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Proximal Tubule Secretory Clearance, Injury, and Kidney Viability in Cirrhosis. 肝硬化患者近端小管分泌物清除率、损伤和肾脏活力
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-07 DOI: 10.14309/ctg.0000000000000775
Michael L Granda, Eric Luitweiler, David K Prince, Andrew S Allegretti, Cary Paine, Raimund Pichler, Lena Sibulesky, Scott W Biggins, Bryan Kestenbaum

Introduction: Cirrhosis affects all structures of the kidney, in particular the tubules, which are responsible for secretion of protein-bound metabolites and electrolyte/water homeostasis. Yet, prevailing assessments of kidney function focus solely on glomerular filtration rate (GFR), which may incompletely reflect these processes. We sought to characterize markers of tubular function, injury, and viability in patients with and without cirrhosis.

Methods: We recruited outpatients undergoing liver transplantation evaluation for a collection of plasma and 24-hour urine, matching by GFR to control participants without cirrhosis. We measured urinary kidney injury molecule-1, a marker of proximal tubular injury, as well as epidermal growth factor (EGF), a marker of viability necessary for tubular epithelial cell proliferation after injury. We also estimated secretory clearance by measuring several highly secreted endogenous metabolites in urine and plasma.

Results: We recruited 39 patients with cirrhosis (mean model for end-stage liver disease 17 ± 4, Child-Pugh 8 ± 2, estimated glomerular filtration rate 66 ± 20 mL/min/1.73 m 2 ) and 58 GFR-matched controls without cirrhosis (estimated glomerular filtration rate 66 ± 21 mL/min/1.73 m 2 ). Urinary kidney injury molecule-1 was 4.4-fold higher than controls (95% confidence interval: 2.9-6.5), and EGF averaged 7.41-fold higher than controls (95% confidence interval: 2.15-25.53). We found that of 8 solutes, 5 had significantly greater kidney clearance in cirrhosis (1.3-2.1-fold higher): indoxyl sulfate, p-cresol sulfate, pyridoxic acid, tiglylglycine, and xanthosine.

Discussion: Cirrhosis was characterized by molecular signs of tubular injury in stable outpatients without acute kidney injury, accompanied by largely preserved tubular secretory clearance and greater signs of tubular viability. Within the limitations of the study, this suggests a phenotype of chronic ischemic injury but with initial preservation of tubular function in cirrhosis.

目的:肝硬化会影响肾脏的所有结构,尤其是肾小管,因为肾小管负责分泌与蛋白质结合的代谢产物和维持电解质/水的平衡。然而,目前对肾功能的评估仅关注肾小球滤过率(GFR),这可能无法完全反映这些过程。我们试图描述肝硬化和非肝硬化患者肾小管功能、损伤和存活能力的标志物:我们招募了正在接受肝移植评估的门诊患者,收集他们的血浆和 24 小时尿液,并通过 GFR 与未患肝硬化的对照参与者进行比对。我们测量了尿液中的肾损伤分子-1(KIM-1)和表皮生长因子(EGF),前者是近端肾小管损伤的标志物,后者是损伤后肾小管上皮细胞增殖所必需的活力标志物。我们还通过测量尿液和血浆中几种高度分泌的内源性代谢物来估计分泌清除率:我们招募了 39 名肝硬化患者(平均 MELD-Na 17±4,Child-Pugh 8±2,eGFR 66±20 ml/min/1.73m2)和 58 名无肝硬化的 GFR 匹配对照组(eGFR 66±21 ml/min/1.73m2)。尿 KIM-1 比对照组高 4.4 倍(95% CI:2.9-6.5),EGF 平均比对照组高 7.41 倍(95% CI:2.15-25.53)。我们发现,在 8 种溶质中,有 5 种物质在肝硬化时的肾脏清除率明显增高(高出 1.3-2.1 倍):硫酸吲哚啉、硫酸对甲酚、吡哆醇酸、替甘氨酸和黄嘌呤:肝硬化的特点是,在病情稳定的门诊患者中,肾小管损伤的分子标志没有急性肾损伤,同时肾小管分泌清除率基本保持不变,肾小管活力的标志较强。在研究的局限性范围内,这表明肝硬化患者存在慢性缺血性损伤的表型,但肾小管功能最初仍得以保留。
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引用次数: 0
Opioid and Nonopioid Analgesic Prescribing Patterns of Hepatologists for Medicare Beneficiaries. 肝病医生为医疗保险受益人开具阿片类和非阿片类镇痛药处方的模式。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.14309/ctg.0000000000000729
Preetha Iyengar, Nicole Prause, Wendi LeBrett, Anna Lee, Lin Chang, Arpan Patel

Introduction: Opioids are commonly prescribed to patients with chronic liver disease, but little is known regarding medication prescribing patterns of hepatologists. Opioid use increased until national guidelines limited opioid prescriptions in early 2016. We aimed to describe rates of opioid and nonopioid analgesics to Medicare beneficiaries by hepatologists from 2013 to 2017 and identify demographic characteristics associated with higher prescribing.

Methods: Prescription data from 2013 to 2017 by 761 hepatologists identified in the Centers for Medicare and Medicaid Services Part D Public Use File were analyzed. Annual prescription volumes were compared for providers with >10 annual prescriptions of a given drug type. Provider characteristics associated with opioid prescriptions were identified through multivariate logistic regression analyses.

Results: The proportion of hepatologists prescribing >10 annual opioid prescriptions decreased from 29% to 20.6%. Median annual opioid prescriptions per hepatologist significantly decreased from 24 to 20. Tramadol remained the most prescribed analgesic. Nonopioid analgesic prescription volume did not increase significantly. Provider characteristics associated with increased opioid prescriptions included male sex, practice location in the South and Midwest (vs West), more years in practice, and a greater proportion of beneficiaries who are white or with low-income subsidy claims. Characteristics associated with fewer prescriptions included non-university-based practice, having a greater proportion of female beneficiaries, and later prescription year.

Discussion: Hepatologists are prescribing less opioids. However, the prevalence of tramadol use and the lack of increase in nonopioid analgesic use highlights the need for advancing the science and training of pain management in chronic liver disease and targeted implementation of nonopioid treatment programs.

简介:阿片类药物是慢性肝病患者的常用处方药,但人们对肝病医生的处方用药模式知之甚少。在 2016 年初国家指南限制阿片类药物处方之前,阿片类药物的使用有所增加。我们旨在描述 2013-2017 年间肝病专家为医疗保险受益人开具阿片类和非阿片类镇痛药的比例,并确定与较高处方量相关的人口统计学特征:方法: 分析了美国医疗保险与医疗补助服务中心 D 部分公共使用文件中确定的 761 名肝病医生 2013-2017 年的处方数据。对年度处方量大于 10 个特定药物类型的医疗机构的年度处方量进行了比较。通过多变量逻辑回归分析确定了与阿片类药物处方相关的医疗机构特征:结果:每年开具超过 10 张阿片类药物处方的肝病医生比例从 29% 降至 20.6%。每位肝病专家的阿片类药物年处方量中位数从 24 例大幅降至 20 例。曲马多仍然是处方量最大的镇痛药。非阿片类镇痛药处方量没有明显增加。与阿片类药物处方量增加相关的提供者特征包括:男性、执业地点位于南部和中西部(相对于西部)、执业年限较长、白人或低收入补贴申请受益人比例较高。与处方较少相关的特征包括非大学执业、女性受益人比例较高以及处方年份较晚:结论:肝病医生开出的阿片类药物处方越来越少。然而,曲马多使用的普遍性和非阿片类镇痛药使用的不增加突出表明,有必要推进慢性肝病疼痛管理的科学和培训,并有针对性地实施非阿片类治疗计划。
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引用次数: 0
Radiomic Features at Contrast-Enhanced CT Predict Virus-Driven Liver Fibrosis: A Multi-Institutional Study. 对比增强 CT 的放射学特征可预测病毒导致的肝纤维化:一项多机构研究
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.14309/ctg.0000000000000712
Jincheng Wang, Shengnan Tang, Jin Wu, Shanshan Xu, Qikai Sun, Zheyu Zhou, Xiaoliang Xu, Yang Liu, Qiaoyu Liu, Yingfan Mao, Jian He, Xudong Zhang, Yin Yin

Introduction: Liver fibrosis is a major cause of morbidity and mortality among in patients with chronic hepatitis. Radiomics, particularly of the spleen, may improve diagnostic accuracy and treatment strategies. External validations are necessary to ensure reliability and generalizability.

Methods: In this retrospective study, we developed 3 radiomics models using contrast-enhanced computed tomography scans from 167 patients with liver fibrosis (training group) between January 2020 and December 2021. Radiomic features were extracted from arterial venous, portal venous, and equilibrium phase images. Recursive feature selection random forest and the least absolute shrinkage and selection operator logistic regression were used for feature selection and dimensionality reduction. Performance was assessed by area under the curve, C-index, calibration plots, and decision curve analysis. External validation was performed on 114 patients from 2 institutions.

Results: Twenty-five radiomic features were significantly associated with fibrosis stage, with 80% of the top 10 features originating from portal venous phase spleen images. The radiomics models showed good performance in the validation cohort (C-indices 0.723-0.808) and excellent calibration. Decision curve analysis indicated clinical benefits, with machine learning-based radiomics models (Random Forest score and support vector machine based radiomics score) providing more significant advantages.

Discussion: Radiomic features offer significant benefits over existing serum indices for staging virus-driven liver fibrosis, underscoring the value of radiomics in enhancing diagnostic accuracy. Specifically, radiomics analysis of the spleen presents additional noninvasive options for assessing fibrosis, highlighting its potential in improving patient management and outcomes.

背景:肝纤维化是慢性肝炎患者发病和死亡的主要原因。放射组学,尤其是脾脏的放射组学,可提高诊断的准确性并改善治疗策略。为确保可靠性和可推广性,有必要进行外部验证:在这项回顾性研究中,我们利用 2020 年 1 月至 2021 年 12 月期间 167 名肝脏纤维化患者(训练组)的对比增强 CT 扫描结果开发了三种放射组学模型。我们从动静脉、门静脉和平衡相图像中提取了放射组学特征。递归特征选择随机森林(RFS-RF)和最小绝对收缩和选择算子(LASSO)逻辑回归用于特征选择和降维。通过曲线下面积、C-指数、校准图和决策曲线分析来评估其性能。对两家机构的114名患者进行了外部验证:结果:25个放射组学特征与纤维化分期显著相关,前10个特征中有80%来自门静脉期脾脏图像。放射组学模型在验证队列中表现良好(C指数:0.723-0.808),校准效果极佳。决策曲线分析表明,基于机器学习的放射组学模型(RFR-score 和 SVMR-score)具有更显著的临床优势:结论:在对病毒驱动的肝纤维化进行分期时,放射组学特征比现有的血清指数更有优势,凸显了放射组学在提高诊断准确性方面的价值。特别是,脾脏的放射组学分析为评估肝纤维化提供了更多的无创选择,凸显了其在改善患者管理和预后方面的潜力。
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引用次数: 0
Shifts in Serum Bile Acid Profiles Associated With Barrett's Esophagus and Stages of Progression to Esophageal Adenocarcinoma. 与巴雷特食管和食管腺癌进展阶段相关的血清胆汁酸谱变化
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.14309/ctg.0000000000000762
Aarti Kumar, Pranav Gwalani, Prasad G Iyer, Kenneth K Wang, Gary W Falk, Gregory G Ginsberg, Charles J Lightdale, Armando Del Portillo, Stephen M Lagana, Yun Li, Hongzhe Li, Jeanine Genkinger, Zhezhen Jin, Anil K Rustgi, Timothy C Wang, Harris H Wang, Michael Quante, Julian A Abrams

Introduction: Reflux bile acids are believed to promote esophageal adenocarcinoma (EAC), but the role of systemic bile acids is unknown. This study aimed to assess associations between systemic bile acids and stages of Barrett's esophagus (BE) progression.

Methods: Subjects with and without BE were enrolled in this multicenter cross-sectional study. Targeted serum bile acid profiling was performed, and a subset of subjects completed a validated food frequency questionnaire. RNA sequencing was performed on BE or gastric cardia tissue to assess bile acid associations with gene expression.

Results: A total of 141 subjects were enrolled with serum bile acids profiled (49 non-BE; 92 BE: 44 no dysplasia, 25 indefinite/low grade dysplasia, 23 high-grade dysplasia/EAC). Lower Healthy Eating Index score, older age, higher body mass index, and no proton pump inhibitor use were associated with increased levels of multiple bile acids. Global bile acid pools were distinct between non-BE and stages of BE neoplasia ( P = 0.004). Increasing cholic acid was associated with high-grade dysplasia/EAC compared with non-BE, even after adjusting for EAC risk factors (adjusted odds ratio 2.03, 95% confidence interval 1.11-3.71) as was the combination of unconjugated primary bile acids (adjusted odds ratio 1.81, 95% confidence interval 1.04-3.13). High cholic acid levels were associated with tissue gene expression changes including increased DNA replication and reduced lymphocyte differentiation genes.

Discussion: Alterations in serum bile acids are independently associated with advanced neoplasia in BE and may contribute to neoplastic progression. Future studies should explore associated gut microbiome changes, proneoplastic effects of bile acids, and whether these bile acids, particularly cholic acid, represent potential biomarkers or viable therapeutic targets for advanced neoplasia in BE.

导言:反流胆汁酸被认为会促进EAC,但全身胆汁酸的作用尚不清楚。本研究旨在评估全身胆汁酸与巴雷特食管(BE)进展阶段之间的关系:这项多中心横断面研究招募了患有和未患有BE的受试者。方法:这项多中心横断面研究招募了患有和未患有BE的受试者,进行了有针对性的血清胆汁酸分析,一部分受试者填写了有效的食物频率问卷。对 BE 或胃贲门组织进行了 RNA 测序,以评估胆汁酸与基因表达的关系:结果:141名受试者的血清胆汁酸得到分析(49名非BE受试者;92名BE受试者:44名无发育不良,25名不确定/低度发育不良,23名高度发育不良/EAC)。健康饮食指数得分较低、年龄较大、体重指数较高以及未使用质子泵抑制剂与多种胆汁酸水平升高有关。非胆汁瘤和胆汁瘤各期之间的总体胆汁酸库是不同的(p=0.004)。与非 BE 相比,胆汁酸的增加与高级别发育不良/EAC 相关,即使在调整了 EAC 风险因素后也是如此(aOR 2.03,95% CI 1.11-3.71),非结合型初级胆汁酸的组合也是如此(aOR 1.81,95% CI 1.04-3.13)。高胆汁酸水平与组织基因表达变化有关,包括 DNA 复制增加和淋巴细胞分化基因减少:讨论:血清胆汁酸的变化与BE晚期肿瘤独立相关,并可能导致肿瘤进展。未来的研究应探讨相关的肠道微生物组变化、胆汁酸的促肿瘤作用,以及这些胆汁酸(尤其是胆酸)是否代表潜在的生物标志物或治疗 BE 晚期肿瘤的可行靶点。
{"title":"Shifts in Serum Bile Acid Profiles Associated With Barrett's Esophagus and Stages of Progression to Esophageal Adenocarcinoma.","authors":"Aarti Kumar, Pranav Gwalani, Prasad G Iyer, Kenneth K Wang, Gary W Falk, Gregory G Ginsberg, Charles J Lightdale, Armando Del Portillo, Stephen M Lagana, Yun Li, Hongzhe Li, Jeanine Genkinger, Zhezhen Jin, Anil K Rustgi, Timothy C Wang, Harris H Wang, Michael Quante, Julian A Abrams","doi":"10.14309/ctg.0000000000000762","DOIUrl":"10.14309/ctg.0000000000000762","url":null,"abstract":"<p><strong>Introduction: </strong>Reflux bile acids are believed to promote esophageal adenocarcinoma (EAC), but the role of systemic bile acids is unknown. This study aimed to assess associations between systemic bile acids and stages of Barrett's esophagus (BE) progression.</p><p><strong>Methods: </strong>Subjects with and without BE were enrolled in this multicenter cross-sectional study. Targeted serum bile acid profiling was performed, and a subset of subjects completed a validated food frequency questionnaire. RNA sequencing was performed on BE or gastric cardia tissue to assess bile acid associations with gene expression.</p><p><strong>Results: </strong>A total of 141 subjects were enrolled with serum bile acids profiled (49 non-BE; 92 BE: 44 no dysplasia, 25 indefinite/low grade dysplasia, 23 high-grade dysplasia/EAC). Lower Healthy Eating Index score, older age, higher body mass index, and no proton pump inhibitor use were associated with increased levels of multiple bile acids. Global bile acid pools were distinct between non-BE and stages of BE neoplasia ( P = 0.004). Increasing cholic acid was associated with high-grade dysplasia/EAC compared with non-BE, even after adjusting for EAC risk factors (adjusted odds ratio 2.03, 95% confidence interval 1.11-3.71) as was the combination of unconjugated primary bile acids (adjusted odds ratio 1.81, 95% confidence interval 1.04-3.13). High cholic acid levels were associated with tissue gene expression changes including increased DNA replication and reduced lymphocyte differentiation genes.</p><p><strong>Discussion: </strong>Alterations in serum bile acids are independently associated with advanced neoplasia in BE and may contribute to neoplastic progression. Future studies should explore associated gut microbiome changes, proneoplastic effects of bile acids, and whether these bile acids, particularly cholic acid, represent potential biomarkers or viable therapeutic targets for advanced neoplasia in BE.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Efficacy and Safety of Long-Term Treatment of Tenofovir Alafenamide vs Tenofovir Disoproxil Fumarate for Chronic Hepatitis B in Vietnam. 越南慢性乙型肝炎长期治疗替诺福韦-阿拉非那胺与富马酸替诺福韦二吡呋酯的临床疗效和安全性。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.14309/ctg.0000000000000749
Thao Huynh Phuong Nguyen, Quynh Thi Huong Bui, Thong Duy Vo

Introduction: Hepatitis B virus (HBV) infection is a contagious condition posing a major public health risk in various nations, including Vietnam. In 2019, the Ministry of Health introduced tenofovir alafenamide (TAF) to treat patients with chronic HBV infection and reduce the long-term toxicity of tenofovir disoproxil fumarate (TDF). This study aimed to assess the effectiveness and safety of these 2 medications in individuals with hepatitis B e antigen (HBeAg)-positive chronic HBV.

Methods: This retrospective cohort study included data collected from the medical records of patients with chronic HBV who visited the Liver Clinic at University Medical Center Ho Chi Minh City between 2018 and 2020.

Results: After 2 years of treatment, the proportion of HBeAg loss in the TAF group was twice that of the TDF group (22.4% vs 11.2%), indicating a statistically significant difference in the probability of HBeAg loss (adjusted hazard ratio = 2.22; 95% confidence interval [CI] 1.43-3.42; P < 0.01). In addition, there was a statistically significant difference in the rate and ability of antiviral response between patients treated with TAF and TDF (65% vs 54.5%, respectively; adjusted hazard ratio = 1.34; 95% CI 1.08-1.69; P < 0.01). A total of 93.9% of patients achieved the goal of restoring alanine aminotransferase to normal, a higher percentage compared with the 81.2% in the TDF group, and the likelihood of achieving normal alanine aminotransferase levels with TAF was greater compared with those on TDF (adjusted hazard ratio = 1.67; 95% CI 1.38-2.01; P < 0.01). Moreover, there was a statistically significant difference in the variation in renal function between the TAF and TDF groups. Serum creatinine levels in the TAF group increased less than those in the TDF group by 0.03 mg/dL every 6 months (95% CI -0.04 to -0.01, P < 0.01), and the estimated glomerular filtration rate in the TAF group was higher than that in the TDF group every 6 months by 2.78 mL/min/1.73 m 2 (95% CI 0.98-4.57, P < 0.01). However, there was no statistically significant difference in the likelihood of HBeAg seroconversion between patients with chronic hepatitis B treated with TAF or TDF (adjusted hazard ratio = 1.79; 95% CI 0.91-3.53; P = 0.09), nor in the risk of adverse events between the 2 groups (adjusted odds ratio = 1.34; 95% CI 0.88-2.05; P = 0.17). In addition, although the HBsAg concentration in the TAF group was lower than in the TDF group by an average of 0.05 log 10 IU/mL every 6 months (95% CI -0.15 to 0.05), this difference also did not reach statistical significance ( P = 0.35).

Discussion: TAF has been demonstrated to achieve some therapeutic efficacy goals and reduce nephrotoxicity better than TDF. However, no differences were found in seroconversion or adverse events between the patient groups.

导言:乙型肝炎病毒(HBV)感染是一种传染性疾病,在包括越南在内的多个国家构成重大公共卫生风险。2019 年,越南卫生部推出了替诺福韦-阿拉非那胺(TAF),用于治疗慢性 HBV 感染患者,并降低富马酸替诺福韦二吡呋酯(TDF)的长期毒性。本研究旨在评估这两种药物对 HBeAg 阳性慢性 HBV 感染者的有效性和安全性:这项回顾性队列研究包括从2018年至2020年期间在胡志明市大学医学中心肝病门诊就诊的慢性HBV患者病历中收集的数据:治疗两年后,TAF组的HBeAg丢失比例是TDF组的两倍(22.4% vs. 11.2%),表明HBeAg丢失的概率存在显著统计学差异(调整后危险比=2.22;95% CI 1.43至3.42;P <0.01)。此外,接受 TAF 和 TDF 治疗的患者的抗病毒应答率和应答能力也有显著统计学差异(分别为 65% 对 54.5%;调整后危险比 = 1.34;95% CI 1.08 至 1.69;P < 0.01)。93.9%的患者实现了ALT恢复正常的目标,这一比例高于TDF组的81.2%,与服用TDF的患者相比,服用TAF的患者实现ALT水平正常的可能性更大(调整后危险比=1.67;95% CI 1.38至2.01;p <0.01)。此外,TAF组和TDF组之间的肾功能差异也有统计学意义。TAF组的血清肌酐水平每6个月比TDF组低0.03 mg/dL (95% CI -0.04 to -0.01,p < 0.01),TAF组的eGFR每6个月比TDF组高2.78 mL/min/1.73 m2 (95% CI 0.98 to 4.57,p < 0.01)。然而,接受 TAF 或 TDF 治疗的慢性乙型肝炎患者发生 HBeAg 血清转换的可能性没有显著统计学差异(调整后危险比 = 1.79;95% CI 0.91 至 3.53;p = 0.09),两组患者发生不良事件的风险也没有显著统计学差异(调整后几率比 = 1.34;95% CI 0.88 至 2.05;p = 0.17)。此外,虽然TAF组的HBsAg浓度比TDF组平均每6个月低0.05 log10 IU/mL(95% CI -0.15至0.05),但这一差异也未达到统计学意义(P = 0.35):讨论:事实证明,TAF比TDF更能达到某些疗效目标并减少肾毒性。然而,在血清转换或不良事件方面,两组患者之间没有发现差异。
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引用次数: 0
Factors Associated With Mailed Fecal Immunochemical Test Completion in an Integrated Academic-Community Healthcare System. 学术-社区综合医疗系统中与完成邮寄粪便免疫化学检验 (FIT) 相关的因素。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.14309/ctg.0000000000000757
Samuel Simpson, Kaiyue Yu, Ari Bell-Brown, Amanda Kimura, Allison Meisner, Rachel B Issaka

Introduction: Mailed fecal immunochemical test (FIT) outreach is an effective strategy to increase colorectal cancer (CRC) screening. The aim of this study was to determine the patient-level, clinic-level, and geographic-level factors associated with CRC screening completion in a mailed FIT outreach program.

Methods: This retrospective cohort study was conducted in the integrated healthcare system of University of Washington Medicine and included patients aged 50-75 years, who were due for CRC screening, and had a primary care encounter in the past 3 years. Eligible patients received mailed outreach that included a letter with information about CRC screening, FIT kit, and a prepaid return envelope. CRC screening and factors associated with completion were obtained from electronic health records and the CRC screening program database.

Results: Of the 9,719 patients who received mailed outreach, 29.6% completed FIT mailed outreach. The median FIT return time was 27 days (interquartile range 14-54). On multivariate analysis, patients with a higher area deprivation index, insured through Medicaid, living without a partner, and whose last primary care visit was >12 months ago were less likely to complete a FIT compared with their counterparts. Over a 12-month period, overall CRC screening across the health system increased by 2 percentage points (68%-70%).

Discussion: Mailed FIT outreach in an integrated academic-community practice was feasible, with 32% of invited patients completing CRC screening by FIT or colonoscopy, on par with published literature. Patient and geographic-level factors were associated with CRC screening completion. These data will inform additional interventions aimed to increase CRC screening participation in this population.

简介:邮寄粪便免疫化学检验(FIT)推广项目是提高大肠癌(CRC)筛查率的有效策略。本研究旨在确定与邮寄 FIT 推广项目中完成 CRC 筛查相关的患者、诊所和地理因素:这项回顾性队列研究在华大医学部的综合医疗系统中进行,研究对象包括年龄在 50-75 岁之间、应进行 CRC 筛查且在过去 3 年中接受过初级保健的患者。符合条件的患者会收到邮寄的宣传资料,其中包括一封关于 CRC 筛查信息的信件、FIT 套件和一个预付费的回邮信封。我们从电子健康记录和 CRC 筛查项目数据库中获取了 CRC 筛查信息以及与完成筛查相关的因素:在接受邮寄宣传的 9719 名患者中,29.6% 完成了 FIT 邮寄宣传。FIT 返回时间的中位数为 27 天(IQR 14 - 54)。通过多变量分析发现,地区贫困指数较高、通过医疗补助计划投保、无伴侣生活、最后一次初级保健就诊时间超过 12 个月的患者完成 FIT 的可能性低于同类患者。在12个月的时间里,整个医疗系统的CRC筛查率提高了2个百分点(从68%提高到70%):讨论:在学术与社区综合实践中开展邮寄 FIT 推广活动是可行的,32% 的受邀患者通过 FIT 或结肠镜完成了 CRC 筛查,与已发表的文献一致。患者和地域因素与完成 CRC 筛查有关。这些数据将为旨在提高该人群参与 CRC 筛查率的其他干预措施提供参考。
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引用次数: 0
24-Hour Urinary Sodium Excretion Is Associated With Increased Risk of Pancreatic Cancer: A Prospective Cohort Study. 24 小时尿钠排泄与胰腺癌风险增加有关:一项前瞻性队列研究。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.14309/ctg.0000000000000741
Jiayi Wang, Yangjie Liao, Minzi Deng, Xing Wu, Xiaoyan Wang, Jingbo Li

Introduction: This study builds on previous research and its limitations, which indicate the need for further investigation in prospective cohorts. Our aim was to explore the association between estimated 24-hour urinary sodium excretion (indicative of daily sodium consumption) and the occurrence of pancreatic cancer in the UK Biobank's large prospective cohort.

Methods: Using the INTERSALT equation, the study computed estimated 24-hour urinary sodium excretion by analyzing the baseline spot urine sodium measurements of 434,372 individuals enrolled in the UK Biobank. Pancreatic cancer cases were identified through UK cancer registries. Adjusted Cox proportional hazards models were used to evaluate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between estimated 24-hour urinary sodium excretion and the risk of pancreatic cancer.

Results: Over a median follow-up period of 13.8 years, 1,765 cases of pancreatic cancer were detected. The multivariable adjusted Cox model showed that each 1-gram rise in estimated 24-hour urinary sodium excretion corresponded to a 1.12 HR for incident pancreatic cancer (95% CI: 1.03, 1.22). The estimated HR for 24-hour urinary sodium excretion in binary form was 1.23 (95% CI: 1.05, 1.44). Compared with the lowest group, the group with the highest estimated 24-hour urinary sodium excretion exhibited an HR of 1.38 (95% CI: 1.21, 1.58).

Discussion: These results propose an association between elevated sodium consumption and a heightened risk of pancreatic cancer. Further validation and exploration of potential mechanisms are warranted.

研究背景该研究建立在以往研究的基础之上,其局限性表明需要在前瞻性队列中开展进一步调查:我们的目的是探讨英国生物库大型前瞻性队列中估计的 24 小时尿钠排泄量(表明每日钠消耗量)与胰腺癌发生率之间的关联:该研究使用 INTERSALT 方程,通过分析英国生物库中 434,372 名注册者的基线定点尿钠测量值,计算出估计的 24 小时尿钠排泄量。胰腺癌病例是通过英国癌症登记处确定的。采用调整后的 Cox 比例危险模型来评估估计的 24 小时尿钠排泄量与胰腺癌风险之间的危险比 (HR) 和 95% 置信区间 (CI):中位随访期为 13.8 年,共发现 1,765 例胰腺癌病例。多变量调整 Cox 模型显示,估计的 24 小时尿钠排泄量每增加 1 克,胰腺癌发病 HR 为 1.12(95% CI:1.03, 1.22)。二进制形式的 24 小时尿钠排泄估计 HR 为 1.23(95% CI:1.05, 1.44)。与最低组相比,估计 24 小时尿钠排泄量最高的一组的 HR 为 1.38(95% CI:1.21,1.58):这些结果表明,钠摄入量升高与胰腺癌风险增加之间存在关联。需要进一步验证和探索潜在的机制。
{"title":"24-Hour Urinary Sodium Excretion Is Associated With Increased Risk of Pancreatic Cancer: A Prospective Cohort Study.","authors":"Jiayi Wang, Yangjie Liao, Minzi Deng, Xing Wu, Xiaoyan Wang, Jingbo Li","doi":"10.14309/ctg.0000000000000741","DOIUrl":"10.14309/ctg.0000000000000741","url":null,"abstract":"<p><strong>Introduction: </strong>This study builds on previous research and its limitations, which indicate the need for further investigation in prospective cohorts. Our aim was to explore the association between estimated 24-hour urinary sodium excretion (indicative of daily sodium consumption) and the occurrence of pancreatic cancer in the UK Biobank's large prospective cohort.</p><p><strong>Methods: </strong>Using the INTERSALT equation, the study computed estimated 24-hour urinary sodium excretion by analyzing the baseline spot urine sodium measurements of 434,372 individuals enrolled in the UK Biobank. Pancreatic cancer cases were identified through UK cancer registries. Adjusted Cox proportional hazards models were used to evaluate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between estimated 24-hour urinary sodium excretion and the risk of pancreatic cancer.</p><p><strong>Results: </strong>Over a median follow-up period of 13.8 years, 1,765 cases of pancreatic cancer were detected. The multivariable adjusted Cox model showed that each 1-gram rise in estimated 24-hour urinary sodium excretion corresponded to a 1.12 HR for incident pancreatic cancer (95% CI: 1.03, 1.22). The estimated HR for 24-hour urinary sodium excretion in binary form was 1.23 (95% CI: 1.05, 1.44). Compared with the lowest group, the group with the highest estimated 24-hour urinary sodium excretion exhibited an HR of 1.38 (95% CI: 1.21, 1.58).</p><p><strong>Discussion: </strong>These results propose an association between elevated sodium consumption and a heightened risk of pancreatic cancer. Further validation and exploration of potential mechanisms are warranted.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Low Prevalence of Reporting of Participant Race and Ethnicity in Gastroenterology Research Publications. 在胃肠病学研究出版物中,报告参与者种族和族裔的比例较低。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.14309/ctg.0000000000000753
Helen Burton-Murray, Christopher Vélez, Taylor Boyd, Isabelle Garcia-Fischer, Mary Paz, Imani Weeks, Katheryn Kiser, Andrew T Chan

Introduction: Empirical information on the evolution of reporting race and ethnicity information in gastroenterology research is lacking. To facilitate understanding of where improvements are needed to increase diversity, equity, and inclusion in gastroenterology research, we aimed to evaluate reporting and representation by race and ethnicity in studies published in flagship US-based gastroenterology journals over 20 years.

Methods: We manually reviewed reporting and representation by race and ethnicity in all original research articles published in the American Journal of Gastroenterology and Gastroenterology in 2000, 2010, and 2020.

Results: Of 1,168 publications, 24% reported information on race/ethnicity, significantly more commonly reported in US-based study samples vs non-US-based samples. While reporting significantly increased over time, reporting rates were still low as of 2020 (37% overall; 54% with US-based samples).

Discussion: We recommend that gastroenterology journals create standard reporting requirements for sociodemographic information, including information on race, ethnicity, and/or cultural background.

背景:目前还缺乏有关胃肠病学研究中种族和民族信息报告演变的经验信息。为了便于了解在哪些方面需要改进,以提高胃肠病学研究的多样性、公平性和包容性,我们旨在评估 20 年来发表在美国胃肠病学旗舰期刊上的研究中按种族和民族分列的报告和代表性:我们手动审查了 2000 年、2010 年和 2020 年发表在《美国胃肠病学杂志》和《胃肠病学》上的所有原创研究文章中按种族和民族分列的报告和代表性:在 1,168 篇论文中,有 24% 的论文报告了种族/族裔信息,其中以美国为基地的研究与非美国为基地的研究相比,报告种族/族裔信息的比例明显更高。虽然随着时间的推移,报告率明显增加,但截至2020年,报告率仍然很低(总体报告率为37%;美国样本报告率为54%):我们建议胃肠病学期刊制定社会人口学信息的标准报告要求,包括种族、民族和/或文化背景信息。
{"title":"Low Prevalence of Reporting of Participant Race and Ethnicity in Gastroenterology Research Publications.","authors":"Helen Burton-Murray, Christopher Vélez, Taylor Boyd, Isabelle Garcia-Fischer, Mary Paz, Imani Weeks, Katheryn Kiser, Andrew T Chan","doi":"10.14309/ctg.0000000000000753","DOIUrl":"10.14309/ctg.0000000000000753","url":null,"abstract":"<p><strong>Introduction: </strong>Empirical information on the evolution of reporting race and ethnicity information in gastroenterology research is lacking. To facilitate understanding of where improvements are needed to increase diversity, equity, and inclusion in gastroenterology research, we aimed to evaluate reporting and representation by race and ethnicity in studies published in flagship US-based gastroenterology journals over 20 years.</p><p><strong>Methods: </strong>We manually reviewed reporting and representation by race and ethnicity in all original research articles published in the American Journal of Gastroenterology and Gastroenterology in 2000, 2010, and 2020.</p><p><strong>Results: </strong>Of 1,168 publications, 24% reported information on race/ethnicity, significantly more commonly reported in US-based study samples vs non-US-based samples. While reporting significantly increased over time, reporting rates were still low as of 2020 (37% overall; 54% with US-based samples).</p><p><strong>Discussion: </strong>We recommend that gastroenterology journals create standard reporting requirements for sociodemographic information, including information on race, ethnicity, and/or cultural background.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fecal and Serum Granulocyte Protein Levels in Inflammatory Bowel Disease and Irritable Bowel Syndrome and Their Relation to Disease Activity. 炎症性肠病和肠易激综合征的粪便和血清粒细胞蛋白水平及其与疾病活动的关系。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.14309/ctg.0000000000000733
Helena Ekoff, Niclas Rydell, Per M Hellström, Robert Movérare

Introduction: Neutrophilic calprotectin (CP) and myeloperoxidase (MPO), neutrophil gelatinase-associated lipocalin (NGAL), and eosinophil-derived neurotoxin (EDN) are suggested proxy markers for gut inflammation. However, there are insufficient supporting data for MPO, NGAL, and EDN.

Methods: In a cross-sectional investigation including adult patients, we studied the ability of CP, MPO, NGAL, and EDN, measured in fecal and serum samples, to differentiate between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), and to predict disease activity.

Results: Fifty-nine patients had ulcerative colitis (UC), 38 had Crohn's disease, and 100 patients had IBS. The protein concentrations were higher in patients with IBD in the fecal samples ( P < 0.001) and the serum samples ( P < 0.01), and they correlated weakly (r s ≤0.38) between the sample sources. Fecal EDN was higher in patients with Crohn's disease compared with UC (1.79 vs 0.50 mg/kg, P = 0.016). The neutrophilic proteins were superior to EDN in the fecal samples for differentiating between patients with IBD and IBS. Fecal MPO (cutoff: 0.86 mg/kg) had the highest sensitivity (74.7%) and specificity (84.6%). Combining fecal CP and MPO increased the sensitivity to 82.3% (specificity: 73.6%). NGAL (cutoff: 196.9 μg/L) showed the best discriminating performance in serum (sensitivity: 62.9%; specificity: 68.0%). Serum NGAL (cutoff: 272.4 μg/L) predicted active disease in UC (Partial Mayo Score ≥2) with a sensitivity and specificity of 57.1% and 83.3%, respectively.

Discussion: Fecal MPO and serum NGAL are promising novel biomarkers, in addition to fecal CP, for differentiating between IBD and IBS. Serum NGAL may also predict disease activity in patients with UC.

导言:中性粒细胞钙蛋白(CP)和髓过氧化物酶(MPO)、中性粒细胞明胶酶相关脂褐质(NGAL)和嗜酸性粒细胞衍生神经毒素(EDN)被认为是肠道炎症的替代标记物。然而,MPO、NGAL 和 EDN 的支持数据并不充分:在一项包括成年患者在内的横断面调查中,我们研究了粪便和血清样本中测得的 CP、MPO、NGAL 和 EDN 在区分炎症性肠病(IBD)和肠易激综合征(IBS)以及预测疾病活动性方面的能力:59名患者患有溃疡性结肠炎(UC),38名患者患有克罗恩病(CD),100名患者患有肠易激综合征。在粪便样本中,IBD 患者的蛋白质浓度更高(p 结论:粪便 MPO 和血清凝乳酶原的浓度在 IBD 患者中更高:除粪便 CP 外,粪便 MPO 和血清 NGAL 是很有前途的新型生物标记物,可用于区分 IBD 和 IBS。血清 NGAL 还能预测 UC 患者的疾病活动性。
{"title":"Fecal and Serum Granulocyte Protein Levels in Inflammatory Bowel Disease and Irritable Bowel Syndrome and Their Relation to Disease Activity.","authors":"Helena Ekoff, Niclas Rydell, Per M Hellström, Robert Movérare","doi":"10.14309/ctg.0000000000000733","DOIUrl":"10.14309/ctg.0000000000000733","url":null,"abstract":"<p><strong>Introduction: </strong>Neutrophilic calprotectin (CP) and myeloperoxidase (MPO), neutrophil gelatinase-associated lipocalin (NGAL), and eosinophil-derived neurotoxin (EDN) are suggested proxy markers for gut inflammation. However, there are insufficient supporting data for MPO, NGAL, and EDN.</p><p><strong>Methods: </strong>In a cross-sectional investigation including adult patients, we studied the ability of CP, MPO, NGAL, and EDN, measured in fecal and serum samples, to differentiate between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), and to predict disease activity.</p><p><strong>Results: </strong>Fifty-nine patients had ulcerative colitis (UC), 38 had Crohn's disease, and 100 patients had IBS. The protein concentrations were higher in patients with IBD in the fecal samples ( P < 0.001) and the serum samples ( P < 0.01), and they correlated weakly (r s ≤0.38) between the sample sources. Fecal EDN was higher in patients with Crohn's disease compared with UC (1.79 vs 0.50 mg/kg, P = 0.016). The neutrophilic proteins were superior to EDN in the fecal samples for differentiating between patients with IBD and IBS. Fecal MPO (cutoff: 0.86 mg/kg) had the highest sensitivity (74.7%) and specificity (84.6%). Combining fecal CP and MPO increased the sensitivity to 82.3% (specificity: 73.6%). NGAL (cutoff: 196.9 μg/L) showed the best discriminating performance in serum (sensitivity: 62.9%; specificity: 68.0%). Serum NGAL (cutoff: 272.4 μg/L) predicted active disease in UC (Partial Mayo Score ≥2) with a sensitivity and specificity of 57.1% and 83.3%, respectively.</p><p><strong>Discussion: </strong>Fecal MPO and serum NGAL are promising novel biomarkers, in addition to fecal CP, for differentiating between IBD and IBS. Serum NGAL may also predict disease activity in patients with UC.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141449858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Metagenomics Analysis Reveals Unique Gut Microbiota Signature of Slow-Transit Constipation. 元基因组学分析揭示了缓慢型便秘的独特肠道微生物群特征。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.14309/ctg.0000000000000766
Kyungsun Han, Braden Kuo, Hamed Khalili, Kyle Staller

Introduction: Altered gut microbiota may play a role in slow-transit constipation (STC). We conducted a study of gut microbiota composition and functionality in STC using metagenomic analyses.

Methods: We assembled a clinical cohort of 24 patients with STC physiology age- and sex-matched to 24 controls. We performed shotgun metagenomic sequencing followed by prediction of metabolite composition from functional profiles.

Results: In a middle-aged (mean 55.3 years), predominantly female cohort, there were no significant differences in α-diversity indices, but permutational multivariate analysis of variance analysis showed significant between-group differences (R 2 = 0.050, P < 0.001) between STC patients and controls. Gordonibacter pamelaeae , Bifidobacterium longum , Firmicutes bacterium co-abundance gene group 94, and Anaerotruncus colihominis were more abundant in STC, whereas Coprococcus comes and Roseburia intestinalis were more abundant in controls. Gut-derived metabolites varying in STC relative to controls were related to bile acid and cholesterol metabolism.

Discussion: We found a unique metagenomic and metabolomic signature of STC.

简介:肠道微生物群的改变可能是导致慢传输性便秘(STC)的原因之一。我们利用元基因组分析法对慢行性便秘患者的肠道微生物群组成和功能进行了研究:方法:我们组建了一个临床队列,其中包括 24 名与 24 名对照组年龄和性别相匹配的 STC 生理病患者。我们进行了霰弹枪元基因组测序,然后根据功能图谱预测代谢物组成:结果:在以女性为主的中年(平均 55.3 岁)组群中,α 多样性指数无显著差异,但 permutational 多变量方差分析显示组间差异显著(R2=0.050,p 讨论:我们发现了 STC 独特的元基因组和代谢组特征。
{"title":"Metagenomics Analysis Reveals Unique Gut Microbiota Signature of Slow-Transit Constipation.","authors":"Kyungsun Han, Braden Kuo, Hamed Khalili, Kyle Staller","doi":"10.14309/ctg.0000000000000766","DOIUrl":"10.14309/ctg.0000000000000766","url":null,"abstract":"<p><strong>Introduction: </strong>Altered gut microbiota may play a role in slow-transit constipation (STC). We conducted a study of gut microbiota composition and functionality in STC using metagenomic analyses.</p><p><strong>Methods: </strong>We assembled a clinical cohort of 24 patients with STC physiology age- and sex-matched to 24 controls. We performed shotgun metagenomic sequencing followed by prediction of metabolite composition from functional profiles.</p><p><strong>Results: </strong>In a middle-aged (mean 55.3 years), predominantly female cohort, there were no significant differences in α-diversity indices, but permutational multivariate analysis of variance analysis showed significant between-group differences (R 2 = 0.050, P < 0.001) between STC patients and controls. Gordonibacter pamelaeae , Bifidobacterium longum , Firmicutes bacterium co-abundance gene group 94, and Anaerotruncus colihominis were more abundant in STC, whereas Coprococcus comes and Roseburia intestinalis were more abundant in controls. Gut-derived metabolites varying in STC relative to controls were related to bile acid and cholesterol metabolism.</p><p><strong>Discussion: </strong>We found a unique metagenomic and metabolomic signature of STC.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Clinical and Translational Gastroenterology
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