Pub Date : 2025-01-01DOI: 10.1016/j.clinre.2024.102513
Vincent Zimmer
{"title":"The flaming and pulled up anorectal line: Ulcerative colitis-associated squamous metaplasia of the lower rectum","authors":"Vincent Zimmer","doi":"10.1016/j.clinre.2024.102513","DOIUrl":"10.1016/j.clinre.2024.102513","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102513"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812275","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}
Pub Date : 2025-01-01DOI: 10.1016/j.clinre.2024.102510
Xiaoqing Cao , Yurou Kang , Ping Tai, Pei Zhang, Xin Lin, Fei Xu, Zhenlin Nie, Bangshun He
Background
To analyze the relationship between tumor-infiltrating lymphocytes (TILs) subtypes and infiltration locations and the prognosis of gastric cancer (GC) patients.
Methods
Eligible articles were obtained through systematic retrieval and rigorous screening, collecting study information and extracting hazard ratio (HR), 95 % confidence interval (CI) for pooled analyses of disease-free survival (DFS) and overall survival (OS).
Results
Higher CD4+ TILs were correlated with favorable OS (HR=0.79, 95 %CI: 0.66–0.94, P = 0.009), the similar results were observed in tumor center and in infiltration margin. Higher CD8+ TILs prolonged DFS (HR=0.69, 95 %CI: 0.51–0.95, P = 0.02) and OS (HR=0.96, 95 %CI: 0.94–0.99, P = 0.006); For OS, tumor center and infiltration margin groups showed positive results. Neither the overall analysis nor the subgroup analyses indicated that the level of FOXP3+ TILs was associated with prognosis (DFS: HR=0.89, 95 %CI: 0.66–1.19, P = 0.42; OS: HR=0.98, 95 %CI: 0.85–1.13, P = 0.75). Pooled results revealed that higher CD3+ TILs were correlated with favorable DFS (HR=0.69, 95 %CI: 0.56–0.84, P = 0.0003) but not OS (HR=1.00, 95 %CI: 0.99–1.01, P = 0.48).
Conclusions
High infiltrating CD3+, CD4+, CD8+ T cells prolong survival, and FOXP3+ subset is not related to prognosis in GC. For CD4+ and CD8+, positive correlations between the infiltration level and OS were present in tumor center and infiltration margin groups.
{"title":"Prognostic role of tumor-infiltrating lymphocytes in gastric cancer: A systematic review and meta-analysis","authors":"Xiaoqing Cao , Yurou Kang , Ping Tai, Pei Zhang, Xin Lin, Fei Xu, Zhenlin Nie, Bangshun He","doi":"10.1016/j.clinre.2024.102510","DOIUrl":"10.1016/j.clinre.2024.102510","url":null,"abstract":"<div><h3>Background</h3><div>To analyze the relationship between tumor-infiltrating lymphocytes (TILs) subtypes and infiltration locations and the prognosis of gastric cancer (GC) patients.</div></div><div><h3>Methods</h3><div>Eligible articles were obtained through systematic retrieval and rigorous screening, collecting study information and extracting hazard ratio (HR), 95 % confidence interval (CI) for pooled analyses of disease-free survival (DFS) and overall survival (OS).</div></div><div><h3>Results</h3><div>Higher CD4<sup>+</sup> TILs were correlated with favorable OS (HR=0.79, 95 %CI: 0.66–0.94, <em>P</em> = 0.009), the similar results were observed in tumor center and in infiltration margin. Higher CD8<sup>+</sup> TILs prolonged DFS (HR=0.69, 95 %CI: 0.51–0.95, <em>P</em> = 0.02) and OS (HR=0.96, 95 %CI: 0.94–0.99, <em>P</em> = 0.006); For OS, tumor center and infiltration margin groups showed positive results. Neither the overall analysis nor the subgroup analyses indicated that the level of FOXP3<sup>+</sup> TILs was associated with prognosis (DFS: HR=0.89, 95 %CI: 0.66–1.19, <em>P</em> = 0.42; OS: HR=0.98, 95 %CI: 0.85–1.13, <em>P</em> = 0.75). Pooled results revealed that higher CD3<sup>+</sup> TILs were correlated with favorable DFS (HR=0.69, 95 %CI: 0.56–0.84, <em>P</em> = 0.0003) but not OS (HR=1.00, 95 %CI: 0.99–1.01, <em>P</em> = 0.48).</div></div><div><h3>Conclusions</h3><div>High infiltrating CD3<sup>+</sup>, CD4<sup>+</sup>, CD8<sup>+</sup> T cells prolong survival, and FOXP3<sup>+</sup> subset is not related to prognosis in GC. For CD4<sup>+</sup> and CD8<sup>+</sup>, positive correlations between the infiltration level and OS were present in tumor center and infiltration margin groups.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102510"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766915","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}
Pub Date : 2025-01-01DOI: 10.1016/j.clinre.2024.102518
Héloïse Giudicelli, Manon Allaire
{"title":"Exploring gender disparities in hepatocellular carcinoma: Insights from a French study","authors":"Héloïse Giudicelli, Manon Allaire","doi":"10.1016/j.clinre.2024.102518","DOIUrl":"10.1016/j.clinre.2024.102518","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102518"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827314","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}
Pub Date : 2025-01-01DOI: 10.1016/j.clinre.2024.102516
Jia-Wen Xie , Hui-Ling Wang , Ling-Qing Lin , Yin-Feng Guo , Mao Wang , Xiao-Zhen Zhu , Jian-Jun Niu , Li-Rong Lin
Background
Since telomere length and DNA methylation both correlate with hepatocellular carcinoma (HCC) prognosis, telomere-methylation genes could be novel prognostic markers for HCC.
Method
This study first investigated the interaction between telomere length and DNA methylation in HCC through Mendelian randomization analysis. Then, this study identified telomere-methylation genes in HCC by employing the TCGA-LIHC cohort, and explored the expression patterns of these genes in the tumor microenvironment of HCC and potential underlying mechanisms. Finally, the HCC risk-scoring model and prognostic model based on these genes were established, and the performance of the model was assessed.
Result
The findings revealed a bidirectional relationship between telomere length and DNA methylation in HCC. Fifty telomere-methylation genes were identified, and the prognosis-related telomere-methylation genes were closely associated with Treg and Tprolif cell subsets within the HCC tumor microenvironment. Telomere-methylation genes could potentially impact the prognosis of HCC patients by modulating chromosome stability and regulating the cell cycle. Additionally, the constructed risk scoring model and prognostic prediction model showcased compelling clinical applicability, as evidenced by the receiver operating characteristic curve, the decision curve analysis, and the calibration curves.
Conclusion
This study elucidated the potential of telomere-methylation genes as prognostic biomarkers for HCC and paves the way for novel approaches in prognostication and treatment management for HCC patients.
{"title":"Telomere-methylation genes: Novel prognostic biomarkers for hepatocellular carcinoma","authors":"Jia-Wen Xie , Hui-Ling Wang , Ling-Qing Lin , Yin-Feng Guo , Mao Wang , Xiao-Zhen Zhu , Jian-Jun Niu , Li-Rong Lin","doi":"10.1016/j.clinre.2024.102516","DOIUrl":"10.1016/j.clinre.2024.102516","url":null,"abstract":"<div><h3>Background</h3><div>Since telomere length and DNA methylation both correlate with hepatocellular carcinoma (HCC) prognosis, telomere-methylation genes could be novel prognostic markers for HCC.</div></div><div><h3>Method</h3><div>This study first investigated the interaction between telomere length and DNA methylation in HCC through Mendelian randomization analysis. Then, this study identified telomere-methylation genes in HCC by employing the TCGA-LIHC cohort, and explored the expression patterns of these genes in the tumor microenvironment of HCC and potential underlying mechanisms. Finally, the HCC risk-scoring model and prognostic model based on these genes were established, and the performance of the model was assessed.</div></div><div><h3>Result</h3><div>The findings revealed a bidirectional relationship between telomere length and DNA methylation in HCC. Fifty telomere-methylation genes were identified, and the prognosis-related telomere-methylation genes were closely associated with Treg and Tprolif cell subsets within the HCC tumor microenvironment. Telomere-methylation genes could potentially impact the prognosis of HCC patients by modulating chromosome stability and regulating the cell cycle. Additionally, the constructed risk scoring model and prognostic prediction model showcased compelling clinical applicability, as evidenced by the receiver operating characteristic curve, the decision curve analysis, and the calibration curves.</div></div><div><h3>Conclusion</h3><div>This study elucidated the potential of telomere-methylation genes as prognostic biomarkers for HCC and paves the way for novel approaches in prognostication and treatment management for HCC patients.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102516"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827401","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}
Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line procedure for choledocholithiasis treatment. However, it is associated with a 10 % rate of adverse events. Spontaneous migration of common bile duct (CBD) stones occurs in 6–33 % of choledocholithiasis cases, making ERCP avoidable. This study aimed to identify predictors of spontaneous CBD stones’ migration.
Methods
Retrospective study including patients diagnosed with choledocholithiasis and submitted to ERCP. Patients were divided into 2 groups considering spontaneous stone migration (i.e.: the absence of CBD stones on ERCP). Data on patients’ characteristics, imaging findings, biochemical analysis, and ERCP procedure were analyzed to identify predictors of spontaneous migration of CBD stones.
Results
334 patients with a mean age of 71.7 years were included in the study: 76.6 % without and 23.4 % with spontaneous migration of CBD stones. Although some patients’ features (gender and clinical presentation), imaging findings (diameters of the largest stone and CBD), biochemical analysis (bilirubin levels at diagnosis and pre-ERCP), and ERCP procedure characteristics (time from diagnosis to ERCP) were different between groups, only three variables were defined as predictors: the absence of acute cholangitis, the largest stone diameter ≤5 mm, and the bilirubin levels pre-ERCP ≤ 2mg/dL. When using those variables together there was a chance of 81–86 % to correctly distinguishing patients with and without spontaneous CBD stone migration.
Conclusion
The size of the largest stone at diagnosis was validated as a predictor of CBD stones’ spontaneous migration. Furthermore, two new predictors were identified: bilirubin levels pre-ERCP ≤ 2 mg/dL, and no acute cholangitis at the clinical presentation of choledocholithiasis. EUS and ERCP in the same session should be considered in patients with factors predictive of stone migration, especially when combined, to minimize unnecessary ERCP and possible complications.
{"title":"Predictive factors of spontaneous common bile duct clearance and unnecessary ERCP in patients with choledocholithiasis","authors":"Fábio Pereira Correia , Henrique Coelho , Mónica Francisco , Gonçalo Alexandrino , Joana Carvalho Branco , Jorge Canena , David Horta , Luís Carvalho Lourenço","doi":"10.1016/j.clinre.2024.102515","DOIUrl":"10.1016/j.clinre.2024.102515","url":null,"abstract":"<div><h3>Background</h3><div>Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line procedure for choledocholithiasis treatment. However, it is associated with a 10 % rate of adverse events. Spontaneous migration of common bile duct (CBD) stones occurs in 6–33 % of choledocholithiasis cases, making ERCP avoidable. This study aimed to identify predictors of spontaneous CBD stones’ migration.</div></div><div><h3>Methods</h3><div>Retrospective study including patients diagnosed with choledocholithiasis and submitted to ERCP. Patients were divided into 2 groups considering spontaneous stone migration (i.e.: the absence of CBD stones on ERCP). Data on patients’ characteristics, imaging findings, biochemical analysis, and ERCP procedure were analyzed to identify predictors of spontaneous migration of CBD stones.</div></div><div><h3>Results</h3><div>334 patients with a mean age of 71.7 years were included in the study: 76.6 % without and 23.4 % with spontaneous migration of CBD stones. Although some patients’ features (gender and clinical presentation), imaging findings (diameters of the largest stone and CBD), biochemical analysis (bilirubin levels at diagnosis and pre-ERCP), and ERCP procedure characteristics (time from diagnosis to ERCP) were different between groups, only three variables were defined as predictors: the absence of acute cholangitis, the largest stone diameter ≤5 mm, and the bilirubin levels pre-ERCP ≤ 2mg/dL. When using those variables together there was a chance of 81–86 % to correctly distinguishing patients with and without spontaneous CBD stone migration.</div></div><div><h3>Conclusion</h3><div>The size of the largest stone at diagnosis was validated as a predictor of CBD stones’ spontaneous migration. Furthermore, two new predictors were identified: bilirubin levels pre-ERCP ≤ 2 mg/dL, and no acute cholangitis at the clinical presentation of choledocholithiasis. EUS and ERCP in the same session should be considered in patients with factors predictive of stone migration, especially when combined, to minimize unnecessary ERCP and possible complications.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102515"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-22DOI: 10.1016/j.clinre.2024.102506
Dan-Lei Han , Jian Zha , Lin-Yan Wan , Wei Liu
{"title":"Primary hepatic large B-cell lymphoma","authors":"Dan-Lei Han , Jian Zha , Lin-Yan Wan , Wei Liu","doi":"10.1016/j.clinre.2024.102506","DOIUrl":"10.1016/j.clinre.2024.102506","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102506"},"PeriodicalIF":2.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695277","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}
The aim of this research was to evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) protocol in hepatectomy patients with liver cancer.
Materials and methods
We searched three databases, including PubMed, Embase, and the Cochrane Library database, from inception to April 25, 2023. The outcomes were postoperative complications, and postoperative length of stay (PLOS). This study was performed by Stata (V. 16.0) software.
Results
Twelve investigations involving 1,892 patients were included in this study. The ERAS group had lower overall postoperative complications [odds ratio (OR) = 0.49, I² = 54.89 %, 95 % confidence interval (CI) = 0.33–0.74, P = 0.00], postoperative Clavien-Dindo Grade 1–2 complications (OR = 0.39, I² = 55.14 %, 95 %CI = 0.23–0.69, P = 0.00), Clavien-Dindo Grade 3–4 complications (OR = 0.56, I² = 0.00 %, 95 %CI = 0.38–0.83, P = 0.00) , pneumonia (OR = 0.34, I² = 0.00 %, 95 %CI = 0.15–0.76, P = 0.01), ascites (OR = 0.25, I² = 0.00 %, 95 %CI = 0.09–0.68, P = 0.01), vomit (OR = 0.39, I² = 0.00 %, 95 %CI = 0.21–0.73, P = 0.00), intraoperative blood loss [mean difference (MD) = 1.69, I² = 0.00 %, 95 %CI = 1.15–2.47, P = 0.01], PLOS (MD = -0.42, I² = 94.87 %, 95 %CI = -0.86–0.03, P = 0.07), duration of abdominal drain (MD = -1.23, I² = 96.96 %, 95 %CI = -2.04 to -0.42, P = 0.00), and hospital readmission (OR = 0.44, I² = 0.00 %, 95 %CI = 0.23–0.85, P = 0.01) compared to the non-ERAS group.
Conclusion
For patients with liver cancer treated with ERAS. The ERAS protocol reduces the percentage of overall postoperative complications. Moreover, ERAS does not increase the rate of blood transfusions, hospital readmission, reoperation, or mortality.
{"title":"Safety and efficacy of the enhanced recovery after surgery protocol in hepatectomy for liver cancer","authors":"Quan Lv , Ying-Chun Xiang , Yan-Yu Qiu , Zheng Xiang","doi":"10.1016/j.clinre.2024.102493","DOIUrl":"10.1016/j.clinre.2024.102493","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this research was to evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) protocol in hepatectomy patients with liver cancer.</div></div><div><h3>Materials and methods</h3><div>We searched three databases, including PubMed, Embase, and the Cochrane Library database, from inception to April 25, 2023. The outcomes were postoperative complications, and postoperative length of stay (PLOS). This study was performed by Stata (V. 16.0) software.</div></div><div><h3>Results</h3><div>Twelve investigations involving 1,892 patients were included in this study. The ERAS group had lower overall postoperative complications [odds ratio (OR) = 0.49, I² = 54.89 %, 95 % confidence interval (CI) = 0.33–0.74, <em>P</em> = 0.00], postoperative Clavien-Dindo Grade 1–2 complications (OR = 0.39, I² = 55.14 %, 95 %CI = 0.23–0.69, <em>P</em> = 0.00), Clavien-Dindo Grade 3–4 complications (OR = 0.56, I² = 0.00 %, 95 %CI = 0.38–0.83, <em>P</em> = 0.00) , pneumonia (OR = 0.34, I² = 0.00 %, 95 %CI = 0.15–0.76, <em>P</em> = 0.01), ascites (OR = 0.25, I² = 0.00 %, 95 %CI = 0.09–0.68, <em>P</em> = 0.01), vomit (OR = 0.39, I² = 0.00 %, 95 %CI = 0.21–0.73, <em>P</em> = 0.00), intraoperative blood loss [mean difference (MD) = 1.69, I² = 0.00 %, 95 %CI = 1.15–2.47, <em>P</em> = 0.01], PLOS (MD = -0.42, I² = 94.87 %, 95 %CI = -0.86–0.03, <em>P</em> = 0.07), duration of abdominal drain (MD = -1.23, I² = 96.96 %, 95 %CI = -2.04 to -0.42, <em>P</em> = 0.00), and hospital readmission (OR = 0.44, I² = 0.00 %, 95 %CI = 0.23–0.85, <em>P</em> = 0.01) compared to the non-ERAS group.</div></div><div><h3>Conclusion</h3><div>For patients with liver cancer treated with ERAS. The ERAS protocol reduces the percentage of overall postoperative complications. Moreover, ERAS does not increase the rate of blood transfusions, hospital readmission, reoperation, or mortality.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 10","pages":"Article 102493"},"PeriodicalIF":2.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686262","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}
Background and Aim: Less than 25 % of hepatocellular carcinoma (HCC) occurs in women, in whom prognosis could be better. Due to the lack of date in Europe, this study aims to assess survival of patients with HCC according sex in a tertiary French liver center.
Patients and Methods: Every patient diagnosed with a first diagnosis of HCC presented at our weekly multidisciplinary tumor board between 2013 and 2017 were included. Baseline characteristics of patients and tumors were compared according sex using the Mann-Whitney test for Continuous variables and the Fisher or Chi-square test for dichotomous variables. Survival analyses according sex were conducted using the Kaplan-Meier method, the log-rank test, Cox models and a propensity score.
Results: 694 patients were included, of whom 130 (18.7 %) were women. Among them, 587 (86 %) had cirrhosis, mainly compensated (Child A 62.7 %), and related to alcohol (48.7 %), HCV (27.2 %), and/or metabolic-associated fatty liver disease (25.8 %). HCC was unifocal in 54 % of cases, with a mean main nodule size of 37 mm. Curative treatment was administered in 45.4 % of cases (percutaneous ablation 93 %). Compared to men, women diagnosed with HCC were older (73 vs. 65 years, p < 0.001), were more frequently HCV-infected (40 % vs. 24 %, p = 0.0003) and presented more often with a solitary HCC (63 % vs. 52 %, p = 0.020). After a median follow-up of 57 months, overall survival was significantly longer in women both in multivariate analysis (aHR 1.39 (CI95 %: 1.07-1.81) p=0.014) and using a propensity score (HR 1.51 (1.13-2.02, p=0.005)).
Conclusion: Despite being diagnosed at an older age, women with HCC exhibit significant better overall survival.
{"title":"Prolonged survival in women with hepatocellular carcinoma: A French observational study","authors":"Cécilia Busso , Jean-Charles Nault , Richard Layese , Alix Demory , Lorraine Blaise , Gisèle Nkontchou , Véronique Grando , Pierre Nahon , Nathalie Ganne-Carrié","doi":"10.1016/j.clinre.2024.102498","DOIUrl":"10.1016/j.clinre.2024.102498","url":null,"abstract":"<div><div>Background and Aim: Less than 25 % of hepatocellular carcinoma (HCC) occurs in women, in whom prognosis could be better. Due to the lack of date in Europe, this study aims to assess survival of patients with HCC according sex in a tertiary French liver center.</div><div>Patients and Methods: Every patient diagnosed with a first diagnosis of HCC presented at our weekly multidisciplinary tumor board between 2013 and 2017 were included. Baseline characteristics of patients and tumors were compared according sex using the Mann-Whitney test for Continuous variables and the Fisher or Chi-square test for dichotomous variables. Survival analyses according sex were conducted using the Kaplan-Meier method, the log-rank test, Cox models and a propensity score.</div><div>Results: 694 patients were included, of whom 130 (18.7 %) were women. Among them, 587 (86 %) had cirrhosis, mainly compensated (Child A 62.7 %), and related to alcohol (48.7 %), HCV (27.2 %), and/or metabolic-associated fatty liver disease (25.8 %). HCC was unifocal in 54 % of cases, with a mean main nodule size of 37 mm. Curative treatment was administered in 45.4 % of cases (percutaneous ablation 93 %). Compared to men, women diagnosed with HCC were older (73 vs. 65 years, p < 0.001), were more frequently HCV-infected (40 % vs. 24 %, p = 0.0003) and presented more often with a solitary HCC (63 % vs. 52 %, p = 0.020). After a median follow-up of 57 months, overall survival was significantly longer in women both in multivariate analysis (aHR 1.39 (CI95 %: 1.07-1.81) p=0.014) and using a propensity score (HR 1.51 (1.13-2.02, p=0.005)).</div><div>Conclusion: Despite being diagnosed at an older age, women with HCC exhibit significant better overall survival.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 10","pages":"Article 102498"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.1016/j.clinre.2024.102500
Christophe Souaid, Eddy Fares, Paul Primard, Gilles Macaigne, Weam El Hajj, Stephane Nahon
Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract where early diagnosis and timely, appropriate management are essential to prevent severe complications and reduce the need for surgery. This review sought to investigate factors contributing to diagnostic delays in CD, which typically ranged from 5 to 16 months. Delays were often due to nonspecific symptoms that could be mistaken for irritable bowel syndrome (IBS) and were influenced by various factors including age, education level, smoking, NSAID use, and disease characteristics like isolated ileal involvement. Healthcare system disparities also played a significant role, with delays varying by access to care. The review highlighted that delayed diagnosis was linked to worse disease outcomes, such as increased severity and complications, and underscored the importance of early intervention combined with timely management. Strategies to mitigate delays included implementing red flag tools, using inflammatory biomarkers like fecal calprotectin, and enhancing public and healthcare provider awareness. Addressing these factors and improving referral pathways and healthcare system efficiencies were crucial for enhancing early diagnosis and patient outcomes.
克罗恩病（Crohn's disease，CD）是一种慢性胃肠道炎症，早期诊断和及时、适当的治疗对于预防严重并发症和减少手术需求至关重要。本综述旨在研究导致 CD 诊断延误的因素，延误时间通常为 5 到 16 个月不等。延误往往是由于非特异性症状造成的，这些症状可能会被误认为是肠易激综合征（IBS），而且受到各种因素的影响，包括年龄、教育水平、吸烟、非甾体抗炎药的使用以及疾病特征（如孤立回肠受累）。医疗保健系统的差异也起着重要作用，不同的医疗机构延误诊断的情况也不尽相同。审查强调，延误诊断与疾病恶化的结果有关，如严重程度和并发症增加，并强调了早期干预与及时管理相结合的重要性。减少延误的策略包括采用红旗工具、使用炎症生物标志物（如粪便钙蛋白）以及提高公众和医疗服务提供者的认识。解决这些因素并改善转诊途径和医疗保健系统的效率，对于提高早期诊断和患者预后至关重要。
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Pub Date : 2024-11-15DOI: 10.1016/j.clinre.2024.102499
Ali Jaan , Umer Farooq , Abdulrahman Alyounes Alayoub , Hamna Nadeem , Effa Zahid , Ashish Dhawan , Savanna Thor , Asad Ur Rahman
Background
Clostridium difficile infection (CDI) has become a significant healthcare issue with increasing morbidity and mortality in the US and Europe. Frailty, characterized by reduced physical reserves and resistance to stressors, is linked to poor outcomes but its impact on CDI patients remains underexplored. This study seeks to address this gap through a nationwide analysis.
Methods
Using the National Readmission Database from 2016 to 2020, we employed the International Classification of Diseases, 10th revision, Clinical Modifications codes to identify adult patients admitted with CDI. We further stratified CDI hospitalizations based on frailty. Utilizing a regression model, we assessed the impact of frailty on CDI outcomes.
Results
We included 144,611 CDI patients of whom 98,167 (67.88 %) were frail. Multivariate analysis showed that frail CDI patients had significantly higher mortality (adjusted odds ratio (aOR) 4.87), acute kidney injury requiring dialysis (aOR 9.50), septic shock (aOR 14.23), and intensive care unit admission (aOR 6.80). CDI-specific complications were more likely in frail patients, including toxic megacolon (aOR 10.22), intestinal perforation (aOR 2.30), need for colectomy (aOR 3.90) and CDI recurrence (aOR 3.65). Resource utilization, indicated by hospitalization charges, length of stay, and 30-day readmission rates, was greater among frail patients.
Conclusion
Our study underscores the significant association between frailty and various critical endpoints of CDI, including its incidence, mortality, and recurrence. Additionally, frailty independently predicts higher resource utilization and elevated 30-day readmission. Recognizing frailty as a determinant of CDI outcomes can aid clinicians in risk stratification and guide tailored interventions for this population.
{"title":"Superiority of frailty over age in predicting outcomes among clostridium difficile patients: Evidence from national data","authors":"Ali Jaan , Umer Farooq , Abdulrahman Alyounes Alayoub , Hamna Nadeem , Effa Zahid , Ashish Dhawan , Savanna Thor , Asad Ur Rahman","doi":"10.1016/j.clinre.2024.102499","DOIUrl":"10.1016/j.clinre.2024.102499","url":null,"abstract":"<div><h3>Background</h3><div>Clostridium difficile infection (CDI) has become a significant healthcare issue with increasing morbidity and mortality in the US and Europe. Frailty, characterized by reduced physical reserves and resistance to stressors, is linked to poor outcomes but its impact on CDI patients remains underexplored. This study seeks to address this gap through a nationwide analysis.</div></div><div><h3>Methods</h3><div>Using the National Readmission Database from 2016 to 2020, we employed the International Classification of Diseases, 10th revision, Clinical Modifications codes to identify adult patients admitted with CDI. We further stratified CDI hospitalizations based on frailty. Utilizing a regression model, we assessed the impact of frailty on CDI outcomes.</div></div><div><h3>Results</h3><div>We included 144,611 CDI patients of whom 98,167 (67.88 %) were frail. Multivariate analysis showed that frail CDI patients had significantly higher mortality (adjusted odds ratio (aOR) 4.87), acute kidney injury requiring dialysis (aOR 9.50), septic shock (aOR 14.23), and intensive care unit admission (aOR 6.80). CDI-specific complications were more likely in frail patients, including toxic megacolon (aOR 10.22), intestinal perforation (aOR 2.30), need for colectomy (aOR 3.90) and CDI recurrence (aOR 3.65). Resource utilization, indicated by hospitalization charges, length of stay, and 30-day readmission rates, was greater among frail patients.</div></div><div><h3>Conclusion</h3><div>Our study underscores the significant association between frailty and various critical endpoints of CDI, including its incidence, mortality, and recurrence. Additionally, frailty independently predicts higher resource utilization and elevated 30-day readmission. Recognizing frailty as a determinant of CDI outcomes can aid clinicians in risk stratification and guide tailored interventions for this population.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102499"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643891","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}
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