Clinics and research in hepatology and gastroenterology最新文献_第8页

Selective inner muscle layer myotomy is associated with lower pain and same clinical efficacy that full-thickness myotomy in patients treated by POEM for achalasia: A multicenter retrospective comparative analysis of 158 patients 选择性内肌层肌层切开术与全厚肌层肌层切开术相比，对贲门失弛缓症患者进行选择性内肌层肌层切开术疼痛更轻，临床疗效相同：一项对158例患者进行的多中心回顾性比较分析。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-06-17 DOI: 10.1016/j.clinre.2024.102401

Mathilde Sanavio , Blandine Vauquelin , Marie-Christine Picot , Romain Altwegg , Anne Bozon , Flora Charpy , Ludovic Caillo , Arthur Berger , Frank Zerbib , Antoine Debourdeau

Introduction

The aim of this study was to compare the impact of the depth of myotomy (selective inner layer myotomy (SIM) vs. full-thickness myotomy (FTM)) on the outcome of patients treated with POEM for achalasia.

Methods

This was a retrospective, observational, conducted in two tertiary centers between October 2018 and September 2022. Patients were divided into two groups: SIM and FTM. The primary endpoint was clinical efficacy at 6 months, while secondary endpoints were postoperative criteria (such as pain, length of hospital stay, complications) and occurrence of gastroesophageal reflux disease (GERD) (esophagitis at 6 months, heartburn, and pH-metry).

Results

158 patients were included in the study (33 in the FTM group and 125 in the SIM group). The success rates at 6 and 12 months were similar in both groups, with 84 % and 70 % in the SIM group versus 90 % and 80 % in the FTM group, respectively (p = 0.57 and p = 0.74). However, more opioid analgesics were consumed in the FTM group compared to the SIM group (41% vs 21 %, p < 0.01). The length of hospitalization was longer in the FTM group than in the SIM group (2.17 ± 2.62 vs 2.94 ± 2.33, p < 0.001). The rate of esophagitis at 6 months was comparable (16 % in the SIM group vs 12 % in the FTM group, p = 0.73). There was no significant difference in terms of heartburn at 6 or 12 months between the SIM and FTM groups (18.5% vs 3.8 %, p = 0.07 and 27% vs 12.5 %, p = 0.35, respectively).

Conclusion

There was no significant difference in terms of clinical efficacy and GERD occurrence between FTM and SIM. However, full-thickness myotomy was associated with more postoperative pain and a longer length of hospital stay. Therefore, selective internal myotomy should be preferred over full-thickness myotomy.

简介本研究旨在比较肌切术深度（选择性内层肌切术（SIM）与全厚肌切术（FTM））对使用POEM治疗贲门失弛缓症患者预后的影响：这是一项回顾性、观察性研究，于2018年10月至2022年9月期间在两个三级中心进行。患者分为两组：SIM组和FTM组。主要终点为6个月时的临床疗效，次要终点为术后标准（如疼痛、住院时间、并发症）和胃食管反流病（GERD）发生情况（6个月时的食管炎、烧心和pH值测量）：研究共纳入 158 名患者（FTM 组 33 人，SIM 组 125 人）。两组 6 个月和 12 个月的成功率相似，SIM 组分别为 84% 和 70%，而 FTM 组分别为 90% 和 80%（P=0.57 和 P=0.74）。然而，与 SIM 组相比，FTM 组消耗了更多的阿片类镇痛药（41% 对 21%，p）：FTM和SIM在临床疗效和胃食管反流发生率方面没有明显差异。然而，全厚肌切开术与更多的术后疼痛和更长的住院时间有关。因此，选择性内肌切开术应优于全厚肌切开术。

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引用次数: 0

Clinical improvement effect of regulating gut microbiota on metabolic dysfunction-associated steatotic liver disease: Systematic review and meta-analysis of randomized controlled trials 调节肠道微生物群对代谢功能障碍相关脂肪性肝病的临床改善效果：随机对照试验的系统回顾和荟萃分析。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-06-13 DOI: 10.1016/j.clinre.2024.102397

Juan Wu , Xiaoyang Chen , Jun Qian , Guochun Li

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) is constantly rising globally. There are barely any effective medications or supplements for the management of MASLD. We aim to systematically evaluate the most current evidence for gut microbiota-regulating supplements in patients with MASLD.

Methods

We searched multiple electronic data for randomized controlled trials (RCTs) published from January 1, 2012, to July 15, 2023. The intervention measures included probiotics, prebiotics, synbiotics, antibiotics, and fecal microbiota transplantation (FMT). The control group was treated with a placebo or usual care. The intervention duration was divided into two periods (>12 weeks and ≤12 weeks). Adequate evaluation data for antibiotics and FMT have not been obtained. Therefore, the other three microbiota regulators are the primary evaluation measures in this study.

Results

We found that probiotics alone could not improve clinical indicators in MASLD patients. However, synbiotics exhibited an improvement in reducing liver steatosis, TNF-ɑ levels, and increasing HDL-c levels, and the inflammatory markers of liver cells (ALT and AST) were also improved. For the effective intervention duration, this systematic review suggested that around 12 weeks is an ideal intervention cycle for MASLD patients.

Conclusions

This meta-analysis supported the modulation of gut microbiota with synbiotics in the management of MASLD.

背景：代谢功能障碍相关性脂肪性肝病（MASLD）在全球呈上升趋势。目前几乎没有任何有效的药物或保健品可用于治疗代谢性脂肪肝。我们的目的是系统评估肠道微生物群调节补充剂治疗 MASLD 患者的最新证据：我们检索了 2012 年 1 月 1 日至 2023 年 7 月 15 日期间发表的多项随机对照试验 (RCT) 的电子数据。干预措施包括益生菌、益生元、合成益生菌、抗生素和粪便微生物群移植（FMT）。对照组采用安慰剂或常规治疗。干预持续时间分为两个阶段（>12 周和≤12 周）。抗生素和 FMT 尚未获得充分的评估数据。因此，本研究将其他三种微生物群调节剂作为主要评估指标：结果：我们发现，单独使用益生菌无法改善 MASLD 患者的临床指标。然而，合成益生菌在降低肝脏脂肪变性、TNF-ɑ 水平和提高 HDL-c 水平方面有所改善，肝细胞炎症指标（ALT 和 AST）也有所改善。对于有效的干预时间，本系统综述认为，12周左右是MASLD患者理想的干预周期：这项荟萃分析支持使用益生菌调节肠道微生物群来治疗 MASLD。

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引用次数: 0

Higher risk of in-hospital mortality and hepatic encephalopathy during weekend admission in Transjugular Intrahepatic Portosystemic Shunt procedure 经颈静脉肝内门体分流术周末入院时出现院内死亡和肝性脑病的风险更高

IF 2.7 4区医学 Q3 Medicine

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-06-12 DOI: 10.1016/j.clinre.2024.102396

Renxi Li , SeungEun Lee , William Rienas , Shawn Sarin

Objectives

Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to alleviate portal hypertension in patients with decompensated liver cirrhosis. The weekend effect refers to a higher risk of adverse outcomes associated with procedures performed on weekends compared to weekdays. The goal of this study is to determine whether a weekend effect is evident in TIPS procedures.

Materials and Method

The study identified patients who underwent TIPS procedures in the NIS database from 2015 to 2020. Patients who were admitted on the weekday or weekends were classified into two cohorts. Preoperative variables, including demographics, comorbidities, primary payer status, and hospital characteristics, were noted. Multivariable analysis was used to assess outcomes.

Results

Compared to patients admitted on the weekdays, weekend patients had higher in-hospital mortality (12.87 % vs. 7.96 %, aOR = 1.62, 95 CI 1.32–1.00, p < 0.01), hepatic encephalopathy (33.24 % vs. 26.18 %, aOR = 1.41, 95 CI 1.23–1.63, p < 0.01), acute kidney injury (39.03 % vs. 28.36 %, aOR = 1.68, 95 CI 1.46–1.93, p < 0.01), and transfer out (15.91 % vs. 12.76 %, aOR=1.33, 95 CI 1.11–1.60, p < 0.01). It was also found that weekend patients had longer wait from admission to operation (3.83 ± 0.15 days vs 2.82 ± 0.07 days, p < 0.01), longer LOS (11.22 ± 0.33 days vs 8.38 ± 0.15 days, p < 0.01), and higher total hospital charge (219,973 ± 7,352 dollars vs 172,663 ± 3,183 dollars, p < 0.01).

Conclusion

Our research unveiled a significant relationship between weekend admission and a higher risk of mortality and morbidity post-TIPS procedure. Eliminating delays in treatment associated with the weekend effect may mitigate this gap to deliver consistent and high-quality care to all patients.

目的：经颈静脉肝内门体分流术（TIPS经颈静脉肝内门体分流术（TIPS）是一种用于缓解肝硬化失代偿期患者门脉高压的手术。周末效应指的是与工作日相比，在周末进行手术会有更高的不良后果风险。本研究旨在确定 TIPS 手术是否存在明显的周末效应：该研究在国家信息系统数据库中识别了 2015 年至 2020 年期间接受 TIPS 手术的患者。在工作日或周末入院的患者被分为两个队列。研究人员注意到了术前变量，包括人口统计学、合并症、主要付款人身份和医院特征。采用多变量分析评估结果：结果：与平日入院的患者相比，周末入院的患者院内死亡率更高（12.87% vs. 7.96%，aOR=1.62，95 CI 1.32-1.00，p）：我们的研究揭示了周末入院与 TIPS 术后死亡率和发病率较高风险之间的重要关系。消除与周末效应相关的治疗延迟可能会缩小这一差距，从而为所有患者提供始终如一的高质量医疗服务。

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引用次数: 0

Clinical significance of lncRNA XIST expression in cholangiocarcinoma and its effect on cell migration and invasion 胆管癌中 lncRNA XIST 表达的临床意义及其对细胞迁移和侵袭的影响

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-06-11 DOI: 10.1016/j.clinre.2024.102398

Chenxi Li , Yifei Dong , Yichuan Zhang , Caihong Wu

Background

Cholangiocarcinoma is a malignant tumor that occurs in the bile duct system, and the prognosis of patients is poor. Currently, research suggests that long non-coding RNAs (lncRNAs) in the treatment and prevention of cholangiocarcinoma. This study primarily focuses on the regulation and potential mechanism of the lncRNA XIST (XIST) in cholangiocarcinoma.

Methods

The levels of XIST and miR-126–3p in cholangiocarcinoma tissues and cells were detected using real-time quantitative polymerase chain reaction (RT-qPCR). Cell transfection status, including migration and invasion, was examined via the Transwell method. The relationship between XIST and miR-126–3p was observed by dual-luciferase gene reporter assay and verified by rescue assays. Additionally, the prognostic significance of XIST in cholangiocarcinoma was determined using Kaplan-Meier and multivariate Cox regression analyses.

Results

XIST expression was increased in cholangiocarcinoma, while miR-126–3p was decreased, in both tissues and cells. The successful construction of silencing XIST was found to inhibit the count of cell migration and invasion. XIST directly targeted miR-126–3p to regulate the progression of cholangiocarcinoma.

Conclusion

XIST sponging miR-126–3p inhibited the progression of cholangiocarcinoma and improved the prognosis for patients. This finding provides new insights and opportunities for future studies on cholangiocarcinoma prognostic biomarkers.

背景：胆管癌是发生在胆管系统的恶性肿瘤，患者预后较差。目前，研究表明长非编码 RNA（lncRNA）可用于治疗和预防胆管癌。本研究主要关注lncRNA XIST（XIST）在胆管癌中的调控和潜在机制：方法：采用实时定量聚合酶链反应（RT-qPCR）检测胆管癌组织和细胞中 XIST 和 miR-126-3p 的水平。通过 Transwell 法检测细胞的转染状态，包括迁移和侵袭。通过双荧光素酶基因报告实验观察了 XIST 与 miR-126-3p 之间的关系，并通过挽救实验进行了验证。此外，还利用 Kaplan-Meier 和多变量 Cox 回归分析确定了 XIST 在胆管癌中的预后意义：结果：在组织和细胞中，胆管癌中的XIST增加，而miR-126-3p减少。沉默 XIST 的成功构建可抑制细胞的迁移和侵袭。XIST直接靶向miR-126-3p，调控胆管癌的进展：结论：XIST与miR-126-3p的结合抑制了胆管癌的进展，改善了患者的预后。这一发现为今后研究胆管癌预后生物标志物提供了新的见解和机会。

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引用次数: 0

Hepatitis B virus-associated hepatocellular carcinoma with invasion into right atrium 侵犯右心房的乙型肝炎病毒相关肝细胞癌

IF 2.7 4区医学 Q3 Medicine

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-06-11 DOI: 10.1016/j.clinre.2024.102399

Qiong Wang , Wei Liu , Jeffrey V. Esteron

引用次数: 0

The pan immune inflammatory value in relation to non-alcoholic fatty liver disease and hepatic fibrosis 泛免疫炎症值与非酒精性脂肪肝和肝纤维化的关系。

IF 2.7 4区医学 Q3 Medicine

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-06-10 DOI: 10.1016/j.clinre.2024.102393

Rong Jiang , Yunfeng Hua , Xiang Hu , Zhen Hong

Background

Inflammation played a critical role in non-alcoholic fatty liver disease (NAFLD). Here, we aimed to explore the relationship between inflammatory biomarkers and the prevalence of NAFLD and hepatic fibrosis in US participants.

Methods

Individuals with complete data from National Health and Nutrition Examination Survey (NHANES), 2017–2020 pre-pandemic cycle dataset were referred to this study. We identified NAFLD by vibration-controlled transient elastography (VCTE) on the basis of controlling attenuation parameter (CAP) ≥274dB/m. Liver fibrosis was confirmed by liver stiffness measurement (LSM) ≥8.2kPa. Multivariate logistic regression models were applied to estimate the correlations between inflammatory biomarkers and the prevalence of NAFLD and hepatic fibrosis based on sample weights.

Results

All together 5026 subjects were incorporated into the study cohort. Among these subjects, 2209 were classified as having NAFLD, and 8.35 % were diagnosed with hepatic fibrosis. Pan immune inflammatory value (PIV), instead of systemic immune inflammatory index (SII), was positively correlated with the rate of NAFLD or hepatic fibrosis. Subgroup analysis for NAFLD revealed that the positive relationships of the PIV existed in males (OR=1.52, 95 % CI: 1.01–2.28, p = 0.046) and participants below 60 years of age (OR=1.49, 95 % CI: 1.05–2.1, p = 0.028). Moreover, subgroup analysis for hepatic fibrosis revealed that the positive relationships of the PIV existed in females (OR=2.09, 95 % CI: 1.2–3.63, p = 0.014) and participants below 60 years of age (OR=1.74, 95 % CI: 1.09–2.77, p = 0.023).

Conclusions

A higher PIV, but not SII, is associated with a higher likelihood of NAFLD and liver fibrosis, suggesting that the PIV is a more valuable inflammatory marker for assessing NAFLD and liver fibrosis in participants, especially for those who are below 60 years of age.

背景：炎症在非酒精性脂肪肝（NAFLD）中起着至关重要的作用。在此，我们旨在探讨美国参与者中的炎症生物标志物与非酒精性脂肪肝和肝纤维化患病率之间的关系：本研究参考了美国国家健康与营养调查（NHANES）2017-2020年大流行前周期数据集中的完整数据。我们根据控制衰减参数（CAP）≥274dB/m，通过振动控制瞬态弹性成像（VCTE）确定非酒精性脂肪肝。肝脏硬度测量（LSM）≥8.2kPa可确认肝纤维化。根据样本权重，应用多变量逻辑回归模型估算炎症生物标志物与非酒精性脂肪肝和肝纤维化患病率之间的相关性：共有 5026 名受试者被纳入研究队列。在这些受试者中，2209 人被归类为非酒精性脂肪肝，8.35% 的受试者被诊断为肝纤维化。泛免疫炎症值（PIV）而非全身免疫炎症指数（SII）与非酒精性脂肪肝或肝纤维化的发生率呈正相关。对非酒精性脂肪肝进行的亚组分析表明，男性（OR=1.52，95% CI：1.01-2.28，P=0.046）和 60 岁以下的参与者（OR=1.49，95% CI：1.05-2.1，P=0.028）的 PIV 值呈正相关。此外，肝纤维化亚组分析显示，女性（OR=2.09，95% CI：1.2-3.63，p=0.014）和 60 岁以下参与者（OR=1.74，95% CI：1.09-2.77，p=0.023）的 PIV 存在正相关关系：PIV值越高，而SII值越低，发生非酒精性脂肪肝和肝纤维化的可能性越大，这表明PIV是评估参与者非酒精性脂肪肝和肝纤维化的更有价值的炎症标志物，尤其是对于60岁以下的参与者。

{"title":"The pan immune inflammatory value in relation to non-alcoholic fatty liver disease and hepatic fibrosis","authors":"Rong Jiang , Yunfeng Hua , Xiang Hu , Zhen Hong","doi":"10.1016/j.clinre.2024.102393","DOIUrl":"10.1016/j.clinre.2024.102393","url":null,"abstract":"<div><h3>Background</h3><p>Inflammation played a critical role in non-alcoholic fatty liver disease (NAFLD). Here, we aimed to explore the relationship between inflammatory biomarkers and the prevalence of NAFLD and hepatic fibrosis in US participants.</p></div><div><h3>Methods</h3><p>Individuals with complete data from National Health and Nutrition Examination Survey (NHANES), 2017–2020 pre-pandemic cycle dataset were referred to this study. We identified NAFLD by vibration-controlled transient elastography (VCTE) on the basis of controlling attenuation parameter (CAP) ≥274dB/m. Liver fibrosis was confirmed by liver stiffness measurement (LSM) ≥8.2kPa. Multivariate logistic regression models were applied to estimate the correlations between inflammatory biomarkers and the prevalence of NAFLD and hepatic fibrosis based on sample weights.</p></div><div><h3>Results</h3><p>All together 5026 subjects were incorporated into the study cohort. Among these subjects, 2209 were classified as having NAFLD, and 8.35 % were diagnosed with hepatic fibrosis. Pan immune inflammatory value (PIV), instead of systemic immune inflammatory index (SII), was positively correlated with the rate of NAFLD or hepatic fibrosis. Subgroup analysis for NAFLD revealed that the positive relationships of the PIV existed in males (OR=1.52, 95 % CI: 1.01–2.28, <em>p =</em> 0.046) and participants below 60 years of age (OR=1.49, 95 % CI: 1.05–2.1, <em>p =</em> 0.028). Moreover, subgroup analysis for hepatic fibrosis revealed that the positive relationships of the PIV existed in females (OR=2.09, 95 % CI: 1.2–3.63, <em>p =</em> 0.014) and participants below 60 years of age (OR=1.74, 95 % CI: 1.09–2.77, <em>p =</em> 0.023).</p></div><div><h3>Conclusions</h3><p>A higher PIV, but not SII, is associated with a higher likelihood of NAFLD and liver fibrosis, suggesting that the PIV is a more valuable inflammatory marker for assessing NAFLD and liver fibrosis in participants, especially for those who are below 60 years of age.</p></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310223","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

Exploring the role of mitochondrial proteins SIRT5 and MRPL33 through Mendelian randomization in primary biliary cholangitis 通过孟德尔随机化探索线粒体蛋白 SIRT5 和 MRPL33 在原发性胆汁性胆管炎中的作用

IF 2.7 4区医学 Q3 Medicine

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-06-08 DOI: 10.1016/j.clinre.2024.102394

Jingqin Hu , Yuqiang Mi , Li Wang , Feng Jiang , Ping Li

Background

Primary biliary cholangitis (PBC) is an autoimmune liver disease characterized by elevated serum antimitochondrial antibody levels in 90–95 % of cases. However, the exact causal relationship between mitochondrial proteins and PBC remains unclear. This study aims to investigate and clarify this relationship.

Methods

Genome-wide association data for mitochondrial proteins and PBC were obtained from public databases. The assessment of causal relationships between exposures and outcomes employed the Inverse Variance Weighted (IVW) method, MR Egger regression, and Weighted Median. Sensitivity analyses were systematically carried out to appraise the robustness of the Mendelian Randomization (MR) findings.

Results

The analysis revealed two mitochondrial proteins exhibiting a causal relationship with PBC. Elevated SIRT5 levels demonstrated a positive correlation with an augmented susceptibility to PBC in the IVW approach (odds ratio, OR: 1.2907, 95 % CI: 1.062–1.568, p = 0.0102). Conversely, increased MRPL33 levels were associated with a decreased risk of PBC (OR: 0.8957, 95 % CI: 0.807–0.993, p = 0.0376). Sensitivity analysis corroborated these findings consistently.

Conclusion

This investigation advances the notion of a potential causal association between elevated SIRT5 levels and an increased risk of PBC, alongside a decreased risk of PBC linked to elevated MRPL33 levels. The identified mitochondrial proteins may serve as viable biomarkers, offering pertinent insights for the understanding and addressing of PBC.

背景：原发性胆汁性胆管炎（PBC）是一种自身免疫性肝病，90%-95% 的病例以血清抗线粒体抗体水平升高为特征。然而，线粒体蛋白与 PBC 之间的确切因果关系仍不清楚。本研究旨在调查并澄清这种关系：方法：从公共数据库中获取线粒体蛋白与 PBC 的全基因组关联数据。采用反方差加权法（IVW）、MR Egger 回归法和加权中位数法评估暴露与结果之间的因果关系。系统地进行了敏感性分析，以评估孟德尔随机化（MR）结果的稳健性：结果：分析发现两种线粒体蛋白与 PBC 存在因果关系。在 IVW 方法中，SIRT5 水平升高与 PBC 易感性增加呈正相关（几率比，OR：1.2907，95% CI：1.062-1.568，p = 0.0102）。相反，MRPL33 水平升高与 PBC 风险降低相关（OR：0.8957，95% CI：0.807-0.993，p = 0.0376）。敏感性分析一致证实了这些结果：这项研究提出了 SIRT5 水平升高与 PBC 风险增加之间存在潜在因果关系的观点，同时，MRPL33 水平升高也会降低 PBC 风险。鉴定出的线粒体蛋白可作为可行的生物标志物，为了解和解决 PBC 问题提供相关见解。

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引用次数: 0

Crigler Najjar syndrome type II with severe jaundice as a new subtype(?) : A rare case report 伴有严重黄疸的克里格勒-纳贾尔综合征 II 型是一种新的亚型（......）：罕见病例报告。

IF 2.7 4区医学 Q3 Medicine

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-06-08 DOI: 10.1016/j.clinre.2024.102395

Xinqi Li, Dechun Wang, Ruobing Li, Fumei Yang, Rong Zhu

引用次数: 0

Dependent functional status is an independent risk factor for 30-day mortality and morbidities following colectomy for volvulus: An ACS-NSQIP study from the United States 依赖性功能状态是结肠切除术后 30 天死亡率和发病率的独立风险因素：美国 ACS-NSQIP 研究。

IF 2.7 4区医学 Q3 Medicine

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-06-02 DOI: 10.1016/j.clinre.2024.102391

Renxi Li

Objectives

Colonic volvulus is a common cause of bowel obstructions and surgery is the definitive treatment. Functional status is often associated with adverse postoperative outcomes but its effect on colectomy for volvulus remained under-explored. This study sought to analyze the effect of functional status on the 30-day outcomes of colectomy for volvulus.

Materials and method

National Surgical Quality Improvement Program (NSQIP) targeted colectomy database from 2012 to 2022 was utilized. Only patients with volvulus as the primary indication for colectomy were included. Thirty-day postoperative outcomes were compared between patients with dependent functional status (DFS) and independent functional status (IFS), adjusted for demographics, baseline characteristics, preoperative preparation, indication for surgery, and operative approaches by multivariable logistic regression.

Results

There were 1,476 patients with DFS (945 partially DFS and 531 fully DFS) and 8,824 (85.67 %) IFS patients who underwent colectomy for volvulus. After multivariable analysis, DFS patients had higher risks of mortality (aOR=1.671, 95 CI=1.37–2.038, p < 0.01), pulmonary complications (aOR=2.166, 95 CI=1.85–2.536, p < 0.01), sepsis (aOR=1.31, 95 CI=1.107–1.551, p < 0.01), prolonged postoperative nothing by mouth (NPO) or nasogastric tube (NGT) use (aOR=1.436, 95 CI=1.269–1.626, p < 0.01), discharge not to home (aOR=3.774, 95 CI=3.23–4.411, p < 0.01), and 30-day readmission (aOR=1.196, 95 CI=1.007–1.42, p = 0.04). Moreover, DFS patients had a longer length of stay (p = 0.01).

Conclusion

DFS was identified as an independent risk factor for increased mortality and complications after colectomy for volvulus. Given the substantial overlap between DFS patients and those who have colonic volvulus, these insights can contribute to preoperative risk assessments and postoperative care in these patients.

目的：结肠旋转是肠梗阻的常见原因，手术是最终治疗方法。功能状态通常与术后不良预后有关，但其对结肠切除术的影响仍未得到充分探讨。本研究旨在分析功能状态对结肠切除术治疗肠腔肿物 30 天预后的影响：研究利用了 2012 年至 2022 年国家外科质量改进计划（NSQIP）目标结肠切除术数据库。只纳入了以结肠肿物为结肠切除术主要适应症的患者。通过多变量逻辑回归比较了依赖功能状态（DFS）和独立功能状态（IFS）患者的术后30天预后，并对人口统计学、基线特征、术前准备、手术指征和手术方法进行了调整：共有1,476名DFS患者（945名部分DFS患者和531名完全DFS患者）和8,824名IFS患者（85.67%）接受了结肠切除术治疗。经过多变量分析，DFS 患者的死亡风险更高（aOR=1.671，95 CI=1.37-2.038，pConclusion）：DFS被认为是结肠切除术后死亡率和并发症增加的独立风险因素。鉴于DFS患者和结肠肠卷患者之间存在大量重叠，这些见解有助于对这些患者进行术前风险评估和术后护理。

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引用次数: 0

Use of PNPLA3, TM6SF2, and HSD17B13 for detection of fibrosis in MASLD in the general population 使用 PNPLA3、TM6SF2 和 HSD17B13 检测普通人群中 MASLD 的纤维化情况。

IF 2.7 4区医学 Q3 Medicine

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-06-01 DOI: 10.1016/j.clinre.2024.102389

Elias Badal Rashu , Mikkel Parsberg Werge , Liv Eline Hetland , Mira Thing , Puria Nabilou , Nina Kimer , Anders Ellekaer Junker , Anne-Sofie Houlberg Jensen , Børge Grønne Nordestgaard , Stefan Stender , Lise Lotte Gluud

Background

Genetic testing can be used to evaluate disease risk. We evaluated if the use of three Single Nucleotide Polymorphisms (SNPs), alone or combined into a genetic risk score (GRS), can aid identify significant fibrosis in subjects with metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods

We assessed three known risk variants: PNPLA3 rs738409, TM6SF2 rs58542926, and HSD17B13 rs72613567. The study included 414 adult individuals invited from the Danish population, who were defined as at-risk of MASLD due to elevated ALT and body mass index (BMI) >25 kg/m². Participants were assessed clinically and by the Fibrosis-4 (FIB-4) index and Fibroscan.

Results

In total, 17 participants (4.1 %) had alcohol-related liver disease, 79 (19.1 %) had no evidence of liver disease, and four (1.0 %) were diagnosed with other liver diseases, including malignant disease. The remaining 314 participants (75.8 %) were diagnosed with MASLD. Of the 27 who underwent a liver biopsy for suspected fibrosis, 15 had significant fibrosis (≥F2) and 12 had no/mild fibrosis (F0/F1). The GRS was not associated with significant fibrosis (p = 0.09) but PNPLA3 was with an odds ratio of 6.75 (95 % CI 1.29 – 50.7; p = 0.039) risk allele CG/GG versus CC. The diagnostic accuracy of PNPLA3 combined with an increased Fib-4 (>1.3) was excellent for detecting significant fibrosis with a sensitivity of 1.00 (95 % CI 0.72–1.00), but the specificity was no better than for FIB-4 alone.

Conclusions

This study found no evidence to support the use of GRS for diagnosing significant fibrosis in MASLD. However, the combination of PNPLA3 and Fib-4 increased sensitivity considerably. In addition, ALT remains a useful tool for screening diagnosing other liver diseases than MASLD.

背景：基因检测可用于评估疾病风险：基因检测可用于评估疾病风险。我们评估了使用三种单核苷酸多态性（SNPs），单独或组合成遗传风险评分（GRS），是否有助于识别代谢功能障碍相关性脂肪性肝病（MASLD）受试者的明显纤维化：我们评估了三种已知的风险变异：方法：我们评估了三种已知的风险变异：PNPLA3 rs738409、TM6SF2 rs58542926 和 HSD17B13 rs72613567。该研究纳入了从丹麦人口中邀请的 414 名成人，他们因 ALT 升高和体重指数 (BMI) >25 kg/m2 而被定义为 MASLD 的高危人群。参与者接受了临床评估以及纤维化-4（FIB-4）指数和纤维扫描评估：共有 17 人（4.1%）患有酒精相关肝病，79 人（19.1%）无肝病迹象，4 人（1.0%）被诊断患有其他肝病，包括恶性疾病。其余 314 名参与者（75.8%）被确诊为 MASLD。在因怀疑肝纤维化而进行肝活检的 27 人中，15 人有明显纤维化（≥F2），12 人无/轻度纤维化（F0/F1）。GRS与严重肝纤维化无关（p=0.09），但PNPLA3与严重肝纤维化相关，风险等位基因CG/GG与CC的几率比为6.75（95% CI 1.29 - 50.7；p=0.039）。PNPLA3结合Fib-4增高（>1.3）对检测明显纤维化的诊断准确性非常好，灵敏度为1.00（95% CI 0.72-1.00），但特异性并不比单独检测FIB-4好：结论：本研究没有发现证据支持使用GRS诊断MASLD的明显纤维化。然而，PNPLA3 和 Fib-4 的联合应用大大提高了灵敏度。此外，ALT仍是筛查诊断MASLD以外其他肝病的有用工具。

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引用次数: 0