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Metabolic-associated fatty liver disease (MAFLD) is one of the most common chronic liver diseases worldwide. In recent years, the occurrence rate of MAFLD has been on the rise, mainly due to lifestyle changes, high-calorie diets, and imbalanced dietary structures, thereby posing a threat to human health and creating heavy social and economic burdens. With the development of 16S sequencing and integrated multi-omics analysis, the role of the gut microbiota (GM) and its metabolites in MAFLD has been further recognized. The GM plays a role in digestion, energy metabolism, vitamin synthesis, the prevention of pathogenic bacteria colonisation, and immunoregulation. The gut-liver axis is one of the vital links between the GM and the liver. Toxic substances in the intestine can enter the liver through the portal vascular system when the intestinal barrier is severely damaged. The liver also influences the GM in various ways, such as bile acid circulation. The gut-liver axis is essential in maintaining the body's normal physiological state and plays a role in the onset and prognosis of many diseases, including MAFLD. This article reviews the status of the GM and MAFLD and summarizes the GM characteristics in MAFLD. The relationship between the GM and MAFLD is discussed in terms of bile acid circulation, energy metabolism, micronutrients, and signalling pathways. Current MAFLD treatments targeting the GM are also listed., Competing Interests: Conflict-of-interest statement: The authors declare that they have no competing interests., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

The aim of management of hepatocellular carcinoma (HCC) is to improve the prognosis of the patients by radical resection and preserve remnant liver function. Although liver transplantation is associated with a lower tumor recurrence rate, this benefit is counteracted by long-term complications. Therefore, hepatectomy could be the first choice of treatment in selected patients with HCC. However, the higher frequency of tumor recurrence and the lower rate of resectability after hepatectomy for HCC led to an unsatisfactory prognosis. New strategies are required to improve the long-term outcome of HCC after hepatectomy. In this paper, we introduce some strategies to increase the low rate of resectability and reduce the high rate of tumor recurrence. Some aggressive treatments for tumor recurrence to extend long-term survival are also involved. We believe that hepatectomy combined with other therapies, such as portal vein embolization, transarterial chemoembolization, radioembolization, antiviral treatment, radiofrequency ablation and salvage transplantation, is a promising treatment modality for HCC and may improve survival greatly.

Aim: To study the anti-cancer mechanism of Yangwei Kangliu (YWKL) granules from the view point of red blood cell (RBC) immunity and to investigate the relationship between RBC immunity and T lymphocyte immunity., Methods: Fifty patients with advanced gastric carcinoma were treated with a combination of YWKL granules and chemotherapy. Venous blood samples were obtained before treatment and after one course of treatment. The rosette rate of c-3b-receptor (RBC-C-3bRR), tumor and red cell (RRTR) and RBC immune complex (RBC-ICR) were measured under microscopy by counting the rosettes formed by sensitized or unsensitized yeast adherence. The T lymphocyte subset was observed by the method of APAAP. Control patients were treated with chemotherapy alone (n = 20). In addition, mouse tumor studies were performed to investigate the dynamic changes of RBC-C-3bRR, RRTR and RBC-ICR in response to treatment with YWKL granules (n = 30). Mice treated with chemotherapy alone (n = 30) or water alone (n = 30) were used as controls., Results: The clinical therapeutic effect of combination treatment with YWKL granules and chemotherapy (i.e. the treatment group) was markedly superior to that of chemotherapy alone (i.e. the control group) (P < 0.01). In the treatment group, the rosette rates of RBC-C-3bRR and of RRTR were significantly increased (P < 0.01) after treatment, the rate of RBC-ICR was markedly decreased (P < 0.01), and the ratio of CD4 to CD8 was obviously elevated (P < 0.01). Moreover, CD8 was much lower (P < 0.01) and the ratio of CD4 to CD8 was much higher (P < 0.01) than that in the control group. The RRTR rate was positively correlated with the ratio of CD4 to CD8. In mice, on day 9 of bearing cancer, the tumor weight in the group treated with YWKL granules alone was much lower than that of the tumors in the control mice groups; in addition, the YWKL treated mice showed higher RBC immune function than the mice of the two control groups. On day 13 of bearing cancer, however, the differences in both tumor weight and RBC immune function had disappeared., Conclusion: The anti-cancer mechanism of YWKL granules may involve enhancement of RBC immunity and of T lymphocyte immune function, which is supported by the finding of RBC immune function being correlated with T lymphocyte immune function.