ObjectiveTo investigate the effect of Yiqi Yangyin Jiedu Huayu prescription on minimal hepatic encephalopathy in liver cirrhosis based on intestinal metabolomics. MethodsA total of 11 patients with liver cirrhosis who were hospitalized in Beijing Ditan Hospital， Capital Medical University， from March to May 2024， and were diagnosed with MHE based on psychometric hepatic encephalopathy score were enrolled as subjects， and 11 healthy family members of the patients were enrolled as control group. Fecal samples were collected for metabolomics analysis from the control group and the patients with MHE before and after treatment with Yiqi Yangyin Jiedu Huayu prescription， and a population cohort study was conducted to investigate the effect of Yiqi Yangyin Jiedu Huayu prescription on intestinal metabolism of patients with MHE. The Fisher’s exact test was used for categorical data between two groups； the independent samples t-test was used for comparison of normally distributed continuous data between two groups， the paired t-test was used for comparision before and after treatment within the same group， and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups. ResultsA total of 29 differentially expressed metabolites were detected between the MHE group and the control group， mainly amino acids， organic acids， organic amines， carbohydrates， fatty acids， and vitamins， and there were 12 upregulated metabolites and 17 downregulated metabolites in the MHE group， which were mainly enriched in the metabolic pathways of ornithine， branched-chain amino acid， and aromatic amino acid. After the treatment with Yiqi Yangyin Jiedu Huayu prescription， 80 differentially expressed metabolites were detected in the patients with MHE， mainly carbohydrates， organic acids， and amino acids， and there were 56 upregulated metabolites and 24 downregulated metabolites， which were mainly enriched in the metabolic pathways of ornithine， branched-chain amino acid， and aromatic amino acid. ConclusionYiqi Yangyin Jiedu Huayu prescription can exert a therapeutic effect on patients with MHE by regulating intestinal metabolism.

Acute-on-chronic liver failure （ACLF） is a dangerous disease with severe conditions， rapid progression， and high short-term mortality. Intestinal flora and metabolites are closely associated with the development， progression， and pathogenesis of ACLF. During the development of ACLF， the destruction of intestinal integrity and the dysregulation of intestinal microecology and its metabolites mediate immune disturbance and thus aggravate systemic inflammatory response. This article elaborates on the role of intestinal flora and metabolites in the development and progression of ACLF and related therapeutic strategies.

ObjectiveTo investigate the impact of anticentromere antibody （ACA） on the clinical features and prognosis of patients with primary biliary cholangitis （PBC） by comparing clinical classification， ursodeoxycholic acid （UDCA） response， GLOBE score， and UK-PBC score between ACA-positive PBC patients and ACA-negative PBC patients. MethodsA total of 749 patients who were admitted to Beijing Ditan Hospital， Capital Medical University， from August 2013 to December 2022 and were diagnosed with PBC were enrolled and divided into ACA-positive group with 147 patients and ACA-negative group with 602 patients. According to their conditions on admission， the two groups were compared in terms of the distribution of clinical types， i.e.， chronic progression-type PBC， portal hypertension-type PBC， and standard jaundice/liver failure-type PBC. There were 261 patients with complete data after 1-year follow-up， among whom there were 53 patients with positive ACA and 208 with negative ACA. A statistical analysis was performed， and propensity score matching was performed based on sex and age at a ratio of 1∶2. The two groups were compared in terms of 1-year UDCA response rate， GLOBE score， and UK-PBC score before and after matching. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. ResultsCompared with the ACA-negative group， the ACA-positive group had a significantly higher age （61.28±10.35 years vs 56.74±12.17 years， t=4.164， P<0.001）， a significantly higher proportion of female patients （93.9% vs 77.6%， χ²=20.221， P<0.001）， a significantly higher proportion of patients with portal hypertension （48.3% vs 27.6%， χ²=23.289， P<0.001）， and a significantly lower proportion of patients with jaundice/liver failure （24.5% vs 38.5%， χ²=10.205， P<0.001）. After 1-year follow-up， for the 261 PBC patients with complete data， there was no significant difference in UDCA response rate before propensity score matching between the ACA-positive group and the ACA-negative group （41.5% vs 41.8%， P>0.05）， and there was a significant difference in the proportion of patients with a GLOBE score of >0.3 between the ACA-positive group and the ACA-negative group （92.5% vs 80.3%， χ²=3.935， P=0.047）. There were 53 patients in the ACA-positive group and 106 patients in the ACA-negative group after propensity score matching， and there were no significant differences between the two groups in UDCA response rate， GLOBE score， and UK-PBC score （all P>0.05）. ConclusionACA-positive patients tend to have an older age， with a higher proportion of female patients or patients with portal hypertension， while there is a relatively low proportion of patients with jaundice/liver failure. Positive ACA has no significant impact on UDCA response rate， GLOBE score， and UK-PBC score.

Acute-on-chronic liver failure （ACLF） is a complex clinical syndrome characterized by acute deterioration of liver function caused by different factors on the basis of chronic liver disease， accompanied by liver failure and/or extrahepatic organ failure， and it often has a high short-term mortality rate. With the increasing evidence of evidence-based medicine， multiple guidelines and consensus statements have been released， such as Guidelines for clinical diagnosis and treatment of acute-on-chronic liver failure in traditional Chinese medicine， Expert consensus on the diagnosis and treatment of acute-on-chronic liver failure with integrated traditional Chinese and Western medicine， and Guidelines for the integrated traditional Chinese and Western medicine diagnosis and treatment of acute-on-chronic liver failure， and integrated traditional Chinese and Western medicine therapies for ACLF have been constantly standardized and perfected. This article explores the characteristics and advantages of integrated traditional Chinese and Western medicine therapy in the whole-course management of ACLF from the aspects of early warning and prevention， treatment in the acute stage， management of complications， and rehabilitation care， in order to enhance the understanding of traditional Chinese and Western medicine treatment strategies among clinicians.

BACKGROUND: Preclinical studies have indicated that Angong Niuhuang Pills (ANP) reduce cerebral infarct and edema volumes. This study aimed to investigate whether ANP safely reduces cerebral infarct and edema volumes in patients with moderate to severe acute ischemic stroke. METHODS: This randomized, double-blind, placebo-controlled pilot trial included patients with acute ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) scores ranging from 10 to 20 in 17 centers in China between April 2021 and July 2022. Patients were allocated within 36 h after onset via block randomization to receive ANP or placebo (3 g/day for 5 days). The primary outcomes were changes in cerebral infarct and edema volumes after 14 days of treatment. The primary safety outcome was severe adverse events (SAEs) for 90 days. RESULTS: There were 57 and 60 patients finally included in the ANP and placebo groups, respectively for modified intention-to-treat analysis. The median age was 66.0 years, and the median NIHSS score at baseline was 12.0. The changes in cerebral infarct volume at day 14 were 0.3 mL and 0.4 mL in the ANP and placebo groups, respectively (median difference: -7.1 mL; interquartile range [IQR]: -18.3 to 2.3 mL, P = 0.30). The changes in cerebral edema volume of the ANP and placebo groups on day 14 were 11.4 mL and 4.0 mL, respectively ( median difference: 3.0 mL, IQR: -1.3 to 9.9 mL, P = 0.15). The rates of SAE within 90 days were similar in the ANP (3/57, 5%) and placebo (7/60, 12%) groups ( P = 0.36). Changes in serum mercury and arsenic concentrations were comparable. In patients with large artery atherosclerosis, ANP reduced the cerebral infarct volume at 14 days (median difference: -12.3 mL; IQR: -27.7 to -0.3 mL, P = 0.03). CONCLUSIONS: ANP showed a similar safety profile to placebo and non-significant tendency to reduce cerebral infarct volume in patients with moderate-to-severe stroke. Further studies are warranted to assess the efficacy of ANP in reducing cerebral infarcts and improving clinical prognosis. TRAIL REGISTRATION Clinicaltrials.gov , No. NCT04475328.
Aged ; Female ; Humans ; Male ; Middle Aged ; Double-Blind Method ; Drugs, Chinese Herbal/adverse effects* ; Ischemic Stroke/drug therapy* ; Pilot Projects ; Stroke/drug therapy* ; Treatment Outcome

ObjectiveTo investigate the influencing factors for death within 30 days in patients with decompensated hepatitis B cirrhosis and hepatic encephalopathy. MethodsA retrospective analysis was performed for 616 patients with hepatitis B cirrhosis and hepatic encephalopathy in Beijing Ditan Hospital from January 2008 to April 2018， and all patients were followed up for 30 days. According to their prognosis， they were divided into survival group with 488 patients and death group with 128 patients. The Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The Cox regression analysis was used to investigate the independent risk factors for death within 30 days in patients with hepatitis B cirrhosis and hepatic encephalopathy. ResultsThe multivariate Cox regression analysis showed that age （hazard ratio ［HR］=1.029， 95% confidence interval ［CI］： 1.014‍ — ‍1.044， P<0.001）， Model for End-Stage Liver Disease （MELD） score （HR=1.118， 95%CI： 1.098‍ — ‍1.139， P<0.001）， and neutrophil-to-lymphocyte ratio （NLR） （HR=1.036， 95%CI： 1.015‍ — ‍1.057， P=0.001） were independent risk factors for death within 30 days in patients with hepatitis B cirrhosis and hepatic encephalopathy. The stratified analysis showed that the patients with a MELD score of≥20 and an NLR of≥4 had a higher risk of death， with a 30-day mortality rate of 57.1% （80/140）. The patients with a MELD score of<20 and an NLR of<4 had a 30-day mortality rate of 3.9% （9/232）. ConclusionAge， MELD score， and NLR are independent risk factors for death within 30 days in patients with hepatitis B cirrhosis and hepatic encephalopathy， and patients with a MELD score of≥20 and an NLR of≥4 tend to have a high risk of death.

Chronic hepatitis B(CHB)is still a major public health issue in China,and without effective control,it can further progress to liver cirrhosis and liver cancer,bringing huge social and economic burdens.At present,antiviral therapy is the main treatment method for CHB,and integrated traditional Chinese and Western medicine therapy is the characteristic treatment method for CHB in China and can improve clinical efficacy by complementing each other's advantages.In order to promote the concept integrated traditional Chinese and Western medicine collaborative diagnosis and treatment,facilitate the development of integrated traditional Chinese and Western medicine diagnosis and treatment techniques for CHB,and establish standardized disease diagnosis and treatment regimens,Expert Committee on Hepatology in Doctor Society of Integrative Medicine,Chinese Medical Doctor Association,established a consensus expert group to discuss and formulate Expert consensus on integrated traditional Chinese and Western medicine diagnosis and treatment of chronic hepatitis B,which elaborated on the concept of integrated traditional Chinese and Western medicine collaborative diagnosis and treatment from the four aspects of CHB epidemiology,pathogenesis and etiology,integrated traditional Chinese and Western medicine diagnosis and syndrome differentiation,and integrated traditional Chinese and Western medicine therapy and proposed related recommendations,in order to improve the prognosis and quality of life of CHB patients.

Primary biliary cholangitis(PBC)is a chronic autoimmune liver disease.In recent years,related studies in China and globally have provided some evidence-based medical evidence for the integrated traditional Chinese and Western medicine treatment of PBC.Based on the latest diagnosis and treatment experience and guidelines in China and globally,Expert Committee on Hepatology,Doctor Society of Integrative Medicine,Chinese Medical Doctor Association,organized related experts in China to formulate this consensus,in order to provide guidance and reference for clinicians in the diagnosis,TCM syndrome differentiation,and integrated traditional Chinese and Western medicine treatment of PBC.

Objective To investigate the differences in clinical features between the primary biliary cholangitis(PBC)patients with negative or positive anti-mitochondrial antibody(AMA)by analyzing related immune and biochemical parameters.Methods This study was conducted among the patients who attended Beijing Ditan Hospital,Capital Medical University,from January 2013 to December 2022 and were diagnosed with PBC,and they were divided into AMA negative group with 139 patients(24.5%)and AMA positive group with 428 patients(75.5%).Propensity score matching at a ratio of 1∶1 was performed with age and sex as matching factors and a matching tolerance of 0.06.Liver function,coagulation,and immune parameters on admission were analyzed,as well as the changes in liver function and other indicators after 6 months of treatment and the response to ursodeoxycholic acid(UDCA)at 6 and 12 months of treatment.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.Results There were 139 AMA-negative PBC patients and 139 AMA-positive PBC patients after propensity score matching.Compared with the AMA positive group on admission,the AMA negative group had significantly lower levels of direct bilirubin and globulin(Glo)and significantly higher levels of albumin,albumin/globulin ratio,prealbumin,and fibrinogen(all P<0.05).After 6 months of UDCA treatment,there were significant differences in Glo and prealbumin between the AMA negative group and the AMA positive group(P<0.05).Both the AMA negative group and the AMA positive group had an increase in prealbumin after 6 months of treatment,and the AMA negative group had a significantly greater increase than the AMA positive group(U=41.00,P=0.015).After UDCA treatment for 6 and 12 months,there was no significant difference in treatment response to UDCA between the AMA negative group and the AMA positive group(all P>0.05).Conclusion After matching for age and sex,compared with the AMA-positive PBC patients,the AMA-negative PBC patients tend to have a milder degree of liver inflammation and damage,significantly greater improvements in inflammation and liver synthesis ability after UDCA treatment,and better response to UDCA.

The Hedgehog （Hh） signaling pathway plays an important role in the development and progression of hepatocellular carcinoma and its tumor microenvironment， and abnormal activation of Hh signal can accelerate the growth of tumor. The crosstalk between the Hh signaling pathway and TME is closely associated with tumor growth and the formation of inhibitory tumor microenvironment. Evidence shows that inhibition of Hh signal plays an important role in inhibiting the growth of hepatocellular carcinoma. This article reviews the current research status of the role， mechanism， and potential therapeutic significance of abnormal activation of Hh signal in hepatocellular carcinoma and its tumor microenvironment， so as to provide new ideas for the treatment of hepatocellular carcinoma.