Objective: To investigate the inhibitory effect of honeysuckle on Streptococcus mutans UA159 in vitro. Methods: We used a double-dilution method to measure the minimum inhibitory concentration (MIC) of honeysuckle against Streptococcus mutans UA159. Lonicerae lonicerae powder was dissolved in the solvent DMSO, different concentrations of liquid medicine were prepared, and bacterial liquid was added. The solution control group and bacterial liquid control group were set at the same time. The growth and acid production of UA159 were determined using antibacterial experiments. A growth curve and acid production curves were drawn, and the adhesion rate and adhesion inhibition rate were calculated. The effect of honeysuckle on the formation of Streptococcus mutans UA159 was determined by crystal violet quantification, and a microscope and a scanning electron microscope were used to observe biofilm formation and structural changes. Results : The MIC of honeysuckle against Streptococcus mutans UA159 was 12.5 mg/mL. The bacteriostatic experiments showed a difference in the growth, acid production and adhesion of UA159 after honeysuckle treatment (P<0.05) compared with the controls, and the inhibitory effect increased as the drug liquid concentration increased. Crystal violet quantification showed a significant difference in biofilm formation between the pharmaceutical liquid group and the control group (P<0.05). Meanwhile, the forward microscope showed a significant decrease in biofilm formation. Under SEM, the number of bacteria decreased significantly at 0, 6 and 12 h after honeysuckle addition. Conclusion Honeysuckle inhibits the growth and acid production of UA159 and inhibits adhesion and the formation of biofilms.

Acute-on-chronic liver failure(ACLF)is generally accepted as a clinical syndrome characterized by an acute hepatic insult and rapid deterioration of liver function in patients with pre-existing chronic liver disease in combination with multi-organ failure with high short-term mortality.Because of the differences in etiology and inducement,there are different definitions and diagnostic criteria of ACLF in the East and West.Attempting to cover all ACLF diagnosed,WGO defined ACLF into three categories in 2014:patients with CLD but no cirrhosis(type A),compensated cirrhosis(type B),and decompensated cirrhosis(type C).However,different types of ACLF have different pathophysiology,which leads to obvious differences in predisposition,injury,response,organ failure and mortality among different types of ACLF.The concept of PIRO,which is similar to that used in determining outcomes of sepsis,is contribute to comprehensively understand different types of HBV-ACLF,improve management.Therefore,it is of great significance to improve the survival rate of ACLF.

ObjectiveTo investigate the clinical features of elderly patients with hepatitis B virus-related acute-on-chronic liver failure （HBV-ACLF） and the risk factors affecting the short-term prognosis of patients. MethodsA retrospective analysis was performed for 417 patients with HBV-ACLF who were admitted to The General Hospital of Western Theater Command from January 2015 to January 2023， and related clinical data were collected， including general status， routine blood test results， biochemical parameters， and conditions of liver cirrhosis and decompensated events （ascites， hepatic encephalopathy， and their severities）. The patients were followed up to observe 90-day survival. According to the age， the patients were divided into elderly group （with 106 patients aged ≥60 years） and non-elderly group （with 311 patients aged<60 years）， and according to the 90-day survival， the elderly group were further divided into survival group with 41 patients and death/transplantation group with 65 patients. The independent-samples t test or the Mann-Whitney U test was used for comparison of quantitative data between two groups， and the chi-square test was used for comparison of qualitative data between two groups. The binary logistic regression analysis was used to determine the independent influencing factors for the risk of death within 90 days in elderly patients with HBV-ACLF， and a nomogram model was constructed for predicting the risk of death. The receiver operating characteristic （ROC） curve was used to investigate the value of the model in predicting the prognosis of HBV-ACLF patients in both the training set and the validation set. Calibration curve and decision curve were plotted for the models constructed in the training set and the validation set， and the model was assessed in terms of the degree of fitness and predicting benefits. ResultsThe elderly patients had a significantly higher 90-day mortality rate than the non-elderly patients （P<0.05）， and compared with the non-elderly group， the elderly group had significantly higher incidence rate in female individuals， basic incidence rate of liver cirrhosis， incidence rate and grade of hepatic encephalopathy， incidence rate of ascites， and liver fibrosis markers （aspartate aminotransferase-to-platelet ratio index and fibrosis-4） （all P<0.05）， as well as significantly lower total cholesterol， high-density lipoprotein， albumin， alpha-fetoprotein， and lymphocytes （all P<0.05）. As for the elderly patients with HBV-ACLF， there were significant differences between the survival group and the death/transplantation group in total cholesterol， total bilirubin， international normalized ratio （INR）， alpha-fetoprotein， platelet， creatinine， serum sodium， monocytes， and the incidence rate and grade of hepatic encephalopathy （all P<0.05）. In addition， the multivariate logistic regression analysis showed that INR （odds ratio ［OR］=11.351， 95% confidence interval ［CI］： 1.942‍ ‍—‍ ‍66.362， P<0.05）， monocyte count （OR=23.636， 95%CI： 1.388‍ ‍—‍ ‍402.529， P<0.05）， total bilirubin （OR=1.007， 95%CI： 1.001‍ ‍—‍ ‍1.013， P<0.05）， and platelet count （OR=0.968， 95%CI： 0.945‍ ‍—‍ ‍0.993， P<0.05） were independent influencing factors for the 90-day prognosis of elderly patients with HBV-ACLF， and the nomogram model constructed based on these factors had a relatively high predictive value， with an area under the ROC curve of 0.915， a sensitivity of 88.0%， and a specificity of 86.7%. The nomogram model showed relatively high efficiency and degree of fitness in the verification set， and the decision curve suggested that the model had good benefits， with a higher prediction efficiency compared with the commonly used prediction models such as MELD score and COSSH-ACLF Ⅱ score. ConclusionElderly HBV-ACLF patients may have a high short-term mortality rate due to the reductions in liver synthesis， reserve function， and regenerative ability and immune dysfunction. INR， monocyte count， total bilirubin， and platelet count have a relatively high value in predicting the risk of death in elderly HBV-ACLF patients， and the nomogram model constructed based on these factors has a relatively high prediction efficiency.

Acute-on-chronic liver failure (ACLF) is a clinical syndrome with rapid deterioration of liver function caused by a series of predisposing factors on the basis of chronic liver diseases, and it is characterized by multiple organ failure and high short-term mortality. The onset of systemic inflammation is one of the important influencing factors for the progression of ACLF and is the body's natural defense against infection; however, the excessive release of inflammatory mediators breaks the original dynamic balance between "pro-inflammation" and "anti-inflammation", which may aggravate liver function impairment and even lead to decompensation. Therefore, the intensity of inflammatory response is closely associated with the prognosis of patients with ACLF, while at present, not enough attention has been paid to the impact of inflammatory response on patients with ACLF and the measures to deal with cytokine storm. Therefore, this article summarizes the impact of inflammatory response on ACLF and related advances in treatment, so as to provide ideas for the diagnosis and treatment of ACLF in clinical practice.

Objective To investigate the association between platelet count (PLT) and the prognosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), to establish a new PLT-related scoring model, and to assess its value in predicting the short-term prognosis of HBV-ACLF. Methods A retrospective cohort study was conducted among the patients with HBV-ACLF who were hospitalized and treated in Department of Gastroenterology, The General Hospital of Western Theater Command, from January 2018 to January 2022. Clinical data within 24 hours after admission were collected from all patients, and according to the survival after 180 days of follow-up, the patients were divided into survival group and death group. The independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Pearson correlation coefficient was used to investigate the correlation between different indicators, and the logistic regression model was used to analyze the influencing factors for prognosis. The receiver operating characteristic (ROC) curve was used to assess the predictive value of the prognostic model, and the Kaplan-Meier curve analysis was used to investigate the survival condition of the high AIP group and the low AIP group. Results A total of 236 patients were enrolled, with a 180-day survival rate of 75.85% (179/236). Compared with the survival group, the death group had significantly higher age (53.98±10.45 vs 47.44±12.46, P =0.001), international normalized ratio (INR) [1.78 (1.46-2.04) vs 1.47 (1.23-1.68), P < 0.001], total bilirubin [275.60 (165.00-451.45) vs 230.60 (154.90-323.70), P =0.035], Model for End-Stage Liver Disease (MELD) score [21.47 (18.14-24.76) vs 18.67 (15.70-21.62), P < 0.001], and albumin-bilirubin (ALBI) score [-1.06 (-1.64~-0.86) vs-1.32 (-1.73~-1.01), P =0.034], as well as significantly lower PLT [80.00 (50.00~124.50) vs 115.00 (82.00~143.00), P =0.001] and platelet-to-white blood cell ratio (PWR) [13.40 (9.54~20.70) vs 18.49 (13.95~24.74), P =0.001]. The Pearson correlation analysis showed that PLT was negatively correlated with liver cirrhosis and INR ( r =-0.332 and -0.194, P < 0.001 and P =0.003). The multivariate logistic regression analysis showed that age (odds ratio [ OR ]=1.045, 95% confidence interval [ CI ]: 1.015-1.076), PLT ( OR =0.990, 95% CI : 0.983-0.998), and INR ( OR =2.591, 95% CI : 1.363-4.925) were independent risk factors for the 180-day prognosis of HBV-ACLF patients. The new predictive model was established as follows: AIP=0.006×age+0.187×INR-0.001×PLT. The AIP scoring model had an area under the ROC curve (AUC) of 0.718 in predicting the 180-day prognosis of HBV-ACLF patients, with a sensitivity of 81.1% and a specificity of 54.1%, while PLT, PWR, LPACLF score, MELD score, and ALBI score had an AUC of 0.673, 0.659, 0.588, 0.647, and 0.578, respectively. The AIP scoring model had an optimal cut-off value of 0.48. The Kaplan-Meier survival analysis showed that the high AIP group had a significantly lower survival rate than the low AIP group ( P < 0.001). Conclusion The PLT-related scoring model has a better value than other models in predicting the prognosis of HBV-ACLF, and HBV-ACLF patients with a relatively high PLT level tend to have a high overall survival rate.