BACKGROUND Hepatic eosinophilic pseudotumor(HEPT)is a rare condition that mimics ma-lignant hepatic tumors,posing significant diagnostic challenges.This case report highlights the importance of considering parasitic i...BACKGROUND Hepatic eosinophilic pseudotumor(HEPT)is a rare condition that mimics ma-lignant hepatic tumors,posing significant diagnostic challenges.This case report highlights the importance of considering parasitic infections like Fasciola hepatica(F.hepatica)in the differential diagnosis of hepatic masses,especially in endemic regions,to prevent unnecessary interventions.CASE SUMMARY A 40-year-old female presented with a 1-month history of epigastric pain and significant weight loss.Imaging revealed a hepatic mass,initially misdiagnosed as intrahepatic cholangiocarcinoma.Laboratory results showed marked eosinophilia,and histopathological examination confirmed significant eosinophilic infiltration without malignancy.Serological testing identified F.hepatica infection.The patient was treated with a single dose of triclabendazole,leading to complete symptom resolution and normalization of hepatic imaging findings within days.CONCLUSION HEPT due to F.hepatica can closely mimic malignancy;timely antiparasitic treat-ment is crucial for resolution.展开更多
BACKGROUND Wedged hepatic venous pressure(WHVP)is a crucial variable for accurately assessing the hepatic venous pressure gradient(HVPG)and is vital for the diagnosis and prognostic evaluation of patients with portal ...BACKGROUND Wedged hepatic venous pressure(WHVP)is a crucial variable for accurately assessing the hepatic venous pressure gradient(HVPG)and is vital for the diagnosis and prognostic evaluation of patients with portal hypertension(PH).AIM To investigate the anatomical characteristics of balloon-occluded hepatic venous angiography in patients with PH and analyze the relationship between the WHVP and portal venous pressure(PVP).METHODS This retrospective study included 877 patients with PH who met the inclusion criteria from January 2020 to June 2024.Routine and innovative hepatic venous angiography was performed during transjugular intrahepatic portosystemic shunt procedures to measure hepatic venous and PVPs.All patients'angiographic images were collected for analysis.The associations between WHVP and PVP in each group were analyzed via linear regression analysis,and a predictive model was established.RESULTS The 877 patients had a mean age of 52.6±13.0 years,with 582 males and 295 females.Patients were categorized into four groups on the basis of their anatomical structure.All groups showed strong correlations between WHVP and PVP.The regression coefficient between the WHVP and PVP in the hepatic right vein-portal venous angiography group was 0.884(P<0.05);in the hepatic right vein-accessory hepatic venous angiography group,it was 0.721(P<0.05);in the hepatic right vein-middle hepatic venous angiography group,it was 0.344(P<0.05);and in the hepatic right vein-nonangiography group,it was 0.293(P<0.05).CONCLUSION The presence and anatomical classification of hepatic venous collaterals are key factors influencing the relationship between WHVP with and PVP.Based on the different anatomical classifications of hepatic veins,WHVP can be used to estimate PVP,improving the accuracy of PVP prediction.展开更多
In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following tran...In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and treatment.By comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy group.The gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome therapies.Furthermore,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated PH.Despite these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal models.In conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.展开更多
To the Editor: Hepatic cavernous hemangiomas constitute 73%of all benign hepatic tumors,and large hemangiomas may protrude beyond the hepatic contour and exert compression on adjacent structures[1].The diagnosis of he...To the Editor: Hepatic cavernous hemangiomas constitute 73%of all benign hepatic tumors,and large hemangiomas may protrude beyond the hepatic contour and exert compression on adjacent structures[1].The diagnosis of hepatic hemangioma is usually accidental,rarely related to symptoms,and most cases are diagnosed through ultrasound.Surgical treatment,including locoregional ablation techniques and radical intent,is advised for patients with symptomatic hemangioma[2,3].展开更多
Liver transplantation(LT)is the most effective treatment for patients with end-stage liver disease,and maintaining vascular patency of the transplanted liver is one of the crucial prerequisites for surgical success.De...Liver transplantation(LT)is the most effective treatment for patients with end-stage liver disease,and maintaining vascular patency of the transplanted liver is one of the crucial prerequisites for surgical success.Despite hepatic vein complic-ations following LT occurring at a relatively low frequency,ranging between 2%to 11%,delayed diagnosis and treatment may lead to graft dysfunction and even patient mortality.Clinical manifestations of hepatic vein complications are often subtle and nonspecific,posing challenges for early diagnosis.Signs may initially present as mild abnormalities in liver function,delayed recovery of liver function,unexplained ascites,lower limb edema,and perineal edema.Prolonged duration of these complications can lead to hepatic sinusoidal dilatation and eventual liver failure due to prolonged hepatic congestion.Ultrasonography has become the preferred imaging modality for post-liver transplant evaluation due to its convenience and non-invasiveness.Although hepatic vein complications may manifest as disappearance or flattening of the hepatic vein spectrum on routine ultrasound imaging,these findings lack specificity.Contrast-enhanced ultrasound that visualizes the filling of contrast agent in the hepatic veins and dynamically displays blood flow perfusion information in the drainage area can,however,significantly improve diagnostic confidence and provide additional information beyond routine ultrasound examination.展开更多
BACKGROUND The integrity and functionality of the hepatic microcirculation are essential for maintaining liver health,which is influenced by sex and genetic background.Understanding these variations is crucial for add...BACKGROUND The integrity and functionality of the hepatic microcirculation are essential for maintaining liver health,which is influenced by sex and genetic background.Understanding these variations is crucial for addressing disparities in liver disease outcomes.AIM To investigate the sexual dimorphism and genetic heterogeneity of liver microcirculatory function in mice.METHODS We assessed hepatic microhemodynamics in BALB/c,C57BL/6J,and KM mouse strains using laser Doppler flowmetry and wavelet analysis.We analyzed the serum levels of alanine transaminase,glutamic acid aminotransferase,total bile acid,total protein,alkaline phosphatase,and glucose.Histological and immunohistochemical staining were employed to quantify microvascular density and the expression levels of cluster of differentiation(CD)31,and estrogen receptorα,andβ.Statistical analyses,including the Mantel test and Pearson correlation,were conducted to determine the relationships among hepatic function,microcirculation,and marcocirculation between different sexes and across genetic backgrounds.RESULTS We identified sex-based disparities in hepatic microhemodynamics across all strains,with males exhibiting higher microvascular perfusion and erythrocyte concentration,but lower blood velocity.Strain-specific differences were evident,particularly in the endothelial oscillatory characteristics of the erythrocyte concentration.No sexdependent differences in estrogen receptor expression were observed,while significant variations in CD31 expression and microvascular density were observed.The correlations highlighted relationships between hepatic microhemodynamics and liver function indicators.CONCLUSION Our findings indicate the influence of genetic and sex differences on hepatic microcirculation and liver function,highlighting the necessity of incorporating both genetic background and sex into hepatic physiology studies and potential liver disease management strategies.展开更多
BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incide...BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incidence post-TIPS across various groups and the prophylactic efficacies of various medications.METHODS A thorough literature search was performed in PubMed,Web of Science,EMBASE,and the Cochrane Library databases from their inception to November 24,2024,to collect data regarding HE incidence.The main outcome was HE incidence post-TIPS.A meta-analysis using a random effects model was performed to obtain odds ratios(ORs)and 95%confidence intervals.Statistical analyses were conducted using Stata and RevMan software.RESULTS This meta-analysis included nine studies with 1140 patients;647 received pharmacological agents including lactulose,rifaximin,albumin,and l-ornithin-l-aspartate,and 493 did not(controls).(1)In the single-group meta-analysis,the control group had higher short-and long-term HE rates than the drug intervention group.Among patients with and without prior HE,the non-intervention group's HE rates were also higher;(2)Pharmacological prevention post-TIPS significantly reduced HE incidence[OR=0.59(0.45,0.77),P=0.0001].Compared with the no prophylaxis,rifaximin reduced the risk of HE after TIPS[OR=0.52(0.29,0.95),P=0.03],but lactulose did not;(3)In patients without prior HE,pharmacological prevention significantly reduced post-TIPS HE incidence[OR=0.62(0.41,0.95),P=0.03];and(4)Network meta-analysis showed no significant differences among five prevention strategies.CONCLUSION The HE incidence after TIPS was relatively high,and the use of drugs after TIPS may reduce the HE incidence.However,research,especially large-scale randomized controlled trials,is still lacking.展开更多
BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic c...BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic chemotherapy,targeted therapies,and immune checkpoint inhibitors have demonstrated synergistic effects in converting unresectable ICC to resectable status and improving patient survival.CASE SUMMARY A 39-year-old male presented with unresectable stage IIIB ICC(cT3N1M0),abdominal pain,and elevated carbohydrate antigen(CA)19-9 levels.He received tri-modal therapy consisting of gemcitabine-oxaliplatin hepatic arterial infusion chemotherapy(GEMOX-HAIC),lenvatinib(8 mg daily),and toripalimab(160 mg every three weeks).After five cycles,significant tumor shrinkage and normalization of CA19-9 levels enabled a left hepatectomy.Complications,including biliary stenosis and liver abscesses,were managed with biliary stenting and percutaneous drainage,which allowed for the continuation of chemotherapy.Postoperative pathological examination confirmed a pathological complete response.At the last follow-up,the patient had maintained 29 months of diseasefree survival post-resection and was continuing postoperative therapy.CONCLUSION This case highlights the potential of a tri-modal therapy combining GEMOX-HAIC,lenvatinib,and toripalimab to convert unresectable ICC to a resectable status,thereby potentially improving patient survival by surgical resection.Further clinical trials investigating this regimen are warranted.展开更多
Trans-jugular intrahepatic portosystemic stent shunting(TIPSS)has been in use for many years with great results and many evolutions.The procedure essentially involves the insertion of a metal covert stent to create an...Trans-jugular intrahepatic portosystemic stent shunting(TIPSS)has been in use for many years with great results and many evolutions.The procedure essentially involves the insertion of a metal covert stent to create an Hepato-Hepatic portosystemic shunt.Over time,TIPSS has become the subject of many studies aimed at examining its clinical utility and evaluating the results of using TIPSS to manage complications related to portal hypertension.From the outset,this procedure has been met with hope and enthusiasm and give the chance to consider another possibility to treat the complications of portal hypertension without the use of surgery.Considering that TIPSS is an attractive alternative to shunt surgery because it does not require the use of general anesthesia or laparotomy,in fact this method is applicable to many patients with severe liver disease not suitable for it.TIPSS has been studied for the management of variceal bleeding,ascites,hepatic hydrothorax,hepatorenal syndrome,and other types of cirrhosis.However,some drawbacks of the TIPSS,such as shunt stenosis and hepatic encephalopathy,have also been reported in the literature.On the basis of the available evidence and the new epidemiological findings regarding liver disease,the following question may be posed:What is the place of TIPSS in current clinical practice?展开更多
BACKGROUND Portal hypertension(PHT),a complication of liver cirrhosis,is sometimes managed with transjugular intrahepatic portosystemic shunt(TIPS)to reduce portal pressure.Although effective,TIPS poses risks,includin...BACKGROUND Portal hypertension(PHT),a complication of liver cirrhosis,is sometimes managed with transjugular intrahepatic portosystemic shunt(TIPS)to reduce portal pressure.Although effective,TIPS poses risks,including hepatic enceph-alopathy(HE).This study investigates whether a significant reduction in the portal pressure gradient(PPG)after TIPS improves outcomes in PHT patients.AIM To evaluate the impact of post-TIPS PPG reduction on clinical outcomes and explore the relationship between PPG reduction and portal vein diameter.METHODS This retrospective cohort study included 815 patients with PHT who underwent TIPS at two tertiary hospitals between 2014 and 2022.Patients were categorized based on whether they achieved a 50%reduction in PPG.Propensity score matching was applied to balance baseline characteristics.Kaplan-Meier analysis assessed clinical outcomes,including rebleeding,HE,liver failure,and hepato-cellular carcinoma.Cox regression identified risk factors,and Spearman correlation analyzed the relationship between PPG reduction and portal vein diameter.RESULTS Patients with a PPG reduction>50%had significantly lower risks of rebleeding(P=0.004),shunt dysfunction(P=0.002),and mortality(P=0.024)compared to those with a PPG reduction≤50%.However,these patients faced higher risks of HE(P<0.001)and liver failure(P=0.003).A significant negative correlation was observed between the percentage of PPG reduction and portal vein diameter(ρ=-0.632,P<0.001),suggesting that patients with smaller portal vein diameters may achieve greater PPG reductions.CONCLUSION A significant PPG reduction following TIPS is associated with improved clinical outcomes,including reduced risks of rebleeding,shunt dysfunction,hepatocellular carcinoma,and mortality,though it increases HE and liver failure risks.The observed correlation between portal vein diameter and PPG reduction highlights the potential role of portal vein anatomy in predicting TIPS efficacy,warranting further investigation.展开更多
BACKGROUND Aorto-hepatic conduits(AHCs)are an effective revascularization method for liver allografts when the native hepatic artery is unusable.Various studies have confirmed that outcomes with AHCs are inferior to t...BACKGROUND Aorto-hepatic conduits(AHCs)are an effective revascularization method for liver allografts when the native hepatic artery is unusable.Various studies have confirmed that outcomes with AHCs are inferior to those with native hepatic artery inflow.AIM To investigate the published evidence on the outcomes according to different inflow site for AHCs.METHODS A systematic search was conducted for studies reporting on AHCs in liver transplantation over the last 10 years(January 2014 onwards).Two independent reviewers selected articles,assessed quality,and evaluated bias in the included systematic reviews.The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.The protocol was registered with PROSPERO(CRD42024545810).Review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis statement standards.RESULTS Fourteen studies identified a total of 32486 deceased donor liver transplants,of which 1136(3.5%)required AHCs.The most frequent indications for AHC use included poor arterial flow,intimal dissections,and hepatic artery thrombosis.Among all AHCs,207(18.2%)were supra-coeliac(SC)AHCs,738(65.0%)infrarenal(IR)AHCs,25(2.2%)iliac artery conduits,and 166(14.6%)had unspecified origins.Pooled analysis revealed comparable demographic characteristics.The median follow-up duration ranged from 18 to 52 months.There were no significant differences in early occlusions of AHCs[odds ratio(OR)=0.94(0.48,1.84);P=0.86],late occlusions of AHCs[OR=0.46(0.16,1.32);P=0.15],early allograft dysfunction[OR=0.82(0.46,1.47);P=0.51],biliary complications[OR=1.10(0.69,1.76);P=0.68],post-transplant renal replacement therapy(RRT)requirement[OR=1.12(0.72,1.72);P=0.62],and major surgical complications(Clavien-Dindo>3b)[OR=1.06(0.70,1.61);P=0.79].The median duration for graft occlusion was approximately 142 days,ranging from 13 to 3313 days.One-year graft and patient survival rates for SC conduits were 77%to 81.1%and 80%to 85.1%,respectively.For IR conduits,one-year graft and patient survival rates were 66%to 79.1%and 73%to 88.3%,respectively.Five-year graft and patient survival rates for SC conduits were 53.9%to 67%and 67.8%to 74%,respectively.For IR conduits,five-year graft and patient survival rates were 50%to 56%and 56%to 64.9%,respectively.CONCLUSION Considering these findings,there is no significant difference in early and late outcomes between SC and IR AHCs,although there is a discernible tendency towards higher late occlusion rates in the IR group.展开更多
Transjugular intrahepatic portosystemic shunt(TIPS)is widely used to treat portal hypertension and its complications patients with cirrhosis.However,managing post-TIPS hepatic encephalopathy(HE)remains a major clinica...Transjugular intrahepatic portosystemic shunt(TIPS)is widely used to treat portal hypertension and its complications patients with cirrhosis.However,managing post-TIPS hepatic encephalopathy(HE)remains a major clinical challenge.HE is characterized by a high incidence and a complex pathogenesis,influenced by various factors.Therefore,careful patient assessment and selection for TIPS is essential.While previous studies have identified several factors contributing to the occurrence of post-TIPS HE,there is a gap in the comprehen-sive integration of surgical procedural parameters and metabolic mechanisms within a multidimensional analysis.This minireview aims to optimize treatment protocols and refine management strategies by conducting a comprehensive analysis of risk factors,ultimately aiming to reduce the incidence of post-TIPS HE.展开更多
Transjugular intrahepatic portosystemic shunts(TIPSs)are generally used for the management of complications of portal hypertension in patients with decompensated cirrhosis.However,hepatic encephalopathy(HE),which impa...Transjugular intrahepatic portosystemic shunts(TIPSs)are generally used for the management of complications of portal hypertension in patients with decompensated cirrhosis.However,hepatic encephalopathy(HE),which impairs neuropsychiatric function and motor control,remains the primary adverse effect of TIPS,limiting its utility.Prompt prevention and treatment of post-TIPS HE are critical,as they are strongly associated with readmission rates and poor quality of life.This review focuses on the main pathophysiological mechanisms underlying post-TIPS HE,explores advanced biomarkers and predictive tools,and discusses current management strategies and future directions to prevent or reverse HE following TIPS.These strategies include preoperative patient assessment,individualized shunt diameter optimization,spontaneous portosystemic shunt embolization during the TIPS procedure,postoperative preventive and therapeutic measures such as nutrition management,medical therapy,fecal microbiota transplantation,and stent reduction.展开更多
This is a narrative review in which the advances in technical aspects,the main indications,limitations and clinical results of the transjugular intrahepatic portosystemic shunt(TIPS)in portal hypertension(PH)are addre...This is a narrative review in which the advances in technical aspects,the main indications,limitations and clinical results of the transjugular intrahepatic portosystemic shunt(TIPS)in portal hypertension(PH)are addressed.With the emergence of the coated prosthesis,a better shunt patency,a lower incidence of hepatic encephalopathy(HE)and better survival when compared to TIPS with the conventional prosthesis are demonstrated.The main indications for TIPS are refractory ascites,acute variceal bleeding unresponsive to pharmacological/endoscopic therapy and,lastly,patients considered at high risk for rebleeding preemptive TIPS(pTIPS).Absolute contraindications to the use of TIPS are severe uncontrolled HE,systemic infection or sepsis,congestive heart failure,severe pulmonary arterial hypertension,and biliary obstruction.The control of hemorrhage due to variceal rupture can reach up to 90%-100%of cases,and 55%in refractory ascites.Despite evidences regarding pTIPS in patients at high risk for rebleeding,less than 20%of eligible patients are treated.TIPS may also decrease the incidence of future decompensation in cirrhosis and increase survival in selected patients.In conclusion,TIPS is an essential treatment for patients with PH,but is often neglected.It is important for the hepatologist to form a multidisciplinary team,in which the role of the radiologist with experience in interventional procedures is prominent.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is an effective intervention for managing complications of portal hypertension,particularly acute variceal bleeding(AVB).While effective in reducing portal...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is an effective intervention for managing complications of portal hypertension,particularly acute variceal bleeding(AVB).While effective in reducing portal pressure and preventing rebleeding,TIPS is associated with a considerable risk of overt hepatic encephalopathy(OHE),a complication that significantly elevates mortality rates.AIM To develop a machine learning(ML)model to predict OHE occurrence post-TIPS in patients with AVB using a 5-year dataset.METHODS This retrospective single-center study included 218 patients with AVB who underwent TIPS.The dataset was divided into training(70%)and testing(30%)sets.Critical features were identified using embedded methods and recursive feature elimination.Three ML algorithms-random forest,extreme gradient boosting,and logistic regression-were validated via 10-fold cross-validation.SHapley Additive exPlanations analysis was employed to interpret the model’s predictions.Survival analysis was conducted using Kaplan-Meier curves and stepwise Cox regression analysis to compare overall survival(OS)between patients with and without OHE.RESULTS The median OS of the study cohort was 47.83±22.95 months.Among the models evaluated,logistic regression demonstrated the highest performance with an area under the curve(AUC)of 0.825.Key predictors identified were Child-Pugh score,age,and portal vein thrombosis.Kaplan-Meier analysis revealed that patients without OHE had a significantly longer OS(P=0.005).The 5-year survival rate was 78.4%,with an OHE incidence of 15.1%.Both actual OHE status and predicted OHE value were significant predictors in each Cox model,with model-predicted OHE achieving an AUC of 88.1 in survival prediction.CONCLUSION The ML model accurately predicts post-TIPS OHE and outperforms traditional models,supporting its use in improving outcomes in patients with AVB.展开更多
BACKGROUND Hepatic organoid-based modelling,through the elucidation of a range of in vivo biological processes and the recreation of the intricate liver microenvironment,is yielding groundbreaking insights into the pa...BACKGROUND Hepatic organoid-based modelling,through the elucidation of a range of in vivo biological processes and the recreation of the intricate liver microenvironment,is yielding groundbreaking insights into the pathophysiology and personalized medicine approaches for liver diseases.AIM This study was designed to analyse the global scientific output of hepatic organoid research and assess current achievements and future trends through bibliometric analysis.METHODS Articles were retrieved from the Web of Science Core Collection,and CiteSpace 6.3.R1 was employed to analyse the literature,including outputs,journals,and countries,among others.RESULTS Between 2010 and 2024,a total of 991 articles pertaining to hepatic organoid research were published.The journal Hepatology published the greatest number of papers,and journals with an impact factor greater than 10 constituted 60%of the top 10 journals.The United States and Utrecht University were identified as the most prolific country and institution,respectively.Clevers H emerged as the most prolific author,whereas Huch M had the highest number of cocitations,suggesting that both are ideal candidates for academic collaboration.Research on hepatic organoids has exhibited a progressive shift in focus,evolving from initial investigations into model building,differentiation research in stem cells,bile ducts,and progenitor cells,to a broader spectrum encompassing lipid metabolism,single-cell RNA sequencing,and therapeutic applications.The phrases exhibiting citation bursts from 2022 to 2024 include“drug resistance”,“disease model”,and“patient-derived tumor organoids”.CONCLUSION Research on hepatic organoids has increased over the past decade and is expected to continue to grow.Key research areas include applications for liver diseases and drug development.Future trends likely to gain focus include patient-derived tumour organoids,disease modelling,and personalized medicine.展开更多
Background:Congenital hepatic hemangioma(CHH)is a rare benign vascular tumor that occurs prenatally.However,only a few cases have been summarized and evaluated for the prenatal and postnatal imaging features of CHH,an...Background:Congenital hepatic hemangioma(CHH)is a rare benign vascular tumor that occurs prenatally.However,only a few cases have been summarized and evaluated for the prenatal and postnatal imaging features of CHH,and no studies have conducted long-term follow-up on it.This study aimed to explore the ultrasound and magnetic resonance features,growth patterns,and clinical outcomes of CHH.Methods:Thirty-six pregnancies with a prenatal fetal diagnosis and postnatal diagnosis of CHH were studied.CHHs were grouped into those with a diameter≥4 cm and those with a diameter<4 cm according to the largest diameter.Fisher's exact test was used to compare the imaging characteristics between the groups.The volume of CHHs was measured at each follow-up visit to plot the growth pattern of the tumors,and the volume of CHHs was compared before and after birth using a rank sum test analysis.Results:Thirty-three cases of CHHs were confirmed by postnatal imaging,and three were confirmed by a biopsy.Mixed echoes were more common in the diameter≥4 cm group than in the diameter<4 cm group(p=0.026).Complications were more likely to occur in the large-diameter group.Eighteen(54.5%)cases were classified as rapidly involuting congenital hemangioma,nine(27.3%)as partially involuting congenital hemangioma,and two(6.1%)as noninvoluting congenital hemangioma.A new type of CHH was identified in which four(12.1%)cases continued to proliferate after birth and spontaneously subsided in subsequent months.The CHH volume decreased with age and was significantly decreased at 9 months postnatal compared to birth(p=0.001).Conclusion:This study showed the imaging features of CHH were associated with the lesion size.Based on postnatal follow-up,a new type of CHH was identified.If there are no complications at birth in CHH cases,a good prognosis is indicated.展开更多
Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)enters host cells via the angiotensin-converting enzyme 2(ACE2)receptor.Mounting evidence has indicated the presence of hepatic SARS-CoV-2 infection and liver...Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)enters host cells via the angiotensin-converting enzyme 2(ACE2)receptor.Mounting evidence has indicated the presence of hepatic SARS-CoV-2 infection and liver injury in pa-tients with coronavirus disease 2019(COVID-19).Understanding the mechanisms of hepatic SARS-CoV-2 infection is crucial for addressing COVID-19–related liver pathology and developing targeted therapies.This editorial discusses the signi-ficance of ACE2 in hepatic SARS-CoV-2 infection,drawing on the research by Jacobs et al.Their findings indicate that hepatic ACE2 expression,frequency of hepatic SARS-CoV-2 infection,and severity of liver injury are elevated in patients with pre-existing chronic liver diseases.These data suggest that hepatic ACE2 could be a promising therapeutic target for COVID-19.展开更多
This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinom...This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.展开更多
BACKGROUND Hepatic alveolar echinococcosis(HAE)is a chronic parasitic disease caused by the larval stage of Echinococcus multilocularis.Although significant research has been conducted on the pathogenesis and immunolo...BACKGROUND Hepatic alveolar echinococcosis(HAE)is a chronic parasitic disease caused by the larval stage of Echinococcus multilocularis.Although significant research has been conducted on the pathogenesis and immunological aspects of HAE,comprehensive bibliometric analyses in this area are still lacking.This study sought to fill this gap by systematically analyzing the immunological literature on HAE using bibliometric methods.AIM To identify research trends,key contributors,and emerging developments and offer insights to guide future research in this field.METHODS Research articles on HAE published between 1983 and 2023 were retrieved from the Web of Science Core Collection database.A total of 319 articles were selected for bibliometric analysis,which was conducted using the CiteSpace and VOSviewer software.The analysis focused on key variables such as publication volume,authors,journals,countries,references,and keywords.RESULTS The analysis revealed a significant increase in research on HAE over the past four decades,particularly after 1995.China and Switzerland emerged as the leading countries in terms of publication volume,with Bruno Gottstein and Vuitton DA identified as the most influential authors in this field.Key research areas include the interaction between the pathogen and the host immune system,as well as advances in disease diagnosis and treatment strategies.The keyword co-occurrence analysis highlighted the primary themes and identified emerging trends within the research landscape.CONCLUSION This study provides a comprehensive framework for understanding HAE immunology and highlights research hotspots,future directions,key contributors,and the importance of international cooperation.展开更多
文摘BACKGROUND Hepatic eosinophilic pseudotumor(HEPT)is a rare condition that mimics ma-lignant hepatic tumors,posing significant diagnostic challenges.This case report highlights the importance of considering parasitic infections like Fasciola hepatica(F.hepatica)in the differential diagnosis of hepatic masses,especially in endemic regions,to prevent unnecessary interventions.CASE SUMMARY A 40-year-old female presented with a 1-month history of epigastric pain and significant weight loss.Imaging revealed a hepatic mass,initially misdiagnosed as intrahepatic cholangiocarcinoma.Laboratory results showed marked eosinophilia,and histopathological examination confirmed significant eosinophilic infiltration without malignancy.Serological testing identified F.hepatica infection.The patient was treated with a single dose of triclabendazole,leading to complete symptom resolution and normalization of hepatic imaging findings within days.CONCLUSION HEPT due to F.hepatica can closely mimic malignancy;timely antiparasitic treat-ment is crucial for resolution.
基金Supported by Capital Medical University Affiliated Beijing Shijitan Hospital Talent Development Program during the 14th Five-Year Plan,No.2023 LJRCLFQ.
文摘BACKGROUND Wedged hepatic venous pressure(WHVP)is a crucial variable for accurately assessing the hepatic venous pressure gradient(HVPG)and is vital for the diagnosis and prognostic evaluation of patients with portal hypertension(PH).AIM To investigate the anatomical characteristics of balloon-occluded hepatic venous angiography in patients with PH and analyze the relationship between the WHVP and portal venous pressure(PVP).METHODS This retrospective study included 877 patients with PH who met the inclusion criteria from January 2020 to June 2024.Routine and innovative hepatic venous angiography was performed during transjugular intrahepatic portosystemic shunt procedures to measure hepatic venous and PVPs.All patients'angiographic images were collected for analysis.The associations between WHVP and PVP in each group were analyzed via linear regression analysis,and a predictive model was established.RESULTS The 877 patients had a mean age of 52.6±13.0 years,with 582 males and 295 females.Patients were categorized into four groups on the basis of their anatomical structure.All groups showed strong correlations between WHVP and PVP.The regression coefficient between the WHVP and PVP in the hepatic right vein-portal venous angiography group was 0.884(P<0.05);in the hepatic right vein-accessory hepatic venous angiography group,it was 0.721(P<0.05);in the hepatic right vein-middle hepatic venous angiography group,it was 0.344(P<0.05);and in the hepatic right vein-nonangiography group,it was 0.293(P<0.05).CONCLUSION The presence and anatomical classification of hepatic venous collaterals are key factors influencing the relationship between WHVP with and PVP.Based on the different anatomical classifications of hepatic veins,WHVP can be used to estimate PVP,improving the accuracy of PVP prediction.
基金Supported by Clinical Research Center for Hepatopathy and Intestinal Diseases of Fujian Province,No.2023GBYJ-YL-1.
文摘In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and treatment.By comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy group.The gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome therapies.Furthermore,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated PH.Despite these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal models.In conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.
基金supported by a grant from the National Natural Science Foundation of China (No.81972671)。
文摘To the Editor: Hepatic cavernous hemangiomas constitute 73%of all benign hepatic tumors,and large hemangiomas may protrude beyond the hepatic contour and exert compression on adjacent structures[1].The diagnosis of hepatic hemangioma is usually accidental,rarely related to symptoms,and most cases are diagnosed through ultrasound.Surgical treatment,including locoregional ablation techniques and radical intent,is advised for patients with symptomatic hemangioma[2,3].
基金Supported by The Shenzhen Science and Technology Research and Development Fund,No.JCYJ20220530163011026 and No.JCYJ20210324131809027Shenzhen Medical Key Discipline Project,No.G2021008 and No.G2022008.
文摘Liver transplantation(LT)is the most effective treatment for patients with end-stage liver disease,and maintaining vascular patency of the transplanted liver is one of the crucial prerequisites for surgical success.Despite hepatic vein complic-ations following LT occurring at a relatively low frequency,ranging between 2%to 11%,delayed diagnosis and treatment may lead to graft dysfunction and even patient mortality.Clinical manifestations of hepatic vein complications are often subtle and nonspecific,posing challenges for early diagnosis.Signs may initially present as mild abnormalities in liver function,delayed recovery of liver function,unexplained ascites,lower limb edema,and perineal edema.Prolonged duration of these complications can lead to hepatic sinusoidal dilatation and eventual liver failure due to prolonged hepatic congestion.Ultrasonography has become the preferred imaging modality for post-liver transplant evaluation due to its convenience and non-invasiveness.Although hepatic vein complications may manifest as disappearance or flattening of the hepatic vein spectrum on routine ultrasound imaging,these findings lack specificity.Contrast-enhanced ultrasound that visualizes the filling of contrast agent in the hepatic veins and dynamically displays blood flow perfusion information in the drainage area can,however,significantly improve diagnostic confidence and provide additional information beyond routine ultrasound examination.
基金Supported by the Beijing Municipal Natural Science Foundation,No.7212068the National Natural Science Foundation of China,No.81900747.
文摘BACKGROUND The integrity and functionality of the hepatic microcirculation are essential for maintaining liver health,which is influenced by sex and genetic background.Understanding these variations is crucial for addressing disparities in liver disease outcomes.AIM To investigate the sexual dimorphism and genetic heterogeneity of liver microcirculatory function in mice.METHODS We assessed hepatic microhemodynamics in BALB/c,C57BL/6J,and KM mouse strains using laser Doppler flowmetry and wavelet analysis.We analyzed the serum levels of alanine transaminase,glutamic acid aminotransferase,total bile acid,total protein,alkaline phosphatase,and glucose.Histological and immunohistochemical staining were employed to quantify microvascular density and the expression levels of cluster of differentiation(CD)31,and estrogen receptorα,andβ.Statistical analyses,including the Mantel test and Pearson correlation,were conducted to determine the relationships among hepatic function,microcirculation,and marcocirculation between different sexes and across genetic backgrounds.RESULTS We identified sex-based disparities in hepatic microhemodynamics across all strains,with males exhibiting higher microvascular perfusion and erythrocyte concentration,but lower blood velocity.Strain-specific differences were evident,particularly in the endothelial oscillatory characteristics of the erythrocyte concentration.No sexdependent differences in estrogen receptor expression were observed,while significant variations in CD31 expression and microvascular density were observed.The correlations highlighted relationships between hepatic microhemodynamics and liver function indicators.CONCLUSION Our findings indicate the influence of genetic and sex differences on hepatic microcirculation and liver function,highlighting the necessity of incorporating both genetic background and sex into hepatic physiology studies and potential liver disease management strategies.
文摘BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incidence post-TIPS across various groups and the prophylactic efficacies of various medications.METHODS A thorough literature search was performed in PubMed,Web of Science,EMBASE,and the Cochrane Library databases from their inception to November 24,2024,to collect data regarding HE incidence.The main outcome was HE incidence post-TIPS.A meta-analysis using a random effects model was performed to obtain odds ratios(ORs)and 95%confidence intervals.Statistical analyses were conducted using Stata and RevMan software.RESULTS This meta-analysis included nine studies with 1140 patients;647 received pharmacological agents including lactulose,rifaximin,albumin,and l-ornithin-l-aspartate,and 493 did not(controls).(1)In the single-group meta-analysis,the control group had higher short-and long-term HE rates than the drug intervention group.Among patients with and without prior HE,the non-intervention group's HE rates were also higher;(2)Pharmacological prevention post-TIPS significantly reduced HE incidence[OR=0.59(0.45,0.77),P=0.0001].Compared with the no prophylaxis,rifaximin reduced the risk of HE after TIPS[OR=0.52(0.29,0.95),P=0.03],but lactulose did not;(3)In patients without prior HE,pharmacological prevention significantly reduced post-TIPS HE incidence[OR=0.62(0.41,0.95),P=0.03];and(4)Network meta-analysis showed no significant differences among five prevention strategies.CONCLUSION The HE incidence after TIPS was relatively high,and the use of drugs after TIPS may reduce the HE incidence.However,research,especially large-scale randomized controlled trials,is still lacking.
基金Supported by Shenzhen Clinical Research Center for Gastroenterology(Gastrointestinal Surgery),No.LCYSSQ20220823091203008.
文摘BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic chemotherapy,targeted therapies,and immune checkpoint inhibitors have demonstrated synergistic effects in converting unresectable ICC to resectable status and improving patient survival.CASE SUMMARY A 39-year-old male presented with unresectable stage IIIB ICC(cT3N1M0),abdominal pain,and elevated carbohydrate antigen(CA)19-9 levels.He received tri-modal therapy consisting of gemcitabine-oxaliplatin hepatic arterial infusion chemotherapy(GEMOX-HAIC),lenvatinib(8 mg daily),and toripalimab(160 mg every three weeks).After five cycles,significant tumor shrinkage and normalization of CA19-9 levels enabled a left hepatectomy.Complications,including biliary stenosis and liver abscesses,were managed with biliary stenting and percutaneous drainage,which allowed for the continuation of chemotherapy.Postoperative pathological examination confirmed a pathological complete response.At the last follow-up,the patient had maintained 29 months of diseasefree survival post-resection and was continuing postoperative therapy.CONCLUSION This case highlights the potential of a tri-modal therapy combining GEMOX-HAIC,lenvatinib,and toripalimab to convert unresectable ICC to a resectable status,thereby potentially improving patient survival by surgical resection.Further clinical trials investigating this regimen are warranted.
文摘Trans-jugular intrahepatic portosystemic stent shunting(TIPSS)has been in use for many years with great results and many evolutions.The procedure essentially involves the insertion of a metal covert stent to create an Hepato-Hepatic portosystemic shunt.Over time,TIPSS has become the subject of many studies aimed at examining its clinical utility and evaluating the results of using TIPSS to manage complications related to portal hypertension.From the outset,this procedure has been met with hope and enthusiasm and give the chance to consider another possibility to treat the complications of portal hypertension without the use of surgery.Considering that TIPSS is an attractive alternative to shunt surgery because it does not require the use of general anesthesia or laparotomy,in fact this method is applicable to many patients with severe liver disease not suitable for it.TIPSS has been studied for the management of variceal bleeding,ascites,hepatic hydrothorax,hepatorenal syndrome,and other types of cirrhosis.However,some drawbacks of the TIPSS,such as shunt stenosis and hepatic encephalopathy,have also been reported in the literature.On the basis of the available evidence and the new epidemiological findings regarding liver disease,the following question may be posed:What is the place of TIPSS in current clinical practice?
基金Supported by the“14th Five-Year”Talent Training Program of Beijing Shijitan Hospital,Capital Medical University,No.2023 LJRCLFQ.
文摘BACKGROUND Portal hypertension(PHT),a complication of liver cirrhosis,is sometimes managed with transjugular intrahepatic portosystemic shunt(TIPS)to reduce portal pressure.Although effective,TIPS poses risks,including hepatic enceph-alopathy(HE).This study investigates whether a significant reduction in the portal pressure gradient(PPG)after TIPS improves outcomes in PHT patients.AIM To evaluate the impact of post-TIPS PPG reduction on clinical outcomes and explore the relationship between PPG reduction and portal vein diameter.METHODS This retrospective cohort study included 815 patients with PHT who underwent TIPS at two tertiary hospitals between 2014 and 2022.Patients were categorized based on whether they achieved a 50%reduction in PPG.Propensity score matching was applied to balance baseline characteristics.Kaplan-Meier analysis assessed clinical outcomes,including rebleeding,HE,liver failure,and hepato-cellular carcinoma.Cox regression identified risk factors,and Spearman correlation analyzed the relationship between PPG reduction and portal vein diameter.RESULTS Patients with a PPG reduction>50%had significantly lower risks of rebleeding(P=0.004),shunt dysfunction(P=0.002),and mortality(P=0.024)compared to those with a PPG reduction≤50%.However,these patients faced higher risks of HE(P<0.001)and liver failure(P=0.003).A significant negative correlation was observed between the percentage of PPG reduction and portal vein diameter(ρ=-0.632,P<0.001),suggesting that patients with smaller portal vein diameters may achieve greater PPG reductions.CONCLUSION A significant PPG reduction following TIPS is associated with improved clinical outcomes,including reduced risks of rebleeding,shunt dysfunction,hepatocellular carcinoma,and mortality,though it increases HE and liver failure risks.The observed correlation between portal vein diameter and PPG reduction highlights the potential role of portal vein anatomy in predicting TIPS efficacy,warranting further investigation.
文摘BACKGROUND Aorto-hepatic conduits(AHCs)are an effective revascularization method for liver allografts when the native hepatic artery is unusable.Various studies have confirmed that outcomes with AHCs are inferior to those with native hepatic artery inflow.AIM To investigate the published evidence on the outcomes according to different inflow site for AHCs.METHODS A systematic search was conducted for studies reporting on AHCs in liver transplantation over the last 10 years(January 2014 onwards).Two independent reviewers selected articles,assessed quality,and evaluated bias in the included systematic reviews.The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.The protocol was registered with PROSPERO(CRD42024545810).Review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis statement standards.RESULTS Fourteen studies identified a total of 32486 deceased donor liver transplants,of which 1136(3.5%)required AHCs.The most frequent indications for AHC use included poor arterial flow,intimal dissections,and hepatic artery thrombosis.Among all AHCs,207(18.2%)were supra-coeliac(SC)AHCs,738(65.0%)infrarenal(IR)AHCs,25(2.2%)iliac artery conduits,and 166(14.6%)had unspecified origins.Pooled analysis revealed comparable demographic characteristics.The median follow-up duration ranged from 18 to 52 months.There were no significant differences in early occlusions of AHCs[odds ratio(OR)=0.94(0.48,1.84);P=0.86],late occlusions of AHCs[OR=0.46(0.16,1.32);P=0.15],early allograft dysfunction[OR=0.82(0.46,1.47);P=0.51],biliary complications[OR=1.10(0.69,1.76);P=0.68],post-transplant renal replacement therapy(RRT)requirement[OR=1.12(0.72,1.72);P=0.62],and major surgical complications(Clavien-Dindo>3b)[OR=1.06(0.70,1.61);P=0.79].The median duration for graft occlusion was approximately 142 days,ranging from 13 to 3313 days.One-year graft and patient survival rates for SC conduits were 77%to 81.1%and 80%to 85.1%,respectively.For IR conduits,one-year graft and patient survival rates were 66%to 79.1%and 73%to 88.3%,respectively.Five-year graft and patient survival rates for SC conduits were 53.9%to 67%and 67.8%to 74%,respectively.For IR conduits,five-year graft and patient survival rates were 50%to 56%and 56%to 64.9%,respectively.CONCLUSION Considering these findings,there is no significant difference in early and late outcomes between SC and IR AHCs,although there is a discernible tendency towards higher late occlusion rates in the IR group.
基金Supported by Hefei Natural Science Foundation,No.202341.
文摘Transjugular intrahepatic portosystemic shunt(TIPS)is widely used to treat portal hypertension and its complications patients with cirrhosis.However,managing post-TIPS hepatic encephalopathy(HE)remains a major clinical challenge.HE is characterized by a high incidence and a complex pathogenesis,influenced by various factors.Therefore,careful patient assessment and selection for TIPS is essential.While previous studies have identified several factors contributing to the occurrence of post-TIPS HE,there is a gap in the comprehen-sive integration of surgical procedural parameters and metabolic mechanisms within a multidimensional analysis.This minireview aims to optimize treatment protocols and refine management strategies by conducting a comprehensive analysis of risk factors,ultimately aiming to reduce the incidence of post-TIPS HE.
基金Supported by the National Natural Science Foundation of China,No.82270649.
文摘Transjugular intrahepatic portosystemic shunts(TIPSs)are generally used for the management of complications of portal hypertension in patients with decompensated cirrhosis.However,hepatic encephalopathy(HE),which impairs neuropsychiatric function and motor control,remains the primary adverse effect of TIPS,limiting its utility.Prompt prevention and treatment of post-TIPS HE are critical,as they are strongly associated with readmission rates and poor quality of life.This review focuses on the main pathophysiological mechanisms underlying post-TIPS HE,explores advanced biomarkers and predictive tools,and discusses current management strategies and future directions to prevent or reverse HE following TIPS.These strategies include preoperative patient assessment,individualized shunt diameter optimization,spontaneous portosystemic shunt embolization during the TIPS procedure,postoperative preventive and therapeutic measures such as nutrition management,medical therapy,fecal microbiota transplantation,and stent reduction.
文摘This is a narrative review in which the advances in technical aspects,the main indications,limitations and clinical results of the transjugular intrahepatic portosystemic shunt(TIPS)in portal hypertension(PH)are addressed.With the emergence of the coated prosthesis,a better shunt patency,a lower incidence of hepatic encephalopathy(HE)and better survival when compared to TIPS with the conventional prosthesis are demonstrated.The main indications for TIPS are refractory ascites,acute variceal bleeding unresponsive to pharmacological/endoscopic therapy and,lastly,patients considered at high risk for rebleeding preemptive TIPS(pTIPS).Absolute contraindications to the use of TIPS are severe uncontrolled HE,systemic infection or sepsis,congestive heart failure,severe pulmonary arterial hypertension,and biliary obstruction.The control of hemorrhage due to variceal rupture can reach up to 90%-100%of cases,and 55%in refractory ascites.Despite evidences regarding pTIPS in patients at high risk for rebleeding,less than 20%of eligible patients are treated.TIPS may also decrease the incidence of future decompensation in cirrhosis and increase survival in selected patients.In conclusion,TIPS is an essential treatment for patients with PH,but is often neglected.It is important for the hepatologist to form a multidisciplinary team,in which the role of the radiologist with experience in interventional procedures is prominent.
基金Natural Science Foundation of Guangdong Province,No.2024A1515013069.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is an effective intervention for managing complications of portal hypertension,particularly acute variceal bleeding(AVB).While effective in reducing portal pressure and preventing rebleeding,TIPS is associated with a considerable risk of overt hepatic encephalopathy(OHE),a complication that significantly elevates mortality rates.AIM To develop a machine learning(ML)model to predict OHE occurrence post-TIPS in patients with AVB using a 5-year dataset.METHODS This retrospective single-center study included 218 patients with AVB who underwent TIPS.The dataset was divided into training(70%)and testing(30%)sets.Critical features were identified using embedded methods and recursive feature elimination.Three ML algorithms-random forest,extreme gradient boosting,and logistic regression-were validated via 10-fold cross-validation.SHapley Additive exPlanations analysis was employed to interpret the model’s predictions.Survival analysis was conducted using Kaplan-Meier curves and stepwise Cox regression analysis to compare overall survival(OS)between patients with and without OHE.RESULTS The median OS of the study cohort was 47.83±22.95 months.Among the models evaluated,logistic regression demonstrated the highest performance with an area under the curve(AUC)of 0.825.Key predictors identified were Child-Pugh score,age,and portal vein thrombosis.Kaplan-Meier analysis revealed that patients without OHE had a significantly longer OS(P=0.005).The 5-year survival rate was 78.4%,with an OHE incidence of 15.1%.Both actual OHE status and predicted OHE value were significant predictors in each Cox model,with model-predicted OHE achieving an AUC of 88.1 in survival prediction.CONCLUSION The ML model accurately predicts post-TIPS OHE and outperforms traditional models,supporting its use in improving outcomes in patients with AVB.
基金Supported by National Natural Science Foundation of China,No.81630080,No.82305179,and No.82374181The China Postdoctoral Science Foundation Grant,No.2019M650600+1 种基金The Beijing University of Chinese Medicine“Decoding Traditional Chinese Medicine”Project,No.2023-JYB-JBZD-036The Hefei National Research Center for Physical Sciences at the Microscale,No.KF2021104.
文摘BACKGROUND Hepatic organoid-based modelling,through the elucidation of a range of in vivo biological processes and the recreation of the intricate liver microenvironment,is yielding groundbreaking insights into the pathophysiology and personalized medicine approaches for liver diseases.AIM This study was designed to analyse the global scientific output of hepatic organoid research and assess current achievements and future trends through bibliometric analysis.METHODS Articles were retrieved from the Web of Science Core Collection,and CiteSpace 6.3.R1 was employed to analyse the literature,including outputs,journals,and countries,among others.RESULTS Between 2010 and 2024,a total of 991 articles pertaining to hepatic organoid research were published.The journal Hepatology published the greatest number of papers,and journals with an impact factor greater than 10 constituted 60%of the top 10 journals.The United States and Utrecht University were identified as the most prolific country and institution,respectively.Clevers H emerged as the most prolific author,whereas Huch M had the highest number of cocitations,suggesting that both are ideal candidates for academic collaboration.Research on hepatic organoids has exhibited a progressive shift in focus,evolving from initial investigations into model building,differentiation research in stem cells,bile ducts,and progenitor cells,to a broader spectrum encompassing lipid metabolism,single-cell RNA sequencing,and therapeutic applications.The phrases exhibiting citation bursts from 2022 to 2024 include“drug resistance”,“disease model”,and“patient-derived tumor organoids”.CONCLUSION Research on hepatic organoids has increased over the past decade and is expected to continue to grow.Key research areas include applications for liver diseases and drug development.Future trends likely to gain focus include patient-derived tumour organoids,disease modelling,and personalized medicine.
文摘Background:Congenital hepatic hemangioma(CHH)is a rare benign vascular tumor that occurs prenatally.However,only a few cases have been summarized and evaluated for the prenatal and postnatal imaging features of CHH,and no studies have conducted long-term follow-up on it.This study aimed to explore the ultrasound and magnetic resonance features,growth patterns,and clinical outcomes of CHH.Methods:Thirty-six pregnancies with a prenatal fetal diagnosis and postnatal diagnosis of CHH were studied.CHHs were grouped into those with a diameter≥4 cm and those with a diameter<4 cm according to the largest diameter.Fisher's exact test was used to compare the imaging characteristics between the groups.The volume of CHHs was measured at each follow-up visit to plot the growth pattern of the tumors,and the volume of CHHs was compared before and after birth using a rank sum test analysis.Results:Thirty-three cases of CHHs were confirmed by postnatal imaging,and three were confirmed by a biopsy.Mixed echoes were more common in the diameter≥4 cm group than in the diameter<4 cm group(p=0.026).Complications were more likely to occur in the large-diameter group.Eighteen(54.5%)cases were classified as rapidly involuting congenital hemangioma,nine(27.3%)as partially involuting congenital hemangioma,and two(6.1%)as noninvoluting congenital hemangioma.A new type of CHH was identified in which four(12.1%)cases continued to proliferate after birth and spontaneously subsided in subsequent months.The CHH volume decreased with age and was significantly decreased at 9 months postnatal compared to birth(p=0.001).Conclusion:This study showed the imaging features of CHH were associated with the lesion size.Based on postnatal follow-up,a new type of CHH was identified.If there are no complications at birth in CHH cases,a good prognosis is indicated.
基金Supported by National Natural Science Foundation of China,No.82172915,No.81972648,and No.81773011Chongqing Medical University Program for Youth Innovation in Future Medicine,No.W0084+1 种基金Science and Technology Innovation Project of Chongqing Medical Universityand Chongqing Postdoctoral Science Foundation,No.CSTB2023NSCQ-BHX0134.
文摘Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)enters host cells via the angiotensin-converting enzyme 2(ACE2)receptor.Mounting evidence has indicated the presence of hepatic SARS-CoV-2 infection and liver injury in pa-tients with coronavirus disease 2019(COVID-19).Understanding the mechanisms of hepatic SARS-CoV-2 infection is crucial for addressing COVID-19–related liver pathology and developing targeted therapies.This editorial discusses the signi-ficance of ACE2 in hepatic SARS-CoV-2 infection,drawing on the research by Jacobs et al.Their findings indicate that hepatic ACE2 expression,frequency of hepatic SARS-CoV-2 infection,and severity of liver injury are elevated in patients with pre-existing chronic liver diseases.These data suggest that hepatic ACE2 could be a promising therapeutic target for COVID-19.
文摘This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.
基金Supported by National Natural Science Foundation of China,No.82270632 and No.82260411.
文摘BACKGROUND Hepatic alveolar echinococcosis(HAE)is a chronic parasitic disease caused by the larval stage of Echinococcus multilocularis.Although significant research has been conducted on the pathogenesis and immunological aspects of HAE,comprehensive bibliometric analyses in this area are still lacking.This study sought to fill this gap by systematically analyzing the immunological literature on HAE using bibliometric methods.AIM To identify research trends,key contributors,and emerging developments and offer insights to guide future research in this field.METHODS Research articles on HAE published between 1983 and 2023 were retrieved from the Web of Science Core Collection database.A total of 319 articles were selected for bibliometric analysis,which was conducted using the CiteSpace and VOSviewer software.The analysis focused on key variables such as publication volume,authors,journals,countries,references,and keywords.RESULTS The analysis revealed a significant increase in research on HAE over the past four decades,particularly after 1995.China and Switzerland emerged as the leading countries in terms of publication volume,with Bruno Gottstein and Vuitton DA identified as the most influential authors in this field.Key research areas include the interaction between the pathogen and the host immune system,as well as advances in disease diagnosis and treatment strategies.The keyword co-occurrence analysis highlighted the primary themes and identified emerging trends within the research landscape.CONCLUSION This study provides a comprehensive framework for understanding HAE immunology and highlights research hotspots,future directions,key contributors,and the importance of international cooperation.
