<strong>Purpose</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"><strong>: </strong></span><span style=&q...<strong>Purpose</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"><strong>: </strong></span><span style="font-family:Verdana;">To improve the liver auto-segmentation performance of three-</span><span style="font-family:Verdana;">dimensional (3D) U-net by replacing the conventional up-sampling convolution layers with the Pixel De-convolutional Network (PDN) that considers spatial features. </span><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;">: The U-net was originally developed to segment neuronal structure with outstanding performance but suffered serious artifacts from indirectly unrelated adjacent pixels in its up-sampling layers. The hypothesis of this study was that the segmentation quality of </span></span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">liver could be improved with PDN in which the up-sampling layer was replaced by a pixel de-convolution layer (PDL). Seventy</span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""><span style="font-family:Verdana;">eight plans of abdominal cancer patients were anonymized and exported. Sixty-two were chosen for training two networks: 1) 3D U-Net, and 2) 3D PDN, by minimizing the Dice loss function. The other sixteen plans were used to test the performance. The similarity Dice and Average Hausdorff Distance (AHD) were calculated and compared between these two networks. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: The computation time for 62 training cases and 200 training epochs was about 30 minutes for both networks. The segmentation performance was evaluated using the remaining 16 cases. For the Dice score, the mean ± standard deviation were 0.857 ± 0.011 and 0.858 ± 0.015 for the PDN and U-Net, respectively. For the AHD, the mean ± standard deviation were 1.575 ± 0.373 and 1.675 ± 0.769, respectively, corresponding to an improvement of 6.0% and 51.5% of mean and standard deviation for the PDN. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: The PDN has outperformed the U-Net on liver auto-segmentation. The predicted contours of PDN are more conformal and smoother when compared with</span></span><span style="font-family:Verdana;"> the</span><span style="font-family:Verdana;"> U-Net.</span>展开更多
Existing imaging techniques cannot simultaneously achieve high resolution and a wide field of view,and manual multi-mineral segmentation in shale lacks precision.To address these limitations,we propose a comprehensive...Existing imaging techniques cannot simultaneously achieve high resolution and a wide field of view,and manual multi-mineral segmentation in shale lacks precision.To address these limitations,we propose a comprehensive framework based on generative adversarial network(GAN)for characterizing pore structure properties of shale,which incorporates image augmentation,super-resolution reconstruction,and multi-mineral auto-segmentation.Using real 2D and 3D shale images,the framework was assessed through correlation function,entropy,porosity,pore size distribution,and permeability.The application results show that this framework enables the enhancement of 3D low-resolution digital cores by a scale factor of 8,without paired shale images,effectively reconstructing the unresolved fine-scale pores under a low resolution,rather than merely denoising,deblurring,and edge clarification.The trained GAN-based segmentation model effectively improves manual multi-mineral segmentation results,resulting in a strong resemblance to real samples in terms of pore size distribution and permeability.This framework significantly improves the characterization of complex shale microstructures and can be expanded to other heterogeneous porous media,such as carbonate,coal,and tight sandstone reservoirs.展开更多
BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly dev...BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.展开更多
Metabolic dysfunction-associated steatotic liver disease(MASLD),formerly known as nonalcoholic fatty liver disease,is a chronic liver disease characterized by hepatic lipid deposition and hepatocellular steatosis,resu...Metabolic dysfunction-associated steatotic liver disease(MASLD),formerly known as nonalcoholic fatty liver disease,is a chronic liver disease characterized by hepatic lipid deposition and hepatocellular steatosis,resulting from nonalcoholic causes and closely linked to metabolic dysfunction[1].It is strongly associated with metabolic abnormalities,including type 2 diabetes,overweight,and obesity.The global prevalence of MASLD is estimated to be approximately 25%−33%,and its incidence is rising rapidly,particularly among younger populations,due to increasingly prevalent unhealthy lifestyle behaviors such as sleep deprivation,sedentary habits,and diets rich in calories.展开更多
Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progre...Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progression and provide symptomatic improvement in patients with IEM.Each metabolic disorder is unique,with the missing enzyme or transporter protein causing substrate deficiency or toxic byproduct production.Knowledge about the distribution of deficient enzymes,the percentage of enzymes replaced by LT,and the extent of extrahepatic involvement helps anticipate and manage complications in the perioperative period.Most patients have multisystem involvement and can be on complex dietary regimens.Metabolic decompensation can be triggered due to the stress response to surgery,fasting and other unanticipated complications perioperatively.Thus,a multidisciplinary team’s input including those from metabolic specialists is essential to develop disease and patient-specific strategies for the perioperative management of these patients during LT.In this review,we outline the classification of IEM,indications for LT along with potential benefits,basic metabolic defects and their implications,details of extrahepatic involvement and perioperative management strategies for LT in children with some of the commonly presenting IEM,to assist anesthesiologists handling this cohort of patients.展开更多
BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or ga...BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or gastric varices.While rare,omental varices pose a risk for hemoperitoneum if ruptured,which is a lifethreatening complication with high mortality rates despite surgical intervention.CASE SUMMARY This report reviews the case of a patient 36-year-old female with alcohol related cirrhosis decompensated by ascites,but no history of varices admitted for hemorrhagic shock from spontaneous rupture of omental varices requiring emergency surgery.She underwent the first documented successful orthotopic liver transplantation the same admission.CONCLUSION This case report and literature review stresses the importance of early consideration and identification of intraabdominal variceal sources in cirrhotic patients with refractory shock.展开更多
Twelve new diterpenoids,euphorwallnoids A-L(1-12),comprising five rhamnofolanes(1-5),five tiglianes(6-10),and two daphnanes(11 and 12),along with six known analogues(13-18),were isolated from the whole plants of Eupho...Twelve new diterpenoids,euphorwallnoids A-L(1-12),comprising five rhamnofolanes(1-5),five tiglianes(6-10),and two daphnanes(11 and 12),along with six known analogues(13-18),were isolated from the whole plants of Euphorbia wallichii(E.wallichii).Their structures were determined using spectroscopic analysis,computational methods,chemical derivatization,and single-crystal X-ray diffraction.Euphorwallnoid A(1)features an unusual 5/7/6/5-tetracyclic scaffold,whereas 2-5 represent a rare subclass of 4-deoxygenated rhamnofolanes and 6-8 constitute 13-deoxygenated tiglianes.Notably,compound 1 demonstrated promising anti-liver fibrosis activity by significantly inhibiting the expression of fibronectin(FN),α-smooth muscle actin(α-SMA),and collagen I in transforming growth factorβ1(TGF-β1)-stimulated LX-2 cells at micromolar concentrations.展开更多
Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have signi...Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.展开更多
BACKGROUND The liver represents a common site of distant metastasis in patients with esophageal cancer(EC).Conventional chemotherapy(CMT)presents limited efficacy for EC,and EC patients with liver metastases typically...BACKGROUND The liver represents a common site of distant metastasis in patients with esophageal cancer(EC).Conventional chemotherapy(CMT)presents limited efficacy for EC,and EC patients with liver metastases typically experience a poor prognosis,highlighting an urgent need to explore novel treatment approaches.This study evaluated the overall efficacy and safety of CMT vs CMT combined with immune checkpoint inhibitors(ICIs)in the treatment of EC patients with liver metastases.Furthermore,prognostic factors influencing outcomes in this patient population were identified.AIM To evaluate the efficacy and safety of first-line chemoimmunotherapy for EC patients with liver metastases and to analyze prognostic factors.METHODS This retrospective study included 126 EC patients with liver metastases at Zhejiang Cancer Hospital between 2014 and 2024.Patients receiving CMT were compared with those receiving CMT+ICI.Analyzed variables included clinicopathological features,treatment history,characteristics of metastasis,systemic and local treatments,overall survival(OS),and treatment-related adverse events(TRAEs).Prognostic factors were evaluated using univariate and multivariate Cox proportional-hazards regression models.Finally,efficacy outcomes and TRAE profiles were compared between the two groups.RESULTS A significant difference in median OS was identified between the two groups(10.8 months in the CMT group vs 20.8 months in the CMT+ICI group,P=0.004).The CMT+ICI group also demonstrated a significantly longer median progression-free survival of 11.7 months(P<0.001).Patients receiving combination therapy exhibited significantly improved systemic objective response rate and disease control rate.Multivariate analysis identified key factors significantly influencing OS in EC patients with liver metastases:Karnofsky Performance Status score≥70,receipt of local therapy for liver metastases,and the number of cycles of CMT and immunotherapy received.Furthermore,the incidence of TRAEs did not significantly differ between the CMT+ICI and CMT groups.CONCLUSION For EC patients with liver metastases,the combination of CMT and ICIs demonstrates significantly superior efficacy compared with CMT alone,while maintaining manageable TRAEs.展开更多
Liver transplantation(LT)remains the optimal life-saving intervention for patients with end-stage liver disease.Despite the recent advances in LT several barriers,including organ allocation,donor-recipient matching,an...Liver transplantation(LT)remains the optimal life-saving intervention for patients with end-stage liver disease.Despite the recent advances in LT several barriers,including organ allocation,donor-recipient matching,and patient education,persist.With the growing progress of artificial intelligence,particularly large language models(LLMs)like ChatGPT,new applications have emerged in the field of LT.Current studies demonstrating usage of ChatGPT in LT include various areas of application,from clinical settings to research and education.ChatGPT usage can benefit both healthcare professionals,by decreasing the time spent on non-clinical work,but also LT recipients by providing accurate information.Future potential applications include the expanding usage of ChatGPT and other LLMs in the field of LT pathology and radiology as well as the automated creation of discharge summaries or other related paperwork.Additionally,the next models of ChatGPT might have the potential to provide more accurate patient education material with increased readability.Although ChatGPT usage presents promising applications,there are certain ethical and practical limitations.Key concerns include patient data privacy,information accuracy,misinformation possibility and lack of legal framework.Healthcare providers and policymakers should collaborate for the establishment of a controlled framework for the safe use of ChatGPT.The aim of this minireview is to summarize current literature on ChatGPT in LT,highlighting both opportunities and limitations,while also providing future possible applications.展开更多
For early hepatocellular carcinoma(HCC),curative therapies include surgical excision and radiofrequency ablation.Other treatment modes for advanced HCC involve transarterial chemoembolization.For HCC patients who do n...For early hepatocellular carcinoma(HCC),curative therapies include surgical excision and radiofrequency ablation.Other treatment modes for advanced HCC involve transarterial chemoembolization.For HCC patients who do not fit the Milan criteria or are waiting for liver transplantation(LT),studies of transarterial radioembolization with Yttrium-90(Y-90)demonstrated that Y-90 may accomplish a good downstaging or bridging effect before LT and can even achieve complete pathological necrosis.The present review discussed Y-90 radioembolization as a local regional treatment option for advanced and unresectable HCC,with a focus on neoadjuvant intervention before LT.展开更多
Hepatitis B Virus(HBV)infection and heavy alcohol consumption are the two primary pathogenic causes of liver cirrhosis.In this paper,we proposed a deterministic mathematical model and a logistic equation to investigat...Hepatitis B Virus(HBV)infection and heavy alcohol consumption are the two primary pathogenic causes of liver cirrhosis.In this paper,we proposed a deterministic mathematical model and a logistic equation to investigate the dynamics of liver cirrhosis progression as well as to explain the implications of variations in alcohol consumption on chronic hepatitis B patients,respectively.The intricate interactions between liver cirrhosis,recovery,and treatment dynamics are captured by the model.This study aims to show that alcohol consumption by Hepatitis B-infected individuals accelerates liver cirrhosis progression while treatment of acutely infected individuals reduces it.We proved that a unique solution of the proposed model exists,which is positive and bounded.Using the next-generation matrix approach,two basic reproductive numbers R_(A_(0))and R_(A_(max))are calculated to identify future recurrence.The equilibrium points are calculated,and both equilibria are proved locally and globally asymptotically stable when R_(0)is below and above one,respectively.It is shown that bifurcation exists at R_(0)=1 and a detailed proof for forward bifurcation is given.Furthermore,we performed the sensitivity analysis of the model parameters on R_(0).For the confirmation of analytical work,we performed numerical simulations,and the results indicate that the treatment and the inhibitory effects reduce the risk of developing liver cirrhosis in individuals,while heavy alcohol consumption accelerates markedly the liver cirrhosis progression in patients with chronic hepatitis B.展开更多
Objective Previous Mendelian randomization(MR)studies have suggested an association between the gut microbiome and metabolic-associated fatty liver disease(MAFLD).However,the reliance on 16S rRNA sequencing data has l...Objective Previous Mendelian randomization(MR)studies have suggested an association between the gut microbiome and metabolic-associated fatty liver disease(MAFLD).However,the reliance on 16S rRNA sequencing data has led to inconsistent findings and limited species-level insights.To address this,we conducted a de novo MR analysis using species-level shotgun metagenomic data,combined it with a meta-analysis to consolidate the existing evidence,and explored metabolite-mediated pathways.Methods Bidirectional MR analyses were performed between 883 gut microbiota taxa(derived from shotgun metagenomic genome-wide association study)and MAFLD.Published MR studies(up to December 1,2024)were identified using PubMed,Embase,Web of Science,and the Cochrane Library for meta-analysis.Multivariable MR(MVMR)and mediation analyses were applied to assess the mediating effects of 1,400 blood metabolites.Results The de novo MR identified 25 MAFLD-associated microbial taxa.Integration with 7 published studies revealed 34 causal taxa,including 10 at the species level.Among the 1,400 metabolites,53 showed causal links with MAFLD.MVMR and mediation analyses identified deoxycholate as a mediator of the effect of Bifidobacterium on MAFLD risk(22.06%mediation proportion).Conclusion This study elucidated the connections between species-level gut microbiota and MAFLD,highlighting the interplay between microbiota,metabolites,and disease pathogenesis.These findings provide novel insights into the potential therapeutic targets for MAFLD.展开更多
Selective internal radiation therapy using yttrium-90 has been used to treat hepatocellular carcinoma,intrahepatic cholangiocarcinoma,and other malignant tumors that have spread to the liver locally.The authors used t...Selective internal radiation therapy using yttrium-90 has been used to treat hepatocellular carcinoma,intrahepatic cholangiocarcinoma,and other malignant tumors that have spread to the liver locally.The authors used the bibliometric approach in response to the neoplasms,using the keyword“Yttrium 90 AND Liver Neoplasms”as a search parameter and then looked up pertinent English-language literature in the Web of Science core collection database’s selfbuilt database through November 30,2025.For statistical analysis and literature management,EndNote and Excel tools were utilized.In addition to co-citation and emergent keyword analysis of authors,VOSviewer and CiteSpace were utilized for social network and chronological order of countries,institutions,authors,and keywords.The aim of this study was to serve as a reference for future research by methodically sorting through the international research literature on Yttrium 90 treatment of liver neoplasms and summarizing the research status and hot trends in this field.In recent years,research focus has increasingly shifted toward high-quality,multi-center clinical trials that combine SIRT-targeted systemic therapy with hepatectomy following the descending stage.This approach is likely to remain a significant research trend in the field.展开更多
Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hyperten...Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.展开更多
BACKGROUND Perimenopausal women are prone to anxiety and depression due to fluctuating hormone levels,which significantly impair their quality of life.The current treatments have certain limitations.In traditional Chi...BACKGROUND Perimenopausal women are prone to anxiety and depression due to fluctuating hormone levels,which significantly impair their quality of life.The current treatments have certain limitations.In traditional Chinese medicine,liver-soothing formulas are commonly prescribed for mood-related disorders,but their overall efficacy in perimenopausal anxiety and depression remains uncertain and requires verification through meta-analysis.AIM To provide evidence-based support for clinical decision-making and research,a meta-analysis was conducted to evaluate the effectiveness of liver-soothing formulas in treating perimenopausal anxiety and depression.METHODS Relevant studies published up to April 2025 were retrieved from ClinicalTrials.gov,PubMed,Web of Science,EMBASE,and the Cochrane Library.Eligible studies were screened according to predefined inclusion and exclusion criteria.Data were extracted and analyzed using the Stata 12.0 software.RESULTS After searching and screening,12 articles involving 1798 patients(922 in the treatment group and 876 in the control group)were included in the analysis.Meta-analysis showed that the standardized scores for anxiety[standardized mean difference(SMD)=-0.71,95%confidence interval(95%CI):-1.06 to-0.36]and depression(SMD=-0.67,95%CI:-1.06 to-0.27)of the treatment group were lower than those of the control group.Subgroup analysis results revealed that for anxiety,liver-soothing formulas used alone(SMD=-0.34,95%CI:-0.50 to-0.18)or in combination(SMD=-0.88,95%CI:-1.43 to-0.34)both significantly reduced scores compared with the control group.For depression,monotherapy of liversoothing formulas showed no significant statistical difference between the treatment and control groups(SMD=-0.47,95%CI:-1.11 to 0.17),whereas combination therapy produced significantly lower standardized scale scores in the treatment group than in the control group,with a statistically significant difference(SMD=-0.83,95%CI:-1.39 to-0.28).Regarding Greene scores,no statistically significant difference was observed with monotherapy(SMD=0.87,95%CI:-0.32 to 2.06),whereas combination therapy had significantly lower Greene scores(SMD=-0.24,95%CI:-0.44 to-0.04).No statistically significant difference was found between the groups in the occurrence of adverse reactions(odds ratio=0.90,95%CI:0.57-1.43).However,liver-soothing formulas did not affect estrogen levels in perimenopausal women.CONCLUSION Compared with placebo,conventional Western medicine,or other interventions,the monotherapy of liver-soothing formulas demonstrates superior efficacy in treating perimenopausal anxiety.When used as an adjuvant,they exert a synergistic effect in alleviating negative emotions and improving overall perimenopausal symptoms.展开更多
Objective To analyze the diagnostic efficacy of lipid-related insulin resistance(IR)markers in patients with non-alcoholic fatty liver disease(NAFLD)and metabolic abnormalities(MA).Method Patients with NAFLD with MA,n...Objective To analyze the diagnostic efficacy of lipid-related insulin resistance(IR)markers in patients with non-alcoholic fatty liver disease(NAFLD)and metabolic abnormalities(MA).Method Patients with NAFLD with MA,non-NAFLD patients with MA,and patients with NAFLD without MA underwent liver biopsy.Homeostasis model assessment of insulin resistance(HOMA-IR),triglyceride/high-density lipoprotein cholesterol(TG/HDL-C),visceral obesity index(VAI),lipid accumulation product(LAP),and triglyceride glucose(TyG)index were analyzed.The diagnostic efficacy of these indicators of NAFLD was also evaluated.Results In the NAFLD-MA group,BMI,HOMA-IR,LAP,VAI,TyG index,and TG/HDL-C ratio were higher than those in the non-NAFLD-MA group(P<0.001).Logistic regression indicated that BMI and TyG index were independent risk factors for NAFLD.Receiver Operating Characteristic(ROC)curves analysis revealed that the Area Under the ROC Curve(AUC)for TyG-BMI was 0.819,and the optimal cutoff for NAFLD was TyG-BMI 39.77.For patients with NAFLD with or without MA,logistic regression analysis suggested that age,TG level,and TyG index were independent risk factors.The area under the ROC curve showed that AUC for the TyG index was 0.724.The optimal cutoff for NAFLD-non MA was a TyG index of 1.580.Conclusion TyG index has diagnostic value in both types of NAFLD;however,TyG-BMI is better in patients with NAFLD with MA and may be an effective screening indicator alone in patients with NAFLD without MA.展开更多
Artificial intelligence(AI)is revolutionizing medical imaging,particularly in chronic liver diseases assessment.AI technologies,including machine learning and deep learning,are increasingly integrated with multiparame...Artificial intelligence(AI)is revolutionizing medical imaging,particularly in chronic liver diseases assessment.AI technologies,including machine learning and deep learning,are increasingly integrated with multiparametric ultrasound(US)techniques to provide more accurate,objective,and non-invasive evaluations of liver fibrosis and steatosis.Analyzing large datasets from US images,AI enhances diagnostic precision,enabling better quantification of liver stiffness and fat content,which are essential for diagnosing and staging liver fibrosis and steatosis.Combining advanced US modalities,such as elastography and doppler imaging with AI,has demonstrated improved sensitivity in identifying different stages of liver disease and distinguishing various degrees of steatotic liver.These advancements also contribute to greater reproducibility and reduced operator dependency,addressing some of the limitations of traditional methods.The clinical implications of AI in liver disease are vast,ranging from early detection to predicting disease progression and evaluating treatment response.Despite these promising developments,challenges such as the need for large-scale datasets,algorithm transparency,and clinical validation remain.The aim of this review is to explore the current applications and future potential of AI in liver fibrosis and steatosis assessment using multiparametric US,highlighting the technological advances and clinical relevance of this emerging field.展开更多
BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical perf...BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.展开更多
Metabolic dysfunction-associated steatotic liver disease(MASLD)is an increasingly prevalent condition associated with hepatic complications and cardiovascular and renal events.Given its significant clinical impact,the...Metabolic dysfunction-associated steatotic liver disease(MASLD)is an increasingly prevalent condition associated with hepatic complications and cardiovascular and renal events.Given its significant clinical impact,the development of new strategies for early diagnosis and treatment is essential to improve patient outcomes.Over the past decade,the integration of artificial intelligence(AI)into gastroenterology has led to transformative advancements in medical practice.AI represents a major step towards personalized medicine,offering the potential to enhance diagnostic accuracy,refine prognostic assessments,and optimize treatment strategies.Its applications are rapidly expanding.This article explores the emerging role of AI in the management of MASLD,emphasizing its ability to improve clinical prediction,enhance the diagnostic performance of imaging modalities,and support histopathological confirmation.Additionally,it examines the development of AI-guided personalized treatments,where lifestyle modifications and close monitoring play a pivotal role in achieving therapeutic success.展开更多
文摘<strong>Purpose</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"><strong>: </strong></span><span style="font-family:Verdana;">To improve the liver auto-segmentation performance of three-</span><span style="font-family:Verdana;">dimensional (3D) U-net by replacing the conventional up-sampling convolution layers with the Pixel De-convolutional Network (PDN) that considers spatial features. </span><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;">: The U-net was originally developed to segment neuronal structure with outstanding performance but suffered serious artifacts from indirectly unrelated adjacent pixels in its up-sampling layers. The hypothesis of this study was that the segmentation quality of </span></span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">liver could be improved with PDN in which the up-sampling layer was replaced by a pixel de-convolution layer (PDL). Seventy</span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""><span style="font-family:Verdana;">eight plans of abdominal cancer patients were anonymized and exported. Sixty-two were chosen for training two networks: 1) 3D U-Net, and 2) 3D PDN, by minimizing the Dice loss function. The other sixteen plans were used to test the performance. The similarity Dice and Average Hausdorff Distance (AHD) were calculated and compared between these two networks. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: The computation time for 62 training cases and 200 training epochs was about 30 minutes for both networks. The segmentation performance was evaluated using the remaining 16 cases. For the Dice score, the mean ± standard deviation were 0.857 ± 0.011 and 0.858 ± 0.015 for the PDN and U-Net, respectively. For the AHD, the mean ± standard deviation were 1.575 ± 0.373 and 1.675 ± 0.769, respectively, corresponding to an improvement of 6.0% and 51.5% of mean and standard deviation for the PDN. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: The PDN has outperformed the U-Net on liver auto-segmentation. The predicted contours of PDN are more conformal and smoother when compared with</span></span><span style="font-family:Verdana;"> the</span><span style="font-family:Verdana;"> U-Net.</span>
基金Supported by the National Natural Science Foundation of China(U23A20595,52034010,52288101)National Key Research and Development Program of China(2022YFE0203400)+1 种基金Shandong Provincial Natural Science Foundation(ZR2024ZD17)Fundamental Research Funds for the Central Universities(23CX10004A).
文摘Existing imaging techniques cannot simultaneously achieve high resolution and a wide field of view,and manual multi-mineral segmentation in shale lacks precision.To address these limitations,we propose a comprehensive framework based on generative adversarial network(GAN)for characterizing pore structure properties of shale,which incorporates image augmentation,super-resolution reconstruction,and multi-mineral auto-segmentation.Using real 2D and 3D shale images,the framework was assessed through correlation function,entropy,porosity,pore size distribution,and permeability.The application results show that this framework enables the enhancement of 3D low-resolution digital cores by a scale factor of 8,without paired shale images,effectively reconstructing the unresolved fine-scale pores under a low resolution,rather than merely denoising,deblurring,and edge clarification.The trained GAN-based segmentation model effectively improves manual multi-mineral segmentation results,resulting in a strong resemblance to real samples in terms of pore size distribution and permeability.This framework significantly improves the characterization of complex shale microstructures and can be expanded to other heterogeneous porous media,such as carbonate,coal,and tight sandstone reservoirs.
文摘BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.
文摘Metabolic dysfunction-associated steatotic liver disease(MASLD),formerly known as nonalcoholic fatty liver disease,is a chronic liver disease characterized by hepatic lipid deposition and hepatocellular steatosis,resulting from nonalcoholic causes and closely linked to metabolic dysfunction[1].It is strongly associated with metabolic abnormalities,including type 2 diabetes,overweight,and obesity.The global prevalence of MASLD is estimated to be approximately 25%−33%,and its incidence is rising rapidly,particularly among younger populations,due to increasingly prevalent unhealthy lifestyle behaviors such as sleep deprivation,sedentary habits,and diets rich in calories.
文摘Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progression and provide symptomatic improvement in patients with IEM.Each metabolic disorder is unique,with the missing enzyme or transporter protein causing substrate deficiency or toxic byproduct production.Knowledge about the distribution of deficient enzymes,the percentage of enzymes replaced by LT,and the extent of extrahepatic involvement helps anticipate and manage complications in the perioperative period.Most patients have multisystem involvement and can be on complex dietary regimens.Metabolic decompensation can be triggered due to the stress response to surgery,fasting and other unanticipated complications perioperatively.Thus,a multidisciplinary team’s input including those from metabolic specialists is essential to develop disease and patient-specific strategies for the perioperative management of these patients during LT.In this review,we outline the classification of IEM,indications for LT along with potential benefits,basic metabolic defects and their implications,details of extrahepatic involvement and perioperative management strategies for LT in children with some of the commonly presenting IEM,to assist anesthesiologists handling this cohort of patients.
文摘BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or gastric varices.While rare,omental varices pose a risk for hemoperitoneum if ruptured,which is a lifethreatening complication with high mortality rates despite surgical intervention.CASE SUMMARY This report reviews the case of a patient 36-year-old female with alcohol related cirrhosis decompensated by ascites,but no history of varices admitted for hemorrhagic shock from spontaneous rupture of omental varices requiring emergency surgery.She underwent the first documented successful orthotopic liver transplantation the same admission.CONCLUSION This case report and literature review stresses the importance of early consideration and identification of intraabdominal variceal sources in cirrhotic patients with refractory shock.
基金supported by the National Natural Science Foundation of China(Nos.82404454,22407144,82304322)the China Postdoctoral Science Foundation(No.2024M753800)+1 种基金the Postdoctoral Fellowship Program of CPSF(No.GZC20242113)the Open Program of Shenzhen Bay Laboratory(No.SZBL2021080601007)。
文摘Twelve new diterpenoids,euphorwallnoids A-L(1-12),comprising five rhamnofolanes(1-5),five tiglianes(6-10),and two daphnanes(11 and 12),along with six known analogues(13-18),were isolated from the whole plants of Euphorbia wallichii(E.wallichii).Their structures were determined using spectroscopic analysis,computational methods,chemical derivatization,and single-crystal X-ray diffraction.Euphorwallnoid A(1)features an unusual 5/7/6/5-tetracyclic scaffold,whereas 2-5 represent a rare subclass of 4-deoxygenated rhamnofolanes and 6-8 constitute 13-deoxygenated tiglianes.Notably,compound 1 demonstrated promising anti-liver fibrosis activity by significantly inhibiting the expression of fibronectin(FN),α-smooth muscle actin(α-SMA),and collagen I in transforming growth factorβ1(TGF-β1)-stimulated LX-2 cells at micromolar concentrations.
文摘Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.
基金Supported by National Natural Science Foundation of China,No.82303672Zhejiang Provincial Health Commission and Zhejiang Provincial Administration of Traditional Chinese Medicine through the Targeted Project for Medical and Health Research,No.2025ZL017and China Primary Health Care Foundation,No.ZLMY20240311001ZJ.
文摘BACKGROUND The liver represents a common site of distant metastasis in patients with esophageal cancer(EC).Conventional chemotherapy(CMT)presents limited efficacy for EC,and EC patients with liver metastases typically experience a poor prognosis,highlighting an urgent need to explore novel treatment approaches.This study evaluated the overall efficacy and safety of CMT vs CMT combined with immune checkpoint inhibitors(ICIs)in the treatment of EC patients with liver metastases.Furthermore,prognostic factors influencing outcomes in this patient population were identified.AIM To evaluate the efficacy and safety of first-line chemoimmunotherapy for EC patients with liver metastases and to analyze prognostic factors.METHODS This retrospective study included 126 EC patients with liver metastases at Zhejiang Cancer Hospital between 2014 and 2024.Patients receiving CMT were compared with those receiving CMT+ICI.Analyzed variables included clinicopathological features,treatment history,characteristics of metastasis,systemic and local treatments,overall survival(OS),and treatment-related adverse events(TRAEs).Prognostic factors were evaluated using univariate and multivariate Cox proportional-hazards regression models.Finally,efficacy outcomes and TRAE profiles were compared between the two groups.RESULTS A significant difference in median OS was identified between the two groups(10.8 months in the CMT group vs 20.8 months in the CMT+ICI group,P=0.004).The CMT+ICI group also demonstrated a significantly longer median progression-free survival of 11.7 months(P<0.001).Patients receiving combination therapy exhibited significantly improved systemic objective response rate and disease control rate.Multivariate analysis identified key factors significantly influencing OS in EC patients with liver metastases:Karnofsky Performance Status score≥70,receipt of local therapy for liver metastases,and the number of cycles of CMT and immunotherapy received.Furthermore,the incidence of TRAEs did not significantly differ between the CMT+ICI and CMT groups.CONCLUSION For EC patients with liver metastases,the combination of CMT and ICIs demonstrates significantly superior efficacy compared with CMT alone,while maintaining manageable TRAEs.
文摘Liver transplantation(LT)remains the optimal life-saving intervention for patients with end-stage liver disease.Despite the recent advances in LT several barriers,including organ allocation,donor-recipient matching,and patient education,persist.With the growing progress of artificial intelligence,particularly large language models(LLMs)like ChatGPT,new applications have emerged in the field of LT.Current studies demonstrating usage of ChatGPT in LT include various areas of application,from clinical settings to research and education.ChatGPT usage can benefit both healthcare professionals,by decreasing the time spent on non-clinical work,but also LT recipients by providing accurate information.Future potential applications include the expanding usage of ChatGPT and other LLMs in the field of LT pathology and radiology as well as the automated creation of discharge summaries or other related paperwork.Additionally,the next models of ChatGPT might have the potential to provide more accurate patient education material with increased readability.Although ChatGPT usage presents promising applications,there are certain ethical and practical limitations.Key concerns include patient data privacy,information accuracy,misinformation possibility and lack of legal framework.Healthcare providers and policymakers should collaborate for the establishment of a controlled framework for the safe use of ChatGPT.The aim of this minireview is to summarize current literature on ChatGPT in LT,highlighting both opportunities and limitations,while also providing future possible applications.
文摘For early hepatocellular carcinoma(HCC),curative therapies include surgical excision and radiofrequency ablation.Other treatment modes for advanced HCC involve transarterial chemoembolization.For HCC patients who do not fit the Milan criteria or are waiting for liver transplantation(LT),studies of transarterial radioembolization with Yttrium-90(Y-90)demonstrated that Y-90 may accomplish a good downstaging or bridging effect before LT and can even achieve complete pathological necrosis.The present review discussed Y-90 radioembolization as a local regional treatment option for advanced and unresectable HCC,with a focus on neoadjuvant intervention before LT.
文摘Hepatitis B Virus(HBV)infection and heavy alcohol consumption are the two primary pathogenic causes of liver cirrhosis.In this paper,we proposed a deterministic mathematical model and a logistic equation to investigate the dynamics of liver cirrhosis progression as well as to explain the implications of variations in alcohol consumption on chronic hepatitis B patients,respectively.The intricate interactions between liver cirrhosis,recovery,and treatment dynamics are captured by the model.This study aims to show that alcohol consumption by Hepatitis B-infected individuals accelerates liver cirrhosis progression while treatment of acutely infected individuals reduces it.We proved that a unique solution of the proposed model exists,which is positive and bounded.Using the next-generation matrix approach,two basic reproductive numbers R_(A_(0))and R_(A_(max))are calculated to identify future recurrence.The equilibrium points are calculated,and both equilibria are proved locally and globally asymptotically stable when R_(0)is below and above one,respectively.It is shown that bifurcation exists at R_(0)=1 and a detailed proof for forward bifurcation is given.Furthermore,we performed the sensitivity analysis of the model parameters on R_(0).For the confirmation of analytical work,we performed numerical simulations,and the results indicate that the treatment and the inhibitory effects reduce the risk of developing liver cirrhosis in individuals,while heavy alcohol consumption accelerates markedly the liver cirrhosis progression in patients with chronic hepatitis B.
基金supported by grants from the National Natural Science Foundation of China(82270924)the CAMS Innovation Fund for Medical Sciences(CIFMS 2021-I2M-1-016)the National High Level Hospital Clinical Research Funding(2022-PUMCH-C-014,2025-PUMCH-C-041).
文摘Objective Previous Mendelian randomization(MR)studies have suggested an association between the gut microbiome and metabolic-associated fatty liver disease(MAFLD).However,the reliance on 16S rRNA sequencing data has led to inconsistent findings and limited species-level insights.To address this,we conducted a de novo MR analysis using species-level shotgun metagenomic data,combined it with a meta-analysis to consolidate the existing evidence,and explored metabolite-mediated pathways.Methods Bidirectional MR analyses were performed between 883 gut microbiota taxa(derived from shotgun metagenomic genome-wide association study)and MAFLD.Published MR studies(up to December 1,2024)were identified using PubMed,Embase,Web of Science,and the Cochrane Library for meta-analysis.Multivariable MR(MVMR)and mediation analyses were applied to assess the mediating effects of 1,400 blood metabolites.Results The de novo MR identified 25 MAFLD-associated microbial taxa.Integration with 7 published studies revealed 34 causal taxa,including 10 at the species level.Among the 1,400 metabolites,53 showed causal links with MAFLD.MVMR and mediation analyses identified deoxycholate as a mediator of the effect of Bifidobacterium on MAFLD risk(22.06%mediation proportion).Conclusion This study elucidated the connections between species-level gut microbiota and MAFLD,highlighting the interplay between microbiota,metabolites,and disease pathogenesis.These findings provide novel insights into the potential therapeutic targets for MAFLD.
文摘Selective internal radiation therapy using yttrium-90 has been used to treat hepatocellular carcinoma,intrahepatic cholangiocarcinoma,and other malignant tumors that have spread to the liver locally.The authors used the bibliometric approach in response to the neoplasms,using the keyword“Yttrium 90 AND Liver Neoplasms”as a search parameter and then looked up pertinent English-language literature in the Web of Science core collection database’s selfbuilt database through November 30,2025.For statistical analysis and literature management,EndNote and Excel tools were utilized.In addition to co-citation and emergent keyword analysis of authors,VOSviewer and CiteSpace were utilized for social network and chronological order of countries,institutions,authors,and keywords.The aim of this study was to serve as a reference for future research by methodically sorting through the international research literature on Yttrium 90 treatment of liver neoplasms and summarizing the research status and hot trends in this field.In recent years,research focus has increasingly shifted toward high-quality,multi-center clinical trials that combine SIRT-targeted systemic therapy with hepatectomy following the descending stage.This approach is likely to remain a significant research trend in the field.
基金supported by grants from the Sichuan Science and Technology Program(2023YFQ0094)the 1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(25HXJS028).
文摘Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.
文摘BACKGROUND Perimenopausal women are prone to anxiety and depression due to fluctuating hormone levels,which significantly impair their quality of life.The current treatments have certain limitations.In traditional Chinese medicine,liver-soothing formulas are commonly prescribed for mood-related disorders,but their overall efficacy in perimenopausal anxiety and depression remains uncertain and requires verification through meta-analysis.AIM To provide evidence-based support for clinical decision-making and research,a meta-analysis was conducted to evaluate the effectiveness of liver-soothing formulas in treating perimenopausal anxiety and depression.METHODS Relevant studies published up to April 2025 were retrieved from ClinicalTrials.gov,PubMed,Web of Science,EMBASE,and the Cochrane Library.Eligible studies were screened according to predefined inclusion and exclusion criteria.Data were extracted and analyzed using the Stata 12.0 software.RESULTS After searching and screening,12 articles involving 1798 patients(922 in the treatment group and 876 in the control group)were included in the analysis.Meta-analysis showed that the standardized scores for anxiety[standardized mean difference(SMD)=-0.71,95%confidence interval(95%CI):-1.06 to-0.36]and depression(SMD=-0.67,95%CI:-1.06 to-0.27)of the treatment group were lower than those of the control group.Subgroup analysis results revealed that for anxiety,liver-soothing formulas used alone(SMD=-0.34,95%CI:-0.50 to-0.18)or in combination(SMD=-0.88,95%CI:-1.43 to-0.34)both significantly reduced scores compared with the control group.For depression,monotherapy of liversoothing formulas showed no significant statistical difference between the treatment and control groups(SMD=-0.47,95%CI:-1.11 to 0.17),whereas combination therapy produced significantly lower standardized scale scores in the treatment group than in the control group,with a statistically significant difference(SMD=-0.83,95%CI:-1.39 to-0.28).Regarding Greene scores,no statistically significant difference was observed with monotherapy(SMD=0.87,95%CI:-0.32 to 2.06),whereas combination therapy had significantly lower Greene scores(SMD=-0.24,95%CI:-0.44 to-0.04).No statistically significant difference was found between the groups in the occurrence of adverse reactions(odds ratio=0.90,95%CI:0.57-1.43).However,liver-soothing formulas did not affect estrogen levels in perimenopausal women.CONCLUSION Compared with placebo,conventional Western medicine,or other interventions,the monotherapy of liver-soothing formulas demonstrates superior efficacy in treating perimenopausal anxiety.When used as an adjuvant,they exert a synergistic effect in alleviating negative emotions and improving overall perimenopausal symptoms.
基金Beijing Research Ward Excellence Program(BRWEP2024W102170101)The National Key Research and Development Program(2022YFC2603500,2022YFC2603505)+5 种基金Beijing Municipal Health Commission high-level public health technical personnel construction project(discipline leader-03-26,discipline backbone-02-28)Capital’s Funds for Health Improvement and Research(2022-1-2172)Beijing Hospitals Authority Clinical medicine Development of special funding support(ZLRK202301)Beijing Hospitals Authority"peak"talent training program(DFL20241803)National Key Research and Development Program of China(2023YFC2306900)National Key Research and Development Program of Ministry of Science and Technology(2023YFC2308105).
文摘Objective To analyze the diagnostic efficacy of lipid-related insulin resistance(IR)markers in patients with non-alcoholic fatty liver disease(NAFLD)and metabolic abnormalities(MA).Method Patients with NAFLD with MA,non-NAFLD patients with MA,and patients with NAFLD without MA underwent liver biopsy.Homeostasis model assessment of insulin resistance(HOMA-IR),triglyceride/high-density lipoprotein cholesterol(TG/HDL-C),visceral obesity index(VAI),lipid accumulation product(LAP),and triglyceride glucose(TyG)index were analyzed.The diagnostic efficacy of these indicators of NAFLD was also evaluated.Results In the NAFLD-MA group,BMI,HOMA-IR,LAP,VAI,TyG index,and TG/HDL-C ratio were higher than those in the non-NAFLD-MA group(P<0.001).Logistic regression indicated that BMI and TyG index were independent risk factors for NAFLD.Receiver Operating Characteristic(ROC)curves analysis revealed that the Area Under the ROC Curve(AUC)for TyG-BMI was 0.819,and the optimal cutoff for NAFLD was TyG-BMI 39.77.For patients with NAFLD with or without MA,logistic regression analysis suggested that age,TG level,and TyG index were independent risk factors.The area under the ROC curve showed that AUC for the TyG index was 0.724.The optimal cutoff for NAFLD-non MA was a TyG index of 1.580.Conclusion TyG index has diagnostic value in both types of NAFLD;however,TyG-BMI is better in patients with NAFLD with MA and may be an effective screening indicator alone in patients with NAFLD without MA.
文摘Artificial intelligence(AI)is revolutionizing medical imaging,particularly in chronic liver diseases assessment.AI technologies,including machine learning and deep learning,are increasingly integrated with multiparametric ultrasound(US)techniques to provide more accurate,objective,and non-invasive evaluations of liver fibrosis and steatosis.Analyzing large datasets from US images,AI enhances diagnostic precision,enabling better quantification of liver stiffness and fat content,which are essential for diagnosing and staging liver fibrosis and steatosis.Combining advanced US modalities,such as elastography and doppler imaging with AI,has demonstrated improved sensitivity in identifying different stages of liver disease and distinguishing various degrees of steatotic liver.These advancements also contribute to greater reproducibility and reduced operator dependency,addressing some of the limitations of traditional methods.The clinical implications of AI in liver disease are vast,ranging from early detection to predicting disease progression and evaluating treatment response.Despite these promising developments,challenges such as the need for large-scale datasets,algorithm transparency,and clinical validation remain.The aim of this review is to explore the current applications and future potential of AI in liver fibrosis and steatosis assessment using multiparametric US,highlighting the technological advances and clinical relevance of this emerging field.
文摘BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.
文摘Metabolic dysfunction-associated steatotic liver disease(MASLD)is an increasingly prevalent condition associated with hepatic complications and cardiovascular and renal events.Given its significant clinical impact,the development of new strategies for early diagnosis and treatment is essential to improve patient outcomes.Over the past decade,the integration of artificial intelligence(AI)into gastroenterology has led to transformative advancements in medical practice.AI represents a major step towards personalized medicine,offering the potential to enhance diagnostic accuracy,refine prognostic assessments,and optimize treatment strategies.Its applications are rapidly expanding.This article explores the emerging role of AI in the management of MASLD,emphasizing its ability to improve clinical prediction,enhance the diagnostic performance of imaging modalities,and support histopathological confirmation.Additionally,it examines the development of AI-guided personalized treatments,where lifestyle modifications and close monitoring play a pivotal role in achieving therapeutic success.
