Prognostication of compensated advanced chronic liver disease(cACLD)is of paramount importance for the physician-and-patient communication and for rational clinical decisions.The paper published by Dallio et al report...Prognostication of compensated advanced chronic liver disease(cACLD)is of paramount importance for the physician-and-patient communication and for rational clinical decisions.The paper published by Dallio et al reports on red cell distribution width(RDW)/platelet ratio(RPR)as a non-invasive biomarker in predicting decompensation of metabolic dysfunction-associated steatotic liver disease(MASLD)-related cACLD.Differently from other biomarkers and algorithms,RPR is inexpensive and widely available,based on parameters which are included in a complete blood count.RPR is computed on the grounds of two different items,one of which,RDW,mirrors the host’s response to a variety of disease stimuli and is non-specific.The second parameter involved in RPR,platelet count,is more specific and has been used in the hepatological clinic to discriminate cirrhotic from non-cirrhotic chronic liver disease for decades.Cardiovascular disease is the primary cause of mortality among MASLD subjects,followed by extra-hepatic cancers and liver-related mortality.Therefore,MASLD biomarkers should be validated not only in terms of liver-related events but also in the prediction of major adverse cardiovascular events and cardiovascular mortality and extra-hepatic cancers.Adequately sized multi-ethnic confirmatory investigation is required to define the role and significance of RPR in the stratification of MASLD-cACLD.展开更多
BACKGROUND Patients with chronic hepatitis B(CHB)require long-term antiviral therapy.The effects of different antiviral drugs on kidney function are unclear.There is a lack of effective markers for monitoring early re...BACKGROUND Patients with chronic hepatitis B(CHB)require long-term antiviral therapy.The effects of different antiviral drugs on kidney function are unclear.There is a lack of effective markers for monitoring early renal impairment.AIM To investigate the rate of abnormal renal function index and related potential hazards in patients with CHB.METHODS Clinical data of patients with CHB with urinaryβ2-microglobulin(β2-M)detec-tion,including demographic characteristics,hepatitis B virus(HBV)DNA,serum liver function(alanine aminotransferase,aspartate aminotransferase,total bilirubin,direct bilirubin),serum renal function(urea nitrogen,creatinine),blood lipid index(high density lipoprotein,low density lipoprotein,cholesterol,trigly-ceride),liver imaging,and other routine tests were retrospectively collected.The normal level of urinaryβ2-M and estimated glomerular filtration rate(eGFR)is defined as<0.173 mg/L and≥90 mL/min/1.73 m^(2),retrospectively.The pro-portion of patients with abnormal renal function index and related risk factors were analyzed.RESULTS A total of 500 patients with CHB were enrolled;these patients were aged 44.7±10.8 years,67.2%(336/500)were male,57.2%(286/500)were treated with anti-viral drugs,and 52.2%(261/500)had an HBV-related family history.In total,28.8%(144/500)of patients had fatty liver,35.0%(175/500)had liver fibrosis,and 13.2%(66/500)had cirrhosis.The proportion of patients with eGFR<90 mL/min/1.73 m^(2) was 43.2%(216/500),and the abnormal rate of urinaryβ2-M was 56.2%(281/500).There was no significant difference in the abnormal rate of urinaryβ2-M between the untreated group and the antiviral treated group(54.2%vs 57.7%;P=0.25).The abnormal rate ofβ2-M after long-term entecavir treatment(more than 1 year)was 54.6%(89/163).In the treatment group,56.4%(92/163)of patients with eGFR≥90 mL/min/1.73 m^(2) had abnormal urinaryβ2-M.CONCLUSION In patients with CHB,a higher proportion had greater urinaryβ2-M levels than eGFR for renal injury.Male patients should pay more attention to renal function and use antiviral regimens with a renal safety profile.展开更多
BACKGROUND Liver function of chronic hepatitis B(CHB)patients is essentially normal after treatment with antiviral drugs.In rare cases,persistently abnormally elevatedα-fetoprotein(AFP)is seen in CHB patients followi...BACKGROUND Liver function of chronic hepatitis B(CHB)patients is essentially normal after treatment with antiviral drugs.In rare cases,persistently abnormally elevatedα-fetoprotein(AFP)is seen in CHB patients following long-term antiviral treatment.However,in the absence of imaging evidence of liver cancer,a reasonable expla-nation for this phenomenon is still lacking.AIM To explore the causes of abnormal AFP in patients with CHB who were not diag-nosed with liver cancer.METHODS From November 2019 to May 2023,15 patients with CHB after antiviral treatment and elevated AFP were selected.Clinical data and quality indicators related to laboratory testing,imaging data,and pathological data were obtained through inpatient medical records.RESULTS All patients had increased AFP and significantly elevated IgG.Cancer was excluded by imaging examination.Only four patients had elevated alanine ami-notransferase,10 had elevated aspartate aminotransferase,nine had elevated total bilirubin,and two had antinuclear antibodies.The liver biopsy and histopatho-logical examination indicated that 14 patients had rosette,moderate,or higher interfacial inflammation,lymphocyte infiltration,and severe hepatic fibers(11 cases),which was consistent with the pathological features of autoimmune hepa-titis(AIH).After 8-12 week of hormone therapy,the levels of AFP and IgG,and liver function returned to normal(P<0.05).CONCLUSION For patients with CHB and elevated AFP after antiviral treatment,autoimmune hepatitis should be considered.CHB with AIH is clinically insidious and difficult to detect,and prone to progression to cirrhosis.Liver puncture pathological examination should be performed when necessary to confirm diagnosis.展开更多
Cholangiocarcinoma(CCA)is a rare type of cancer which arises from the bile duct epithelium and carries a poor prognosis.One of the main risk factors in the Western world is primary sclerosing cholangitis.Surgical rese...Cholangiocarcinoma(CCA)is a rare type of cancer which arises from the bile duct epithelium and carries a poor prognosis.One of the main risk factors in the Western world is primary sclerosing cholangitis.Surgical resection has traditionally been the only curative treatment but can only be offered to patients with early disease,excluding those with locally advanced disease.Despite initial poor outcomes,liver transplantation(LT)has evolved as a viable treatment for a select group of patients with CCAs that are deemed unresectable.This review aims to explore the evolution of the role of LT in patients with CCA.展开更多
Objective Hepatocellular carcinoma(HCC)is sensitive to ferroptosis,a new form of programmed cell death that occurs in most tumor types.However,the mechanism through which ferroptosis modulates HCC remains unclear.This...Objective Hepatocellular carcinoma(HCC)is sensitive to ferroptosis,a new form of programmed cell death that occurs in most tumor types.However,the mechanism through which ferroptosis modulates HCC remains unclear.This study aimed to investigate the oncogenic role and prognostic value of FANCD2 and provide novel insights into the prognostic assessment and prediction of immunotherapy.Methods Using clinicopathological parameters and bioinformatic techniques,we comprehensively examined the expression of FANCD2 macroscopically and microcosmically.We conducted univariate and multivariate Cox regression analyses to identify the prognostic value of FANCD2 in HCC and elucidated the detailed molecular mechanisms underlying the involvement of FANCD2 in oncogenesis by promoting iron-related death.Results FANCD2 was significantly upregulated in digestive system cancers with abundant immune infiltration.As an independent risk factor for HCC,a high FANCD2 expression level was associated with poor clinical outcomes and response to immune checkpoint blockade.Gene set enrichment analysis revealed that FANCD2 was mainly involved in the cell cycle and CYP450 metabolism.Conclusion To the best of our knowledge,this is the first study to comprehensively elucidate the oncogenic role of FANCD2.FANCD2 has a tumor-promoting aspect in the digestive system and acts as an independent risk factor in HCC;hence,it has recognized value for predicting tumor aggressiveness and prognosis and may be a potential biomarker for poor responsiveness to immunotherapy.展开更多
Objective To investigate chronic hepatitis C virus(HCV)infection's effect on gestational liver function,pregnancy and delivery complications,and neonatal development.Methods A total of 157 HCV antibody-positive(an...Objective To investigate chronic hepatitis C virus(HCV)infection's effect on gestational liver function,pregnancy and delivery complications,and neonatal development.Methods A total of 157 HCV antibody-positive(anti-HCV[+])and HCV RNA(+)patients(Group C)and121 anti-HCV(+)and HCV RNA(-)patients(Group B)were included as study participants,while 142 antiHCV(-)and HCV RNA(-)patients(Group A)were the control group.Data on biochemical indices during pregnancy,pregnancy complications,delivery-related information,and neonatal complications were also collected.Results Elevated alanine aminotransferase(ALT)rates in Group C during early,middle,and late pregnancy were 59.87%,43.95%,and 42.04%,respectively—significantly higher than Groups B(26.45%,15.70%,10.74%)and A(23.94%,19.01%,6.34%)(P<0.05).Median ALT levels in Group C were significantly higher than in Groups A and B at all pregnancy stages(P<0.05).No significant differences were found in neonatal malformation rates across groups(P>0.05).However,neonatal jaundice incidence was significantly greater in Group C(75.16%)compared to Groups A(42.25%)and B(57.02%)(χ^(2)=33.552,P<0.001).HCV RNA positivity during pregnancy was an independent risk factor for neonatal jaundice(OR=2.111,95%CI 1.242–3.588,P=0.006).Conclusions Chronic HCV infection can affect the liver function of pregnant women,but does not increase the pregnancy or delivery complication risks.HCV RNA(+)is an independent risk factor for neonatal jaundice.展开更多
BACKGROUND Although acute pancreatitis and walled-off necrosis(WON)are rare complications following aortic surgery,they are serious risk factors for postoperative mortality.Considering the poor general condition of th...BACKGROUND Although acute pancreatitis and walled-off necrosis(WON)are rare complications following aortic surgery,they are serious risk factors for postoperative mortality.Considering the poor general condition of the postoperative patient,more effective and less invasive treatments are favorable.CASE SUMMARY A 67-year-old man was referred to our hospital for the treatment of WON after acute pancreatitis.He had undergone total aortic arch replacement due to aortic arch aneurysm and coronary artery bypass grafting due to angina pectoris 6 weeks prior in another hospital.On the second postoperative day,laboratory data and computed tomography showed that the patient had developed acute pancreatitis.Although conservative management(antibiotics,hydration,etc.)had helped in relieving the symptoms of acute pancreatitis,peripancreatic fluid collection(PFC)persisted,accompanied by duodenal obstruction and vomiting.Contrastenhanced computed tomography showed that the heterogeneous enhancement and fluid collection in the pancreatic body and tail had increased,consistent with walled-off WON.We therefore performed endoscopic ultrasound-guided transluminal drainage for the PFC.As a result,the WON resolved gradually,resulting in improved oral intake.CONCLUSION Acute pancreatitis is a rare gastrointestinal complication following thoracic and thoracoabdominal aortic aneurysm surgery.To the best of our knowledge,this is the first case of WON after aortic arch surgery treated with endoscopic ultrasound-guided transluminal drainage for PFC.展开更多
Hepatocellular carcinoma remains a significant cause of mortality worldwide,particularly among patients with liver cirrhosis.In most cases,surveillance in cirrhotic patients is neglected,leading to a diagnosis when th...Hepatocellular carcinoma remains a significant cause of mortality worldwide,particularly among patients with liver cirrhosis.In most cases,surveillance in cirrhotic patients is neglected,leading to a diagnosis when the neoplasm is at an advanced stage.Within this context,Zhou et al carried out a network metaanalysis to demonstrate the effectiveness of hepatic arterial infusion chemotherapy,concluding that it is a superior approach compared to sorafenib and transarterial chemoembolization in the treatment of advanced hepatocellular carcinoma.Unfortunately,the meta-analysis in question lacks methodological rigor,preventing the authors from making more definitive assertions.Additionally,we understand that transarterial chemoembolization,when properly indicated,is a highly effective therapeutic option,and that sorafenib,given the results of new therapies based on immune checkpoint inhibitors,is no longer the recommended drug for the treatment of these patients.Therefore,we believe the use of hepatic arterial infusion chemotherapy is increasingly limited and lacks strong scientific support.展开更多
Background:Liver cancer(LC)remains a leading cause of cancer-related mortality worldwide,with current treatments often limited by suboptimal efficacy and adverse effects.Banxia Houpu Decoction(BHD),a traditional Chine...Background:Liver cancer(LC)remains a leading cause of cancer-related mortality worldwide,with current treatments often limited by suboptimal efficacy and adverse effects.Banxia Houpu Decoction(BHD),a traditional Chinese herbal formula,has demonstrated potential anti-tumor properties in clinical practice.However,its precise mechanisms against LC remain unclear.This study employs network pharmacology(NP)and molecular docking(MD)approaches to systematically identify BHD’s active components and their molecular targets,aiming to elucidate its anti-LC mechanisms and provide a scientific basis for further investigation.Methods:We utilized Liquid Chromatography-Mass Spectrometry alongside the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP)to identify the constituents of BHD.We identified potential targets through the utilization of TCMSP,SwissTargetPrediction,Comparative Toxicogenomics Database,and SuperPred Database.Targets linked to LC were obtained from GeneCards,OMIM,the Therapeutic Target Database,and DrugBank.A Venn diagram illustrated the intersection between component and disease targets,while a protein-protein interaction(PPI)network was developed utilizing Cytoscape 3.9.1.Primary targets were discerned through the analysis of centrality metrics,including“Degree,”“Betweenness,”and“Closeness.”The study encompassed analyses of Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathways to clarify the biological roles and pathways associated with these proteins.The essential interactions between the active constituents of BHD and the principal LC targets were investigated through MD using AutoDock software.Results:We identified 34 active components in BHD.The PPI network revealed 212 interaction targets relevant to drug-disease correlations,emphasizing key proteins including Epidermal Growth Factor Receptor(EGFR),Signal Transducer and Activator of Transcription 3(STAT3),Steroid Receptor Coactivator(SRC),Heat Shock Protein 90 Alpha Family Class A Member 1(HSP90AA1),and AKT Serine/Threonine Protein Kinase 1(AKT1).The GO analysis revealed a total of 443 biological processes,94 cellular components,and 182 molecular functions.The KEGG analysis revealed a total of 169 pathways that are involved.The results from MD revealed that the majority of binding energies fell below−7 kcal/mol,indicating strong interactions between the active compounds and their target proteins.Conclusion:Evidence suggests that BHD effectively manages LC through a synergistic mechanism encompassing various components(Magnolol,Chrysoeriol,Cerevisterol,etc.),targets(EGFR,STAT3,SRC,HSP90AA1,AKT1,etc.),and pathways(PI3K-Akt,FoxO,and Ras signaling pathways,etc.).This analysis offers a comprehensive theoretical framework for further investigative and clinical exploration.展开更多
BACKGROUND Deep learning-based super-resolution(SR)reconstruction can obtain high-quality images with more detailed information.AIM To compare multiparametric normal-resolution(NR)and SR magnetic resonance imaging(MRI...BACKGROUND Deep learning-based super-resolution(SR)reconstruction can obtain high-quality images with more detailed information.AIM To compare multiparametric normal-resolution(NR)and SR magnetic resonance imaging(MRI)in predicting the histopathologic grade in hepatocellular carcinoma.METHODS We retrospectively analyzed a total of 826 patients from two medical centers(training 459;validation 196;test 171).T2-weighted imaging,diffusion-weighted imaging,and portal venous phases were collected.Tumor segmentations were conducted automatically by 3D U-Net.Based on generative adversarial network,we utilized 3D SR reconstruction to produce SR MRI.Radiomics models were developed and validated by XGBoost and Catboost.The predictive efficiency was demonstrated by calibration curves,decision curve analysis,area under the curve(AUC)and net reclassification index(NRI).RESULTS We extracted 3045 radiomic features from both NR and SR MRI,retaining 29 and 28 features,respectively.For XGBoost models,SR MRI yielded higher AUC value than NR MRI in the validation and test cohorts(0.83 vs 0.79;0.80 vs 0.78),respectively.Consistent trends were seen in CatBoost models:SR MRI achieved AUCs of 0.89 and 0.80 compared to NR MRI’s 0.81 and 0.76.NRI indicated that the SR MRI models could improve the prediction accuracy by-1.6%to 20.9%compared to the NR MRI models.CONCLUSION Deep learning-based SR MRI could improve the predictive performance of histopathologic grade in HCC.It may be a powerful tool for better stratification management for patients with operable HCC.展开更多
Endocrine disorders frequently lead to metabolic disturbances that significantly affect liver function.Understanding the complex interplay between hormonal imbalances and liver dysfunction is essential for advancing t...Endocrine disorders frequently lead to metabolic disturbances that significantly affect liver function.Understanding the complex interplay between hormonal imbalances and liver dysfunction is essential for advancing targeted therapeutic strategies.This comprehensive review explores the pathophysiological mechanisms linking major endocrine disorders to liver disease,with a focus on the roles of the thyroid,parathyroid,pancreas,adrenal glands,and sex hormones.Thyroid dysfunction is associated with alterations in liver enzyme levels and metabolic regulation,often resulting in hepatic steatosis or cholestasis.Hyperparathyroidism and consequent hypercalcemia have been linked to hepatic calcifications.Insulin resistance,both hepatic and peripheral,contributes to excessive lipid accumulation in the liver,exacerbating steatotic changes.Adrenal gland disorders,particularly in the setting of chronic liver disease,impair cortisol metabolism and may worsen hepatic injury.Additionally,sex hormones such as estrogen and testosterone modulate the progression of liver fibrosis and influence the development of metabolic syndrome.The intricate relationship between endocrine and hepatic systems underscores the need for a multidisciplinary approach in the management of liver disease.Addressing underlying hormonal disturbances may enhance patient outcomes and prevent further hepatic deterioration.Future research should prioritize integrative therapeutic strategies that concurrently target endocrine and liver dysfunction.展开更多
BACKGROUND Noninvasive tests are crucial for the management and follow-up of patients with autoimmune hepatitis,but their validation is limited because of insufficient data.AIM To investigate the diagnostic performanc...BACKGROUND Noninvasive tests are crucial for the management and follow-up of patients with autoimmune hepatitis,but their validation is limited because of insufficient data.AIM To investigate the diagnostic performance of three fibrosis noninvasive tests[FibroTest,vibration-controlled transient elastography(VCTE),and the fibrosis-4 index(FIB-4)and two activity biomarkers(alanine aminotransferase(ALT)and ActiTest].METHODS This study enrolled 103 patients for whom liver biopsy,hepatic elastography results,and laboratory markers were available.Diagnostic performance was assessed with receiver operating characteristic(ROC)curves,the Obuchowski measure(OM),and the Bayesian latent class model.RESULTS FibroTest and VCTE outperformed FIB-4 in cases of significant fibrosis(≥F2),with areas under the ROC curve of 0.83[95%confidence interval(CI):0.73-0.90],0.86(95%CI:0.77-0.92),and 0.71(95%CI:0.60-0.80),respectively.The mean(standard error)OM values were 0.92(0.01),0.93(0.01),and 0.88(0.02)for FibroTest,VCTE,and FIB-4,respectively;FibroTest and VCTE performed comparably,and both were superior to FIB-4(P=0.03 and P=0.005).The areas under the ROC curve values for activity biomarkers were 0.86(95%CI:0.76-0.92)for ActiTest and 0.84(95%CI:0.73-0.90)for ALT(P=0.06).The OM values for ActiTest and ALT were 0.92(0.02)and 0.90(0.02),respectively(P=0.005).CONCLUSION FibroTest and VCTE outperformed FIB-4 according to the OM.FibroTest-ActiTest facilitated the evaluation of both fibrosis and activity.展开更多
BACKGROUND Core-fucosylated low-molecular-weight kininogen(LMWK-Fc)levels are significantly elevated in patients with liver fibrosis and cirrhosis.AIM To assess the value of LMWK-Fc as a diagnostic biomarker for liver...BACKGROUND Core-fucosylated low-molecular-weight kininogen(LMWK-Fc)levels are significantly elevated in patients with liver fibrosis and cirrhosis.AIM To assess the value of LMWK-Fc as a diagnostic biomarker for liver fibrosis.METHODS Our study included 132 healthy people and 132 patients with liver fibrosis.The LMWK-Fc level was measured based on the principle of chemiluminescence.Fibrosis stage and inflammatory activity were assessed by liver biopsy.Comparative analysis between groups and receiver operating characteristic curve analysis were performed.RESULTS LMWK-Fc had an area under the curve of 0.871,which indicates a good level of performance in distinguishing between patients with and without fibrosis.Furthermore,the LMWK-Fc level had a certain correlation with the liver stiffness value,which reached 0.5789.CONCLUSION LMWK-Fc could be used as a non-invasive marker of liver fibrosis.Further studies are needed to evaluate the usefulness of this marker.展开更多
BACKGROUND Endoscopic bilateral biliary drainage is a first line palliative treatment for unresectable malignant hilar biliary obstruction(MHBO)but remains technically challenging.The emergence of self-expandable meta...BACKGROUND Endoscopic bilateral biliary drainage is a first line palliative treatment for unresectable malignant hilar biliary obstruction(MHBO)but remains technically challenging.The emergence of self-expandable metallic stents carried by an ultrathin(6 Fr or smaller)delivery system now permits simultaneous bilateral stent placement.To date,only a few studies have compared this new method with conventional sequential bilateral stenting.AIM To evaluate a possible superiority of simultaneous“side by side”(SBS)biliary drainage in unresectable MHBO.METHODS We identified 135 patients who benefited from bilateral drainage using uncovered self-expandable metallic stents between 2010 and 2023.Among them,62 benefited from simultaneous SBS bilateral drainage between 2017 and 2023,and 73 benefited from sequential bilateral drainage[38 using“stent in stent”(SIS)technique and 35 using SBS technique between 2010 and 2017].RESULTS Technical success was significantly increased in simultaneous drainage compared with sequential drainage(94%vs 75%,P=0.008).However,simultaneous SBS drainage and sequential SIS drainage had a similar technical success(94%vs 95%).We observed no differences regarding clinical success,procedure duration and recurrent biliary obstruction rate.Stent patency was shorter in the SIS group compared with the simultaneous group(103 days vs 144 days).Early adverse events were more frequent in the sequential group(31%vs 21%,P=0.205),with no differences regarding SIS or SBS technique.Technical failure was associated with a higher rate of infectious fatal adverse events(9.5%vs 1.7%,P=0.02).Reintervention after recurrent biliary obstruction seems to be more successful after using SBS rather than SIS techniques(83%vs 75%,P=0.53).CONCLUSION Simultaneous SBS metallic stent placement using an ultra-thin delivery system was technically easier and as efficient as sequential bilateral stenting in unresectable MHBO to achieve bilateral drainage.The SIS procedure remains a good option in unresectable MHBO.展开更多
BACKGROUND The Mac-2 binding protein glycosylated isomer(M2BPGi)is a serum marker for fibrosis that correlates with the fibrosis stages in various liver diseases.AIM To examine the M2BPGi’s threshold for staging fibr...BACKGROUND The Mac-2 binding protein glycosylated isomer(M2BPGi)is a serum marker for fibrosis that correlates with the fibrosis stages in various liver diseases.AIM To examine the M2BPGi’s threshold for staging fibrosis in patients with chronic hepatitis B(CHB),and its changes during treatment.METHODS This was a prospective,longitudinal study.A total of 348 eligible patients were recruited from the Hepatology Department,Medic Medical Center between March 2020 and December 2023.Liver enzyme tests,platelet counts,M2BPGi levels,and FibroScan were conducted at baseline and at 3-month intervals until six months post-treatment.Correlation plots of M2BPGi,FibroScan,and the other parameters were generated.Receiver operating characteristic curves were constructed for M2BPGi and the other parameters to evaluate their performance.RESULTS M2BPGi levels correlated well with FibroScan results and increased as the fibrosis stage advanced.The median M2BPGi levels at the different stages of fibrosis showed statistically significant differences.The cut-off values of M2BPGi for diagnosing significant fibrosis(F≥2),advanced fibrosis(F3),and cirrhosis(F4)were determined to be 1.08,1.4,and 1.52,respectively.In the context of fibrosis regression in CHB patients during the first 6-month of treatment,M2BPGi levels appeared to decrease before this pattern occurred in the FibroScan results.CONCLUSION M2BPGi levels were strongly correlated with FibroScan.M2BPGi can be used to assess liver fibrosis,and to serve as a tool for monitoring fibrosis regression in CHB patients undergoing treatment.展开更多
BACKGROUND Mac-2 binding protein glycosylation isomer(M2BPGi)serves as a marker of activated hepatic stellate cells and as such holds potential as a biomarker for liver fibrosis.In Viet Nam,metabolic dysfunction-assoc...BACKGROUND Mac-2 binding protein glycosylation isomer(M2BPGi)serves as a marker of activated hepatic stellate cells and as such holds potential as a biomarker for liver fibrosis.In Viet Nam,metabolic dysfunction-associated steatotic liver disease(MASLD)is rising in prevalence and there is an urgent need for better clinical management,particularly in early detection methods that will improve overall prognosis.AIM To examine M2BPGi cut-off values for staging liver fibrosis in patients with MASLD and risk factors associated with disease progression.METHODS A total of 301 individuals with ultrasound-confirmed or FibroScan-confirmed diagnosis of fatty liver were enrolled in the study.The participants were stratified according to fibrosis stage,measured via magnetic resonance elastography.M2-BPGi,Fibrosis-4(FIB-4)Index score,and routine parameters of liver function were assessed to statistically investigate the correlation of M2BPGi levels in various fibrosis stages and to identify risk factors associated with fibrosis severity.RESULTS M2BPGi levels positively correlated with fibrosis stages,with cut-off indexes of 0.57 for F0-1,0.68 for F2-3,and 0.78 for F4.M2BPGi levels in the F0-1 group were significantly different from those in both the F2-3 group(P=0.038)and the F4 group(P=0.0051);the F2-3 and F4 groups did not show a significant difference(P=0.39).Females exhibited significantly higher M2BPGi levels than males for all fibrosis stages,particularly in the F2-3 group(P=0.01)and F4 group(P=0.0006).In the F4(cirrhosis)group,individuals with diabetes had significantly higher M2BPGi levels than those without.M2BPGi,hemoglobin A1c,and FIB-4 score were identified as independent risk factors for greater fibrosis and cirrhosis.CONCLUSION M2BPGi levels varied significantly throughout fibrosis progression,from early MASLD to cirrhosis,with sex correlation.M2BPGi holds promise as an early biomarker for fibrosis characterization in MASLD adult patient populations.展开更多
BACKGROUND Pediatric living-donor liver transplantation is considered a safe alternative for the treatment of children with end-stage liver disease.Experienced tertiary centers and specialized medical staff are necess...BACKGROUND Pediatric living-donor liver transplantation is considered a safe alternative for the treatment of children with end-stage liver disease.Experienced tertiary centers and specialized medical staff are necessary to ensure compatible long-term survival rates and quality-of-life for these children.AIM To report the results and the 10-year learning curve of a pediatric living-donor liver transplantation program.METHODS We conducted a retrospective cohort study of pediatric recipients from 2013 to 2023.Post-transplant outcomes and patient survival rates were compared between two 5-year periods of the program.RESULTS A total of 25 and 48 patients underwent transplantation in the first(2013-2017)and second period(2018-2023),respectively.Portal vein and hepatic artery thrombosis occurred in 11(15.1%)and seven(9.6%)patients,respectively.Biliary complications were observed in 39 of 73 patients(53.4%).A lower warm ischemia time was observed in the second period compared to the first(32.6±8.6 minutes vs 38.4±9.8 minutes,P=0.018,respectively).Patient survival rates at 1 and 5 years were 84%in the first period and 91.7%in the second period,with no significant difference(P=0.32).CONCLUSION The reported indications and outcomes align with the current literature.Our findings provide crucial evidence regarding the feasibility of establishing a living donor program with consistent results over time.展开更多
BACKGROUND Tumor-associated macrophages(TAMs)have demonstrated significant potential as a research and treatment approach for hepatocellular carcinoma(HCC).Nevertheless,a comprehensive quantitative analysis of TAMs in...BACKGROUND Tumor-associated macrophages(TAMs)have demonstrated significant potential as a research and treatment approach for hepatocellular carcinoma(HCC).Nevertheless,a comprehensive quantitative analysis of TAMs in HCC remained insufficient.Therefore,the objective of this study was to employ bibliometric methods to investigate the development trends and research frontiers pertaining to this field.AIM To determine the knowledge structure and current research hotspots by bibliometric analysis of scholarly papers pertaining to TAMs in HCC.METHODS The present study employed the Web of Science Core Collection to identify all papers related to TAMs in HCC research.Utilizing the Analysis Platform of Bibliometrics,CiteSpace 6.2.R4,and Vosviewer 1.6.19,the study conducted a comprehensive analysis encompassing multiple dimensions such as publication quantity,countries of origin,affiliated institutions,publishing journals,contributing authors,co-references,author keywords,and emerging frontiers within this research domain.RESULTS A thorough examination was undertaken on 818 papers within this particular field,published between January 1,1985 to September 1,2023,which has witnessed a substantial surge in scholarly contributions since 2012,with a notable outbreak in 2019.China was serving as the central hub in this field,with Fudan University leading in terms of publications and citations.Chinese scholars have taken the forefront in driving the research expansion within this field.Hepatology emerged as the most influential journal in this field.The study by Qian and Pollard in 2010 received the highest number of co-citations.It was observed that the citation bursts of references coincided with the outbreak of publications.Notably,“tumor microenvironment”,“immunotherapy”,“prognostic”,“inflammation”,and“polarization”,etc.emerged as frequently occurring keywords in this field.Of particular interest,“immune evasion”,“immune infiltration”,and“cancer genome atlas”were identified as emerging frontiers in recent research.CONCLUSION The field of TAMs in HCC exhibited considerable potential,as evidenced by the promising prospects of immunotherapeutic interventions targeting TAMs for the amelioration of HCC.The emerging frontiers in this field primarily revolved around modulating the immunosuppressive characteristics of TAMs within a liver-specific immune environment,with a focus on how to counter immune evasion and reduce immune infiltration.展开更多
Background:Developing a granulomatous liver injury preclinical model may pave the way to understanding hepatic-TB(tuberculosis)and autoimmune granulomatous liver diseases.Antitubercular(ATT)and other drugs'metabol...Background:Developing a granulomatous liver injury preclinical model may pave the way to understanding hepatic-TB(tuberculosis)and autoimmune granulomatous liver diseases.Antitubercular(ATT)and other drugs'metabolism in the presence of a specific type of liver injury is not well understood.The present study aimed to establish a preclinical model of granulomatous hepatitis by using the BCG(Bacillus CalmetteGuérin)vaccine,further studying it in the presence of ATT dosing,and analyze the pharmacokinetics of isoniazid,rifampicin,and their respective primary metabolites.Methods:We used 56 rats in seven equal groups.Group I functioned as a normal control(NC)receiving normal saline only.Groups II-IV received intravenous injections of low-,medium-,and high-dose BCG vaccine daily for 21 days.Groups V,VI,and VII received isoniazid(H)alone,rifampicin(R)alone,and isoniazid+rifampicin(HR)for a subsequent 15 days in addition to high dose BCG for the first 21 days,respectively.Liver function tests(LFT)were monitored on days 0,21,28,and 36.Rats were sacrificed later for oxidative stress and histopathological examination.Results:The study observed BCG dose-specific LFT derangements in groups II-IV compared to group I on day 21(p<0.05).Isoniazid,rifampicin,and combination intervention groups demonstrated normalization of the BCG-led LFT changes.Histology and oxidative stress parameters confirmed model development and biochemical changes.Isoniazid area under the curve(AUC)showed a reduction of 16.9%in BCG+HR group in comparison to the BCG+H group(p=0.01).Des-acetyl-rifampicin AUC and maximum-concentration value demonstrated a significant rise in BCG+HR group in comparison to the BCG+R group(p=0.001).Conclusion:A novel preclinical model of granulomatous liver injury was developed using the BCG vaccine strain and validated with ATT response.展开更多
Artificial intelligence(AI)has become an indispensable tool in modern health care,offering transformative potential across clinical workflows and diagnostic innovations.This review explores the sation of AI technologi...Artificial intelligence(AI)has become an indispensable tool in modern health care,offering transformative potential across clinical workflows and diagnostic innovations.This review explores the sation of AI technologies in synthesizing and analyzing multimodal data to enhance efficiency and accuracy in health care delivery.Specifically,deep learning models have demonstrated remarkable capabilities in identifying seven categories of hepatobiliary disorders using ocular imaging datasets,including slit-lamp,retinal fundus,and optical coherence tomography images.Leveraging ResNet-101 neural networks,researchers have developed screening models and independent diagnostic tools,showcasing how AI can redefine diagnostic practices and improve accessibility,particularly in resource-limited settings.By examining advancements in AI-driven health care solutions,this article sheds light on both the challenges and opportunities that lie ahead in integrating such technologies into routine clinical practice.展开更多
文摘Prognostication of compensated advanced chronic liver disease(cACLD)is of paramount importance for the physician-and-patient communication and for rational clinical decisions.The paper published by Dallio et al reports on red cell distribution width(RDW)/platelet ratio(RPR)as a non-invasive biomarker in predicting decompensation of metabolic dysfunction-associated steatotic liver disease(MASLD)-related cACLD.Differently from other biomarkers and algorithms,RPR is inexpensive and widely available,based on parameters which are included in a complete blood count.RPR is computed on the grounds of two different items,one of which,RDW,mirrors the host’s response to a variety of disease stimuli and is non-specific.The second parameter involved in RPR,platelet count,is more specific and has been used in the hepatological clinic to discriminate cirrhotic from non-cirrhotic chronic liver disease for decades.Cardiovascular disease is the primary cause of mortality among MASLD subjects,followed by extra-hepatic cancers and liver-related mortality.Therefore,MASLD biomarkers should be validated not only in terms of liver-related events but also in the prediction of major adverse cardiovascular events and cardiovascular mortality and extra-hepatic cancers.Adequately sized multi-ethnic confirmatory investigation is required to define the role and significance of RPR in the stratification of MASLD-cACLD.
文摘BACKGROUND Patients with chronic hepatitis B(CHB)require long-term antiviral therapy.The effects of different antiviral drugs on kidney function are unclear.There is a lack of effective markers for monitoring early renal impairment.AIM To investigate the rate of abnormal renal function index and related potential hazards in patients with CHB.METHODS Clinical data of patients with CHB with urinaryβ2-microglobulin(β2-M)detec-tion,including demographic characteristics,hepatitis B virus(HBV)DNA,serum liver function(alanine aminotransferase,aspartate aminotransferase,total bilirubin,direct bilirubin),serum renal function(urea nitrogen,creatinine),blood lipid index(high density lipoprotein,low density lipoprotein,cholesterol,trigly-ceride),liver imaging,and other routine tests were retrospectively collected.The normal level of urinaryβ2-M and estimated glomerular filtration rate(eGFR)is defined as<0.173 mg/L and≥90 mL/min/1.73 m^(2),retrospectively.The pro-portion of patients with abnormal renal function index and related risk factors were analyzed.RESULTS A total of 500 patients with CHB were enrolled;these patients were aged 44.7±10.8 years,67.2%(336/500)were male,57.2%(286/500)were treated with anti-viral drugs,and 52.2%(261/500)had an HBV-related family history.In total,28.8%(144/500)of patients had fatty liver,35.0%(175/500)had liver fibrosis,and 13.2%(66/500)had cirrhosis.The proportion of patients with eGFR<90 mL/min/1.73 m^(2) was 43.2%(216/500),and the abnormal rate of urinaryβ2-M was 56.2%(281/500).There was no significant difference in the abnormal rate of urinaryβ2-M between the untreated group and the antiviral treated group(54.2%vs 57.7%;P=0.25).The abnormal rate ofβ2-M after long-term entecavir treatment(more than 1 year)was 54.6%(89/163).In the treatment group,56.4%(92/163)of patients with eGFR≥90 mL/min/1.73 m^(2) had abnormal urinaryβ2-M.CONCLUSION In patients with CHB,a higher proportion had greater urinaryβ2-M levels than eGFR for renal injury.Male patients should pay more attention to renal function and use antiviral regimens with a renal safety profile.
文摘BACKGROUND Liver function of chronic hepatitis B(CHB)patients is essentially normal after treatment with antiviral drugs.In rare cases,persistently abnormally elevatedα-fetoprotein(AFP)is seen in CHB patients following long-term antiviral treatment.However,in the absence of imaging evidence of liver cancer,a reasonable expla-nation for this phenomenon is still lacking.AIM To explore the causes of abnormal AFP in patients with CHB who were not diag-nosed with liver cancer.METHODS From November 2019 to May 2023,15 patients with CHB after antiviral treatment and elevated AFP were selected.Clinical data and quality indicators related to laboratory testing,imaging data,and pathological data were obtained through inpatient medical records.RESULTS All patients had increased AFP and significantly elevated IgG.Cancer was excluded by imaging examination.Only four patients had elevated alanine ami-notransferase,10 had elevated aspartate aminotransferase,nine had elevated total bilirubin,and two had antinuclear antibodies.The liver biopsy and histopatho-logical examination indicated that 14 patients had rosette,moderate,or higher interfacial inflammation,lymphocyte infiltration,and severe hepatic fibers(11 cases),which was consistent with the pathological features of autoimmune hepa-titis(AIH).After 8-12 week of hormone therapy,the levels of AFP and IgG,and liver function returned to normal(P<0.05).CONCLUSION For patients with CHB and elevated AFP after antiviral treatment,autoimmune hepatitis should be considered.CHB with AIH is clinically insidious and difficult to detect,and prone to progression to cirrhosis.Liver puncture pathological examination should be performed when necessary to confirm diagnosis.
文摘Cholangiocarcinoma(CCA)is a rare type of cancer which arises from the bile duct epithelium and carries a poor prognosis.One of the main risk factors in the Western world is primary sclerosing cholangitis.Surgical resection has traditionally been the only curative treatment but can only be offered to patients with early disease,excluding those with locally advanced disease.Despite initial poor outcomes,liver transplantation(LT)has evolved as a viable treatment for a select group of patients with CCAs that are deemed unresectable.This review aims to explore the evolution of the role of LT in patients with CCA.
基金supported by Beijing Science and Technology Commission(grant number Z211100002921059)National Science and Technology Major Projects of China(2017ZX10201201-001-006,2017ZX10201201-002-006,and 2018ZX10715-005-003-005)+5 种基金Digestive Medical Coordinated Development Center of Beijing Hospital Authority(XXZ0302 and XXT28)National Key R&D Program China(2022YFC2603505)Beijing Hospital Authority Clinical Medicine Development with Special Funding Support(XMLX 202127)High-Level Public Health Technical Personnel Training Program of Beijing the Municipal Health Commission(2022-3-050)Capital Health Research and Development of Special(2022-1-2172)HBV infection,Clinical Cure and Immunology Joint Laboratory for Clinical Medicine Capital Medical University.
文摘Objective Hepatocellular carcinoma(HCC)is sensitive to ferroptosis,a new form of programmed cell death that occurs in most tumor types.However,the mechanism through which ferroptosis modulates HCC remains unclear.This study aimed to investigate the oncogenic role and prognostic value of FANCD2 and provide novel insights into the prognostic assessment and prediction of immunotherapy.Methods Using clinicopathological parameters and bioinformatic techniques,we comprehensively examined the expression of FANCD2 macroscopically and microcosmically.We conducted univariate and multivariate Cox regression analyses to identify the prognostic value of FANCD2 in HCC and elucidated the detailed molecular mechanisms underlying the involvement of FANCD2 in oncogenesis by promoting iron-related death.Results FANCD2 was significantly upregulated in digestive system cancers with abundant immune infiltration.As an independent risk factor for HCC,a high FANCD2 expression level was associated with poor clinical outcomes and response to immune checkpoint blockade.Gene set enrichment analysis revealed that FANCD2 was mainly involved in the cell cycle and CYP450 metabolism.Conclusion To the best of our knowledge,this is the first study to comprehensively elucidate the oncogenic role of FANCD2.FANCD2 has a tumor-promoting aspect in the digestive system and acts as an independent risk factor in HCC;hence,it has recognized value for predicting tumor aggressiveness and prognosis and may be a potential biomarker for poor responsiveness to immunotherapy.
基金The National Key Research and Development Program(2022YFC2603500,2022YFC2603505,2023YFC2306901,2023YFC2308105)The capital health research and development of special public health project(2022-1-2172)+3 种基金Beijing Municipal Health Commission high-level public health technical personnel construction project,discipline leader-03-26Beijing Hospitals Authority“peak”talent training program(DFL20241803)Beijing Hospitals Authority Clinical medicine Development of special funding support(ZLRK202301)Beijing Research Ward Excellence Program(BRWEP2024W102170101)。
文摘Objective To investigate chronic hepatitis C virus(HCV)infection's effect on gestational liver function,pregnancy and delivery complications,and neonatal development.Methods A total of 157 HCV antibody-positive(anti-HCV[+])and HCV RNA(+)patients(Group C)and121 anti-HCV(+)and HCV RNA(-)patients(Group B)were included as study participants,while 142 antiHCV(-)and HCV RNA(-)patients(Group A)were the control group.Data on biochemical indices during pregnancy,pregnancy complications,delivery-related information,and neonatal complications were also collected.Results Elevated alanine aminotransferase(ALT)rates in Group C during early,middle,and late pregnancy were 59.87%,43.95%,and 42.04%,respectively—significantly higher than Groups B(26.45%,15.70%,10.74%)and A(23.94%,19.01%,6.34%)(P<0.05).Median ALT levels in Group C were significantly higher than in Groups A and B at all pregnancy stages(P<0.05).No significant differences were found in neonatal malformation rates across groups(P>0.05).However,neonatal jaundice incidence was significantly greater in Group C(75.16%)compared to Groups A(42.25%)and B(57.02%)(χ^(2)=33.552,P<0.001).HCV RNA positivity during pregnancy was an independent risk factor for neonatal jaundice(OR=2.111,95%CI 1.242–3.588,P=0.006).Conclusions Chronic HCV infection can affect the liver function of pregnant women,but does not increase the pregnancy or delivery complication risks.HCV RNA(+)is an independent risk factor for neonatal jaundice.
文摘BACKGROUND Although acute pancreatitis and walled-off necrosis(WON)are rare complications following aortic surgery,they are serious risk factors for postoperative mortality.Considering the poor general condition of the postoperative patient,more effective and less invasive treatments are favorable.CASE SUMMARY A 67-year-old man was referred to our hospital for the treatment of WON after acute pancreatitis.He had undergone total aortic arch replacement due to aortic arch aneurysm and coronary artery bypass grafting due to angina pectoris 6 weeks prior in another hospital.On the second postoperative day,laboratory data and computed tomography showed that the patient had developed acute pancreatitis.Although conservative management(antibiotics,hydration,etc.)had helped in relieving the symptoms of acute pancreatitis,peripancreatic fluid collection(PFC)persisted,accompanied by duodenal obstruction and vomiting.Contrastenhanced computed tomography showed that the heterogeneous enhancement and fluid collection in the pancreatic body and tail had increased,consistent with walled-off WON.We therefore performed endoscopic ultrasound-guided transluminal drainage for the PFC.As a result,the WON resolved gradually,resulting in improved oral intake.CONCLUSION Acute pancreatitis is a rare gastrointestinal complication following thoracic and thoracoabdominal aortic aneurysm surgery.To the best of our knowledge,this is the first case of WON after aortic arch surgery treated with endoscopic ultrasound-guided transluminal drainage for PFC.
文摘Hepatocellular carcinoma remains a significant cause of mortality worldwide,particularly among patients with liver cirrhosis.In most cases,surveillance in cirrhotic patients is neglected,leading to a diagnosis when the neoplasm is at an advanced stage.Within this context,Zhou et al carried out a network metaanalysis to demonstrate the effectiveness of hepatic arterial infusion chemotherapy,concluding that it is a superior approach compared to sorafenib and transarterial chemoembolization in the treatment of advanced hepatocellular carcinoma.Unfortunately,the meta-analysis in question lacks methodological rigor,preventing the authors from making more definitive assertions.Additionally,we understand that transarterial chemoembolization,when properly indicated,is a highly effective therapeutic option,and that sorafenib,given the results of new therapies based on immune checkpoint inhibitors,is no longer the recommended drug for the treatment of these patients.Therefore,we believe the use of hepatic arterial infusion chemotherapy is increasingly limited and lacks strong scientific support.
基金funded by the National Natural Science Foundation of China(No.82204250)the China Postdoctoral Science Foundation(No.2021M693961)+2 种基金the Young and Middle-Aged Talent Project of the Hubei Provincial Department of Education(No.Q20222808)High-level Talent Research Initiation Fund Project of Hunan University of Chinese Medicine(No.0004010)the Hunan Science Fund for Distinguished Young Scholars(No.2025JJ20098).
文摘Background:Liver cancer(LC)remains a leading cause of cancer-related mortality worldwide,with current treatments often limited by suboptimal efficacy and adverse effects.Banxia Houpu Decoction(BHD),a traditional Chinese herbal formula,has demonstrated potential anti-tumor properties in clinical practice.However,its precise mechanisms against LC remain unclear.This study employs network pharmacology(NP)and molecular docking(MD)approaches to systematically identify BHD’s active components and their molecular targets,aiming to elucidate its anti-LC mechanisms and provide a scientific basis for further investigation.Methods:We utilized Liquid Chromatography-Mass Spectrometry alongside the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP)to identify the constituents of BHD.We identified potential targets through the utilization of TCMSP,SwissTargetPrediction,Comparative Toxicogenomics Database,and SuperPred Database.Targets linked to LC were obtained from GeneCards,OMIM,the Therapeutic Target Database,and DrugBank.A Venn diagram illustrated the intersection between component and disease targets,while a protein-protein interaction(PPI)network was developed utilizing Cytoscape 3.9.1.Primary targets were discerned through the analysis of centrality metrics,including“Degree,”“Betweenness,”and“Closeness.”The study encompassed analyses of Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathways to clarify the biological roles and pathways associated with these proteins.The essential interactions between the active constituents of BHD and the principal LC targets were investigated through MD using AutoDock software.Results:We identified 34 active components in BHD.The PPI network revealed 212 interaction targets relevant to drug-disease correlations,emphasizing key proteins including Epidermal Growth Factor Receptor(EGFR),Signal Transducer and Activator of Transcription 3(STAT3),Steroid Receptor Coactivator(SRC),Heat Shock Protein 90 Alpha Family Class A Member 1(HSP90AA1),and AKT Serine/Threonine Protein Kinase 1(AKT1).The GO analysis revealed a total of 443 biological processes,94 cellular components,and 182 molecular functions.The KEGG analysis revealed a total of 169 pathways that are involved.The results from MD revealed that the majority of binding energies fell below−7 kcal/mol,indicating strong interactions between the active compounds and their target proteins.Conclusion:Evidence suggests that BHD effectively manages LC through a synergistic mechanism encompassing various components(Magnolol,Chrysoeriol,Cerevisterol,etc.),targets(EGFR,STAT3,SRC,HSP90AA1,AKT1,etc.),and pathways(PI3K-Akt,FoxO,and Ras signaling pathways,etc.).This analysis offers a comprehensive theoretical framework for further investigative and clinical exploration.
基金Supported by AI+Health Collaborative Innovation Cultivation Project of Beijing City,No.Z221100003522005.
文摘BACKGROUND Deep learning-based super-resolution(SR)reconstruction can obtain high-quality images with more detailed information.AIM To compare multiparametric normal-resolution(NR)and SR magnetic resonance imaging(MRI)in predicting the histopathologic grade in hepatocellular carcinoma.METHODS We retrospectively analyzed a total of 826 patients from two medical centers(training 459;validation 196;test 171).T2-weighted imaging,diffusion-weighted imaging,and portal venous phases were collected.Tumor segmentations were conducted automatically by 3D U-Net.Based on generative adversarial network,we utilized 3D SR reconstruction to produce SR MRI.Radiomics models were developed and validated by XGBoost and Catboost.The predictive efficiency was demonstrated by calibration curves,decision curve analysis,area under the curve(AUC)and net reclassification index(NRI).RESULTS We extracted 3045 radiomic features from both NR and SR MRI,retaining 29 and 28 features,respectively.For XGBoost models,SR MRI yielded higher AUC value than NR MRI in the validation and test cohorts(0.83 vs 0.79;0.80 vs 0.78),respectively.Consistent trends were seen in CatBoost models:SR MRI achieved AUCs of 0.89 and 0.80 compared to NR MRI’s 0.81 and 0.76.NRI indicated that the SR MRI models could improve the prediction accuracy by-1.6%to 20.9%compared to the NR MRI models.CONCLUSION Deep learning-based SR MRI could improve the predictive performance of histopathologic grade in HCC.It may be a powerful tool for better stratification management for patients with operable HCC.
文摘Endocrine disorders frequently lead to metabolic disturbances that significantly affect liver function.Understanding the complex interplay between hormonal imbalances and liver dysfunction is essential for advancing targeted therapeutic strategies.This comprehensive review explores the pathophysiological mechanisms linking major endocrine disorders to liver disease,with a focus on the roles of the thyroid,parathyroid,pancreas,adrenal glands,and sex hormones.Thyroid dysfunction is associated with alterations in liver enzyme levels and metabolic regulation,often resulting in hepatic steatosis or cholestasis.Hyperparathyroidism and consequent hypercalcemia have been linked to hepatic calcifications.Insulin resistance,both hepatic and peripheral,contributes to excessive lipid accumulation in the liver,exacerbating steatotic changes.Adrenal gland disorders,particularly in the setting of chronic liver disease,impair cortisol metabolism and may worsen hepatic injury.Additionally,sex hormones such as estrogen and testosterone modulate the progression of liver fibrosis and influence the development of metabolic syndrome.The intricate relationship between endocrine and hepatic systems underscores the need for a multidisciplinary approach in the management of liver disease.Addressing underlying hormonal disturbances may enhance patient outcomes and prevent further hepatic deterioration.Future research should prioritize integrative therapeutic strategies that concurrently target endocrine and liver dysfunction.
文摘BACKGROUND Noninvasive tests are crucial for the management and follow-up of patients with autoimmune hepatitis,but their validation is limited because of insufficient data.AIM To investigate the diagnostic performance of three fibrosis noninvasive tests[FibroTest,vibration-controlled transient elastography(VCTE),and the fibrosis-4 index(FIB-4)and two activity biomarkers(alanine aminotransferase(ALT)and ActiTest].METHODS This study enrolled 103 patients for whom liver biopsy,hepatic elastography results,and laboratory markers were available.Diagnostic performance was assessed with receiver operating characteristic(ROC)curves,the Obuchowski measure(OM),and the Bayesian latent class model.RESULTS FibroTest and VCTE outperformed FIB-4 in cases of significant fibrosis(≥F2),with areas under the ROC curve of 0.83[95%confidence interval(CI):0.73-0.90],0.86(95%CI:0.77-0.92),and 0.71(95%CI:0.60-0.80),respectively.The mean(standard error)OM values were 0.92(0.01),0.93(0.01),and 0.88(0.02)for FibroTest,VCTE,and FIB-4,respectively;FibroTest and VCTE performed comparably,and both were superior to FIB-4(P=0.03 and P=0.005).The areas under the ROC curve values for activity biomarkers were 0.86(95%CI:0.76-0.92)for ActiTest and 0.84(95%CI:0.73-0.90)for ALT(P=0.06).The OM values for ActiTest and ALT were 0.92(0.02)and 0.90(0.02),respectively(P=0.005).CONCLUSION FibroTest and VCTE outperformed FIB-4 according to the OM.FibroTest-ActiTest facilitated the evaluation of both fibrosis and activity.
文摘BACKGROUND Core-fucosylated low-molecular-weight kininogen(LMWK-Fc)levels are significantly elevated in patients with liver fibrosis and cirrhosis.AIM To assess the value of LMWK-Fc as a diagnostic biomarker for liver fibrosis.METHODS Our study included 132 healthy people and 132 patients with liver fibrosis.The LMWK-Fc level was measured based on the principle of chemiluminescence.Fibrosis stage and inflammatory activity were assessed by liver biopsy.Comparative analysis between groups and receiver operating characteristic curve analysis were performed.RESULTS LMWK-Fc had an area under the curve of 0.871,which indicates a good level of performance in distinguishing between patients with and without fibrosis.Furthermore,the LMWK-Fc level had a certain correlation with the liver stiffness value,which reached 0.5789.CONCLUSION LMWK-Fc could be used as a non-invasive marker of liver fibrosis.Further studies are needed to evaluate the usefulness of this marker.
文摘BACKGROUND Endoscopic bilateral biliary drainage is a first line palliative treatment for unresectable malignant hilar biliary obstruction(MHBO)but remains technically challenging.The emergence of self-expandable metallic stents carried by an ultrathin(6 Fr or smaller)delivery system now permits simultaneous bilateral stent placement.To date,only a few studies have compared this new method with conventional sequential bilateral stenting.AIM To evaluate a possible superiority of simultaneous“side by side”(SBS)biliary drainage in unresectable MHBO.METHODS We identified 135 patients who benefited from bilateral drainage using uncovered self-expandable metallic stents between 2010 and 2023.Among them,62 benefited from simultaneous SBS bilateral drainage between 2017 and 2023,and 73 benefited from sequential bilateral drainage[38 using“stent in stent”(SIS)technique and 35 using SBS technique between 2010 and 2017].RESULTS Technical success was significantly increased in simultaneous drainage compared with sequential drainage(94%vs 75%,P=0.008).However,simultaneous SBS drainage and sequential SIS drainage had a similar technical success(94%vs 95%).We observed no differences regarding clinical success,procedure duration and recurrent biliary obstruction rate.Stent patency was shorter in the SIS group compared with the simultaneous group(103 days vs 144 days).Early adverse events were more frequent in the sequential group(31%vs 21%,P=0.205),with no differences regarding SIS or SBS technique.Technical failure was associated with a higher rate of infectious fatal adverse events(9.5%vs 1.7%,P=0.02).Reintervention after recurrent biliary obstruction seems to be more successful after using SBS rather than SIS techniques(83%vs 75%,P=0.53).CONCLUSION Simultaneous SBS metallic stent placement using an ultra-thin delivery system was technically easier and as efficient as sequential bilateral stenting in unresectable MHBO to achieve bilateral drainage.The SIS procedure remains a good option in unresectable MHBO.
文摘BACKGROUND The Mac-2 binding protein glycosylated isomer(M2BPGi)is a serum marker for fibrosis that correlates with the fibrosis stages in various liver diseases.AIM To examine the M2BPGi’s threshold for staging fibrosis in patients with chronic hepatitis B(CHB),and its changes during treatment.METHODS This was a prospective,longitudinal study.A total of 348 eligible patients were recruited from the Hepatology Department,Medic Medical Center between March 2020 and December 2023.Liver enzyme tests,platelet counts,M2BPGi levels,and FibroScan were conducted at baseline and at 3-month intervals until six months post-treatment.Correlation plots of M2BPGi,FibroScan,and the other parameters were generated.Receiver operating characteristic curves were constructed for M2BPGi and the other parameters to evaluate their performance.RESULTS M2BPGi levels correlated well with FibroScan results and increased as the fibrosis stage advanced.The median M2BPGi levels at the different stages of fibrosis showed statistically significant differences.The cut-off values of M2BPGi for diagnosing significant fibrosis(F≥2),advanced fibrosis(F3),and cirrhosis(F4)were determined to be 1.08,1.4,and 1.52,respectively.In the context of fibrosis regression in CHB patients during the first 6-month of treatment,M2BPGi levels appeared to decrease before this pattern occurred in the FibroScan results.CONCLUSION M2BPGi levels were strongly correlated with FibroScan.M2BPGi can be used to assess liver fibrosis,and to serve as a tool for monitoring fibrosis regression in CHB patients undergoing treatment.
文摘BACKGROUND Mac-2 binding protein glycosylation isomer(M2BPGi)serves as a marker of activated hepatic stellate cells and as such holds potential as a biomarker for liver fibrosis.In Viet Nam,metabolic dysfunction-associated steatotic liver disease(MASLD)is rising in prevalence and there is an urgent need for better clinical management,particularly in early detection methods that will improve overall prognosis.AIM To examine M2BPGi cut-off values for staging liver fibrosis in patients with MASLD and risk factors associated with disease progression.METHODS A total of 301 individuals with ultrasound-confirmed or FibroScan-confirmed diagnosis of fatty liver were enrolled in the study.The participants were stratified according to fibrosis stage,measured via magnetic resonance elastography.M2-BPGi,Fibrosis-4(FIB-4)Index score,and routine parameters of liver function were assessed to statistically investigate the correlation of M2BPGi levels in various fibrosis stages and to identify risk factors associated with fibrosis severity.RESULTS M2BPGi levels positively correlated with fibrosis stages,with cut-off indexes of 0.57 for F0-1,0.68 for F2-3,and 0.78 for F4.M2BPGi levels in the F0-1 group were significantly different from those in both the F2-3 group(P=0.038)and the F4 group(P=0.0051);the F2-3 and F4 groups did not show a significant difference(P=0.39).Females exhibited significantly higher M2BPGi levels than males for all fibrosis stages,particularly in the F2-3 group(P=0.01)and F4 group(P=0.0006).In the F4(cirrhosis)group,individuals with diabetes had significantly higher M2BPGi levels than those without.M2BPGi,hemoglobin A1c,and FIB-4 score were identified as independent risk factors for greater fibrosis and cirrhosis.CONCLUSION M2BPGi levels varied significantly throughout fibrosis progression,from early MASLD to cirrhosis,with sex correlation.M2BPGi holds promise as an early biomarker for fibrosis characterization in MASLD adult patient populations.
文摘BACKGROUND Pediatric living-donor liver transplantation is considered a safe alternative for the treatment of children with end-stage liver disease.Experienced tertiary centers and specialized medical staff are necessary to ensure compatible long-term survival rates and quality-of-life for these children.AIM To report the results and the 10-year learning curve of a pediatric living-donor liver transplantation program.METHODS We conducted a retrospective cohort study of pediatric recipients from 2013 to 2023.Post-transplant outcomes and patient survival rates were compared between two 5-year periods of the program.RESULTS A total of 25 and 48 patients underwent transplantation in the first(2013-2017)and second period(2018-2023),respectively.Portal vein and hepatic artery thrombosis occurred in 11(15.1%)and seven(9.6%)patients,respectively.Biliary complications were observed in 39 of 73 patients(53.4%).A lower warm ischemia time was observed in the second period compared to the first(32.6±8.6 minutes vs 38.4±9.8 minutes,P=0.018,respectively).Patient survival rates at 1 and 5 years were 84%in the first period and 91.7%in the second period,with no significant difference(P=0.32).CONCLUSION The reported indications and outcomes align with the current literature.Our findings provide crucial evidence regarding the feasibility of establishing a living donor program with consistent results over time.
基金Supported by the Sanming Project of Medicine in Shenzhen,No.SZZYSM202111002Shenzhen Medical Research Fund,No.B2302008+1 种基金Shenzhen Science and Technology Program,No.JCYJ20220531091809022,No.JSGG20210802093208023,No.JCYJ20220818103402006,and No.ZDSYS201606081515458Traditional Chinese Medicine Bureau of Guangdong Province,No.20231286.
文摘BACKGROUND Tumor-associated macrophages(TAMs)have demonstrated significant potential as a research and treatment approach for hepatocellular carcinoma(HCC).Nevertheless,a comprehensive quantitative analysis of TAMs in HCC remained insufficient.Therefore,the objective of this study was to employ bibliometric methods to investigate the development trends and research frontiers pertaining to this field.AIM To determine the knowledge structure and current research hotspots by bibliometric analysis of scholarly papers pertaining to TAMs in HCC.METHODS The present study employed the Web of Science Core Collection to identify all papers related to TAMs in HCC research.Utilizing the Analysis Platform of Bibliometrics,CiteSpace 6.2.R4,and Vosviewer 1.6.19,the study conducted a comprehensive analysis encompassing multiple dimensions such as publication quantity,countries of origin,affiliated institutions,publishing journals,contributing authors,co-references,author keywords,and emerging frontiers within this research domain.RESULTS A thorough examination was undertaken on 818 papers within this particular field,published between January 1,1985 to September 1,2023,which has witnessed a substantial surge in scholarly contributions since 2012,with a notable outbreak in 2019.China was serving as the central hub in this field,with Fudan University leading in terms of publications and citations.Chinese scholars have taken the forefront in driving the research expansion within this field.Hepatology emerged as the most influential journal in this field.The study by Qian and Pollard in 2010 received the highest number of co-citations.It was observed that the citation bursts of references coincided with the outbreak of publications.Notably,“tumor microenvironment”,“immunotherapy”,“prognostic”,“inflammation”,and“polarization”,etc.emerged as frequently occurring keywords in this field.Of particular interest,“immune evasion”,“immune infiltration”,and“cancer genome atlas”were identified as emerging frontiers in recent research.CONCLUSION The field of TAMs in HCC exhibited considerable potential,as evidenced by the promising prospects of immunotherapeutic interventions targeting TAMs for the amelioration of HCC.The emerging frontiers in this field primarily revolved around modulating the immunosuppressive characteristics of TAMs within a liver-specific immune environment,with a focus on how to counter immune evasion and reduce immune infiltration.
文摘Background:Developing a granulomatous liver injury preclinical model may pave the way to understanding hepatic-TB(tuberculosis)and autoimmune granulomatous liver diseases.Antitubercular(ATT)and other drugs'metabolism in the presence of a specific type of liver injury is not well understood.The present study aimed to establish a preclinical model of granulomatous hepatitis by using the BCG(Bacillus CalmetteGuérin)vaccine,further studying it in the presence of ATT dosing,and analyze the pharmacokinetics of isoniazid,rifampicin,and their respective primary metabolites.Methods:We used 56 rats in seven equal groups.Group I functioned as a normal control(NC)receiving normal saline only.Groups II-IV received intravenous injections of low-,medium-,and high-dose BCG vaccine daily for 21 days.Groups V,VI,and VII received isoniazid(H)alone,rifampicin(R)alone,and isoniazid+rifampicin(HR)for a subsequent 15 days in addition to high dose BCG for the first 21 days,respectively.Liver function tests(LFT)were monitored on days 0,21,28,and 36.Rats were sacrificed later for oxidative stress and histopathological examination.Results:The study observed BCG dose-specific LFT derangements in groups II-IV compared to group I on day 21(p<0.05).Isoniazid,rifampicin,and combination intervention groups demonstrated normalization of the BCG-led LFT changes.Histology and oxidative stress parameters confirmed model development and biochemical changes.Isoniazid area under the curve(AUC)showed a reduction of 16.9%in BCG+HR group in comparison to the BCG+H group(p=0.01).Des-acetyl-rifampicin AUC and maximum-concentration value demonstrated a significant rise in BCG+HR group in comparison to the BCG+R group(p=0.001).Conclusion:A novel preclinical model of granulomatous liver injury was developed using the BCG vaccine strain and validated with ATT response.
文摘Artificial intelligence(AI)has become an indispensable tool in modern health care,offering transformative potential across clinical workflows and diagnostic innovations.This review explores the sation of AI technologies in synthesizing and analyzing multimodal data to enhance efficiency and accuracy in health care delivery.Specifically,deep learning models have demonstrated remarkable capabilities in identifying seven categories of hepatobiliary disorders using ocular imaging datasets,including slit-lamp,retinal fundus,and optical coherence tomography images.Leveraging ResNet-101 neural networks,researchers have developed screening models and independent diagnostic tools,showcasing how AI can redefine diagnostic practices and improve accessibility,particularly in resource-limited settings.By examining advancements in AI-driven health care solutions,this article sheds light on both the challenges and opportunities that lie ahead in integrating such technologies into routine clinical practice.
