ObjectiveTo investigate the effects of rhizosphere organic acids secreted by the roots of Salvia miltiorrhiza on continuous cropping obstacles. MethodsThe mixed solution of organic acids in the rhizosphere of S. miltiorrhiza in continuous cropping and rotation cropping was added to the hairy roots subcultured for 21 days， and samples were collected on days 0， 2， 4， 6， 8， and 10. The changes of biomass， effective components， primary metabolites， secondary metabolites， antioxidant enzymes， and hormones in hairy roots of S. miltiorrhiza were observed and determined. ResultsCompared with the rotation cropping group and the blank control group， the simulation of organic acid secretion from the roots of S. miltiorrhiza had a significant inhibitory effect on the growth of hairy roots and decreased the content of effective components as well as total sugar and total protein in primary metabolites. Compared with the blank control group， the rotation cropping group and the continuous cropping group showed total sugar and total protein content decreases of 33.9% and 5.1%， respectively. On the other hand， the secretion of organic acids from S. miltiorrhiza roots significantly promoted the accumulation of total phenolic acids and total tanshinone， which showed increases of 14.6% and 1.6%， respectively， in continuous cropping group and rotation cropping group compared with the blank control group. ConclusionThe organic acid environment under continuous cropping significantly inhibited the growth of hairy roots and the accumulation of primary metabolites， while promoting the synthesis and accumulation of secondary metabolites of S. miltiorrhiza.

Major research efforts in liver cancer have been devoted to increasing the efficacy and effectiveness of surveillance for hepatocellular carcinoma (HCC). As with other cancers, surveillance programmes aim to detect tumors at an early stage, facilitate curative-intent treatment, and reduce cancer-related mortality. HCC surveillance is supported by a large randomized controlled trial in patients with chronic hepatitis B virus infection and several cohort studies in cirrhosis; however, effectiveness in clinical practice is limited by several barriers, including inadequate risk stratification, underuse of surveillance, and suboptimal accuracy of screening tests. There are several proposed strategies to address these limitations, including risk stratification algorithms and biomarkers to better identity at-risk individuals, interventions to increase surveillance, and emerging imaging- and blood-based surveillance tests with improved sensitivity and specificity for early HCC detection. Beyond clinical validation, data are needed to establish clinical utility, i. e. increased early tumor detection and reduced HCC-related mortality. If successful, these data could facilitate a precision screening paradigm in which surveillance strategies are tailored to individual HCC risk to maximise overall surveillance value. However, practical and logistical considerations must be considered when designing and implementing these validation efforts.To address these issues, the International Liver Cancer Association (ILCA) adjourned a single topic workshop on HCC risk stratification and surveillance in June 2022. Herein, we present a white paper on these topics, including the status of the field, ongoing research efforts, and barriers to the translation of emerging strategies.

This article is an excerpt from the Expert Management of Congenital Portosystemic Shunts and Their Complications, which was published by the European Association for the Study of the Liver (EASL). Some of the most challenging systemic complications that often associated with congenital portosystemic shunts (CPSS) are liver nodules, pulmonary hypertension, endocrine abnormalities, and neurocognitive dysfunction. This article mainly provides expert clinical guidance for the management of liver nodules, pulmonary hypertension, and endocrine abnormalities, along with recommendations for shunt closure and follow-up.

Acute variceal bleeding (AVB) continues to be a fatal complications of cirrhotic portal hypertension. Although the hospitalization rate of patients with acute variceal bleeding has significantly decreased with the advancement of medical technology, and the mortality rate has dropped from 50% three decades before to 15%～20% now, the in-hospital mortality rate is still high and is closely related to the severity of cirrhosis, ranging from 0 in Child A grade to 32% in Child C grade. Therefore, it is a good choice to risk stratify these patients and individualize the treatment method according to the expected risk, as the risk of death in patients with acute variceal bleeding is highly heterogeneous. This article mainly reviews the current status of risk stratification and treatment of acute variceal bleeding in cirrhosis.

Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy.Whether pregnancy-related or not,liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality.Thus,the European Association for the Study of the Liver invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations,based on the best available evidence,for the management of liver diseases in pregnancy for hepatologists,gastroenter-ologists,obstetric physicians,general physicians,training specialists and other healthcare professionals who provide care for this patient population.

This Practice Guidance intends to coalesce best practice recommendations for the identification of portal hypertension （PH）， for prevention of initial hepatic decompensation， for the management of acute variceal hemorrhage （AVH）， and for reduction of the risk of recurrent variceal hemorrhage in chronic liver disease. The most significant changes in the current Guidance relate to recognition of the concept of compensated advanced chronic liver disease， codification of methodology to use noninvasive assessments to identify clinically significant PH （CSPH）， and endorsement of a change in paradigm with the recommendation of early utilization of nonselective beta-blocker therapy when CSPH is identified. The updated guidance further explores potential future pharmacotherapy options for PH， clarifies the role of preemptive transjugular intrahepatic portosystemic shunt in AVH， discusses more recent data related to the management of cardiofundal varices， and addresses new topics such as portal hypertensive gastropathy and endoscopy prior to transesophageal echocardiography and antineoplastic therapy.

Objective To investigate the role and mechanism of circular RNA(circRNA)has_circ_0003304(circAZIN1)in regulating chondrocyte degeneration in osteoarthritis(OA).Methods Gene chip was used to detect the expression level of circRNA during the chondrogenic differentiation of human adipose-de-rived stem cells(hADSC).The circAZIN1 was further screened through the chondrocyte inflammation model constructed with interleukin-β(IL-β)and tumor necrosis factor-α(TNF-α)from the top 10 circRNAs with the most differentiated expression detected by gene chip.Real-time fluorescence quantitative polymerase chain re-action PCR(qPCR)was used to detect the effect of circAZIN1 overexpression(transfected with pcDNA3.1-circAZIN1-EF1-ZsGreen plasmid)on the metabolism of chondrocyte extracellular matrix(ECM).RNA-Pull down test was conducted to detect the protein bound by circAZIN1,miRNA-circRNA Interactions predicted the microRNAs(miRNAs)and their sites that circAZIN1 may be sponge-adsorbed,further TargetMiner,miRDB and TargetScan databases were applied to predict miRNAs which circAZIN1 may sponge-adsorbed.circAZIN1,miRNA and downstream mRNA were detected to find whether there was mirror regulation phe-nomenon after overexpression of miRNA.Results CircAZIN1 had the most significant differential expression during the chondrogenic differentiation of hADSC(day 3 and day 21)and in the chondrocyty inflammation model constructed by IL-β,TNF-α(day 3 group vs.day 21 group,the conttrol group vs.the IL-β group,the control group vs.the TNF-α group).Overexpression of circAZIN1 could promote the ECM synthesis in chon-drocytes and inhibit its decomposition.RNA-Pull down test result showed that circAZIN1 obviously bound AGO2 protein,suggesting that circAZIN1 had a high possibility of sponge adsorbing miRNAs.Further data-base predicted that its downstream was hsa-miR-654-3p,and the downstream mRNA of hsa-miR-654-3p was CACNA1I.After the overexpression of hsa-miR-654-3p,qPCR test found that circAZIN1,hsa-miR-654-3p and CACNA1I had a mirror image regulation phenomenon.Conclusion circAZIN1 inhibits the silencing effect of CACNA1I through sponge adsorption of hsa-miR-654-3p and thus plays a role in inhibiting chondrocyte de-generation,which provides a reference for the study of the regulatory mechanism of circRNA in the develop-ment of OA.

This is the American Association for the Study of Liver Diseases (AASLD) comprehensive guideline on the application of endovascular interventional radiological procedures in the treatment of variceal bleeding, which supplements Risk Stratification and Management of Portal Hypertensive Bleeding in Cirrhosis by describing recent advances in invasive surgery. Transjugular intrahepatic portosystemic shunt (TIPS) dates back to the 80s of the 20th century, and over the past few years, several new technical improvements have been made to TIPS stents. Another major treatment for gastric variceal bleeding in North America is the use of different forms of retrograde transvenous embolization. This guideline is intended to provide healthcare professionals with an in-depth understanding of the use of TIPS and/or variceal embolization/occlusion in the treatment of variceal bleeding, with the goal of facilitating multidisciplinary discussions on treatment strategies among hepatologists, gastroenterologists, interventional radiologists, and surgeons. Additionally, it provides a data-based approach to the endovascular treatment of variceal bleeding. However, it differs from the AASLD guidelines by being supported by a systematic review of the literature, a formal rating of the quality of the evidence, and the strength of the recommendations. Consequently, this guideline was developed by a consensus of an expert panel under the supervision of the AASLD Practice Guidelines Committee and provides guidance statements based on a comprehensive review and analysis of the literature on the relevant topic. Importantly, the AASLD Practice Guidelines Committee selected this topic because, for the most part, there are not a sufficient number of randomized controlled trials on this topic to provide meaningful systematic reviews and meta-analyses.

The 2023 American Association for the Study of Liver Diseases practice guidelines (hereinafter referred to as the Guidelines) provide the latest approach for the prevention, diagnosis, and treatment of hepatocellular carcinoma. The prior American Association for the study of Liver Diseases (AASLD) HCC guidelines have been updated to reflect the clinically significant advances in multiple fields of HCC. Notable examples of these updates include recommendations for the use of ultrasound and alpha-fetoprotein for HCC monitoring, the expansion of surgical treatment indications, the addition of immunosuppressive therapy as first-line systemic therapy, and the implementation of clear multidisciplinary care and proactive care planning.

In 2022, the European Association for the Study of the Liver clinical practice guidelines on the management of hepatic encephalopathy (HE) present evidence ⁃ based answers to a set of relevant questions, which formulated in participant, intervention, comparison, and outcome (PICO) format on the definition, diagnosis, differential diagnosis and treatment of HE. This excerpt does not cover the pathophysiology of HE and does not cover all available treatment options. It presents the readers with translations and summarizations of the above mentioned recommendations. The methods through which it was developed and any information relevant to its interpretation are also provided.