BACKGROUND Acute variceal bleeding(AVB)in patients with cirrhosis remains life-threatening;moreover,the current risk stratification methods have certain limitations.Rebleeding and mortality after AVB remain major chal...BACKGROUND Acute variceal bleeding(AVB)in patients with cirrhosis remains life-threatening;moreover,the current risk stratification methods have certain limitations.Rebleeding and mortality after AVB remain major challenges.Although preemptive transjugular intrahepatic portosystemic shunt(p-TIPS)can improve outcomes,not all patients benefit equally.Accurate risk stratification is needed to guide treatment decisions and identify those most likely to benefit from p-TIPS.AIM To develop an artificial intelligence(AI)-driven model to guide AVB treatment decisions,and identify candidates eligible for p-TIPS.METHODS Patients with cirrhosis and AVB,from two multicenter retrospective cohorts in China,who received endoscopic variceal ligation plus pharmacotherapy(n=1227)or p-TIPS(n=1863)were included.Baseline data within 24 hours of hospital admission were obtained.The AI-AVB model,based on the six-week failure and one-year mortality rates,was developed to predict treatment efficacy and compared with standard risk scores.Outcomes and adverse events of the treatments were compared across the high-and low-risk subgroups stratified using the AI-AVB model.RESULTS The AI-AVB model demonstrated superior predictive performance compared to traditional risk stratification methods.In the internal validation cohort,the model achieved an area under the curve(AUC)of 0.842 for predicting six-week treatment failure and 0.954 for one-year mortality.In the external validation cohort,the AUCs were 0.814 and 0.889,respectively.The model effectively identified patients at high risk of first-line treatment failure who may benefit from aggressive interventions such as p-TIPS.In contrast,advancing the treatment strategy for low-risk patients did not notably improve the short-term prognosis.CONCLUSION The AI-AVB model can predict treatment outcomes,stratify the failure risk in cirrhotic patients with AVB,aid in clinical decisions,identify p-TIPS beneficiaries,and optimize personalized treatment strategies.展开更多
Background and Aims:This study aimed to determine the performance of the non-invasive score using noncontrastenhanced MRI(CHESS-DIS score)for detecting portal hy-pertension in cirrhosis.Methods:In this international m...Background and Aims:This study aimed to determine the performance of the non-invasive score using noncontrastenhanced MRI(CHESS-DIS score)for detecting portal hy-pertension in cirrhosis.Methods:In this international multicenter,diagnostic study(ClinicalTrials.gov,NCT03766880),patients with cirrhosis who had hepatic venous pressure gradient(HVPG)measurement and noncontrast-enhanced MRI were prospectively recruited from four university hospitals in China(n=4)and Turkey(n=1)between December 2018 and April 2019.A cohort of patients was retrospectively recruited from a university hospital in Italy between March 2015 and November 2017.After segmentation of the liver on fat-suppressed T1-weighted MRI maps,CHESS-DIS score was calculated automatically by an in-house developed code based on the quantification of liver surface nodularity.Results:A total of 149 patients were included,of which 124 were from four Chinese hospitals(training cohort)and 25 were from two international hospitals(validation cohort).A positive correlation between CHESS-DIS score and HVPG was found with the correlation coefficients of 0.36(p<0.0001)and 0.55(p<0.01)for the training and validation cohorts,respectively.The area under the receiver operating characteristic curve of CHESS-DIS score in detection of clinically significant portal hypertension(CSPH)was 0.81 and 0.9 in the training and validation cohorts,respectively.The intra-class correlation coefficients for assessing the inter-and intra-observer agreement were 0.846 and 0.841,respectively.Conclusions:A non-invasive score using noncontrast-enhanced MRI was developed and proved to be significantly correlated with invasive HVPG.Besides,this score could be used to detect CSPH in patients with cirrhosis.展开更多
To the Editor:During the ongoing coronavirus disease 2019(COVID-19)pan-demic globally,patients with chronic liver diseases(CLD),par-ticularly cirrhosis,hepatobiliary malignancies,candidates for liver transplantation(L...To the Editor:During the ongoing coronavirus disease 2019(COVID-19)pan-demic globally,patients with chronic liver diseases(CLD),par-ticularly cirrhosis,hepatobiliary malignancies,candidates for liver transplantation(LT),and immunosuppressed LT recipients appear to be at increased risk of infections,which leads to an increase in mortality[1-6].Apart from physical distancing,quarantine and isolation,vaccination is crucial for the restraining of the epidemic and the protection from severe acute respiratory syndrome coron-avirus 2(SARS-CoV-2)infection and aggravation of COVID-19[7,8].A recent prospective,multicenter,open-label study in China has demonstrated the safety of inactivated whole-virion SARS-CoV-2 vaccines in patients with CLD.展开更多
Tissue engineering(TE)is promising for the regeneration of failed organs.However,immune rejection,shortage of seed cells,and unintegrated blood vessels restrict the development and clinical application of TE.The last ...Tissue engineering(TE)is promising for the regeneration of failed organs.However,immune rejection,shortage of seed cells,and unintegrated blood vessels restrict the development and clinical application of TE.The last factor is the most challenging and intractable.Harnessing the mature blood vessel network in existing dispensable organs could be a powerful approach to effectively overcome the obstacles.After being remodeled to harbor an immunosuppressive and proregenerative niche,these potential target organs can be transformed into other organs with specific physiological functions,compensating the latter's failed native functions.Organ transformation,such as a hepatized spleen,represents an effective and encouraging TE strategy.In this review,we discuss the current development and obstacles of TE and its feasibility and superiority in organ transformation.展开更多
Aims:Patients with liver disease may exhibit higher infection rates and mortality rates from coronavirus disease 2019(COVID-19)than healthy individuals,and vaccination against severe acute respiratory syndrome coronav...Aims:Patients with liver disease may exhibit higher infection rates and mortality rates from coronavirus disease 2019(COVID-19)than healthy individuals,and vaccination against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is an effective prevention strategy.This metaanalysis aimed to assess the effectiveness and safety of SARS-CoV-2 vaccines in patients with chronic liver disease(CLD)and post-liver transplantation(LT).Methods:The PubMed,Embase,and Cochrane databases were searched.A random-effects model meta-analysis was used to determine the seropositivity rates of SARS-CoV-2 antibodies,odds ratio(OR)compared with healthy controls(HC),risk ratio(RR)between the booster and standard vaccination regimen,and the rate of adverse reactions(ADR).Results:In the standard vaccination regimen analysis,17 controlled articles were included for effectiveness analysis,and six articles for ADR analysis.The pooled seropositivity rates of SARS-CoV-2 antibodies in patients with CLD and post-LT were 93.3%(95%confidence interval[CI]:89.0%-97.6%)and 69.1%(95%CI:63.0%-75.3%),respectively.Both rates were lower than those in HC(p<0.001).The differences remained significant after sorting by detection interval,vaccine type,antibody type,or CLD type.LT recipients showed much lower seropositivity rates of antibodies than patients with CLD(69.1%vs.93.3%)or HC(OR:0.055).The pooled total ADR rate of patients was 24.0%(95%CI:16.2%-31.8%).In the booster vaccination regimen analysis,11 prospective studies were enrolled,and the seropositivity rates of antibodies after the booster dose were increased by 27%compared with those of the standard vaccination regimen(RR:1.27,95%CI:1.15-1.41,p<0.001).Conclusion:Patients with CLD and post-LT can gain protection against COVID-19 from standard vaccines,demonstrating a potentially weaker immunogenic response than HC.Booster vaccines can compensate for this deficiency.Therefore,patients with CLD and post-LT should be prioritized for receiving the COVID-19 booster vaccine.展开更多
Nonalcoholic fatty liver disease(NAFLD)has become the most common chronic liver disease worldwide.NAFLD‐related cirrhosis is often complicated by portal hypertension(PHT).Recent evidence showed that portal venous pr...Nonalcoholic fatty liver disease(NAFLD)has become the most common chronic liver disease worldwide.NAFLD‐related cirrhosis is often complicated by portal hypertension(PHT).Recent evidence showed that portal venous pressure(PVP)starts to rise in the early stages of NAFLD,even in absence of advanced fibrosis or cirrhosis.However,the precise pathological mechanisms of this process are still poorly understood.Lipid accumulation,hepatocellular ballooning,sinusoidal endothelial cell dysfunction,capillarization,microthrombosis,increased angiogenesis,and pericellular fibrosis may all be involved in the early development of increased PVP in NAFLD.Direct measurement of PHT is invasive and impractical in noncirrhotic NAFLD individuals and may also underestimate its severity.Thus,the development and validation of noninvasive and more accurate measurements,including new serum biomarkers,scoring models,and imaging techniques(such as ultrasonography,elastography,and magnetic resonance imaging),are urgently needed.Owing to the increasing morbidity,challenges in the prevention and management of PHT in NAFLD are unprecedented.This review article aims to briefly discuss these challenges and summarizes the mechanisms,diagnosis,and emerging therapies for PHT in people with NAFLD.展开更多
基金Supported by Key Research and Development Program of Jiangsu Province,No.BE2023767Xuzhou Key Research and Development Program under Grant,No.KC23273+1 种基金Affiliated Hospital of Xuzhou Medical University,No.2022ZL26Construction Project of High-Level Hospital of Jiangsu Province,No.GSPSJ20240802.
文摘BACKGROUND Acute variceal bleeding(AVB)in patients with cirrhosis remains life-threatening;moreover,the current risk stratification methods have certain limitations.Rebleeding and mortality after AVB remain major challenges.Although preemptive transjugular intrahepatic portosystemic shunt(p-TIPS)can improve outcomes,not all patients benefit equally.Accurate risk stratification is needed to guide treatment decisions and identify those most likely to benefit from p-TIPS.AIM To develop an artificial intelligence(AI)-driven model to guide AVB treatment decisions,and identify candidates eligible for p-TIPS.METHODS Patients with cirrhosis and AVB,from two multicenter retrospective cohorts in China,who received endoscopic variceal ligation plus pharmacotherapy(n=1227)or p-TIPS(n=1863)were included.Baseline data within 24 hours of hospital admission were obtained.The AI-AVB model,based on the six-week failure and one-year mortality rates,was developed to predict treatment efficacy and compared with standard risk scores.Outcomes and adverse events of the treatments were compared across the high-and low-risk subgroups stratified using the AI-AVB model.RESULTS The AI-AVB model demonstrated superior predictive performance compared to traditional risk stratification methods.In the internal validation cohort,the model achieved an area under the curve(AUC)of 0.842 for predicting six-week treatment failure and 0.954 for one-year mortality.In the external validation cohort,the AUCs were 0.814 and 0.889,respectively.The model effectively identified patients at high risk of first-line treatment failure who may benefit from aggressive interventions such as p-TIPS.In contrast,advancing the treatment strategy for low-risk patients did not notably improve the short-term prognosis.CONCLUSION The AI-AVB model can predict treatment outcomes,stratify the failure risk in cirrhotic patients with AVB,aid in clinical decisions,identify p-TIPS beneficiaries,and optimize personalized treatment strategies.
基金the National Natural Science Foundation of China(81830053,82001780)Guangzhou Industry-Academia-Research Collaborative Innovation Major Project(201704020015)+2 种基金Natural Science Foundation of Jiangsu Province of China(BK20200361)President Foundation of Nanfang Hospital,Southern Medical University(2017Z012)Distinguished Young Scholars of Gansu Province(20JR10RA713).
文摘Background and Aims:This study aimed to determine the performance of the non-invasive score using noncontrastenhanced MRI(CHESS-DIS score)for detecting portal hy-pertension in cirrhosis.Methods:In this international multicenter,diagnostic study(ClinicalTrials.gov,NCT03766880),patients with cirrhosis who had hepatic venous pressure gradient(HVPG)measurement and noncontrast-enhanced MRI were prospectively recruited from four university hospitals in China(n=4)and Turkey(n=1)between December 2018 and April 2019.A cohort of patients was retrospectively recruited from a university hospital in Italy between March 2015 and November 2017.After segmentation of the liver on fat-suppressed T1-weighted MRI maps,CHESS-DIS score was calculated automatically by an in-house developed code based on the quantification of liver surface nodularity.Results:A total of 149 patients were included,of which 124 were from four Chinese hospitals(training cohort)and 25 were from two international hospitals(validation cohort).A positive correlation between CHESS-DIS score and HVPG was found with the correlation coefficients of 0.36(p<0.0001)and 0.55(p<0.01)for the training and validation cohorts,respectively.The area under the receiver operating characteristic curve of CHESS-DIS score in detection of clinically significant portal hypertension(CSPH)was 0.81 and 0.9 in the training and validation cohorts,respectively.The intra-class correlation coefficients for assessing the inter-and intra-observer agreement were 0.846 and 0.841,respectively.Conclusions:A non-invasive score using noncontrast-enhanced MRI was developed and proved to be significantly correlated with invasive HVPG.Besides,this score could be used to detect CSPH in patients with cirrhosis.
基金the"Clinic+X"of the Affiliated Hospital of Qingdao University(No.3754)Social Sci-ence Popularization and Application Research Project of Shandong Province(No.2021-SKZC-18).
文摘To the Editor:During the ongoing coronavirus disease 2019(COVID-19)pan-demic globally,patients with chronic liver diseases(CLD),par-ticularly cirrhosis,hepatobiliary malignancies,candidates for liver transplantation(LT),and immunosuppressed LT recipients appear to be at increased risk of infections,which leads to an increase in mortality[1-6].Apart from physical distancing,quarantine and isolation,vaccination is crucial for the restraining of the epidemic and the protection from severe acute respiratory syndrome coron-avirus 2(SARS-CoV-2)infection and aggravation of COVID-19[7,8].A recent prospective,multicenter,open-label study in China has demonstrated the safety of inactivated whole-virion SARS-CoV-2 vaccines in patients with CLD.
基金Fundo para o Desenvolvimento das Ciências e da Tecnologia(the Science and Technology Development Fund,Macao SAR),Grant/Award Number:FDCT 0060/2020/AGJSpanish Ministry of Health–Instituto de Salud Carlos III,Grant/Award Number:FIS PI20/00220+4 种基金Universidade de Macao(the University of Macao Research Committee),Grant/Award Number:MYRG2020‐00084‐ICMSNatural Science Foundation of Jiangsu Province,Grant/Award Number:BK20200318Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung(the Swiss National Science Foundation),Grant/Award Number:310030_185219&320030_189252the Stiftung für Leberkrankheiten(Swiss Liver Foundation)National Natural Science Foundation of China,Grant/Award Numbers:31961160701,31971309,and 32001069。
文摘Tissue engineering(TE)is promising for the regeneration of failed organs.However,immune rejection,shortage of seed cells,and unintegrated blood vessels restrict the development and clinical application of TE.The last factor is the most challenging and intractable.Harnessing the mature blood vessel network in existing dispensable organs could be a powerful approach to effectively overcome the obstacles.After being remodeled to harbor an immunosuppressive and proregenerative niche,these potential target organs can be transformed into other organs with specific physiological functions,compensating the latter's failed native functions.Organ transformation,such as a hepatized spleen,represents an effective and encouraging TE strategy.In this review,we discuss the current development and obstacles of TE and its feasibility and superiority in organ transformation.
基金The National Key R&D Program of China,Grant/Award Number:2020YFC0860900The Emergency Key Program of Guangzhou Laboratory,Grant/Award Number:EKPG21-30-4。
文摘Aims:Patients with liver disease may exhibit higher infection rates and mortality rates from coronavirus disease 2019(COVID-19)than healthy individuals,and vaccination against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is an effective prevention strategy.This metaanalysis aimed to assess the effectiveness and safety of SARS-CoV-2 vaccines in patients with chronic liver disease(CLD)and post-liver transplantation(LT).Methods:The PubMed,Embase,and Cochrane databases were searched.A random-effects model meta-analysis was used to determine the seropositivity rates of SARS-CoV-2 antibodies,odds ratio(OR)compared with healthy controls(HC),risk ratio(RR)between the booster and standard vaccination regimen,and the rate of adverse reactions(ADR).Results:In the standard vaccination regimen analysis,17 controlled articles were included for effectiveness analysis,and six articles for ADR analysis.The pooled seropositivity rates of SARS-CoV-2 antibodies in patients with CLD and post-LT were 93.3%(95%confidence interval[CI]:89.0%-97.6%)and 69.1%(95%CI:63.0%-75.3%),respectively.Both rates were lower than those in HC(p<0.001).The differences remained significant after sorting by detection interval,vaccine type,antibody type,or CLD type.LT recipients showed much lower seropositivity rates of antibodies than patients with CLD(69.1%vs.93.3%)or HC(OR:0.055).The pooled total ADR rate of patients was 24.0%(95%CI:16.2%-31.8%).In the booster vaccination regimen analysis,11 prospective studies were enrolled,and the seropositivity rates of antibodies after the booster dose were increased by 27%compared with those of the standard vaccination regimen(RR:1.27,95%CI:1.15-1.41,p<0.001).Conclusion:Patients with CLD and post-LT can gain protection against COVID-19 from standard vaccines,demonstrating a potentially weaker immunogenic response than HC.Booster vaccines can compensate for this deficiency.Therefore,patients with CLD and post-LT should be prioritized for receiving the COVID-19 booster vaccine.
基金National Natural Science Foundation of China,Grant/Award Number:82070588Agenzia Italiana del Farmaco,Ministero della Salute,Grant/Award Number:RF‐2016‐02364358。
文摘Nonalcoholic fatty liver disease(NAFLD)has become the most common chronic liver disease worldwide.NAFLD‐related cirrhosis is often complicated by portal hypertension(PHT).Recent evidence showed that portal venous pressure(PVP)starts to rise in the early stages of NAFLD,even in absence of advanced fibrosis or cirrhosis.However,the precise pathological mechanisms of this process are still poorly understood.Lipid accumulation,hepatocellular ballooning,sinusoidal endothelial cell dysfunction,capillarization,microthrombosis,increased angiogenesis,and pericellular fibrosis may all be involved in the early development of increased PVP in NAFLD.Direct measurement of PHT is invasive and impractical in noncirrhotic NAFLD individuals and may also underestimate its severity.Thus,the development and validation of noninvasive and more accurate measurements,including new serum biomarkers,scoring models,and imaging techniques(such as ultrasonography,elastography,and magnetic resonance imaging),are urgently needed.Owing to the increasing morbidity,challenges in the prevention and management of PHT in NAFLD are unprecedented.This review article aims to briefly discuss these challenges and summarizes the mechanisms,diagnosis,and emerging therapies for PHT in people with NAFLD.
