Journal of Clinical and Experimental Hepatology最新文献

{"title":"Bile Duct Paucity in a Case of Neonatal Intrahepatic Cholestasis Due to Citrin Deficiency: Finding the Missing Piece of the Puzzle!","authors":"Upasana Ghosh, Ankit Agrawal, Varunvenkat M. Srinivasan, Rani Manisha, Vikas Jain, Umesh Shukla","doi":"10.1016/j.jceh.2025.103122","DOIUrl":"10.1016/j.jceh.2025.103122","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 103122"},"PeriodicalIF":3.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Tiny Acorns do Mighty Oaks Grow!","authors":"Vivek A. Saraswat","doi":"10.1016/j.jceh.2025.103180","DOIUrl":"10.1016/j.jceh.2025.103180","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 103180"},"PeriodicalIF":3.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Hepatic Leiomyosarcoma: A Case Series Highlighting a Rare Malignancy","authors":"Divya Khosla ,&nbsp;Treshita Dey ,&nbsp;Rakesh Kapoor ,&nbsp;Suvradeep Mitra ,&nbsp;Divyesh Kumar ,&nbsp;Shikha Goyal ,&nbsp;Renu Madan ,&nbsp;Kimavat Hemanth Kumar ,&nbsp;Rajesh Gupta","doi":"10.1016/j.jceh.2025.102602","DOIUrl":"10.1016/j.jceh.2025.102602","url":null,"abstract":"<div><h3>Objectives</h3><div>Primary hepatic leiomyosarcoma (PHLMS) is an exceedingly rare malignant tumor originating from the liver with only a handful of cases reported in literature. Herein, we present five cases of PHLMS diagnosed and managed at our institute.</div></div><div><h3>Results</h3><div>The patients presented with non-specific symptoms, e.g., abdominal pain, lump, jaundice, etc., and imaging showed a space-occupying lesion in the liver. Hence, histopathological examination plays a pivotal role in diagnosis, revealing characteristic features of spindle-shaped cells arranged in fascicles or bundles with high mitotic rate and varying degrees of necrosis. Only 1 out of 5 patients underwent surgery. The remaining patients were planned with either palliative chemotherapy or best supportive care based on their performance status. The prognosis is however poor in such patients.</div></div><div><h3>Conclusion</h3><div>Despite aggressive management, prognosis of PHLMS remains guarded. Surgical resection is the backbone of a radical treatment. This case series presents a rare entity providing insights into the diagnosis, management, and prognosis of the patients with PHLMS.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102602"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the GALAD, GAAP, and ASAP Scores for Hepatocellular Carcinoma Detection in Patients With Chronic Liver Diseases","authors":"Kessarin Thanapirom ,&nbsp;Sirinporn Suksawatamnuay ,&nbsp;Panarat Thaimai ,&nbsp;Nipaporn Siripon ,&nbsp;Nopavut Geratikornsupuk ,&nbsp;Sombat Treeprasertsuk ,&nbsp;Piyawat Komolmit","doi":"10.1016/j.jceh.2025.102607","DOIUrl":"10.1016/j.jceh.2025.102607","url":null,"abstract":"<div><h3>Background</h3><div>Developing biomarker panels for early hepatocellular carcinoma (HCC) detection is crucial to overcome the limitations of current imaging-based surveillance strategies. The GALAD, GAAP, and ASAP scores are well-established algorithms for estimating the risk of HCC based on gender, age, alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-II, and AFP-L3. This study aimed to evaluate the diagnostic performance of these biomarkers and models in detecting HCC in patients with chronic liver diseases (CLDs).</div></div><div><h3>Methods</h3><div>The study enrolled 529 patients, comprising 193 with HCC, 223 with chronic hepatitis, and 113 with cirrhosis. HCC was diagnosed based on the standard imaging criteria. The diagnostic performance of the GALAD, GAAP, and ASAP models, along with individual biomarkers, was assessed using the area under the receiver operating characteristic curve (AUC) to identify HCC in patients with various etiologies of CLDs.</div></div><div><h3>Results</h3><div>The GALAD, GAAP, and ASAP models showed better AUCs (0.876–0.889) in detecting any stage of HCC in patients with CLD than individual biomarkers (0.741–0.842). These models also exhibited improved accuracy for early HCC detection (0.825–0.889) compared with individual biomarkers (0.654–0.710). The GAAP score achieved the best accuracy in detecting early HCC in patients with CLD. Furthermore, the GAAP and ASAP models performed best in identifying all-stage HCC in patients with viral hepatitis, while GAAP and GALAD scores were most effective in those with nonviral etiologies. The optimal cutoff values for detecting HCC were GALAD &gt;0.13, GAAP &gt; −0.64, and ASAP &gt; −0.71, all with sensitivities and specificities above 80%.</div></div><div><h3>Conclusions</h3><div>The GAAP model demonstrated excellent discriminatory ability between HCC and CLD in both viral and nonviral subgroups and outperformed other models in detecting early-stage HCC.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102607"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor on “Risk of Liver Fibrosis in Patients With Psoriasis on Long-term Methotrexate: Role of Cumulative Dose and Comorbidities in 483 Patients”","authors":"Enzo Emanuele,&nbsp;Piercarlo Minoretti","doi":"10.1016/j.jceh.2025.102632","DOIUrl":"10.1016/j.jceh.2025.102632","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102632"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indian National Association for the Study of the Liver Position Statements on Prevention, Diagnosis, and Management of Hepatitis B Virus Infection in India","authors":"A. Arora ,&nbsp;P. Sharma ,&nbsp;R.K. Dhiman ,&nbsp;A. Duseja ,&nbsp;V. Saraswat ,&nbsp;V.G. Mohan ,&nbsp;S.K. Sarin ,&nbsp;S. Acharya ,&nbsp;S.P. Singh ,&nbsp;P.N. Rao ,&nbsp;R.R. Rai ,&nbsp;A.C. Anand ,&nbsp;M. Dwiwedi ,&nbsp;S.P. Misra ,&nbsp;A. Goel ,&nbsp;A. Kumar ,&nbsp;S.K. Tyagi ,&nbsp;C.E. Eapen ,&nbsp;S. Babu ,&nbsp;V. Jayanthi ,&nbsp;K.T. Sheony","doi":"10.1016/j.jceh.2025.102608","DOIUrl":"10.1016/j.jceh.2025.102608","url":null,"abstract":"<div><div>Hepatitis B virus (HBV) remains a significant global health problem, particularly in India, where its prevalence is gradually decreasing, both in the general population and among healthcare workers. The management of HBV treatment should be individualized based on key factors such as HBV DNA levels, alanine transaminase (ALT) levels, and the presence of comorbid conditions like diabetes mellitus (DM), metabolic dysfunction associated steatotic liver disease (MASLD), pregnancy, cirrhosis, and decompensated cirrhosis. The “treat for all” strategy, although debated, was partially endorsed by the Indian National Association for the Study of the Liver (INASL). Pegylated interferon (Peg IFN) was not widely recommended due to limited practice, and genotype testing was avoided. Hepatitis D was not considered a prevalent condition; thus, testing for it was not emphasized. Special conditions, including immunosuppression and steroid therapy, were also discussed, and INASL provided comprehensive guidelines to address these unique scenarios in HBV management. High-resistance-barrier drugs like tenofovir alafenamide (TAF) were highlighted for their effectiveness and safety, particularly in pregnant women. Vaccination was strongly recommended for special risk groups, including healthcare workers and high-risk populations, while the debate on universal screening and vaccination continues, weighing its potential benefits against logistical challenges.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102608"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Resistance Associated Substitutions and Predictors of Treatment Failure Following Direct-acting Antiviral Therapy in a Viral Hepatitis C Elimination Cohort","authors":"Madhumita Premkumar MD, DM ,&nbsp;Ekta Gupta MD ,&nbsp;Anchal Sandhu BSc ,&nbsp;Prerna Sharma BSc ,&nbsp;Jasvinder Nain MPH ,&nbsp;Sunil Taneja MD, DM ,&nbsp;Nipun Verma MD, DM ,&nbsp;Arka De MD, DM ,&nbsp;Ajay Duseja MD, DM, FAMS, FACG, FAASLD ,&nbsp;Gagandeep S. Grover MD ,&nbsp;Radha K. Dhiman MD, DM, FAMS, FACG, FRCP, FAASLD","doi":"10.1016/j.jceh.2025.102601","DOIUrl":"10.1016/j.jceh.2025.102601","url":null,"abstract":"<div><h3>Background</h3><div>The National Viral Hepatitis Control Program (NVHCP) has a cure rate of 91.6% when using direct-acting antivirals (DAAs)–sofosbuvir with an NS5A inhibitor (ledipasvir, daclatasvir or velpatasvir) ± ribavirin in the Punjab hub-and-spoke model of hepatitis C virus (HCV) elimination.</div></div><div><h3>Methods</h3><div>We collected the clinical and virological data for the ∼8.4% treatment failure cases. Sanger nucleotide sequencing was performed to identify the resistance-associated substitutions (RAS) following treatment failure. We ascertained the clinical and virological predictors of treatment failure under the NVHCP.</div></div><div><h3>Results</h3><div>Between April 2019 and December 2023, 50865 patients with HCV were treated; median age 41.6 years, 65% men, 85.8% without cirrhosis, 8.5% treatment experienced, median viral load (x10⁶) of 4.1 (2.9–7.8),71.3% genotype (GT)-3, with cure rate of 89.5%. On multivariable analysis, age (aOR 1.5, 95% CI: 1.3–1.9, <em>P</em> = 0.021), presence of cirrhosis (aOR1.8, 95% CI: 1.3–2.5, <em>P</em> &lt; 0.001), and poor drug compliance (aOR 0.3, 95% CI: 0.2–0.6, <em>P</em> &lt; 0.001) predicted treatment failure. We enrolled a difficult-to-treat group of 640 persons for virological testing, aged 39.2 ± 15.1 years, median HCV viral load (x10⁶) of 1.98 (1.5–2.4). Of these, 56.6% were treatment-experienced, 11.1% were prior defaulters, with predominant GT3 (73.3%) and GT1 (18.7%) with coinfection rates of 3.8% and 4.4% for hepatitis B virus (HBV) and human immunodeficiency virus (HIV), respectively. Presumed modes of transmission in this subgroup were unsafe injections (57%), and injection drug use (32.8%). A total of 243 patient samples underwent RAS testing, with 45 patients having detectable variants, and finally 31 RAS mutations were detected in the NS5A gene, with no clinically significant resistance observed in the NS5B gene. In GT-3, the RAS observed were A30K, L31 M/R, A62S, A62T, and Y93H. In GT-1, the RAS observed were M28A, H58P, G30 H/R, H58D, and Y93K. Among these Y93K, L30R, G30 H/R confer resistance to velpatasvir; such patients received retreatment with voxilaprevir-containing regimens.</div></div><div><h3>Conclusion</h3><div>Patient factors like compliance and the presence of cirrhosis predicted treatment failures. RAS do not appear to be a primary factor for treatment failure in a public health setting.</div></div><div><h3>Clinical trials gov number</h3><div>NCT03488485 available from <span><span>https://clinicaltrials.gov/study/NCT03488485</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102601"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144291167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Liver Fibrosis in Patients With Psoriasis on Long-term Methotrexate: Role of Cumulative Dose and Comorbidities in 483 Patients","authors":"Harshad Devarbhavi ,&nbsp;Govinda Narayanareddy Devamsh ,&nbsp;Anaberu Basavaraj Chiranth ,&nbsp;Mallikarjun Patil ,&nbsp;Rajvir Singh ,&nbsp;Ekta Parikh ,&nbsp;Syed Shafiq","doi":"10.1016/j.jceh.2025.102606","DOIUrl":"10.1016/j.jceh.2025.102606","url":null,"abstract":"<div><h3>Background and aims</h3><div>Methotrexate (MTX) remains the cornerstone in the treatment of psoriasis. However, concerns about its potential to contribute to liver fibrosis or cirrhosis have remained. We aimed to define the relationship between MTX exposure or other risk factors with liver fibrosis in patients with psoriasis.</div></div><div><h3>Methods</h3><div>We examined the liver stiffness measurement (LSM) in patients with psoriasis from a single center between 2019 and 2024. At the time of LSM, baseline clinical, demographic, comorbidities, laboratory, and medication information were obtained. Psoriasis patients were stratified into two groups: one that had not been exposed to MTX (no MTX), and another that had been exposed to MTX for more than 6 months. Liver fibrosis was measured by transient elastography (TE) and FIB 4. We used a cut-off of ≤7.9 kPa to rule out advanced fibrosis and ≥11.5 kPa to rule in cirrhosis, respectively.</div></div><div><h3>Results</h3><div>Of the 483 individuals with psoriasis, 101 (21%) patients showed TE values ≥ 7.9 kPa. Sixty-five (22.3%) of MTX-exposed group showed TE ≥ 7.9 kPa compared to thirty-six (19.3% with no-MTX (<em>P</em> = 0.33). On multivariate logistic regression analysis, the only significant factor linked to stiffness <strong>≥</strong> 7.9 was type 2 diabetes mellitus (T2DM) (adjusted odds ratio = 2.8; 95% CI 1.44–5.43; <em>P</em> = 0.002). Liver fibrosis did not correlate with age, MTX cumulative dose, hyperlipidemia, obesity, or hypertension in multivariate analysis, despite some of these factors showing significance on univarite analysis.</div></div><div><h3>Conclusions</h3><div>T2DM, not cumulative methotrexate dose, was associated with liver stiffness. These findings reinforce the need to revise methotrexate monitoring guidelines to incorporate transient elastography, particularly for patients with metabolic risk factors.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102606"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transfemoral Hepatic Vein Puncture as a Nonpercutaneous Alternative Facilitating Anatomical Recanalization in Budd-Chiari Syndrome","authors":"Ranjan K. Patel,&nbsp;Taraprasad Tripathy,&nbsp;Subhabrata Biswal,&nbsp;Hemanta K. Nayak,&nbsp;Manas K. Panigrahi,&nbsp;Sudipta Mohakud","doi":"10.1016/j.jceh.2025.103113","DOIUrl":"10.1016/j.jceh.2025.103113","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 103113"},"PeriodicalIF":3.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144771546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperammonemic Encephalopathy in Fibrolamellar Hepatocellular Carcinoma: A Case of Rapid Neurologic Recovery Following Cytoreductive Surgery","authors":"Robert Schoeneich,&nbsp;Udhayvir S. Grewal,&nbsp;Tanner J. Simonson,&nbsp;Bohae R. Lee,&nbsp;Rishi R. Patel,&nbsp;Andrew J. Vegel,&nbsp;Mark W. Karwal,&nbsp;Carlos H.F. Chan,&nbsp;Naomi H. Fei","doi":"10.1016/j.jceh.2025.102629","DOIUrl":"10.1016/j.jceh.2025.102629","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102629"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}