World Journal of Hepatology最新文献

Background: Hepatic encephalopathy (HE) affects more than 30% of patients with cirrhosis. Extrahepatic portosystemic shunt (EHPSS) has been suggested to be a contributing factor to HE recurrence and mortality. Therefore, early detection and intervention in EHPSS may improve patient outcomes.

Aim: To evaluate the effects of shunt embolization on mortality and HE recurrence.

Methods: In this retrospective case-control study, 16 cirrhotic patients with HE treated at a tertiary care center from January 2012 to August 2022 were included. Outcomes in eight patients who underwent embolization of EHPSS were compared with those in eight patients receiving standard care without embolization. Data on baseline characteristics, HE recurrence, and overall survival were collected and analyzed using Kaplan-Meier and log-rank tests.

Results: Baseline characteristics were comparable between the groups. The 1-year overall survival rate was significantly higher in the treatment group (0.50) than in the control group (0.33). The HE recurrence-free rate was also higher in the treatment group (1.00) than in the control group (0.17). The median survival duration was longer in the treatment group {not reached [95% confidence interval (CI): 23.84 to not available (NA)]} than in the control group [15.02 months (95%CI: 9.86 to NA)] (P = 0.006). Similarly, the recurrence-free duration was longer in the treatment group [63.09 months (95%CI: 63.09 to NA)] than in the control group [9.21 months (95%CI: 4.47 to NA)] (P = 0.006). EHPSS embolization significantly reduced 1-year HE recurrence (hazard ratio = 0.09; 95%CI: 0.01-0.75; P = 0.026).

Conclusion: EHPSS embolization significantly improves 1-year survival and prevents recurrence of HE in cirrhotic patients. Routine computed tomography and early embolization are clinically beneficial.

Hepatocellular carcinoma (HCC) is a major global health challenge, particularly in regions with high aflatoxin B1 (AFB1) exposure. This editorial explores the mechanistic interplay between AFB1 and tissue inhibitor of metalloproteinase-3 (TIMP-3) in AFB1-related HCC. TIMP-3, frequently downregulated in HCC due to promoter methylation, is linked to increased tumor aggressiveness and poor prognosis. We propose that AFB1 induces epigenetic silencing of TIMP-3, potentially via DNA adducts and oxidative stress, exacerbating AFB1-related HCC progression. This AFB1-TIMP-3 axis highlights TIMP-3's potential as a prognostic biomarker and therapeutic target. Future research should focus on elucidating these molecular pathways and integrating TIMP-3 into clinical practice for early detection and targeted therapies in AFB1-prevalent regions.

Non-alcoholic fatty liver disease (NAFLD) is an increasingly prevalent global health concern, contributing to the development of insulin resistance, diabetes, cardiovascular disease, cirrhosis, and hepatocellular carcinoma. Since no approved drugs for the treatment of NAFLD exist, there is an urgent need for novel therapeutic strategies. Two such strategies are mitochondrial transplantation and platelet rich plasma (PRP) therapy. In preclinical NAFLD, mitochondrial transplantation alleviates steatosis by improving the hepatic imbalance between fatty acid utilization and synthesis. Moreover, it reduces excessive reactive oxygen species production and lipid peroxidation, thereby reducing inflammation and fibrosis. In contrast, PRP therapy ameliorates hepatic damage induced by xenobiotics by deactivating stellate cells, reducing fibrosis and apoptosis, and decreasing inflammation via NF-κB inhibition, while enhancing antioxidant defenses. These effects may be related to the improvement of NAFLD observed in a preclinical study. We propose that a combination of mitochondrial transplantation and PRP therapy may represent a novel approach for treating NAFLD by targeting different aspects of NAFLD in a complementary manner. We discuss the limitations of these therapies, as preclinical studies addressing NAFLD with these therapies are scarce, and there are no clinical trials in humans.

Genomic medicine has evolved significantly, merging centuries of scientific progress with modern molecular biology and clinical care. It utilizes knowledge of the human genome to enhance disease prevention, diagnosis, treatment, and potential reversal. Genomic medicine in hepatology is particularly promising due to the crucial role of the liver in several metabolic processes and its association with diseases such as metabolic dysfunction-associated steatotic liver disease, type 2 diabetes mellitus, liver cirrhosis, and cardiovascular conditions. The mid-20^th century witnessed a paradigm shift in medicine, marked by the emergence of molecular biology, which enabled a deeper understanding of gene expression and regulation. This connection between basic science and clinical practice has enhanced our knowledge of the role of gene-environment interactions in the onset and progression of liver diseases. In Latin America, including Mexico, with its genetically diverse and admixed populations, genomic medicine provides a foundation for personalized and culturally relevant health strategies. This review highlights the need for genomic medicine, examining its historical evolution, integration into hepatology in Mexico, and its potential applications in the prevention of chronic diseases. It emphasizes the importance of training in genomic literacy and interdisciplinary education in medical training, particularly in the field of hepatology, with a focus on genomic medicine expertise.

Background: The molecular mechanisms associated with semaglutide and empagliflozin in metabolic dysfunction-associated steatotic liver disease (MASLD) still require further studies to develop precise therapeutic strategies.

Aim: To investigate the effects and the mechanism of action of semaglutide and empagliflozin on MASLD in obese mice.

Methods: The experimental subjects consisted of 32 mice, which were arbitrarily allocated into four distinct groups: (1) The control group; (2) The high-fat group; (3) The Sema group; and (4) The Empa group. Mice were assessed for body weight changes, glycolipid metabolic status, inflammatory oxidative stress levels, pathology and metabolomics.

Results: Semaglutide and empagliflozin have been demonstrated to exert a substantial impact on glycolipid reduction, the amelioration of glycolipid metabolism disorders, the attenuation of inflammation and oxidative stress levels, and the restoration of the pathological structure of liver injury to a certain extent in obese mice. No statistically significant differences in the outcomes associated with MASLD were identified between the two cohorts. The results of this study demonstrated that both semaglutide and empagliflozin had the capacity to influence the levels of several lysophosphatidylcholine (LPC).

Conclusion: It has been hypothesised that the amelioration of MASLD by semaglutide and empagliflozin may be associated with a decrease in the levels of several LPCs in liver tissue.

Background: Patients and providers are often unaware of available treatment options for alcohol use disorder (AUD) and how to pursue them.

Aim: To improve AUD treatment rates using an educational video module (EVM).

Methods: Prospective single-center cohort study evaluating the impact of a novel interactive patient EVM in promoting AUD treatment among hospitalized patients with alcohol-associated liver disease. Treatment was defined as receiving medication or participating in psychosocial treatment within 30 days of discharge. Primary outcome was change in treatment rates after viewing the EVM compared to a retrospective control cohort. Secondary outcomes were predictors of receiving treatment, EVM feedback, 30-day hospital readmission, outpatient follow-up, return to alcohol use, and mortality.

Results: Forty-two patients were included. Mean age was 45 years, 50% were female, and mean model for end-stage liver disease score 15.5. After viewing the EVM, treatment rates increased for pharmacologic (50% vs 22%, P = 0.0008) and psychosocial treatment (73.8% vs 44%, P = 0.01). Return to alcohol use was significantly lower (7.9% vs 35.6%, P = 0.003). All 100% of patients would recommend the EVM.

Conclusion: EVM allows hospitalized patients to receive standardized education about AUD treatment. This may address patient and provider knowledge gaps and reduce the growing burden of alcohol-associated liver disease. Future studies should evaluate EVM in larger patient populations using a multi-center study design.

Zuo and Liu investigated the value of a novel noninvasive approach integrating biparametric magnetic resonance imaging, radiomics, deep transfer learning, and clinical factors in predicting Ki-67 risk stratification and recurrence-free survival (RFS) in hepatocellular carcinoma (HCC). The study included 198 HCC patients and utilized histopathological Ki-67 expression as the reference standard for risk stratification. The integrated multimodal model combining radiomic features, deep transfer learning signatures, and clinical factors (nonsmooth tumor margin and absence of an enhanced capsule), achieved an area under the curve of 0.92 in the training and validation cohorts for predicting high Ki-67 risk, with a sensitivity and specificity of 0.88 and 0.85, respectively. Furthermore, the model effectively stratified RFS, with median RFS of 33.53 months in the high-risk group vs 66.74 months in the low-risk group, consistent with histopathological findings that directly refer to Ki-67 stratification. The findings highlight the potential of biparametric magnetic resonance imaging-based multimodal models in noninvasive HCC prognostication, though external validation in larger cohorts is warranted. The demand for precise, noninvasive preoperative assessment tools in HCC management remains high in clinical practice.

Portal vein thrombosis (PVT) is one of the most common serious complications in patients with liver cirrhosis. The occurrence of PVT not only aggravates the condition of liver cirrhosis but can also cause several serious complications, such as portal hypertension, esophagogastric variceal bleeding, and refractory ascites. All these factors have a serious impact on patients' quality of life and prognosis. This article evaluates the current evidence on the management of PVT in cirrhosis and explores the role of direct oral anticoagulants, but data on individualized anticoagulation strategies are limited and lacking for the treatment of PVT in cirrhosis, and it is hoped that it will inform a broad range of clinicians on the treatment of cirrhosis combined with PVT.

Haemochromatosis is the most common genetic condition among people of European descent, resulting in iron overload and multi-organ dysfunction. Despite early detection and treatment advances, affected individuals experience significant morbidity impacting their quality of life (QoL). To scope the literature for QoL issues and rank them in order of relevance by professional bodies. A literature search was conducted using PubMed, EMBASE, and MEDLINE in addition to a grey literature search against the eligibility criteria up to July 2023. Inclusion criteria included original articles with data concerning symptoms and QoL in patients with haemochromatosis. Nineteen issues were identified from 47 articles and scored by a haemochromatosis special interest group using a scale of 1 to 10 (10 = highest importance). Mean scores were then calculated for each issue. Fatigue, joint pain and sexual issues were key factors associated with impaired QoL. The least relevant were weight changes and abdominal pain. Other issues raised were anxiety, the development of diabetes, and concerns about genetics and family. This is the first scoping review examining common symptoms affecting QoL of patients with hereditary haemochromatosis. Further studies, including patient interviews and a randomised controlled trial, will inform a validated QoL questionnaire.

Background: Synchronous double primary malignancies of the gallbladder and liver are exceedingly rare clinically and prone to misdiagnosis as metastatic lesions. Due to anatomic contiguity and overlapping imaging characteristics, distinguishing primary carcinomas from metastatic disease is challenging, often delaying curative-intent treatment. Current lack of consensus on management underscores the imperative to investigate their pathologic features and individualized strategies for improved prognostication.

Case summary: This study presents a rare case of synchronous double primary malignancies involving both gallbladder adenocarcinoma and hepatocellular carcinoma. Following a comprehensive analysis of the patient's diagnostic workup, therapeutic interventions, and 12-month follow-up outcome, the clinicopathological characteristics and prognostic determinants of such synchronous malignancies are described. These findings offer valuable guidance for clinicians in optimizing diagnostic strategies and treatment decision-making for complex presentations of multiple primary cancers.

Conclusion: The critical insights obtained from this case, integrated with a review of current literature, identify the key diagnostic challenges in differentiating primary vs metastatic lesions and propose a multidisciplinary management framework.