Clinics and research in hepatology and gastroenterology最新文献

Real-life effectiveness of allogeneic expanded adipose-derived mesenchymal stem cell therapy for perianal fistulizing refractory Crohn's disease. 异体扩增脂肪间充质干细胞治疗肛周瘘难治性克罗恩病的实际疗效：异体间充质干细胞治疗肛周瘘CD。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-09-28 DOI: 10.1016/j.clinre.2024.102473

Maria Alonso-Gomez, Anne Laure Charlois, Eddy Cotte, Claire Gay, Pauline Danion, Emilie Malezieux, Romain Altwegg, Gilles Boschetti, Stéphane Nancey

Background: Real life data about the long-term efficacy of darvadstrocel for treating perianal fistulas in Crohn's disease (CD) remain scarce.

Aim: To report the effectiveness and safety of darvadstrocel therapy to close perianal fistula in a real-life cohort of CD patients.

Methods: All patients with CD suffering complex draining perianal fistulas who consecutively underwent administration of a single local injection of darvadstrocel at two centres were followed up and evaluated. The primary endpoint was clinical remission (closure of all external openings with no discharge at pressure) at week 24. Combined remission (defined as clinically plus MRI-assessed fistula closure) were also assessed at week 24 and 52.

Results: A total of 36 CD patients (19 Male, mean age 38.5 years) were included with a median follow up of 16 months. Clinical remission was achieved in 17 out of 36 patients (47.2 %) and combined remission in 15 out of 36 patients (41.6 %) at week 24. At week 52, clinical and combined remission was achieved in 17 out of 36 patients (47.2 %) and in 15 out of 33 evaluable patients (45.4 %), respectively.

Conclusion: In this real-world setting, a successful response to darvadstrocel therapy based on clinical remission was reported in around half of the patients and combined remission including radiological assessment in more than 4 out of 10 patients.

背景：有关达伐司他韦治疗克罗恩病（CD）肛周瘘管的长期疗效的真实数据仍然很少。目的：报告达伐司他韦治疗克罗恩病患者肛周瘘管的有效性和安全性：方法：在两个中心对所有患有复杂引流性肛周瘘的 CD 患者进行随访和评估，这些患者连续接受了达伐司他赛单次局部注射。主要终点是第24周时的临床缓解（所有外部开口闭合，按压无分泌物）。在第24周和第52周还对综合缓解（定义为临床和核磁共振评估的瘘管闭合）进行了评估：共纳入 36 名 CD 患者（19 名男性，平均年龄 38.5 岁），中位随访时间为 16 个月。在第 24 周，36 名患者中有 17 人（47.2%）获得临床缓解，36 名患者中有 15 人（41.6%）获得综合缓解。第 52 周时，36 名患者中有 17 人（47.2%）实现了临床缓解，33 名可评估患者中有 15 人（45.4%）实现了综合缓解：结论：在这一真实世界环境中，约半数患者对达伐司曲塞疗法的临床缓解做出了成功的反应，10 例患者中有 4 例以上获得了包括放射学评估在内的综合缓解。

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引用次数: 0

Optimization of endoscopic treatment strategies for R0 resection of rectal neuroendocrine tumors smaller than 10 mm. 小于 10 毫米的直肠神经内分泌肿瘤 R0 切除术的内窥镜治疗策略优化。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-09-26 DOI: 10.1016/j.clinre.2024.102469

Jieti Wang, Xiaolan Zhang, Ke Chen, Yun Liang, Yuan Liu, Ziting Jiang, Yiping He, Jie Chen, Jianqiang Liu

Background: The optimal histologically complete (R0) resection methods of endoscopy for rectal neuroendocrine tumor (NET) ≤ 10 mm remains controversial. We aimed to assess the optimal endoscopic treatments for NETs.

Methods: The retrospective enrolled patients (n = 208) with rectal NETs were divided into 3 subsets according to pathological tumor size: 2 - 3 mm, 4 - 5 mm, and 6 - 10 mm NETs. Factors associated with R0 resection according to different endoscopic treatments (accidental diagnostic biopsy by cold forceps, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD)) and tumor size were investigated. All patients underwent follow-up and no local recurrence or metastasis were identified.

Results: A total of 208 patients were enrolled. In patients with 2 - 3 mm NETs, the R0 resection rate was 100.0 % for biopsy, EMR, and ESD. The R0 resection rate for biopsy of 4 - 5 mm and 6 - 10 mm NETs was 34.3 % and 0.0 % respectively, which was inferior to the EMR/ESD rate (4 - 5mm: p < 0.001; 6 - 10 mm: p < 0.001: respectively). For patients with ≤ 10 mm NETs, EMR and ESD had a comparable en bloc (p = 0.082) and R0 resection rates (p = 0.651).

Conclusion: Accidental diagnostic biopsy by cold forceps could be considered as the possible treatment for 2 - 3 mm rectal NETs. And for patients with ≤ 10 mm rectal NETs, both EMR and ESD might be sufficient.

背景：对于直肠神经内分泌肿瘤（NET）≤10 mm的最佳组织学完全（R0）切除方法仍存在争议。我们旨在评估NET的最佳内镜治疗方法：回顾性入组的直肠NET患者（n = 208）根据病理肿瘤大小分为3个亚组：2 - 3 mm、4 - 5 mm和6 - 10 mm的NET。研究人员根据不同的内镜治疗方法（冷钳意外诊断性活检、内镜下粘膜切除术（EMR）和内镜下粘膜下剥离术（ESD））和肿瘤大小调查了R0切除率的相关因素。所有患者均接受了随访，未发现局部复发或转移：结果：共有 208 名患者入选。在2-3毫米的NET患者中，活检、EMR和ESD的R0切除率均为100.0%。4-5毫米和6-10毫米NET活检的R0切除率分别为34.3%和0.0%，低于EMR/ESD的R0切除率（4-5毫米：P＜0.001；6-10毫米：P＜0.001）。对于≤10毫米的NET患者，EMR和ESD的全切率（p = 0.082）和R0切除率（p = 0.651）相当：结论：对于2-3毫米的直肠NET，可以考虑使用冷钳进行诊断性活检。对于≤10毫米的直肠NET患者，EMR和ESD可能都足够了。

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引用次数: 0

Propensity score matching-based analysis of the effect of corticosteroids in treating severe drug-induced liver injury. 基于倾向得分匹配的皮质类固醇治疗严重药物性肝损伤效果分析。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-09-25 DOI: 10.1016/j.clinre.2024.102472

Huanyu Wu, Wanping Yan, Ke Liu, Jisheng Jing, Wei Ye

<p><strong>Background and aim: </strong>There is no conventional treatment for patients with severe drug-induced liver injury (DILI) except for discontinuation of liver injury drugs and symptomatic supportive therapy. Opinions on whether corticosteroids can be used to treat severe DILI are conflicting, and most of the relevant clinical studies are case reports or retrospective studies, which still need to be supported by high-level evidence-based medical studies. This study aimed to evaluate the effect and tolerance of corticosteroids in patients with severe DILI. Risk factors associated with patient failure to cure were also explored.</p><p><strong>Methods: </strong>Propensity score matching based on nearest-neighbor 1:1 matching was used to screen severe DILI patients in the corticosteroids and control groups. Severe DILI was defined as elevated serum ALT and/or ALP with TBIL≥5 ULN (5 mg/dL or 85.5 μmol/L) with or without INR ≥1.5. Patients were treated with conventional therapy combined with corticosteroids in the corticosteroids group and only conventional therapy in the control group.</p><p><strong>Results: </strong>A total of 146 patients, 73 each in the corticosteroids and control groups, were included in this study. By analyzing the entire cohort, we found no significant difference in cure rates between patients in the corticosteroid group and control group (34.2% vs. 20.5 %, p = 0.095), and there was no significant difference in the incidence of adverse effects between the two groups (20.5% vs. 20.5 %, p = 1.000). However, TBIL decreased more in the corticosteroids group on day 7 (89.2 ± 107.6 μmol/L vs. 58.8 ± 70.7 μmol/L, p = 0.046). In subgroup analyses, patients whose TBIL remained elevated despite conventional treatment had a higher TBIL decline on day 7,14 after use of corticosteroid (99.2 ± 98.5μmol/L vs. -23.3 ± 50.4μmol/L, p < 0.001; 120 ± 119.1μmol/L vs. 61.2 ± 98.5μmol/L, p = 0.047). The cure rate of patients in the corticosteroid group was significantly higher than that of the control group (36.1 % versus 4.5 %, p = 0.016). The proportion of patients with TBIL <85.5 μmol/L was also significantly higher in the corticosteroid group than in the control group at day 7 (p = 0.016) and day 14 (p = 0.004) after treatment. In the subgroup analysis of patients with different clinical phenotypes, the causative agent was herbal, autoimmune antibody-positive and 40 % < PTA ≤ 50 % of patients, corticosteroid use did not increase the cure rate of the patients. Univariate and multifactorial analyses found corticosteroid use to be a protective factor for failure to cure in patients with severe DILI (p < 0.001, OR:0.191,95 % CI:0.072-0.470), and peak TBIL to be a risk factor (p = 0.003, OR:1.016,95 % CI:1.007-1.028).</p><p><strong>Conclusions: </strong>The addition of corticosteroids could not increase the cure rate in patients with severe DILI, but it could rapidly reduce the patient's TBIL at an earlier stage. Corticosteroids could also pro

背景和目的：对于严重药物性肝损伤（DILI）患者，除了停用肝损伤药物和对症支持治疗外，尚无常规治疗方法。关于皮质类固醇是否可用于治疗重度 DILI 的观点不一，相关临床研究大多为病例报告或回顾性研究，仍需高水平循证医学研究的支持。本研究旨在评估皮质类固醇对重度DILI患者的疗效和耐受性。研究还探讨了与患者未能治愈相关的风险因素：方法：采用基于近邻 1:1 匹配的倾向得分匹配法筛选皮质类固醇组和对照组中的重度 DILI 患者。严重 DILI 的定义是血清 ALT 和/或 ALP 升高，TBIL≥5 ULN（5 mg/dL 或 85.5 μmol/L），且 INR≥1.5 或不≥1.5。皮质类固醇组患者接受常规疗法联合皮质类固醇治疗，对照组患者仅接受常规疗法：本研究共纳入 146 名患者，其中皮质类固醇组和对照组各 73 名。通过分析整个队列，我们发现皮质类固醇组和对照组患者的治愈率无显著差异（34.2% vs. 20.5%，P=0.095），两组患者的不良反应发生率也无显著差异（20.5% vs. 20.5%，P=1.000）。然而，皮质类固醇组在第 7 天的 TBIL 下降幅度更大（89.2 ± 107.6 μmol/L vs. 58.8 ± 70.7 μmol/L，p=0.046）。在亚组分析中，使用皮质类固醇后，TBIL在常规治疗后仍升高的患者在第7天和第14天的TBIL降幅更大（99.2 ± 98.5μmol/L vs. -23.3 ± 50.4μmol/L，p结论：添加皮质类固醇并不能提高重度 DILI 患者的治愈率，但能在早期迅速降低患者的 TBIL。皮质类固醇还能促进常规治疗后 TBIL 升高患者的治愈。使用皮质类固醇是重度 DILI 患者治愈失败的保护因素，而 TBIL 峰值则是风险因素。

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引用次数: 0

Adenosquamous intrahepatic cholangiocarcinoma in a patient with primary sclerosing cholangitis and ulcerative colitis 一名原发性硬化性胆管炎和溃疡性结肠炎患者的肝内胆管腺鳞癌

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-09-23 DOI: 10.1016/j.clinre.2024.102471

引用次数: 0

Different bacteria species lipopolysaccharide co-exposure with NASH diet exacerbate NASH and liver fibrosis progress in mice. 不同菌种的脂多糖与 NASH 饮食共同暴露会加剧小鼠的 NASH 和肝纤维化进程。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-09-22 DOI: 10.1016/j.clinre.2024.102470

Yen-Peng Lee, Chien-Chao Chiu, Yung-Chi Chang, Yi-Hsun Chen, Wei-Kai Wu, Ming-Shiang Wu, Hsiao-Li Chuang

Background and aim: Given the obesity epidemic, nonalcoholic fatty liver disease has become a public health concern; however, the progression mechanism remains obscure. Therefore, experimental nonalcoholic fatty liver disease/steatohepatitis (NASH) animal models that reflect human disease are necessary. In this study, we simulated the effects of gut microbiota imbalance on NASH and liver fibrosis.

Methods: Different bacterial sources of lipopolysaccharide, including Escherichia coli (GEC) and Salmonella abortus equi (GSE), were combined with a Gubra Amylin NASH (GAN) diet to induce NASH and liver fibrosis.

Results: Serum levels of alanine aminotransferase, hydroxyproline, CD68-positive cells, α-smooth muscle actin, and glial fibrillary acidic protein as well as TNF-α, COL1A1, TGF-β, and NLRP3 expressions in the livers of the GSE group were markedly increased compared to those in the GAN group. The GAN diet with lipopolysaccharide (LPS) treatment resulted in a marked difference in microbiota α-diversity. The GSE group had higher numbers ofincreased Erysipelotrichaceae, Akkermansiaceae, and Bacteroidaceae families than the other groups.

Conclusions: Based on these results, the GAN diet combined with LPS treatment successfully induced the progression of liver disease to NASH and fibrosis. With consistent histologically proven fibrosis, this obese NASH mouse model has relatively good clinical translatability and is highly applicable for preclinical drug testing for NASH.

背景和目的：鉴于肥胖症的流行，非酒精性脂肪肝已成为公共卫生问题；然而，其发展机制仍不清楚。因此，有必要建立能反映人类疾病的实验性非酒精性脂肪肝/脂肪性肝炎（NASH）动物模型。在这项研究中，我们模拟了肠道微生物群失衡对 NASH 和肝纤维化的影响：不同细菌来源的脂多糖，包括大肠杆菌（GEC）和流产马沙门氏菌（GSE），与古布拉淀粉酶NASH（GAN）饮食相结合，诱导NASH和肝纤维化：结果：与GAN组相比，GSE组肝脏中血清丙氨酸氨基转移酶、羟脯氨酸、CD68阳性细胞、α-平滑肌肌动蛋白、胶质纤维酸性蛋白的水平以及TNF-α、COL1A1、TGF-β和NLRP3的表达均明显升高。经脂多糖（LPS）处理的 GAN 饮食导致微生物群 α 多样性的显著差异。与其他组相比，GSE 组 Erysipelotrichaceae、Akkermansiaceae 和 Bacteroidaceae 的数量增加较多：基于这些结果，GAN 饮食结合 LPS 治疗成功地诱导了肝病向 NASH 和纤维化的进展。这种肥胖 NASH 小鼠模型具有一致的组织学证实的纤维化，具有相对较好的临床转化性，非常适合用于 NASH 的临床前药物测试。

{"title":"Different bacteria species lipopolysaccharide co-exposure with NASH diet exacerbate NASH and liver fibrosis progress in mice.","authors":"Yen-Peng Lee, Chien-Chao Chiu, Yung-Chi Chang, Yi-Hsun Chen, Wei-Kai Wu, Ming-Shiang Wu, Hsiao-Li Chuang","doi":"10.1016/j.clinre.2024.102470","DOIUrl":"https://doi.org/10.1016/j.clinre.2024.102470","url":null,"abstract":"<p><strong>Background and aim: </strong>Given the obesity epidemic, nonalcoholic fatty liver disease has become a public health concern; however, the progression mechanism remains obscure. Therefore, experimental nonalcoholic fatty liver disease/steatohepatitis (NASH) animal models that reflect human disease are necessary. In this study, we simulated the effects of gut microbiota imbalance on NASH and liver fibrosis.</p><p><strong>Methods: </strong>Different bacterial sources of lipopolysaccharide, including Escherichia coli (GEC) and Salmonella abortus equi (GSE), were combined with a Gubra Amylin NASH (GAN) diet to induce NASH and liver fibrosis.</p><p><strong>Results: </strong>Serum levels of alanine aminotransferase, hydroxyproline, CD68-positive cells, α-smooth muscle actin, and glial fibrillary acidic protein as well as TNF-α, COL1A1, TGF-β, and NLRP3 expressions in the livers of the GSE group were markedly increased compared to those in the GAN group. The GAN diet with lipopolysaccharide (LPS) treatment resulted in a marked difference in microbiota α-diversity. The GSE group had higher numbers ofincreased Erysipelotrichaceae, Akkermansiaceae, and Bacteroidaceae families than the other groups.</p><p><strong>Conclusions: </strong>Based on these results, the GAN diet combined with LPS treatment successfully induced the progression of liver disease to NASH and fibrosis. With consistent histologically proven fibrosis, this obese NASH mouse model has relatively good clinical translatability and is highly applicable for preclinical drug testing for NASH.</p>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Selenium inhibits ferroptosis in ulcerative colitis through the induction of Nrf2/Gpx4 硒通过诱导 Nrf2/GPX4 抑制溃疡性结肠炎的铁蛋白沉积。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-09-21 DOI: 10.1016/j.clinre.2024.102467

Background and aim

Selenium, an essential micronutrient for human and has been reported to have a protective effect in ulcerative colitis (UC). However, the role of selenium in UC is unclear. Our aim was to investigate the mechanism of action of selenium in UC.

Methods

Serum selenium levels were measured in UC patients and healthy controls. In addition, the effect of sodium selenite supplementation on experimental colitis in mice treated with dextran sulfate sodium (DSS) was investigated. The effect of sodium selenite on IECs ferroptosis was evaluated by observing the cell mortality, intracellular ferrous content, lipid reactive oxygen species and mitochondrial membrane damage in DSS-treated Caco2 cells. In addition, glutathione peroxidase 4 (Gpx4) and nuclear factor erythroid 2-like 2 (Nrf2) were detected in Caco2 cells and mouse intestines to explore their mechanisms.

Results

The serum selenium content of UC patients was lower than that of healthy subjects. In addition, serum selenium levels were negatively correlated with disease activity. The in vivo results showed that selenium treatment could improve colitis induced by DSS and inhibit IECs ferroptosis. The in vitro results further showed that selenium inhibited the ferroptosis of Caco-2 cells induced by DSS. Nrf2/Gpx4 was up-regulated after selenium supplementation in vivo and in vitro.

Conclusions

Serum selenium level is associated with IECs ferroptosis in UC patients. Selenium can relieve DSS-induced colitis and inhibit IECs ferroptosis by up-regulating the expression of Nrf2/Gpx4.

背景和目的：硒是人体必需的微量营养素，有报道称硒对溃疡性结肠炎（UC）有保护作用。然而，硒在溃疡性结肠炎中的作用尚不明确。我们的目的是研究硒在溃疡性结肠炎中的作用机制：方法：测量 UC 患者和健康对照组的血清硒水平。此外，我们还研究了补充亚硒酸钠对硫酸葡聚糖钠（DSS）治疗小鼠实验性结肠炎的影响。通过观察 DSS 处理的 Caco2 细胞的细胞死亡率、细胞内亚铁含量、脂质活性氧和线粒体膜损伤，评估了亚硒酸钠对 IECs 铁变态反应的影响。此外，还检测了 Caco2 细胞和小鼠肠道中的谷胱甘肽过氧化物酶 4（Gpx4）和类红细胞核因子 2（Nrf2），以探讨其作用机制：结果：UC 患者的血清硒含量低于健康人。此外，血清硒含量与疾病活动呈负相关。体内研究结果表明，硒治疗可改善由 DSS 诱导的结肠炎，并抑制 IECs 铁突变。体外研究结果进一步表明，硒抑制了DSS诱导的Caco-2细胞的铁突变。体内和体外补硒后，Nrf2/Gpx4上调：结论：血清硒水平与 UC 患者 IECs 铁突变有关。硒能缓解DSS诱导的结肠炎，并通过上调Nrf2/Gpx4的表达抑制IECs的铁梭形细胞增多。

{"title":"Selenium inhibits ferroptosis in ulcerative colitis through the induction of Nrf2/Gpx4","authors":"","doi":"10.1016/j.clinre.2024.102467","DOIUrl":"10.1016/j.clinre.2024.102467","url":null,"abstract":"<div><h3>Background and aim</h3><div>Selenium, an essential micronutrient for human and has been reported to have a protective effect in ulcerative colitis (UC). However, the role of selenium in UC is unclear. Our aim was to investigate the mechanism of action of selenium in UC.</div></div><div><h3>Methods</h3><div>Serum selenium levels were measured in UC patients and healthy controls. In addition, the effect of sodium selenite supplementation on experimental colitis in mice treated with dextran sulfate sodium (DSS) was investigated. The effect of sodium selenite on IECs ferroptosis was evaluated by observing the cell mortality, intracellular ferrous content, lipid reactive oxygen species and mitochondrial membrane damage in DSS-treated Caco2 cells. In addition, glutathione peroxidase 4 (Gpx4) and nuclear factor erythroid 2-like 2 (Nrf2) were detected in Caco2 cells and mouse intestines to explore their mechanisms.</div></div><div><h3>Results</h3><div>The serum selenium content of UC patients was lower than that of healthy subjects. In addition, serum selenium levels were negatively correlated with disease activity. The in vivo results showed that selenium treatment could improve colitis induced by DSS and inhibit IECs ferroptosis. The in vitro results further showed that selenium inhibited the ferroptosis of Caco-2 cells induced by DSS. Nrf2/Gpx4 was up-regulated after selenium supplementation in vivo and in vitro.</div></div><div><h3>Conclusions</h3><div>Serum selenium level is associated with IECs ferroptosis in UC patients. Selenium can relieve DSS-induced colitis and inhibit IECs ferroptosis by up-regulating the expression of Nrf2/Gpx4.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Associations between single and combined exposures to environmental phenols and ulcerative colitis in American adults 美国成年人单一和综合暴露于环境酚类与溃疡性结肠炎之间的关系。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-09-21 DOI: 10.1016/j.clinre.2024.102468

Objective

The etiology of ulcerative colitis (UC) is complex and involves multiple factors, with exposure to environmental toxins potentially contributing greatly to its pathogenesis. Therefore, this study was carried out with the purpose of delving into the associations between single and combined exposures to environmental phenols and UC among American adults.

Methods

Survey data from the 2009–2010 National Health and Nutrition Examination Survey were selected for our research. The associations between single and combined exposures to environmental phenols and the prevalence of UC were analyzed using weighted multivariate logistic regression models as well as Bayesian kernel machine regression (BKMR).

Results

A total of 1,422 adults aged 20 years old and above were included in this study, 17 of whom had UC. The correlation matrix showed strong associations between 2,4-dichlorophenol (2,4-DCP) and 2,5-dichlorophenol (2,5-DCP) (R = 0.81), as well as between 2,4,5-trichlorophenol (2,4,5-TCP) and 2,4,6-trichlorophenol (2,4,6-TCP) (R = 0.73). The logistic regression model revealed that, after adjusting for confounders, exposure to environmental phenols was positively associated with the prevalence of UC, with 2,4,6-TCP showing a significant association (OR = 2.37, 95 % CI = 1.10, 5.09, P = 0.037). The BKMR analysis indicated an upward trend in the overall effect of combined exposures to environmental phenols on UC. All five phenols contributed to this effect, with 2,4,6-TCP exhibiting the most pronounced effect. When other compounds were fixed at the 50th percentile, the impact of the five phenols on UC demonstrated a positive association, without any noteworthy interaction among the compounds.

Conclusion

Our findings suggested that exposure to environmental phenols may contribute to the occurrence of UC among American adults.

目的：溃疡性结肠炎（UC）的病因复杂，涉及多种因素，环境毒素的暴露可能在很大程度上导致其发病。因此，我们开展了这项研究，旨在深入研究美国成年人单一和综合暴露于环境酚类与溃疡性结肠炎之间的关系：我们的研究选取了 2009-2010 年全国健康与营养调查的调查数据。我们使用加权多元逻辑回归模型和贝叶斯核机器回归（BKMR）分析了环境酚类的单一暴露和综合暴露与 UC 患病率之间的关系：本研究共纳入了 1 422 名 20 岁及以上的成年人，其中 17 人患有 UC。相关矩阵显示，2,4-二氯苯酚（2,4-DCP）和 2,5-二氯苯酚（2,5-DCP）之间（R = 0.81）以及 2,4,5-三氯苯酚（2,4,5-TCP）和 2,4,6-三氯苯酚（2,4,6-TCP）之间（R = 0.73）存在密切联系。逻辑回归模型显示，在对混杂因素进行调整后，暴露于环境酚类与 UC 患病率呈正相关，其中 2,4,6-TCP 显示出显著的相关性（OR = 2.37，95% CI = 1.10，5.09，P = 0.037）。BKMR 分析表明，环境酚类的综合暴露对 UC 的总体影响呈上升趋势。所有五种酚类都对这一效应有影响，其中 2,4,6-三氯丙醇的影响最为明显。当其他化合物的浓度固定在第 50 百分位数时，五种酚类对 UC 的影响呈正相关，而化合物之间没有任何值得注意的相互作用：我们的研究结果表明，接触环境中的酚类物质可能会导致美国成年人发生多发性硬化症。

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引用次数: 0

Efficacy and safety of ramucirumab in gastric or gastroesophageal cancer: A systematic review and meta-analysis 雷莫芦单抗治疗胃癌或胃食管癌的有效性和安全性：系统回顾与荟萃分析

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-09-20 DOI: 10.1016/j.clinre.2024.102466

Background

Ramucirumab is considered a potential treatment for gastric or gastroesophageal cancer; however, its safety has not been evaluated. This meta-analysis aimed to evaluate the efficacy and safety of ramucirumab for treating gastric or gastroesophageal cancer.

Methods

The databases of PubMed, Embase, and Cochrane Library were searched through October 2023. The search focused on randomized controlled trials (RCTs) comparing ramucirumab (with or without chemotherapy) to a placebo (with or without chemotherapy) in patients with gastric or gastroesophageal cancer. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs) were pooled.

Results

Seven RCTs with a total of 2613 patients were included. Compared with placebo (with or without chemotherapy), ramucirumab (with or without chemotherapy) significantly improved OS (HR: 0.90, 95% CI: 0.82–0.99, p = 0.030), PFS (HR: 0.74, 95% CI: 0.60–0.90, p = 0.003), ORR (OR: 1.39, 95% CI: 1.15–1.67, p < 0.001), and DCR (OR: 1.91, 95% CI: 1.38–2.63, p < 0.001). However, ramucirumab (with or without chemotherapy) also increased the incidence of decreased appetite (OR: 1.29, 95% CI: 1.09–1.53, p = 0.004), diarrhea (OR: 1.39, 95% CI: 1.01–1.91, p = 0.05), hypertension (OR: 3.13, 95% CI: 2.03–4.83, p < 0.00001), and bleeding or hemorrhage (OR: 2.34, 95% CI: 1.93–2.85, p < 0.00001).

Conclusions

Ramucirumab (with or without chemotherapy) can improve OS, PFS, ORR and DCR in patients with gastric or gastroesophageal cancer. However, it may also increase the incidence of specific AEs.

背景Ramucirumab被认为是一种潜在的胃癌或胃食管癌治疗方法，但其安全性尚未得到评估。本荟萃分析旨在评估雷莫芦单抗治疗胃癌或胃食管癌的有效性和安全性。方法检索了 PubMed、Embase 和 Cochrane Library 等数据库，检索期至 2023 年 10 月。检索的重点是在胃癌或胃食管癌患者中比较雷莫芦单抗（联合或不联合化疗）与安慰剂（联合或不联合化疗）的随机对照试验（RCT）。对总生存期（OS）、无进展生存期（PFS）、客观反应率（ORR）、疾病控制率（DCR）和不良事件（AEs）进行了汇总。与安慰剂（化疗或不化疗）相比，ramucirumab（化疗或不化疗）明显改善了OS（HR：0.90，95% CI：0.82-0.99，P = 0.030）、PFS（HR：0.74，95% CI：0.60-0.90，p = 0.003）、ORR（OR：1.39，95% CI：1.15-1.67，p <0.001）和DCR（OR：1.91，95% CI：1.38-2.63，p <0.001）。然而，雷莫芦单抗（无论是否化疗）也会增加食欲下降（OR：1.29，95% CI：1.09-1.53，p = 0.004）、腹泻（OR：1.39，95% CI：1.01-1.91，p = 0.05）、高血压（OR：3.13，95% CI：2.03-4.结论Ramucirumab（联合或不联合化疗）可改善胃癌或胃食管癌患者的OS、PFS、ORR和DCR。然而，它也可能会增加特定 AE 的发生率。

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引用次数: 0

Effect of sarcopenia on liver cirrhosis with complicating oesophageal and gastric varices after endoscopic therapy 肌肉疏松症对肝硬化并发食道和胃静脉曲张内窥镜治疗的影响。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-09-13 DOI: 10.1016/j.clinre.2024.102459

Several investigators have reported that sarcopenia is common in patients with liver cirrhosis. However, few studies have probed the association between sarcopenia and liver cirrhosis complicated with oesophageal and gastric variceal bleeding (LC-EGVB). We aimed to investigate the impact of sarcopenia on rebleeding after endoscopic therapy in patients with LC-EGVB. Computed tomography (CT) radiographs from the third lumbar vertebra were selected to analyse body composition, including skeletal muscle tissue, visceral and subcutaneous adipose tissue using SliceOmatic software. Sarcopenia was defined using validated cutoff values for patients with liver cirrhosis: 44.77 cm²/m² for men and 32.50 cm²/m² for women. A total of 187 patients with LC-EGVB and 309 controls were included in this study. The rate of sarcopenia in controls (17.4 %) was significantly lower than that in patients with LC-EGVB (41.2 %). Patients with LC-EGVB exhibiting sarcopenia showed a high prevalence of portal vein thrombosis and rebleeding rate at 1 year. The rate of sarcopenia in the rebleeding group was significantly higher than that in the non-rebleeding group. Univariate and multivariate analyses showed that sarcopenia was an independent risk factor for rebleeding within 1 year in patients with LC-EGVB. Patients with LC-EGVB displayed a high prevalence of sarcopenia. Sarcopenia was observed to be an independent risk factor for rebleeding within 1 year.

一些研究者报告称，肝硬化患者普遍存在肌肉疏松症。然而，很少有研究探讨肌肉疏松症与肝硬化并发食道和胃静脉曲张出血（LC-EGVB）之间的关系。我们旨在研究肌肉疏松症对 LC-EGVB 患者内镜治疗后再出血的影响。我们选取了第三腰椎的计算机断层扫描（CT）X光片，使用SliceOmatic软件分析身体成分，包括骨骼肌组织、内脏和皮下脂肪组织。根据肝硬化患者的有效临界值定义 "肌肉疏松症"：男性为 44.77 cm2/m2，女性为 32.50 cm2/m2。本研究共纳入了 187 名 LC-EGVB 患者和 309 名对照组患者。对照组的肌肉疏松率（17.4%）明显低于 LC-EGVB 患者（41.2%）。LC-EGVB患者出现肌肉疏松症的门静脉血栓形成率和1年后再出血率均较高。再出血组的肌肉疏松率明显高于非再出血组。单变量和多变量分析表明，肌肉疏松症是LC-EGVB患者1年内再出血的独立危险因素。LC-EGVB 患者肌肉疏松症的发病率很高。据观察，肌肉疏松症是一年内再出血的独立风险因素。

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引用次数: 0

Development of a nomogram for postoperative surgical site infections in patients undergoing bowel resection for Crohn's disease 制定克罗恩病肠道切除术患者术后手术部位感染的提名图

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-09-12 DOI: 10.1016/j.clinre.2024.102462

Background

Surgical site infection (SSI) is a significant concern due to its potential to cause delayed wound healing and prolonged hospital stays. This study aims to develop a predictive model in patients with Crohn's disease.

Methods

We conducted single-factor and multi-factor logistic regression analyses to identify risk factors, resulting in the development of a logistic regression model and the creation of a nomogram. The model's effect was validated by employing enhanced bootstrap resampling techniques, calibration curves, and DCA curves. Finally, we investigated the risk factors for wall and intra-abdominal infections separately.

Results

90 of 675 patients (13.3 %) developed SSI. Several independent risk factors for SSI were identified, including higher postoperative day one neutrophil count (p = 0.033), higher relative blood loss (p = 0.018), female gender (p = 0.021), preoperative corticosteroid use (p = 0.007), Montreal classification A1 and L2 (p < 0.05), previous intestinal resection (p = 0.017), and remaining lesions (p = 0.015). Additionally, undergoing strictureplasty (p = 0.041) is a protective factor against SSI. These nine variables were used to develop an SSI prediction model presented as a nomogram. The model demonstrated strong discrimination (adjusted C-statistic=0.709, 95 % CI: 0.659∼0.757) and precise calibration. The decision curve showed that the nomogram was clinically effective within a probability threshold range of 3 % to 54 %. Further subgroup analysis revealed distinct risk factors for wall infections and intra-abdominal infections.

Conclusion

We established a new predictive model, which can guide the prevention and postoperative care of SSI after Crohn's disease bowel resection surgery to minimize its occurrence rate.

背景手术部位感染（SSI）可能导致伤口愈合延迟和住院时间延长，因此备受关注。本研究旨在建立克罗恩病患者的预测模型。方法我们进行了单因素和多因素逻辑回归分析以确定风险因素，最终建立了逻辑回归模型并绘制了提名图。通过使用增强型引导重采样技术、校准曲线和 DCA 曲线验证了模型的效果。最后，我们分别研究了腹壁感染和腹腔内感染的风险因素。结果 675 例患者中有 90 例（13.3%）发生了 SSI，其中包括术后第一天中性粒细胞计数较高（p = 0.033）、相对失血量较高（p = 0.018）、女性（p = 0.021）、术前使用皮质类固醇（p = 0.007）、蒙特利尔分类 A1 和 L2（p <0.05）、既往肠切除术（p = 0.017）和剩余病灶（p = 0.015）。此外，接受狭窄成形术（p = 0.041）是防止 SSI 的保护因素。这九个变量被用来建立一个 SSI 预测模型，以提名图的形式呈现。该模型具有很强的区分度（调整后的 C 统计量=0.709，95 % CI：0.659∼0.757）和精确的校准。决策曲线显示，在 3% 至 54% 的概率阈值范围内，提名图在临床上是有效的。结论我们建立了一个新的预测模型，可以指导克罗恩病肠切除手术后 SSI 的预防和术后护理，最大限度地降低其发生率。

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引用次数: 0