BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifyi...BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pretransplant risk stratification and improving post-transplant outcomes.AIM To determine the prevalence of left ventricular hypertrophy(LVH),left ventricular systolic dysfunction(LVSD),diastolic dysfunction(DD),pulmonary hypertension(PH),and their predictors,and to assess their impact on graft function in pre-transplant candidates.METHODS The study included all successful transplant candidates older than 14 who had a baseline echocardiogram.Binary logistic regression models were constructed to identify factors associated with LVH,LVSD,DD,and PH.RESULTS Out of 259 patients,LVH was present in 64%(166),12%(31)had LVSD,27.5%(71)had DD,and 66(25.5%)had PH.Independent predictors of LVH included male gender[odds ratio(OR):2.51;95%CI:1.17-5.41 P=0.02],PH(OR=2.07;95%CI:1.11-3.86;P=0.02),DD(OR:2.47;95%CI:1.29-4.73;P=0.006),and dyslipidemia(OR=1.94;95%CI:1.07-3.53;P=0.03).Predictors for LVSD included patients with DD(OR=3.3,95%CI:1.41-7.81;P=0.006)and a family history of coronary artery disease(OR=4.50,95%CI:1.33-15.20;P=0.015).Peritoneal dialysis was an independent predictor for DD(OR=10.03;95%CI:1.71-58.94,P=0.011).The presence of LVH(OR=3.32,95%CI:1.05-10.55,P=0.04)and mild to moderate or moderate to severe mitral regurgitation(OR=4.63,95%CI:1.45-14.78,P=0.01)were significant factors associated with PH.These abnormalities had no significant impact on estimated glomerular filtration at discharge,6 months,1 year,or 2 years post-transplant.CONCLUSION Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance,although they don’t affect future graft function.Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre-and post-transplant to achieve better outcomes.展开更多
BACKGROUND This case report describes a protocol developed by Danaun Medical Clinic for the introduction of a pioneering intervention comprising intravenous human placen-tal extract(HPE)therapy to improve the liver fu...BACKGROUND This case report describes a protocol developed by Danaun Medical Clinic for the introduction of a pioneering intervention comprising intravenous human placen-tal extract(HPE)therapy to improve the liver function of patients with chronic liver disease(CLD).CASE SUMMARY This study involved data from patients whose chief complaint was reduced quality of life attributable to CLD.The new treatment approach resulted in improvements in the liver function and fatty liver of 30 patients with CLD.Im-provements were observed using abdominal ultrasonography.Unlike traditional methods,this protocol provided more sustainable and meaningful results.Treat-ment with 10 mL of HPE administered intravenously once or twice per week significantly improved liver function.The observed improvements in fatty liver and liver function suggest the utility of this approach for the management of patients with CLD.CONCLUSION This case series highlights the potential of innovative treatments for patients with CLD that could improve the quality of life of the patients.展开更多
The recent study exploring the bidirectional associations between gallstone disease,non-alcoholic fatty liver disease,and kidney stone disease highlights a critical concern in chronic disease management.Given the risi...The recent study exploring the bidirectional associations between gallstone disease,non-alcoholic fatty liver disease,and kidney stone disease highlights a critical concern in chronic disease management.Given the rising global prevalence of these conditions,understanding their interconnections is essential.The study emphasizes the importance of shared risk factors,such as obesity,type 2 diabetes,dyslipidemia,and oxidative stress,and calls for multidisciplinary screening strategies.This approach would improve patient outcomes and reduce the socio-economic burden.While the study contributes valuable insights from a Chinese population,further research across diverse populations is necessary to validate and extend these findings globally.Ultimately,the research underscores the need for integrated prevention programs to better manage these interconnected diseases and improve health outcomes.展开更多
BACKGROUND Growing evidence supports a genetic link between non-alcoholic fatty liver disease(NAFLD)and chronic kidney disease(CKD).Interesting data demonstrated that both the major NAFLD risk polymorphisms such as th...BACKGROUND Growing evidence supports a genetic link between non-alcoholic fatty liver disease(NAFLD)and chronic kidney disease(CKD).Interesting data demonstrated that both the major NAFLD risk polymorphisms such as the I148M polymorphism in the patatin like phospholipase containing domain 3(PNPLA3)and the E167K allele in the transmembrane 6 superfamily member 2 gene(TM6SF2)affect renal function.Recently the hydroxysteroid 17-beta dehydrogenase 13(HSD17B13)gene has been recognized as a novel genetic variant involved in NAFLD pathophysiology.In particular,it has been showed the protective effect of the rs72613567:TA variant of this gene against liver damage both in adults and children.AIM To investigate the impact of the rs72613567:TA variant of the HSD17B13 gene on estimated glomerular filtration rate(eGFR)in obese children.METHODS We enrolled 684 obese children(mean age 10.56±2.94 years;mean BMI-SDS 2.98±0.78)consecutively attending our Obesity Clinic.All the patients underwent a careful clinical assessment and a comprehensive biochemical evaluation.To detect hepatic steatosis,a liver ultrasound was performed.NAFLD was defined by ultrasound detected liver steatosis and/or alanine aminotransferase(ALT)levels>40 IU/L.The study population was divided on the basis of the NAFLD presence.Genotyping for the rs72613567:TA variant of the HSD17B13 gene in all the enrolled subjects was also made.RESULTS Patients carrying the HSD17B13 rare A allele showed higher eGFR levels compared with homozygous patients both among subjects with and without NAFLD.A general linear model confirmed a direct and significant association of eGFR values with HSD17B13 genotype independently of PNPLA3 and TM6SF2 polymorphisms both in patients with and without NAFLD.A comparison of regression line confirmed the influence of HSD17B13 genotype on the relationship between eGFR and age both among patients with and without NAFLD.H omozygous patients for HSD17B13 genotype with NAFLD showed a significantly higher decline of eGFR with the increase of the age compared with the patients with NAFLD carrying the HSD17B13 rare A allele(P value for intercepts=0.005;P value for slopes=0.94).The same effect was observed among patients without NAFLD(P value for intercepts=0.0012;P value for slopes=0.87).CONCLUSION Carriers of the HSD17B13 rare A allele showed higher eGFR levels than homozygous subjects both among subjects with and without NAFLD and independently of PNPLA3 I148M and TM6SF6 E167K polymorphisms.展开更多
Objective Rheumatoid arthritis(RA)is a systemic autoimmune disease that affects the small joints of the whole body and degrades the patients’quality of life.Zhengqing Fengtongning(ZF)is a traditional Chinese medicine...Objective Rheumatoid arthritis(RA)is a systemic autoimmune disease that affects the small joints of the whole body and degrades the patients’quality of life.Zhengqing Fengtongning(ZF)is a traditional Chinese medicine preparation used to treat RA.ZF may cause liver injury.In this study,we aimed to develop a prediction model for abnormal liver function caused by ZF.Methods This retrospective study collected data from multiple centers from January 2018 to April 2023.Abnormal liver function was set as the target variable according to the alanine transaminase(ALT)level.Features were screened through univariate analysis and sequential forward selection for modeling.Ten machine learning and deep learning models were compared to find the model that most effectively predicted liver function from the available data.Results This study included 1,913 eligible patients.The LightGBM model exhibited the best performance(accuracy=0.96)out of the 10 learning models.The predictive metrics of the LightGBM model were as follows:precision=0.99,recall rate=0.97,F1_score=0.98,area under the curve(AUC)=0.98,sensitivity=0.97 and specificity=0.85 for predicting ALT<40 U/L;precision=0.60,recall rate=0.83,F1_score=0.70,AUC=0.98,sensitivity=0.83 and specificity=0.97 for predicting 40≤ALT<80 U/L;and precision=0.83,recall rate=0.63,F1_score=0.71,AUC=0.97,sensitivity=0.63 and specificity=1.00 for predicting ALT≥80 U/L.ZF-induced abnormal liver function was found to be associated with high total cholesterol and triglyceride levels,the combination of TNF-αinhibitors,JAK inhibitors,methotrexate+nonsteroidal anti-inflammatory drugs,leflunomide,smoking,older age,and females in middle-age(45-65 years old).Conclusion This study developed a model for predicting ZF-induced abnormal liver function,which may help improve the safety of integrated administration of ZF and Western medicine.展开更多
This article discusses the recent study written by Koizumi et al.Alcohol-associated liver disease(ALD)is a major cause of liver-related morbidity and mortality,which is driven by complex mechanisms,including lipid acc...This article discusses the recent study written by Koizumi et al.Alcohol-associated liver disease(ALD)is a major cause of liver-related morbidity and mortality,which is driven by complex mechanisms,including lipid accumulation,apoptosis,and inflammatory responses exacerbated by gut barrier dysfunction.The study explored the therapeutic potential of elafibranor,a dual peroxisome proliferatoractivated receptor alpha/delta agonist.In clinical trials,elafibranor has shown promise for the treatment of other liver conditions;however,its effects on ALD remain unclear.The authors’findings indicate that elafibranor significantly reduced liver fibrosis and enhanced gut barrier integrity in patients with ALD.These positive effects of elafibranor are mediated through multiple pathways.Elafibranor promotes lipid metabolism,reduces oxidative stress,and inhibits inflammatory responses by restoring gut barrier function.Specifically,it improves hepatocyte function by enhancing autophagic and antioxidant capacity,and it mitigates inflammation by suppressing the lipopolysaccharide/toll-like receptor 4/nuclear factor kappa B signaling pathway.These findings indicate that elafibranor has promising clinical applications.In addition,the study highlights elafibranor’s potential as a therapeutic agent for liver diseases,particularly ALD.This article underscores the importance of understanding the mechanistic pathways underlying ALD and suggests directions for future research aimed at elucidating the benefits and limitations of elafibranor.展开更多
The recently proposed nomenclature change from non-alcoholic fatty liver disease to metabolic dysfunction-associated fatty liver disease(MAFLD)has resulted in the reappraisal of epidemiological trends and associations...The recently proposed nomenclature change from non-alcoholic fatty liver disease to metabolic dysfunction-associated fatty liver disease(MAFLD)has resulted in the reappraisal of epidemiological trends and associations with other chronic diseases.In this context,MAFLD appears to be tightly linked to incident chronic kidney disease(CKD).This association may be attributed to multiple shared risk factors including type 2 diabetes mellitus,arterial hypertension,obesity,dyslipidemia,and insulin resistance.Moreover,similarities in their molecular pathophysiologic mechanisms can be detected,since inflammation,oxidative stress,fibrosis,and gut dysbiosis are highly prevalent in these pathologic states.At the same time,lines of evidence suggest a genetic predisposition to MAFLD due to gene polymorphisms,such as the PNPLA3 rs738409 G allele polymorphism,which may also propagate renal dysfunction.Concerning their management,available treatment considerations for obesity(bariatric surgery)and novel antidiabetic agents(glucagon-like peptide 1 receptor agonists,sodiumglucose co-transporter 2 inhibitors)appear beneficial in preclinical and clinical studies of MAFLD and CKD modeling.Moreover,alternative approaches such as melatonin supplementation,farnesoid X receptor agonists,and gut microbiota modulation may represent attractive options in the future.With a look to the future,additional adequately sized studies are required,focusing on preventing renal complications in patients with MAFLD and the appropriate management of individuals with concomitant MAFLD and CKD.展开更多
BACKGROUND Propolis and honey are known for their antioxidant,hypoglycemic,and antiproteinuric effects.AIM To explore the effect of propolis,and honey,against D-glucose-induced hyperglycemia,acute kidney injury(AKI),l...BACKGROUND Propolis and honey are known for their antioxidant,hypoglycemic,and antiproteinuric effects.AIM To explore the effect of propolis,and honey,against D-glucose-induced hyperglycemia,acute kidney injury(AKI),liver injury,dyslipidemia,and changes in the oxidants and antioxidants in renal,hepatic,and pancreatic tissues.METHODS The chemical analysis and antioxidant content of propolis and honey and their effect on alpha-amylase and alpha-glucosidase activity were studied.The study included five groups of male rats;four groups(2,3,4 and 5)were treated with Dglucose,and one group was untreated,group 1.In addition to D-glucose,groups 3,4,and 5 were treated with propolis,honey,and their combination,respectively.Blood glucose levels,liver and renal function tests,urine protein and electrolytes,oxidant and antioxidant parameters,and histopathological changes in hepatic,renal,and pancreatic tissues were examined.RESULTS Propolis contains a higher level of total protein and exhibits a higher antioxidant activity.Honey has a higher alpha-amylase and glucosidase inhibitory activity than propolis.D-glucose caused a significant elevation of blood glucose,insulin,homeostasis model assessment,blood urea,creatinine,lipid parameters,liver enzymes,and urine protein levels.It significantly increases malondialdehyde and decreases antioxidant parameters in pancreatic,hepatic,and renal tissues.D-glucose caused histopathological changes in hepatic,renal,and pancreatic tissues;these changes were significantly ameliorated by honey and propolis.CONCLUSION Propolis,honey,or their combination treated hyperglycemia,AKI,proteinuria,liver injury,and dyslipidemia induced by D-glucose,most likely,through their antioxidant activity and alpha-amylase and alpha-glucosidase inhibitory activity.This will pave the way for testing this natural combination in the prevention of diabetic complications,as a complement to basic therapies.展开更多
BACKGROUND Tacrolimus is a key immunosuppressive agent used to prevent allograft rejection in kidney transplant recipients.Due to its narrow therapeutic index,careful monitoring is essential to avoid adverse effects,p...BACKGROUND Tacrolimus is a key immunosuppressive agent used to prevent allograft rejection in kidney transplant recipients.Due to its narrow therapeutic index,careful monitoring is essential to avoid adverse effects,particularly neurotoxicity and nephrotoxicity.Hepatic metabolism is an important part of tacrolimus pharmacokinetics.This case report highlights the impact of liver resection on tacrolimus pharmacokinetics in a kidney transplant recipient.CASE SUMMARY A 61-year-old male with end-stage kidney disease underwent a living-unrelated donor kidney transplant at age 46 and has maintained a stable tacrolimus regimen for 15 years.He was later diagnosed with hepatocellular carcinoma and underwent an open wedge liver resection.Despite stable preoperative tacrolimus levels,he developed acute kidney injury and neurotoxicity(manifested as new-onset tremors and headache)postoperatively.Tacrolimus levels rose from 3.4 ng/mL before surgery to 19.5 ng/mL postoperatively,despite no changes in dosage.This increase was most likely due to reduced liver mass and function following resection,in addition to ischemic injury of the remaining liver parenchyma,leading to impaired drug metabolism and acute toxicity.Liver function tests showed transient abnormalities postoperatively,with transaminase levels peaking at 30 times the normal range before gradually returning to normal,coinciding with the decline in tacrolimus levels.The patient’s symptoms and acute kidney injury improved as tacrolimus concentration returned to normal.CONCLUSION This is the first reported case of acute tacrolimus neurotoxicity and nephrotoxicity in a kidney transplant recipient following liver resection.It highlights the critical need for vigilant therapeutic drug monitoring of tacrolimus after liver surgery to prevent severe adverse effects.展开更多
BACKGROUND Insulin resistance is a cardiometabolic risk factor characterized by elevated insulin levels.It is associated with fatty liver disease and elevated liver function tests(LFT)in cross-sectional studies,but da...BACKGROUND Insulin resistance is a cardiometabolic risk factor characterized by elevated insulin levels.It is associated with fatty liver disease and elevated liver function tests(LFT)in cross-sectional studies,but data from cohort studies are scarce.AIM To investigate the association between insulin and pathological LFT,liver disease,and cirrhosis in a populationbased retrospective cohort study.METHODS Anthropometric and cardiometabolic factors of 857 men and 1228 women from prospective cohort studies were used.LFT were obtained at two time points 8 years to 24 years after baseline.Liver disease diagnoses were obtained from nationwide registries.The association between insulin levels and the development of elevated LFT or liver disease and cirrhosis was analyzed.RESULTS Total follow-up was 54054 person-years for women and 27556 person-years for men.Insulin levels were positively correlated with elevated LFT during follow-up,whereas physical activity and coffee consumption were negatively correlated.Individuals with both insulin levels in the upper tertile and alcohol consumption above MASLD thresholds had an increased risk for both liver disease,adjusted hazard ratio(aHR)of 4.3(95%CI:1.6-14.6)and cirrhosis(aHR=4.8,95%CI:1.6-14.6).CONCLUSION This population-based study provides evidence that high insulin levels are a risk factor for development of elevated liver enzymes and clinically manifest liver disease.The results support the concept of metabolic dysfunction associated liver disease.展开更多
BACKGROUND Kidney disease is a common complication in liver transplant(LT)recipients,contributing to substantial morbidity and mortality.Calcineurin inhibitors are associated with short-and long-term decline in kidney...BACKGROUND Kidney disease is a common complication in liver transplant(LT)recipients,contributing to substantial morbidity and mortality.Calcineurin inhibitors are associated with short-and long-term decline in kidney function.AIM To assess how changes in immunosuppression over three decades have impacted the evolution of renal function in the first year post-LT.METHODS This single-center,observational,retrospective study was conducted in a tertiary hospital in Madrid.Adult patients who received a first LT in our center from 1987 to 2019 were included.Patients with simultaneous or prior transplantation of another organ and patients who required re-transplantation,or were lost to follow-up or died during the first year after transplantation were excluded.The development of chronic kidney disease(CKD)pre-transplant or at the first year after LT was analyzed.RESULTS A total of 594 patients(median age:52.9 years,25th-75th percentiles=45-59.08 years;29.3%female)were included.At 1 year post-transplant,290(48.82%)patients had developed CKD.Older age[odds ratio(OR)=1.03,95%CI:1.01-1.05],female sex(OR=1.88,95%CI:1.23-2.89),pre-transplant renal dysfunction(RD)(OR=2.69,95%CI:1.58-4.58),and treatment with cyclosporine A(CsA)(OR=3.77,95%CI:2.45-5.78)were independent risk factors for CKD at 1 year after LT.In patients treated with tacrolimus(Tac)(n=375),the combination of basiliximab and mycophenolic acid(MPA)resulted in decreased Tac blood levels(P<0.001);additionally,MPA was associated with a lower incidence of RD in the first year(P=0.016).CONCLUSION Age,female sex,pre-transplant RD,and CsA are associated with increased risk of CKD within 1 year after LT.Addition of MPA to Tac is associated with lower RD incidence.展开更多
Objective:To study the clinical value of combined detection of blood lipids,blood glucose,and liver function in non-alcoholic fatty liver disease.Methods:105 patients with non-alcoholic fatty liver disease treated in ...Objective:To study the clinical value of combined detection of blood lipids,blood glucose,and liver function in non-alcoholic fatty liver disease.Methods:105 patients with non-alcoholic fatty liver disease treated in our hospital from May 2022 to July 2024 were selected as the research subjects.All patients underwent a B-ultrasound examination.According to the severity of the disease,they were divided into group A(mild,n=35),group B(moderate,n=44),and group C(severe,n=26).Another 30 healthy residents who came to the hospital for physical examination during the same period were selected as group D.The differences in blood lipids,blood glucose,and liver function indicators between groups were compared.Results:The triglyceride(TG),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL)levels in groups A,B,and C were higher than those in group D,while the high-density lipoprotein cholesterol(HDL)level was lower(P<0.05).The fasting plasma glucose(FPG)levels in groups B and C were higher than those in group D(P<0.05).The TG,LDL,and FPG levels in groups B and C were higher than those in group A(P<0.05).The TC level in group C was higher than that in group A,while the HDL level was lower(P<0.05).The TC and FPG levels in group C were higher than those in group B(P<0.05).The total bilirubin(TBil),aspartate aminotransferase(AST),and alanine aminotransferase(ALT)levels in groups A,B,and C were higher than those in group D(P<0.05).The TBil and ALT levels in groups B and C were higher than those in group A(P<0.05).The AST level in group C was higher than that in group A(P<0.05).The AST and ALT levels in group C were higher than those in group B(P<0.05).Conclusion:Patients with non-alcoholic fatty liver disease have disordered glucose and lipid metabolism.Blood lipids,blood glucose,and liver function are closely related to the severity of the disease.Strengthening exercise and dietary intervention early on can help control the progression of simple fatty liver disease and reduce the risk of severe liver diseases such as steatohepatitis and cirrhosis.展开更多
BACKGROUND Acute kidney injury(AKI)is a frequent complication after liver transplantation(LT).How to realize the early diagnosis of AKI,perform active intervention,and reduce the mortality of post-LT patients is an ur...BACKGROUND Acute kidney injury(AKI)is a frequent complication after liver transplantation(LT).How to realize the early diagnosis of AKI,perform active intervention,and reduce the mortality of post-LT patients is an urgent problem to be solved.AIM To investigate the accuracy of hepatorenal index(HRI)and renal resistive index(RRI)in monitoring of early AKI after LT.METHODS This observational study included adult deceased-donor LT recipients at our center between February 2022 and February 2023 with no preoperative renal dysfunction.The HRI and RRI were recorded once per day in the postoperative period through to postoperative day(POD)7.We followed up with the patients at 1 month after LT.The patients were divided into the AKI and non-AKI groups according to the Kidney Disease Improving Global Outcomes criteria.RESULTS Of 121 patients were included in the study(mean age:50.18±8.88years;female:17.36%).AKI developed in 53 patients(43.80%).The AKI and non-AKI groups were similar in terms of their baseline characteristics.An HRI of≤1.12 on POD 1 detected AKI with a sensitivity of 62.30%and a specificity of 87.80%[area under the receiver operating characteristic curve(AUC)=0.801,P<0.01].An RRI of≥0.65 on POD 1 detected AKI with a sensitivity of 87.80%and a specificity of 67.60%(AUC=0.825,P<0.01).The HRI combined with the RRI was more effective at detecting AKI than either the HRI or RRI alone(AUC=0.890,P<0.01).The HRI increased as AKI resolved while the RRI decreased as AKI resolved.CONCLUSION The HRI and RRI are non-invasive bedside indices that can identify the occurrence and recovery of early AKI after LT.展开更多
BACKGROUND Autoimmune liver diseases,including primary biliary cholangitis(PBC),autoi-mmune hepatitis(AIH),and their overlap syndrome(OS),involve immune-mediated liver injury,with OS occurring in 1.2%-25%of PBC patien...BACKGROUND Autoimmune liver diseases,including primary biliary cholangitis(PBC),autoi-mmune hepatitis(AIH),and their overlap syndrome(OS),involve immune-mediated liver injury,with OS occurring in 1.2%-25%of PBC patients.OS carries a higher risk of cirrhosis,hepatocellular carcinoma,and reduced survival.While its pathogenesis remains unclear,gut microbiota dysbiosis and serum metabolite alterations may play key roles.This study uses 16S rRNA sequencing and liquid chromatography-mass spec-trometry(LC-MS)metabolomics to compare gut microbiota and serum metabolites among PBC,AIH,and OS patients,and explores their associations with liver function.AIM To differentiate OS from PBC and AIH based on gut microbiota,serum metabolites,and liver function.METHODS Gut microbiota profiles were analyzed using 16S rRNA sequencing,while untargeted serum metabolomics was conducted via LC-MS.Comparative analyses were performed to identify differences in microbial composition and serum metabolite levels among PBC,AIH,and OS groups.Correlation analyses and network visualization tech-niques were applied to elucidate the interactions among liver function parameters,gut microbiota,and serum metabolites in OS patients.RESULTS Compared to patients with PBC or AIH,OS patients demonstrated significantly reduced microbial diversity and richness.Notable taxonomic shifts included decreased abundances of Firmicutes,Bacteroidetes,and Actinobacteria,alongside increased levels of Proteobacteria and Verrucomicrobia.Distinct serum metabolites,such as pentadecanoic acid and aminoimidazole carboxamide ribonucleotide,were identified in OS patients.Correlation analysis revealed that aspartate aminotransferase(AST)levels were negatively associated with the bacterial genus Fusicatenibacter and the metabolite L-Tyrosine.A microbial-metabolite network diagram further confirmed a strong association between Fusicatenibacter and L-Tyrosine in OS patients.CONCLUSION OS patients show decreased gut microbiota diversity and unique serum metabolites.Multi-omics linked AST,Fusicatenibacter,and L-Tyrosine,revealing OS mechanisms and diagnostic potential.展开更多
Liver-directed therapies such as resection,ablation,and embolization offer potentially curative options for patients with primary and metastatic liver tumors as part of multidisciplinary oncology care.However,these tr...Liver-directed therapies such as resection,ablation,and embolization offer potentially curative options for patients with primary and metastatic liver tumors as part of multidisciplinary oncology care.However,these treatments pose significant hepatic decompensation risks,particularly with underlying liver disease and chemotherapy-associated steatohepatitis.Accurate assessment of liver function and portal hypertension(PH)is critical for candidate selection.While Child-Pugh score and model for end-stage liver disease are commonly used,they have substantial limitations.Hepatic venous pressure gradient(HVPG)measurement remains the gold standard for assessing PH but is invasive and not widely available.Endoscopic ultrasound(EUS)guided portal pressure gradient(PPG)measurement has emerged as a promising minimally invasive alternative.EUSPPG demonstrates excellent technical success rates,safety profile,and correlation with HVPG in early studies.By providing direct portal pressure measurement,EUS-PPG offers several advantages over existing methods for prognostication and risk stratification prior to liver-directed therapies,particularly in detecting presinusoidal hypertension.Furthermore,it has potential applications in assessing response to neoadjuvant treatments and guiding adjuvant therapies.However,research is needed to validate its predictive performance and cost-effectiveness in larger prospective cohorts and to establish its accuracy compared to non-invasive assessment of liver function.展开更多
The recent article by Jiang et al published in World Journal of Gastroenterology reports substantial bidirectional associations between gallstone disease(GSD),non-alcoholic fatty liver disease(NAFLD),and kidney stone ...The recent article by Jiang et al published in World Journal of Gastroenterology reports substantial bidirectional associations between gallstone disease(GSD),non-alcoholic fatty liver disease(NAFLD),and kidney stone disease(KSD),based on multicenter cross-sectional studies and a systematic review with meta-analysis.While the findings have the potential to significantly impact clinical and pre-ventive strategies,several methodological issues merit closer examination.This letter critiques key aspects of the study,including sample population hetero-geneity,potential confounding variables,and the reliance on cross-sectional data that may limit causal inferences.We also discuss the generalizability of these results to broader populations given the study's focus on the Chinese demogra-phic.By addressing these concerns,we suggest a more nuanced interpretation of the associations between GSD,NAFLD,and KSD,advocating for longitudinal studies to validate these findings and enhance their applicability in global health contexts.展开更多
BACKGROUND:Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology.We aimed to investigate the relationships between liver fu...BACKGROUND:Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology.We aimed to investigate the relationships between liver function indicators at hospital admission and mortality in children receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO)support following cardiac surgery.METHODS:We retrospectively analysed the clinical data of pediatric patients who received postcardiotomy VA-ECMO support at Fuwai Hospital between January 2010 and June 2020.Univariable and multivariable-adjusted Cox proportional hazard models were constructed to evaluate the risk factors associated with 30-day and 180-day mortality.The cut-off values for the liver function variables measured at hospital admission were categorized into high and low groups and then compared using Kaplan-Meier survival curves and log-rank tests.RESULTS:Our study included 96 pediatric patients who received VA-ECMO support after cardiotomy.Among the patients receiving VA-ECMO,the 30-day and 180-day mortality rates were 37.5% and 52.1%,respectively.The level of aspartate aminotransferase(AST)at admission was associated with 30-day mortality(hazard ratios[HRs]=1.852,95%CI 1.010-3.398,P=0.046).The AST and alkaline phosphatase(ALP)levels were predictors of 180-day mortality,with adjusted HRs of 1.799(95%CI 1.074-3.014;P=0.025)and 1.384(95%CI 1.050-1.825;P=0.021),respectively.The cut-off value for AST to predict mortality at 30 d was 77 U/L,and that for ALP to predict mortality at 180 d was 269 U/L.CONCLUSION:Liver function indicators,including AST and ALP,at hospital admission are associated with mortality risk in children with congenital heart disease receiving VA-ECMO after cardiac surgery.展开更多
BACKGROUND End-stage renal disease(ESRD)is associated with a multitude of physical,psychological,and social health challenges,including a profound impact on sexual and reproductive health.Among males with ESRD,erectil...BACKGROUND End-stage renal disease(ESRD)is associated with a multitude of physical,psychological,and social health challenges,including a profound impact on sexual and reproductive health.Among males with ESRD,erectile dysfunction(ED)is highly prevalent due to factors such as underlying comorbidities,including diabetes and hypertension,and the physiological effects of long-term dialysis.Kidney transplantation(KTx)has been proposed as a potential intervention to mitigate the effects of ED by restoring renal function and improving hormonal balance.However,the evidence surrounding the effectiveness of KTx in improving sexual function,specifically erectile function(EF),remains inconclusive.This systematic review and meta-analysis aim to evaluate the effects of KTx on sexual dysfunction(SexDys),particularly ED,in male ESRD patients.AIM To evaluate the benefits and potential harms of KTx compared to other forms of renal replacement therapy in improving EF in adult males with ESRD,assessed using the international index of EF(IIEF),to survey the prevalence of SexDys in this population,and to assess the correlation between various factors and SexDys through regression analysis.METHODS A systematic search of PubMed,EMBASE,Cochrane Library,Scopus,Clinical-Trials.gov,and Google Scholar was conducted,following the PRISMA 2020 guidelines.Prospective and retrospective cohort studies,as well as cross-sectional studies assessing EF pre-and post-transplantation,were included.These studies used validated tools such as the IIEF to measure EF.Meta-analyses were performed using a random-effects model to estimate standardized mean differences(SMD)and hazard ratios(HR)with 95%confidence intervals(CI).Heterogeneity was assessed using the I²statistic,and publication bias was evaluated with a funnel plot and the Egger’s test.RESULTS A total of 2419 studies were identified,with 362 abstracts screened and 193 full-text articles reviewed.Ultimately,11 studies were included for qualitative analysis and 7 for quantitative synthesis.The random effects model for SMD yielded a combined estimate of 0.43(95%CI:-0.20-1.07),indicating a small but non-significant improvement in EF post-transplantation.The heterogeneity across studies was substantial(I²=90%),reflecting significant variability in outcomes.Subgroup analysis showed greater improvements in EF among living-donor transplant recipients compared to those receiving organs from deceased donors.Despite this trend,the overall result for changes in EF was not statistically significant(P=0.15).Additionally,the combined HR from the meta-analysis was 2.87(95%CI:1.76-4.69),suggesting that KTx significantly increases the likelihood of improved EF,though variability between studies persisted(I²=63%).CONCLUSION While KTx offers some promise for improving EF in male ESRD patients,the overall evidence remains inconclusive due to high heterogeneity between studies and a lack of statistical significance in the combined results.Despite this,individual studies suggest that KTx may lead to significant improvements in EF for certain subgroups,particularly living-donor recipients.Future research should focus on larger,well-designed cohort studies with standardized outcome measures to provide more definitive conclusions.Addressing SexDys as part of routine care for ESRD patients undergoing KTx is crucial to improving their overall quality of life.However,adjunct therapies such as phosphodiesterase type 5 inhibitors may be necessary for those who do not experience adequate improvements post-transplantation.展开更多
In this letter,we comment on the article by Xuan Yuan et al,published in the recent issue of the World Journal of Gastroenterology.Mixed lineage kinase domainlike protein(MLKL)exhibits cell-type-specific functions in ...In this letter,we comment on the article by Xuan Yuan et al,published in the recent issue of the World Journal of Gastroenterology.Mixed lineage kinase domainlike protein(MLKL)exhibits cell-type-specific functions in liver parenchymal and non-parenchymal cells,playing dual roles in the pathogenesis of liver diseases.In hepatocytes,MLKL primarily mediates necroptosis and inhibits autophagy,thereby exacerbating liver injury.Conversely,in non-parenchymal liver cells,MLKL modulates inflammatory responses and promotes fibrotic processes,thereby driving disease progression.Notably,MLKL also demonstrates protective functions under specific conditions.For instance,MLKL can inhibit intracellular bacterial replication,promote endosomal trafficking,and facilitate the generation and release of extracellular vesicles,potentially exerting hepatoprotective effects.Understanding these cell-type-specific mechanisms of MLKL action,including its dual roles in promoting injury and providing protection,is crucial for elucidating the complex pathogenesis of liver diseases and developing targeted therapeutic strategies.展开更多
BACKGROUND Research has shown that several factors can influence postoperative abnormal liver function;however,most studies on this issue have focused specifically on hepatic and cardiac surgeries,leaving limited rese...BACKGROUND Research has shown that several factors can influence postoperative abnormal liver function;however,most studies on this issue have focused specifically on hepatic and cardiac surgeries,leaving limited research on contributing factors in other types of surgeries.AIM To identify the risk factors for early postoperative abnormal liver function in multiple surgery types and construct a risk prediction model.METHODS This retrospective cohort study involved 3720 surgical patients from 5 surgical departments at Guangdong Provincial Hospital of Traditional Chinese Medicine.Patients were divided into abnormal(n=108)and normal(n=3612)groups based on liver function post-surgery.Univariate analysis and LASSO regression screened variables,followed by logistic regression to identify risk factors.A prediction model was constructed based on the variables selected via logistic re-gression.The goodness-of-fit of the model was evaluated using the Hosm-er–Lemeshow test,while discriminatory ability was measured by the area under the receiver operating characteristic curve.Calibration curves were plotted to visualize the consistency between predicted probabilities and observed outcomes.RESULTS The key factors contributing to abnormal liver function after surgery include elevated aspartate aminotransferase and alanine aminotransferase levels and reduced platelet counts pre-surgery,as well as the sevoflurane use during the procedure,among others.CONCLUSION The above factors collectively represent notable risk factors for postoperative liver function injury,and the prediction model developed based on these factors demonstrates strong predictive efficacy.展开更多
文摘BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pretransplant risk stratification and improving post-transplant outcomes.AIM To determine the prevalence of left ventricular hypertrophy(LVH),left ventricular systolic dysfunction(LVSD),diastolic dysfunction(DD),pulmonary hypertension(PH),and their predictors,and to assess their impact on graft function in pre-transplant candidates.METHODS The study included all successful transplant candidates older than 14 who had a baseline echocardiogram.Binary logistic regression models were constructed to identify factors associated with LVH,LVSD,DD,and PH.RESULTS Out of 259 patients,LVH was present in 64%(166),12%(31)had LVSD,27.5%(71)had DD,and 66(25.5%)had PH.Independent predictors of LVH included male gender[odds ratio(OR):2.51;95%CI:1.17-5.41 P=0.02],PH(OR=2.07;95%CI:1.11-3.86;P=0.02),DD(OR:2.47;95%CI:1.29-4.73;P=0.006),and dyslipidemia(OR=1.94;95%CI:1.07-3.53;P=0.03).Predictors for LVSD included patients with DD(OR=3.3,95%CI:1.41-7.81;P=0.006)and a family history of coronary artery disease(OR=4.50,95%CI:1.33-15.20;P=0.015).Peritoneal dialysis was an independent predictor for DD(OR=10.03;95%CI:1.71-58.94,P=0.011).The presence of LVH(OR=3.32,95%CI:1.05-10.55,P=0.04)and mild to moderate or moderate to severe mitral regurgitation(OR=4.63,95%CI:1.45-14.78,P=0.01)were significant factors associated with PH.These abnormalities had no significant impact on estimated glomerular filtration at discharge,6 months,1 year,or 2 years post-transplant.CONCLUSION Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance,although they don’t affect future graft function.Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre-and post-transplant to achieve better outcomes.
文摘BACKGROUND This case report describes a protocol developed by Danaun Medical Clinic for the introduction of a pioneering intervention comprising intravenous human placen-tal extract(HPE)therapy to improve the liver function of patients with chronic liver disease(CLD).CASE SUMMARY This study involved data from patients whose chief complaint was reduced quality of life attributable to CLD.The new treatment approach resulted in improvements in the liver function and fatty liver of 30 patients with CLD.Im-provements were observed using abdominal ultrasonography.Unlike traditional methods,this protocol provided more sustainable and meaningful results.Treat-ment with 10 mL of HPE administered intravenously once or twice per week significantly improved liver function.The observed improvements in fatty liver and liver function suggest the utility of this approach for the management of patients with CLD.CONCLUSION This case series highlights the potential of innovative treatments for patients with CLD that could improve the quality of life of the patients.
文摘The recent study exploring the bidirectional associations between gallstone disease,non-alcoholic fatty liver disease,and kidney stone disease highlights a critical concern in chronic disease management.Given the rising global prevalence of these conditions,understanding their interconnections is essential.The study emphasizes the importance of shared risk factors,such as obesity,type 2 diabetes,dyslipidemia,and oxidative stress,and calls for multidisciplinary screening strategies.This approach would improve patient outcomes and reduce the socio-economic burden.While the study contributes valuable insights from a Chinese population,further research across diverse populations is necessary to validate and extend these findings globally.Ultimately,the research underscores the need for integrated prevention programs to better manage these interconnected diseases and improve health outcomes.
文摘BACKGROUND Growing evidence supports a genetic link between non-alcoholic fatty liver disease(NAFLD)and chronic kidney disease(CKD).Interesting data demonstrated that both the major NAFLD risk polymorphisms such as the I148M polymorphism in the patatin like phospholipase containing domain 3(PNPLA3)and the E167K allele in the transmembrane 6 superfamily member 2 gene(TM6SF2)affect renal function.Recently the hydroxysteroid 17-beta dehydrogenase 13(HSD17B13)gene has been recognized as a novel genetic variant involved in NAFLD pathophysiology.In particular,it has been showed the protective effect of the rs72613567:TA variant of this gene against liver damage both in adults and children.AIM To investigate the impact of the rs72613567:TA variant of the HSD17B13 gene on estimated glomerular filtration rate(eGFR)in obese children.METHODS We enrolled 684 obese children(mean age 10.56±2.94 years;mean BMI-SDS 2.98±0.78)consecutively attending our Obesity Clinic.All the patients underwent a careful clinical assessment and a comprehensive biochemical evaluation.To detect hepatic steatosis,a liver ultrasound was performed.NAFLD was defined by ultrasound detected liver steatosis and/or alanine aminotransferase(ALT)levels>40 IU/L.The study population was divided on the basis of the NAFLD presence.Genotyping for the rs72613567:TA variant of the HSD17B13 gene in all the enrolled subjects was also made.RESULTS Patients carrying the HSD17B13 rare A allele showed higher eGFR levels compared with homozygous patients both among subjects with and without NAFLD.A general linear model confirmed a direct and significant association of eGFR values with HSD17B13 genotype independently of PNPLA3 and TM6SF2 polymorphisms both in patients with and without NAFLD.A comparison of regression line confirmed the influence of HSD17B13 genotype on the relationship between eGFR and age both among patients with and without NAFLD.H omozygous patients for HSD17B13 genotype with NAFLD showed a significantly higher decline of eGFR with the increase of the age compared with the patients with NAFLD carrying the HSD17B13 rare A allele(P value for intercepts=0.005;P value for slopes=0.94).The same effect was observed among patients without NAFLD(P value for intercepts=0.0012;P value for slopes=0.87).CONCLUSION Carriers of the HSD17B13 rare A allele showed higher eGFR levels than homozygous subjects both among subjects with and without NAFLD and independently of PNPLA3 I148M and TM6SF6 E167K polymorphisms.
基金supported by the Budgeted Fund of Shanghai University of Traditional Chinese Medicine(Natural Science)(No.2021LK037)the Open Project of Qinghai Province Key Laboratory of Tibetan Medicine Pharmacology and Safety Evaluation(No.2021-ZY-03).
文摘Objective Rheumatoid arthritis(RA)is a systemic autoimmune disease that affects the small joints of the whole body and degrades the patients’quality of life.Zhengqing Fengtongning(ZF)is a traditional Chinese medicine preparation used to treat RA.ZF may cause liver injury.In this study,we aimed to develop a prediction model for abnormal liver function caused by ZF.Methods This retrospective study collected data from multiple centers from January 2018 to April 2023.Abnormal liver function was set as the target variable according to the alanine transaminase(ALT)level.Features were screened through univariate analysis and sequential forward selection for modeling.Ten machine learning and deep learning models were compared to find the model that most effectively predicted liver function from the available data.Results This study included 1,913 eligible patients.The LightGBM model exhibited the best performance(accuracy=0.96)out of the 10 learning models.The predictive metrics of the LightGBM model were as follows:precision=0.99,recall rate=0.97,F1_score=0.98,area under the curve(AUC)=0.98,sensitivity=0.97 and specificity=0.85 for predicting ALT<40 U/L;precision=0.60,recall rate=0.83,F1_score=0.70,AUC=0.98,sensitivity=0.83 and specificity=0.97 for predicting 40≤ALT<80 U/L;and precision=0.83,recall rate=0.63,F1_score=0.71,AUC=0.97,sensitivity=0.63 and specificity=1.00 for predicting ALT≥80 U/L.ZF-induced abnormal liver function was found to be associated with high total cholesterol and triglyceride levels,the combination of TNF-αinhibitors,JAK inhibitors,methotrexate+nonsteroidal anti-inflammatory drugs,leflunomide,smoking,older age,and females in middle-age(45-65 years old).Conclusion This study developed a model for predicting ZF-induced abnormal liver function,which may help improve the safety of integrated administration of ZF and Western medicine.
文摘This article discusses the recent study written by Koizumi et al.Alcohol-associated liver disease(ALD)is a major cause of liver-related morbidity and mortality,which is driven by complex mechanisms,including lipid accumulation,apoptosis,and inflammatory responses exacerbated by gut barrier dysfunction.The study explored the therapeutic potential of elafibranor,a dual peroxisome proliferatoractivated receptor alpha/delta agonist.In clinical trials,elafibranor has shown promise for the treatment of other liver conditions;however,its effects on ALD remain unclear.The authors’findings indicate that elafibranor significantly reduced liver fibrosis and enhanced gut barrier integrity in patients with ALD.These positive effects of elafibranor are mediated through multiple pathways.Elafibranor promotes lipid metabolism,reduces oxidative stress,and inhibits inflammatory responses by restoring gut barrier function.Specifically,it improves hepatocyte function by enhancing autophagic and antioxidant capacity,and it mitigates inflammation by suppressing the lipopolysaccharide/toll-like receptor 4/nuclear factor kappa B signaling pathway.These findings indicate that elafibranor has promising clinical applications.In addition,the study highlights elafibranor’s potential as a therapeutic agent for liver diseases,particularly ALD.This article underscores the importance of understanding the mechanistic pathways underlying ALD and suggests directions for future research aimed at elucidating the benefits and limitations of elafibranor.
文摘The recently proposed nomenclature change from non-alcoholic fatty liver disease to metabolic dysfunction-associated fatty liver disease(MAFLD)has resulted in the reappraisal of epidemiological trends and associations with other chronic diseases.In this context,MAFLD appears to be tightly linked to incident chronic kidney disease(CKD).This association may be attributed to multiple shared risk factors including type 2 diabetes mellitus,arterial hypertension,obesity,dyslipidemia,and insulin resistance.Moreover,similarities in their molecular pathophysiologic mechanisms can be detected,since inflammation,oxidative stress,fibrosis,and gut dysbiosis are highly prevalent in these pathologic states.At the same time,lines of evidence suggest a genetic predisposition to MAFLD due to gene polymorphisms,such as the PNPLA3 rs738409 G allele polymorphism,which may also propagate renal dysfunction.Concerning their management,available treatment considerations for obesity(bariatric surgery)and novel antidiabetic agents(glucagon-like peptide 1 receptor agonists,sodiumglucose co-transporter 2 inhibitors)appear beneficial in preclinical and clinical studies of MAFLD and CKD modeling.Moreover,alternative approaches such as melatonin supplementation,farnesoid X receptor agonists,and gut microbiota modulation may represent attractive options in the future.With a look to the future,additional adequately sized studies are required,focusing on preventing renal complications in patients with MAFLD and the appropriate management of individuals with concomitant MAFLD and CKD.
文摘BACKGROUND Propolis and honey are known for their antioxidant,hypoglycemic,and antiproteinuric effects.AIM To explore the effect of propolis,and honey,against D-glucose-induced hyperglycemia,acute kidney injury(AKI),liver injury,dyslipidemia,and changes in the oxidants and antioxidants in renal,hepatic,and pancreatic tissues.METHODS The chemical analysis and antioxidant content of propolis and honey and their effect on alpha-amylase and alpha-glucosidase activity were studied.The study included five groups of male rats;four groups(2,3,4 and 5)were treated with Dglucose,and one group was untreated,group 1.In addition to D-glucose,groups 3,4,and 5 were treated with propolis,honey,and their combination,respectively.Blood glucose levels,liver and renal function tests,urine protein and electrolytes,oxidant and antioxidant parameters,and histopathological changes in hepatic,renal,and pancreatic tissues were examined.RESULTS Propolis contains a higher level of total protein and exhibits a higher antioxidant activity.Honey has a higher alpha-amylase and glucosidase inhibitory activity than propolis.D-glucose caused a significant elevation of blood glucose,insulin,homeostasis model assessment,blood urea,creatinine,lipid parameters,liver enzymes,and urine protein levels.It significantly increases malondialdehyde and decreases antioxidant parameters in pancreatic,hepatic,and renal tissues.D-glucose caused histopathological changes in hepatic,renal,and pancreatic tissues;these changes were significantly ameliorated by honey and propolis.CONCLUSION Propolis,honey,or their combination treated hyperglycemia,AKI,proteinuria,liver injury,and dyslipidemia induced by D-glucose,most likely,through their antioxidant activity and alpha-amylase and alpha-glucosidase inhibitory activity.This will pave the way for testing this natural combination in the prevention of diabetic complications,as a complement to basic therapies.
文摘BACKGROUND Tacrolimus is a key immunosuppressive agent used to prevent allograft rejection in kidney transplant recipients.Due to its narrow therapeutic index,careful monitoring is essential to avoid adverse effects,particularly neurotoxicity and nephrotoxicity.Hepatic metabolism is an important part of tacrolimus pharmacokinetics.This case report highlights the impact of liver resection on tacrolimus pharmacokinetics in a kidney transplant recipient.CASE SUMMARY A 61-year-old male with end-stage kidney disease underwent a living-unrelated donor kidney transplant at age 46 and has maintained a stable tacrolimus regimen for 15 years.He was later diagnosed with hepatocellular carcinoma and underwent an open wedge liver resection.Despite stable preoperative tacrolimus levels,he developed acute kidney injury and neurotoxicity(manifested as new-onset tremors and headache)postoperatively.Tacrolimus levels rose from 3.4 ng/mL before surgery to 19.5 ng/mL postoperatively,despite no changes in dosage.This increase was most likely due to reduced liver mass and function following resection,in addition to ischemic injury of the remaining liver parenchyma,leading to impaired drug metabolism and acute toxicity.Liver function tests showed transient abnormalities postoperatively,with transaminase levels peaking at 30 times the normal range before gradually returning to normal,coinciding with the decline in tacrolimus levels.The patient’s symptoms and acute kidney injury improved as tacrolimus concentration returned to normal.CONCLUSION This is the first reported case of acute tacrolimus neurotoxicity and nephrotoxicity in a kidney transplant recipient following liver resection.It highlights the critical need for vigilant therapeutic drug monitoring of tacrolimus after liver surgery to prevent severe adverse effects.
文摘BACKGROUND Insulin resistance is a cardiometabolic risk factor characterized by elevated insulin levels.It is associated with fatty liver disease and elevated liver function tests(LFT)in cross-sectional studies,but data from cohort studies are scarce.AIM To investigate the association between insulin and pathological LFT,liver disease,and cirrhosis in a populationbased retrospective cohort study.METHODS Anthropometric and cardiometabolic factors of 857 men and 1228 women from prospective cohort studies were used.LFT were obtained at two time points 8 years to 24 years after baseline.Liver disease diagnoses were obtained from nationwide registries.The association between insulin levels and the development of elevated LFT or liver disease and cirrhosis was analyzed.RESULTS Total follow-up was 54054 person-years for women and 27556 person-years for men.Insulin levels were positively correlated with elevated LFT during follow-up,whereas physical activity and coffee consumption were negatively correlated.Individuals with both insulin levels in the upper tertile and alcohol consumption above MASLD thresholds had an increased risk for both liver disease,adjusted hazard ratio(aHR)of 4.3(95%CI:1.6-14.6)and cirrhosis(aHR=4.8,95%CI:1.6-14.6).CONCLUSION This population-based study provides evidence that high insulin levels are a risk factor for development of elevated liver enzymes and clinically manifest liver disease.The results support the concept of metabolic dysfunction associated liver disease.
文摘BACKGROUND Kidney disease is a common complication in liver transplant(LT)recipients,contributing to substantial morbidity and mortality.Calcineurin inhibitors are associated with short-and long-term decline in kidney function.AIM To assess how changes in immunosuppression over three decades have impacted the evolution of renal function in the first year post-LT.METHODS This single-center,observational,retrospective study was conducted in a tertiary hospital in Madrid.Adult patients who received a first LT in our center from 1987 to 2019 were included.Patients with simultaneous or prior transplantation of another organ and patients who required re-transplantation,or were lost to follow-up or died during the first year after transplantation were excluded.The development of chronic kidney disease(CKD)pre-transplant or at the first year after LT was analyzed.RESULTS A total of 594 patients(median age:52.9 years,25th-75th percentiles=45-59.08 years;29.3%female)were included.At 1 year post-transplant,290(48.82%)patients had developed CKD.Older age[odds ratio(OR)=1.03,95%CI:1.01-1.05],female sex(OR=1.88,95%CI:1.23-2.89),pre-transplant renal dysfunction(RD)(OR=2.69,95%CI:1.58-4.58),and treatment with cyclosporine A(CsA)(OR=3.77,95%CI:2.45-5.78)were independent risk factors for CKD at 1 year after LT.In patients treated with tacrolimus(Tac)(n=375),the combination of basiliximab and mycophenolic acid(MPA)resulted in decreased Tac blood levels(P<0.001);additionally,MPA was associated with a lower incidence of RD in the first year(P=0.016).CONCLUSION Age,female sex,pre-transplant RD,and CsA are associated with increased risk of CKD within 1 year after LT.Addition of MPA to Tac is associated with lower RD incidence.
文摘Objective:To study the clinical value of combined detection of blood lipids,blood glucose,and liver function in non-alcoholic fatty liver disease.Methods:105 patients with non-alcoholic fatty liver disease treated in our hospital from May 2022 to July 2024 were selected as the research subjects.All patients underwent a B-ultrasound examination.According to the severity of the disease,they were divided into group A(mild,n=35),group B(moderate,n=44),and group C(severe,n=26).Another 30 healthy residents who came to the hospital for physical examination during the same period were selected as group D.The differences in blood lipids,blood glucose,and liver function indicators between groups were compared.Results:The triglyceride(TG),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL)levels in groups A,B,and C were higher than those in group D,while the high-density lipoprotein cholesterol(HDL)level was lower(P<0.05).The fasting plasma glucose(FPG)levels in groups B and C were higher than those in group D(P<0.05).The TG,LDL,and FPG levels in groups B and C were higher than those in group A(P<0.05).The TC level in group C was higher than that in group A,while the HDL level was lower(P<0.05).The TC and FPG levels in group C were higher than those in group B(P<0.05).The total bilirubin(TBil),aspartate aminotransferase(AST),and alanine aminotransferase(ALT)levels in groups A,B,and C were higher than those in group D(P<0.05).The TBil and ALT levels in groups B and C were higher than those in group A(P<0.05).The AST level in group C was higher than that in group A(P<0.05).The AST and ALT levels in group C were higher than those in group B(P<0.05).Conclusion:Patients with non-alcoholic fatty liver disease have disordered glucose and lipid metabolism.Blood lipids,blood glucose,and liver function are closely related to the severity of the disease.Strengthening exercise and dietary intervention early on can help control the progression of simple fatty liver disease and reduce the risk of severe liver diseases such as steatohepatitis and cirrhosis.
基金Supported by the Clinical+X Scientific Research Project of Affiliated Hospital of Qingdao University,No.QYFY+X202101060Natural Science Foundation of Shandong Province,No.ZR2023MH240.
文摘BACKGROUND Acute kidney injury(AKI)is a frequent complication after liver transplantation(LT).How to realize the early diagnosis of AKI,perform active intervention,and reduce the mortality of post-LT patients is an urgent problem to be solved.AIM To investigate the accuracy of hepatorenal index(HRI)and renal resistive index(RRI)in monitoring of early AKI after LT.METHODS This observational study included adult deceased-donor LT recipients at our center between February 2022 and February 2023 with no preoperative renal dysfunction.The HRI and RRI were recorded once per day in the postoperative period through to postoperative day(POD)7.We followed up with the patients at 1 month after LT.The patients were divided into the AKI and non-AKI groups according to the Kidney Disease Improving Global Outcomes criteria.RESULTS Of 121 patients were included in the study(mean age:50.18±8.88years;female:17.36%).AKI developed in 53 patients(43.80%).The AKI and non-AKI groups were similar in terms of their baseline characteristics.An HRI of≤1.12 on POD 1 detected AKI with a sensitivity of 62.30%and a specificity of 87.80%[area under the receiver operating characteristic curve(AUC)=0.801,P<0.01].An RRI of≥0.65 on POD 1 detected AKI with a sensitivity of 87.80%and a specificity of 67.60%(AUC=0.825,P<0.01).The HRI combined with the RRI was more effective at detecting AKI than either the HRI or RRI alone(AUC=0.890,P<0.01).The HRI increased as AKI resolved while the RRI decreased as AKI resolved.CONCLUSION The HRI and RRI are non-invasive bedside indices that can identify the occurrence and recovery of early AKI after LT.
基金Supported by WBE Liver Foundation,No.WBE20220182022 Young and Middle-aged Talents Incubation Project(Youth Innovation)of Beijing Youan Hospital,Capital Medical University,No.BJYAYY-YN-2022-092023 Young and Middle-aged Talents Incubation Project(Youth Innovation)of Beijing Youan Hospital,Capital Medical University,No.BJYAYYYN2023-14.
文摘BACKGROUND Autoimmune liver diseases,including primary biliary cholangitis(PBC),autoi-mmune hepatitis(AIH),and their overlap syndrome(OS),involve immune-mediated liver injury,with OS occurring in 1.2%-25%of PBC patients.OS carries a higher risk of cirrhosis,hepatocellular carcinoma,and reduced survival.While its pathogenesis remains unclear,gut microbiota dysbiosis and serum metabolite alterations may play key roles.This study uses 16S rRNA sequencing and liquid chromatography-mass spec-trometry(LC-MS)metabolomics to compare gut microbiota and serum metabolites among PBC,AIH,and OS patients,and explores their associations with liver function.AIM To differentiate OS from PBC and AIH based on gut microbiota,serum metabolites,and liver function.METHODS Gut microbiota profiles were analyzed using 16S rRNA sequencing,while untargeted serum metabolomics was conducted via LC-MS.Comparative analyses were performed to identify differences in microbial composition and serum metabolite levels among PBC,AIH,and OS groups.Correlation analyses and network visualization tech-niques were applied to elucidate the interactions among liver function parameters,gut microbiota,and serum metabolites in OS patients.RESULTS Compared to patients with PBC or AIH,OS patients demonstrated significantly reduced microbial diversity and richness.Notable taxonomic shifts included decreased abundances of Firmicutes,Bacteroidetes,and Actinobacteria,alongside increased levels of Proteobacteria and Verrucomicrobia.Distinct serum metabolites,such as pentadecanoic acid and aminoimidazole carboxamide ribonucleotide,were identified in OS patients.Correlation analysis revealed that aspartate aminotransferase(AST)levels were negatively associated with the bacterial genus Fusicatenibacter and the metabolite L-Tyrosine.A microbial-metabolite network diagram further confirmed a strong association between Fusicatenibacter and L-Tyrosine in OS patients.CONCLUSION OS patients show decreased gut microbiota diversity and unique serum metabolites.Multi-omics linked AST,Fusicatenibacter,and L-Tyrosine,revealing OS mechanisms and diagnostic potential.
文摘Liver-directed therapies such as resection,ablation,and embolization offer potentially curative options for patients with primary and metastatic liver tumors as part of multidisciplinary oncology care.However,these treatments pose significant hepatic decompensation risks,particularly with underlying liver disease and chemotherapy-associated steatohepatitis.Accurate assessment of liver function and portal hypertension(PH)is critical for candidate selection.While Child-Pugh score and model for end-stage liver disease are commonly used,they have substantial limitations.Hepatic venous pressure gradient(HVPG)measurement remains the gold standard for assessing PH but is invasive and not widely available.Endoscopic ultrasound(EUS)guided portal pressure gradient(PPG)measurement has emerged as a promising minimally invasive alternative.EUSPPG demonstrates excellent technical success rates,safety profile,and correlation with HVPG in early studies.By providing direct portal pressure measurement,EUS-PPG offers several advantages over existing methods for prognostication and risk stratification prior to liver-directed therapies,particularly in detecting presinusoidal hypertension.Furthermore,it has potential applications in assessing response to neoadjuvant treatments and guiding adjuvant therapies.However,research is needed to validate its predictive performance and cost-effectiveness in larger prospective cohorts and to establish its accuracy compared to non-invasive assessment of liver function.
基金Supported by The National Natural Science Foundation of China,No.82074508Fujian Provincial Natural Science Foundation,No.2023J011627+2 种基金Fujian Provincial Health and Wellness Science and Technology Plan Project,No.2023CXB003Xiamen City Support for the Development of Traditional Chinese Medicine Special TCM Scientific Research Project,No.XWZY-2023-0603The Seventh Batch of National Famous Old Traditional Chinese Medicine Experts Experience Heritage Construction Program of National Administration of TCM,No.76(2022).
文摘The recent article by Jiang et al published in World Journal of Gastroenterology reports substantial bidirectional associations between gallstone disease(GSD),non-alcoholic fatty liver disease(NAFLD),and kidney stone disease(KSD),based on multicenter cross-sectional studies and a systematic review with meta-analysis.While the findings have the potential to significantly impact clinical and pre-ventive strategies,several methodological issues merit closer examination.This letter critiques key aspects of the study,including sample population hetero-geneity,potential confounding variables,and the reliance on cross-sectional data that may limit causal inferences.We also discuss the generalizability of these results to broader populations given the study's focus on the Chinese demogra-phic.By addressing these concerns,we suggest a more nuanced interpretation of the associations between GSD,NAFLD,and KSD,advocating for longitudinal studies to validate these findings and enhance their applicability in global health contexts.
基金supported by the CAMS Innovation Fund for Medical Sciences(2024-12M-C&T-B-045).
文摘BACKGROUND:Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology.We aimed to investigate the relationships between liver function indicators at hospital admission and mortality in children receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO)support following cardiac surgery.METHODS:We retrospectively analysed the clinical data of pediatric patients who received postcardiotomy VA-ECMO support at Fuwai Hospital between January 2010 and June 2020.Univariable and multivariable-adjusted Cox proportional hazard models were constructed to evaluate the risk factors associated with 30-day and 180-day mortality.The cut-off values for the liver function variables measured at hospital admission were categorized into high and low groups and then compared using Kaplan-Meier survival curves and log-rank tests.RESULTS:Our study included 96 pediatric patients who received VA-ECMO support after cardiotomy.Among the patients receiving VA-ECMO,the 30-day and 180-day mortality rates were 37.5% and 52.1%,respectively.The level of aspartate aminotransferase(AST)at admission was associated with 30-day mortality(hazard ratios[HRs]=1.852,95%CI 1.010-3.398,P=0.046).The AST and alkaline phosphatase(ALP)levels were predictors of 180-day mortality,with adjusted HRs of 1.799(95%CI 1.074-3.014;P=0.025)and 1.384(95%CI 1.050-1.825;P=0.021),respectively.The cut-off value for AST to predict mortality at 30 d was 77 U/L,and that for ALP to predict mortality at 180 d was 269 U/L.CONCLUSION:Liver function indicators,including AST and ALP,at hospital admission are associated with mortality risk in children with congenital heart disease receiving VA-ECMO after cardiac surgery.
文摘BACKGROUND End-stage renal disease(ESRD)is associated with a multitude of physical,psychological,and social health challenges,including a profound impact on sexual and reproductive health.Among males with ESRD,erectile dysfunction(ED)is highly prevalent due to factors such as underlying comorbidities,including diabetes and hypertension,and the physiological effects of long-term dialysis.Kidney transplantation(KTx)has been proposed as a potential intervention to mitigate the effects of ED by restoring renal function and improving hormonal balance.However,the evidence surrounding the effectiveness of KTx in improving sexual function,specifically erectile function(EF),remains inconclusive.This systematic review and meta-analysis aim to evaluate the effects of KTx on sexual dysfunction(SexDys),particularly ED,in male ESRD patients.AIM To evaluate the benefits and potential harms of KTx compared to other forms of renal replacement therapy in improving EF in adult males with ESRD,assessed using the international index of EF(IIEF),to survey the prevalence of SexDys in this population,and to assess the correlation between various factors and SexDys through regression analysis.METHODS A systematic search of PubMed,EMBASE,Cochrane Library,Scopus,Clinical-Trials.gov,and Google Scholar was conducted,following the PRISMA 2020 guidelines.Prospective and retrospective cohort studies,as well as cross-sectional studies assessing EF pre-and post-transplantation,were included.These studies used validated tools such as the IIEF to measure EF.Meta-analyses were performed using a random-effects model to estimate standardized mean differences(SMD)and hazard ratios(HR)with 95%confidence intervals(CI).Heterogeneity was assessed using the I²statistic,and publication bias was evaluated with a funnel plot and the Egger’s test.RESULTS A total of 2419 studies were identified,with 362 abstracts screened and 193 full-text articles reviewed.Ultimately,11 studies were included for qualitative analysis and 7 for quantitative synthesis.The random effects model for SMD yielded a combined estimate of 0.43(95%CI:-0.20-1.07),indicating a small but non-significant improvement in EF post-transplantation.The heterogeneity across studies was substantial(I²=90%),reflecting significant variability in outcomes.Subgroup analysis showed greater improvements in EF among living-donor transplant recipients compared to those receiving organs from deceased donors.Despite this trend,the overall result for changes in EF was not statistically significant(P=0.15).Additionally,the combined HR from the meta-analysis was 2.87(95%CI:1.76-4.69),suggesting that KTx significantly increases the likelihood of improved EF,though variability between studies persisted(I²=63%).CONCLUSION While KTx offers some promise for improving EF in male ESRD patients,the overall evidence remains inconclusive due to high heterogeneity between studies and a lack of statistical significance in the combined results.Despite this,individual studies suggest that KTx may lead to significant improvements in EF for certain subgroups,particularly living-donor recipients.Future research should focus on larger,well-designed cohort studies with standardized outcome measures to provide more definitive conclusions.Addressing SexDys as part of routine care for ESRD patients undergoing KTx is crucial to improving their overall quality of life.However,adjunct therapies such as phosphodiesterase type 5 inhibitors may be necessary for those who do not experience adequate improvements post-transplantation.
基金Supported by the Science and Technology Planning Projects of Guizhou Province,No.QKHJC-ZK[2022]YB642Health Research Project of Guizhou Province,No.gzwkj2024-324,and No.gzwkj2024-103+2 种基金WBE Liver Fibrosis Foundation,No.CFHPC2025028Beijing Liver and Gallbladder Mutual Aid Public Welfare Foundation Artificial Liver Special Fund,No.iGandanF-1082024-Rgg018Student Innovation and Entrepreneurship Training Program of Zunyi Medical University,No.S2024106612360.
文摘In this letter,we comment on the article by Xuan Yuan et al,published in the recent issue of the World Journal of Gastroenterology.Mixed lineage kinase domainlike protein(MLKL)exhibits cell-type-specific functions in liver parenchymal and non-parenchymal cells,playing dual roles in the pathogenesis of liver diseases.In hepatocytes,MLKL primarily mediates necroptosis and inhibits autophagy,thereby exacerbating liver injury.Conversely,in non-parenchymal liver cells,MLKL modulates inflammatory responses and promotes fibrotic processes,thereby driving disease progression.Notably,MLKL also demonstrates protective functions under specific conditions.For instance,MLKL can inhibit intracellular bacterial replication,promote endosomal trafficking,and facilitate the generation and release of extracellular vesicles,potentially exerting hepatoprotective effects.Understanding these cell-type-specific mechanisms of MLKL action,including its dual roles in promoting injury and providing protection,is crucial for elucidating the complex pathogenesis of liver diseases and developing targeted therapeutic strategies.
基金Supported by Guangdong Provincial Hospital of Chinese Medicine Science and Technology Research Special Project,No.YN2023WSSQ01State Key Laboratory of Traditional Chinese Medicine Syndrome.
文摘BACKGROUND Research has shown that several factors can influence postoperative abnormal liver function;however,most studies on this issue have focused specifically on hepatic and cardiac surgeries,leaving limited research on contributing factors in other types of surgeries.AIM To identify the risk factors for early postoperative abnormal liver function in multiple surgery types and construct a risk prediction model.METHODS This retrospective cohort study involved 3720 surgical patients from 5 surgical departments at Guangdong Provincial Hospital of Traditional Chinese Medicine.Patients were divided into abnormal(n=108)and normal(n=3612)groups based on liver function post-surgery.Univariate analysis and LASSO regression screened variables,followed by logistic regression to identify risk factors.A prediction model was constructed based on the variables selected via logistic re-gression.The goodness-of-fit of the model was evaluated using the Hosm-er–Lemeshow test,while discriminatory ability was measured by the area under the receiver operating characteristic curve.Calibration curves were plotted to visualize the consistency between predicted probabilities and observed outcomes.RESULTS The key factors contributing to abnormal liver function after surgery include elevated aspartate aminotransferase and alanine aminotransferase levels and reduced platelet counts pre-surgery,as well as the sevoflurane use during the procedure,among others.CONCLUSION The above factors collectively represent notable risk factors for postoperative liver function injury,and the prediction model developed based on these factors demonstrates strong predictive efficacy.
