A large number of studies have confirmed that endoplasmic reticulum stress (ERS) is closely related to the development and progression of liver diseases, but the mechanism of the association between ERS and liver disease progression has not been clarified and needs to be further explored. Numerous studies have found that moderate ERS can activate the unfolded protein response (UPR) to protect cells, while severe or persistent ERS can induce apoptosis. Therefore, exploring the role of ERS in the pathogenesis of liver diseases may help to discover new therapeutic strategies. This paper describes the current research status and potential therapeutic strategies of ERS and UPR in various liver diseases.

In recent years, screening, early diagnosis and early treatment of upper gastrointestinal cancer have been successively carried out in various provinces and cities in China. At present, there are few studies on the screening results of upper gastrointestinal cancer and influencing factors of gastric cancer in coastal area of northern Jiangsu.

To analyze the influencing factors of gastric cancer based on the results of opportunistic screening for upper gastrointestinal cancer in rural population in coastal areas of northern Jiangsu, so as to provide a reference for the development of relevant prevention and control strategies.

A total of 8 564 rural subjects at high risk for upper gastrointestinal cancer admitted to the outpatient department of gastroenterology of the Affiliated Lianyungang Hospital of Xuzhou Medical University and received gastroscopy screening from January 2021 to December 2022 were selected, and divided into the gastric cancer group (n=183) and benign gastric disease group (n=366) after matching according to age (±2 years) and gender (1∶2) based on the screening results. The baseline data of the subjects were collected, the cancer detection rate and cancer early diagnosis rate were calculated. Multivariate Logistic regression analysis was used to explore the influencing factors of gastric cancer in rural population in coastal area of northern Jiangsu.

A total of 521 patients with upper gastrointestinal neoplastic lesions were detected, including 183 patients with gastric (including cardia) cancer, with a detection rate of 2.14% (183/8 564) ; and 46 patients with early gastric (including cardia) cancer, with the early diagnosis rate of 25.14% (46/183) . There was no significant difference in the distribution of different categories of gastric neoplastic lesions in different genders and ages (P>0.05) . The detection rate of gastric (including cardia) neoplastic lesions in males (5.14%, 195/3 795) was higher than females (2.05%, 98/4 769) , and the difference was statistically significant (χ²=60.807, P<0.001) . There were significant differences in the detection rate of gastric (including cardia) neoplastic lesions among different age groups (χ²=163.216, P<0.001) and early diagnosis rate of gastric cancer among different age groups (χ²=69.349, P<0.001) , among which the early diagnosis rate was the highest in the group of 40-49 years (37.50%) and the lowest in the group over 80 years (10.53%) . Multivariate Logistic regression analysis showed that junior high school education or below (OR=4.001, 95%CI=2.029-7.890, P<0.001) , smoking (OR=3.710, 95%CI=2.127-6.470, P<0.001) , salty taste (OR=1.777, 95%CI=1.067-2.957, P=0.027) , frequent spicy diet (OR=2.147, 95%CI=1.297-3.556, P=0.003) , preference for red meat (OR=1.787, 95%CI=1.018-3.139, P=0.043) , frequent consumption of leftovers (OR=2.452, 95%CI=1.538-3.912, P<0.001) , irregular diet (OR=2.420, 95%CI=1.420-4.124, P=0.001) and helicobacter pylori (H. pylori) positive/previously positive (OR=3.785, 95%CI=2.394-5.984, P<0.001) were risk factors for gastric cancer in rural population, while regular physical exercise (OR=0.598, 95%CI=0.359-0.996, P=0.048) and frequent consumption of fresh fruits (OR=0.531, 95%CI=0.328-0.860, P=0.010) were protective factors for gastric cancer in rural population.

Opportunistic screening of upper gastrointestinal cancer is beneficial for the detection of upper gastrointestinal cancer in Coastal Area of Northern Jiangsu. Junior high school education and below, smoking, multiple unhealthy food habits and H. pylori positive/previously positive are risk factors for gastric cancer in rural population. Future efforts should focus on improving the awareness of gastric cancer prevention among rural males and elderly population in the region.

Both portal vein thrombosis (PVT) and gastrointestinal bleeding are complications in patients with liver cirrhosis, and PVT can aggravate the risk of gastrointestinal bleeding, but the conflicting treatment of both is another challenge in clinical work.

To investigate the clinical characteristics and risk factors of concomitant gastrointestinal bleeding in patients with PVT in liver cirrhosis.

A total of 279 patients diagnosed with PVT in liver cirrhosis at the First Affiliated Hospital of Kunming Medical University from 2016-10-01 to 2021-09-30 were retrospectively collected and divided into the bleeding group (n=127) and non-bleeding group (n=152) according to the presence of gastrointestinal bleeding symptoms of hematemesis and melena in this admission. The differences in general information, complications, laboratory and imaging tests, surgical history and other relevant information between the two groups were compared. Multivariate Logistic regression analysis was used to explore the influencing factors of the complications of gastrointestinal bleeding in cirrhotic patients with PVT.

A total of 5 807 patients were retrospectively investigated in the study, including 350 patients combined with PVT with a incidence of 6.0%. PVT was most common in 279 cirrhotic patients with PVT complicated by liver function Child B grade[146 (52.3%) ]. There were significant differences in etiology, vascular involvement, jaundice, internal diameter of main portal vein, gastroesophageal varices, white blood cell (WBC), blood urea nitrogen (BUN), hemoglobin (Hb), hematocrit (HCT), total bilirubin (TBiL), fibrinogen (FIB), and history of laparotomy between the bleeding group and non-bleeding group (P<0.05). Multivariate Logistic regression analysis showed that elevated WBC level (OR=2.555, 95%CI=1.318-6.542), decreased HCT level (OR=0.511, 95%CI=0.247-0.925), decreased FIB level (OR=0.085, 95%CI=0.005-0.661), and involvement of superior mesenteric vein thrombosis (OR=27.873, 95%CI=1.452-1 335.715) were independent risk factors for concomitant gastrointestinal bleeding in cirrhotic patients with PVT (P<0.05) .

Elevated WBC level, decreased HCT level, decreased FIB level and involvement of superior mesenteric vein thrombosis are independent risk factors for gastrointestinal bleeding in cirrhotic patients with PVT, and early intervention should be implemented to improve the prognosis.

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.

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.

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.

With the incidence of chronic metabolic diseases rising by year, which has threatened the national health, the study of non-coding RNA and endocrine metabolism-related diseases has become a research hotspot at home and abroad, while lncRNA NEAT1 and miRNA-182-5p in type 2 diabetes mellitus (T2DM) combined with metabolic-related fatty liver disease (MAFLD) has been rarely reported.

To investigate the mechanism and clinical significance of lncRNA NEAT1 and miRNA-182-5p in the development of liver fibrosis in T2DM patients with MAFLD.

A total of 236 T2DM patients admitted to the endocrinology department of the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology from October 2021 to June 2022 were included as the study subjects, and 49 healthy people were included as the healthy control group. General information and laboratory test results of the subjects were collected. Visceral fat area (VFA) and subcutaneous fat area (SFA) were measured. Peripheral blood was collected and lncRNA NEAT1, miRNA-182-5p were determined. T2DM patients were divided into the T2DM with non-MAFLD group (n=82) and T2DM with MAFLD group (n=154). T2DM with MAFLD group was further divided into the low-risk subgroup (n=55), medium-risk subgroup (n=69) and high-risk subgroup (n=30) according to the liver fibrosis index (FIB-4). In addition, healthy people were selected as the healthy control group (n=49). Spearman rank correlation analysis was used to explore the correlation of lncRNA NEAT1 and miRNA-182-5p expression levels in the high-risk subgroup of liver fibrosis, and multilevel ordinal Logistic regression was used to explore the influencing factors of liver fibrosis risk in T2DM patients with MAFLD.

Age, neck circumference (NC), fasting blood glucose (FPG) and glycosylated hemoglobin (HbA_1c) in the healthy control group were lower than those in the T2DM with non-MAFLD and T2DM with MAFLD groups, the albumin (Alb) in the healthy control group was higher than that in the T2DM with non-MAFLD and T2DM with MAFLD groups (P<0.05). BMI, waist circumference (WC), VFA, SFA, homeostatic model assessment for insulin resistance (HOMA-IR), triglyceride (TG), serum uric acid (SUA) and lncRNA NEAT1 in the T2DM with MAFLD group were higher than those in the healthy control group and T2DM with non-MAFLD group, platelet count (PLT) was lower than that of the healthy control group and T2DM with non-MAFLD group, total cholesterol (TC) was lower than that of the healthy control group (P<0.05). HOMA-IR and lncRNA NEAT1 in the T2DM with non-MAFLD groups were higher than those in the healthy control group, miRNA-182-5p was higher than that in the healthy control group and T2DM with MAFLD group, alanine aminotransferase (ALT) and aspartate transferase (AST) were lower than those in the healthy control group and T2DM with MAFLD group (P<0.05). VFA, SFA, AST and lncRNA NEAT1 in the low-risk subgroup were lower than those in the medium-risk subgroup and high-risk subgroup, PLT and miRNA-182-5p were higher than those in the medium-risk subgroup and high-risk subgroup, BMI, WC and NC were lower than those in the high-risk subgroup, TC was higher than that in the high-risk group of liver fibrosis (P<0.05). PLT and miRNA-182-5p in the medium-risk subgroup were higher than the high-risk subgroup, AST and lncRNA NEAT1 were lower than those in the high risk group (P<0.05). Spearman rank correlation analysis showed that lncRNA NEAT1 was significantly negatively correlated with miRNA-182-5p in the high-risk subgroup of liver fibrosis (r_s=-0.438, P<0.05). The results of multilevel ordinal Logistic regression analysis showed that lncRNA NEAT1 (OR=1.326, 95%CI=1.087-1.616), VFA (OR=1.019, 95%CI=1.006-1.033), miRNA-182-5p (OR=0.083, 95%CI=0.027-0.257), PLT (OR=0.956, 95%CI=0.942-0.970), AST (OR=1.048, 95%CI=1.022-1.075) were the risk factors of liver fibrosis in T2DM patients with MAFLD.

Peripheral blood lncRNA NEAT1 and miRNA-182-5p are closely related to the complicated liver fibrosis in T2DM patients with MAFLD, providing a new basis for the early prediction, diagnosis and treatment of the disease.

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.

Microvascular invasion (MVI) is an aggressive behavior of hepatocellular carcinoma (HCC) that being an independent predictor of tumor recurrence after hepatectomy or liver transplantation. Preoperative prediction of MVI has important clinical significance.

To use non-invasive imaging and serological indicators to construct a nomogram for predicting MVI in order to provide a clinical reference.

The relevant clinical data of 284 patients who underwent radical resection of HCC in the Second Affiliated Hospital of Kunming Medical University from 2016 to 2021 were retrospectively analyzed, and HCC patients admitted from 2016 to 2020 were categorized as the model group (n=208) according to the admission time, and HCC patients admitted in 2021 were categorized as the validation group (n=76) . LASSO regression and multivariate Logistic regression analysis were performed to determine the independent risk factors for MVI in HCC, and R software was used to establish a nomogram model for predicting the risk of MVI in HCC before operation. The internal validation of the model was performed by Bootstrap method, external validation of the model was performed by using the validation group. The consistency index, calibration curve and decision curve analysis (DCA) were used to evaluate the discrimination, calibration ability and clinical application value of the nomogram.

Multivariate Logistic regression analysis showed that WBC>7.1×10⁹/L〔OR=3.144, 95%CI (1.301, 7.598) , P=0.011〕, tumor diameter>7.05 cm〔OR=3.836, 95%CI (1.758, 8.372) , P=0.001〕, S-Index>0.097〔OR=3.165, 95%CI (1.024, 9.779) , P=0.040〕, AAR>0.879〔OR=2.146, 95%CI (1.062, 4.337) , P=0.030〕, ANRI>24.074〔OR=2.769, 95%CI (1.175, 6.526) , P=0.020〕 were independent predictors of MVI in HCC. The consistency index of the nomogram model established using the five variables combined with AFP was 0.800〔95%CI (0.739, 0.861) 〕 and 0.755〔95%CI (0.641, 0.868) 〕 in the model group and validation group, respectively. The model fitted well with the calibration prediction curve. The optimal critical value of the nomogram calculated by Youden index was 174 points. The sensitivity, specificity, positive predictive value and negative predictive value at the critical value were 90%, 61%, 71%, and 85% in the model group, and 78%, 71%, 76% and 74% in the validation set, respectively.

The nomogram constructed with AFP>45 ng/mL, WBC>7.1×10⁹/L, tumor diameter>7.05 cm, S-Index>0.097, AAR>0.879, ANRI>24.074 can better predict the risk of preoperative MVI in HCC, the use of this nomogram can conveniently guide the clinical treatment of HCC patients by routine examination test indicators.

At present, the incidence and mortality of primary liver cancer (hereafter referred to as liver cancer) in China are high with heavy economic and disease burden. Standardized screening and health surveillance management for population as risk of liver cancer are important measures to effectively reduce the related burden of liver cancer. Currently, patients with liver cancer in primary care institutions in China lack the awareness of the necessity of liver cancer screening and surveillance with poor compliance, and the existing screening tools are less sensitive and cost-effective. This paper discusses the strategies of liver cancer screening and health surveillance management in primary care institutuons in terms of stratification of liver cancer risk assessment and screening in primary care institutions of chronic liver disease population in China, the current status of enhanced screening and long-term surveillance for population at high risk of liver cancer, to provide a reference for the standardization of screening, early diagnosis and treatment of liver cancer in China, with the aim of improving the screening coverage and control effects of liver cancer in primary care in China.

Fatty liver disease is a common frequently-occurring disease in daily life, and the number of non-alcoholic fatty liver disease (NAFLD) patients has been gradually increasing in recent years with an important impact on people's health. The differences in lifestyle and basal metabolism in different gender groups may lead to differences in the prevalence of NAFLD. However, few studies have been conducted to investigate the prevalence of NAFLD in different gender populations.

To explore the prevalence and influencing factors of NAFLD in different gender groups, so as to provide reference for the prevention and treatment of NAFLD.

A total of 29 271 subjects received physical examination in the Physical Examination Center of Jinshan Hospital of Fudan University were selected in the retrospective case-control study from August 2020 to August 2021. General data, physical examination data, laboratory indexes, combination of underlying diseases, and imaging findings of the subjects were collected. The included subjects were divided into the NAFLD group and control group according to the diagnostic criteria of NAFLD, and the prevalence and characteristics of NAFLD in different gender groups were analyzed. Multivariate Logistic regression analysis was used to explore the influencing factors of NAFLD by gender; the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of related indicators for NAFLD in different gender groups, and the area under the ROC curve (AUC), sensitivity and specificity were calculated.

There were 10 524 cases of NAFLD among 29 271 subjects with an overall prevalence of 35.95%, including 7 854 NAFLD patients in the 18 322 male subjects with a prevalence of 42.87%, 2 670 NAFLD patients in the 10 949 male subjects with a prevalence of 24.39%. There was a statistically significant difference in the prevalence of NAFLD among subjects with different genders (χ²=1 016.505, P<0.001). Multivariate Logistic regression analysis showed that waist circumference, BMI, age, alanine aminotransferase, uric acid, total cholesterol, triglyceride, fasting blood glucose and electrocardiogram results were the influencing factors of NAFLD in the subjects by gender (P<0.05). Waist circumference, BMI, and the combination of waist circumference and BMI had a high predictive value for NAFLD in different gender populations. The sensitivity and specificity of waist circumference in predicting NAFLD risk in male subjects were 0.778 and 0.613, respectively, with the optimal cut-off value of 85.5 cm, the sensitivity and specificity of BMI in predicting the NAFLD risk in male subjects were 0.720 and 0.711, with the optimal cut-off value of 24.6 kg/m², the sensitivity and specificity of the combination of waist circumference and BMI were 0.744 and 0.692, with the AUC of 0.789, the optimal cutoff value is 0.394. The sensitivity and specificity of waist circumference in predicting the risk of NAFLD in female subjects were 0.815 and 0.754, respectively, with the optimal cut-off value of 78.5 cm, the sensitivity and specificity of BMI in predicting the risk of NAFLD in female subjects were 0.797 and 0.759, respectively, with the optimal cut-off value of 23.6 kg/m², the sensitivity and specificity of the combination of waist circumference and BMI were 0.853 and 0.734, with the AUC of 0.872, the optimal cutoff value is 0.202.

The influencing factors of NAFLD in male and female are slightly different. Age, alanine transaminase, uric acid, triacylglycerol, total cholesterol, fasting blood glucose, electrocardiogram results, waist circumference and BMI were all influencing factors of NAFLD in different gender groups. Waist circumference, BMI and waist circumference combined with BMI have a high predictive value for NAFLD risk in both males and females, which can be applied to the screening of NAFLD in physical examination.

Patients with liver cirrhosis complicated by gastroesophageal variceal and rupture hemorrhage have a certain probability of rebleeding events after endoscopic treatment, and the bleeding volume of rebleeding events is greater with higher risk, which seriously affects the survival rates of patients.

To investigate the independent risk factors of rebleeding events within 3 years after endoscopic treatment in cirrhotic patients with gastroesophageal variceal hemorrhage, construct a nomogram risk prediction model and validate it internally.

Four hundred and three patients who underwent endoscopic treatment for liver cirrhosis associated gastroesophageal varices at the Tangdu Hospital and Xijing Hospital, Air Force Medical University from 2011-2022 were retrospectively collected and divided into the rebleeding group (n=252) and control group (n=151) based on the presence of rebleeding within 3 years. The general data and auxiliary examination results of the patients between both groups were compared, and the statistically significant factors were included in the multivariate Logistic regression analysis to analyze the independent risk factors. These data were then input into the R language software to construct a nomogram risk prediction model by using a specific program package.

Multivariate Logistic regression analysis showed that smoking〔OR=2.499, 95%CI (1.232, 5.066), P=0.011〕, portal vein internal diameter〔OR=1.047, 95%CI (1.028, 1.066), P<0.001〕, serum sodium concentration〔OR=0.649, 95%CI (0.562, 0.750), P<0.001〕 and endoscopic red sign〔OR=3.023, 95%CI (1.341, 6.814), P=0.008〕 were influencing factors of rebleeding events within 3 years after endoscopic treatment in cirrhotic patients with gastroesophageal variceal hemorrhage. A nomogram prediction model for rebleeding within 3 years after endoscopic treatment was subsequently constructed, and the area under the receiver operating characteristic (ROC) curve was 0.900〔95%CI (0.876, 0.929) 〕 with sensitivity and specificity of 0.927 and 0.750, respectively.

Serum sodium level, positive endoscopic red sign, smoking, and enlarged portal vein internal diameter are independent influencing factors for rebleeding events within three years after endoscopic treatment in cirrhotic patients with gastroesophageal variceal hemorrhage. The nomogram prediction model exhibited a good fit with an area under the ROC curve of 0.900, showing its high-quality predictive value.

Primary liver cancer (PLC) is one of the common malignant tumors and the main causes of tumor death in China. Although the diagnosis and treatment technology of PLC in China has made great progress in recent years, its morbidity and mortality have been decreasing year by year, but the low early diagnosis rate and 5-year survival rate of PLC are major public health problems that need to be solved urgently in the field of chronic disease prevention and control. Effective implementation of early screening, detection, diagnosis and treatment of PLC is an important measure to improve the rates of radical treatment and survival. The combination of serum alpha-fetoprotein (AFP) and liver ultrasound is a routine method for screening hepatocellular carcinoma (HCC) in patients with chronic liver disease; the combination of AFP and AFP-L3 and/or abnormal prothrombin can improve the early diagnosis rate of early-stage HCC; the early diagnosis rate of small hepatocellular carcinoma can be improved by Gd-EOB-DTPA-enhanced magnetic resonance imaging or its combination with computerized tomography. With the continuous promotion of hierarchical medical system and improvement of primary medical resources allocation and health service capacity in China, primary care institutions have become an important force for early screening of many cancers. Based on this context, this paper mainly discusses the development opportunities, risk challenges and future thinking of surveillance for liver cancer in primary care institutions in China, in order to provide new ideas and direction guidance for it in the future.

Lymph node metastasis is an important factor affecting the prognosis of patients with intrahepatic cholangiocarcinoma, but lymphadenectomy extent remains controversial both domestically and internationally.

To explore the current status of lymphadenectomy during radical resection of intrahepatic cholangiocarcinoma.

A retrospective analysis of the clinical data of 152 patients with intrahepatic cholangiocarcinoma who underwent radical resection at Zhejiang Cancer Hospital from 2017 to 2022 was conducted to determine the current status of lymphadenectomy during radical resection of intrahepatic cholangiocarcinoma, including the decision to perform lymphadenectomy, the extent of lymphadenectomy and the distribution of positive lymph nodes. The patients were divided into the left hemi-liver group and right hemi-liver group according to the location of the tumour in the liver.

A total of 152 patients were selected, including 83 patients in the left hemi-liver group and 69 in the right hemi-liver group. Eighty-six of them underwently mphadenectomy, accounting for higher proportion in the left hemi-liver group〔61 cases (73.5%) 〕 than the right hemi-liver group〔25 cases (36.2%) 〕 (P<0.05) . The average number of dissected lymph nodes was (7.6±6.1) , with no significant difference between the left〔7.0 (4.0, 10.5) 〕 and right hemi-liver groups 〔5.0 (1.5, 9.5) 〕 (P>0.05) . Of the 86 patients underwent lymphadenectomy, 39 (45.3%) cases showed lymph node metastasis (positive lymph nodes) on pathological examination, accounting for higher proportion in the left hemi-liver group〔34 cases (55.7%) 〕 than the right hemi-liver group〔5 cases (20.0%) 〕 (P<0.05) . Regardless of which lobe the tumour was located, lymph node stations 8, 12, and 13 accounted for a higher proportion of metastasis in routine dissection areas, among which the proportion of lymph nodes station 12 was the highest, with 79.4% (27/34) in the left hemi-liver group and 80.0% (4/5) in the right hemi-liver group.

Regardless of the location of tumour, lymph node stations 8, 12 and 13 have a higher incidence of lymph node metastasis and should be considered for routine dissection during radical resection.

Gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA) are both common clinical diseases with the increasing prevalence year by year. There is still controversy as to whether continuous airway positive pressure ventilation (CPAP) can improve both OSA and GERD at the same time.

To investigate the efficacy of CPAP on OSA complicated with GERD.

A total of 169 patients diagnosed with OSA complicated with GERD in the geriatric and respiratory departments of Peking University People's Hospital from September 2020 to January 2023 were selected as research subjects, their general data were collected. The included patients were followed up regularly with the endpoint of GERD remission or 8 weeks of treatment, excluding those with no treatment compliance. The included patients were divided into the patients without proton pump inhibitor (PPI) and patients with PPI according to whether they received PPI. The patients without PPI were further divided into the CPAP group (n=43) and non-treatment group (n=53), the patients with PPI were divided into the CPAP+PPI group (n=32) and PPI group (n=41) according to whether they received CPAP treatment. The Kaplan-Meier method was used to plot the survival curves of GERD remission rates in the CPAP group and non-treatment group, and the differences were compared by Log-rank test. Multivariate Cox proportional risk regression model was used to explore the effects of CPAP on GERD remission in patients with OSA complicated with GERD.

The median remission time to remission was 6 weeks in the CPAP group and 7.5 weeks in the non-treatment group; the cumulative GERD remission rate in the CPAP group was higher than the non-treatment group and the difference was statistically significant (χ²=4.182, P=0.041). The median remission time to remission was 3.9 weeks in the CPAP+PPI group and 6.1 weeks in the PPI group; the cumulative GERD remission rate in the CPAP+PPI group was higher than the PPI group and the difference was statistically significant (χ²=14.333, P<0.001). The results of the multivariate Cox proportional risk regression showed that CPAP was an influential factor for GERD remission in patients with OSA complicated with GERD without PPI〔HR=2.360, 95%CI (1.044, 5.338), P<0.05〕, CPAP was an influential factor for GERD remission in patients with OSA complicated with GERD treated with PPI〔HR=6.123, 95%CI (2.562, 14.635), P<0.05〕.

CPAP can improve GERD symptom in patients with OSA complicated with GERD. The efficacy of CPAP+PPI on GERD is superior to PPI alone.

The liver is the largest metabolic organ in the human body, and impaired liver function can lead to a variety of acute and chronic liver diseases, which can affect the quality of life in mild cases or be life-threatening in severe cases. Therefore, it is important to explore accurate and effective molecular diagnostic markers and therapeutic targets. Mitofusin 2 (Mfn2) is a transmembrane motor protein on the outer membrane of mitochondria, and plays an important role not only in mitochondrial fusion regulation, but also in cell energy metabolism, cell apoptosis, cell proliferation, mitochondrial endoplasmic reticulum (ER) connections, ER stress and mitochondrial autophagy, etc. It has been found that abnormal expression or function loss of Mfn2 can lead to abnormal mitochondrial function, which in turn leads to a variety of liver diseases. In this paper, a systematic review of the structure and function of Mfn2 and its mechanisms of action in liver diseases was conducted and found that Mfn2 can be involved in the development of chronic liver diseases through multiple pathways, and improve liver function through modulating Mfn2 overexpression to further slow down and reverse disease progression. This paper aims to provide a scientific reference for basic research of Mfn2 and liver diseases, as well as its clinical application.

Major hepatectomy for liver malignancies carries with large risks. Perioperative nutritional support plays a vital role for postoperative recovery. However, there are few studies focusing on predictions of postoperative complications and prognosis using postoperative loss of skeletal muscle mass (PLSMM) in acute stage after major hepatectomy.

To identify the change inskeletal muscle index (SMI), and to investigate risk factors for PLSMM, as well as its correlation with postoperative complications after major hepatectomy for liver cancer.

A total of 97 patients who received major hepatectomy for liver cancer from Department of General Surgery, the Second Affiliated Hospital of Soochow University between July 2018 and August 2022 were included. The preoperative and postoperative day 5 skeletal muscle area at the third lumbar vertebra level was measured, respectively, using computed tomographic images. The postoperative change rate of SMI was calculated. The PLSMM was defined as the lowest tertile of the percent change in SMI, according to which the patients were divided into PLSMM and Non-PLSMM group. Baseline data, surgical and postoperative indices were collected and analyzed.

SMI was decreased in 54 patients postoperatively. Thirty-two and 65 patients were assigned to the PLSMM group (SMI≤-3.59%) and Non-PLSMM groups (SMI>-3.59%), respectively. Compared with Non-PLSMM group, PLSMM group had longer operation time, more intraoperative blood loss and higher ratio of microvascular invasion (MVI) (P<0.05). Moreover, PLSMM group had longer postoperative hospital stay, higher levels of white blood cell and international normalized ratio and lower level of fibrinogen on postoperative day 5 (P<0.05). PLSMM group showed a lower incidence of overall complications (P<0.05). Multivariate Logistic regression analysis indicated that MVI〔OR=2.751, 95%CI (1.173, 6.642) 〕 and operation time >210 min〔OR=1.973, 95%CI (1.286, 4.936) 〕were risk factors associated with PLSMM (P<0.05). PLSMM〔OR=2.591, 95%CI (1.173, 6.977) 〕, preoperative myopenia〔OR=1.798, 95%CI (1.133, 3.792) 〕, operation time >210 min〔OR=2.958, 95%CI (0.918, 9.529) 〕 and blood loss >500 mL〔OR=1.003, 95%CI (1.001, 1.007) 〕 were risk factors associated with postoperative complications (P<0.05) .

MVI and operation time >210 min were risk factors associated with PLSMM. PLSMM was the independent predictor of postoperative complications, which negatively affected postoperative outcomes after major hepatectomy.

Metabolism-associated fatty liver disease (MAFLD) is considered as a major cause of increased morbidity and mortality from liver disease, type 2 diabetes mellitus (T2DM) is a driving factor in the progression of MAFLD. Estimated glucose processing rate (eGDR) is a simple evaluation indicator of insulin resistance in patients with T2DM, while its relationship with MAFLD has been rarely studied.

To investigate the correlation between eGDR and MAFLD in type 2 Diabetes and its predictive value.

A total of 1 434 patients with T2DM who were hospitalized in Hebei Provincial People's Hospital from 2019-01-01 to 2019-12-31 were selected as the study subjects. baseline data of the patients was collected, with their venous blood from the elbow collected for laboratory examination, and liver condition examined by abdominal ultrasound. According to the results of abdominal ultrasonography, T2DM patients were divided into MAFLD group (n=734) and non-MAFLD group (n=700). The subjects were divided into T1 group (eGDR≤5.09, n=477), T2 group (5.09<eGDR≤7.11, n=478) and T3 group (eGDR>7.11, n=479) according to the eGDR tertiles. Spearman rank correlation analysis was used to explore the correlation between eGDR and baseline data. Univariate and multivariate Logistic regression analysis was used to explore the influencing factors of combined MAFLD. The multiplicative interactions of eGDR with gender, age, hypertension, glycated hemoglobin A1c (HbA_1c), BMI and glutamyl transferase (GGT) were evaluated. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of combined prediction model, FBG and HbA_1c for MAFLD in T2DM and areas under curve (AUC) were calculated and compared by Delong test.

Age, disease course, HDL-C and eGDR of MAFLD group were lower than non-MAFLD group. BMI, alcohol consumption, proportions of hypertension and smoking, fasting blood glucose (FBG), uric acid (UA), total cholesterol (TC), TG, low density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), GGT and ALB were higher than non-MAFLD group (P<0.05). The proportion of hypertension, age, BMI, FBG, HbA_1c, Scr and TG in T3 group were lower than those in T1 and T2 groups, GGT was lower than that in T1 group, HDL-C and ALB were higher than those in T1 and T2 groups, the proportion of hypertension, BMI, FBG, HbA_1c and TG in T2 group were lower than those in T1 group (P<0.05). eGDR was negatively correlated with age, FBG and ALB in patients with MAFLD (P<0.05). In patients without MAFLD, eGDR was negatively correlated with age, disease course, FBG, Scr, TG and ALB (P<0.05), and positively correlated with HDL-C, AST and GGT (P<0.05). Multivariate Logistic regression analysis showed that eGDR〔OR=0.814, 95%CI (0.772, 0.858), P<0.001〕, T1 group〔OR=1.310, 95%CI (1.003, 1.712), P=0.048〕and T2 group〔OR=2.554, 95%CI (1.941, 3.359), P<0.001〕 was an influencing factor of T2DM with MAFLD (P<0.05). BMI (P_interaction<0.001), GGT (P_interaction=0.033), hypertension (P_interaction<0.001) had interaction with eGDR. The AUC of the combined prediction model was 0.743, which was greater than FBG (Z=3.227, P=0.001) and HbA_1c (Z=1.877, P=0.061) .

The level of eGDR in T2DM patients with MAFLD is significantly lower than that in patients without MAFLD, and patients with low eGDR level have a higher risk of MAFLD. eGDR is a risk factor for MAFLD with T2MD. The combined prediction model of eGDR can be used as a predictor to evaluate the risk of MAFLD with T2MD.

Azovudine is a widely used antiviral drug for COVID-19 in China, but published trials on its effect on hepaticand renal function are extremely scarce.

To explore the changes of in hepatic and renal function in patients with COVID-19 infection after using Azovudine, so as to provide a reference for thesafe use of Azovudine in patients with renal insufficiency.

Inpatients ina tertiary general hospitalwho used Azovudine for COVID-19 from December 26, 2022 to December 31, 2022 were consecutively included in the retrospective study and divided into the normal group, mild injury group, moderate injury group, severe injury group, and end-stage groupaccording to estimated glomerularrate (eGFR) levels. The changes of biochemical parametersof liver and kidney including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), albumin (ALB), total bilirubin (TB), serum creatinine (Scr), eGFR were observed in each group; the formula D_FR=D_NL×[1-F_k (1-K_f) ] was used to correct the maintenance dose of Azivudine in patients with eGFR<60 mL·min^-1· (1.73 m²) ^-1. The patients were divided into the corrected group and uncorrected group according to whether they were administered according to this formula, the biochemical parameters of liver and kidney were compared between the two groups.

Among 322 patients who used Azovudine, 190 patients met the inclusion and exclusion criteria. After grouping by the level of eGFR, there were statistically significant differences in the distribution of age, COVID-19 severity, peak procalcitonin (PCT) values, antihypertensive drugs, loop diuretics and Azovudine maintenance dose in each group (P<0.05) ; there were 73 cases (38.4%) with elevated ALT level after Azovudine treatment, and 68 cases (93.2%) with elevated ALT level within one time of the upper normal limit; eGFR decreased in 58 cases (30.5%), of which 7 cases (12.1%) dropped to the next renal function grade; regardless of the grade of renal injury, there were no deterioration in eGFR, ALT, AST, TB, ALP and albumin after the use of conventional dose or corrected dose of Azivudine (P>0.05) ; because the patients with moderate and severe renal injury were dose-corrected with Azivudine, the safety of this population was not compared if the dose was not corrected.

The use of Azivudine is prone to cause the elevation of ALT level and the decrease of eGFR, but the injury with clinical significance is 2.6% and 3.7%, respectively; there was no aggravation of liver and kidney injury in patients with moderate and severe kidney injury after using the corrected dose of Azivudine, however, this conclusion needs to be confirmed in a multicenter randomized controlled study with a large sample.

Both fatty liver disease and thyroid nodules are common clinical chronic diseases that are closely related to metabolism, but there is little research on whether there is a certain correlation between them.

To explore the overall and disease severity-specific correlations between metabolic-associated fatty liver disease (MAFLD) and thyroid nodules.

This study selected 666 MAFLD patients〔including 316 mild cases (group A) , and 350 moderate to severe cases (group B) 〕, and 330 health examinees (group C) from Shengjing Hospital of China Medical University from December 2020 to December 2021. All the subjects underwent general anthropometric measurement, blood tests and ultrasound examination of the liver and thyroid. Multivariate Logistic regression was used to explore the influencing factors of thyroid nodules in MAFLD.

The prevalence rate of thyroid nodules in group C (19.70%, 65/330) was lower than that in group A (25.36%, 81/316) or B (34.86%, 122/350) (P<0.05) . Compared with group A, group B had higher prevalence rate of thyroid nodules (P<0.05) , and higher prevalence rates of C-TIRADS 3 and ≥4 thyroid nodules (P<0.05) . Multivariate Logistic regression analysis showed that age (OR=1.447) , BMI (OR=2.847) , triacylglycerol (TG) (OR=2.947) , total cholesterol (TC) (OR=3.235) , fasting plasma glucose (FPG) (OR=2.780) and glycated haemoglobin (HbA_1c) (OR=3.371) were the risk factors of thyroid nodules in MAFLD (P<0.05) .

MAFLD is associated with increased prevalence rate of thyroid nodules. The risk of malignant thyroid nodules increases with the aggravation of hepatic steatosis (namely progression from mild/moderate to severe) . Age, BMI, TG, TC, FPG and HbA_1c are associated factors of MAFLD complicated with thyroid nodules.

The incidence rate of nonalcoholic fatty liver disease is increasing year by year, but there is still no effective cure. Clinical and basic studies show that a type of hypoglycemic drug, namely glucagon-like peptide-1 (GLP-1) receptor agonists can improve liver lipid deposition, but the specific mechanism is unknown.

To explore the mechanism of GLP-1 receptor agonists improving liver lipid deposition in a rat model of insulin resistance induced by high-fructose diet.

This experiment was carried out from January to April 2016. Thirty-six Wistar rats were randomly divided into a control group (ND) receiving a normal diet and a model group receiving a high-fructose diet. After 8 weeks, a hyperinsulinemic-euglycemic clamp test was performed in the model group to verify the formation of insulin resistance. The rats in the model group were further randomized into a high-fructose (HFD) subgroup and a high fructose with exenatide (HFD+Ex) subgroup. The changes of glucose and lipid levels, insulin resistance, liver lipid deposition, the expression and nuclear translocation of β-catenin and lipid synthesis pathway related factors were observed in HFD+Ex subgroup at four weeks after receiving subcutaneous abdominal injection of exenatide injection. Further changes in cell lipid deposition and lipid synthesis pathway related factors were observed after inhibiting the expression of β-catenin with small interfering RNA (siRNA) by transfection techniques in HepG2 cells. HepG2 cells were treated with 25 mmol/L fructose, 100 nmol/L exendin-4, and non-transfected HepG2 cells were used as controls. ALL of the cells were divided into normal control group (Con) , high-fructose (HF) group, high fructose with exendin-4 (HF+Ex4) group, high fructose with exendin-4 and control siRNA (HF+Ex4+Si-control) group, and high fructose with exendin-4 and β-catenin siRNA (HF+Ex4+Si-β-catenin) group. After the experiment, the rats' weight and liver index, serum concentrations of triglyceride (TG) , total cholesterol (TC) , free fatty acid (FFA) , alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , fasting blood glucose (FBG) , fasting insulin (FINS) and liver TG concentration were measured, and the area under the plasma glucose curve (AUC_glu) , and glucose infusion rate (GIR) were calculated, and lipid droplets in liver tissues were observed using Oil Red O staining. The protein expression levels of sterol regulatory element binding protein 1 (SREBP-1) and the key enzymes for downstream lipid synthesis, fatty acid synthase (FAS) , acetyl coenzyme A carboxylase (ACC) , stearoyl-CoA desaturase 1 (SCD-1) and β-catenin of liver tissues and HepG2 cells were also measured.

(1) After 8-week high-fructose feeding, the model group had significantly higher weight, liver index and liver TG concentration, and lower GIR than the ND group (P<0.05) . After 4 weeks of drug intervention, HFD subgroup demonstrated higher weight, liver index, TG, FFA, ALT, FBG, FINS and AUC_glu, and lower GIR than the ND group (P<0.05) . HFD+Ex subgroup showed lower weight, liver index, FFA, ALT, FBG, FINS, and AUC_glu, and higher GIR than HFD subgroup (P<0.05) . (2) Compared with ND group, HFD subgroup demonstrated higher concentration of TG in the liver (P<0.05) , and a large number of red lipid droplets in liver cells. HFD+Ex subgroup had lower concentration of TG in the liver (P<0.05) and reduced red lipid droplets in liver cells compared with HFD subgroup. (3) Compared with ND group, the expression of SREBP-1, FAS, SCD-1 and ACC in liver of rats in HFD subgroup increased (P<0.05) . Compared with HFD subgroup, the protein expression of SREBP-1, FAS, SCD-1 and ACC in HFD+Ex subgroup decreased (P<0.05) . (4) Compared with ND group, the expression levels of total protein and nuclear protein of β-catenin in liver of rats in HFD subgroup were significantly decreased (P<0.05) . Compared with HFD subgroup, the expression levels of total protein and nuclear protein of β-catenin increased in HFD+Ex subgroup (P<0.05) . (5) Compared the HepG2 cells treated with HF, HF+Ex4 group had higher expression levels of total protein and nuclear protein of β-catenin and lower levels of serum TG, and so did HF+Ex4+Si-control group (P<0.05) . Compared with HF+Ex4 group, HF+Ex4+Si-β-catenin group had down-regulated expression of total protein and nuclear protein of β-catenin (P<0.05) . The levels of serum TG of HepG2 cells in HF+Ex4+Si-β-catenin group was higher than that in HF+Ex4 group (P<0.05) . (6) HF+Ex4 group had lower protein expression levels of SREBP-1, ACC, FAS, and SCD-1 of HepG2 cells than HF group, and so did the HF+Ex4+Si-control group (P<0.05) . The protein expression levels of SREBP-1, ACC, FAS, and SCD-1 of HepG2 cells in HF+Ex4+Si-β-catenin group were higher than those in HF+Ex4 group (P<0.05) .

GLP-1 receptor agonists may regulate β-catenin expression to improve liver lipid deposition in rats with insulin resistance, which are potential new drugs for nonalcoholic fatty liver disease. β-catenin may be an important target for drug treatment.

Early diagnosis of gastric cancer is essential for patient prognosis. Currently, endoscopic forceps biopsy (EFB) is an important tool for the diagnosis of gastric cancer. However, it has been shown in relevant studies that there are some differences between EFB-based diagnosis and pathological diagnosis after endoscopic submucosal dissection (ESD), resulting in an underestimation of the patient's condition. No related research has been conducted in northern Shaanxi.

To calculate the rate of pathological upgrading in gastric mucosal lesions after ESD in five hospitals in northern Shaanxi, and to analyze the factors associated with pathological upgrading.

We recruited patients with gastric mucosal lesions who underwent ESD following EFB in five hospitals (Yan'an University Affiliated Hospital, Yan'an People's Hospital, the First Hospital of Yulin, Yan'an Traditional Chinese Medicine Hospital, Zichang People's Hospital) from 2016 to 2021. We classified the pathological results of gastric mucosal lesions into the following categories: chronic gastric inflammatory changes (CIC), low-grade gastric intraepithelial neoplasia (LGIN), high-grade gastric intraepithelial neoplasia (HGIN), early gastric cancer (EGC) and progressive gastric cancer. The difference between EFB-based diagnosis and pathological diagnosis of ESD specimens was analyzed. Pathological upgrading was defined as progression in pathological results. The pathological upgrading in patients with CIC, LGIN or HGIN was counted. The factors associated with pathological upgrading were analyzed.

A total of 241 patients were included. The EFB-based diagnosis of CIC, LGIN, HGIN, and EGC were 84, 75, 65, 17 cases, respectively. Seventy-six (31.5%) were found with pathological upgrading after ESD compared with their EFB-based diagnoses. Binary logistic regression analysis showed that endoscopic classification〔OR=0.134, 95%CI (0.029, 0.617) 〕 and superficial ulceration〔OR=3.595, 95%CI (1.226, 10.536) 〕 were associated with pathological upgrading in CIC by EFB-based diagnosis (P<0.05). Age〔OR=3.961, 95%CI (1.071, 14.650) 〕, endoscopic classification〔OR=0.311, 95%CI (0.127, 0.765) 〕, redness of mucosal surface〔OR=5.830, 95%CI (1.591, 21.355) 〕, and number of specimens〔OR=0.234, 95%CI (0.063, 0.872) 〕 were associated with pathological upgrading in LGIN by EFB-based diagnosis (P<0.05). Lesion size〔OR=3.143, 95%CI (1.003, 9.852) 〕 was associated with pathological upgrading in HGIN by EFB-based diagnosis (P<0.05) .

Medical workers should be alert to the potential possibility of underestimated pathology in EFB if the lesion is CIC suggested by EFB but is endoscopically classified as flat or concave with surface ulceration. And the potential possibility is also should be considered if there is only one biopsy specimen obtained from a patient aged greater than 60 years, and the lesion is LGIN suggested by EFB, but is endoscopically classified as flat with redness of mucosal surface, and an ESD can be underwent if necessary. Moreover, if a lesion greater than 2 cm in size is HGIN suggested by EFB, which is probably EGC, and an ESD is recommended to verify it.

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.

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.

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.

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.

Minimal hepatic encephalopathy has atypical clinical symptoms but mild neuropsychiatric deficits, which are easily neglected by patients and their family members as a specific type of hepatic encephalopathy. The degree centrality (DC) analysis method based on resting-state blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) is a data analysis method derived from graph-theoretic approach reflecting whole-brain network connectivity, which can provide a more complete, faster and better representation of brain function.

To explore the effects of abnormal changes in the brain functional network connectivity properties and functional brain regions on cognitive function in patients with minimal hepatic encephalopathy and their neuroimaging mechanisms.

A total of 65 patients with hepatitis B cirrhosis hospitalized in the department of infectious diseases in General Hospital of Ningxia Medical University from October 2020 to February 2022 and 40 healthy volunteers recruited during the same period were selected as the study subjects. Gender, age, education level, number connection test A (NCT-A) score, digit symbol test (DST) score and Montreal cognitive assessment (MoCA) score of the study subjects were collected. Finally, patients with hepatitis B cirrhosis were divided into cirrhosis group (n=30) and MHE group (n=28) according to NCT-A and DST scores, and the recruited healthy volunteers were considered as the healthy control group (n=34) . The DC values of brain regions in each group were calculate, the differences in DC values of brain image between MHE group and cirrhosis group, cirrhosis group and healthy control group, MHE group and healthy control group were compared, respectively. The correlations between the DC values of brain regions with the scores of NCT-A, DST and MoCA in MHE patients was analyzed by using person correlation analysis, the distribution of brain regions with DC values correlated with the scores of above scales and the corresponding scatter plots were drawn.

The NCT-A score in the healthy control and cirrhotic group was lower than MHE group, DST score and MoCA score in the healthy control and cirrhotic group were higher than MHE group (P<0.05) . Compared with healthy control group, the MHE group had increased DC values in right middle frontal gyrus, left middle temporal gyrus, right inferior parietal lobule and decreased DC values in left angular gyrus, right middle occipital gyrus, right precentral gyrus (voxel cluster>18, P<0.05) . Compared with healthy control group, cirrhotic group had increased DC values in the bilateral middle temporal gyrus and decreased DC values in the left angular gyrus (voxel cluster>18, P<0.05) ; compared with cirrhotic group, MHE group had decreased values in the right middle temporal gyrus and left precuneus (voxel cluster>18, P<0.05) . The results of correlation analysis showed that in the MHE group, the DST score was correlated with DC values in the left superior temporal gyrus (r=0.639, P<0.001) , and the NCT-A score was negatively correlated with the DC values in the right inferior temporal gyrus (r=-0.722, P<0.001) ; MoCA scale score was positively correlated with DC values in the right inferior frontal gyrus and left inferior frontal gyrus (r=0.437, P=0.020; r=0.549, P=0.002) and negatively correlated with DC values in the left inferior temporal gyrus (r=-0.591, P=0.001) .

The abnormal functional connectivity of several brain regions and the correlation of DC values in some brain regions with NCT-A, DST and MoCA scale scores in MHE patients suggest that DC value may be a potential neuroimaging marker to quantify the severity of cognitive changes in MHE patients.

Pyogenic liver abscess (PLA) is a common visceral infectious disease, its associated thrombocytopenia has been rarely studied clinically.

To discuss the epidemiological and clinical characteristics as well as risk factors of thrombocytopenia secondary to PLA.

All 161 patients hospitalized for PLA in Peking University People's Hospital from January 2011 to December 2020 were recruited. Patient data were collected, including general demographics〔age, gender, body mass index (BMI) , symptoms (fever, abdominal pain, nausea, vomiting) , and past medical history information (hypertension, diabetes, coronary heart disease, hepatobiliary disease, and cancer) , auxiliary examination results, including white blood cell count, absolute neutrophil count, absolute lymphocyte count (ALC) , absolute monocyte count, hemoglobin, C-reactive protein (CRP) , procalcitonin (PCT) , alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , total bilirubin (TBiL) , blood urea nitrogen (BUN) , serum creatinine (Scr) , albumin (ALB) , prothrombin time (PT) , activated partial thromboplastin time, fibrinogen, D-Dimer, platelet count (PLT) 〕, imaging examination results (abdominal CT or ultrasonographic findings of liver abscesses) , pathogenic examination results (blood culture, prevalence of cultured Klebsiella pneumoniae) and complications and prognosis. The above-mentioned data were compared between group with decreased PLT (n=21) and group without decreased PLT (n=140) divided by the prevalence of PLT less than 100×10⁹/L. The risk factors of thrombocytopenia were analyzed by multivariate Logistic regression analysis.

The mean BMI in PLT reduction group was statistically significant higher than that in non-PLT reduction group (P<0.05) . PLT reduction group had much lower mean levels of ALC and ALB, PT, and much higher mean levels of CRP, PCT, ALT, AST, TBiL, BUN, Scr and D-Dimer than non-PLT reduction group (P<0.05) . Furthermore, PLT reduction group had significantly higher prevalence of concomitant pneumonia, brain abscess and ICU admission (P<0.05) . ALB〔OR=0.255, 95%CI (0.074, 0.877) 〕and PT〔OR=0.282, 95%CI (0.085, 0.941) 〕were influencing factors for thrombocytopenia in PLA (P<0.05) .

ALB and PT are the influencing factors of thrombocytopenia in PLA patients. PLT levels should be closely monitored in PLA patients, especially those with reduced ALB and decreased PT.

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.

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.

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.

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.

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.

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.

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.

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.