World Journal of Hepatology最新文献

Background: The global incidence of hyperlipidemia has been increasing on an annual basis, concomitant with improvements in living standards and dietary changes. Hyperlipidemia is closely associated with the development of numerous diseases, and in clinical cases, drug-induced cholestasis may lead to elevated serum cholesterol and triglyceride levels, a phenomenon known as secondary hyperlipidemia. Hyperlipidemia is recognized as a significant risk factor for the development of cardiovascular disease. Therefore, effective monitoring and control of lipid levels is crucial in the management of patients diagnosed with drug-induced cholestatic liver disease.

Case summary: We present a special case of refractory hyperlipidemia associated with cholestatic liver disease in a 49-year-old woman.

Conclusion: In the treatment of clinical cases of drug-induced cholestatic liver disease and hyperlipidemia, it is essential for medical professionals to consider the patient's overall condition, formulate an individualized treatment plan, and closely monitor the patient's biochemical indices and clinical symptoms to ensure treatment efficacy and prognosis.

The study by Devan et al presents an ultrasound-based protocol for monitoring tumor growth in a syngeneic orthotopic rat model of hepatocellular carcinoma (HCC). This approach is commendable for its reproducibility, cost-effectiveness, and alignment with ethical imperatives, particularly in reducing the need for invasive assessments. The strong correlation of ultrasound-based volumes with histology and therapeutic response highlights its translational promise. However, certain considerations merit further discussion. Ultrasound imaging, while accessible, is inherently operator-dependent, and its accuracy may decline with irregular or heterogeneous tumor morphology. Moreover, the exclusive reliance on the rat hepatoma cell line (N1S1) cells raises questions about generalizability to other HCC models with differing immune interactions. Future refinements should standardize training protocols, incorporate multimodal validation, and explore diverse tumor settings. Despite these limitations, the study provides a useful approach, and its broader integration could democratize preclinical oncology research, especially in resource-constrained environments.

Background: Advanced chronic liver disease is a progressive condition associated with high morbidity and mortality, leading to complications such as decompensation and hepatocellular carcinoma. Although prognostic scores such as the Child-Pugh score (which combines clinical assessment and laboratory parameters) and laboratory-based models, including Model for End-Stage Liver Disease (MELD) 3.0, albumin-bilirubin (ALBI) grade, and fibrosis-4 (FIB-4), are often used, their accuracy is limited by subjective assessments and variability in laboratory results. The Functional Liver Imaging Score (FLIS), a semi-quantitative magnetic resonance imaging (MRI) measure of liver function, may also be influenced by observer variability. This emphasizes the need for objective, reproducible tools to improve risk stratification and support treatment decision-making.

Aim: To evaluate the prognostic value of hepatic enhancement (HE) and signal intensity measured by gadoxetate disodium-enhanced MRI.

Methods: In this retrospective cohort study, 100 patients with advanced chronic liver disease underwent gadoxetate-enhanced MRI. HE and signal intensity were measured quantitatively in liver segments III, VI, VIII, and the caudate lobe, and global values were calculated by averaging segmental measurements. Correlations were assessed with FLIS, Child-Pugh, MELD 3.0, ALBI, FIB-4, liver stiffness (FibroScan), and hepatic venous pressure gradient. Cox regression and receiver operating characteristic analysis were used to evaluate associations with hepatic decompensation, mortality, and hepatocellular carcinoma (HCC) occurrence during follow-up.

Results: Global HE showed a significant correlation with FLIS (r = 0.797), Child-Pugh (r = -0.589), MELD 3.0 (r = -0.658), ALBI (r = -0.599), FIB-4 (r = -0.308), liver stiffness (r = -0.470), and hepatic venous pressure gradient (r = -0.340). Lower HE was significantly associated with a higher risk of decompensation and mortality in univariate Cox regression. After adjustment for MELD 3.0, etiology, and prior HCC, segment VI HE remained independently predictive of mortality. At 12 months, HE improved risk stratification for mortality and reduced unnecessary interventions by 11 per 100 patients at a 10% threshold in the decision curve analysis. HE had an area under the receiver operating characteristic curve of 0.74 for predicting decompensation and 0.74 for predicting mortality. HE was higher in patients who developed or experienced recurrence of HCC during follow-up, but this was not statistically significant (P = 0.1).

Conclusion: Lower HE in segment VI improved prognostic classification of high-risk patients. These patients align with Baveno VII criteria for intensified management, supporting the potential role of HE in risk-adapted surveillance.

Background: Direct acting antivirals have revolutionized hepatitis C virus (HCV) treatment. However, the high price of the brand forms is a barrier for their use in resource limited countries as Egypt.

Aim: To assess the safety and efficacy of the generic sofosbuvir (SOF)/ledipasvir (LED) in Egyptian HCV-infected children and to compare the results with the brand form.

Methods: This analytical retrospective study included HCV infected children and adolescents aged 12-18 years or weighing > 35 kg. Collected data included: Age, sex, risk factors of HCV acquisition, comorbidities, liver functions, HCV viral load, degree of hepatic fibrosis, sustained virologic response (SVR) and frequency of treatment adverse effects. Patients who received the generic form of SOF/LED (Ledisbuvir) were compared to patients who received the brand form (Harvoni^®) regarding SVR and frequency of adverse events.

Results: The study included 43 patients who received Ledisbuvir and 73 who received Harvoni^®. All patients achieved SVR. Treatment side effects were mild, transient and comparable in both groups.

Conclusion: The use of generic SOF/LED in HCV infected children is safe and effective. It is comparable to the brand form at a reduced price and represents an affordable and effective alternative.

Background: Laparoscopic hepatectomy has been widely accepted for the treatment of liver tumors. Compared with open surgery, it provides a reduced hospital stay, less intraoperative blood loss, less trauma, and fewer incisional infections, without affecting tumor outcomes. However, lesions in the right lobe of the liver are deep and obstructed by the ribs, making exposure difficult and increasing the degree of surgical difficulty; thus, liver tumors in the deep right lobe pose technical challenges in standard laparoscopic surgery.

Aim: To investigate the safety and efficacy of laparoscopic retroperitoneal partial hepatectomy for liver tumors.

Methods: The clinical data of 72 patients who underwent laparoscopic retroperitoneal partial hepatectomy for liver tumors between January 2018 and December 2024 at the First People's Hospital of Yunnan Province were analyzed. Of the 72 patients included, 34 were male and 38 were female, with ages ranging from 34 years to 72 years (median age, 45 years). The tumors were all located in the right lobe of the liver, with 30 cases in segment S6, 27 cases in segment S7, and 15 cases in segment S8; the mean tumor diameter was 7.5 ± 3.4 cm. The postoperative tumor indices, liver function, and postoperative complications were analyzed to evaluate the clinical efficacy of laparoscopic partial hepatectomy via the retroperitoneal approach.

Results: The surgeries were successfully completed in all patients, and conversion to open surgery was required in 10 patients. The mean operative time, blood loss, drain retention time, and length of postoperative hospital stay were 140 ± 30 minutes, 150 ± 46 mL, 3.8 ± 1.2 days, and 8.3 ± 5.3 days, respectively. Liver function tests returned to normal in all patients within two weeks of surgery. Fifteen patients developed atelectasis and pleural effusion and were managed with incision and drainage and antibiotics. Two patients developed uncomplicated minimal ascites, and the remaining patients had no perioperative complications, such as abdominal hemorrhage, infection, liver failure, bile leakage, and other adverse events. All patients were successfully treated.

Conclusion: Laparoscopic retroperitoneal partial hepatectomy is a safe and effective approach for right hepatic space-occupying lesions, particularly in segments S6, S7, and S8, with fewer postoperative complications, less trauma, and faster recovery times. This procedure provides a new surgical access for resection of deep tumors in the right lobe of the liver and has clear clinical implications.

Background: Cerebrospinal fluid (CSF) pseudocysts are uncommon complications of ventriculoperitoneal (VP) shunts, usually occurring within 3 weeks to 10 years of insertion. We report a perihepatic CSF pseudocyst presenting over 27 years after shunt placement, representing an exceptionally long interval compared with prior reports. This case highlights the importance of maintaining diagnostic openness when investigating unexplained ascites, and demonstrates the role of fluid beta-2 transferrin in confirming a rare diagnosis.

Case summary: A 42-year-old man with spina bifida and prior VP shunt insertion was admitted for urinary tract infection, later developing recurrent symptomatic perihepatic fluid collections. Extensive hepatic, cardiac, and surgical evaluations were unremarkable, and repeated percutaneous drainages failed. The possibility of CSF origin was raised after clinical reappraisal, and beta-2 transferrin testing of the drained fluid confirmed a CSF pseudocyst. The patient underwent VP shunt exploration and revision with relocation to the pleural space, leading to resolution of the abdominal collections and symptoms.

Conclusion: Persistent diagnostic uncertainty requires broad clinical suspicion and selective testing to identify rare causes of ascites.

In this article, the author comment on the article by Zang et al. Tumor necrosis factor alpha-induced protein 3 (TNFAIP3) was examined in this study as a novel biomarker to predict the efficiency of ursodeoxycholic acid (UDCA) and thereby improved primary biliary cholangitis (PBC) treatment. Differentially expressed genes in PBC patients and healthy controls (HCs) were detected using microarray expression analysis. PBC patients and HCs were examined for predictive performance and associations between important genes and clinicopathological features using immunohistochemistry, logistic regression, and receiver operating characteristic curve methods. Thirteen genes linked to the development of PBC were detected by the bioinformatic research. TNFAIP3 was chosen for additional examination from these 13 genes. TNFAIP3 was shown to be more expressed in PBCs patients than in HCs using immunohistochemical method. TNFAIP3 and fatigue have a significant impact on UDCA in PBC patients in multivariate cox regression analysis. Additionally, there was a correlation between TNFAIP3 expression and splenomegaly, alkaline phosphatase, albumin, total bilirubin, and age. In conclusion, TNFAIP3 and fatigue have significant impact on UDCA in PBC. These findings provide a new view on PBC pathophysiology and suggest that TNFAIP3 may be a suitable biomarker or therapeutic target for the disease.

Background: Liver cirrhosis often leads to significant impairments in functional capacity, which are associated with disease severity and prognosis. Simple, reliable, and low-cost tests are essential to monitor these patients in clinical practice. The 6-min walk test (6MWT) is widely used in other chronic conditions, but its measurement properties in cirrhosis remain underexplored.

Aim: To assess the reliability of the 6MWT in patients with liver cirrhosis (LC).

Methods: This cross-sectional study was conducted at a teaching hospital in Juiz de Fora-Minas Gerais. Patients diagnosed with LC at any stage of the disease and under clinical follow-up were included. Patients with grade 2 or higher encephalopathy, respiratory, and/or musculoskeletal diseases or who did not understand the test were excluded. Initially, anamnesis and anthropometric evaluation were performed, followed by the 6MWT. After 24 h the test was repeated. Descriptive statistics were used to present the data. Continuous variables were tested for normality using the Shapiro-Wilk test. The reliability of the 6MWT was tested through Bland-Altman analysis, typical error of measurement, and intraclass correlation coefficient (ICC) as well as a one-sample t-test. A paired Student's t-test was used to check for differences between means, and Pearson's correlation coefficient was used to verify the relationship between the two moments [first 6MWT (6MWT-1) and second 6MWT (6MWT-2)].

Results: The mean difference between 6MWT-2 and 6MWT-1 was -18.9 m; the lower limit of the Bland-Altman agreement was -83.5 m, and the upper limit was 45.7 m. One participant was excluded from further analyses for being outside these limits. The typical error of measurement was 18.9 m. The ICC showed excellent reliability between the two tests (ICC = 0.97, 95% confidence internal: 0.90-0.99, P < 0.001). The Student's one-sample t-value was -2.35 (P = 0.03). The paired t-value was 2.35 (P = 0.03). Pearson's correlation coefficient between the 6MWT-1 and 6MWT-2 was r = 0.98 (P = 0.0001).

Conclusion: The 6MWT is a test with excellent reliability. It is safe, easy to administer, inexpensive, and can be introduced into routine practice without loss of diagnostic precision in estimating the functional capacity of patients with LC.

PANoptosis is an inflammatory programmed cell death pathway possessing critical characteristics of apoptosis, pyroptosis, and necroptosis. It is regulated by PANoptosome complexes, involves interaction between these three key programmed cell death pathways, yet is distinct from any alone. PANoptosis holds vital significance in liver-related diseases, particularly hepatocellular carcinoma (HCC). This article summarizes research on the mechanism and treatments of PANoptosis in HCC. Current research has partially elucidated PANoptosis-related mechanisms in HCC and identified several molecules modulating it. Therapeutic strategies targeting PANoptosis hold significant promise. Investigations into these critical molecules have led to the development of traditional targeted drug therapies and emerging strategies like nanotechnology-based immunocombination therapies. However, there are still challenges in the mechanistic and pharmacological studies of PANoptosis in HCC, including the bidirectional regulation of key apoptotic factors, specific molecular mechanisms, and preclinical models. This article offers a new orientation for studying the pathogenesis and potential therapeutic strategies for HCC.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common and increasingly prevalent condition in the Middle East, but its determinants in the region are underexplored. Diet and lifestyle are known to significantly influence MASLD progression.

Aim: To assess energy and nutrient intake among MASLD patients living in Qatar and evaluate their dietary patterns.

Methods: Using a cross-sectional design, 94 Arab patients with MASLD, aged ≥ 18 years, living in Qatar were studied. MASLD was diagnosed using ultrasonography, fibro scan, or elastography. Sociodemographic information was collected using a self-administered questionnaire. Dietary intake was assessed through three 24-hour recalls and a qualitative food frequency questionnaire. Energy, macro-, and micronutrient intake were analyzed using Elizabeth Stewart Hands and Associates Food Processor^® Nutrition Analysis software. Statistical analyses, including factor loadings were performed using STATA 18.

Results: Compared to recommended dietary allowance, MASLD patients had high intakes of fat, saturated fat, and cholesterol. They also showed reduced intakes of vitamin K in men, and vitamins E and A (retinol), calcium and magnesium in both genders, while selenium and sodium intakes were higher than recommendations. Three dietary patterns were identified: The 'Traditional Qatari food' pattern, the 'Prudent' pattern, and the 'Fast-food' pattern. However, no significant associations were found between these dietary patterns and body mass index or low-density lipoprotein, using adjusted regression models.

Conclusion: Findings warrant replication in longitudinal studies and call for dietary interventions to reduce energy density and enhance overall diet quality, including micronutrient intake, for MASLD prevention and management in the region.