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Utilization of Contrast-Enhanced Ultrasound in Diagnosis of Focal Liver Lesions. 利用对比增强超声波诊断肝脏病灶。
IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-24 eCollection Date: 2024-01-01 DOI: 10.1155/2024/3879328
Fady Salama, Nimish Thakral, Christina Delacruz Leyson, Venkata Konjeti, Karim Benrajab, Gregory Hawk, Harrison Fouch, Roberto Gedaly, Aman Khurana

Background and aims: Focal liver lesions (FLL) are one of the most common indications for hepatology and hepatobiliary surgery consultation. In this retrospective study, we aim to assess if contrast-enhanced ultrasound (CEUS) can address diagnostic dilemmas in the evaluation of indeterminate liver lesions by identifying characteristics of indeterminate FLL on CEUS and correlating these with cross-sectional imaging and pathology findings. Methods: We retrospectively reviewed all patients who underwent CEUS evaluation for liver lesions over a 28-month period (Oct 2020 to Jan 2023) at the University of Kentucky. To assess the relationship between CEUS results and the corresponding CT, MRI, and/or pathologic findings, the McNemar-Bowker tests were performed. Results: Twenty-nine patients were included (after two exclusions from a total n of 31). Mean age was 54 years, 62% were female, and 48% had underlying cirrhosis. Of the 29 patients with initial cross-sectional imaging, the initial results showed malignancy or likely malignant lesion in 6 patients and benign or likely benign lesion in 6 patients. The remaining 17 patients had inconclusive/indeterminate results. CEUS clarified an "indeterminate" CT/MRI result 15 times out of 17 (88.2%), moving the diagnosis to "benign" 11 times while suggesting "malignant" only four times. When aggregating indeterminate cross-sectional results with either benign or malignant categories suggested by CEUS, CEUS never reversed a benign CT/MRI diagnosis but often reversed a malignant CT/MRI diagnosis. Conclusion: CEUS provided a definitive diagnosis of indeterminate liver lesions in approximately 90% of patients and avoided the need for biopsy in most patients. In cases where the liver lesions were biopsied, CEUS accurately distinguished malignant versus benign lesions as confirmed by biopsy findings. CEUS, therefore, has the potential to provide a precise diagnosis for the majority of indeterminate lesions.

背景和目的:局灶性肝脏病变(FLL)是肝脏病学和肝胆外科会诊最常见的适应症之一。在这项回顾性研究中,我们旨在评估造影剂增强超声(CEUS)是否能通过确定 CEUS 上不确定 FLL 的特征并将这些特征与横断面成像和病理结果相关联,从而解决评估不确定肝脏病变时的诊断难题。方法:我们回顾性分析了肯塔基大学在 28 个月内(2020 年 10 月至 2023 年 1 月)接受 CEUS 评估肝脏病变的所有患者。为了评估 CEUS 结果与相应 CT、MRI 和/或病理结果之间的关系,我们进行了 McNemar-Bowker 检验。结果:共纳入 29 名患者(31 人中排除了 2 人)。平均年龄为 54 岁,62% 为女性,48% 有潜在肝硬化。在29名进行初步横断面成像的患者中,初步结果显示6名患者为恶性或可能为恶性病变,6名患者为良性或可能为良性病变。其余 17 名患者的结果为不确定/不确定。17例患者中有15例(88.2%)的CT/MRI结果为 "不确定",CEUS对其进行了澄清,11次将诊断结果改为 "良性",只有4次提示 "恶性"。当将不确定的横断面结果与 CEUS 建议的良性或恶性类别汇总时,CEUS 从未逆转良性 CT/MRI 诊断,但经常逆转恶性 CT/MRI 诊断。结论:CEUS为约90%的患者提供了不确定肝脏病变的明确诊断,避免了对大多数患者进行活组织检查。在对肝脏病变进行活检的病例中,CEUS能准确区分恶性和良性病变,活检结果也证实了这一点。因此,CEUS有可能为大多数不确定的病变提供精确诊断。
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引用次数: 0
Anatomical Variations of the Gallbladder and Bile Ducts: An MRI Study. 胆囊和胆管的解剖变异:核磁共振成像研究。
IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-19 eCollection Date: 2024-01-01 DOI: 10.1155/2024/3877814
Kigundu Yason, Kirum Gonzaga Gonza, Okello Michael, Buwembo William, Ian Munabi, Kawooya Michael

Background: The anatomy of the biliary tree is complex with anatomical variations which can be found in ~50% of the patients. Purpose: Existing research on these variations primarily stems from studies in developed countries, with uncertain applicability to the Ugandan population due to noted ethnic differences in incidence rates. Objective: The study was aimed at describing the anatomical variations of the gallbladder and bile ducts. Methods: This retrospective cross-sectional study conducted at Kampala MRI Centre from January 2017 to December 2022 analyzed MRCP images and reports from 231 patients to document gallbladder and bile duct variations. Results: 53.2% of patients exhibited typical cystic duct anatomy, and 51% had Type 1 variations in intrahepatic ducts. Importantly, the study identified a significant correlation between age and common bile duct diameter. Conclusion: The findings showed various anatomical variations that were slightly higher in the study population than those reported in the literature. This study emphasizes the critical need for comprehensive knowledge to enhance surgical safety, minimize iatrogenic trauma, and improve the accuracy of diagnostic imaging and hepatobiliary procedures.

背景:胆道树的解剖结构复杂,约有 50% 的患者存在解剖变异。目的:有关这些变异的现有研究主要源自发达国家的研究,由于在发病率方面存在明显的种族差异,因此无法确定这些研究是否适用于乌干达人口。研究目的本研究旨在描述胆囊和胆管的解剖变异。研究方法这项回顾性横断面研究于 2017 年 1 月至 2022 年 12 月在坎帕拉磁共振成像中心进行,分析了 231 名患者的 MRCP 图像和报告,以记录胆囊和胆管的变异。结果:53.2%的患者表现出典型的胆囊管解剖结构,51%的患者肝内胆管存在1型变异。重要的是,研究发现年龄与胆总管直径之间存在显著相关性。结论研究结果显示,研究人群中的各种解剖变异略高于文献报道。本研究强调了对全面知识的迫切需要,以提高手术安全性,最大限度地减少先天性创伤,并提高诊断成像和肝胆手术的准确性。
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引用次数: 0
The Role of Gut Microbiota Modification in Nonalcoholic Fatty Liver Disease Treatment Strategies. 肠道微生物群改变在非酒精性脂肪肝治疗策略中的作用。
IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-16 eCollection Date: 2024-01-01 DOI: 10.1155/2024/4183880
Hessam Yaghmaei, Amirhossein Bahanesteh, Masood Soltanipur, Sobhan Takaloo, Mahdi Rezaei, Seyed Davar Siadat

One of the most common chronic liver diseases is nonalcoholic fatty liver disease (NAFLD), which affects many people around the world. Gut microbiota (GM) dysbiosis seems to be an influential factor in the pathophysiology of NAFLD because changes in GM lead to fundamental changes in host metabolism. Therefore, the study of the effect of dysbiosis on the pathogenicity of NAFLD is important. European clinical guidelines state that the best advice for people with NAFLD is to lose weight and improve their lifestyle, but only 40% of people can achieve this goal. Accordingly, it is necessary to provide new treatment approaches for prevention and treatment. In addition to dietary interventions and lifestyle modifications, GM modification-based therapies are of interest. These therapies include probiotics, synbiotics, fecal microbiota transplantation (FMT), and next-generation probiotics. All of these treatments have had promising results in animal studies, and it can be imagined that acceptable results will be obtained in human studies as well. However, further investigations are required to generalize the outcomes of animal studies to humans.

非酒精性脂肪肝(NAFLD)是最常见的慢性肝病之一,影响着世界各地的许多人。肠道微生物群(GM)失调似乎是非酒精性脂肪肝病理生理学的一个影响因素,因为肠道微生物群的变化会导致宿主新陈代谢发生根本性变化。因此,研究菌群失调对非酒精性脂肪肝致病性的影响非常重要。欧洲临床指南指出,对非酒精性脂肪肝患者的最佳建议是减轻体重和改善生活方式,但只有 40% 的人能实现这一目标。因此,有必要提供新的预防和治疗方法。除了饮食干预和生活方式调整外,基于基因改造的疗法也备受关注。这些疗法包括益生菌、合成益生菌、粪便微生物群移植(FMT)和新一代益生菌。所有这些疗法在动物实验中都取得了可喜的成果,可以想象在人体实验中也会取得可接受的结果。然而,要将动物实验的结果推广到人类身上,还需要进一步的研究。
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引用次数: 0
Evaluation of Noninvasive Tools for Predicting Esophageal Varices in Patients With Cirrhosis at Tygerberg Hospital, Cape Town. 评估用于预测开普敦泰格贝格医院肝硬化患者食管静脉曲张的无创工具。
IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-11 eCollection Date: 2024-01-01 DOI: 10.1155/2024/9952610
Lawrence Kwape, Shiraaz Gabriel, Ahmad Abdelsalem, Penelope Rose, Lefika Bathobakae, Dale Peterson, Desiree Moodley, Mohammed Parker, Saadiq Moolla, Arifa Parker, Keatlaretse Siamisang, Christoffel Van Rensburg, Ernst Fredericks
<p><p><b>Background:</b> In patients with cirrhosis, esophageal variceal hemorrhage (EVH) is a devastating consequence of portal hypertension (PH). Upper endoscopy is considered the gold standard for the detection and diagnosis of esophageal varices (EVs), despite being invasive and costly. This study was aimed at identifying and evaluating the diagnostic accuracy of noninvasive tools in predicting EVs in patients with compensated cirrhosis. <b>Methods:</b> This cross-sectional study included 50 patients with compensated cirrhosis at the Tygerberg Hospital Gastroenterology Clinic in Cape Town between November 2022 and May 2023. We collected clinical, anthropometric, and laboratory data from patients' physical and electronic charts. All patients underwent an abdominal ultrasound, vibration-controlled transient elastography (VCTE) to assess liver and splenic stiffness, and upper endoscopy. In this comparative study, we evaluated the diagnostic accuracy of different noninvasive tools in detecting EVs in patients with compensated cirrhosis. <b>Results:</b> Of the 50 patients included in the study, 30 (60%) were female and 20 (40%) were male. The patients' age ranged from 18 to 83, with a mean age of 46.6 years. Cirrhosis was mainly due to alcohol use (<i>n</i> = 11, 22%), hepatitis B virus (HBV) infection (<i>n</i> = 11, 22%), and autoimmune hepatitis (<i>n</i> = 10, 20%). The patients included in the study were divided into two subgroups: with (<i>n</i> = 34, 68%) or without (<i>n</i> = 16, 32%) EVs. Statistically significant differences were detected between groups in platelet count (PC), liver stiffness measurement (LSM), spleen stiffness measurement (SSM), portal vein diameter (PVD), bipolar spleen diameter (SBD), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4), platelet/bipolar spleen diameter ratio (PSR), liver stiffness-spleen size-platelet ratio (LSPS), liver stiffness-spleen stiffness-platelet ratio score (LS<sup>3</sup>PS), and spleen stiffness-spleen size-platelet ratio score (SSPS) (<i>p</i> < 0.001). The highest diagnostic precision was observed with SSM (96%), SSPS (96%), LS<sup>3</sup>PS (94%), LSPS (94%), PSR (94%), and PC (92%). SBD (88%), LSM (86%), APRI (82%), and FIB-4 (82%) had the lowest diagnostic accuracy. <b>Conclusion</b>: SSM and SSPS have the highest diagnostic accuracy for predicting the presence of EVs in patients with compensated cirrhosis. LSPS, LS<sup>3</sup>PS, and PSR come second at 94%. We recommend SSM and SSPS in institutions with transient elastography equipped with the software necessary to measure splenic stiffness. We introduce and propose LS<sup>3</sup>PS as a novel composite score for predicting the presence of EVs in patients with compensated cirrhosis. Large-sample-size studies are needed to validate these prediction scores and to allow direct comparison with Baveno VII. These prediction tools can help clinicians avoid unnecessary endoscopic procedures in patients with
背景:在肝硬化患者中,食管静脉曲张出血(EVH)是门静脉高压症(PH)的一种破坏性后果。上消化道内窥镜被认为是检测和诊断食管静脉曲张(EVs)的金标准,尽管它具有侵入性且费用昂贵。本研究旨在确定和评估无创工具在预测代偿期肝硬化患者食管静脉曲张方面的诊断准确性。研究方法这项横断面研究纳入了 2022 年 11 月至 2023 年 5 月期间在开普敦 Tygerberg 医院消化内科门诊就诊的 50 名代偿期肝硬化患者。我们从患者的体格检查和电子病历中收集了临床、人体测量和实验室数据。所有患者都接受了腹部超声波检查、振动控制瞬态弹性成像(VCTE)以评估肝脏和脾脏的硬度,以及上内镜检查。在这项比较研究中,我们评估了不同无创工具在检测代偿期肝硬化患者 EVs 方面的诊断准确性。研究结果在纳入研究的 50 名患者中,30 名(60%)为女性,20 名(40%)为男性。患者年龄从18岁到83岁不等,平均年龄为46.6岁。肝硬化的主要原因是酗酒(11 人,22%)、乙型肝炎病毒(HBV)感染(11 人,22%)和自身免疫性肝炎(10 人,20%)。参与研究的患者被分为两个亚组:有 EVs(34 人,占 68%)或无 EVs(16 人,占 32%)。在血小板计数(PC)、肝脏硬度测量(LSM)、脾脏硬度测量(SSM)、门静脉直径(PVD)、双极脾脏直径(SBD)、天门冬氨酸氨基转移酶与血小板比值指数(APRI)等指标上,发现组间存在明显统计学差异、纤维化-4 指数(FIB-4)、血小板/双极脾直径比值(PSR)、肝硬度-脾大小-血小板比值(LSPS)、肝硬度-脾硬度-血小板比值评分(LS3PS)和脾硬度-脾大小-血小板比值评分(SSPS)(P < 0.001).诊断精确度最高的是 SSM(96%)、SSPS(96%)、LS3PS(94%)、LSPS(94%)、PSR(94%)和 PC(92%)。SBD(88%)、LSM(86%)、APRI(82%)和 FIB-4(82%)的诊断精确度最低。结论SSM 和 SSPS 预测代偿期肝硬化患者体内存在 EVs 的诊断准确率最高。其次是 LSPS、LS3PS 和 PSR,准确率为 94%。我们建议拥有瞬态弹性成像技术并配备了测量脾脏硬度所需软件的机构采用 SSM 和 SSPS。我们提出并建议将 LS3PS 作为预测代偿期肝硬化患者是否存在 EVs 的新型综合评分。需要进行大样本量的研究来验证这些预测评分,并与 Baveno VII 进行直接比较。这些预测工具可以帮助临床医生避免对代偿期肝硬化患者进行不必要的内镜手术,尤其是在南非等资源有限的发展中国家。
{"title":"Evaluation of Noninvasive Tools for Predicting Esophageal Varices in Patients With Cirrhosis at Tygerberg Hospital, Cape Town.","authors":"Lawrence Kwape, Shiraaz Gabriel, Ahmad Abdelsalem, Penelope Rose, Lefika Bathobakae, Dale Peterson, Desiree Moodley, Mohammed Parker, Saadiq Moolla, Arifa Parker, Keatlaretse Siamisang, Christoffel Van Rensburg, Ernst Fredericks","doi":"10.1155/2024/9952610","DOIUrl":"https://doi.org/10.1155/2024/9952610","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; In patients with cirrhosis, esophageal variceal hemorrhage (EVH) is a devastating consequence of portal hypertension (PH). Upper endoscopy is considered the gold standard for the detection and diagnosis of esophageal varices (EVs), despite being invasive and costly. This study was aimed at identifying and evaluating the diagnostic accuracy of noninvasive tools in predicting EVs in patients with compensated cirrhosis. &lt;b&gt;Methods:&lt;/b&gt; This cross-sectional study included 50 patients with compensated cirrhosis at the Tygerberg Hospital Gastroenterology Clinic in Cape Town between November 2022 and May 2023. We collected clinical, anthropometric, and laboratory data from patients' physical and electronic charts. All patients underwent an abdominal ultrasound, vibration-controlled transient elastography (VCTE) to assess liver and splenic stiffness, and upper endoscopy. In this comparative study, we evaluated the diagnostic accuracy of different noninvasive tools in detecting EVs in patients with compensated cirrhosis. &lt;b&gt;Results:&lt;/b&gt; Of the 50 patients included in the study, 30 (60%) were female and 20 (40%) were male. The patients' age ranged from 18 to 83, with a mean age of 46.6 years. Cirrhosis was mainly due to alcohol use (&lt;i&gt;n&lt;/i&gt; = 11, 22%), hepatitis B virus (HBV) infection (&lt;i&gt;n&lt;/i&gt; = 11, 22%), and autoimmune hepatitis (&lt;i&gt;n&lt;/i&gt; = 10, 20%). The patients included in the study were divided into two subgroups: with (&lt;i&gt;n&lt;/i&gt; = 34, 68%) or without (&lt;i&gt;n&lt;/i&gt; = 16, 32%) EVs. Statistically significant differences were detected between groups in platelet count (PC), liver stiffness measurement (LSM), spleen stiffness measurement (SSM), portal vein diameter (PVD), bipolar spleen diameter (SBD), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4), platelet/bipolar spleen diameter ratio (PSR), liver stiffness-spleen size-platelet ratio (LSPS), liver stiffness-spleen stiffness-platelet ratio score (LS&lt;sup&gt;3&lt;/sup&gt;PS), and spleen stiffness-spleen size-platelet ratio score (SSPS) (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The highest diagnostic precision was observed with SSM (96%), SSPS (96%), LS&lt;sup&gt;3&lt;/sup&gt;PS (94%), LSPS (94%), PSR (94%), and PC (92%). SBD (88%), LSM (86%), APRI (82%), and FIB-4 (82%) had the lowest diagnostic accuracy. &lt;b&gt;Conclusion&lt;/b&gt;: SSM and SSPS have the highest diagnostic accuracy for predicting the presence of EVs in patients with compensated cirrhosis. LSPS, LS&lt;sup&gt;3&lt;/sup&gt;PS, and PSR come second at 94%. We recommend SSM and SSPS in institutions with transient elastography equipped with the software necessary to measure splenic stiffness. We introduce and propose LS&lt;sup&gt;3&lt;/sup&gt;PS as a novel composite score for predicting the presence of EVs in patients with compensated cirrhosis. Large-sample-size studies are needed to validate these prediction scores and to allow direct comparison with Baveno VII. These prediction tools can help clinicians avoid unnecessary endoscopic procedures in patients with ","PeriodicalId":46297,"journal":{"name":"International Journal of Hepatology","volume":"2024 ","pages":"9952610"},"PeriodicalIF":1.5,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11410406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of Renal Replacement Therapy on Outcomes of Living Donor Liver Transplantation for Acute Liver Failure: A Cohort Study. 肾脏替代疗法对急性肝功能衰竭活体肝移植疗效的影响:队列研究
IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-05 eCollection Date: 2024-01-01 DOI: 10.1155/2024/8422308
Abu Bakar Hafeez Bhatti, Nauman Ul Haq, Nayyer Mehmood, Danyal Hassan, Arsalan Ahmed, Wasim Tariq Malik, Haseeb Haider Zia, Mohammad Salih, Nusrat Yar Khan, Abid Ilyas, Nasir Ayub Khan

Despite the promising role of renal replacement therapy (RRT) in acute liver failure (ALF), high-risk patients need liver transplantation and remain at risk for death due to cerebral complications. The objective of this study was to report outcomes of living donor liver transplantation (LDLT) for ALF with perioperative RRT. This was a single-center retrospective cohort study. Out of 1167 LDLTs, 24 patients had ALF and met the King's College criteria for transplantation. They were categorized into no-RRT (n = 13) and RRT (n = 11) groups. We looked at 1-year posttransplant survival in these patients. The median serum ammonia level at the time of transplant in the no-RRT and RRT groups was 259.5 mcg/dL (222.7-398) and 70.6 mcg/dL (58.1-92.6) (p = 0.005). In the RRT group, serum ammonia level < 100 mcg/dL was achieved in all patients. Seven (53.8%) patients in the no-RRT group and 11/11 (100%) in the RRT group were extubated and regained full consciousness after LDLT (p = 0.013). The 90-day mortality was 6/13 (46.1%) and 2/11 (18.1%) (p = 0.211). There was no brainstem herniation-related mortality in the RRT group, that is, 5/13 (38.4%) and 0/11 (0%) (p = 0.030). The 1-year posttransplant survival was also significantly higher in the RRT group (p = 0.031). The use of RRT lowers serum ammonia levels and might reduce posttransplant mortality due to brainstem herniation.

尽管肾脏替代疗法(RRT)在急性肝衰竭(ALF)中的作用前景广阔,但需要进行肝脏移植的高危患者仍有可能因脑部并发症而死亡。本研究的目的是报告围手术期RRT活体肝移植(LDLT)治疗ALF的结果。这是一项单中心回顾性队列研究。在1167例LDLT中,有24例患者患有ALF并符合国王学院的移植标准。他们被分为无 RRT 组(13 人)和 RRT 组(11 人)。我们观察了这些患者移植后 1 年的存活率。无 RRT 组和 RRT 组移植时的血清氨水平中位数分别为 259.5 mcg/dL (222.7-398) 和 70.6 mcg/dL (58.1-92.6) (p = 0.005)。在 RRT 组,所有患者的血清氨水平均小于 100 mcg/dL。无 RRT 组中有 7 名患者(53.8%)和 RRT 组中有 11/11 名患者(100%)在 LDLT 后拔管并完全恢复意识(p = 0.013)。90天死亡率分别为6/13(46.1%)和2/11(18.1%)(p = 0.211)。RRT 组没有脑干疝相关死亡率,即 5/13 例(38.4%)和 0/11 例(0%)(p = 0.030)。RRT 组的移植后 1 年存活率也明显更高(p = 0.031)。使用RRT可降低血清氨水平,并可能降低因脑干疝导致的移植后死亡率。
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引用次数: 0
miRNA-221: A Potential Biomarker of Progressive Liver Injury in Chronic Liver Disease (CLD) due to Hepatitis B Virus (HBV) and Nonalcoholic Fatty Liver Disease (NAFLD). miRNA-221:乙型肝炎病毒(HBV)所致慢性肝病(CLD)和非酒精性脂肪肝(NAFLD)中渐进性肝损伤的潜在生物标志物
IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-08-16 eCollection Date: 2024-01-01 DOI: 10.1155/2024/4221368
Parthana Rani Sutradhar, Nahida Sultana, Afzalun Nessa

Background: Early detection of progressive liver damage in chronic liver disease (CLD) patients is crucial for better treatment response. Several studies have shown the association of microRNA (miRNA) in the progression of CLD in regulating cell proliferation, fibrosis, and apoptosis as well as in carcinogenesis. Objectives: The study was aimed at determining the expression of miRNA-221 among different stages of fibrosis in CLD patients due to hepatitis B virus (HBV) and nonalcoholic fatty liver disease (NAFLD) and thus evaluate its role as an early biomarker in CLD. Methods: A total of 100 participants (75 CLD patients and 25 healthy control) were recruited in this cross-sectional study and divided into four groups, of which 25 as healthy control, 25 in CLD without fibrosis, 25 were CLD with fibrosis, and 25 were CLD with cirrhosis. Total RNA was extracted from plasma followed by cDNA synthesis, and finally, the expression of miRNA-221 was analyzed for its diagnostic potential as a single biomarker using the qRT-PCR method. Results: The plasma level of miRNA-221 was significantly upregulated in different fibrosis stages of CLD (p < 0.05), and this upregulation was positively correlated with the progression of fibrosis (p < 0.05). Significantly increased expression of miRNA-221 was found in NAFLD patients compared to HBV patients in the CLD without fibrosis patient group (p < 0.05), while expression of miRNA-221 was significantly upregulated among HBV patients in the CLD with the fibrosis group. miRNA-221 showed high diagnostic accuracy in discriminating different stages of fibrosis from healthy control (p < 0.05). Conclusion: miRNA-221 may be used as a potential plasma biomarker for early prediction of fibrosis progression in CLD patients.

背景:及早发现慢性肝病(CLD)患者肝脏的进展性损伤对于改善治疗反应至关重要。多项研究表明,微小核糖核酸(miRNA)在调节细胞增殖、纤维化、细胞凋亡和癌变方面与慢性肝病的进展有关。研究目的本研究旨在确定 miRNA-221 在乙型肝炎病毒(HBV)和非酒精性脂肪肝(NAFLD)导致的 CLD 患者不同纤维化阶段的表达情况,从而评估其作为 CLD 早期生物标志物的作用。研究方法这项横断面研究共招募了 100 名参与者(75 名 CLD 患者和 25 名健康对照组),并将其分为四组,其中 25 名健康对照组、25 名无纤维化的 CLD 患者、25 名有纤维化的 CLD 患者和 25 名有肝硬化的 CLD 患者。从血浆中提取总RNA,然后合成cDNA,最后用qRT-PCR方法分析miRNA-221作为单一生物标志物的诊断潜力。结果显示在CLD的不同纤维化阶段,血浆中miRNA-221的水平显著上调(P<0.05),并且这种上调与纤维化的进展呈正相关(P<0.05)。在无纤维化的CLD患者组中,与HBV患者相比,非酒精性脂肪肝患者的miRNA-221表达显著增加(p < 0.05),而在有纤维化的CLD患者组中,HBV患者的miRNA-221表达显著上调。miRNA-221在区分不同阶段的纤维化与健康对照方面表现出很高的诊断准确性(p < 0.05)。结论:miRNA-221 可作为一种潜在的血浆生物标记物,用于早期预测 CLD 患者的纤维化进展。
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引用次数: 0
Survival and Disease Progression in Older Adult Patients With Cirrhosis: A Retrospective Study. 老年肝硬化患者的生存期和疾病进展:回顾性研究
IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-08-08 eCollection Date: 2024-01-01 DOI: 10.1155/2024/5852680
Khaled Al-Smadi, Ammar Qureshi, Michelle Buitrago, Besher Ashouri, Zeid Kayali

Background: Cirrhosis incidence in older adult patients has been increasing with limited data on their survival. This study is aimed at investigating the survival and disease progression in older adult patients with cirrhosis compared to younger patients. Methods: This is a retrospective single-center study. Patients aged above 50 with a confirmed diagnosis of cirrhosis based on biopsy, FibroSure test, splenomegaly, and low platelets < 120 × 109/L) or imaging findings including FibroScan were included. Patients with active substance abuse, transjugular intrahepatic portosystemic shunt (TIPS), prior spontaneous bacterial peritonitis (SBP), variceal hemorrhage, model for end-stage liver disease-Na (MELD - Na) ≥ 20, had liver transplantation, malignancy except for squamous cell carcinoma, and other comorbidities such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and end-stage kidney disease with glomerular filtration rate (GFR) < 30 were excluded. Patients' records from the liver clinic were reviewed and demographics, laboratory, and compensation and decompensation status were collated. Patients were separated into two groups based on age 50-64 years and age ≥ 65. The primary endpoint was death, and the secondary endpoint was disease progression measured by the baseline to 12-month increase in MELD-Na score. The Kaplan-Meier analysis was conducted to compare the survival between the two groups. Cox regression analysis was performed to identify independent risk factors for poor survival. Results: A total of 191 patients diagnosed with cirrhosis met the inclusion and exclusion criteria. There were 80 patients aged 50-64 years and 111 patients aged ≥ 65 years. Significantly shorter survival times were seen among patients aged ≥ 65 years compared to those aged 50-64 years (73.3 ± 4.8 vs. 151.5 ± 22.7; p < .001). Age of diagnosis ≥ 65 years (p < 0.001), male gender (p = .013), body mass index (BMI) < 30 (p = 0.005), and decompensation (p = 0.008) were found to be independent risk factors for poor survival. MELD-Na scores increased significantly in 12 months of follow-up from baseline, but only in patients with decompensated cirrhosis (p = 0.013). Conclusions: Cirrhotic patients aged ≥ 65 years have significantly poor survival compared to younger patients. A prospective study is needed to further investigate the effect of age and obesity on survival and disease progression in older adult patients with cirrhosis.

背景:老年肝硬化患者的发病率越来越高,但有关其存活率的数据却很有限。本研究旨在调查与年轻患者相比,老年肝硬化患者的存活率和疾病进展情况。研究方法这是一项回顾性单中心研究。纳入的患者年龄在 50 岁以上,根据活检、FibroSure 检测、脾脏肿大、血小板低 < 120 × 109/L)或包括 FibroScan 在内的影像学检查结果确诊为肝硬化。滥用药物、经颈静脉肝内门体分流术(TIPS)、自发性细菌性腹膜炎(SBP)、静脉曲张出血、终末期肝病模型-Na(MELD - Na)≥20、接受过肝移植的患者、排除恶性肿瘤(鳞状细胞癌除外),以及其他合并症,如充血性心力衰竭(CHF)、慢性阻塞性肺病(COPD)和肾小球滤过率(GFR)小于 30 的终末期肾病。研究人员查阅了患者在肝脏门诊的病历,并对人口统计学、实验室、补偿和失代偿状况进行了整理。根据 50-64 岁和≥65 岁将患者分为两组。主要终点是死亡,次要终点是疾病进展,以 MELD-Na 评分从基线到 12 个月的增加来衡量。对两组患者的生存率进行了卡普兰-梅耶尔分析比较。进行了 Cox 回归分析,以确定导致生存率低下的独立风险因素。结果共有 191 名肝硬化患者符合纳入和排除标准。其中 50-64 岁患者 80 人,≥ 65 岁患者 111 人。与 50-64 岁的患者相比,年龄≥ 65 岁的患者生存时间明显较短(73.3 ± 4.8 vs. 151.5 ± 22.7; p < .001)。研究发现,确诊年龄≥ 65 岁(p < 0.001)、男性(p = .013)、体重指数(BMI)< 30(p = 0.005)和失代偿(p = 0.008)是生存率低的独立危险因素。从基线开始随访 12 个月后,MELD-Na 评分显著增加,但只有失代偿期肝硬化患者的 MELD-Na 评分显著增加(p = 0.013)。结论与年轻患者相比,年龄≥ 65 岁的肝硬化患者生存率明显较低。需要进行前瞻性研究,进一步探讨年龄和肥胖对老年肝硬化患者生存和疾病进展的影响。
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引用次数: 0
Macrophage-2-Binding Protein Glycosylation Isomer (M2BPGi) and AGAP Score as Markers of Noninvasive Test for Liver Fibrosis versus FibroScan in Chronic Hepatitis B Patients: A Retrospective Observational Study. 将巨噬细胞-2 结合蛋白糖基化异构体 (M2BPGi) 和 AGAP 评分作为慢性乙型肝炎患者肝纤维化无创检测与纤维扫描对比的标志物:一项回顾性观察研究
IF 1.8 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-29 eCollection Date: 2024-01-01 DOI: 10.1155/2024/6635625
Laila Kurnia Pramono, Anna Tjandrawati, Dewi Kartika Turbawaty, Tiene Rostini, Muhammad Begawan Bestari, Haryono, Deny Budiman, Prapanca Nugraha

Background: Liver biopsy as the gold standard for assessing the degree and diagnosis of fibrosis still has significant drawbacks, which make the emergence of a much less invasive diagnostic marker possible. M2BPGi levels and the AGAP score, the two newest serological markers, are known to have good sensitivity for detecting liver fibrosis. This study is aimed at determining the validity of examining M2BPGi levels and AGAP scores on the Fibroscan examination as markers of noninvasive test for liver fibrosis in chronic hepatitis B patients.

Methods: This is an observational, descriptive study with a retrospective design. This study used secondary data taken from medical records and blood specimen research materials of outpatients at the Hepatology Gastroenterology Polyclinic at a tertiary general hospital in West Java, Indonesia, with a diagnosis of chronic hepatitis B.

Results: There were 109 research subjects included. There were 73 (66.9%) subjects with no- or low-grade fibrosis and 36 (33.1%) with advanced fibrosis. The sensitivity and specificity of the M2BPGi were 88.9% and 61.6% (PPV 55.3%; NPV 91.8%; AUC 0.753), while the AGAP score was 47.2% and 100% (PPV 100%; NPV 79.3%; AUC 0.736). The combined M2BPGi level and the AGAP score showed a sensitivity of 80.9% and a specificity of 100% (PPV 100%; NPV 91.8%; AUC 0.905).

Conclusion: The AGAP score and M2BPGi levels together are a better way to measure the degree of liver fibrosis in people with chronic hepatitis B than either M2BPGi or the AGAP score alone.

背景:肝活检作为评估肝纤维化程度和诊断肝纤维化的金标准仍有很大缺陷,这使得一种创伤性更小的诊断标记物的出现成为可能。众所周知,M2BPGi 水平和 AGAP 评分这两种最新的血清学标记物在检测肝纤维化方面具有良好的灵敏度。本研究旨在确定将纤维扫描检查中的 M2BPGi 水平和 AGAP 评分作为慢性乙型肝炎患者肝纤维化无创检测指标的有效性:这是一项观察性、描述性研究,采用回顾性设计。本研究使用的二手数据来自印度尼西亚西爪哇省一家三级综合医院肝病消化科综合门诊诊断为慢性乙型肝炎患者的病历和血液标本研究资料:共纳入 109 名研究对象。73人(66.9%)为无或低度纤维化,36人(33.1%)为晚期纤维化。M2BPGi的敏感性和特异性分别为88.9%和61.6%(PPV 55.3%; NPV 91.8%; AUC 0.753),而AGAP评分的敏感性和特异性分别为47.2%和100%(PPV 100%; NPV 79.3%; AUC 0.736)。M2BPGi水平和AGAP评分的综合灵敏度为80.9%,特异性为100%(PPV 100%;NPV 91.8%;AUC 0.905):结论:与单独使用 M2BPGi 或 AGAP 评分相比,联合使用 AGAP 评分和 M2BPGi 水平能更好地测量慢性乙型肝炎患者的肝纤维化程度。
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引用次数: 0
The Efficacy of On-Site Integration Screening and Microelimination Programs for Chronic Hepatitis C in a Detection Center: A Comparison of the Treatment Outcomes and Characteristics of Incarcerated Patients and Outpatients. 检测中心慢性丙型肝炎现场综合筛查和微量消除计划的有效性:被监禁患者和门诊患者的治疗结果和特征比较。
IF 1.8 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-03-13 eCollection Date: 2024-01-01 DOI: 10.1155/2024/3184892
Hsuan-Yuan Chang, Su-Hung Wang, Hsing-Tao Kuo, Ming-Jen Sheu, I-Che Feng, Chung-Han Ho, Jui-Yi Chen, Chi-Shu Sun, Chi-Hsing Chen, Cheng-Yi Lin, Chun-Chi Yang

We aimed to analyze the different patient characteristics and treatment outcomes (such as sustained viral response, SVR) between incarcerated patients with chronic hepatitis C (CHC) and those with CHC from the outpatient department through an on-site integrated screening and microelimination program in a detection center. In this retrospective study, which ran from May 2021 to April 2022, we included 32 consenting male prisoners aged at least 20 years who were willing to participate in the study. Members of the control group (who received DAAs in an outpatient setting) were selected from the treated CHC patient databank of individuals who received DAA regimens at Chi Mei Hospital between January 2021 and December 2022. The patients in the two groups did not differ significantly in terms of age, FIB-4 score, HCV RNA, HBV coinfection, hemogram findings, coagulation profiles, and renal function tests. However, the patients in the incarcerated group had a significantly different genotype distribution compared to the control group, significantly lower liver enzyme levels, and higher albumin and bilirubin levels compared to those in the control group. The rate of SVR to DAA treatment obtained among incarcerated patients did not differ significantly from that obtained among patients in the control group. Loss to follow-up (for several reasons) is a major reason for treatment discontinuation among these patients.

我们旨在通过检测中心的现场综合筛查和微清除项目,分析被监禁的慢性丙型肝炎(CHC)患者与门诊部的CHC患者之间不同的患者特征和治疗结果(如持续病毒应答,SVR)。在这项2021年5月至2022年4月的回顾性研究中,我们纳入了32名年龄在20岁以上、愿意参加研究的男性囚犯。对照组(在门诊环境中接受DAA治疗)的成员是从接受治疗的CHC患者数据库中挑选出来的,这些患者在2021年1月至2022年12月期间在奇美医院接受了DAA治疗。两组患者在年龄、FIB-4评分、HCV RNA、HBV合并感染、血图结果、凝血功能和肾功能检查方面没有明显差异。然而,与对照组相比,监禁组患者的基因型分布明显不同,肝酶水平明显较低,白蛋白和胆红素水平较高。监禁患者接受 DAA 治疗的 SVR 率与对照组患者相比没有明显差异。失去随访(出于多种原因)是这些患者中断治疗的主要原因。
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引用次数: 0
Severe Hepatotoxicity in Mushroom Poisoning by Lepiota brunneoincarnata from Complete Recovery to Liver Transplantation: A Case Series with Review on Liver Function Tests and Liver Histopathology. 从完全康复到肝移植的蘑菇中毒严重肝中毒:肝功能测试和肝组织病理学回顾:一个病例系列。
IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-22 eCollection Date: 2024-01-01 DOI: 10.1155/2024/2797712
Mohammad Hossein Anbardar, Neda Soleimani, Kourosh Kazemi, Zahra Jafarpour, Mahsa Hasani, Sahand Mohammadzadeh, Parnia Torfehnezhad, Sedighe Jafarian, Mahsa Farhadi, Mina Salari Sardari

Background: In spite of the scientific evidence supporting health advantages of mushrooms, some of them are seriously poisonous. The clinical picture of mushroom intoxication ranges from minor gastrointestinal symptoms to organ failure, such as liver failure and death.

Method: We provided demographics, clinicopathological characteristics, applied treatments, and outcomes of mushroom poisoning by Lepiota species in a series of 18 cases that were referred from Kermanshah and Lorestan provinces to Abu-Ali-Sina Hospital, Shiraz, Iran. Clinical and paraclinical data were collected by taking history and reviewing of medical documents. Pathologic findings were extracted through a review of hematoxylin and eosin pathologic slides.

Results: The patients were between the ages of 18 and 67 years, composed of ten females and eight males. The most frequent clinical manifestations were nausea and vomiting followed by abdominal pain. Four cases presented decreased consciousness on admission. One of them passed away. Three other cases underwent liver transplantation, two of them died after transplantation, and one fully recovered without any major issues. All instances had elevated ALT levels, which ranged from 44 to 9,140 IU/L (mean: 3259 ± 2476), with most of them also having concurrent AST elevations (mean: 1,361 ± 1,532). Only few patients had modest elevations in alkaline phosphatase. Total and direct bilirubin elevations up to 47.6 and 24 mg/dL, respectively, were found in most cases. Decreased total protein and albumin concentrations and increased BUN and creatinine levels were observed in some patients. In addition, some instances revealed increased LDH, increased WBC, decreased hemoglobin, and decreased platelet count. Most patients had increased prothrombin time; hematuria and positive stool occult blood were observed in few patients. Histopathologic examination of three explanted livers revealed massive necrosis with moderate to severe macrovesicular steatosis, significant ductular reaction, and parenchymal inflammation. Other patients followed a recovery process with a considerable drop in liver enzymes, especially ALT, during hospitalization utilizing conservative treatment. They had no liver problems or relevant issues after a two-year follow-up.

Conclusion: In our study, highly elevated liver enzymes with a significantly high ALT/AST ratio were observed in cases of mushroom poisoning by Lepiota species, leading to fulminant liver failure and death in some cases. These laboratory findings were correlated with liver necrosis and macrovesicular steatosis in explanted livers.

背景:尽管有科学证据证明蘑菇对健康有益,但有些蘑菇却有剧毒。蘑菇中毒的临床表现从轻微的胃肠道症状到器官衰竭,如肝功能衰竭和死亡:方法:我们提供了从克尔曼沙阿省和洛雷斯坦省转诊至伊朗设拉子市 Abu-Ali-Sina 医院的 18 例蘑菇中毒患者的人口统计学特征、临床病理学特征、应用治疗方法和结果。通过询问病史和查看医疗文件收集了临床和辅助临床数据。通过查看苏木精和伊红病理切片提取病理结果:患者年龄在 18 岁至 67 岁之间,其中女性 10 人,男性 8 人。最常见的临床表现是恶心和呕吐,其次是腹痛。四例患者在入院时出现意识减退,其中一人去世。其中一人已经去世。另外三例接受了肝移植,其中两例在移植后死亡,一例完全康复,没有出现任何重大问题。所有病例的谷丙转氨酶(ALT)水平均升高,范围从 44 到 9,140 IU/L(平均值:3259 ± 2476)不等,其中大多数还同时伴有谷草转氨酶(AST)升高(平均值:1,361 ± 1,532)。只有少数患者的碱性磷酸酶略有升高。大多数患者的总胆红素和直接胆红素分别升高至 47.6 和 24 毫克/分升。一些患者的总蛋白和白蛋白浓度降低,尿素氮和肌酐水平升高。此外,一些病例还显示 LDH 升高、白细胞升高、血红蛋白降低和血小板计数减少。大多数患者的凝血酶原时间延长;少数患者出现血尿和大便潜血阳性。对三个切除的肝脏进行的组织病理学检查显示,肝脏大量坏死,伴有中度至重度大泡性脂肪变性、明显的导管反应和实质炎症。其他患者在住院期间通过保守治疗,肝酶(尤其是谷丙转氨酶)显著下降,病情得到恢复。结论:在我们的研究中,在牛肝菌中毒病例中观察到肝酶高度升高,ALT/AST 比值明显偏高,导致急性肝衰竭,部分病例死亡。这些实验室结果与肝脏坏死和大泡性脂肪变性有关。
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International Journal of Hepatology
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