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Effect of Pemafibrate on the Lipid Profile, Liver Function, and Liver Fibrosis Among Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease. 培马贝特对代谢功能障碍相关性脂肪肝患者血脂谱、肝功能和肝纤维化的影响
IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-08-01 Epub Date: 2024-08-31 DOI: 10.14740/gr1750
Mona Hassan, Hasan Al-Obaidi, Megan Karrick, Nooraldin Merza, Yusuf Nawras, Omar Saab, Ahmed Dheyaa Al-Obaidi, Fatima Merza, Hashim Talib Hashim, Khalid Al Zubaidi, Daniah Al-Sabbagh, Rand Matbachi, Zainab Noori, Hajra Amatul-Raheem, Sarmad Mansur, Omer Al Najafi, Marwah Algodi, Tamarah Al Hamdany, Abdallah Kobeissy

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are prevalent conditions linked to obesity and metabolic disturbances, with potential complications such as cirrhosis and cardiovascular risks. This systematic review and meta-analysis aimed to evaluate the efficacy of pemafibrate, a drug targeting fat and sugar metabolism genes, in treating patients with MASLD/MASH.

Methods: Databases such as MEDLINE, Web of Science, Cochrane Library, and Scopus were searched until September 2023 to identify relevant studies. Selected studies underwent a thorough quality assessment using tools like Risk of Bias 2 tool (ROB-2) and the National Institutes of Health (NIH) Quality Assessment Tools. Comprehensive meta-analysis software was used for statistical evaluations, with a focus on lipid profiles, liver function tests, and fibrosis measurements.

Results: A total of 13 studies were included; 10 of them were included in the quantitative analysis. Our findings showed that pemafibrate significantly decreased low-density lipoprotein cholesterol (LDL-C) (effect size (ES) = -9.61 mg/dL, 95% confidence interval (CI): -14.15 to -5.08), increased high-density lipoprotein cholesterol (HDL-C) (ES = 3.15 mg/dL, 95% CI: 1.53 to 4.78), and reduced triglycerides (TG) (ES = -85.98 mg/dL, 95% CI: -96.61 to -75.36). Additionally, pemafibrate showed a marked reduction in liver enzyme levels, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (GGT), and alkaline phosphatase (ALP), with significant effect sizes and P values. For liver stiffness outcomes, pemafibrate decreased AST to platelet ratio index (APRI) (ES = -0.180, 95% CI: -0.221 to -0.138).

Conclusions: Pemafibrate, with its enhanced efficacy and safety profile, presents as a pivotal agent in MASLD/MASH treatment. Its lipid-regulating properties, coupled with its beneficial effects on liver inflammation markers, position it as a potentially invaluable therapeutic option.

背景:代谢功能障碍相关性脂肪性肝病(MASLD)和代谢功能障碍相关性脂肪性肝炎(MASH)是与肥胖和代谢紊乱有关的流行病,具有肝硬化和心血管风险等潜在并发症。本系统综述和荟萃分析旨在评估培马贝特(一种针对脂肪和糖代谢基因的药物)治疗 MASLD/MASH 患者的疗效:方法:检索MEDLINE、Web of Science、Cochrane Library和Scopus等数据库,以确定相关研究,检索期至2023年9月。利用偏倚风险2工具(ROB-2)和美国国立卫生研究院(NIH)质量评估工具等工具对所选研究进行了全面的质量评估。使用综合荟萃分析软件进行统计评估,重点关注血脂概况、肝功能检测和纤维化测量:共纳入 13 项研究,其中 10 项纳入定量分析。我们的研究结果表明,培马贝特能显著降低低密度脂蛋白胆固醇(LDL-C)(效应大小(ES)= -9.61 mg/dL,95% 置信区间(CI):-14.15 至 -5.08),增加高密度脂蛋白胆固醇(LDL-C)(效应大小(ES)= -9.61 mg/dL,95% 置信区间(CI):-14.15 至 -5.0808),增加高密度脂蛋白胆固醇(HDL-C)(ES = 3.15 mg/dL,95% 置信区间(CI):1.53 至 4.78),降低甘油三酯(TG)(ES = -85.98 mg/dL,95% 置信区间(CI):-96.61 至 -75.36)。此外,培马贝特还能明显降低肝酶水平,包括天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(GGT)和碱性磷酸酶(ALP),并具有显著的效应大小和P值。在肝僵化结果方面,培马贝特可降低谷草转氨酶与血小板比率指数(APRI)(ES = -0.180,95% CI:-0.221 至 -0.138):结论:培马贝特具有更好的疗效和安全性,是治疗 MASLD/MASH 的关键药物。培马贝特具有调节血脂的特性,同时对肝脏炎症指标也有益处,因此可能成为一种非常有价值的治疗选择。
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引用次数: 0
Clinical Efficacy of Transcatheter Arterial Chemoembolization Combined With Percutaneous Microwave Coagulation Therapy for Advanced Hepatocellular Carcinoma. 经导管动脉化疗栓塞联合经皮微波凝固疗法治疗晚期肝细胞癌的临床疗效
IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-18 DOI: 10.14740/gr1713
Hu Hu Ren, Zhi Qun Wu, Jian Chen, Chen Li

Background: The aim of the study was to explore the clinical efficacy of transcatheter arterial chemoembolization (TACE) combined with percutaneous microwave coagulation therapy (PMCT) for advanced hepatocellular carcinoma (HCC).

Methods: Eighty-three advanced HCC patients were divided into the experimental group (TACE + PMCT, 57 cases) and the control group (TACE alone, 26 cases). They received TACE treatment first, and computed tomography (CT) or hepatic artery angiography was performed 3 - 4 weeks after each treatment. Based on the comprehensive evaluation of iodine oil deficiency, fistula recanalization, residual lesions, and lesion progression, TACE or PMCT treatment was selectively performed, and three consecutive treatments were considered as one treatment cycle.

Results: The experimental group had a response rate (RR) of 49.1%, and the control group had a RR of 38.4%. The reduction rate of alpha-fetoprotein (AFP) in the experimental group was significantly higher than the control group (P < 0.05). The cumulative survival rates in the experimental at 1-, 1.5-, and 2-year post-treatment were higher than the control group. The cumulative recurrence and metastasis rates in the experimental at 1.5-, and 2-year post-treatment were significantly lower than those in the control group (P < 0.05). In addition, there were no significant differences in treatment-related complications in the two groups.

Conclusions: The combined treatment of TACE and PMCT for advanced HCC is a safe, feasible, and effective treatment method, prolonging the survival time, and reducing the recurrence and metastasis rate, without increased toxic and side effects.

研究背景该研究旨在探讨经导管动脉化疗栓塞术(TACE)联合经皮微波凝固疗法(PMCT)治疗晚期肝细胞癌(HCC)的临床疗效:83例晚期HCC患者被分为实验组(TACE + PMCT,57例)和对照组(单纯TACE,26例)。他们首先接受 TACE 治疗,每次治疗后 3-4 周进行计算机断层扫描(CT)或肝动脉造影。根据碘油缺乏、瘘管再通、残余病灶、病灶进展等综合评估结果,有选择性地进行TACE或PMCT治疗,连续三次治疗视为一个治疗周期:实验组反应率(RR)为 49.1%,对照组反应率为 38.4%。实验组甲胎蛋白(AFP)下降率明显高于对照组(P < 0.05)。实验组在治疗后 1 年、1.5 年和 2 年的累积生存率均高于对照组。实验组治疗后 1.5 年和 2 年的累积复发率和转移率明显低于对照组(P < 0.05)。此外,两组在治疗相关并发症方面无明显差异:结论:TACE和PMCT联合治疗晚期HCC是一种安全、可行、有效的治疗方法,可延长患者生存时间,降低复发率和转移率,且不会增加毒副作用。
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引用次数: 0
Pre-Cut Papillotomy Versus Endoscopic Ultrasound-Rendezvous for Difficult Biliary Cannulation: A Systematic Review and Meta-Analysis. 预切乳头切开术与内镜超声穿刺术治疗困难胆道插管:系统综述与元分析》。
IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-18 DOI: 10.14740/gr1738
Amna Iqbal, Zohaib Ahmad, Muhammad Aziz, Abdulmajeed Alharbi, Hassam Ali, Ahmed Al-Chalabi, Manesh Kumar Gangwani, Dushyant Singh Dahiya, Wade Lee Smith, Shailendra Singh, Yaseen Alastal, Abdallah Kobeissy

Background: Various endoscopic techniques are employed to achieve biliary cannulation when confronted with difficult biliary access. Every procedure carries its own risk in terms of bleeding, infection, pancreatitis, and cholangitis. Our meta-analysis aimed to compare pre-cut papillotomy and endoscopic ultrasound (EUS)-rendezvous in terms of technical success rates, and post-procedure pancreatitis and bleeding.

Methods: We conducted a systematic review and meta-analysis of studies that compared pre-cut papillotomy and EUS-rendezvous. The primary outcome was technical success by achieving biliary cannulation. Secondary outcomes were postoperative pancreatitis and bleeding. A random-effects model was used to calculate the risk ratios (RRs) and confidence intervals (CIs). A P value < 0.05 was considered statistically significant.

Results: Our meta-analysis included four studies comparing pre-cut papillotomy and EUS-rendezvous. The studies included 13,659 total endoscopic retrograde cholangiopancreatography (ERCP) procedures, of whom 1,004 patients underwent alternate biliary cannulation procedures due to difficult biliary cannulation. The mean age of the study population was noted to be 49.5 years and males represented 53.3% of the total participants. Both procedures were similar in terms of technical success (RR: 0.95, 95% CI (0.88, 1.02)). No difference was found between rates of post procedure pancreatitis (RR: 1.82, 95% CI (0.80, 4.15)) and post procedure bleeding (RR: 2.80, 95% CI (0.67, 11.66)).

Conclusions: There was no difference in technical success of procedure or post-procedure complications such as pancreatitis and bleeding between pre-cut papillotomy and EUS-rendezvous technique. More randomized controlled trials (RCTs) are needed to compare both procedural techniques and complications rates. However, currently, both procedures are equally effective and safe during difficult biliary cannulation in the hands of experienced endoscopists.

背景:在胆道入路困难的情况下,可采用各种内窥镜技术实现胆道插管。每种手术都有出血、感染、胰腺炎和胆管炎等风险。我们的荟萃分析旨在从技术成功率、术后胰腺炎和出血方面比较预切乳头切开术和内镜超声(EUS)-肾切除术:我们对比较预切乳头切开术和 EUS-环切术的研究进行了系统回顾和荟萃分析。主要结果是实现胆道插管的技术成功率。次要结果是术后胰腺炎和出血。采用随机效应模型计算风险比 (RR) 和置信区间 (CI)。P值小于0.05被认为具有统计学意义:我们的荟萃分析包括四项比较预切乳头切开术和 EUS-rendezvous 的研究。这些研究共纳入了13659例内镜逆行胰胆管造影(ERCP)手术,其中1004例患者因胆道插管困难而接受了备用胆道插管手术。研究对象的平均年龄为 49.5 岁,男性占总人数的 53.3%。两种手术的技术成功率相似(RR:0.95,95% CI (0.88,1.02))。术后胰腺炎(RR:1.82,95% CI(0.80,4.15))和术后出血(RR:2.80,95% CI(0.67,11.66))的发生率没有差异:结论:预切乳头切开术与 EUS-rendezvous技术在手术成功率或术后并发症(如胰腺炎和出血)方面没有差异。需要更多的随机对照试验(RCT)来比较两种手术技术和并发症发生率。不过,目前在经验丰富的内镜医师手中,这两种手术在困难胆道插管时同样有效和安全。
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引用次数: 0
Extraction Basket Entangled in Surgical Sutures in Common Bile Duct Forty-Five Years After Hepatobiliary Surgery: A Bizarre Adverse Event of Endoscopic Retrograde Cholangiopancreatography. 肝胆手术 45 年后,胆总管内的手术缝合线缠绕着抽取篮:内镜逆行胰胆管造影的奇特不良事件。
IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-08-01 Epub Date: 2024-08-10 DOI: 10.14740/gr1752
Ante Bogut, Ivan Saric, Vedran Dragisic, Andela Azinovic, Ivan Romic, Branko Bakula, Marko Puljiz, Zeljko Puljiz

Endoscopic retrograde cholangiopancreatography (ERCP) is an important technique for treating biliary obstruction. A case report of a 75-year-old male with diagnosed choledocholithiasis and cholangitis was presented. He had a history of hepatic surgery 45 years ago, and during the ERCP, an unusual clinical scenario was encountered. Retained extraction basket during ERCP is a rare but known complication and there are no standard recommendations to manage it. To our knowledge, this is the first case report described in the literature with retention of an extraction basket in surgical sutures at ERCP and the longest period from surgery to stone formation in the biliary system. This case report aims to emphasize that in patients with a history of hepatobiliary surgery, postoperative material can cause complications during ERCP.

内镜逆行胰胆管造影术(ERCP)是治疗胆道梗阻的一项重要技术。本病例报告了一名 75 岁男性的病例,他被诊断患有胆总管结石和胆管炎。他在 45 年前曾做过肝脏手术,在进行 ERCP 时遇到了不寻常的临床情况。在ERCP过程中,提取筐的残留是一种罕见但已知的并发症,目前还没有标准的处理建议。据我们所知,这是文献中描述的第一例ERCP手术缝合处留置取石筐的病例报告,也是胆道系统中从手术到结石形成时间最长的病例报告。本病例报告旨在强调,对于有肝胆手术史的患者,术后材料可能会在ERCP过程中引起并发症。
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引用次数: 0
Adult-Onset Autoimmune Enteropathy Mimicking Disaccharidase Deficiency. 模仿二糖酶缺乏症的成人发病型自身免疫性肠病
IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-18 DOI: 10.14740/gr1737
Georgeta Giblen, Jerry Huang, Brandon Yu, Jinping Lai

Adult-onset autoimmune enteropathy is a rare disorder characterized by severe diarrhea, weight loss, malnutrition, and enteric mucosal atrophy resulting from immune-mediated injury. Disaccharidase deficiencies are a group of disorders characterized by inadequate activity of disaccharidase in the small intestine, leading to impaired digestion of disaccharides and malabsorption. Here, we present a case of adult-onset autoimmune enteropathy initially diagnosed as disaccharidase deficiency based on the clinical symptoms of chronic diarrhea, weight loss, and severely reduced levels of lactase, maltase, palatinase, and sucrase in duodenal aspirates. However, follow-up duodenal biopsy revealed markedly villous blunting, goblet and Paneth cell depletion, increased crypt apoptotic bodies and lamina propria lymphoplasmacytic inflammation, leading to a revised diagnosis of autoimmune enteropathy. This case highlights the diagnostic challenges of adult-onset autoimmune enteropathy and the importance of considering it in adults with unexplained gastrointestinal symptoms. It also emphasizes the need for tissue biopsies in cases with inconclusive initial diagnostic tests. Increased awareness of these disorders and their mimickers can improve diagnosis and management, ultimately benefiting patients with these conditions.

成人自身免疫性肠病是一种罕见的疾病,其特征是免疫介导的损伤导致严重腹泻、体重减轻、营养不良和肠粘膜萎缩。双糖酶缺乏症是一组以小肠中双糖酶活性不足为特征的疾病,会导致双糖消化障碍和吸收不良。在此,我们介绍了一例成人发病型自身免疫性肠病患者,根据慢性腹泻、体重减轻以及十二指肠抽吸物中乳糖酶、麦芽糖酶、巴拉丁酶和蔗糖酶水平严重降低等临床症状,患者最初被诊断为双糖酶缺乏症。然而,随访的十二指肠活检结果显示,绒毛明显变细,鹅口疮细胞和帕奈特细胞耗竭,隐窝凋亡体增加,固有层淋巴细胞炎症,因此诊断为自身免疫性肠病。本病例强调了成人自身免疫性肠病的诊断难题,以及在出现不明原因的胃肠道症状时考虑成人自身免疫性肠病的重要性。该病例还强调了在初步诊断测试不确定的病例中进行组织活检的必要性。提高对这些疾病及其模拟者的认识可以改善诊断和管理,最终使这些疾病的患者受益。
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引用次数: 0
Needle-Knife Fistulotomy Versus Needle-Knife Papillotomy in Difficult Biliary Cannulation: A Systematic Review and Meta-Analysis. 针刀瘘管切开术与针刀乳头切开术在困难胆道插管中的应用:系统综述与元分析》。
IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-06-01 Epub Date: 2024-06-29 DOI: 10.14740/gr1726
Saqr Alsakarneh, Tim Brotherton, Fouad Jaber, Mahmoud Y Madi, Laith Numan, Mohamed Ahmed, Yazan Sallam, Mohammad Adam, Dushyant Singh Dahiya, Pearl Aggarwal, Fazel Dinary

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an essential endoscopic therapeutic modality for biliary and pancreatic diseases. Needle-knife fistulotomy (NKF) and papillotomy (NKP) are the two most commonly used rescue techniques for patients with difficult biliary cannulation. However, there remains a need for comparative studies on these approaches to inform clinical decision-making. This meta-analysis aimed to evaluate the efficacy and safety of NKF compared to NKP as a rescue technique in difficult biliary cannulation after failed conventional ERCP.

Methods: We searched PubMed, Scopus, Embase, and Web of Science databases through November 2023 to include all studies that directly compared the outcomes of NKF with NKP in difficult biliary cannulation. Single-arm studies were excluded. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous data related to clinical events were calculated using the Mantel-Haenszel method within a random-effect model. The primary outcome was the biliary cannulation success rate.

Results: Four studies with 823 patients (n = 376 NKF vs. n = 447 NKP) were included in our analysis. There was no significant difference between the two groups in biliary cannulation success rate (91.7% vs. 86.9%, respectively; OR = 1.54, 95% CI: 0.21 - 2.49, P = 0.14; I2 = 0%). However, the overall rate of adverse events was significantly lower in the NKF group than in the NKP group (OR = 0.46, 95% CI: 0.25 - 0.84, P = 0.01). Pancreatitis (OR = 0.23, 95% CI: 0.05 - 1.11, P = 0.07) and bleeding (OR = 1.43, 95% CI: 0.59 - 3.46, P = 0.42) were similar between the two groups. No significant differences in cholangitis, cholecystitis, perforation, or mortality were observed.

Conclusions: Our meta-analysis indicates comparable success rates in comparing NKF and NKP techniques for difficult biliary cannulation after failed conventional ERCP cannulation. Notably, the NKF technique significantly reduces overall adverse events compared to NKP, suggesting that NKF may be preferable due to its favorable safety profile. Additional randomized controlled trials (RCTs) are warranted to evaluate the interval benefit of an NKF technique.

背景:内镜逆行胰胆管造影术(ERCP)是胆道和胰腺疾病的重要内镜治疗方式。针刀瘘管切开术(NKF)和乳头切开术(NKP)是胆道插管困难患者最常用的两种抢救技术。然而,仍然需要对这些方法进行比较研究,以便为临床决策提供依据。本荟萃分析旨在评估 NKF 与 NKP 作为常规 ERCP 失败后困难胆道插管抢救技术的有效性和安全性:我们检索了截至 2023 年 11 月的 PubMed、Scopus、Embase 和 Web of Science 数据库,以纳入所有直接比较 NKF 与 NKP 在困难胆道插管中的疗效的研究。排除了单臂研究。采用随机效应模型中的 Mantel-Haenszel 法计算了与临床事件相关的二分法数据的汇总几率比 (OR) 和 95% 置信区间 (CI)。主要结果为胆道插管成功率:四项研究共纳入了 823 名患者(n = 376 NKF vs. n = 447 NKP)。两组胆道插管成功率无明显差异(分别为 91.7% 对 86.9%;OR = 1.54,95% CI:0.21 - 2.49,P = 0.14;I2 = 0%)。然而,NKF 组的不良事件总发生率明显低于 NKP 组(OR = 0.46,95% CI:0.25 - 0.84,P = 0.01)。胰腺炎(OR = 0.23,95% CI:0.05 - 1.11,P = 0.07)和出血(OR = 1.43,95% CI:0.59 - 3.46,P = 0.42)在两组之间相似。在胆管炎、胆囊炎、穿孔或死亡率方面没有观察到明显差异:我们的荟萃分析表明,比较 NKF 和 NKP 技术在常规 ERCP 插管失败后进行困难胆道插管的成功率不相上下。值得注意的是,与 NKP 相比,NKF 技术大大降低了总体不良事件,这表明 NKF 因其良好的安全性而更受欢迎。有必要进行更多的随机对照试验 (RCT),以评估 NKF 技术的间隔效益。
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引用次数: 0
The Risk of Infection-Caused Mortality in Gastric Adenocarcinoma: A Population-Based Study. 胃腺癌感染致死风险:一项基于人群的研究
IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-06-01 Epub Date: 2024-06-29 DOI: 10.14740/gr1715
Adnan Malik, Farman Ali, Muhammad Imran Malik, Shahbaz Qureshi

Background: Gastric adenocarcinoma (GAC) is a deadly tumor. Postoperative complications, including infections, worsen its prognosis and may affect overall survival. Little is known about perioperative complications as well as modifiable and non-modifiable risk factors. Early detection and treatment of these risk factors may affect overall survival and mortality.

Methods: We extracted GAC patient's data from the Surveillance, Epidemiology, and End Results (SEER) database and analyzed using Pearson's Chi-square, Cox regression, Kaplan-Meier, and binary regression methods in SPSS.

Results: At the time of analysis, 59,580 GAC patients were identified, of which 854 died of infection. Overall, mean survival in months was better for younger patients, age < 50 years vs. ≥ 50 years (60.45 vs. 56.75), and in females vs. males (65.23 vs. 53.24). The multivariate analysis showed that the risk of infectious mortality was higher in patients with age ≥ 50 years (hazard ratio (HR): 3.137; 95% confidence interval (CI): 2.178 - 4.517), not treated with chemotherapy (HR: 1.669; 95% CI: 1.356 - 2.056), or surgery (HR: 1.412; 95% CI:1.132 - 1.761) and unstaged patients (HR: 1.699; 95% CI: 1.278 - 2.258). In contrast, the mortality risk was lower in females (HR: 0.658; 95% CI: 0.561 - 0.773) and married patients (HR: 0.627; 95% CI: 0.506 - 0.778). The probability of infection was higher in older patients (odds ratio (OR) of 2.094 in ≥ 50 years), other races in comparison to Whites and Blacks (OR: 1.226), lesser curvature, not other specified (NOS) as a primary site (OR: 1.325), and patients not receiving chemotherapy (OR: 1.258).

Conclusion: Older, unmarried males with GAC who are not treated with chemotherapy or surgery are at a higher risk for infection-caused mortality and should be given special attention while receiving treatment.

背景:胃腺癌(GAC)是一种致命的肿瘤:胃腺癌(GAC)是一种致命的肿瘤。包括感染在内的术后并发症会使预后恶化,并可能影响总生存率。人们对围手术期并发症以及可改变和不可改变的风险因素知之甚少。及早发现和治疗这些风险因素可能会影响总体生存率和死亡率:我们从监测、流行病学和最终结果(SEER)数据库中提取了GAC患者的数据,并使用SPSS中的Pearson's Chi-square、Cox回归、Kaplan-Meier和二元回归方法进行了分析:结果:在进行分析时,共发现了 59,580 名 GAC 患者,其中 854 人死于感染。总体而言,年龄小于 50 岁与年龄大于 50 岁(60.45 与 56.75)、女性与男性(65.23 与 53.24)的年轻患者的平均存活月数更高。多变量分析显示,年龄≥50岁(危险比(HR):3.137;95% 置信区间(CI):2.178 - 4.517)、未接受化疗(HR:1.669;95% CI:1.356 - 2.056)或手术(HR:1.412;95% CI:1.132 - 1.761)和未分期患者(HR:1.699;95% CI:1.278 - 2.258)的感染性死亡风险较高。相比之下,女性(HR:0.658;95% CI:0.561 - 0.773)和已婚患者(HR:0.627;95% CI:0.506 - 0.778)的死亡风险较低。年龄较大的患者(≥50 岁的几率比(OR)为 2.094)、其他种族患者(OR:1.226)、曲率较小、原发部位未注明(NOS)的患者(OR:1.325)和未接受化疗的患者(OR:1.258)的感染几率更高:结论:未接受化疗或手术治疗的老年未婚男性 GAC 患者因感染导致死亡的风险较高,在接受治疗时应给予特别关注。
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引用次数: 0
Analysis of Efficacy and Safety of Laparoscopy Plus Choledochoscopy Combined With Holmium Laser Lithotripsy for Choledocholithiasis and Hepatolithiasis. 腹腔镜加胆道镜联合钬激光碎石术治疗胆总管结石和肝结石的有效性和安全性分析
IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-06-01 Epub Date: 2024-06-29 DOI: 10.14740/gr1710
Hui Li, Qun Feng Zhong, Qiong Rong Liu, Qiang Wu, Wen Zhang, Guo Pei Luo

Background: With the advancement of laparoscopic technology, the combination of laparoscopy, choledochoscopy, and holmium laser lithotripsy has emerged as an effective treatment modality for both choledocholithiasis and hepatolithiasis. This study aimed to assess the efficacy and safety of this approach.

Methods: Retrospective analysis was conducted on the medical records of 76 patients diagnosed with choledocholithiasis and hepatolithiasis between April 2021 and March 2023. Patients were divided into two groups based on the treatment plan: the control group, which underwent traditional laparotomy and choledochoscopy lithotripsy (n = 38), and the experimental group, which underwent laparoscopy combined with choledochoscopy and holmium laser lithotripsy (n = 38). Comparative analysis was performed on various operation-related parameters, stone-free rate, complication rates, and changes in biochemical, liver function, inflammatory, stress response indicators, and pain scores between the two groups.

Results: The experimental group demonstrated significantly shorter stone removal time, reduced intraoperative bleeding, and shorter hospital stay compared to the control group (P < 0.05). Moreover, the experimental group exhibited lower incidence of postoperative complications and lower pain scores at 2 weeks to 3 months post-operation (P < 0.05). Biochemical indicators including total bile acid (TBA), total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and glutamyl transpeptidase (GGT) were significantly lower in the observation group compared to the control group (P < 0.05). Additionally, stress and inflammation indicators were also lower in the experimental group (P < 0.05).

Conclusions: The combination of laparoscopy, choledochoscopy, and holmium laser lithotripsy presents favorable therapeutic outcomes in the management of choledocholithiasis and hepatolithiasis, indicating its potential for widespread clinical application.

背景:随着腹腔镜技术的发展,腹腔镜、胆道镜和钬激光碎石术的联合应用已成为治疗胆总管结石和肝结石的有效方法。本研究旨在评估这种方法的有效性和安全性:对 2021 年 4 月至 2023 年 3 月期间确诊的 76 例胆总管结石和肝结石患者的病历进行回顾性分析。根据治疗方案将患者分为两组:对照组,接受传统开腹手术和胆道镜碎石术(38 人);实验组,接受腹腔镜联合胆道镜和钬激光碎石术(38 人)。对两组的各种手术相关参数、无结石率、并发症发生率以及生化指标、肝功能指标、炎症指标、应激反应指标和疼痛评分的变化进行了比较分析:结果:与对照组相比,实验组结石取出时间明显缩短,术中出血减少,住院时间缩短(P < 0.05)。此外,实验组的术后并发症发生率较低,术后 2 周至 3 个月的疼痛评分也较低(P < 0.05)。与对照组相比,观察组的总胆汁酸(TBA)、总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)和谷氨酰转肽酶(GGT)等生化指标明显降低(P < 0.05)。此外,实验组的应激和炎症指标也较低(P < 0.05):结论:腹腔镜、胆道镜和钬激光碎石术的联合应用在胆总管结石和肝结石的治疗中取得了良好的疗效,表明其具有广泛的临床应用潜力。
{"title":"Analysis of Efficacy and Safety of Laparoscopy Plus Choledochoscopy Combined With Holmium Laser Lithotripsy for Choledocholithiasis and Hepatolithiasis.","authors":"Hui Li, Qun Feng Zhong, Qiong Rong Liu, Qiang Wu, Wen Zhang, Guo Pei Luo","doi":"10.14740/gr1710","DOIUrl":"10.14740/gr1710","url":null,"abstract":"<p><strong>Background: </strong>With the advancement of laparoscopic technology, the combination of laparoscopy, choledochoscopy, and holmium laser lithotripsy has emerged as an effective treatment modality for both choledocholithiasis and hepatolithiasis. This study aimed to assess the efficacy and safety of this approach.</p><p><strong>Methods: </strong>Retrospective analysis was conducted on the medical records of 76 patients diagnosed with choledocholithiasis and hepatolithiasis between April 2021 and March 2023. Patients were divided into two groups based on the treatment plan: the control group, which underwent traditional laparotomy and choledochoscopy lithotripsy (n = 38), and the experimental group, which underwent laparoscopy combined with choledochoscopy and holmium laser lithotripsy (n = 38). Comparative analysis was performed on various operation-related parameters, stone-free rate, complication rates, and changes in biochemical, liver function, inflammatory, stress response indicators, and pain scores between the two groups.</p><p><strong>Results: </strong>The experimental group demonstrated significantly shorter stone removal time, reduced intraoperative bleeding, and shorter hospital stay compared to the control group (P < 0.05). Moreover, the experimental group exhibited lower incidence of postoperative complications and lower pain scores at 2 weeks to 3 months post-operation (P < 0.05). Biochemical indicators including total bile acid (TBA), total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and glutamyl transpeptidase (GGT) were significantly lower in the observation group compared to the control group (P < 0.05). Additionally, stress and inflammation indicators were also lower in the experimental group (P < 0.05).</p><p><strong>Conclusions: </strong>The combination of laparoscopy, choledochoscopy, and holmium laser lithotripsy presents favorable therapeutic outcomes in the management of choledocholithiasis and hepatolithiasis, indicating its potential for widespread clinical application.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11236342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association of Baseline Hepatitis B Virus DNA and On-Treatment Risk of Cirrhosis and Hepatocellular Carcinoma. 乙型肝炎病毒 DNA 基线与肝硬化和肝细胞癌治疗风险的关系。
IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-06-01 Epub Date: 2024-06-29 DOI: 10.14740/gr1735
Zeyuan Yang, Ramsey C Cheung, Janice H Jou, Joseph K Lim, Young-Suk Lim, Robert J Wong

Background: Recent studies suggest an inverse relationship between baseline levels of hepatitis B virus (HBV) DNA and on-treatment risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). However, data are limited to Asian cohorts, and it is unclear if similar associations hold true for non-Asians with CHB. We aimed to evaluate association of baseline HBV DNA with long-term risks of cirrhosis and HCC among a predominantly non-Asian cohort of CHB patients in the USA.

Methods: Using longitudinal data from the national Veterans Affairs database, we evaluated the risk of cirrhosis or HCC among adults with non-cirrhotic CHB who are on continuous antiviral therapy, stratified by moderate levels of baseline HBV DNA (4.00 - 6.99 log10 IU/mL) vs. high levels of baseline HBV DNA (7.00 log10 IU/mL or higher). Propensity score weighting was applied, and competing risks cumulative incidence functions and Cox proportional hazards models were utilized.

Results: Among 1,129 non-cirrhotic CHB patients (41% non-Hispanic White, 36% African American, mean age 57.0 years, 62.2% hepatitis B e antigen (HBeAg) positive), 585 had moderate levels of baseline HBV DNA and 544 had high HBV DNA. After propensity score weighting, no significant difference in risk of cirrhosis was observed between moderate vs. high baseline HBV DNA (4.55 vs. 5.22 per 100 person-years, hazard ratio (HR): 0.87, 95% confidence interval (CI): 0.69 - 1.09, P = 0.22), but risk of HCC was significantly higher in patients with moderate vs. high baseline HBV DNA (0.84 vs. 0.69 per 100 person-years, HR: 1.33, 95% CI: 1.09 - 1.62, P < 0.01).

Conclusions: Among a national cohort of predominantly non-Asian US veterans with non-cirrhotic CHB on antiviral therapy, moderate levels of baseline HBV DNA was associated with higher risk of HCC than high HBV DNA.

背景:最近的研究表明,慢性乙型肝炎(CHB)患者的乙型肝炎病毒(HBV)DNA基线水平与治疗后肝细胞癌(HCC)风险之间存在反比关系。然而,这些数据仅限于亚洲队列,尚不清楚非亚洲的慢性乙型肝炎患者是否也存在类似的关联。我们的目的是评估基线 HBV DNA 与美国主要非亚洲 CHB 患者队列中肝硬化和 HCC 长期风险的关系:利用全国退伍军人事务数据库的纵向数据,我们评估了正在接受持续抗病毒治疗的非肝硬化CHB成人患者的肝硬化或HCC风险,并按基线HBV DNA中等水平(4.00 - 6.99 log10 IU/mL)与基线HBV DNA高水平(7.00 log10 IU/mL或更高)进行了分层。该研究采用了倾向得分加权法,并使用了竞争风险累积发病率函数和 Cox 比例危险度模型:在1129名非肝硬化CHB患者中(41%为非西班牙裔白人,36%为非裔美国人,平均年龄57.0岁,62.2%乙肝e抗原(HBeAg)阳性),585人的基线HBV DNA水平为中度,544人的HBV DNA水平为高度。经过倾向评分加权后,中等基线 HBV DNA 与高基线 HBV DNA 的肝硬化风险无明显差异(每 100 人年 4.55 例与 5.22 例,危险比 (HR):0.87,95% 置信区间 (CI):0.69-1.09,P = 0.22),但中度基线 HBV DNA 患者与高度基线 HBV DNA 患者相比,HCC 风险明显更高(0.84 vs. 0.69 per 100 person-years,HR:1.33,95% CI:1.09-1.62,P <0.01):在一个主要由非亚裔美国退伍军人组成、正在接受抗病毒治疗的非肝硬化慢性乙型肝炎患者的全国队列中,与高 HBV DNA 相比,中度基线 HBV DNA 与更高的 HCC 风险相关。
{"title":"Association of Baseline Hepatitis B Virus DNA and On-Treatment Risk of Cirrhosis and Hepatocellular Carcinoma.","authors":"Zeyuan Yang, Ramsey C Cheung, Janice H Jou, Joseph K Lim, Young-Suk Lim, Robert J Wong","doi":"10.14740/gr1735","DOIUrl":"10.14740/gr1735","url":null,"abstract":"<p><strong>Background: </strong>Recent studies suggest an inverse relationship between baseline levels of hepatitis B virus (HBV) DNA and on-treatment risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). However, data are limited to Asian cohorts, and it is unclear if similar associations hold true for non-Asians with CHB. We aimed to evaluate association of baseline HBV DNA with long-term risks of cirrhosis and HCC among a predominantly non-Asian cohort of CHB patients in the USA.</p><p><strong>Methods: </strong>Using longitudinal data from the national Veterans Affairs database, we evaluated the risk of cirrhosis or HCC among adults with non-cirrhotic CHB who are on continuous antiviral therapy, stratified by moderate levels of baseline HBV DNA (4.00 - 6.99 log<sub>10</sub> IU/mL) vs. high levels of baseline HBV DNA (7.00 log<sub>10</sub> IU/mL or higher). Propensity score weighting was applied, and competing risks cumulative incidence functions and Cox proportional hazards models were utilized.</p><p><strong>Results: </strong>Among 1,129 non-cirrhotic CHB patients (41% non-Hispanic White, 36% African American, mean age 57.0 years, 62.2% hepatitis B e antigen (HBeAg) positive), 585 had moderate levels of baseline HBV DNA and 544 had high HBV DNA. After propensity score weighting, no significant difference in risk of cirrhosis was observed between moderate vs. high baseline HBV DNA (4.55 vs. 5.22 per 100 person-years, hazard ratio (HR): 0.87, 95% confidence interval (CI): 0.69 - 1.09, P = 0.22), but risk of HCC was significantly higher in patients with moderate vs. high baseline HBV DNA (0.84 vs. 0.69 per 100 person-years, HR: 1.33, 95% CI: 1.09 - 1.62, P < 0.01).</p><p><strong>Conclusions: </strong>Among a national cohort of predominantly non-Asian US veterans with non-cirrhotic CHB on antiviral therapy, moderate levels of baseline HBV DNA was associated with higher risk of HCC than high HBV DNA.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11236339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Influence of Urbanization on the Patterns of Hepatocellular Carcinoma Mortality From 1999 to 2020. 城市化对 1999 年至 2020 年肝细胞癌死亡率模式的影响。
IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-06-01 Epub Date: 2024-06-29 DOI: 10.14740/gr1743
Alexander Kusnik, Mostafa Najim, Keerthi Mannumbeth Renjith, Charmee Vyas, Sarath Lal Mannumbeth Renjithlal, Richard Alweis

Background: Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related fatalities despite early diagnosis and treatment progress, creating a significant public health issue in the United States. This investigation utilized death certificate data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database to investigate HCC mortality patterns and death locations from 1999 to 2020. The objective was to analyze trends in HCC mortality across different population groups, considering the impact of urbanicity.

Methods: In this study, death certificate data obtained from the CDC WONDER database were utilized to investigate the trends in HCC mortality and location of death between 1999 and 2020. The annual percent change (APC) method was applied to estimate the average annual rate of change during the specified timeframe for the relevant health outcome. Furthermore, including data on the location of death and geographic areas allowed us to gain deeper insights into the patterns and characteristics of HCC and its impact on different regions.

Results: Between 1999 and 2020, there were 184,073 reported deaths attributed to HCC, and data on the location of death were available for all cases. Most deaths occurred during inpatient admissions (34.93%) or at home (41.19%). The study also found that the highest age-adjusted mortality rate (AAMR) for HCC was observed among male patients, particularly among those identified as Asian or Pacific Islander. Variations in AAMR were determined based on the level of urbanization or rurality of the area, with higher rates observed in more densely populated and urbanized regions. In contrast, less urbanized and populated areas experienced a profound increase in AAMR over the past two decades.

Conclusion: The HCC-related AAMRs have worsened over time for most ethnic groups, except for Asian or Pacific Islanders, which showed a reduction in APC despite having the worst AAMR. Although rural and less densely populated areas have substantially increased AAMR over the past two decades, more urbanized areas continued to have higher AAMR rates.

背景:尽管早期诊断和治疗取得了进展,但肝细胞癌(HCC)仍然是导致癌症相关死亡的主要原因之一,在美国造成了重大的公共卫生问题。这项调查利用美国疾病控制和预防中心流行病学研究广泛在线数据(CDC WONDER)数据库中的死亡证明数据,调查了 1999 年至 2020 年期间 HCC 的死亡模式和死亡地点。目的是分析不同人群的 HCC 死亡率趋势,同时考虑城市化的影响:本研究利用疾控中心 WONDER 数据库中的死亡证明数据,调查了 1999 年至 2020 年间 HCC 死亡率和死亡地点的趋势。采用年度百分比变化(APC)法来估算相关健康结果在特定时间段内的年均变化率。此外,包括死亡地点和地理区域的数据使我们能够更深入地了解 HCC 的模式和特征及其对不同地区的影响:1999 年至 2020 年间,共报告了 184,073 例死于 HCC 的病例,所有病例的死亡地点数据均可获得。大多数死亡发生在住院期间(34.93%)或家中(41.19%)。研究还发现,男性患者的 HCC 年龄调整死亡率(AAMR)最高,尤其是那些被确认为亚洲人或太平洋岛民的患者。年龄调整死亡率的变化取决于该地区的城市化或乡村化水平,在人口更稠密和城市化程度更高的地区观察到的死亡率更高。与此相反,城市化程度较低和人口较少的地区在过去二十年中的急性乳腺癌死亡率大幅上升:结论:随着时间的推移,大多数种族群体的 HCC 相关 AAMR 都在恶化,但亚裔或太平洋岛民除外,尽管他们的 AAMR 最差,但 APC 却有所下降。尽管农村和人口密度较低的地区在过去二十年中AAMR大幅增加,但城市化程度较高的地区AAMR率仍然较高。
{"title":"The Influence of Urbanization on the Patterns of Hepatocellular Carcinoma Mortality From 1999 to 2020.","authors":"Alexander Kusnik, Mostafa Najim, Keerthi Mannumbeth Renjith, Charmee Vyas, Sarath Lal Mannumbeth Renjithlal, Richard Alweis","doi":"10.14740/gr1743","DOIUrl":"10.14740/gr1743","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related fatalities despite early diagnosis and treatment progress, creating a significant public health issue in the United States. This investigation utilized death certificate data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database to investigate HCC mortality patterns and death locations from 1999 to 2020. The objective was to analyze trends in HCC mortality across different population groups, considering the impact of urbanicity.</p><p><strong>Methods: </strong>In this study, death certificate data obtained from the CDC WONDER database were utilized to investigate the trends in HCC mortality and location of death between 1999 and 2020. The annual percent change (APC) method was applied to estimate the average annual rate of change during the specified timeframe for the relevant health outcome. Furthermore, including data on the location of death and geographic areas allowed us to gain deeper insights into the patterns and characteristics of HCC and its impact on different regions.</p><p><strong>Results: </strong>Between 1999 and 2020, there were 184,073 reported deaths attributed to HCC, and data on the location of death were available for all cases. Most deaths occurred during inpatient admissions (34.93%) or at home (41.19%). The study also found that the highest age-adjusted mortality rate (AAMR) for HCC was observed among male patients, particularly among those identified as Asian or Pacific Islander. Variations in AAMR were determined based on the level of urbanization or rurality of the area, with higher rates observed in more densely populated and urbanized regions. In contrast, less urbanized and populated areas experienced a profound increase in AAMR over the past two decades.</p><p><strong>Conclusion: </strong>The HCC-related AAMRs have worsened over time for most ethnic groups, except for Asian or Pacific Islanders, which showed a reduction in APC despite having the worst AAMR. Although rural and less densely populated areas have substantially increased AAMR over the past two decades, more urbanized areas continued to have higher AAMR rates.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11236338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Gastroenterology Research
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