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Clinical characteristics, imaging diagnostic accuracy, and prognosis of autoimmune pancreatitis: A real-world study in China 自身免疫性胰腺炎的临床特征、影像诊断准确性和预后:中国真实世界研究。
IF 2.3 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-30 DOI: 10.1111/1751-2980.13316
Yue Liu, Dong Ling Wan, Zheng Hui Yang, Chao Liu, Ya Tao Tu, Yu Ting Liu, Xin Yue Wang, Jia Heng Xu, Meng Ruo Jiang, De Yu Zhang, Chang Wu, Zhen Dong Jin, Zhao Shen Li, Li Qi Sun, Hao Jie Huang

Objective

In this study we aimed to comprehensively evaluate the clinical features and treatment outcomes of Chinese patients with autoimmune pancreatitis (AIP) through a single-center real-world study.

Methods

Patients diagnosed with AIP in Changhai Hospital, Naval Medical University from January 2014 to December 2021 were included. Baseline characteristics, laboratory test results, cross-sectional imaging and endoscopic ultrasound (EUS) findings, and long-term follow-up data were obtained. The differences in these characteristics between type 1 and type 2 AIP patients were analyzed.

Results

Among all 320 patients, 271 (84.7%) and 49 (15.3%) had type 1 and type 2 AIP, respectively. The most common initial symptom was abdominal discomfort (58.1%), followed by obstructive jaundice (32.5%). Extrapancreatic organ involvement was identified in 126 (39.4%) patients, with the biliary system being the most commonly involved (36.6%). Elevated serum IgG4 level was rare in type 2 AIP patients. The diagnostic accuracy of computed tomography (CT), magnetic resonance imaging (MRI), and EUS for definitive and probable AIP were 78.0%, 68.7%, and 80.5%, respectively. EUS-guided tissue acquisition with immunohistochemical staining helped establish a final diagnosis in 39.7% of patients. During the follow-up period of 60 months, 18.6% of patients experienced relapse. The 1-, 3-, and 5-year relapse rates were higher in type 1 AIP patients, with an accumulated rate of 8.0%, 12.6%, and 15.1%, when compared with those with type 2 AIP.

Conclusions

Type 2 AIP is not uncommon in Chinese population. The diagnostic accuracy of CT and EUS for AIP might be superior to that of MRI.

研究目的本研究旨在通过单中心真实世界研究,全面评估中国自身免疫性胰腺炎(AIP)患者的临床特征和治疗效果:纳入2014年1月至2021年12月在海军军医大学附属长海医院确诊的自身免疫性胰腺炎患者。方法:纳入 2014 年 1 月至 2021 年 12 月期间在海军军医大学附属长海医院确诊的 AIP 患者,了解其基线特征、实验室检查结果、横断面成像和内镜超声(EUS)检查结果以及长期随访数据。分析了1型和2型AIP患者在这些特征上的差异:在所有 320 名患者中,1 型和 2 型 AIP 患者分别为 271 人(84.7%)和 49 人(15.3%)。最常见的初始症状是腹部不适(58.1%),其次是阻塞性黄疸(32.5%)。126名患者(39.4%)发现胰腺外器官受累,其中胆道系统最常受累(36.6%)。血清 IgG4 水平升高在 2 型 AIP 患者中很少见。计算机断层扫描(CT)、磁共振成像(MRI)和 EUS 对明确和可能的 AIP 的诊断准确率分别为 78.0%、68.7% 和 80.5%。在 EUS 引导下采集组织并进行免疫组化染色有助于确定 39.7% 患者的最终诊断。在 60 个月的随访期间,18.6% 的患者复发。与2型AIP患者相比,1型AIP患者的1年、3年和5年复发率更高,累计复发率分别为8.0%、12.6%和15.1%:结论:2型AIP在中国人群中并不少见。结论:2型AIP在中国人群中并不少见,CT和EUS对AIP的诊断准确性可能优于MRI。
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引用次数: 0
Impact of rifaximin on cirrhosis complications and gastric microbiota in patients with gastroesophageal variceal bleeding: A pilot randomized controlled trial 利福昔明对胃食管静脉曲张出血患者肝硬化并发症和胃微生物群的影响:随机对照试验
IF 2.3 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-23 DOI: 10.1111/1751-2980.13314
Xiao Quan Huang, Ying Jie Ai, Feng Li, Si Tao Ye, Jia Hao Wang, Rui Zhang, Wei Zhang, Yu Li Zhu, Shi Yao Chen

Objectives

The application of rifaximin, a non-absorbable antibiotic, in hepatic encephalopathy (HE) has been well established; however, its effect on other complications in cirrhotic patients with previous gastroesophageal variceal bleeding (GEVB) remains unclear. Therefore, we performed a pilot randomized controlled trial aiming to evaluate the impact of rifaximin on cirrhosis-related complications and changes in gastric microbiota.

Methods

Eighty cirrhotic patients who received prophylactic endoscopic treatment for variceal rebleeding were randomly assigned to the control or rifaximin treatment group (rifaximin 400 mg twice daily for 8 weeks). Primary outcome was the total liver-related score, consisting of changes in cirrhosis-related complications including rebleeding, ascites, HE and portal vein thrombosis (PVT). The 16S rDNA sequencing analysis was conducted with gastric lavage fluid samples for the analysis of gastric microbiota.

Results

During the 8-week follow-up, the total liver-related score decreased significantly upon rifaximin therapy (−0.35 ± 0.14 vs 0.05 ± 0.14, p = 0.0465) as well as serum C-reactive protein (CRP) (p = 0.019) and interleukin-8 (p = 0.025) compared with the control group. The rate of PVT recanalization was significantly higher in the rifaximin group (p = 0.012). Prominent difference in gastric microbiota between the two groups was observed, and the rifaximin group had a higher abundance of several taxa which were dysregulated in the progression of cirrhosis. CRP was correlated with several taxa including Alphaproteobacteria, Rhizobiales and Collinsella.

Conclusions

Rifaximin may improve cirrhosis-related complications, including PVT, in patients with previous GEVB through anti-inflammatory and microbiota-modulating functions. Trial registration number: NCT02991612.

目的:利福昔明是一种非吸收性抗生素,其在肝性脑病(HE)中的应用已得到证实;然而,它对曾有胃食管静脉曲张出血(GEVB)的肝硬化患者的其他并发症的影响仍不清楚。因此,我们进行了一项试点随机对照试验,旨在评估利福昔明对肝硬化相关并发症和胃微生物群变化的影响:80名因静脉曲张再出血而接受预防性内镜治疗的肝硬化患者被随机分配到对照组或利福昔明治疗组(利福昔明400毫克,每天两次,共8周)。主要结果是肝脏相关总分,包括再出血、腹水、肝硬化和门静脉血栓(PVT)等肝硬化相关并发症的变化。为分析胃微生物群,对洗胃液样本进行了 16S rDNA 测序分析:结果:在 8 周的随访中,与对照组相比,利福昔明治疗后肝脏相关总评分显著下降(-0.35 ± 0.14 vs 0.05 ± 0.14,p = 0.0465),血清 C 反应蛋白(CRP)(p = 0.019)和白细胞介素-8(p = 0.025)也显著下降。利福昔明组的 PVT 再闭合率明显更高(p = 0.012)。观察到两组患者的胃微生物群存在明显差异,利福昔明组的几个分类群丰度更高,而这些分类群在肝硬化进展过程中出现失调。CRP与几个分类群相关,包括Alphaproteobacteria、Rhizobiales和Collinsella:利福昔明可通过抗炎和微生物群调节功能改善既往有GEVB患者的肝硬化相关并发症,包括PVT:NCT02991612.
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引用次数: 0
Granulomas without foreign body giant cells in perianal fistula tissue suggest Crohn's disease 肛周瘘管组织中无异物巨细胞的肉芽肿提示克罗恩病。
IF 2.3 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1111/1751-2980.13312
Yi Na Han, Qian Ru Gu, Yan Chuang Wu, Win Topatana, Zhi Nong Jiang

Objectives

Histopathological characteristics of granulomas in perianal fistula of patients with Crohn's disease (CD) remain unexplored. We aimed to assess the histopathological features of granulomas in perianal fistula in CD.

Methods

A retrospective analysis was conducted by reviewing the medical and pathological records of 4430 cases who underwent perianal fistulectomy at our hospital between June 2015 and June 2023. The patients were divided into the CD group, tuberculosis (TB), and non-CD group, respectively, based on their final diangosis. The detection rate of granulomas and differential histopathological features were investigated.

Results

Among the 4430 patients, granulomas were identified in 41 cases, including 25 had CD, 2 had pulmonary TB, and 14 only exhibiting perianal lesions with no other comorbidities. Additionally, there were altogether 93 CD cases, resulting in a detection rate of granuloma of 26.9%, which was considerably higher than that in the non-CD group (26.9% vs 0.3%, p < 0.001). The majority (85.7%) of the perianal fistula tissues in the non-CD group contained foreign body giant cells, while this was observed in only 1 (4.0%) out of the 25 cases with CD. We proposed that granulomas in the perianal fistula in the non-CD group were mostly foreign body granulomas. Moreover, granulomas in the non-CD group were larger than that of the CD group (1135 μm vs 519 μm, p < 0.001).

Conclusion

Most CD cases have less granulomas (≤3) and no foreign body giant cells. Ribbon-like granulomas can be seen only in CD cases.

目的:克罗恩病(CD)患者肛瘘周围肉芽肿的组织病理学特征仍未得到研究。我们旨在评估 CD 患者肛瘘周围肉芽肿的组织病理学特征:我们回顾了2015年6月至2023年6月期间在我院接受肛周瘘切除术的4430例病例的医疗和病理记录,进行了回顾性分析。根据最终的肛门指诊情况,将患者分别分为 CD 组、结核(TB)组和非 CD 组。研究肉芽肿的检出率和不同的组织病理学特征:结果:在 4430 例患者中,41 例发现肉芽肿,其中 25 例患有 CD,2 例患有肺结核,14 例仅有肛周病变,无其他合并症。此外,CD 病例共有 93 例,肉芽肿检出率为 26.9%,大大高于非 CD 组(26.9% 对 0.3%,P 结 论):大多数 CD 病例的肉芽肿较少(≤3 个),且无异物巨细胞。只有在 CD 病例中才能看到带状肉芽肿。
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引用次数: 0
Long-term intermittent oral administration of selective COX-2 inhibitor improved the clinical outcomes of COVID-19 in patients with cirrhosis 长期间歇性口服选择性 COX-2 抑制剂可改善 COVID-19 对肝硬化患者的临床疗效。
IF 2.3 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-30 DOI: 10.1111/1751-2980.13313
Ming Chen, Zhu Yang, Hui Gong, Hao Wu, Ling Liu, Jing Sun Jiang, Jin Hang Gao, Cheng Wei Tang, Zhi Yin Huang

Objectives

Patients with cirrhosis are more susceptible to coronavirus disease 2019 (COVID-19) due to immune dysfunction. In this retrospective study we aimed to investigate whether suppression of mild systemic inflammation with selective cyclooxygenase-2 inhibitor (COX-2-I) during chronic care of cirrhotic patients would reduce the occurrence of acute decompensated events and improve patient prognosis of COVID-19.

Methods

Medical records of cirrhotic patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were sequentially reviewed. The patients were divided into the COX-2-I and control groups depending on whether they took oral selective COX-2-I for over 3 months or not. The primary outcomes included the occurrence of severe/critical COVID-19, acute decompensated events, and acute-on-chronic liver failure (ACLF).

Results

After propensity score matching analysis, there were 314 cases in the control group and 118 cases in the COX-2-I group. Compared with the control group, the risk of severe/critical COVID-19 in the COX-2-I group was significantly decreased by 83.1% (p = 0.004). Acute decompensated events and ACLF occurred in 23 (7.32%) and nine (2.87%) cases in the control group, but none in the COX-2-I group (p = 0.003 and 0.122). The rate of hospitalization in the COX-2-I group was significantly lower than that of the control group (3.39% vs 13.06%, p = 0.003). No patient in the COX-2-I group required intensive care unit admission.

Conclusions

Long-term intermittent oral administration of selective COX-2-I in cirrhotic patients significantly reduces the occurrence of severe/critical COVID-19, acute decompensated events, and ACLF. It may also be used for systemic inflammation caused by other pathogens.

目的:由于免疫功能紊乱,肝硬化患者更容易感染冠状病毒病2019(COVID-19)。在这项回顾性研究中,我们旨在探讨在肝硬化患者的慢性护理期间使用选择性环氧化酶-2抑制剂(COX-2-I)抑制轻度全身性炎症是否会减少急性失代偿事件的发生并改善COVID-19患者的预后:方法:对感染严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)的肝硬化患者的病历进行顺序回顾。根据患者是否口服选择性 COX-2-I 3 个月以上,将其分为 COX-2-I 组和对照组。主要结果包括严重/危重 COVID-19、急性失代偿事件和急性慢性肝衰竭(ACLF)的发生率:经过倾向评分匹配分析,对照组有 314 例,COX-2-I 组有 118 例。与对照组相比,COX-2-I 组发生严重/危重 COVID-19 的风险显著降低了 83.1%(p = 0.004)。对照组和 COX-2-I 组分别有 23 例(7.32%)和 9 例(2.87%)发生急性失代偿事件和 ACLF,而 COX-2-I 组则没有(P = 0.003 和 0.122)。COX-2-I 组的住院率明显低于对照组(3.39% vs 13.06%,P = 0.003)。COX-2-I组没有患者需要入住重症监护室:结论:肝硬化患者长期间歇性口服选择性 COX-2-I 可显著减少严重/危重 COVID-19、急性失代偿事件和 ACLF 的发生。它还可用于其他病原体引起的全身性炎症。
{"title":"Long-term intermittent oral administration of selective COX-2 inhibitor improved the clinical outcomes of COVID-19 in patients with cirrhosis","authors":"Ming Chen,&nbsp;Zhu Yang,&nbsp;Hui Gong,&nbsp;Hao Wu,&nbsp;Ling Liu,&nbsp;Jing Sun Jiang,&nbsp;Jin Hang Gao,&nbsp;Cheng Wei Tang,&nbsp;Zhi Yin Huang","doi":"10.1111/1751-2980.13313","DOIUrl":"10.1111/1751-2980.13313","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Patients with cirrhosis are more susceptible to coronavirus disease 2019 (COVID-19) due to immune dysfunction. In this retrospective study we aimed to investigate whether suppression of mild systemic inflammation with selective cyclooxygenase-2 inhibitor (COX-2-I) during chronic care of cirrhotic patients would reduce the occurrence of acute decompensated events and improve patient prognosis of COVID-19.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Medical records of cirrhotic patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were sequentially reviewed. The patients were divided into the COX-2-I and control groups depending on whether they took oral selective COX-2-I for over 3 months or not. The primary outcomes included the occurrence of severe/critical COVID-19, acute decompensated events, and acute-on-chronic liver failure (ACLF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After propensity score matching analysis, there were 314 cases in the control group and 118 cases in the COX-2-I group. Compared with the control group, the risk of severe/critical COVID-19 in the COX-2-I group was significantly decreased by 83.1% (<i>p</i> = 0.004). Acute decompensated events and ACLF occurred in 23 (7.32%) and nine (2.87%) cases in the control group, but none in the COX-2-I group (<i>p</i> = 0.003 and 0.122). The rate of hospitalization in the COX-2-I group was significantly lower than that of the control group (3.39% vs 13.06%, <i>p</i> = 0.003). No patient in the COX-2-I group required intensive care unit admission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Long-term intermittent oral administration of selective COX-2-I in cirrhotic patients significantly reduces the occurrence of severe/critical COVID-19, acute decompensated events, and ACLF. It may also be used for systemic inflammation caused by other pathogens.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 8","pages":"517-524"},"PeriodicalIF":2.3,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Recent advances in pathogenesis, diagnosis, and therapeutic approaches for digestive system involvement in systemic lupus erythematosus 系统性红斑狼疮消化系统受累的发病机制、诊断和治疗方法的最新进展
IF 2.3 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-24 DOI: 10.1111/1751-2980.13307
Liang Zhou, Shao Zhe Cai, Ling Li Dong

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by the presence of large amounts of autoantibodies and immune complex formation. Because of their atypical clinical symptoms, SLE patients with digestive system involvement may not be recognized or treated precisely and extensively. Clinicians should pay close attention to SLE with digestive system involvement, as these conditions can easily worsen the condition and possibly endanger the patient's life. In this review we summarized the pathogenesis, pathological characteristics, clinical manifestations, diagnosis, and therapies for digestive system involvement in SLE.

系统性红斑狼疮(SLE)是一种全身性自身免疫性疾病,其特点是存在大量自身抗体并形成免疫复合物。由于其临床症状不典型,受累于消化系统的系统性红斑狼疮患者可能无法被准确识别或广泛治疗。临床医生应密切关注受累消化系统的系统性红斑狼疮,因为这些症状很容易使病情恶化,甚至危及患者的生命。在这篇综述中,我们总结了系统性红斑狼疮消化系统受累的发病机制、病理特征、临床表现、诊断和治疗方法。
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引用次数: 0
Insight into the therapeutic effects of artesunate in relieving metabolic-associated steatohepatitis from transcriptomic and lipidomics analyses 通过转录组学和脂质组学分析深入了解青蒿琥酯缓解代谢相关性脂肪性肝炎的治疗效果
IF 2.3 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-09 DOI: 10.1111/1751-2980.13311
Jing Yang, Lei Jie Huang, Tian Yi Ren, Jing Zeng, Yi Wen Shi, Jian Gao Fan

Objectives

Artesunate (ART) is a water-soluble derivative of artemisinin, which has shown anti-inflammatory, anti-tumor, and immunomodulating effects. We aimed to investigate the potential therapeutic effects and mechanisms of ART in metabolic dysfunction-associated steatohepatitis (MASH).

Methods

The mice were randomly divided into the control group, high-fat, high-cholesterol diet-induced MASH group, and the MASH treated with ART (30 mg/kg once daily) group. Liver enzymes, lipids, and histological features were compared among groups. The molecular mechanisms were studied by transcriptomic and lipidomics analyses of liver tissues.

Results

The mice of the MASH group had significantly increased hepatic fat deposition and inflammation in terms of biochemical indicators and pathological manifestations than the control group. The ART-treated group had improved plasma liver enzymes and hepatic cholesterol, especially at week 4 of intervention (p < 0.05). A total of 513 differentially expressed genes and 59 differentially expressed lipids were identified in the MASH group and the MASH+ART group. Gene Ontology analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment test showed that ART regulated glycerolipid metabolism pathway and enhanced fatty acid degradation. Peroxisome proliferator-activated receptor (PPAR)-α acted as a key transcription factor in the treatment of MASH with ART, which was confirmed by cell experiment.

Conclusions

ART significantly improved fat deposition and inflammatory manifestations in MASH mice, with potential therapeutic effects. The mechanism of artemisinin treatment for MASH may involve extensive regulation of downstream genes by upstream transcription factors, such as PPAR-α, to restore hepatic lipid homeostasis.

目的青蒿琥酯(ART)是青蒿素的一种水溶性衍生物,具有抗炎、抗肿瘤和免疫调节作用。我们旨在研究青蒿琥酯对代谢功能障碍相关性脂肪性肝炎(MASH)的潜在治疗作用和机制。比较各组的肝酶、血脂和组织学特征。结果MASH组小鼠的肝脏脂肪沉积和炎症在生化指标和病理表现方面均明显高于对照组。ART治疗组的血浆肝酶和肝胆固醇有所改善,尤其是在干预第4周时(p < 0.05)。MASH组和MASH+ART组共发现了513个差异表达基因和59个差异表达脂质。基因本体分析和京都基因组百科全书通路富集测试表明,ART可调控甘油脂代谢通路并促进脂肪酸降解。结论ART能显著改善MASH小鼠的脂肪沉积和炎症表现,具有潜在的治疗作用。青蒿素治疗MASH的机制可能涉及上游转录因子(如PPAR-α)对下游基因的广泛调控,从而恢复肝脏脂质平衡。
{"title":"Insight into the therapeutic effects of artesunate in relieving metabolic-associated steatohepatitis from transcriptomic and lipidomics analyses","authors":"Jing Yang,&nbsp;Lei Jie Huang,&nbsp;Tian Yi Ren,&nbsp;Jing Zeng,&nbsp;Yi Wen Shi,&nbsp;Jian Gao Fan","doi":"10.1111/1751-2980.13311","DOIUrl":"10.1111/1751-2980.13311","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Artesunate (ART) is a water-soluble derivative of artemisinin, which has shown anti-inflammatory, anti-tumor, and immunomodulating effects. We aimed to investigate the potential therapeutic effects and mechanisms of ART in metabolic dysfunction-associated steatohepatitis (MASH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The mice were randomly divided into the control group, high-fat, high-cholesterol diet-induced MASH group, and the MASH treated with ART (30 mg/kg once daily) group. Liver enzymes, lipids, and histological features were compared among groups. The molecular mechanisms were studied by transcriptomic and lipidomics analyses of liver tissues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mice of the MASH group had significantly increased hepatic fat deposition and inflammation in terms of biochemical indicators and pathological manifestations than the control group. The ART-treated group had improved plasma liver enzymes and hepatic cholesterol, especially at week 4 of intervention (<i>p</i> &lt; 0.05). A total of 513 differentially expressed genes and 59 differentially expressed lipids were identified in the MASH group and the MASH+ART group. Gene Ontology analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment test showed that ART regulated glycerolipid metabolism pathway and enhanced fatty acid degradation. Peroxisome proliferator-activated receptor (PPAR)-α acted as a key transcription factor in the treatment of MASH with ART, which was confirmed by cell experiment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ART significantly improved fat deposition and inflammatory manifestations in MASH mice, with potential therapeutic effects. The mechanism of artemisinin treatment for MASH may involve extensive regulation of downstream genes by upstream transcription factors, such as PPAR-α, to restore hepatic lipid homeostasis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 8","pages":"490-503"},"PeriodicalIF":2.3,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142216960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Selection strategy for endoscopic necrosectomy approaches of infected walled-off pancreatic necrosis: Analysis of 101 patients from a single center with long-term follow-up 感染性胰腺脱壁坏死内镜下坏死切除术的选择策略:对来自单一中心的 101 例患者的长期随访分析。
IF 2.3 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-03 DOI: 10.1111/1751-2980.13310
Jie Luo, Sheng Wei Zhang, Jia Lin He, Li Xing Tian, Xue Peng, Xu Biao Nie, Shao Song Ye, Ying Zuo, Hui Lin, Jian Ying Bai, En Liu, Shi Ming Yang, Chao Qiang Fan

Objectives

Endoscopic necrosectomy (EN) is a promising minimally invasive approach for treating infected walled-off pancreatic necrosis (WOPN). Multiple EN approaches are currently available, though criteria for selecting the optimal approaches are lacking. We aimed to propose a rational selection strategy of EN and to retrospectively evaluate its safety and effectiveness.

Methods

Altogether 101 patients who underwent EN for infected WOPN at a tertiary hospital between June 2009 and February 2023 were retrospectively included for analysis. Demographic characteristics, details of the EN procedures, procedure-related adverse events, and clinical outcomes were investigated.

Results

Among these 101 patients with WOPN, 56 (55.4%) underwent transluminal EN, 38 (37.6%) underwent percutaneous EN, and seven (6.9%) underwent combined approach, respectively. Clinical success was achieved in 94 (93.1%) patients. Seven (6.9%) experienced procedure-related adverse events, and seven (6.9%) died during the treatment period. During a median follow-up of 50 months, 5 (5.3%) of the 94 patients had disease recurrence, 17.0% (16/94) had new-onset diabetes mellitus, and 6.4% (6/94) needed oral pancreatic enzyme supplementation. The clinical success rate, procedure-related adverse event rate, and long-term follow-up outcomes were not significantly different among the three groups. High APACHE-II scores (≥15) and organ failure were identified as factors related to treatment failure.

Conclusions

A selection strategy for EN approaches, based on the extent of necrosis and its distance from the gastrointestinal lumen (using a threshold of 15 mm), is safe and effective for treating infected WOPN in both short-term and long-term outcomes.

目的:内镜坏死切除术(EN)是治疗感染性胰腺壁脱落坏死(WOPN)的一种很有前景的微创方法。目前有多种内镜坏死切除术方法,但缺乏选择最佳方法的标准。我们旨在提出一种合理的EN选择策略,并对其安全性和有效性进行回顾性评估:我们回顾性地纳入了 2009 年 6 月至 2023 年 2 月期间在一家三甲医院因感染 WOPN 而接受耳鼻喉手术的 101 例患者进行分析。结果:在这 101 例 WOPN 感染患者中,有 1 例患者接受了耳鼻喉手术,有 1 例患者接受了耳鼻喉手术,有 1 例患者接受了耳鼻喉手术,有 1 例患者接受了耳鼻喉手术:结果:在这 101 例 WOPN 患者中,56 例(55.4%)接受了经腔镜EN,38 例(37.6%)接受了经皮EN,7 例(6.9%)接受了联合方法。94例(93.1%)患者获得了临床成功。7例(6.9%)患者出现了与手术相关的不良反应,7例(6.9%)患者在治疗期间死亡。在中位随访 50 个月期间,94 名患者中有 5 人(5.3%)疾病复发,17.0%(16/94)新发糖尿病,6.4%(6/94)需要口服胰酶补充剂。三组患者的临床成功率、手术相关不良事件发生率和长期随访结果无明显差异。高APACHE-II评分(≥15分)和器官衰竭被认为是治疗失败的相关因素:根据坏死程度及其与胃肠管腔的距离(阈值为 15 毫米)选择 EN 方法的策略对治疗感染性 WOPN 在短期和长期结果上都是安全有效的。
{"title":"Selection strategy for endoscopic necrosectomy approaches of infected walled-off pancreatic necrosis: Analysis of 101 patients from a single center with long-term follow-up","authors":"Jie Luo,&nbsp;Sheng Wei Zhang,&nbsp;Jia Lin He,&nbsp;Li Xing Tian,&nbsp;Xue Peng,&nbsp;Xu Biao Nie,&nbsp;Shao Song Ye,&nbsp;Ying Zuo,&nbsp;Hui Lin,&nbsp;Jian Ying Bai,&nbsp;En Liu,&nbsp;Shi Ming Yang,&nbsp;Chao Qiang Fan","doi":"10.1111/1751-2980.13310","DOIUrl":"10.1111/1751-2980.13310","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic necrosectomy (EN) is a promising minimally invasive approach for treating infected walled-off pancreatic necrosis (WOPN). Multiple EN approaches are currently available, though criteria for selecting the optimal approaches are lacking. We aimed to propose a rational selection strategy of EN and to retrospectively evaluate its safety and effectiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Altogether 101 patients who underwent EN for infected WOPN at a tertiary hospital between June 2009 and February 2023 were retrospectively included for analysis. Demographic characteristics, details of the EN procedures, procedure-related adverse events, and clinical outcomes were investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among these 101 patients with WOPN, 56 (55.4%) underwent transluminal EN, 38 (37.6%) underwent percutaneous EN, and seven (6.9%) underwent combined approach, respectively. Clinical success was achieved in 94 (93.1%) patients. Seven (6.9%) experienced procedure-related adverse events, and seven (6.9%) died during the treatment period. During a median follow-up of 50 months, 5 (5.3%) of the 94 patients had disease recurrence, 17.0% (16/94) had new-onset diabetes mellitus, and 6.4% (6/94) needed oral pancreatic enzyme supplementation. The clinical success rate, procedure-related adverse event rate, and long-term follow-up outcomes were not significantly different among the three groups. High APACHE-II scores (≥15) and organ failure were identified as factors related to treatment failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A selection strategy for EN approaches, based on the extent of necrosis and its distance from the gastrointestinal lumen (using a threshold of 15 mm), is safe and effective for treating infected WOPN in both short-term and long-term outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 8","pages":"525-536"},"PeriodicalIF":2.3,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Inhibition of FoxO1 ameliorates hepatic steatosis and hepatitis in nonalcoholic steatohepatitis mice through regulation of gut microbiota 抑制 FoxO1 可通过调节肠道微生物群改善非酒精性脂肪性肝炎小鼠的肝脏脂肪变性和肝炎。
IF 2.3 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-08-30 DOI: 10.1111/1751-2980.13306
Di Wen Shou, Ying Quan, Jie Min Cheng, Si Qi Yang, Jia Wei Chen, Yong Qiang Li, Chen Huang, Hui Ting Chen, Yong Jian Zhou

Objective

We aimed to investigate the role of forkhead box O1 (FoxO1) inhibitor AS1842856 (AS) in nonalcoholic steatohepatitis (NASH) mice and the potential mechanisms.

Methods

Mice were given methionine-choline-sufficient (MCS), or methionine- and choline-deficient (MCD) diet for 5 weeks, along with AS (60 mg/kg) or vehicle gavage treatment (0.2 mL/day). Body and liver weight, serum triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), fasting glucose and insulin levels were measured. Liver macrophage infiltration and ileal ZO-1 protein expression were also detected. Interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF)-α, sterol regulatory element binding protein (SREBP)-1c, phosphoenolpyruvate carboxykinase (PEPCK), and glucose-6-phosphatase (G6Pase), α-smooth muscle actin (SMA), recombinant collagen type III α1 (Col3a1), and connective tissue growth factor (Ctgf) expressions were measured. Stool samples were collected for 16S rDNA sequencing.

Results

Compared to the MCD group, AS attenuated liver weight, reduced serum TG, ALT, and AST levels, increased HDL-C levels, mitigated hepatic steatosis, decreased macrophage infiltration, and augmented ileal ZO-1 proteins in NASH mice. It also reduced the levels of IL-6, IL-1β, and TNF-α, alongside with the Srebp-1c mRNA expression. However, no significant effects on Pepck, G6Pase, α-SMA, Col3a1, or Ctgf were observed. Furthermore, AS promoted diversity and altered gut microbiota composition in NASH mice, causing increased beneficial bacteria like Akkermansia muciniphila, Parabacteroides distasonis, and Prevotellamassilia, which were associated with metabolic functions.

Conclusion

FoxO1 inhibitor AS ameliorated hepatic steatosis, inflammation, and intestinal dysbiosis in NASH mice, making it a potentially promising treatment for NASH.

研究目的我们旨在研究叉头框O1(FoxO1)抑制剂AS1842856(AS)在非酒精性脂肪性肝炎(NASH)小鼠中的作用及其潜在机制:给小鼠喂食蛋氨酸胆碱不足(MCS)或蛋氨酸胆碱缺乏(MCD)饮食 5 周,同时给予 AS(60 毫克/千克)或载体灌胃治疗(0.2 毫升/天)。测定了体重和肝脏重量、血清甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、空腹血糖和胰岛素水平。还检测了肝脏巨噬细胞浸润和回肠 ZO-1 蛋白表达。还检测了白细胞介素(IL)-6、IL-1β、肿瘤坏死因子(TNF)-α、甾醇调节元件结合蛋白(SREBP)-1c、磷酸烯醇丙酮酸羧激酶(PEPCK)、葡萄糖-6-磷酸酶(G6Pase)、α-平滑肌肌动蛋白(SMA)、重组胶原Ⅲ型α1(Col3a1)和结缔组织生长因子(Ctgf)的表达。采集粪便样本进行16S rDNA测序:与 MCD 组相比,AS 减轻了 NASH 小鼠的肝脏重量,降低了血清 TG、ALT 和 AST 水平,提高了 HDL-C 水平,减轻了肝脏脂肪变性,减少了巨噬细胞浸润,增加了回肠 ZO-1 蛋白。它还降低了 IL-6、IL-1β 和 TNF-α 的水平,以及 Srebp-1c mRNA 的表达。然而,没有观察到对 Pepck、G6Pase、α-SMA、Col3a1 或 Ctgf 的明显影响。此外,AS还促进了NASH小鼠肠道微生物群的多样性并改变了其组成,导致Akkermansia muciniphila、Parabacteroides distasonis和Prevotellamassilia等与代谢功能相关的有益菌增加:结论:FoxO1抑制剂AS可改善NASH小鼠的肝脏脂肪变性、炎症和肠道菌群失调,是一种治疗NASH的潜在药物。
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引用次数: 0
Role of artificial intelligence in Crohn's disease intestinal strictures and fibrosis 人工智能在克罗恩病肠道狭窄和纤维化中的作用。
IF 2.3 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-08-27 DOI: 10.1111/1751-2980.13308
Yi Fei Chen, Liu Liu, Bin Lyu, Ye Yang, Si Si Zheng, Xuan Huang, Yi Xu, Yi Hong Fan

Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract. Intestinal fibrosis or stricture is one of the most prevalent complications in CD with a high recurrence rate. Manual examination of intestinal fibrosis or stricture by physicians may be biased or inefficient. A rapid development of artificial intelligence (AI) technique in recent years facilitates the detection of existing or possible intestinal fibrosis and stricture in CD through various modalities, including endoscopy, imaging examination, and serological biomarkers. We reviewed the articles on AI application in diagnosing intestinal fibrosis and stricture in CD during the past decade and categorized them into three aspects based on the detection methods, and found that AI helps accurate and expedient identification and prediction of intestinal fibrosis and stenosis in CD.

克罗恩病(CD)是一种慢性胃肠道炎症性疾病。肠纤维化或狭窄是 CD 最常见的并发症之一,复发率很高。医生对肠纤维化或狭窄的人工检查可能存在偏差或效率低下。近年来,人工智能(AI)技术发展迅速,通过内窥镜检查、影像学检查和血清学生物标志物等多种方式,有助于发现 CD 患者已经存在或可能存在的肠纤维化和肠狭窄。我们回顾了近十年来有关人工智能应用于诊断 CD 肠纤维化和狭窄的文章,并根据检测方法将其分为三个方面,发现人工智能有助于准确、快速地识别和预测 CD 肠纤维化和狭窄。
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引用次数: 0
Dramatic ruxolitinib efficacy in chronic enteropathy associated with SLCO2A1 gene (CEAS) Ruxolitinib对SLCO2A1基因相关慢性肠病(CEAS)的显著疗效。
IF 2.3 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-08-27 DOI: 10.1111/1751-2980.13309
Laure Ricard, Fabienne Charbit-Henrion, Alice Courties, Mohamad Mohty, Ollivier Legrand, Victor Benady, Anne Bourrier, Geneviève Baujat, Florent Malard
{"title":"Dramatic ruxolitinib efficacy in chronic enteropathy associated with SLCO2A1 gene (CEAS)","authors":"Laure Ricard,&nbsp;Fabienne Charbit-Henrion,&nbsp;Alice Courties,&nbsp;Mohamad Mohty,&nbsp;Ollivier Legrand,&nbsp;Victor Benady,&nbsp;Anne Bourrier,&nbsp;Geneviève Baujat,&nbsp;Florent Malard","doi":"10.1111/1751-2980.13309","DOIUrl":"10.1111/1751-2980.13309","url":null,"abstract":"","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 8","pages":"537-539"},"PeriodicalIF":2.3,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
期刊
Journal of Digestive Diseases
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