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Corynoline protects chronic pancreatitis via binding to PSMA2 and alleviating pancreatic fibrosis. 堇青碱通过与 PSMA2 结合并减轻胰腺纤维化来保护慢性胰腺炎。
IF 6.9 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-15 DOI: 10.1007/s00535-024-02145-4
Pengyuan Wang, Bangwei Huang, Yu Liu, Xin Tan, Libo Liu, Baoru Zhang, Zhaoshen Li, Le Kang, Lianghao Hu

Background: Pancreatic fibrosis is the main pathological feature of chronic pancreatitis. There is a lack of medications that effectively alleviate or reverse pancreatic fibrosis and thus cure chronic pancreatitis.

Methods: We screened drugs that could alleviate pancreatic fibrosis from 80 traditional Chinese medicine monomers and verified their efficacy and mechanisms.

Results: We preliminarily identified corynoline as an antifibrotic candidate by drug screening among 80 compounds. In vitro, corynoline dose-dependently reduces collagen I synthesis in pancreatic stellate cells induced by TGF-β1 and inhibits its activation. Furthermore, we found that corynoline could alleviate the morphological disruption, such as acinar cell atrophy, collagen deposition etc., as well as reduced pancreatic weight in mice with chronic pancreatitis. We further validated the antifibrotic effect of corynoline in mRNA and protein levels. We also found that corynoline could inhibit NF-κB signaling pathway in vitro and in vivo. Next, we identified PSMA2 as the binding protein of corynoline by Lip-SMap and validated it using DARTS. Moreover, the siRNA of PSMA2 disrupts the anti-fibrotic effect of corynoline.

Conclusion: In conclusion, corynoline is a promising agent for the treatment of pancreatic fibrosis and chronic pancreatitis.

背景:胰腺纤维化是慢性胰腺炎的主要病理特征:胰腺纤维化是慢性胰腺炎的主要病理特征。目前尚缺乏有效缓解或逆转胰腺纤维化从而治愈慢性胰腺炎的药物:方法:我们从80种中药单体中筛选出能缓解胰腺纤维化的药物,并验证了其疗效和机制:结果:通过对80个化合物的药物筛选,我们初步确定了堇青碱作为抗胰腺纤维化的候选药物。在体外,堇青碱能剂量依赖性地减少 TGF-β1 诱导的胰腺星状细胞胶原 I 的合成,并抑制其活化。此外,我们还发现,可可碱能减轻慢性胰腺炎小鼠的形态学破坏,如针叶细胞萎缩、胶原沉积等,并减轻胰腺重量。我们进一步在 mRNA 和蛋白质水平上验证了堇青碱的抗纤维化作用。我们还发现,在体外和体内,鸡矢藤碱都能抑制 NF-κB 信号通路。接着,我们通过 Lip-SMap 鉴定出 PSMA2 是可可碱的结合蛋白,并用 DARTS 进行了验证。此外,PSMA2的siRNA破坏了corynoline的抗纤维化作用:总之,可可碱是一种治疗胰腺纤维化和慢性胰腺炎的有效药物。
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引用次数: 0
Conditional deletion of IP3R1 by Islet1-Cre in mice reveals a critical role of IP3R1 in interstitial cells of Cajal in regulating GI motility. 通过 Islet1-Cre 小鼠条件性缺失 IP3R1 揭示了 IP3R1 在 Cajal 间质细胞中调节胃肠道运动的关键作用。
IF 6.9 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-30 DOI: 10.1007/s00535-024-02164-1
Hong Wang, Beili Zhao, Lei Huang, Xiangbin Zhu, Na Li, Can Huang, Zhen Han, Kunfu Ouyang

Background and aims: Inositol 1,4,5-trisphosphate receptor type 1 (IP3R1) has been proposed to play a physiological role in regulating gastrointestinal (GI) motility, but the underlying cell-dependent mechanism remains unclear. Here, we utilized cell-specific IP3R1 deletion strategies to address this question in mice.

Methods: Conditional IP3R1 knockout mice using Wnt1-Cre, Islet1-Cre mice, and smMHC-CreEGFP were generated. Cell lineage tracing was performed to determine where gene deletion occurred in the GI tract. Whole-gut transit assay and isometric tension recording were used to assess GI function in vivo and in vitro.

Results: In the mouse GI tract, Islet1-Cre targeted smooth muscle cells (SMCs) and interstitial cells of Cajal (ICCs), but not enteric neurons. IP3R1 deletion by Islet1-Cre (isR1KO) caused a phenotype of intestinal pseudo-obstruction (IPO), evidenced by prolonged whole-gut transit time, enlarged GI tract, abdominal distention, and early lethality. IP3R1 deletion by Islet1-Cre not only reduced the frequency of spontaneous contractions but also decreased the contractile responses to the muscarinic agonist carbachol (CCh) and electrical field stimulation (EFS) in colonic circular muscles. By contrast, smMHC-CreEGFP only targeted SMCs in the mouse GI tract. Although IP3R1 deletion by smMHC-CreEGFP (smR1KO) also reduced the contractile responses to CCh and EFS in colonic circular muscles, the frequency of spontaneous contractions was less affected, and neither global GI abnormalities nor early lethality was found in smR1KO mice.

Conclusions: IP3R1 deletion in both ICCs and SMCs but not in SMCs alone causes an IPO phenotype, suggesting that IP3R1 in ICCs plays an essential role in regulating GI motility in vivo.

背景和目的:1,4,5-三磷酸肌醇受体 1 型(IP3R1)被认为在调节胃肠道(GI)蠕动中发挥生理作用,但其潜在的细胞依赖机制仍不清楚。在此,我们利用细胞特异性 IP3R1 基因缺失策略来解决小鼠的这一问题:方法:利用 Wnt1-Cre、Islet1-Cre 小鼠和 smMHC-CreEGFP 产生了条件性 IP3R1 基因敲除小鼠。方法:利用 Wnt1-Cre 小鼠和 Islet1-Cre 小鼠以及 smMHC-CreEGFP 产生条件性 IP3R1 基因敲除小鼠,并进行细胞系追踪,以确定基因缺失发生在消化道的哪个部位。使用全肠转运试验和等张力记录来评估体内和体外的消化道功能:结果:在小鼠消化道中,Islet1-Cre 以平滑肌细胞(SMCs)和卡雅尔间质细胞(ICCs)为靶细胞,但不以肠神经元为靶细胞。通过 Islet1-Cre 缺失 IP3R1(isR1KO)会导致肠假性梗阻(IPO)表型,表现为全肠转运时间延长、消化道扩大、腹胀和早期死亡。通过 Islet1-Cre 缺失 IP3R1 不仅会降低自发收缩的频率,还会降低结肠圆肌对毒蕈碱激动剂卡巴胆碱(CCh)和电场刺激(EFS)的收缩反应。相比之下,smMHC-CreEGFP 只针对小鼠消化道的 SMC。虽然通过 smMHC-CreEGFP 缺失 IP3R1(smR1KO)也会降低结肠圆肌对 CCh 和 EFS 的收缩反应,但自发收缩的频率受到的影响较小,而且 smR1KO 小鼠既未发现整体消化道异常,也未发现早期致死:结论:在 ICCs 和 SMCs 中同时缺失 IP3R1 而非仅在 SMCs 中缺失 IP3R1 会导致 IPO 表型,这表明 ICCs 中的 IP3R1 在调节体内消化道运动中发挥着重要作用。
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引用次数: 0
Novel subharmonic-aided pressure estimation for identifying high-risk esophagogastric varices. 用于识别高风险食管胃静脉曲张的新型次谐波辅助压力估算。
IF 6.9 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-29 DOI: 10.1007/s00535-024-02161-4
Hidekatsu Kuroda, Tamami Abe, Naohisa Kamiyama, Takuma Oguri, Asami Ito, Ippeki Nakaya, Takuya Watanabe, Hiroaki Abe, Kenji Yusa, Yudai Fujiwara, Hiroki Sato, Akiko Suzuki, Kei Endo, Yuichi Yoshida, Takayoshi Oikawa, Keisuke Kakisaka, Kei Sawara, Akio Miyasaka, Takayuki Matsumoto

Background: Subharmonic-aided pressure estimation (SHAPE) is a technique for determining changes in ambient pressure. We aimed to analyze a novel SHAPE integrated into ultrasound diagnostic equipment to predict patients with liver cirrhosis at high risk of esophagogastric varices (EV).

Methods: This prospective study included 111 patients with liver cirrhosis diagnosed between 2020 and 2023. We obtained liver stiffness measurements (LSM) and spleen stiffness measurements (SSM) using shear wave elastography and hepatic vein-portal vein (HV-PV) gradient using the SHAPE method. The EV risk was determined either as null, low, or high by esophagoscopy and Child-Pugh stage.

Results: HV-PV gradient increased concordantly with the increase in EV risk (- 7.0 dB in null-risk, - 4.4 dB in low-risk, and - 2.0 dB in high-risk) with statistically significant difference among any two groups. The most appropriate cut-off value of the HV-PV gradient was - 3.5 dB, and sensitivity, specificity, and positive and negative predictive values were 80.0%, 89.0%, 80.0%, and 88.0%, respectively. The areas under the curve values for predicting the high-risk EV were 0.920, 0.843, and 0.824 for the HV-PV gradient, LSM, and SSM, respectively.

Conclusions: The novel SHAPE system demonstrated high accuracy in identifying patients with liver cirrhosis at a high risk of EV.

背景:次谐波辅助压力估计(SHAPE)是一种确定环境压力变化的技术。我们旨在分析一种集成到超声诊断设备中的新型 SHAPE,以预测肝硬化患者发生食管胃底静脉曲张(EV)的高风险:这项前瞻性研究纳入了111名在2020年至2023年期间确诊的肝硬化患者。我们使用剪切波弹性成像技术测量了肝脏硬度(LSM)和脾脏硬度(SSM),并使用 SHAPE 方法测量了肝静脉-门静脉(HV-PV)梯度。通过食管镜检查和Child-Pugh分期确定EV风险为无、低或高:结果:HV-PV 梯度随 EV 风险的增加而增加(无 EV 风险为 - 7.0 dB,低 EV 风险为 - 4.4 dB,高 EV 风险为 - 2.0 dB),两组间差异无统计学意义。HV-PV 梯度最合适的临界值为 - 3.5 dB,敏感性、特异性、阳性预测值和阴性预测值分别为 80.0%、89.0%、80.0% 和 88.0%。HV-PV 梯度、LSM 和 SSM 预测高风险 EV 的曲线下面积值分别为 0.920、0.843 和 0.824:新型 SHAPE 系统在识别高危肝硬化患者 EV 方面表现出极高的准确性。
{"title":"Novel subharmonic-aided pressure estimation for identifying high-risk esophagogastric varices.","authors":"Hidekatsu Kuroda, Tamami Abe, Naohisa Kamiyama, Takuma Oguri, Asami Ito, Ippeki Nakaya, Takuya Watanabe, Hiroaki Abe, Kenji Yusa, Yudai Fujiwara, Hiroki Sato, Akiko Suzuki, Kei Endo, Yuichi Yoshida, Takayoshi Oikawa, Keisuke Kakisaka, Kei Sawara, Akio Miyasaka, Takayuki Matsumoto","doi":"10.1007/s00535-024-02161-4","DOIUrl":"https://doi.org/10.1007/s00535-024-02161-4","url":null,"abstract":"<p><strong>Background: </strong>Subharmonic-aided pressure estimation (SHAPE) is a technique for determining changes in ambient pressure. We aimed to analyze a novel SHAPE integrated into ultrasound diagnostic equipment to predict patients with liver cirrhosis at high risk of esophagogastric varices (EV).</p><p><strong>Methods: </strong>This prospective study included 111 patients with liver cirrhosis diagnosed between 2020 and 2023. We obtained liver stiffness measurements (LSM) and spleen stiffness measurements (SSM) using shear wave elastography and hepatic vein-portal vein (HV-PV) gradient using the SHAPE method. The EV risk was determined either as null, low, or high by esophagoscopy and Child-Pugh stage.</p><p><strong>Results: </strong>HV-PV gradient increased concordantly with the increase in EV risk (- 7.0 dB in null-risk, - 4.4 dB in low-risk, and - 2.0 dB in high-risk) with statistically significant difference among any two groups. The most appropriate cut-off value of the HV-PV gradient was - 3.5 dB, and sensitivity, specificity, and positive and negative predictive values were 80.0%, 89.0%, 80.0%, and 88.0%, respectively. The areas under the curve values for predicting the high-risk EV were 0.920, 0.843, and 0.824 for the HV-PV gradient, LSM, and SSM, respectively.</p><p><strong>Conclusions: </strong>The novel SHAPE system demonstrated high accuracy in identifying patients with liver cirrhosis at a high risk of EV.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Definitive-dose adjuvant radiotherapy following endoscopic submucosal dissection for superficial esophageal cancer. 内镜黏膜下剥离术治疗浅表食管癌后的确定剂量辅助放疗。
IF 6.9 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-24 DOI: 10.1007/s00535-024-02156-1
Yuki Wada, Satoshi Kumagai, Noriko Takagi, Tetsugaku Shinozaki, Toshiki Murata, Daichi Sugawara, Kenta Watanabe, Tamotsu Matsuhashi, Katsunori Iijima, Naoko Mori

Background: Prophylactic chemoradiation therapy (CRT) using 40-41.4 Gy post-endoscopic submucosal dissection (ESD) for clinical T1N0M0 esophageal cancer reportedly yields favorable outcomes. However, it cannot completely prevent locoregional lymph node (LN) metastases. We retrospectively analyzed outcomes and adverse events associated with our dose-escalated treatment regimen (definitive-dose radiotherapy [RT] of 50-61.2 Gy, with/without chemotherapy) for these patients, and predictors of progression-free survival (PFS) and overall survival (OS).

Methods: Between 2006 and 2018, 44 consecutive patients (42 men and 2 women; median age, 70 years) who underwent definitive-dose RT post-ESD and had a pathological depth of the muscularis mucosa with lymphovascular invasion (LVI) or the upper-middle submucosal third at our institution were included. We excluded patients who could not obtain a margin-free resection by ESD. If feasible, systemic chemotherapy with 5-fluorouracil plus high- or low-dose cisplatin or nedaplatin was administered concurrently.

Results: Five-year PFS, OS, and disease-specific survival rates were 78.8%, 88.4%, and 97.7%, respectively. Six metachronous esophagus (14%), two locoregional LN within the irradiated area with a prophylactic dose of 41.4 Gy (5%), and two locoregional LN plus liver (5%) recurrences occurred. No LN recurrence occurred within the definitive dose of ≥ 50 Gy in the irradiated area. Metachronous esophageal recurrence involved areas receiving ≥ 50 Gy. Univariate and multivariate analyses revealed that age was an independent prognostic factor for both PFS and OS.

Conclusions: Definitive-dose RT/CRT post-ESD could provide favorable locoregional LN control and PFS/OS regardless of patient characteristics, including pathological findings and chemotherapy regimen/course, except for age. These results need to be interpreted carefully given several limitations, therefore, definitive-dose RT/CRT should be conducted with caution in clinical practice until high-quality prospective clinical trials evaluating the effectiveness and safety.

背景:据报道,内镜粘膜下剥离术(ESD)后使用 40-41.4 Gy 的预防性化放疗(CRT)治疗临床 T1N0M0 食管癌可取得良好疗效。但是,它不能完全防止局部淋巴结(LN)转移。我们回顾性分析了针对这些患者的剂量递增治疗方案(50-61.2 Gy的确定剂量放疗[RT],联合/不联合化疗)的相关结果和不良事件,以及无进展生存期(PFS)和总生存期(OS)的预测因素:2006年至2018年期间,本机构连续纳入了44例ESD后接受确定剂量RT治疗、病理深度为粘膜肌层伴淋巴管侵犯(LVI)或粘膜中上部1/3粘膜下层的患者(42例男性,2例女性;中位年龄70岁)。我们排除了无法通过ESD获得无边缘切除的患者。在可行的情况下,同时进行5-氟尿嘧啶加高剂量或低剂量顺铂或奈达铂的全身化疗:结果:五年的PFS、OS和疾病特异性生存率分别为78.8%、88.4%和97.7%。有6例食管异位(14%)、2例预防剂量为41.4 Gy的照射区域内局部LN(5%)和2例局部LN加肝脏(5%)复发。在最终剂量≥ 50 Gy 的照射区域内,未出现 LN 复发。食管同期复发涉及接受≥ 50 Gy 照射的区域。单变量和多变量分析显示,年龄是PFS和OS的独立预后因素:结论:除年龄外,ESD 后的确定剂量 RT/CRT 可提供良好的局部 LN 控制和 PFS/OS,与患者特征无关,包括病理结果和化疗方案/疗程。鉴于这些结果存在一些局限性,因此在评估其有效性和安全性的高质量前瞻性临床试验之前,临床实践中应谨慎使用确定剂量的RT/CRT。
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引用次数: 0
Possibility of determining high quantitative fecal occult blood on stool surface using hyperspectral imaging. 利用高光谱成像确定粪便表面高定量粪便隐血的可能性。
IF 6.9 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-23 DOI: 10.1007/s00535-024-02163-2
Hiroaki Ikematsu, Yohei Takara, Keiichiro Nishihara, Yuki Kano, Yuji Owaki, Ryuji Okamoto, Takahisa Fujiwara, Toshihiro Takamatsu, Masayuki Yamada, Yutaka Tomioka, Nobuyoshi Takeshita, Atsushi Inaba, Hironori Sunakawa, Keiichiro Nakajo, Tatsuro Murano, Tomohiro Kadota, Kensuke Shinmura, Yoshikatsu Koga, Tomonori Yano

Background: Fecal immunochemical tests are commonly performed for colorectal cancer screening. Instant fecal occult blood measurement in toilet bowel movements would improve convenience. Hyperspectral imaging (HSI) enables the nondestructive evaluation of materials that are difficult to assess visually. This study aimed to determine whether HSI could be used to identify fecal occult blood on stool surfaces.

Methods: The study included 100 patients who underwent colonoscopy, divided into groups A and B (50 patients, each) for creating a discriminant algorithm and validating the accuracy of the algorithm, respectively. In group A, 100 areas were randomly selected from the stool surface, and the fecal occult blood quantitative values were measured and photographed using a hyperspectral camera (cutoff: > 400 ng/mL). A discriminant algorithm image was created to extract spectral feature differences obtained from HSI via machine learning. In group B, 250 random areas were evaluated and compared to fecal occult blood quantitative values, measuring sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).

Results: Groups A and B comprised 28 and 26 patients with cancer, respectively. Cancer detection sensitivity at the 400 ng/mL cutoff was 67.9% and 42.3% in groups A and B, respectively. The discriminant algorithm image exhibited high accuracy in group A (sensitivity; 77.1%, specificity; 96.9%, accuracy; 90.0%, PPV; 93.1%, NPV; 88.7%). In group B, the sensitivity, specificity, accuracy, PPV, and NPV were 83.3, 92.9, 90.8, 76.3, and 95.3%, respectively.

Conclusion: HSI can effectively discriminate high quantitative fecal occult blood, highlighting its potential for improved colorectal cancer screening.

背景:粪便免疫化学检验是筛查结肠直肠癌的常用方法。在厕所排便时即时测量粪便隐血可提高便利性。高光谱成像(HSI)可对难以用肉眼评估的材料进行无损评估。本研究旨在确定高光谱成像是否可用于识别粪便表面的粪便隐血:研究包括 100 名接受结肠镜检查的患者,分为 A 组和 B 组(各 50 名患者),分别用于创建判别算法和验证算法的准确性。A 组从粪便表面随机选取 100 个区域,使用高光谱相机测量粪便潜血定量值并拍照(临界值:> 400 ng/mL)。创建判别算法图像,通过机器学习提取从高光谱仪获得的光谱特征差异。在 B 组中,对 250 个随机区域进行评估,并与粪便潜血定量值进行比较,测量敏感性、特异性、准确性、阳性预测值 (PPV) 和阴性预测值 (NPV):结果:A 组和 B 组分别有 28 名和 26 名癌症患者。A 组和 B 组在 400 纳克/毫升临界值时的癌症检测灵敏度分别为 67.9% 和 42.3%。判别算法图像在 A 组显示出较高的准确性(灵敏度 77.1%,特异性 96.9%,准确性 90.0%,PPV 93.1%,NPV 88.7%)。B 组的灵敏度、特异性、准确性、PPV 和 NPV 分别为 83.3%、92.9%、90.8%、76.3% 和 95.3%:结论:HSI 能有效鉴别高定量粪便潜血,在改进大肠癌筛查方面具有重要潜力。
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引用次数: 0
Impact of age at HBsAg seroclearance on hepatic outcomes and life expectancy in men with chronic HBV infection based on multi-state modeling of the natural history. 基于多州自然史模型的 HBsAg 血清清除年龄对男性慢性 HBV 感染者肝脏预后和预期寿命的影响。
IF 6.9 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-22 DOI: 10.1007/s00535-024-02162-3
Wen-Jie Liu, Wan-Jung Wu, Chih-Lin Lin, Chun-Jen Liu, Yi-Wen Huang, Jui-Ting Hu, Ming-Whei Yu

Background: The effects of age at HBsAg seroclearance on clinical outcomes and survival in chronic hepatitis B (CHB) have not been adequately assessed. We evaluated the impact of age at HBsAg seroclearance on long-term outcomes, along with how coexisting factors modified risks and life expectancy in CHB patients.

Methods: We used multi-state modeling approach to examine transitions through the CHB continuum in a longitudinal cohort study of male civil servants recruited in 1989-1992. Hepatic outcomes and deaths were identified by clinical evaluation and linkage with national health databases. Four sets of risk factors (CHB-related, metabolic, lifestyle, and genetic factors) were assessed.

Results: Of 2551 HBsAg carriers, with follow-up until 2021 or death, 695 achieved HBsAg seroclearance, 490 developed cirrhosis (88 decompensated), 252 developed hepatocellular carcinoma (HCC), and 652 died. The cumulative rates for HCC were 1.1% and 1.5% at 10 years after HBsAg seroclearance, respectively, for patients achieving seroclearance at age 50 and 60; correspondingly, the rates for cirrhosis were 2.3% and 3.0%. Developing HBsAg seroclearance was associated with a reduced risk of cirrhosis (HR = 0.37, 95% CI 0.15-0.92) but not HCC. Patients experiencing HBsAg seroclearance lived longer years free of major liver diseases than HBsAg-persistent patients, and achieving seroclearance at age 50 (vs 60) led to a greater increase in the disease-free life expectancy. However, obesity and smoking were associated with adverse hepatic outcomes and loss of the disease-free life expectancy following HBsAg seroclearance.

Conclusions: Our findings highlight the benefit of earlier HBsAg seroclearance for gains in disease-free life expectancy and the impact of obesity and smoking on loss of the life years free of major liver diseases following HBsAg seroclearance.

背景:目前尚未充分评估HBsAg血清清除年龄对慢性乙型肝炎(CHB)临床结局和存活率的影响。我们评估了 HBsAg 血清清除年龄对长期预后的影响,以及并存因素如何改变慢性乙型肝炎患者的风险和预期寿命:方法:我们采用多状态建模方法,对 1989-1992 年招募的男性公务员进行了纵向队列研究,考察了慢性阻塞性肺病连续过程中的转变。通过临床评估和与国家健康数据库的链接,确定了肝病结果和死亡病例。评估了四组风险因素(CHB 相关因素、代谢因素、生活方式因素和遗传因素):结果:在随访至 2021 年或死亡的 2551 名 HBsAg 携带者中,695 人达到 HBsAg 血清清除率,490 人发展为肝硬化(88 人失代偿),252 人发展为肝细胞癌(HCC),652 人死亡。在 50 岁和 60 岁达到血清清除率的患者中,HBsAg 血清清除后 10 年的 HCC 累计发生率分别为 1.1% 和 1.5%;相应地,肝硬化发生率分别为 2.3% 和 3.0%。HBsAg血清清除与肝硬化风险降低有关(HR = 0.37,95% CI 0.15-0.92),但与 HCC 无关。与HBsAg持续存在的患者相比,HBsAg血清清除的患者无重大肝病的寿命更长,而在50岁(与60岁相比)时实现血清清除可使无病预期寿命延长更多。然而,肥胖和吸烟与HBsAg血清清除后的不良肝病结果和无病预期寿命的减少有关:我们的研究结果凸显了较早清除 HBsAg 对延长无病预期寿命的益处,以及肥胖和吸烟对清除 HBsAg 后无重大肝病寿命损失的影响。
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引用次数: 0
Serum zinc levels as predictors of covert hepatic encephalopathy in patients with liver cirrhosis. 预测肝硬化患者隐匿性肝性脑病的血清锌水平。
IF 6.9 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-16 DOI: 10.1007/s00535-024-02160-5
Naoto Soma, Yoshihito Uchida, Jun-Ichi Kouyama, Kayoko Naiki, Nanase Usui, Aya Sato, Shunsuke Yamada, Shohei Tsuji, Satsuki Ando, Kayoko Sugawara, Masamitsu Nakao, Nobuaki Nakayama, Yukinori Imai, Tomoaki Tomiya, Suguru Mizuno, Satoshi Mochida

Background: Covert hepatic encephalopathy (CHE) significantly impacts the quality of life and prognosis in patients with liver cirrhosis. This study aims to analyze the prevalence and risk factors of CHE to identify high-risk patients who would benefit from therapeutic interventions.

Methods: This single-center, retrospective observational study included 126 patients without a history of overt hepatic encephalopathy (OHE). CHE was defined as a score above the age-based cutoff value in the Stroop test. Factors associated with the occurrence of CHE and the subsequent development of OHE were evaluated.

Results: CHE was detected in 47 patients (37.3%). A multiple logistic regression analysis identified serum zinc levels (per + 1 µg/dL, odds ratio 0.95, P = 0.0007) as the only risk factor associated with CHE, with a cutoff value of 60 µg/dL (AUC 0.71, P = 0.0001). Neither blood ammonia levels nor liver function were predictive of CHE. During a median observation period of 211 days, OHE developed in 18 patients (14.3%). The administration of more than 20 mg of furosemide was identified as a risk factor for developing OHE (hazard ratio 23.52, P = 0.0207).

Conclusion: Cirrhotic patients with serum zinc levels below 60 µg/dL exhibit a high risk of developing CHE, regardless of blood ammonia levels. These patients face a significant risk of developing OHE. Therefore, early zinc supplementation is recommended for the prevention of OHE, particularly for those prescribed 20 mg or more of furosemide.

背景:隐匿性肝性脑病(CHE)严重影响肝硬化患者的生活质量和预后。本研究旨在分析隐匿性肝性脑病的发病率和风险因素,以确定可从治疗干预中获益的高危患者:这项单中心回顾性观察研究纳入了 126 名无明显肝性脑病(OHE)病史的患者。CHE的定义是在Stroop测试中得分超过基于年龄的临界值。研究评估了与CHE发生及随后发展为OHE相关的因素:结果:47 名患者(37.3%)检测出 CHE。多元逻辑回归分析发现,血清锌水平(per + 1 µg/dL,几率比 0.95,P = 0.0007)是与 CHE 相关的唯一风险因素,临界值为 60 µg/dL(AUC 0.71,P = 0.0001)。血氨水平和肝功能均不能预测CHE。在中位 211 天的观察期内,18 名患者(14.3%)出现了 OHE。服用 20 毫克以上的呋塞米被认为是发生 OHE 的风险因素(危险比 23.52,P = 0.0207):结论:无论血氨水平如何,血清锌水平低于 60 µg/dL 的肝硬化患者罹患 CHE 的风险很高。这些患者面临着罹患 OHE 的巨大风险。因此,建议尽早补锌以预防 OHE,尤其是那些服用 20 毫克或更多呋塞米的患者。
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引用次数: 0
A culprit for carcinogenesis hiding in daylight: normal-weight obesity. 隐藏在日光下的致癌元凶:正常体重的肥胖。
IF 6.9 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-08 DOI: 10.1007/s00535-024-02142-7
Osman Cagin Buldukoglu, Serkan Ocal, Ayhan Hilmi Cekin
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引用次数: 0
The potential of an artificial intelligence for diagnosing MRI images in rectal cancer: multicenter collaborative trial. 人工智能诊断直肠癌核磁共振图像的潜力:多中心合作试验。
IF 6.9 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-31 DOI: 10.1007/s00535-024-02133-8
Atsushi Hamabe, Ichiro Takemasa, Masayuki Ishii, Koichi Okuya, Koya Hida, Daisuke Nishizaki, Atsuhiko Sumii, Shigeki Arizono, Shigeshi Kohno, Koji Tokunaga, Hirotsugu Nakai, Yoshiharu Sakai, Masahiko Watanabe

Background: An artificial intelligence-based algorithm we developed, mrAI, satisfactorily segmented the rectal tumor, rectum, and mesorectum from MRI data of rectal cancer patients in an initial study. Herein, we aimed to validate mrAI using an independent dataset.

Methods: We utilized MRI images collected in another nationwide research project, "Open versus Laparoscopic Surgery for Advanced Low Rectal Cancer Patients". MRIs from 467 cases with upfront surgery were utilized; six radiologists centralized the MRI evaluations. The diagnostic accuracies of mrAI and the radiologists for tumor depth were compared using pathologic diagnosis as a reference.

Results: For all cases, centralized diagnosis demonstrated 84.2% sensitivity, 37.7% specificity, and 73.7% accuracy; mrAI exhibited 70.6% sensitivity, 61.3% specificity, and 68.5% accuracy. After limiting MRIs to those acquired by a Philips scanner, with an inter-slice spacing of ≤ 6 mm-both conditions similar to those used in the development of mrAI-the performance of mrAI improved to 76.8% sensitivity, 76.7% specificity, and 76.7% accuracy, while the centralized diagnosis showed 81.8% sensitivity, 36.7% specificity, and 71.3% accuracy. Regarding relapse-free survival, the prognosis for tumors staged ≥ T3 was significantly worse than for tumors staged ≤ T2 (P = 0.0484) in the pathologic diagnosis. While no significant difference was observed between ≥ T3 and ≤ T2 tumors in the centralized diagnosis (P = 0.1510), the prognosis for ≥ T3 was significantly worse in the mrAI diagnosis (P = 0.0318).

Conclusion: Proper imaging conditions for MRI can enhance the accuracy of mrAI, which has the potential to provide feedback to radiologists without overestimating tumor stage.

背景:在一项初步研究中,我们开发的基于人工智能的算法 mrAI 从直肠癌患者的 MRI 数据中分割出了直肠肿瘤、直肠和直肠中膜,效果令人满意。在此,我们旨在使用一个独立的数据集验证 mrAI:我们利用了在另一个全国性研究项目 "晚期低位直肠癌患者开放手术与腹腔镜手术 "中收集的 MRI 图像。我们利用了 467 例先期手术病例的核磁共振成像,由六位放射科医生集中进行核磁共振成像评估。以病理诊断为参考,比较了 mrAI 和放射科医生对肿瘤深度的诊断准确性:在所有病例中,集中诊断的灵敏度为 84.2%,特异度为 37.7%,准确率为 73.7%;mrAI 的灵敏度为 70.6%,特异度为 61.3%,准确率为 68.5%。在将 MRI 限制为由飞利浦扫描仪采集、切片间距小于 6 mm(这两个条件与开发 mrAI 时使用的条件相似)之后,mrAI 的灵敏度、特异度和准确度分别提高到 76.8%、76.7% 和 76.7%,而集中诊断的灵敏度、特异度和准确度分别为 81.8%、36.7% 和 71.3%。在无复发生存率方面,病理诊断分期≥T3的肿瘤的预后明显差于分期≤T2的肿瘤(P = 0.0484)。虽然在集中诊断中,≥T3和≤T2肿瘤之间无明显差异(P = 0.1510),但在mrAI诊断中,≥T3肿瘤的预后明显较差(P = 0.0318):结论:适当的磁共振成像条件可提高 mrAI 的准确性,它有可能在不高估肿瘤分期的情况下向放射科医生提供反馈。
{"title":"The potential of an artificial intelligence for diagnosing MRI images in rectal cancer: multicenter collaborative trial.","authors":"Atsushi Hamabe, Ichiro Takemasa, Masayuki Ishii, Koichi Okuya, Koya Hida, Daisuke Nishizaki, Atsuhiko Sumii, Shigeki Arizono, Shigeshi Kohno, Koji Tokunaga, Hirotsugu Nakai, Yoshiharu Sakai, Masahiko Watanabe","doi":"10.1007/s00535-024-02133-8","DOIUrl":"10.1007/s00535-024-02133-8","url":null,"abstract":"<p><strong>Background: </strong>An artificial intelligence-based algorithm we developed, mrAI, satisfactorily segmented the rectal tumor, rectum, and mesorectum from MRI data of rectal cancer patients in an initial study. Herein, we aimed to validate mrAI using an independent dataset.</p><p><strong>Methods: </strong>We utilized MRI images collected in another nationwide research project, \"Open versus Laparoscopic Surgery for Advanced Low Rectal Cancer Patients\". MRIs from 467 cases with upfront surgery were utilized; six radiologists centralized the MRI evaluations. The diagnostic accuracies of mrAI and the radiologists for tumor depth were compared using pathologic diagnosis as a reference.</p><p><strong>Results: </strong>For all cases, centralized diagnosis demonstrated 84.2% sensitivity, 37.7% specificity, and 73.7% accuracy; mrAI exhibited 70.6% sensitivity, 61.3% specificity, and 68.5% accuracy. After limiting MRIs to those acquired by a Philips scanner, with an inter-slice spacing of ≤ 6 mm-both conditions similar to those used in the development of mrAI-the performance of mrAI improved to 76.8% sensitivity, 76.7% specificity, and 76.7% accuracy, while the centralized diagnosis showed 81.8% sensitivity, 36.7% specificity, and 71.3% accuracy. Regarding relapse-free survival, the prognosis for tumors staged ≥ T3 was significantly worse than for tumors staged ≤ T2 (P = 0.0484) in the pathologic diagnosis. While no significant difference was observed between ≥ T3 and ≤ T2 tumors in the centralized diagnosis (P = 0.1510), the prognosis for ≥ T3 was significantly worse in the mrAI diagnosis (P = 0.0318).</p><p><strong>Conclusion: </strong>Proper imaging conditions for MRI can enhance the accuracy of mrAI, which has the potential to provide feedback to radiologists without overestimating tumor stage.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11415406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Profile of plasma microRNAs as a potential biomarker of Wilson's disease. 作为威尔逊氏病潜在生物标志物的血浆微RNA谱。
IF 6.9 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-26 DOI: 10.1007/s00535-024-02135-6
Ana Sánchez-Monteagudo, Edna Ripollés, Oihana Murillo, Sofia Domènech, María Álvarez-Sauco, Eva Girona, Isabel Sastre-Bataller, Ariadna Bono, Luis García-Villarreal, Antonio Tugores, Francisco García-García, Gloria González-Aseguinolaza, Marina Berenguer, Carmen Espinós

Background: Wilson's disease (WD) is a rare condition resulting from autosomal recessive mutations in ATP7B, a copper transporter, manifesting with hepatic, neurological, and psychiatric symptoms. Timely diagnosis and appropriate treatment yield a positive prognosis, while delayed identification and/or insufficient therapy lead to a poor outcome. Our aim was to establish a prognostic method for WD by characterising biomarkers based on circulating microRNAs.

Methods: We conducted investigations across three cohorts: discovery, validation (comprising unrelated patients), and follow-up (revisiting the discovery cohort 3 years later). All groups were compared to age- and gender-matched controls. Plasma microRNAs were analysed via RNA sequencing in the discovery cohort and subsequently validated using quantitative PCR in all three cohorts. To assess disease progression, we examined the microRNA profile in Atp7b-/- mice, analysing serum samples from 6 to 44 weeks of age and liver samples at three time points: 20, 30, and 40 weeks of age.

Results: In patients, elevated levels of the signature microRNAs (miR-122-5p, miR-192-5p, and miR-885-5p) correlated with serum activities of aspartate transaminase, alanine aminotransferase and gamma-glutamyl transferase. In Atp7b-/- mice, levels of miR-122-5p and miR-192-5p (miR-885-5p lacking a murine orthologue) increased from 12 weeks of age in serum, while exhibiting fluctuations in the liver, possibly attributable to hepatocyte regenerative capacity post-injury and the release of hepatic microRNAs into the bloodstream.

Conclusions: The upregulation of the signature miR-122-5p, miR-192-5p, and miR-885-5p in patients and their correlation with liver disease progression in WD mice support their potential as biomarkers of WD.

背景:威尔逊氏病(WD)是一种罕见的疾病,由铜转运体 ATP7B 的常染色体隐性突变引起,表现为肝脏、神经和精神症状。及时诊断和适当治疗可获得良好的预后,而延迟识别和/或治疗不足则会导致不良预后。我们的目的是根据循环 microRNAs 确定生物标志物的特征,从而建立 WD 的预后方法:我们对三个队列进行了调查:发现队列、验证队列(由非相关患者组成)和随访队列(3 年后再次访问发现队列)。所有组别都与年龄和性别匹配的对照组进行了比较。在发现队列中通过 RNA 测序分析血浆 microRNA,随后在所有三个队列中使用定量 PCR 进行验证。为了评估疾病进展,我们检测了 Atp7b-/- 小鼠的 microRNA 图谱,分析了 6 到 44 周龄的血清样本和三个时间点的肝脏样本:结果:结果:在患者体内,标志性微RNA(miR-122-5p、miR-192-5p和miR-885-5p)水平的升高与血清中天冬氨酸转氨酶、丙氨酸氨基转移酶和γ-谷氨酰转移酶的活性相关。在Atp7b-/-小鼠中,血清中miR-122-5p和miR-192-5p(miR-885-5p缺乏鼠类同源物)的水平从12周龄开始上升,而在肝脏中则表现出波动,这可能与损伤后肝细胞再生能力以及肝脏microRNA释放到血液中有关:患者体内标志性 miR-122-5p、miR-192-5p 和 miR-885-5p 的上调及其与 WD 小鼠肝病进展的相关性支持了它们作为 WD 生物标志物的潜力。
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引用次数: 0
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Journal of Gastroenterology
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