Changes in the etiology of liver cirrhosis and the corresponding management strategies.

We read with interest the article by Xing Wang, which was published in the recent issue of the World Journal of Hepatology 2023; 15: 1294-1306. This article focuses particularly on the prevalence and trends in the etiology of liver cirrhosis (LC), prognosis for patients suffering from cirrhosis-related complications and hepatocellular carcinoma (HCC), and management strategies. The etiology of cirrhosis varies according to geographical, economic, and population factors. Viral hepatitis is the dominant cause in China. Vaccination and effective treatment have reduced the number of people with viral hepatitis, but the overall number is still large. Patients with viral hepatitis who progress over time to LC and HCC remain an important population to manage. The increased incidence of metabolic syndrome and alcohol consumption is likely to lead to a potential exponential increase in metabolic dysfunction-associated steatotic liver disease (MASLD)-associated LC and alcoholic liver disease in the future. Investigating the evolution of the etiology of LC is important for guiding the direction of future research and policy development. These changing trends indicate a need for greater emphasis on tackling obesity and diabetes, and implementing more effective measures to regulate alcohol consumption in order to reduce the occurrence of MASLD. In an effort to help cope with these changing trends, the authors further proposed countermeasures for healthcare authorities doctors, and patients.

Preoperative Combined Prediction Models Have Superior Capability in Predicting Survival as the Child-Pugh Grade in Patients with HCC after Interventional Embolotherapy.

BACKGROUND: It is of important clinical significance for hepatocellular carcinoma (HCC) patients to evaluate prognosis before interventional embolotherapy. METHODS: A total of 106 patients with HCC after interventional embolotherapy who had complete data with follow-up information until September 2019 were included in this study. These data were analyzed using SPSS Version 22.0 and R (version 3.6.1) statistical software. RESULTS: 1) The diameter of the tumor, ascites, FIT, AFP, ALT, AST, GGT, and Child-Pugh score had the ability to predict the prognosis and survival of patients with HCC. Among these molecules, the predictive effectiveness (or the area under the receiver operating characteristic [ROC] curve) of GGT was the highest, although it was slightly lower than the predictive effectiveness of the Child-Pugh score, which is the gold standard for survival analysis. 2) Among survival analyses combining five molecular indicators, the predictive postoperative viability for combination 1 was the strongest with an area under the ROC curve (AUC) of 0.856 (0.779, 0.932), similar to the all-molecular combination (combination 16) with an AUC of 0.872 (0.798, 0.945), but much higher than that of the Child-Pugh score of 0.720 (0.616, 0.823) for HCC patients (all p<0.05). 3) Kaplan-Meier analyses showed that the 3-year cumulative survival rates were 55.3% for low-risk patients and 2.6% for high-risk patients. CONCLUSION: A combined prediction model can determine the optimal combination of preoperative routine detection indices in patients with HCC intervention, and ROC curve analysis can quantify the efficacy of these indices in the survival and prognosis of HCC. Interestingly, combination 1 showed stronger predictive capability than the Child-Pugh score in predicting death risks for postoperative patients with HCC. When combination 1 has several missing clinical data, these combination prediction models (12, 3, 7, 13, 16) are also a replaceable choice. These findings may have important clinical significance in the formulation of individualized medical programs.

[Enhanced Membrane Anti-fouling Ability of Anaerobic Membrane Bioreactor Equipped with Bio-electrochemical System Using Nano-zero-valent Iron and Its Regulation Mechanism].

Membrane fouling is the biggest challenge of membrane bioreactor industrialization. In this study, a bio-electrochemical system (BES)-anaerobic membrane bioreactor (AnMBR) system was constructed, and the effect of nano-zero-valent iron (nZVI) on membrane anti-fouling ability and methane production was investigated. The results showed that the BES-AnMBR system was stable and the chemical oxygen demand (COD) removal rate was maintained at approximately 95%. The optimum condition was observed to be nZVI 0.1 g·g-1(VS). Under this condition, transmembrane pressure (TMP) was reduced by 28.1%, the membrane flux had a slight improvement, and methane production was up to 81.3 mL·g-1(CODremoved). This was 12.1% higher than that of the control. In addition, a further analysis of extracellular polymeric substances (EPS) fraction and membrane resistance showed that nZVI enhanced EPS decomposition, promoted the formation of an iron-rich layer of inorganic and organic matters on the membrane surface, and changed the distribution of organics and inorganics, thereby significantly alleviating membrane fouling. This study will enrich basic theory of conventional AnMBR and provide a new solution for efficient sludge treatment and resource utilization.