The“obesity paradox”in hepatocellular carcinoma(HCC)suggests patients with obesity may experience better treatment outcomes compared to patients without obesity.Wang et al highlighted this paradox in HCC immunothera...The“obesity paradox”in hepatocellular carcinoma(HCC)suggests patients with obesity may experience better treatment outcomes compared to patients without obesity.Wang et al highlighted this paradox in HCC immunotherapy,demonstrating superior progression-free survival and overall survival in patients with overweight and obesity treated with lenvatinib and camrelizumab,focusing on hepatitis B virus-related HCC.Mechanisms such as better nutritional reserves,leptin-mediated immune modulation,and reduced protein breakdown may explain these outcomes.Obesity’s role in anti-programmed cell death protein-1 therapy appears could have a benefit,while its effects on other treatments,such as anti-vascular endothelial growth factor therapy,may reduce efficacy.Further research is needed to explore how obesity influences the effectiveness of other most common immunotherapies like nivolumab,pembrolizumab,and bevacizumab,and whether weight loss as well as weight-loss related sarcopenia impacts these benefits.展开更多
Introduction The incidental detection of pancreatic cystic lesions(PCLs)has increased in recent years,primarily due to improved imaging resolution and the broader use of cross-sectional imaging(1-3).International stud...Introduction The incidental detection of pancreatic cystic lesions(PCLs)has increased in recent years,primarily due to improved imaging resolution and the broader use of cross-sectional imaging(1-3).International studies report a prevalence ranging from 2.2%to 44.7%,influenced by factors such as population,imaging modality,and the indication for imaging,with prevalence rising with age(1-4).While most PCLs do not progress to cancer,their high prevalence and uncertain malignant potential remain a cause for concern(3).The Hong Kong consensus recommendations aim to provide a comprehensive approach to diagnosing and managing patients with PCLs tailored to the clinical context of Hong Kong and East Asia(1).展开更多
Metabolic endoscopy represents a promising alternative in the management of steatotic liver disease,particularly metabolic dysfunction-associated steatohep-atitis(MASH),a progressive form of metabolic dysfunction-asso...Metabolic endoscopy represents a promising alternative in the management of steatotic liver disease,particularly metabolic dysfunction-associated steatohep-atitis(MASH),a progressive form of metabolic dysfunction-associated steatotic liver disease(MASLD).With the rising global prevalence of MASLD—affecting over one-third of the adult population—and its close association with obesity,insulin resistance,and metabolic syndrome,there is an urgent need for inno-vative,minimally invasive therapies that can reverse liver fibrosis and prevent progression to cirrhosis and hepatocellular carcinoma.Traditional management of MASLD relies on lifestyle modifications and bariatric surgery,yet these app-roaches are hampered by issues of adherence,invasiveness,and accessibility.This review examines endoscopic bariatric metabolic therapies including endoscopic sleeve gastroplasty(ESG),intragastric balloons(IGB),duodenal mucosal resur-facing(DMR),and duodeno-jejunal bypass liners(DJBL),as well as revisional procedures like endoscopic revisional gastroplasty(ERG)and transoral outlet reduction(TORe).Clinical studies and meta-analyses indicate that metabolic en-doscopy is safe and effective for liver fibrosis in MASH.ESG appears to offer the greatest fibrosis reduction,while IGB and DJBL yield modest improvements,and DMR shows no significant effect.Among revisional therapies,ERG has dem-onstrated fibrosis reduction,although the benefits of TORe remain to be fully evaluated.展开更多
文摘The“obesity paradox”in hepatocellular carcinoma(HCC)suggests patients with obesity may experience better treatment outcomes compared to patients without obesity.Wang et al highlighted this paradox in HCC immunotherapy,demonstrating superior progression-free survival and overall survival in patients with overweight and obesity treated with lenvatinib and camrelizumab,focusing on hepatitis B virus-related HCC.Mechanisms such as better nutritional reserves,leptin-mediated immune modulation,and reduced protein breakdown may explain these outcomes.Obesity’s role in anti-programmed cell death protein-1 therapy appears could have a benefit,while its effects on other treatments,such as anti-vascular endothelial growth factor therapy,may reduce efficacy.Further research is needed to explore how obesity influences the effectiveness of other most common immunotherapies like nivolumab,pembrolizumab,and bevacizumab,and whether weight loss as well as weight-loss related sarcopenia impacts these benefits.
文摘Introduction The incidental detection of pancreatic cystic lesions(PCLs)has increased in recent years,primarily due to improved imaging resolution and the broader use of cross-sectional imaging(1-3).International studies report a prevalence ranging from 2.2%to 44.7%,influenced by factors such as population,imaging modality,and the indication for imaging,with prevalence rising with age(1-4).While most PCLs do not progress to cancer,their high prevalence and uncertain malignant potential remain a cause for concern(3).The Hong Kong consensus recommendations aim to provide a comprehensive approach to diagnosing and managing patients with PCLs tailored to the clinical context of Hong Kong and East Asia(1).
文摘Metabolic endoscopy represents a promising alternative in the management of steatotic liver disease,particularly metabolic dysfunction-associated steatohep-atitis(MASH),a progressive form of metabolic dysfunction-associated steatotic liver disease(MASLD).With the rising global prevalence of MASLD—affecting over one-third of the adult population—and its close association with obesity,insulin resistance,and metabolic syndrome,there is an urgent need for inno-vative,minimally invasive therapies that can reverse liver fibrosis and prevent progression to cirrhosis and hepatocellular carcinoma.Traditional management of MASLD relies on lifestyle modifications and bariatric surgery,yet these app-roaches are hampered by issues of adherence,invasiveness,and accessibility.This review examines endoscopic bariatric metabolic therapies including endoscopic sleeve gastroplasty(ESG),intragastric balloons(IGB),duodenal mucosal resur-facing(DMR),and duodeno-jejunal bypass liners(DJBL),as well as revisional procedures like endoscopic revisional gastroplasty(ERG)and transoral outlet reduction(TORe).Clinical studies and meta-analyses indicate that metabolic en-doscopy is safe and effective for liver fibrosis in MASH.ESG appears to offer the greatest fibrosis reduction,while IGB and DJBL yield modest improvements,and DMR shows no significant effect.Among revisional therapies,ERG has dem-onstrated fibrosis reduction,although the benefits of TORe remain to be fully evaluated.
