Liver cirrhosis as the terminal stage of chronic liver disease has seen many new insights and advances in its treatment strategies and perspectives in recent years. However, there are still many controversies about cirrhotic portal hypertension management, prevention, therapy, and complications. This article summarizes the main key controversial points in the current treatment of liver cirrhosis from an evidence-based medicine perspective, including the use of non-selective β-blockers during decompensated stages, exploration of precise strategies for albumin, re-evaluation of the risks of statins, weighing the pros and cons of proton pump inhibitors, new understandings of anticoagulation therapy, breakthroughs in targeting gut microbiota, and nutritional support management. In addition, it combines the latest research data and guideline recommendations to explore future development directions so as to provide clinical practice reference.

Liver fibrosis is a common pathological process in various chronic liver diseases. Early-stage and accurate diagnosis, as well as assessment of the degree of liver fibrosis, is crucial for the management of chronic liver diseases. Conventional imaging techniques for liver fibrosis (elastography and magnetic resonance elastography) still have the drawback of low sensitivity in detecting early-stage fibrosis. In recent years, emerging imaging omics based on ultrasound and magnetic resonance have improved the diagnostic accuracy and visualization stage of liver fibrosis. The emergence of artificial intelligence technology has also provided more options for the technological advancement of liver fibrosis imaging. This article aims to review the emerging liver fibrosis imaging technologies in recent years and compare their diagnostic performance with ultrasound elastography, shear wave elastography, and magnetic resonance elastography recommended by the current domestic and international guidelines and to pinpoint simultaneously the limitations and challenges that still exist in liver fibrosis imaging while reflecting the technological advances.

Liver cirrhosis as the terminal stage of chronic liver disease has seen many new insights and advances in its treatment strategies and perspectives in recent years. However, there are still many controversies about cirrhotic portal hypertension management, prevention, therapy, and complications. This article summarizes the main key controversial points in the current treatment of liver cirrhosis from an evidence-based medicine perspective, including the use of non-selective β-blockers during decompensated stages, exploration of precise strategies for albumin, re-evaluation of the risks of statins, weighing the pros and cons of proton pump inhibitors, new understandings of anticoagulation therapy, breakthroughs in targeting gut microbiota, and nutritional support management. In addition, it combines the latest research data and guideline recommendations to explore future development directions so as to provide clinical practice reference.

Liver fibrosis is a common pathological process in various chronic liver diseases. Early-stage and accurate diagnosis, as well as assessment of the degree of liver fibrosis, is crucial for the management of chronic liver diseases. Conventional imaging techniques for liver fibrosis (elastography and magnetic resonance elastography) still have the drawback of low sensitivity in detecting early-stage fibrosis. In recent years, emerging imaging omics based on ultrasound and magnetic resonance have improved the diagnostic accuracy and visualization stage of liver fibrosis. The emergence of artificial intelligence technology has also provided more options for the technological advancement of liver fibrosis imaging. This article aims to review the emerging liver fibrosis imaging technologies in recent years and compare their diagnostic performance with ultrasound elastography, shear wave elastography, and magnetic resonance elastography recommended by the current domestic and international guidelines and to pinpoint simultaneously the limitations and challenges that still exist in liver fibrosis imaging while reflecting the technological advances.

Non-alcoholic fatty liver disease(NAFLD)constitutes a series of histological lesions characterized by varying degrees of hepatocyte damage,fat accumulation,inflammation,and fibrosis.Currently,liver biopsy is considered the"gold standard"for evaluating the degree of hepatic steatosis,inflammation,and fibrosis,and it also serves as the cornerstone for accurate grading of NAFLD.This article reviews the value and application of liver biopsy in the clinical diagnosis,staging,and clinical trials of NAFLD.

Objective:To investigate the factors associated with delay in anticoagulant therapy in patients with cerebral venous sinus thrombosis (CVST) and its effect on outcome.Methods:Patients with CVST admitted to Changhai Hospital, Naval Medical University from January 2010 to August 2021 were retrospectively enrolled. Patients were divided into early anticoagulation group and late anticoagulation group by the median time interval from first symptom to initiation of anticoagulation. The modified Rankin Scale was used for outcome assessment at 90 d after onset. 0-2 scores were defined as good outcome and 3-6 were defined as poor outcome. Demographic and clinical data were compared for the early versus late anticoagulation group and for the good versus poor outcome groups. Multivariable logistic regression was used to identify independent influencing factors of delay in anticoagulation and the correlation of delay in anticoagulation with poor outcome. Results:A total of 131 patients were included, their age was 40.07±15.11 years old, and 68 (51.91%) were male. Of these, 65 patients (49.62%) were in the early anticoagulation group and 14 (10.69%) were in the poor outcome group. Compared with the late anticoagulation group, the early anticoagulation group had a significantly higher proportion of patients with seizures and brain parenchymal damage as well as higher D-dimer levels on admission, while the proportion of patients with visual impairment/papilloedema was significantly lower (all P<0.05). Compared with the good outcome group, the poor outcome group had significantly higher proportions of patients with seizures, dyskinesia, impaired consciousness, low Glasgow Coma Scale score, and brain parenchymal damage as well as higher D-dimer, total cholesterol and low density lipoprotein cholesterol levels, sites of thrombus involvement were more common in the superior sagittal and straight sinuses, and significantly lower proportions of patients with headache and lower albumin levels on admission (all P<0.05). Multivariate logistic regression analysis showed that visual impairment/papilloedema (odds ratio [ OR] 0.119, 95% confidence interval [ CI] 0.030-0.473; P=0.002) and brain parenchymal damage ( OR 1.341, 95% CI 1.042-1.727; P=0.023) were independently associated with a delay in anticoagulation treatment, and a delay in anticoagulation treatment ( OR 6.102, 95% CI 1.185-30.504; P=0.030) and D-dimer level on admission ( OR 1.299, 95% CI 1.141-1.480; P<0.001) were the independent predictors of poor outcome in patients with CVST. Conclusions:Visual impairment/papilloedema and absence of brain parenchymal damage on cranial imaging are the independent risk factors for delay in anticoagulation in patients with CVST. The delay in anticoagulation is strongly associated with the poor outcome in patients with CVST.

ObjectiveTo study the mechanism of myocardial dielectric property changes in radio frequency during hypothermic preservation and explore myocardial viability evaluative method. Methods Hybrid young pigs (20-30 kg) were used in the experiment. Heart arrest was induced with GIK solution. According to preservative temperature, the animals were divided into three groups: group A (4 ℃),group B (15 ℃) and group C (25 C). The heart was preserved in saline for 12,6 and 4 h respectively. Myocardial dielectric properties and ATP content were tested every 5 and 30 min during hypothermic preservation respectively. The relationship between tanoδm and ATP content was analyzed. ResultsTanδm of three groups was decreased significantly at the beginning, most slightly in group A and most obviously in group C. There was no significant difference in Tanδm between group B and group C with group A at 1 h,but there was obvious difference at 2,3 and 4 h (P＜0. 05,P＜0. 05,P＜0. 01 ). There was correlation between tanδm and ATP in the three groups. ConclusionTanδm in three groups is dropped with preservation time and temperature, and tanδm had a correlation with ATP content. Detection of myocardial dielectric property in radio frequency is a kind of quick, accurate and noninvasive method.