Objective:To evaluate the clinical efficacy of infusion of gemcitabine(GEM) and fluorouracil(5-FU)through the celiac artery and superior mesenteric artery in the treatment of pancreatic carcinoma(PC).Methods:We analyz...Objective:To evaluate the clinical efficacy of infusion of gemcitabine(GEM) and fluorouracil(5-FU)through the celiac artery and superior mesenteric artery in the treatment of pancreatic carcinoma(PC).Methods:We analyzed 20 patients diagnosed clinically or pathologically with PC,without metastases,who had an estimated survival duration of>3 months in our department from May 2009 to December 2014.Nine patients were treated directly without surgical resection of the tumor,while the other 11 patients were treated after surgery.In all patients,the femoral artery was punctured using the Seldinger technique,and a catheter was placed in the opening of the celiac artery or the superior mesenteric artery.We administered 500 mg/m2 GEM and 500 mg/m2 5-FU.Observational data included data on clinical efficacy and survival rates during the follow-up period of 3-72 months.Results:Twenty patients were treated 85 times with transcatheter arterial infusion chemotherapy(TAI).The survival rates were 80%,40%,35%,20%,10%,and 5% at 3,6,12,24,and 72 months,respectively.Conclusion: TAI chemotherapy with GEM and 5-FU may be a therapeutic option for the treatment of PC.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentia...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentially serious complication following TIPS creation.Timely identification and management are crucial for preventing further adverse events.CASE SUMMARY We report a 56-year-old male patient who underwent a TIPS procedure for re-current melena caused by portal hypertension secondary to hepatitis B and experienced a stent fracture 15 months post-procedure.He was readmitted 30 months after the initial TIPS due to recurrent esophagogastric variceal bleeding and ascites.An attempt to revise the dysfunctional shunt via a stent-in-stent approach was unsuccessful.Consequently,a parallel TIPS procedure was success-fully performed via the proximal end of the fractured stent to decompress the portal venous system.At the 1-month follow-up,the patient exhibited no recur-rent variceal bleeding,and his ascites had significantly decreased.Twelve-month postoperative monitoring revealed no hepatic encephalopathy and no recurrence of bleeding or ascites.Additionally,we review the existing literature on post-TIPS stent fractures to explore the underlying mechanisms contributing to this com-plication.CONCLUSION Early recognition and prompt intervention are essential in managing stent fractures after TIPS creation to mitigate potential risks and ensure optimal patient outcomes.展开更多
BACKGROUND Patients with cirrhosis with hepatopulmonary syndrome(HPS)have a poorer prognosis.The disease has a subtle onset,symptoms are easily masked,clinical attention is insufficient,and misdiagnosis rates are high...BACKGROUND Patients with cirrhosis with hepatopulmonary syndrome(HPS)have a poorer prognosis.The disease has a subtle onset,symptoms are easily masked,clinical attention is insufficient,and misdiagnosis rates are high.AIM To compare the clinical characteristics of patients with cirrhosis,cirrhosis combined with intrapulmonary vascular dilatation(IPVD),and HPS,and to establish predictive models for IPVD and HPS.METHODS Patients with cirrhosis were prospectively screened at a liver-specialized university teaching hospital.Clinical information and blood samples were collected,and biomarker levels in blood samples were measured.Patients with cirrhosis were divided into three groups:Those with pure cirrhosis,those with combined IPVD,and those with HPS based on contrast-enhanced transthoracic echocardiography results and the pulmonary alveolar-arterial oxygen gradient values.Univariate logistic regression and Least Absolute Shrinkage and Selection Operator(LASSO)regression methods were utilized to identify risk factors for IPVD and HPS,and nomograms were constructed to predict IPVD and HPS.RESULTS A total of 320 patients were analyzed,with 101 diagnosed with IPVD,of whom 54 were diagnosed with HPS.There were statistically significant differences in clinical parameters among these three groups of patients.Among the tested biomarkers,sphingosine 1 phosphate,angiopoietin-2,and platelet-derived growth factor BB were significantly associated with IPVD and HPS in patients with cirrhosis.Following LASSO logistic regression screening,prediction models for IPVD and HPS were established.The area under the receiver operating characteristic curve for IPVD prediction was 0.792(95%confidence interval[CI]:0.737-0.847),and for HPS prediction was 0.891(95%CI:0.848-0.934).CONCLUSION This study systematically compared the clinical characteristics of patients with cirrhosis,IPVD,and HPS,and constructed predictive models for IPVD and HPS based on clinical parameters and laboratory indicators.These models showed good predictive value for IPVD and HPS in patients with cirrhosis.They can assist clinicians in the early prognosis assessment of patients with cirrhosis,ultimately benefiting the patients.展开更多
Background:The extent of pancreatoduodenectomy for pancreatic head cancer remains controversial,and more high-level clinical evidence is needed.This study aimed to evaluate the outcome of extended pancreatoduodenectom...Background:The extent of pancreatoduodenectomy for pancreatic head cancer remains controversial,and more high-level clinical evidence is needed.This study aimed to evaluate the outcome of extended pancreatoduodenectomy(EPD)with retroperitoneal nerve resection in pancreatic head cancer.Methods:This multicenter randomized trial was performed at 6 Chinese highvolume hospitals that enrolled patients between October 3,2012,and September 21,2017.Four hundred patients with stage I or II pancreatic head cancer and without specific pancreatic cancer treatments(preoperative chemotherapy or chemoradiation)within three months were randomly assigned to undergo standard pancreatoduodenectomy(SPD)or EPD,with the latter followed by dissection of additional lymph nodes(LNs),nerves and soft tissues 270◦on the right side surrounding the superior mesenteric artery and celiac axis.The primary endpoint was overall survival(OS)by intention-to-treat(ITT).The secondary endpoints were disease-free survival(DFS),mortality,morbidity,and postoperative pain intensity.Results:TheR1 ratewas slightly lower with EPD(8.46%)thanwith SPD(12.56%).The morbidity and mortality rates were similar between the two groups.The median OS was similar in the EPD and SPD groups by ITT in the whole study cohort(23.0 vs.20.2 months,P=0.100),while the median DFS was superior in the EPD group(16.1 vs.13.2 months,P=0.031).Patients with preoperative CA19–9<200.0 U/mL had significantly improved OS and DFS with EPD(EPD vs.SPD,30.8 vs.20.9 months,P=0.009;23.4 vs.13.5 months,P<0.001).The EPD group exhibited significantly lower locoregional(16.48%vs.35.20%,P<0.001)andmesenteric LNrecurrence rates(3.98%vs.10.06%,P=0.022).The EPD group exhibited less back pain 6 months postoperation than the SPD group.Conclusions:EPD for pancreatic head cancer did not significantly improve OS,but patients with EPD treatment had significantly improved DFS.In the subgroup analysis,improvements in bothOS and DFS in the EPD armwere observed in patients with preoperative CA19–9<200.0 U/mL.EPD could be used as an effective surgical procedure for patients with pancreatic head cancer,especially those with preoperative CA19–9<200.0 U/mL.展开更多
Aims:Although the skeletal muscle index at the third lumbar vertebra(L3-SMI)is commonly utilized for the diagnosis of sarcopenia,the psoas muscle index at L3(L3-PMI)may serve as a reliable alternative indicator.This s...Aims:Although the skeletal muscle index at the third lumbar vertebra(L3-SMI)is commonly utilized for the diagnosis of sarcopenia,the psoas muscle index at L3(L3-PMI)may serve as a reliable alternative indicator.This study aims to investigate the application of the PMI in patients who have undergone transjugular intrahepatic portosystemic shunt(TIPS).Methods:This study included a cohort of 406 patients with cirrhosis who underwent TIPS between February 2016 and July 2022 across three medical centers in China.Clinical and imaging data,specifically L3-SMI and L3-PMI,were collected for these patients.The prognosis of the patients was assessed through re-examinations and telephone follow-ups,which extended up to 5 years.The diagnostic thresholds for sarcopenia,as defined by L3-PMI and L3-SMI,were established at 6.36 or 42.00 cm^(2)/m^(2) for males and 3.92 or 38.00 cm^(2)/m^(2) for females,respectively.Cox proportional hazards and Kaplan–Meier(K-M)analyses were employed to evaluate patient survival.Results:The findings indicated that both L3-PMI and L3-SMI before TIPS were independent risk factors for mortality.The results of the paired t-test demonstrated a significant increase in L3-PMI 1 month post-TIPS(5.11±1.81 vs.5.71±1.90 cm^(2)/m^(2) ,p<0.001),whereas L3-SMI did not exhibit a significant increase until 6 months post-TIPS(45.45±9.41 vs.48.59±10.38 cm^(2)/m^(2) ,p<0.001).Among these patients,191(47.0%)and 159(39.2%)were diagnosed with sarcopenia according to the L3-PMI and L3-SMI models,respectively.Patients identified as sarcopenic by both indicators demonstrated a significantly lower survival rate(L3-SMI model:hazard ratio[HR],1.913;95%confidence interval[CI],1.094–3.410;log-rank p=0.020;L3-PMI model:HR,1.867;95%CI,1.059–3.290;log-rank p=0.030).In sarcopenic patients,the reversal of sarcopenia associated with improved survival occurred 1 month after TIPS in the L3-PMI model(HR,2.675;95%CI,1.245–5.735;log-rank p=0.012),while a similar effect was not observed until 6 months post-TIPS in the L3-SMI model(HR,3.342;95%CI,1.477–7.560;logrank p=0.004).Conclusions:L3-PMI and L3-SMI demonstrate comparable efficacy in diagnosing cirrhosis-related sarcopenia.Furthermore,L3-PMI has the capacity to identify improvements in sarcopenia as early as 1 month following TIPS,thereby providing earlier insights into patient survival outcomes.展开更多
Aim:To determine the tolerance and acceptance of hepatic venous pressure gradient(HVPG)measurements in patients with liver cirrhosis.Methods:This prospective international multicenter study included 271 patients with ...Aim:To determine the tolerance and acceptance of hepatic venous pressure gradient(HVPG)measurements in patients with liver cirrhosis.Methods:This prospective international multicenter study included 271 patients with cirrhosis who were scheduled to undergo HVPG measurement between October 2019 and June 2020.Data related to the tolerance and acceptance of HVPG measurements were collected using descriptive questionnaires.Results:HVPG measurements were technically successful in all 271 patients,with 141(52.0%)undergoing HVPG measurement alone.The complication rate was 0.4%.Postoperative pain was significantly lower than preoperative expected pain(p<0.001)and intraoperative pain(p<0.001),and intraoperative pain was also significantly lower than preoperative expected pain(p=0.036).No,mild,moderate,severe,and intolerable discomfort scores were reported by 36.9%,44.6%,11.1%,6.3%,and 0.4%of these patients,respectively,during HVPG measurement and by 54.6%32.5%,11.4%,1.5%,and 0%,respectively,after HVPG measurement.Of these patients,39.5%had little understanding and 10%had no understanding of the value of HVPG measurement,with 35.1%and 4.1%regarding HVPG measurements as being of little or no help,respectively.Most patients reported that they would definitely(15.5%),probably(46.9%),or possibly(29.9%)choose to undergo additional HVPG measurements again,and 62.7%regarded the cost of the procedure as acceptable.Conclusion:HVPG measurement was safe and well‐tolerated in patients with cirrhosis,but patient education and communication are warranted to improve the acceptance of this procedure.展开更多
To the Editor,Abernethy malformation(AM),also referred to as a congenital extrahepatic portosystemic shunts(CEPS),represents a rare congenital vascular disorder first reported by John Abernethy in 1793[1],in which mos...To the Editor,Abernethy malformation(AM),also referred to as a congenital extrahepatic portosystemic shunts(CEPS),represents a rare congenital vascular disorder first reported by John Abernethy in 1793[1],in which most of the intestinal and splenic venous blood bypasses the portal vein and the liver,draining directly into sys-temic veins through abnormal communications[2].AM can result in hyperammonemia and hepatic encephalopathy(HE)due to lack of hepatic detoxification.展开更多
Background and Aims:To validate prognostic performance of the China liver cancer(CNLC)staging system as well as to compare these parameters with those of the Barcelona Clinic Liver Cancer(BCLC)staging system for Chine...Background and Aims:To validate prognostic performance of the China liver cancer(CNLC)staging system as well as to compare these parameters with those of the Barcelona Clinic Liver Cancer(BCLC)staging system for Chinese hepatocellular carcinoma(HCC)treated with transarterial chemoembolization(TACE).Methods:This multicenter retrospective study included 1,124 patients with HCC between January 2012 and December 2020 from six Chinese hospitals.Based on overall survival(OS),the prognostic performance outcomes for the CNLC and BCLC staging systems were compared by model discrimination[C statistic and Akaike information criterion(AIC)],monotonicity of the gradient(linear trend chi-square test),homogeneity(likelihood ratio chisquare test),and calibration(calibration plots).A prospective cohort of 44 patients receiving TACE-based therapy included between January 2021 and December 2022 was used to prospectively validate the outcomes.Results:Median OS was 19.1(18.2–20.0)months,with significant differences in OS between stages defined by the CNLC and BCLC observed(p<0.001).The CNLC performed better than the BCLC regarding model discrimination(C-index:0.661 vs.0.644;AIC:10,583.28 vs.10,583.72),model monotonicity of the gradient(linear trend chi-square test:66.107 vs.57.418;p<0.001),model homogeneity(159.2 vs.158.7;p<0.001).Both staging systems had good model calibration.Similar results were observed in the prospective cohort.Conclusions:Combining model discrimination,gradient monotonicity,homogeneity,and calibration,the CNLC performed better than the BCLC for Chinese HCC patients receiving TACE.展开更多
There is considerable potential for integrating transarterial chemoembolization(TACE),programmed death-(ligand)1(PD-[L]1)inhibitors,and molecular targeted treatments(MTT)in hepatocellular carcinoma(HCC).It is necessar...There is considerable potential for integrating transarterial chemoembolization(TACE),programmed death-(ligand)1(PD-[L]1)inhibitors,and molecular targeted treatments(MTT)in hepatocellular carcinoma(HCC).It is necessary to investigate the therapeutic efficacy and safety of TACE combined with PD-(L)1 inhibitors and MTT in real-world situations.In this nationwide,retrospective,cohort study,826 HCC patients receiving either TACE plus PD-(L)1 blockades and MTT(combination group,n=376)or TACE monotherapy(monotherapy group,n=450)were included from January 2018 to May 2021.The primary endpoint was progression-free survival(PFS)according to modified RECIST.The secondary outcomes included overall survival(OS),objective response rate(ORR),and safety.We performed propensity score matching approaches to reduce bias between two groups.After matching,228 pairs were included with a predominantly advanced disease population.Median PFS in combination group was 9.5 months(95%confidence interval[CI],8.4-11.0)versus 8.0 months(95%CI,6.6-9.5)(adjusted hazard ratio[HR],0.70,P=0.002).OS and ORR were also significantly higher in combination group(median OS,19.2[16.1-27.3]vs.15.7 months[13.0-20.2];adjusted HR,0.63,P=0.001;ORR,60.1%vs.32.0%;P<0.001).Grade 3/4 adverse events were observed at a rate of 15.8%and 7.5%in combination and monotherapy groups,respectively.Our results suggest that TACE plus PD-(L)1 blockades and MTT could significantly improve PFS,OS,and ORR versus TACE monotherapy for Chinese patients with predominantly advanced HCC in real-world practice,with an acceptable safety profile.展开更多
Aims:Surveys and research on the applications of the hepatic venous pressure gradient(HVPG)are important for understanding the current status and future development of this technology in China.This article aimed to in...Aims:Surveys and research on the applications of the hepatic venous pressure gradient(HVPG)are important for understanding the current status and future development of this technology in China.This article aimed to investigate the status of hepatic venous pressure gradient measurement in China in 2022.Methods:We investigated the overall status of HVPG technology in China-including hospital distribution,hospital level,annual number of cases,catheters used,average cost,indications,and current challenges by using online questionnaire.By counting the number and percentages of cases of these results,we hope to clarify the current status of HVPG measurements in China.Results:According to the survey,85 hospitals in China used HVPG technology in 2022 distributed across 29 provinces.A total of 4989 HVPG measurements were performed in all of the surveyed hospitals in 2022,of which 2813 cases(56.4%)were measured alone.The average cost of HVPG measurement was 5646.8±2327.9 CNY.Of the clinical teams who performed the measurements(sometimes multiple per hospital),94.3%(82/87)used the balloon method,and the majority of the teams(72.4%,63/87)used embolectomy catheters.Conclusions:This survey clarified the clinical application status of HVPG in China and confirmed that some medical institutions in China have established a foundation for this technology.It is still necessary to continue promoting and popularizing this technology in the future.展开更多
基金funded by Zhejiang Provincial Natural Science Foundation of China (Grant No. LZ18H180001)National Natural Science Foundation of China (Grant No. 81971713 and 81,371,658)+5 种基金National S&T Major Project of China (NO.2018ZX10301201)Grant from Health Commission of Zhejiang Province (JBZX-202004)Research Unit of Collaborative Diagnosis and Treatment For Hepatobiliary and Pancreatic Cancer,Chinese Academy of Medical Sciences (2019RU019)The Key Research Development Program of Zhejiang province (Grant No.2018C03018)Key Science and Technology Program of Zhejiang province (No.WKJ-ZJ-1923)National Key R&D Program of China(No.2017YFC0114102)。
文摘Objective:To evaluate the clinical efficacy of infusion of gemcitabine(GEM) and fluorouracil(5-FU)through the celiac artery and superior mesenteric artery in the treatment of pancreatic carcinoma(PC).Methods:We analyzed 20 patients diagnosed clinically or pathologically with PC,without metastases,who had an estimated survival duration of>3 months in our department from May 2009 to December 2014.Nine patients were treated directly without surgical resection of the tumor,while the other 11 patients were treated after surgery.In all patients,the femoral artery was punctured using the Seldinger technique,and a catheter was placed in the opening of the celiac artery or the superior mesenteric artery.We administered 500 mg/m2 GEM and 500 mg/m2 5-FU.Observational data included data on clinical efficacy and survival rates during the follow-up period of 3-72 months.Results:Twenty patients were treated 85 times with transcatheter arterial infusion chemotherapy(TAI).The survival rates were 80%,40%,35%,20%,10%,and 5% at 3,6,12,24,and 72 months,respectively.Conclusion: TAI chemotherapy with GEM and 5-FU may be a therapeutic option for the treatment of PC.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentially serious complication following TIPS creation.Timely identification and management are crucial for preventing further adverse events.CASE SUMMARY We report a 56-year-old male patient who underwent a TIPS procedure for re-current melena caused by portal hypertension secondary to hepatitis B and experienced a stent fracture 15 months post-procedure.He was readmitted 30 months after the initial TIPS due to recurrent esophagogastric variceal bleeding and ascites.An attempt to revise the dysfunctional shunt via a stent-in-stent approach was unsuccessful.Consequently,a parallel TIPS procedure was success-fully performed via the proximal end of the fractured stent to decompress the portal venous system.At the 1-month follow-up,the patient exhibited no recur-rent variceal bleeding,and his ascites had significantly decreased.Twelve-month postoperative monitoring revealed no hepatic encephalopathy and no recurrence of bleeding or ascites.Additionally,we review the existing literature on post-TIPS stent fractures to explore the underlying mechanisms contributing to this com-plication.CONCLUSION Early recognition and prompt intervention are essential in managing stent fractures after TIPS creation to mitigate potential risks and ensure optimal patient outcomes.
基金Supported by the National Key Research and Development Program of China,No.2022YFC2305002Beijing Natural Science Foundation,No.7232079+1 种基金Middle-aged and Young Talent Incubation Programs(Clinical Research)of Beijing Youan Hospital,No.BJYAYY-YN2022-12,No.BJYAYY-YN2022-13,and No.BJYAYY-YN2022-01the China Postdoctoral Science Foundation,No.2023M732410 and No.2024T170595.
文摘BACKGROUND Patients with cirrhosis with hepatopulmonary syndrome(HPS)have a poorer prognosis.The disease has a subtle onset,symptoms are easily masked,clinical attention is insufficient,and misdiagnosis rates are high.AIM To compare the clinical characteristics of patients with cirrhosis,cirrhosis combined with intrapulmonary vascular dilatation(IPVD),and HPS,and to establish predictive models for IPVD and HPS.METHODS Patients with cirrhosis were prospectively screened at a liver-specialized university teaching hospital.Clinical information and blood samples were collected,and biomarker levels in blood samples were measured.Patients with cirrhosis were divided into three groups:Those with pure cirrhosis,those with combined IPVD,and those with HPS based on contrast-enhanced transthoracic echocardiography results and the pulmonary alveolar-arterial oxygen gradient values.Univariate logistic regression and Least Absolute Shrinkage and Selection Operator(LASSO)regression methods were utilized to identify risk factors for IPVD and HPS,and nomograms were constructed to predict IPVD and HPS.RESULTS A total of 320 patients were analyzed,with 101 diagnosed with IPVD,of whom 54 were diagnosed with HPS.There were statistically significant differences in clinical parameters among these three groups of patients.Among the tested biomarkers,sphingosine 1 phosphate,angiopoietin-2,and platelet-derived growth factor BB were significantly associated with IPVD and HPS in patients with cirrhosis.Following LASSO logistic regression screening,prediction models for IPVD and HPS were established.The area under the receiver operating characteristic curve for IPVD prediction was 0.792(95%confidence interval[CI]:0.737-0.847),and for HPS prediction was 0.891(95%CI:0.848-0.934).CONCLUSION This study systematically compared the clinical characteristics of patients with cirrhosis,IPVD,and HPS,and constructed predictive models for IPVD and HPS based on clinical parameters and laboratory indicators.These models showed good predictive value for IPVD and HPS in patients with cirrhosis.They can assist clinicians in the early prognosis assessment of patients with cirrhosis,ultimately benefiting the patients.
基金Sun Yat-sen University Clinical Research 5010 Program,Grant/Award Number:2012007National Natural Science Foundation of China,Grant/Award Number:81871945National Key Clinical Specialty Construction Project,Grant/Award Number:2022YW030009。
文摘Background:The extent of pancreatoduodenectomy for pancreatic head cancer remains controversial,and more high-level clinical evidence is needed.This study aimed to evaluate the outcome of extended pancreatoduodenectomy(EPD)with retroperitoneal nerve resection in pancreatic head cancer.Methods:This multicenter randomized trial was performed at 6 Chinese highvolume hospitals that enrolled patients between October 3,2012,and September 21,2017.Four hundred patients with stage I or II pancreatic head cancer and without specific pancreatic cancer treatments(preoperative chemotherapy or chemoradiation)within three months were randomly assigned to undergo standard pancreatoduodenectomy(SPD)or EPD,with the latter followed by dissection of additional lymph nodes(LNs),nerves and soft tissues 270◦on the right side surrounding the superior mesenteric artery and celiac axis.The primary endpoint was overall survival(OS)by intention-to-treat(ITT).The secondary endpoints were disease-free survival(DFS),mortality,morbidity,and postoperative pain intensity.Results:TheR1 ratewas slightly lower with EPD(8.46%)thanwith SPD(12.56%).The morbidity and mortality rates were similar between the two groups.The median OS was similar in the EPD and SPD groups by ITT in the whole study cohort(23.0 vs.20.2 months,P=0.100),while the median DFS was superior in the EPD group(16.1 vs.13.2 months,P=0.031).Patients with preoperative CA19–9<200.0 U/mL had significantly improved OS and DFS with EPD(EPD vs.SPD,30.8 vs.20.9 months,P=0.009;23.4 vs.13.5 months,P<0.001).The EPD group exhibited significantly lower locoregional(16.48%vs.35.20%,P<0.001)andmesenteric LNrecurrence rates(3.98%vs.10.06%,P=0.022).The EPD group exhibited less back pain 6 months postoperation than the SPD group.Conclusions:EPD for pancreatic head cancer did not significantly improve OS,but patients with EPD treatment had significantly improved DFS.In the subgroup analysis,improvements in bothOS and DFS in the EPD armwere observed in patients with preoperative CA19–9<200.0 U/mL.EPD could be used as an effective surgical procedure for patients with pancreatic head cancer,especially those with preoperative CA19–9<200.0 U/mL.
基金the approval of Ethics Committees of Union Hospital Tongji Medical College,Huazhong University of Science and Technology(No.2022-S207)The First Affiliated Hospital of Soochow University(No.2022412)The First Hospital of Shanxi Medical University(No.2022KK094).
文摘Aims:Although the skeletal muscle index at the third lumbar vertebra(L3-SMI)is commonly utilized for the diagnosis of sarcopenia,the psoas muscle index at L3(L3-PMI)may serve as a reliable alternative indicator.This study aims to investigate the application of the PMI in patients who have undergone transjugular intrahepatic portosystemic shunt(TIPS).Methods:This study included a cohort of 406 patients with cirrhosis who underwent TIPS between February 2016 and July 2022 across three medical centers in China.Clinical and imaging data,specifically L3-SMI and L3-PMI,were collected for these patients.The prognosis of the patients was assessed through re-examinations and telephone follow-ups,which extended up to 5 years.The diagnostic thresholds for sarcopenia,as defined by L3-PMI and L3-SMI,were established at 6.36 or 42.00 cm^(2)/m^(2) for males and 3.92 or 38.00 cm^(2)/m^(2) for females,respectively.Cox proportional hazards and Kaplan–Meier(K-M)analyses were employed to evaluate patient survival.Results:The findings indicated that both L3-PMI and L3-SMI before TIPS were independent risk factors for mortality.The results of the paired t-test demonstrated a significant increase in L3-PMI 1 month post-TIPS(5.11±1.81 vs.5.71±1.90 cm^(2)/m^(2) ,p<0.001),whereas L3-SMI did not exhibit a significant increase until 6 months post-TIPS(45.45±9.41 vs.48.59±10.38 cm^(2)/m^(2) ,p<0.001).Among these patients,191(47.0%)and 159(39.2%)were diagnosed with sarcopenia according to the L3-PMI and L3-SMI models,respectively.Patients identified as sarcopenic by both indicators demonstrated a significantly lower survival rate(L3-SMI model:hazard ratio[HR],1.913;95%confidence interval[CI],1.094–3.410;log-rank p=0.020;L3-PMI model:HR,1.867;95%CI,1.059–3.290;log-rank p=0.030).In sarcopenic patients,the reversal of sarcopenia associated with improved survival occurred 1 month after TIPS in the L3-PMI model(HR,2.675;95%CI,1.245–5.735;log-rank p=0.012),while a similar effect was not observed until 6 months post-TIPS in the L3-SMI model(HR,3.342;95%CI,1.477–7.560;logrank p=0.004).Conclusions:L3-PMI and L3-SMI demonstrate comparable efficacy in diagnosing cirrhosis-related sarcopenia.Furthermore,L3-PMI has the capacity to identify improvements in sarcopenia as early as 1 month following TIPS,thereby providing earlier insights into patient survival outcomes.
基金Gansu Science Fund for Distinguished Young Scholars,Grant/Award Number:20JR10RA713Guangxi Digestive Disease Clinical Medical Research Center Construction Project,Grant/Award Number:AD17129027+7 种基金Tianjin Science and Technology Plan Project,Grant/Award Number:19ZXDBSY00030The Xingtai City Science and Technology Project,Grant/Award Number:2020ZZ026Zhejiang Provincial Natural Science Foundation of China,Grant/Award Number:LZ18H180001The Hebei Provincial Health and Family Planning Commission Scientific Research Fund Project,Grant/Award Number:20181612Wenzhou Municipal Science and Technology Bureau,Grant/Award Number:Y2020013National Natural Science Foundation of China,Grant/Award Numbers:81860654,81971713The Hebei Provincial Key R&D Program Project,Grant/Award Number:18277717DNatural Science Foundation of Science and Technology Department of Tibet Autonomous Region,Grant/Award Number:XZ2017ZRG‐91。
文摘Aim:To determine the tolerance and acceptance of hepatic venous pressure gradient(HVPG)measurements in patients with liver cirrhosis.Methods:This prospective international multicenter study included 271 patients with cirrhosis who were scheduled to undergo HVPG measurement between October 2019 and June 2020.Data related to the tolerance and acceptance of HVPG measurements were collected using descriptive questionnaires.Results:HVPG measurements were technically successful in all 271 patients,with 141(52.0%)undergoing HVPG measurement alone.The complication rate was 0.4%.Postoperative pain was significantly lower than preoperative expected pain(p<0.001)and intraoperative pain(p<0.001),and intraoperative pain was also significantly lower than preoperative expected pain(p=0.036).No,mild,moderate,severe,and intolerable discomfort scores were reported by 36.9%,44.6%,11.1%,6.3%,and 0.4%of these patients,respectively,during HVPG measurement and by 54.6%32.5%,11.4%,1.5%,and 0%,respectively,after HVPG measurement.Of these patients,39.5%had little understanding and 10%had no understanding of the value of HVPG measurement,with 35.1%and 4.1%regarding HVPG measurements as being of little or no help,respectively.Most patients reported that they would definitely(15.5%),probably(46.9%),or possibly(29.9%)choose to undergo additional HVPG measurements again,and 62.7%regarded the cost of the procedure as acceptable.Conclusion:HVPG measurement was safe and well‐tolerated in patients with cirrhosis,but patient education and communication are warranted to improve the acceptance of this procedure.
文摘To the Editor,Abernethy malformation(AM),also referred to as a congenital extrahepatic portosystemic shunts(CEPS),represents a rare congenital vascular disorder first reported by John Abernethy in 1793[1],in which most of the intestinal and splenic venous blood bypasses the portal vein and the liver,draining directly into sys-temic veins through abnormal communications[2].AM can result in hyperammonemia and hepatic encephalopathy(HE)due to lack of hepatic detoxification.
文摘Background and Aims:To validate prognostic performance of the China liver cancer(CNLC)staging system as well as to compare these parameters with those of the Barcelona Clinic Liver Cancer(BCLC)staging system for Chinese hepatocellular carcinoma(HCC)treated with transarterial chemoembolization(TACE).Methods:This multicenter retrospective study included 1,124 patients with HCC between January 2012 and December 2020 from six Chinese hospitals.Based on overall survival(OS),the prognostic performance outcomes for the CNLC and BCLC staging systems were compared by model discrimination[C statistic and Akaike information criterion(AIC)],monotonicity of the gradient(linear trend chi-square test),homogeneity(likelihood ratio chisquare test),and calibration(calibration plots).A prospective cohort of 44 patients receiving TACE-based therapy included between January 2021 and December 2022 was used to prospectively validate the outcomes.Results:Median OS was 19.1(18.2–20.0)months,with significant differences in OS between stages defined by the CNLC and BCLC observed(p<0.001).The CNLC performed better than the BCLC regarding model discrimination(C-index:0.661 vs.0.644;AIC:10,583.28 vs.10,583.72),model monotonicity of the gradient(linear trend chi-square test:66.107 vs.57.418;p<0.001),model homogeneity(159.2 vs.158.7;p<0.001).Both staging systems had good model calibration.Similar results were observed in the prospective cohort.Conclusions:Combining model discrimination,gradient monotonicity,homogeneity,and calibration,the CNLC performed better than the BCLC for Chinese HCC patients receiving TACE.
基金The study was supported by National Key Research and Development Program(2018YFA0704100,2018YFA0704104)National Natural Science Foundation of China(81827805,82130060)Jiangsu Provincial Special Program of Medical Science(BE2019750).The funding sources had no role in the writing of the report,or decision to submit the paper for publication.
文摘There is considerable potential for integrating transarterial chemoembolization(TACE),programmed death-(ligand)1(PD-[L]1)inhibitors,and molecular targeted treatments(MTT)in hepatocellular carcinoma(HCC).It is necessary to investigate the therapeutic efficacy and safety of TACE combined with PD-(L)1 inhibitors and MTT in real-world situations.In this nationwide,retrospective,cohort study,826 HCC patients receiving either TACE plus PD-(L)1 blockades and MTT(combination group,n=376)or TACE monotherapy(monotherapy group,n=450)were included from January 2018 to May 2021.The primary endpoint was progression-free survival(PFS)according to modified RECIST.The secondary outcomes included overall survival(OS),objective response rate(ORR),and safety.We performed propensity score matching approaches to reduce bias between two groups.After matching,228 pairs were included with a predominantly advanced disease population.Median PFS in combination group was 9.5 months(95%confidence interval[CI],8.4-11.0)versus 8.0 months(95%CI,6.6-9.5)(adjusted hazard ratio[HR],0.70,P=0.002).OS and ORR were also significantly higher in combination group(median OS,19.2[16.1-27.3]vs.15.7 months[13.0-20.2];adjusted HR,0.63,P=0.001;ORR,60.1%vs.32.0%;P<0.001).Grade 3/4 adverse events were observed at a rate of 15.8%and 7.5%in combination and monotherapy groups,respectively.Our results suggest that TACE plus PD-(L)1 blockades and MTT could significantly improve PFS,OS,and ORR versus TACE monotherapy for Chinese patients with predominantly advanced HCC in real-world practice,with an acceptable safety profile.
文摘Aims:Surveys and research on the applications of the hepatic venous pressure gradient(HVPG)are important for understanding the current status and future development of this technology in China.This article aimed to investigate the status of hepatic venous pressure gradient measurement in China in 2022.Methods:We investigated the overall status of HVPG technology in China-including hospital distribution,hospital level,annual number of cases,catheters used,average cost,indications,and current challenges by using online questionnaire.By counting the number and percentages of cases of these results,we hope to clarify the current status of HVPG measurements in China.Results:According to the survey,85 hospitals in China used HVPG technology in 2022 distributed across 29 provinces.A total of 4989 HVPG measurements were performed in all of the surveyed hospitals in 2022,of which 2813 cases(56.4%)were measured alone.The average cost of HVPG measurement was 5646.8±2327.9 CNY.Of the clinical teams who performed the measurements(sometimes multiple per hospital),94.3%(82/87)used the balloon method,and the majority of the teams(72.4%,63/87)used embolectomy catheters.Conclusions:This survey clarified the clinical application status of HVPG in China and confirmed that some medical institutions in China have established a foundation for this technology.It is still necessary to continue promoting and popularizing this technology in the future.
