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A Real-World Experience on a Chinese Population of Patients With Unresectable Hepatocellular Carcinoma Treated With Nivolumab. 中国不可切除肝细胞癌患者接受 Nivolumab 治疗的真实世界经验。
IF 1.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-01 Epub Date: 2024-02-28 DOI: 10.14740/gr1684
Shou-Wu Lee, Sheng-Shun Yang, Teng-Yu Lee

Background: For unresectable hepatocellular carcinoma (HCC), nivolumab (anti-programmed death receptor-1 (PD-1)) is used as non-curative interventions. The aim of the study was to focus on the real-world experience of nivolumab applied to patients with HCC.

Methods: Unresectable HCC patients receiving nivolumab treatments at Taichung Veterans General Hospital, from June 2018 to May 2020, were recruited. Exclusion criteria were Child-Pugh stage C, poor performance status, a lack of compliance or intolerable to drug treatments. The tumor radiological responses and survival outcomes of enrolled patients were collected and analyzed.

Results: Among a total of 57 patients, most of them were classified as Child-Pugh stage A (70.2%) and Barcelona Clinic Liver Cancer (BCLC) stage C (66.7%). Nivolumab was given to 14 (24.6%) as the primary-line, and 43 patients (75.4%) as the secondary-line systemic treatments. The mean therapeutic duration was 6.5 months. Objective response rate (ORR) was 24.6%, and disease control rate (DCR) was 42.1%. The overall median progression-free survival (PFS) was 5.8 months (95% confidence interval (CI): 1.1 - 10.6), and overall survival (OS) was 11.5 months (95% CI: 4.3 - 17.8). Immune-related adverse event (IRAE) was 8.8%. Presence of alpha-fetoprotein (AFP) response (a decline in AFP ≥ 10% from baseline) during therapy predicted the tumor radiological response (to objective response: hazard ratio (HR): 4.89, 95% CI: 1.14 - 21.00; to disease control: HR: 4.71, 95% CI: 1.32 - 16.81). Those with tumor radiological responses showed longer PFS and OS.

Conclusions: Decline in AFP during therapy has a predicting role on HCC radiological responses to nivolumab. Achieving radiological responses had better survival outcomes.

背景:对于无法切除的肝细胞癌(HCC),nivolumab(抗程序性死亡受体-1(PD-1))被用作非根治性干预药物。本研究的目的是关注nivolumab在HCC患者中应用的实际经验:招募2018年6月至2020年5月期间在台中荣民总医院接受nivolumab治疗的无法切除的HCC患者。排除标准为Child-Pugh C期、表现状态不佳、缺乏依从性或不能耐受药物治疗。收集并分析入组患者的肿瘤放射学反应和生存结果:结果:在57名患者中,大部分患者属于Child-Pugh A期(70.2%)和巴塞罗那临床肝癌(BCLC)C期(66.7%)。14名患者(24.6%)接受了Nivolumab作为一线治疗,43名患者(75.4%)接受了二线系统治疗。平均疗程为6.5个月。客观反应率(ORR)为24.6%,疾病控制率(DCR)为42.1%。中位无进展生存期(PFS)为5.8个月(95% 置信区间(CI):1.1 - 10.6),总生存期(OS)为11.5个月(95% CI:4.3 - 17.8)。免疫相关不良事件(IRAE)为8.8%。治疗期间出现甲胎蛋白(AFP)反应(AFP从基线下降≥10%)可预测肿瘤放射学反应(客观反应:危险比(HR):4.89,95% CI:1.14 - 21.00;疾病控制:HR:4.71,95% CI:1.32 - 16.81)。肿瘤放射学反应患者的PFS和OS时间更长:结论:治疗期间甲胎蛋白的下降可预测HCC对nivolumab的放射学反应。结论:治疗期间甲胎蛋白的下降对HCC对尼伐单抗的放射学反应有预测作用,获得放射学反应的患者生存期更长。
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引用次数: 0
Primary Non-Function of Hepatic Allograft With Preexisting Microvesicular Steatosis/Foamy Degeneration and Mild Large-Droplet Macrovesicular Steatosis. 肝脏异体移植物原发性无功能,伴有原有的微泡性脂肪变性/泡沫变性和轻度大滴大泡性脂肪变性。
IF 1.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-01 Epub Date: 2024-02-28 DOI: 10.14740/gr1687
Melissa E Limia, Xiu Li Liu, Jennifer Yu, Kathleen Byrnes

It has been established that more than mild large-droplet macrovesicular steatosis (LD-MAS) is associated with increased risk of graft non-function. In contrast, even severe small-droplet macrovesicular steatosis (SD-MAS) has been found to be less prognostically significant. It remains unclear if a donor liver with diffuse microvesicular steatosis is associated with an increased risk of graft dysfunction. A 56-year-old male with alcoholic cirrhosis was transplanted with a liver from a 42-year-old overweight male donor after brain death. The frozen section of the donor liver biopsy taken at harvest showed diffusely enlarged clear/foamy hepatocytes and mild LD-MAS (about 5-10% of total tissue). The reperfusion liver biopsy taken at time 0 of transplantation showed hemorrhage, pale and enlarged hepatocytes, and mild LD-MAS (about 10% of total tissue) with lipopeliosis. The graft became non-functional, and the patient was re-transplanted 24 h after the initial transplantation. Histologic examination of the failed liver allograft showed extensive hemorrhagic necrosis, neutrophilic inflammation, diffuse microvesicular steatosis, and large extracellular fat droplets (about 20% of total tissue). This case demonstrates that precautions are needed to avoid using livers with diffuse and severe microvesicular steatosis.

已经证实,轻度以上的大液滴大泡性脂肪变性(LD-MAS)与移植物无功能的风险增加有关。相比之下,即使是严重的小液滴大泡性脂肪变性(SD-MAS)对预后的影响也较小。目前还不清楚弥漫性小泡脂肪变性的供肝是否会增加移植物功能障碍的风险。一名患有酒精性肝硬化的 56 岁男性在脑死亡后移植了来自一名 42 岁超重男性供体的肝脏。采集供体肝脏活检的冰冻切片显示,透明/泡沫状肝细胞弥漫性增大,轻度LD-MAS(约占组织总量的5-10%)。在移植第0时间进行的再灌注肝脏活检显示出血、肝细胞苍白和增大、轻度LD-MAS(约占组织总量的10%)和脂质沉着。移植肝失去功能,患者在首次移植 24 小时后再次接受移植。对失败的肝脏异体移植组织学检查显示出广泛的出血坏死、中性粒细胞炎症、弥漫性微囊性脂肪变性和大量细胞外脂肪滴(约占组织总量的20%)。该病例表明,需要采取预防措施,避免使用弥漫性严重微囊脂肪变性的肝脏。
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引用次数: 0
Pre- and Post-Implant Endoscopy in Left Ventricular Assist Device Recipients: A Single-Center Experience. 左心室辅助装置受术者植入前后的内窥镜检查:单中心经验。
IF 1.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-02-01 Epub Date: 2024-02-28 DOI: 10.14740/gr1661
Wael T Mohamed, Vinay Jahagirdar, Fouad Jaber, Mohamed K Ahmed, Hassan M Ghoz, Brett W Sperry, Wendell K Clarkston

Background: Gastrointestinal bleeding (GIB) is common in left ventricular assist devices (LVADs) patients, but the optimal screening approach before LVAD implantation is still unclear. The aim of the study was to describe our experience with pre- and post-LVAD implantation endoscopic screening and subsequent GI bleeding in this cohort.

Methods: A retrospective review was conducted among all patients who underwent LVAD implantation at Saint Luke's Hospital, between 2010 and 2020. The data were reviewed to determine the yield and safety of endoscopic procedures performed within 1 month before LVAD placement and the incidence of GIB within 1 year after implantation.

Results: A total of 167 LVAD patients met the inclusion criteria, and 23 underwent pre-implantation endoscopic evaluation. Angiodysplasia had a significantly higher odds ratio (OR) of 9.41 (95% confidence interval (CI): 2.01 - 44.09) in post-LVAD endoscopy, while there was no significant difference in bleeding from other sources such as peptic ulcer disease or diverticular bleeding. There was no difference in the incidence of GIB in patients who underwent endoscopic evaluation pre-LVAD compared to post-LVAD GIB (32.6% vs. 39.1%, P = 0.64). Endoscopy was well-tolerated in this cohort, and argon plasma coagulation was the most commonly used intervention to achieve hemostasis.

Conclusions: According to our results, we recommend against routine pre-LVAD endoscopic screening. Instead, we suggest an individualized approach, where decisions are made on a case-by-case basis.

背景:胃肠道出血(GIB)在左心室辅助装置(LVAD)患者中很常见,但 LVAD 植入前的最佳筛查方法仍不明确。本研究旨在描述我们在 LVAD 植入前后进行内镜筛查的经验以及该人群随后发生消化道出血的情况:方法:我们对 2010 年至 2020 年期间在圣卢克医院接受 LVAD 植入术的所有患者进行了回顾性研究。方法:对 2010 年至 2020 年期间在圣路加医院接受 LVAD 植入术的所有患者进行回顾性研究,以确定 LVAD 植入术前 1 个月内进行内窥镜手术的收益率和安全性,以及植入术后 1 年内 GIB 的发生率:共有 167 名 LVAD 患者符合纳入标准,其中 23 人接受了植入前内镜评估。在LVAD植入后的内镜检查中,血管增生症的几率比(OR)明显较高,为9.41(95%置信区间(CI):2.01 - 44.09),而消化性溃疡病或憩室出血等其他原因引起的出血则无明显差异。在LVAD前接受内镜评估的患者中,GIB的发生率与LVAD后GIB的发生率相比没有差异(32.6% vs. 39.1%,P = 0.64)。该组患者对内镜检查的耐受性良好,氩等离子体凝固是最常用的止血干预措施:根据我们的研究结果,我们建议不要进行常规的 LVAD 术前内镜筛查。结论:根据我们的研究结果,我们建议不要进行常规的 LVAD 术前内镜筛查,而应采取个体化的方法,根据具体情况做出决定。
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引用次数: 0
Serum Activin A Is a Novel Biomarker of Endoscopic Activity in Ulcerative Colitis 血清活化素 A 是溃疡性结肠炎内镜活动的新型生物标记物
IF 1.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-12-01 DOI: 10.14740/gr1677
Ryohei Ogihara, Hiroki Kurumi, Tsutomu Kanda, Kazuo Yashima, Hajime Isomoto, N. Yamaguchi
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引用次数: 0
Comparing the Efficacy and Safety of Adalimumab and Vedolizumab in Treating Moderate to Severe Crohn’s Disease and Ulcerative Colitis 比较阿达木单抗和维多珠单抗治疗中重度克罗恩病和溃疡性结肠炎的疗效和安全性
IF 1.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-12-01 DOI: 10.14740/gr1664
Nooraldin Merza, Yusuf Nawras, Omar Saab, D. Dahiya, Zohaib Ahmed, Meghana Ranabothu, Safa Boujemaa, Mona Hassan, Abdallah A. Kobeissy, Kirthi Lilley
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引用次数: 0
Identifying Key Genes to the Early Diagnosis of Inflammatory Bowel Disease by Integrating Analysis at the Blood and Tissue Levels 通过整合血液和组织水平的分析鉴定炎症性肠病早期诊断的关键基因
IF 1.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-12-01 DOI: 10.14740/gr1683
Xin Yu Wang, Dan Zhang
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引用次数: 0
Timing and Outcomes of Percutaneous Endoscopic Gastrostomy After Ischemic Stroke 缺血性脑卒中后经皮内镜胃造瘘术的时机和疗效
IF 1.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-12-01 DOI: 10.14740/gr1653
Shoma Bommena, Pooja Rangan, Joyce lee-Iannotti, W. Wassef, Rakesh Nanda
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引用次数: 0
Marital Status Is a Prognostic Factor for Cardiovascular Mortality but Not a Prognostic Factor for Cancer Mortality in Siewert Type II Adenocarcinoma of the Esophagogastric Junction 婚姻状况是食管胃交界处 Siewert II 型腺癌心血管死亡率的预后因素,但不是癌症死亡率的预后因素
IF 1.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-12-01 DOI: 10.14740/gr1670
Zhong Qiang Zheng, Xuan Zi Sun
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引用次数: 0
The Impact of COVID-19 on Outcomes of Ischemic Colitis: A Nationwide Retrospective Analysis. 新冠肺炎对缺血性结肠炎预后的影响:全国回顾性分析。
IF 1.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-01 Epub Date: 2023-10-21 DOI: 10.14740/gr1660
Humzah Iqbal, Rakahn Haddadin, Patrick Zhang, Hasib Haidary, Devang Prajapati

Background: Ischemic colitis is the most common presentation of mesenteric ischemia and is associated with significant morbidity and mortality. Coagulopathy has been associated with the development of ischemic colitis. Coronavirus disease 2019 (COVID-19) infection can lead to a variety of pathology and physiological derangements, including coagulopathy. Some case reports have described severe ischemic colitis in patients with COVID-19 infection. Our study aimed to elucidate the impact of COVID-19 infection on ischemic colitis outcomes.

Methods: Patients with a diagnosis of ischemic colitis were identified using the 2020 Nationwide Inpatient Sample (NIS). Patients were stratified based on the presence of COVID-19 infection. Data were collected regarding mortality, shock, blood transfusion, length of stay, hospital charges, age, gender, race, primary insurance, median income, hospital region, hospital bed size, and comorbidities. The relationship between COVID-19 and outcomes was analyzed using multivariate regression analysis.

Results: A total of 67,685 patients were included in the final analysis. COVID-19 was associated with an increased risk of in-hospital mortality (adjusted odds ratio (aOR): 4.006, P < 0.001), shock (aOR: 1.62, P = 0.002), and blood transfusion (aOR: 1.49, P = 0.007). COVID-19 was also associated with an increased length of stay (16.2 days vs. 8.7 days) and higher total hospital charges ($268,884.1 vs. $145,805.9).

Conclusions: Among hospitalized patients with ischemic colitis, COVID-19 infection was associated with worse outcomes and higher resource utilization. Further studies are needed to investigate the mechanisms underlying this association.

背景:缺血性结肠炎是肠系膜缺血最常见的表现,与显著的发病率和死亡率有关。凝血障碍与缺血性结肠炎的发展有关。2019冠状病毒病(新冠肺炎)感染可导致多种病理和生理紊乱,包括凝血障碍。一些病例报告描述了新冠肺炎感染患者的严重缺血性结肠炎。我们的研究旨在阐明新冠肺炎感染对缺血性结肠炎结果的影响。方法:使用2020年全国住院患者样本(NIS)确定诊断为缺血性结肠炎的患者。根据新冠肺炎感染情况对患者进行分层。收集了有关死亡率、休克、输血、住院时间、住院费用、年龄、性别、种族、初级保险、收入中位数、住院地区、病床面积和合并症的数据。使用多变量回归分析分析新冠肺炎与结果之间的关系。结果:共有67685名患者被纳入最终分析。新冠肺炎与住院死亡率(调整比值比(aOR):4.006,P<0.001)、休克(aOR:1.62,P=0.002)、,和输血(aOR:1.49,P=0.007)。新冠肺炎还与住院时间增加(16.2天对8.7天)和总住院费用增加(268884.1美元对145805.9美元)有关。需要进一步的研究来研究这种关联的机制。
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引用次数: 0
COVID-19 Outcomes in Inflammatory Bowel Disease Hospitalized Patients: A Comprehensive Analysis Using the National Inpatient Sample. 炎症性肠病住院患者的新冠肺炎结局:使用全国住院患者样本的综合分析。
IF 1.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-01 Epub Date: 2023-10-21 DOI: 10.14740/gr1657
Justin M Joseph, Anum Akhlaq, Rehmat Ullah Awan, Saleha Aziz, Moon Ryu, Asif Farooq, Karthik Gangu, Ehizogie Edigin, Abu Baker Sheikh

Background: There is no uniformity in the available literature concerning the effects of coronavirus disease 2019 (COVID-19) viral illness on people with inflammatory bowel disease (IBD).

Methods: We conducted an analysis using the 2020 National Inpatient Sample (NIS) database to compare the outcomes of COVID-19 hospitalized patients with and without IBD.

Results: Of 1,050,040 patients admitted with COVID-19, 5,750 (0.5%) also had IBD. The group with COVID-19 and IBD had higher percentages of females and White individuals and a greater prevalence of chronic lung disease, peripheral vascular disease, and liver disease. However, after accounting for confounding variables, there was no significant difference in mortality rates, length of hospital stays, or hospitalization costs between the two groups.

Conclusion: According to our findings, the presence of IBD does not appear to elevate the risk of COVID-19 complications.

背景:关于2019冠状病毒病(新冠肺炎)病毒性疾病对炎症性肠病(IBD)患者的影响的现有文献并不一致新冠肺炎患者中也有5750人(0.5%)患有IBD。新冠肺炎和IBD患者中女性和白人的比例较高,慢性肺病、外周血管病和肝病的患病率较高。然而,在考虑了混杂变量后,两组之间的死亡率、住院时间或住院费用没有显著差异。结论:根据我们的研究结果,IBD的存在似乎不会增加新冠肺炎并发症的风险。
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引用次数: 0
期刊
Gastroenterology Research
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