Despite therapy with potent antiviral agents, chronic hepatitis B (CHB) patients remain at high risk of hepatocellular carcinoma (HCC). While metabolites have been rediscovered as active drivers of biological processes including carcinogenesis, the specific metabolites modulating HCC risk in CHB patients are largely unknown. Here, we demonstrate that baseline plasma from CHB patients who later developed HCC during follow-up exhibits growth-promoting properties in a case-control design nested within a large-scale, prospective cohort. Metabolomics analysis reveals a reduction in long-chain acylcarnitines (LCACs) in the baseline plasma of patients with HCC development. LCACs preferentially inhibit the proliferation of HCC cells in vitro at a physiological concentration and prevent the occurrence of HCC in vivo without hepatorenal toxicity. Uptake and metabolism of circulating LCACs increase the intracellular level of acetyl coenzyme A, which upregulates histone H3 Lys14 acetylation at the promoter region of KLF6 gene and thereby activates KLF6/p21 pathway. Indeed, blocking LCAC metabolism attenuates the difference in KLF6/p21 expression induced by baseline plasma of HCC/non-HCC patients. The deficiency of circulating LCACs represents a driver of HCC in CHB patients with viral control. These insights provide a promising direction for developing therapeutic strategies to reduce HCC risk further in the antiviral era.

Objective To compare the diagnostic value of four signs for superior labrum anterior and posterior (SLAP) lesions of the shoulder. Methods The physical examination was performed randomly on 81 cases with abnormalities of the shoulder. There were four tests, including Kibler anterior sliding test, Liu crank test, O'Brien active compression test and Kim biceps load test Ⅱ. The arthroscopic examination were also performed. The result of the arthroscopic examination was considered as a golden standard, so that we could estimate the diagnosis value of the four tests according to the method of evaluation of diagnosis test on clinical epidemiology, their sensitivity, specificity, positive and negative predictive value, accuracy. Results There were 21 cases diagnosed as SLAP lesions by arthroscopy. The diagnosis value of Kim biceps load test Ⅱ was the highest among the four tests, in which 19 of true positive, 59 of true negative, 1 of false positive, only 2 of false negative case; while the sensitivity was 90.48%, specificity was 98.33%, positive predictive value was 95.00%, negative predictive value was 96.72%, and accuracy was 96.30%. However the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Kibler anterior sliding test were 76.19%, 96.67%, 88.89%, 92.06%, 91.33%; and those of Liu crank test were 85.71%, 93.33%, 81.82%, 94.92%, 91.35%; those of O'Brien active compression test were 80.95%, 91.66%, 77.27%, 93.22%, 88.89%. Conclusion Kim Biceps load test Ⅱ may be the best for clinical diagnosis of SLAP lesions of the shoulder.