the ALB level was higher than that before treatment (P<0.05) ; the DCP value and lesion length-diameter of patients in the observation group were lower than those before treatment (P<0.05) ; the comparison results between the two groups showed that the TCM syndrome scores, AST, and ALP values in the observation group were lower than those in the control group, and the ALB value was higher than that in the control group (P<0.05). The total effective rate of TCM syndrome in the observation group (91.2%) was higher than that in the control group (63.3%) at the end of the treatment cycle (P<0.05) ; there was no statistically significant differences (P>0.05) in the rates of lesion improvement (35.3%) and lesion stability (50.0%) in the observation group compared with the control group (20.0%, 43.3%). There was no statistically significant difference in the incidence of HCC between the observation group (8.8%) and the control group (16.7%) at the end of the follow-up period (P>0.05) ; the incidence of complications (8.8%) in the observation group was lower than that of the control group (30.0%) (P<0.05). Regarding the safety indexes, 2 cases in the observation group showed mild adverse reactions and 3 cases in the control group showed mild adverse reactions, no abnormal safety indexes were observed in both groups, there was no statistically significant difference (P>0.05) in the safety rate between the observation group (94.1%) and the control group (90.0%) .

The treatment of precancerous lesions of HCC (liver depression and spleen deficiency, phlegm and blood stasis syndrome) with Qizhuhuaji formula has better clinical efficacy and higher safety in improving TCM syndrome, improving liver function, shrinking lesion nodules, reducing the incidence of long-term HCC and complications of liver cirrhosis.

Metabolic-associated fatty liver disease (MAFLD) is a group of liver diseases related to metabolic stresses. Studies have shown that serum potassium is closely related to MAFLD. However, their relationship in gout patients remains unclear.

To investigate the relationship between serum potassium and MAFLD in gout patients, to provide a theoretical basis for the management of serum potassium in gout patients.

A total of 347 primary gout patients were recruited from Chu Hsien-I Memorial Hospital, Tianjin Medical University from April 2014 to March 2017. They were divided into simple gout group (n=96) , mild fatty liver group (n=136) and moderate-to-severe fatty liver group (n=115) according to the severity of fatty liver to compare baseline data, serum biochemical indices, overweight/obesity and insulin resistance indices. Spearman rank correlation was used to study the relationship between serum potassium level and the severity of fatty liver. Multivariate Logistic regression analysis was used to identify influencing factors of MAFLD in gout.

Two hundred and fifty-one (72.3%) of the 347 gout patients had MAFLD. Spearman rank correlation analysis demonstrated that serum potassium level was negatively correlated with the severity of fatty liver, fasting blood glucose (FBG) , triglyceride (TG) , body mass index (BMI) , waist-to-hip ratio (WHR) and homeostasis model assessment of insulin resistance (HOMA-IR) (r_s=-0.172, -0.118, -0.182, -0.222, -0.174, -0.197, P<0.05) . The chi-square test for linear trend showed that the severity of fatty liver declined with the increase of serum potassium level (χ² =15.784, P=0.015) . Multivariate Logistic regression analysis showed that advanced age〔OR=0.97, 95%CI (0.95, 0.999) 〕 and high serum potassium〔OR=0.53, 95%CI (0.29, 0.97) 〕 were associated with reduced risk of developing MAFLD in overweight/obese gout patients (P<0.05) , while high TG〔OR=1.16, 95%CI (1.01, 1.34) 〕 and high WHR〔OR=1.09, 95%CI (1.04, 1.13) 〕 were associated with increased risk of developing MAFLD (P<0.05) . High FBG〔OR=1.92, 95%CI (1.12, 3.31) 〕 was associated with increased risk of developing MAFLD in gout patients with normal BMI (P<0.05) .

Maintaining higher serum potassium within the normal range may prevent the development of MAFLD in overweight/obese gout patients.

The microvascular invasion pathologically diagnosed in hepatocellular carcinoma (HCC) has not been valued enough in previous studies. And there are no unified pathological diagnostic criteria for microvascular invasion in HCC. Besides that, microvascular invasion is not included as a routine pathological indicator for HCC. C-reactive protein to albumin ratio (CAR) is a new systemic inflammatory factor that is closely related to the proliferation, invasion, metastasis and other malignant biological behaviors of HCC.

To investigate the value of CAR in predicting microvascular invasion in single small HCC.

Participants (n=346) who were pathologically diagnosed with HCC following the resection of single liver tumor (diameter≤5 cm) were selected from the First Affiliated Hospital of Xinjiang Medical University from June 2017 to June 2021. Demographic data and calculated CAR were collected. ROC analysis was performed to estimate the predictive value and optimal cut-off value of CAR for microvascular invasion in single small HCC. All patients were divided into two groups according to the optimal cut-off value of CAR (≥0.03 or <0.03) , and those with similar propensity scores estimated by Logistic model were matched by 1∶1 nearest neighbor matching, yielding two comparison groups with highly similar clinical characteristics, and the microvascular invasion rate between them was compared. Logistic regression was used in the sensitivity analysis of the predictive value of CAR for microvascular invasion in single small HCC before and after the aforementioned matching.

One hundred and thirty-one (37.9%) cases were found with microvascular invasion and other 125 without (62.1%) . ROC analysis revealed that the AUC of CAR in predicting microvascular invasion in single small HCC was 0.787〔95%CI (0.697, 0.877) 〕, with 82.9% sensitivity and specificity 76.4% when the optimal cut-off point was determined as 0.03. Ninety-two of 145 cases with CAR<0.03 and 92 of 201 cases with CAR≥0.03 were successful matched, and the prevalence of microvascular invasion was found to be lower in the former group〔13.0% (12/92) vs 43.5% (40/92) 〕 (χ²=6.314, P=0.013) . Three Logistic models showed that CAR was an independent predictor of microvascular invasion in single small HCC, regardless of whether the participants were matched or not (P<0.05) .

CAR could be used as a predictor for microvascular invasion in single small HCC. CAR≥0.03 may indicate a very high probability of microvascular invasion.

Hepatic cirrhosis represents the final stage for a wide variety of chronic liver diseases, which may be induced by numerous causes, and is associated with high mortality when complications arise. The relationships between hormone deficiencies due to hypopituitarism and hepatic cirrhosis have been rarely reported.

To analyze the clinical characteristics of 8 cases of hepatic cirrhosis secondary to hypopituitarism, and investigate the potential role of hypopituitarism in the development of hepatic cirrhosis.

Participants were 8 patients with hepatic cirrhosis secondary to hypopituitarism who were recruited from the First Affiliated Hospital of Zhengzhou University from January 2010 to December 2021. A retrospective analysis was conducted on their clinical manifestations, laboratory and imaging test result, treatments and follow-up results.

The age at the diagnosis of hypopituitarism for all cases ranged from 9 to 20 years old, and that at the diagnosis of hepatic cirrhosis was 16 to 24 years old, with an interval of 3 to 14 years old. The causes of hypopituitarism were germ cell tumor surgery (4 cases), craniopharyngioma surgery (2 cases), radiotherapy for nasopharyngeal carcinoma (1 case) and pituitary stalk interruption syndrome (1 case). All cases received no standardized hormone replacement therapy before cirrhosis was diagnosed by biopsy (2 cases) or imaging (6 cases). Fatigue, anorexia, hypoplastic external genitalia, short stature, recurrent upper respiratory tract infection and bleeding were the most common clinical manifestations. All cases had abnormalities in pituitary-thyroid axis, pituitary-gonadal axis, growth hormone, insulin-like growth factor-1, routine blood markers, four markers of hepatic fibrosis and liver imaging results. Moreover, it was found that 7 cases were also with abnormalities in antidiuretic hormone and hepatic function, and 6 cases were with abnormalities in pituitary-adrenal axis, coagulation function and serum lipids. All patients received treatment with desmopress in acetate, thyroid hormone, hydrocortisone and sex hormones as necessary. Four patients also received growth hormone replacement therapy. One-year follow-up indicated that, all cases had significantly improved levels of leukocyte, platelet, aspartate aminotransferase, alkaline phosphatase, total bilirubin, indirect bilirubin, total cholesterol, low-density lipoprotein, high-density lipoprotein, fibrinogen and four markers of hepatic fibrosis after treatment (P<0.05). However, no significant post-treatment improvement was found in the levels of hemoglobin, alanine aminotransferase, gamma-glutamyl transpeptidase, direct bilirubin, triacylglycerol and D-dimer, and in prothrombin time and endogenous prothrombin potential (P>0.05) .

All these 8 patients with hypopituitarism had hormone deficiency for several years before the diagnosis of hepatic cirrhosis, and abnormalities in thyroid hormone, sex hormone, growth hormone, insulin-like growth factor-1, routine blood markers, four markers of hepatic fibrosis and imaging results, with fatigue, anorexia, hypoplastic external genitalia, short stature, recurrent upper respiratory tract infection and bleeding as the most common clinical manifestations. One-year standardized hormone replacement therapy significantly improved the abnormalities in leukocyte, platelets, total cholesterol, high-density lipoprotein, low-density lipoprotein, fibrinogen and four markers of hepatic fibrosis.