Pub Date : 2025-10-03DOI: 10.1016/j.clinre.2025.102706
Amine Antonin Alam, Nadia Fathallah, Manuel Aubert, Paul Benfredj, Elise Pommaret, Vincent de Parades
Background
Management of first-time perianal abscesses remains controversial. While the French school of proctology systematically investigates fistulas, other approaches advocate simple incision, given that over 60 % of patients do not develop recurrence. The role of post-incision antibiotic therapy is also debated. This study aimed at evaluating our department’s approach to managing first perianal abscesses and identifying predictive factors for recurrence.
Methods
We retrospectively included all patients presenting in 2019 with a first perianal abscess treated by incision under local anesthesia, with or without antibiotic therapy post-incision. Patients with evident fistulas underwent surgery. Recurrence was defined as a new abscess or purulent opening. The primary outcome was the rate of patients requiring fistula surgery and/or experiencing abscess recurrence; secondary outcomes included identification of recurrence predictors.
Results
Among the 336 patients who consulted for an abscess, 109 were included. Among 109 patients (mean age 43 ± 13 years; 74 % male), 55 had incision alone, and 54 underwent fistula surgery. The mean follow-up for patients with incision alone was approximately 30 months, during which 18 % (10 patients) experienced abscess recurrence. Univariate logistic regression analysis revealed smoking and absence of antibiotic therapy post-incision as predictive of recurrence with (OR 0.44) were predictive of recurrence. Gender, age, BMI, diabetes, Crohn's disease, HIV infection, prior NSAID use, and abscess location were not predictive. Multivariate analysis was not conducted due to insufficient data.
Conclusion
This study demonstrates that 41 % of patients who underwent incision for a first perianal abscess did not experience recurrence during the follow-up period. Additionally, the administration of antibiotic therapy post-incision was associated with a reduced likelihood of recurrence. However, randomized trials are warranted to validate these findings and specify the optimal antibiotic regimen.
{"title":"Does antibiotic therapy for anal abscess reduce the risk of fistula surgery? A retrospective study","authors":"Amine Antonin Alam, Nadia Fathallah, Manuel Aubert, Paul Benfredj, Elise Pommaret, Vincent de Parades","doi":"10.1016/j.clinre.2025.102706","DOIUrl":"10.1016/j.clinre.2025.102706","url":null,"abstract":"<div><h3>Background</h3><div>Management of first-time perianal abscesses remains controversial. While the French school of proctology systematically investigates fistulas, other approaches advocate simple incision, given that over 60 % of patients do not develop recurrence. The role of post-incision antibiotic therapy is also debated. This study aimed at evaluating our department’s approach to managing first perianal abscesses and identifying predictive factors for recurrence.</div></div><div><h3>Methods</h3><div>We retrospectively included all patients presenting in 2019 with a first perianal abscess treated by incision under local anesthesia, with or without antibiotic therapy post-incision. Patients with evident fistulas underwent surgery. Recurrence was defined as a new abscess or purulent opening. The primary outcome was the rate of patients requiring fistula surgery and/or experiencing abscess recurrence; secondary outcomes included identification of recurrence predictors.</div></div><div><h3>Results</h3><div>Among the 336 patients who consulted for an abscess, 109 were included. Among 109 patients (mean age 43 ± 13 years; 74 % male), 55 had incision alone, and 54 underwent fistula surgery. The mean follow-up for patients with incision alone was approximately 30 months, during which 18 % (10 patients) experienced abscess recurrence. Univariate logistic regression analysis revealed smoking and absence of antibiotic therapy post-incision as predictive of recurrence with (OR 0.44) were predictive of recurrence. Gender, age, BMI, diabetes, Crohn's disease, HIV infection, prior NSAID use, and abscess location were not predictive. Multivariate analysis was not conducted due to insufficient data.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that 41 % of patients who underwent incision for a first perianal abscess did not experience recurrence during the follow-up period. Additionally, the administration of antibiotic therapy post-incision was associated with a reduced likelihood of recurrence. However, randomized trials are warranted to validate these findings and specify the optimal antibiotic regimen.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102706"},"PeriodicalIF":2.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231443","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 : 2025-09-29DOI: 10.1016/j.clinre.2025.102702
Haoxiang Zhu , Jiesen Yu , Jieren Luo , Zihao Cai , Lujin Li , Qingshan Zheng
Background and Aim
Drug development for non-alcoholic fatty liver disease (NAFLD) is frequently hampered by the poor translation of preclinical findings into clinical efficacy. To address this critical challenge, we developed a quantitative cross-species model designed to predict human clinical outcomes from efficacy data in mouse models.
Methods
We performed a model-based meta-analysis (MBMA) of 18 NAFLD drugs, integrating data from published clinical trials with corresponding preclinical mouse studies identified through a systematic search of the Embase and PubMed databases. Using the change in alanine aminotransferase (ΔALT) as the primary biomarker, we constructed an exponential model to define the relationship between ALT reduction in mice and the placebo-corrected response in humans (ΔΔALT). The model's predictive performance was then externally validated using an independent dataset from a study of Linggui Zhugan Tang (LGZGT).
Results
The analysis yielded a robust exponential model, which revealed that a reduction in mouse ΔALT of at least 53.3 U/L is required for a drug to show superiority over placebo in human trials. A more substantial decrease of 128.3 U/L in mice predicted a clinical efficacy exceeding that of Resmetirom, the first FDA-approved therapy for this condition. The model's predictive power was successfully confirmed through external validation with the LGZGT data.
Conclusions
This study developed a cross-species efficacy model from NAFLD clinical and mouse data, revealing an exponential relationship between human and mouse ALT levels. This provides quantitative thresholds for preclinical screening to improve drug development success rates.
{"title":"Development of a cross-species model to predict clinical outcomes based on efficacy in mouse models of non-alcoholic fatty liver disease","authors":"Haoxiang Zhu , Jiesen Yu , Jieren Luo , Zihao Cai , Lujin Li , Qingshan Zheng","doi":"10.1016/j.clinre.2025.102702","DOIUrl":"10.1016/j.clinre.2025.102702","url":null,"abstract":"<div><h3>Background and Aim</h3><div>Drug development for non-alcoholic fatty liver disease (NAFLD) is frequently hampered by the poor translation of preclinical findings into clinical efficacy. To address this critical challenge, we developed a quantitative cross-species model designed to predict human clinical outcomes from efficacy data in mouse models.</div></div><div><h3>Methods</h3><div>We performed a model-based meta-analysis (MBMA) of 18 NAFLD drugs, integrating data from published clinical trials with corresponding preclinical mouse studies identified through a systematic search of the Embase and PubMed databases. Using the change in alanine aminotransferase (ΔALT) as the primary biomarker, we constructed an exponential model to define the relationship between ALT reduction in mice and the placebo-corrected response in humans (ΔΔALT). The model's predictive performance was then externally validated using an independent dataset from a study of Linggui Zhugan Tang (LGZGT).</div></div><div><h3>Results</h3><div>The analysis yielded a robust exponential model, which revealed that a reduction in mouse ΔALT of at least 53.3 U/L is required for a drug to show superiority over placebo in human trials. A more substantial decrease of 128.3 U/L in mice predicted a clinical efficacy exceeding that of Resmetirom, the first FDA-approved therapy for this condition. The model's predictive power was successfully confirmed through external validation with the LGZGT data.</div></div><div><h3>Conclusions</h3><div>This study developed a cross-species efficacy model from NAFLD clinical and mouse data, revealing an exponential relationship between human and mouse ALT levels. This provides quantitative thresholds for preclinical screening to improve drug development success rates.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102702"},"PeriodicalIF":2.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205788","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 : 2025-09-29DOI: 10.1016/j.clinre.2025.102701
Arthur Marichez , Nour Aldajani , Catherine Fleureau , Jean-Philippe Adam , Brigitte Le Bail , Hugo Madar , Loïc Sentilhes , Laurence Chiche
Background
The discovery of a liver mass during pregnancy requires careful etiological assessment.A 29-year-old woman was diagnosed with a 17-cm inflammatory hepatocellular adenoma at 24-weeks of gestation. Given the high risk of spontaneous rupture and bleeding,a multidisciplinary team opted for a right hepatectomy at 26-weeks. To maintain stable maternal hemodynamics and avoid fetal hypoperfusion, a veno-venous cavo-caval bypass was established, allowing liver resection under total vascular exclusion without blood pressure fluctuations. The procedure was uneventful and a healthy child was delivered at term. The use of cavo-caval bypass offers a protective strategy to stabilize maternal circulation and preserve fetal well-being during major hepatectomy.
{"title":"Protecting the fetus during hepatic surgery in pregnancy: the role of cavo-caval bypass","authors":"Arthur Marichez , Nour Aldajani , Catherine Fleureau , Jean-Philippe Adam , Brigitte Le Bail , Hugo Madar , Loïc Sentilhes , Laurence Chiche","doi":"10.1016/j.clinre.2025.102701","DOIUrl":"10.1016/j.clinre.2025.102701","url":null,"abstract":"<div><h3>Background</h3><div>The discovery of a liver mass during pregnancy requires careful etiological assessment.A 29-year-old woman was diagnosed with a 17-cm inflammatory hepatocellular adenoma at 24-weeks of gestation. Given the high risk of spontaneous rupture and bleeding,a multidisciplinary team opted for a right hepatectomy at 26-weeks. To maintain stable maternal hemodynamics and avoid fetal hypoperfusion, a veno-venous cavo-caval bypass was established, allowing liver resection under total vascular exclusion without blood pressure fluctuations. The procedure was uneventful and a healthy child was delivered at term. The use of cavo-caval bypass offers a protective strategy to stabilize maternal circulation and preserve fetal well-being during major hepatectomy.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102701"},"PeriodicalIF":2.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205791","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 : 2025-09-29DOI: 10.1016/j.clinre.2025.102699
Anaïs Bertrand , Antoine Meyer , Julien Kirchgesner , Mathieu Uzzan , Vered Abitbol , Antoine Assaf , Charlotte Gagnière , Philippe Seksik , Aurelien Amiot
Background
The effectiveness of advanced therapies beyond second-line therapies has been poorly described in patients with ulcerative colitis (UC).
Aim
To describe the outcomes of third-line advanced therapy in patients with UC in a real-world setting.
Methods
We conducted a multicentre retrospective study in patients with UC who received third-line advanced therapy after the failure of a first-line anti-TNF agent and second-line vedolizumab. The primary endpoints were steroid-free clinical remission at weeks 14 and 54.
Results
We analysed 237 therapeutic sequences in 150 patients (55 with an anti-TNF agent, 80 with tofacitinib, and 102 with ustekinumab), accounting for 245.3 patient-years. Steroid-free clinical remission at week 14 was achieved in 14 (25.5 %) patients treated with an anti-TNF agent, 40 (50.0 %) with tofacitinib, and 54 (52.9 %) with ustekinumab (RR = 1.96 [1.19–3.25] for tofacitinib and RR = 2.08 [1.28–3.39] for ustekinumab, compared with an anti-TNF agent, respectively). Steroid-free clinical remission at week 54 was achieved in 16 (29.1 %) patients in the anti-TNF group, 37 (46.2 %) in the tofacitinib group and 56 (55.4 %) in the ustekinumab group (RR = 3.07 [0.98–9.60] for tofacitinib and RR = 3.09 [1.01–9.43] for ustekinumab, compared with anti-TNF, respectively). In total, 13.7 % of the patients underwent colectomy. Adverse events occurred in 94 (39.7 %) patients and were less frequent with ustekinumab.
Conclusion
In this retrospective study, third-line advanced therapies resulted in a high rate of steroid-free clinical remission at weeks 14 and 54, especially in patients treated with ustekinumab and tofacitinib.
{"title":"Effectiveness and safety of third-line advanced therapies in patients with ulcerative colitis: A multicentre retrospective cohort study","authors":"Anaïs Bertrand , Antoine Meyer , Julien Kirchgesner , Mathieu Uzzan , Vered Abitbol , Antoine Assaf , Charlotte Gagnière , Philippe Seksik , Aurelien Amiot","doi":"10.1016/j.clinre.2025.102699","DOIUrl":"10.1016/j.clinre.2025.102699","url":null,"abstract":"<div><h3>Background</h3><div>The effectiveness of advanced therapies beyond second-line therapies has been poorly described in patients with ulcerative colitis (UC).</div></div><div><h3>Aim</h3><div>To describe the outcomes of third-line advanced therapy in patients with UC in a real-world setting.</div></div><div><h3>Methods</h3><div>We conducted a multicentre retrospective study in patients with UC who received third-line advanced therapy after the failure of a first-line anti-TNF agent and second-line vedolizumab. The primary endpoints were steroid-free clinical remission at weeks 14 and 54.</div></div><div><h3>Results</h3><div>We analysed 237 therapeutic sequences in 150 patients (55 with an anti-TNF agent, 80 with tofacitinib, and 102 with ustekinumab), accounting for 245.3 patient-years. Steroid-free clinical remission at week 14 was achieved in 14 (25.5 %) patients treated with an anti-TNF agent, 40 (50.0 %) with tofacitinib, and 54 (52.9 %) with ustekinumab (RR = 1.96 [1.19–3.25] for tofacitinib and RR = 2.08 [1.28–3.39] for ustekinumab, compared with an anti-TNF agent, respectively). Steroid-free clinical remission at week 54 was achieved in 16 (29.1 %) patients in the anti-TNF group, 37 (46.2 %) in the tofacitinib group and 56 (55.4 %) in the ustekinumab group (RR = 3.07 [0.98–9.60] for tofacitinib and RR = 3.09 [1.01–9.43] for ustekinumab, compared with anti-TNF, respectively). In total, 13.7 % of the patients underwent colectomy. Adverse events occurred in 94 (39.7 %) patients and were less frequent with ustekinumab.</div></div><div><h3>Conclusion</h3><div>In this retrospective study, third-line advanced therapies resulted in a high rate of steroid-free clinical remission at weeks 14 and 54, especially in patients treated with ustekinumab and tofacitinib.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102699"},"PeriodicalIF":2.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205768","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}
{"title":"Residential proximity to pesticide-treated farmland is associated with elevated liver enzymes","authors":"Mahmood Moosazadeh , Zahra Charkazi , Narges Mirzaei Ilali , Reza Alizadeh-Navaei , Akbar Hedayatizadeh-Omran , Motahareh Kheradmand , Amirhossein Hessami","doi":"10.1016/j.clinre.2025.102703","DOIUrl":"10.1016/j.clinre.2025.102703","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102703"},"PeriodicalIF":2.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205818","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 : 2025-09-28DOI: 10.1016/j.clinre.2025.102700
Clara Yzet , Camille Robert , Franck Brazier , Erica Meudjo , Capucine Moreau , Denis Chatelain , Mathurin Fumery
Background
The STRIDE II guidelines recognize endoscopic healing (EH) as one of the main therapeutic goals in ulcerative colitis (UC). Nevertheless, histological healing (HH) could reduce the risk of long-term complications in UC. The aim of this study was to assess the risk of relapse in UC depending on the degree of remission achieved.
Methods
We conducted a prospective study including all consecutive UC patients in clinical remission and EH (MES 0 or 1) between January 2021 and January 2024. The primary endpoint was UC relapse, defined as the need for treatment intensification and/or corticosteroids initiation and/or UC-related hospitalization and/or colectomy. Patients were followed up every 6 months for two years. HH was defined as a Nancy index ≤ 1 (blinded double reading).
Results
A total of 75 patients were included. The median disease duration was 12 years (IQR [7.5–19.0]) and 66 (82 %) patients had a left side colitis (E2) or pancolitis (E3). Patients were treated for a median of 3 years (IQR [1.2 - 6.9]) prior to colonoscopy, 49 (65 %) patients had MES 0. Fifty-nine (79 %) patients of the cohort had HH. After a median follow-up of 21.0 months (IQR [12.0 - 26.5]), relapse was observed in 13 patients (17 %) after a median delay of 11 months (IQR [6.0 - 18.0]). There was no difference in the risk of relapse between patients with MES 1 and MES (13.6 % vs. 30.7 % respectively p = 0.275). The risk of relapse in patient with MES 1 was significantly higher among patient with absence of HH (39.7 % versus 20.1 % respectively p = 0.04). Similarly, in patients with MES 0, the risk of relapse was significantly higher among patients without HH (70.0 % versus 27.4 % respectively, p = 0.023). No UC-related hospitalizations or colectomy were reported during follow-up. In multivariate analysis, absence of HH was the only factor associated with disease relapse (HR 4.55 [1.69; 12.22], p = 0.0118).
Conclusion
In this prospective cohort, histological healing was the only associated with improved long-term outcome in UC patients whatever the degree of endoscopic mucosal healing.
背景：STRIDE II指南承认内镜下愈合（EH）是溃疡性结肠炎（UC）的主要治疗目标之一。然而，组织学愈合（HH）可以降低UC长期并发症的风险。本研究的目的是评估UC复发的风险，这取决于缓解的程度。方法：我们进行了一项前瞻性研究，包括2021年1月至2024年1月期间所有临床缓解和EH （MES 0或1）的连续UC患者。主要终点是UC复发，定义为需要加强治疗和/或开始使用皮质类固醇和/或UC相关住院和/或结肠切除术。每6个月随访一次，随访2年。HH定义为Nancy指数≤1（盲法双读）。结果：共纳入75例患者。中位病程为12年（IQR[7.5-19.0]）， 66例（82%）患者出现左侧结肠炎（E2）或全结肠炎（E3）。患者在结肠镜检查前平均治疗3年（IQR[1.2 - 6.9]）， 49例（65%）患者MES为0。队列中59例（79%）患者患有HH。在中位随访21.0个月（IQR[12.0 - 26.5]）后，13例患者（17%）在中位延迟11个月（IQR[6.0 - 18.0]）后复发。MES 1和MES患者的复发风险无差异（分别为13.6% vs. 30.7% p = 0.275）。MES 1患者的复发风险明显高于无HH患者（分别为39.7%对20.1% p = 0.04）。同样，在MES 0患者中，无HH患者的复发风险明显更高（分别为70.0%和27.4%,p = 0.023）。随访期间无uc相关住院或结肠切除术报告。在多因素分析中，HH缺失是唯一与疾病复发相关的因素（HR 4.55 [1.69; 12.22], p = 0.0118）。结论：在这个前瞻性队列中，无论内镜下粘膜愈合程度如何，组织学愈合是唯一与UC患者长期预后改善相关的方法。
{"title":"Impact of histological healing on ulcerative colitis disease course among patients with endoscopic healing: results of a prospective study","authors":"Clara Yzet , Camille Robert , Franck Brazier , Erica Meudjo , Capucine Moreau , Denis Chatelain , Mathurin Fumery","doi":"10.1016/j.clinre.2025.102700","DOIUrl":"10.1016/j.clinre.2025.102700","url":null,"abstract":"<div><h3>Background</h3><div>The STRIDE II guidelines recognize endoscopic healing (EH) as one of the main therapeutic goals in ulcerative colitis (UC). Nevertheless, histological healing (HH) could reduce the risk of long-term complications in UC. The aim of this study was to assess the risk of relapse in UC depending on the degree of remission achieved.</div></div><div><h3>Methods</h3><div>We conducted a prospective study including all consecutive UC patients in clinical remission and EH (MES 0 or 1) between January 2021 and January 2024. The primary endpoint was UC relapse, defined as the need for treatment intensification and/or corticosteroids initiation and/or UC-related hospitalization and/or colectomy. Patients were followed up every 6 months for two years. HH was defined as a Nancy index ≤ 1 (blinded double reading).</div></div><div><h3>Results</h3><div>A total of 75 patients were included. The median disease duration was 12 years (IQR [7.5–19.0]) and 66 (82 %) patients had a left side colitis (E2) or pancolitis (E3). Patients were treated for a median of 3 years (IQR [1.2 - 6.9]) prior to colonoscopy, 49 (65 %) patients had MES 0. Fifty-nine (79 %) patients of the cohort had HH. After a median follow-up of 21.0 months (IQR [12.0 - 26.5]), relapse was observed in 13 patients (17 %) after a median delay of 11 months (IQR [6.0 - 18.0]). There was no difference in the risk of relapse between patients with MES 1 and MES (13.6 % vs. 30.7 % respectively <em>p</em> = 0.275). The risk of relapse in patient with MES 1 was significantly higher among patient with absence of HH (39.7 % versus 20.1 % respectively <em>p</em> = 0.04). Similarly, in patients with MES 0, the risk of relapse was significantly higher among patients without HH (70.0 % versus 27.4 % respectively, <em>p</em> = 0.023). No UC-related hospitalizations or colectomy were reported during follow-up. In multivariate analysis, absence of HH was the only factor associated with disease relapse (HR 4.55 [1.69; 12.22], <em>p</em> = 0.0118).</div></div><div><h3>Conclusion</h3><div>In this prospective cohort, histological healing was the only associated with improved long-term outcome in UC patients whatever the degree of endoscopic mucosal healing.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102700"},"PeriodicalIF":2.4,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197861","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 : 2025-09-25DOI: 10.1016/j.clinre.2025.102693
Saqlain Haider
{"title":"Persistent portal hypertension in alcohol-associated hepatitis: A mirror of inflammation rather than mortality predictor","authors":"Saqlain Haider","doi":"10.1016/j.clinre.2025.102693","DOIUrl":"10.1016/j.clinre.2025.102693","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102693"},"PeriodicalIF":2.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181812","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 : 2025-09-24DOI: 10.1016/j.clinre.2025.102692
Fengchun Wang , Xiande Feng , Jianxiang Sun , Xiaoxin Fan , Jian Geng , Yu Leng , Hechao Tang
Background
Dynamic shifts in serum tumor markers during neoadjuvant therapy could refine prognostication in gastrointestinal (GI) cancers, but supporting evidence is limited.
Methods
We prospectively followed 200 patients with gastric (55 %) or colorectal (45 %) cancer who received neoadjuvant chemotherapy ± radiotherapy and curative-intent surgery (2016–2025). Carcinoembryonic antigen (CEA), CA19–9, CA72–4 and CA125 were assayed at baseline and pre-surgery. Three-year disease-free survival (DFS) and overall survival (OS) were primary endpoints. Multivariable Cox models assessed associations between marker dynamics and outcomes.
Results
Baseline positivity rates were 40 % for CEA and 30 % for CA19–9; 31 % of patients had ≥ 2 markers elevated. Therapy converted 45 % of CEA-positive and 53 % of CA19–9-positive cases to negative. Major pathological response (Tumor Regression Grade 0–1) occurred in 30 % overall and was higher in marker converters than non-converters (45 % vs 18 %, p < 0.001). Persistent positivity correlated with lower R0 resection (78 % vs 91 %, p = 0.04), more complications (26 % vs 12 %, p = 0.03) and poorer 3-year DFS (42 % vs 69 %). On multivariable analysis, persistence of ≥ 2 positive markers independently predicted shorter DFS (HR 1.9, 95 % CI 1.2–3.0) and OS (HR 2.1, 95 % CI 1.3–3.3). Sensitivity analyses using alternative cut-offs, multiple imputation and exclusion of borderline metastatic cases yielded consistent results.
Conclusion
Failure of serum tumor markers to normalize after neoadjuvant therapy signals inferior pathological response and survival. Serial marker assessment can enhance perioperative risk stratification and guide surgical decisions in GI cancers.
背景：在新辅助治疗期间血清肿瘤标志物的动态变化可以改善胃肠道（GI）癌症的预后，但支持证据有限。方法：前瞻性随访200例（55%）胃癌或结直肠癌（45%）患者（2016-2025年），接受新辅助化疗±放疗和治愈意图手术。在基线和术前检测癌胚抗原（CEA）、CA19-9、CA72-4和CA125。3年无病生存期（DFS）和总生存期（OS）是主要终点。多变量Cox模型评估了标志物动态和结果之间的关联。结果：CEA的基线阳性率为40%，CA19-9为30%；31%的患者有≥2项标志物升高。治疗将45%的cea阳性病例和53%的ca19 -9阳性病例转化为阴性。主要病理反应（肿瘤消退等级0-1）总体发生率为30%，标志物转换者高于非标记转换者（45% vs 18%, p < 0.001）。持续阳性与较低的R0切除（78%对91%，p = 0.04），更多的并发症（26%对12%，p = 0.03）和较差的3年DFS（42%对69%）相关。在多变量分析中，持续≥2个阳性标记独立预测较短的DFS （HR 1.9, 95% CI 1.2-3.0）和OS （HR 2.1, 95% CI 1.3-3.3）。敏感性分析采用替代截断、多重归算和排除边缘转移病例得出一致的结果。结论：新辅助治疗后血清肿瘤标志物未能恢复正常，表明病理反应和生存期较差。系列标志物评估可提高围手术期风险分层，指导消化道肿瘤的手术决策。
{"title":"Impact of dynamic changes in multiple serum tumor markers during neoadjuvant therapy on clinical outcome in gastrointestinal cancer","authors":"Fengchun Wang , Xiande Feng , Jianxiang Sun , Xiaoxin Fan , Jian Geng , Yu Leng , Hechao Tang","doi":"10.1016/j.clinre.2025.102692","DOIUrl":"10.1016/j.clinre.2025.102692","url":null,"abstract":"<div><h3>Background</h3><div>Dynamic shifts in serum tumor markers during neoadjuvant therapy could refine prognostication in gastrointestinal (GI) cancers, but supporting evidence is limited.</div></div><div><h3>Methods</h3><div>We prospectively followed 200 patients with gastric (55 %) or colorectal (45 %) cancer who received neoadjuvant chemotherapy ± radiotherapy and curative-intent surgery (2016–2025). Carcinoembryonic antigen (CEA), CA19–9, CA72–4 and CA125 were assayed at baseline and pre-surgery. Three-year disease-free survival (DFS) and overall survival (OS) were primary endpoints. Multivariable Cox models assessed associations between marker dynamics and outcomes.</div></div><div><h3>Results</h3><div>Baseline positivity rates were 40 % for CEA and 30 % for CA19–9; 31 % of patients had ≥ 2 markers elevated. Therapy converted 45 % of CEA-positive and 53 % of CA19–9-positive cases to negative. Major pathological response (Tumor Regression Grade 0–1) occurred in 30 % overall and was higher in marker converters than non-converters (45 % vs 18 %, <em>p</em> < 0.001). Persistent positivity correlated with lower R0 resection (78 % vs 91 %, <em>p</em> = 0.04), more complications (26 % vs 12 %, <em>p</em> = 0.03) and poorer 3-year DFS (42 % vs 69 %). On multivariable analysis, persistence of ≥ 2 positive markers independently predicted shorter DFS (HR 1.9, 95 % CI 1.2–3.0) and OS (HR 2.1, 95 % CI 1.3–3.3). Sensitivity analyses using alternative cut-offs, multiple imputation and exclusion of borderline metastatic cases yielded consistent results.</div></div><div><h3>Conclusion</h3><div>Failure of serum tumor markers to normalize after neoadjuvant therapy signals inferior pathological response and survival. Serial marker assessment can enhance perioperative risk stratification and guide surgical decisions in GI cancers.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102692"},"PeriodicalIF":2.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173694","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 : 2025-09-24DOI: 10.1016/j.clinre.2025.102694
Anuradha S Tripathy , Meenal Sharma , Neeta Thorat , Prasad Babar , Nalini Kadgi , Leena Nakate
{"title":"Detection of occult Hepatitis B infection among the blood donors in Pune, India","authors":"Anuradha S Tripathy , Meenal Sharma , Neeta Thorat , Prasad Babar , Nalini Kadgi , Leena Nakate","doi":"10.1016/j.clinre.2025.102694","DOIUrl":"10.1016/j.clinre.2025.102694","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102694"},"PeriodicalIF":2.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173597","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 : 2025-09-22DOI: 10.1016/j.clinre.2025.102691
Mohamed Elnaggar , Ibrahim Hassan , Ahmed Bahnasy , Hatem Eltaly , Houman Rezaizadeh
<div><h3>Background</h3><div>Esophageal carcinoma is the seventh most common cancer worldwide and poses a significant public health concern due to its poor overall survival rates. Although treatment advances, including multimodal approaches and enhanced surgical techniques, have emerged, their effect on national mortality trends remains unclear. Understanding the temporal changes in esophageal cancer mortality and potential disparities across demographic and geographic subgroups is crucial for guiding targeted interventions and resource allocation.</div></div><div><h3>Methods</h3><div>We obtained mortality data for esophageal cancer from the CDC WONDER database covering the years 1999 to 2020, using the ICD-10 code (C15) for malignant neoplasm of the esophagus. Annual mortality rates were age-adjusted to the 2000 U.S. standard population and expressed per 10,000 and 100,000 persons. Analyses were stratified by sex (male, female), race/ethnicity (Non-Hispanic Black or African American, Non-Hispanic White, Hispanic), U.S. Census region (Northeast, Midwest, South, West), and urbanization status (rural versus urban). Joinpoint regression identified periods with distinct trends and estimated annual percent changes (APC); the average annual percent change (AAPC) summarized the overall trend.</div></div><div><h3>Results</h3><div>From 1999 to 2020, there were 374,000 recorded deaths from esophageal cancer across a population of over 8 billion. The overall AAMR declined from 4.36 (95 % CI: 4.28–4.44) in 1999 to 3.69 (3.63–3.75) in 2020 (AAPC:0.8 %). Sex disparities were observed, as males had significantly higher mortality (6.43 per 100,000) compared to females (1.38 per 100,000) in 2020, though both showed declining trends (AAPC:0.84 % and -1.12 %, respectively). By race/ethnicity, Black or African American individuals experienced the most pronounced decline, from 6.61 to 2.73 (AAPC:3.82 %), with particularly steep declines after 2018 (APC:1.58 %). Hispanic populations showed moderate decreases from 2.54 to 1.99 (AAPC:1.32 %), while White populations showed minimal change from 4.3 to 4.28 (AAPC:0.05 %).</div><div>Regionally, the West experienced the greatest decline from 4.17 to 3.36 (AAPC:1.08 %), followed by the Northeast which fell from 4.61 to 3.57 (AAPC:1.07 %), the South from 4.23 to 3.56 (AAPC:0.89 %), and the Midwest displaying the smallest decrease from 4.46 to 4.37 (AAPC:0.31 %). Urban areas demonstrated a consistent decline (AAPC:1.09 %), while rural areas showed a modest increase from 4.16 to 4.52 (AAPC: 0.48 %).</div></div><div><h3>Conclusions</h3><div>Mortality due to esophageal cancer in the U.S. has declined modestly from 1999 to 2020, showing substantial variation across demographic and geographic subgroups. Black or African American populations experienced a significant decline in mortality rates compared to other racial groups, while rural areas exhibited concerning increases in mortality rates. Persistent disparities by sex, race/ethn
{"title":"Trends in esophageal cancer mortality in the United States (1999–2024): Disparities by sex, race/ethnicity, region, and urbanization","authors":"Mohamed Elnaggar , Ibrahim Hassan , Ahmed Bahnasy , Hatem Eltaly , Houman Rezaizadeh","doi":"10.1016/j.clinre.2025.102691","DOIUrl":"10.1016/j.clinre.2025.102691","url":null,"abstract":"<div><h3>Background</h3><div>Esophageal carcinoma is the seventh most common cancer worldwide and poses a significant public health concern due to its poor overall survival rates. Although treatment advances, including multimodal approaches and enhanced surgical techniques, have emerged, their effect on national mortality trends remains unclear. Understanding the temporal changes in esophageal cancer mortality and potential disparities across demographic and geographic subgroups is crucial for guiding targeted interventions and resource allocation.</div></div><div><h3>Methods</h3><div>We obtained mortality data for esophageal cancer from the CDC WONDER database covering the years 1999 to 2020, using the ICD-10 code (C15) for malignant neoplasm of the esophagus. Annual mortality rates were age-adjusted to the 2000 U.S. standard population and expressed per 10,000 and 100,000 persons. Analyses were stratified by sex (male, female), race/ethnicity (Non-Hispanic Black or African American, Non-Hispanic White, Hispanic), U.S. Census region (Northeast, Midwest, South, West), and urbanization status (rural versus urban). Joinpoint regression identified periods with distinct trends and estimated annual percent changes (APC); the average annual percent change (AAPC) summarized the overall trend.</div></div><div><h3>Results</h3><div>From 1999 to 2020, there were 374,000 recorded deaths from esophageal cancer across a population of over 8 billion. The overall AAMR declined from 4.36 (95 % CI: 4.28–4.44) in 1999 to 3.69 (3.63–3.75) in 2020 (AAPC:0.8 %). Sex disparities were observed, as males had significantly higher mortality (6.43 per 100,000) compared to females (1.38 per 100,000) in 2020, though both showed declining trends (AAPC:0.84 % and -1.12 %, respectively). By race/ethnicity, Black or African American individuals experienced the most pronounced decline, from 6.61 to 2.73 (AAPC:3.82 %), with particularly steep declines after 2018 (APC:1.58 %). Hispanic populations showed moderate decreases from 2.54 to 1.99 (AAPC:1.32 %), while White populations showed minimal change from 4.3 to 4.28 (AAPC:0.05 %).</div><div>Regionally, the West experienced the greatest decline from 4.17 to 3.36 (AAPC:1.08 %), followed by the Northeast which fell from 4.61 to 3.57 (AAPC:1.07 %), the South from 4.23 to 3.56 (AAPC:0.89 %), and the Midwest displaying the smallest decrease from 4.46 to 4.37 (AAPC:0.31 %). Urban areas demonstrated a consistent decline (AAPC:1.09 %), while rural areas showed a modest increase from 4.16 to 4.52 (AAPC: 0.48 %).</div></div><div><h3>Conclusions</h3><div>Mortality due to esophageal cancer in the U.S. has declined modestly from 1999 to 2020, showing substantial variation across demographic and geographic subgroups. Black or African American populations experienced a significant decline in mortality rates compared to other racial groups, while rural areas exhibited concerning increases in mortality rates. Persistent disparities by sex, race/ethn","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102691"},"PeriodicalIF":2.4,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136717","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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