Background: Recent studies have demonstrated the presence of associations between metabolic syndrome and the onset of nonalcoholic fatty liver disease (NAFLD). Metabolic syndrome, in turn, has been found to be linked to high serum uric acid to HDL-cholesterol ratios (UHR). However, the relationship between UHR values and the occurrence of NAFLD in non-obese individuals remains unknown. The present study aimed to examine the possible correlation between UHR values and NAFLD onset among a non-obese Chinese population without dyslipidemia, as well as comparing the predictive value of UHR versus other NAFLD onset predictors. Methods: A total of 9837 non-obese patients, with normal blood lipid levels, were included in a 5-year retrospective cohort study, and the onset of NAFLD in these patients was diagnosed by liver ultrasound. Results: Out of the 9837 patients, 855 were diagnosed with NAFLD during the 5-year follow-up period, for an overall total prevalence of 8.7% at the end of the study period. Across quintiles 1, 2, 3, 4 and 5 of UHR (respectively, ratios of ≤ 120.88, 120.89–154.01, 154.02–189.91, 189.92–240.46, and ≥ 240.47), the prevalence of NAFLD among the patients increased from 2.4%, 5%, 7.9%, 10.3%, and 17.8%, respectively. After adjustments for age, gender, liver and kidney functional markers, as well as metabolic indicators, multivariate Cox proportional hazard regression analysis demonstrated that the hazard ratio (HR) was the highest in quintile 5, at 1.76 (1.12–2.75), and the lowest in quintile 1. The area under the curve (AUC) for UHR (0.690) was higher than that for serum uric acid (UA, 0.666) and HDL-C (0.636), suggesting the predictive ability of UHR for NAFLD onset was better than either alone. This finding was further supported by the presence of an independent association between UHR and NAFLD, even within the normal range of UA and HDL-C; the HR (95% confidence interval, CI) for NAFLD was 1.002 (1.000–1.004). Compared with other significant predictors, AUC for UHR (0.67) was similar to that of low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C, 0.68), non-high-density lipoprotein cholesterol (NHDL-C)/HDL-C (0.68) and alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratios (0.7), and was higher than that of LDL-C (0.63), remnant cholesterol (RC,0.59), and albumin (ALB)/alkaline phosphatase (ALP) ratio (0.61). The sensitivity of UHR (71%) was the highest among all indicators. In the subgroup with ALT < 40U/L, the AUC for UHR was 0.70, which was the highest among all predictors; among ALT > 40U/L, UHR was able to predict the occurrence of NAFLD (AUC = 0.61, p = 0.007), which was not the case for RC (P = 0.441), ALB/ALP (P = 0.419), and ALT/AST (P = 0.159). Conclusions: UHR serve as an inexpensive and reliable predictor of NAFLD onset in non-obese Chinese people with normal blood lipid levels, allowing for identification of individuals at high risk for NAFLD.

Background. Thoracic surgery is one of the most painful surgical steps. An important tool for managing postoperative pain is effective postoperative analgesia. This research aimed at comparing the analgesic roles of three new fascial block techniques in the postoperative period after video‐helped thoracoscopic operation (VATS). Methods. We randomly allocated ninety patients into three teams experiencing ultrasound‐directed serratus plane block, erector spinae plane block, and the rhomboid intercostal block, respectively. 0.4% ropivacaine of 20 mL was received by all groups. Outcomes. At 0–12 hours, sufentanil consumption was significantly lower in the RIB (35.2 ± 3.3 mg) and ESP (35.4 ± 2.8 mg) groups than that in the SAB (43.3 ± 2.7 mg) group (P < 0.001), and no obvious diversity in sufentanil consumption was shown between the RIB and ESP groups (P = 0.813). At 12–24 hours, sufentanil consumption was greatly lower in the RIB and ESP groups than that in the SAB group (P < 0.001), and no great diversity in sufentanil consumption was found between the RIB and ESP groups (P = 0.589). No great diversity in sufentanil consumption was shown between the RIB (50.4 ± 1.4 mg), ESP (50.4 ± 1.5 mg), and SAB (51.0 ± 1.7 mg) groups at 24–48 hours (P = 0.192). At 6, 12, 18, and 24 hours, the postoperative dynamic NRS scores were significantly lower in the RIB and ESP groups than in the SAB group ((P < 0.05) for all contrasts). Nevertheless, no great diversity was observed in postoperative pain marks at 0.5, 1, 3, 6, 12, 18, 24, 36, and 48 hours after the surgery across the three groups. No statistical diversity was found in the postoperative NRS mark between groups RIB and ESP within 48 hours after surgery in case of active patients ((P < 0.05) for all contrasts). At 24 hours after surgery, a significant difference in IL‐1β and IL‐6 inflammatory factor concentrations was found between RIB and ESP compared with SAB block ((P < 0.05) for all contrasts). However, no great diversities were observed in IL‐1β, and IL‐6 inflammatory factor concentrations between RIB, ESP, and SAB at 24 hours preoperatively and at 48 hours postoperatively ((P < 0.05) for all comparisons). Conclusion. The dosage of sufentanil can be effectively reduced by ultrasound‐directed rhomboid intercostal block and erector spinae plane block within 24 hours after VATS surgery, and pain can be relieved effectively within 24 hours by comparing with serratus plane block.

Acute liver failure (ALF) is an inflammation‐mediated hepatocyte death process associated with ferroptosis. Avicularin (AL), a Chinese herbal medicine, exerts anti‐inflammatory and antioxidative effects. However, the protective effect of AL and the mechanism on ALF have not been reported. Our in vivo results suggest that AL significantly alleviated lipopolysaccharide (LPS)/D‐galactosamine (D‐GalN)‐induced hepatic pathological injury, liver enzymes, inflammatory cytokines, reactive oxygen species and iron levels and increased the antioxidant enzyme activities (malondialdehyde and glutathione). Our further in vitro experiments demonstrated that AL suppressed inflammatory response in LPS‐stimulated RAW 264.7 cells via blocking the toll‐like receptor 4 (TLR4)/myeloid differentiation protein‐88 (MyD88)/nuclear factor kappa B (NF‐κB) pathway. Moreover, AL attenuated ferroptosis in D‐GalN‐induced HepG2 cells by activating the nuclear factor erythroid 2‐related factor 2 (Nrf2)/heme oxygenase 1 (HO‐1)/glutathione peroxidase 4 (GPX4) pathway. Therefore, AL can alleviate inflammatory response and ferroptosis in LPS/D‐GalN‐induced ALF, and its protective effects are associated with blocking TLR4/MyD88/NF‐κB pathway and activating Nrf2/HO‐1/GPX4 pathway. Moreover, AL is a promising therapeutic option for ALF and should be clinically explored.

Progression of liver failure to coma is a dynamic process. Its prognosis depends primarily on early diagnosis, real-time monitoring of the disease, and appropriate therapy. Current detection methods and repeated blood sampling do not effortlessly meet the clinical requirements. This pilot study aimed to assess the potential of exhaled breath analysis by extractive electrospray ionization mass spectrometry (EESI-MS) as a noninvasive clinical tool to diagnose and provide real-time monitoring of liver failure. A total of 24 healthy controls, 20 chronic hepatitis B patients, and 20 liver failure patients were enrolled in this study. Patients were diagnosed prior to exhaled breath collection; serological biochemical indicators and clinical characteristics were recorded. Exhaled breath samples were detected by EESI-MS; principal component analysis and partial least square discriminant analysis was used to process the final data. Twenty-two mass-to-charge ratio (m/z) values differed significantly between liver failure patients and healthy controls (variable importance plot (VIP)>3.5, P＜0.001), and eight metabolites were identified to be 1-butylene, acetone, glycolaldehyde, isoprene, butanone, 2-ethylacrylic acid, ethylmethylacetic acid, and 2,3-octanedione. Four m/z values differed significantly between liver failure and chronic hepatitis B patients (VIP > 3.5, P＜0.001) and 2 metabolites were identified to be isoprene and glycolaldehyde. Exhaled breath analysis may be valuable as a noninvasive clinical tool to diagnose and provide real-time monitoring of liver failure.

Background and Aims: Chronic hepatitis B (CHB) is a major global health concern. This study aims to investigate the factors influencing hepatitis B surface antigen (HBsAg) clearance in CHB patients treated with pegylated interferon α-2b (Peg-IFNα-2b) for 48 weeks and to establish a predictive model. Methods: This analysis is based on the “OASIS” project, a prospective real-world multicenter study in China. We included CHB patients who completed 48 weeks of Peg-IFNα-2b treatment. Patients were randomly assigned to a training set and a validation set in a ratio of approximately 4:1 by spss 26.0, and were divided into clearance and non-clearance groups based on HBsAg status at 48 weeks. Clinical data were analyzed using SPSS 26.0, employing chi-square tests for categorical data and Mann–Whitney U tests for continuous variables. Significant factors (p < 0.05) were incorporated into a binary logistic regression model to identify independent predictors of HBsAg clearance. The predictive model’s performance was evaluated using ROC curve analysis. Results: We included 868 subjects, divided into the clearance group (187 cases) and the non-clearance group (681 cases). They were randomly assigned to a training set (702 cases) and a validation set (166 cases). Key predictors included female gender (OR = 1.879), lower baseline HBsAg levels (OR = 0.371), and cirrhosis (OR = 0.438). The final predictive model was: Logit(P) = 0.92 + Gender (Female) * 0.66 - HBsAg (log) * 0.96 - Cirrhosis * 0.88. ROC analysis showed an AUC of 0.80 for the training set and 0.82 for the validation set, indicating good predictive performance. Conclusion: Gender, baseline HBsAg levels, and cirrhosis are significant predictors of HBsAg clearance in CHB patients after 48 weeks of Peg-IFNα-2b therapy. The developed predictive model demonstrates high accuracy and potential clinical utility.