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Clinical Outcomes of Drug-Eluting Bead Transarterial Chemoembolization Loaded with Raltitrexed for the Treatment of Unresectable or Recurrent Hepatocellular Carcinoma. 药物洗脱珠载雷曲塞经动脉化疗栓塞治疗不可切除或复发性肝癌的临床疗效。
IF 2.7 4区 医学 Q2 Medicine Pub Date : 2022-08-23 eCollection Date: 2022-01-01 DOI: 10.1155/2022/2602121
Yonghua Bi, Dechao Jiao, Jianzhuang Ren, Xinwei Han

Objectives: Although raltitrexed shows therapeutic effects in many types of malignant tumors, the therapeutic effects and safety of drug-eluting bead transarterial chemoembolization (DEB-TACE) loaded with raltitrexed for the treatment of hepatocellular carcinoma (HCC) are rare. This study aimed to investigate the safety and efficacy of DEB-TACE with raltitrexed-loaded CalliSpheres beads (CB) in patients with unresectable or recurrent HCC.

Methods: Between May 2018 and October 2021, 41 patients with unresectable or recurrent HCC treated by DEB-TACE loaded with raltitrexed were retrospectively enrolled. The primary end points were overall survival and progression-free survival. The response evaluation criteria in solid tumors (RECIST) criteria and modified RECIST criteria (mRECIST) were used to assess the tumor response after the DEB-TACE procedure.

Results: A total of 79 DEB-TACE procedures were successfully performed, and the technical success rate was 100%. The overall response rate and disease control rate assessed by mRECIST criteria were 76.9% and 88.5%, 62.5% and 70.8%, and 35.3% and 47.1%, respectively, at 1, 3, and 6 months postprocedure. The mean progression-free survival and overall survival were 21.6 ± 3.6 and 43.7 ± 5.8 months, respectively. The 6-, 24-, and 36-month overall survival rates were 86.8%, 62.7%, and 57.1%, respectively. Minor complications were observed in 21 patients (51.2%), with no treatment-related mortality or severe adverse events. The most common treatment-related complications were abdominal pain (48.8%) and nausea (29.3%).

Conclusion: DEB-TACE with raltitrexed-loaded CB suggests a feasible, safe, and efficacious palliative regimen in unresectable or recurrent HCC patients.

目的:虽然雷替曲塞对多种类型的恶性肿瘤均有治疗效果,但载雷替曲塞经动脉化疗栓塞(DEB-TACE)治疗肝细胞癌(HCC)的疗效和安全性尚罕见。本研究旨在探讨DEB-TACE与满载雷替曲的calispheres珠(CB)在不可切除或复发性HCC患者中的安全性和有效性。方法:在2018年5月至2021年10月期间,回顾性研究了41例经负载雷曲塞的DEB-TACE治疗的不可切除或复发性HCC患者。主要终点是总生存期和无进展生存期。采用实体瘤反应评价标准(RECIST)和修改后的RECIST标准(mRECIST)来评价DEB-TACE手术后的肿瘤反应。结果:共完成79例DEB-TACE手术,技术成功率100%。术后1个月、3个月和6个月,mRECIST标准评估的总有效率和疾病控制率分别为76.9%和88.5%,62.5%和70.8%,35.3%和47.1%。平均无进展生存期和总生存期分别为21.6±3.6个月和43.7±5.8个月。6个月、24个月和36个月的总生存率分别为86.8%、62.7%和57.1%。21例患者(51.2%)出现轻微并发症,无治疗相关死亡或严重不良事件。最常见的治疗相关并发症是腹痛(48.8%)和恶心(29.3%)。结论:对于不可切除或复发的HCC患者,DEB-TACE联合雷替曲塞CB是一种可行、安全、有效的姑息治疗方案。
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引用次数: 1
The Feasibility and Safety of the Clip-and-Snare Method with a Prelooping Technique for Gastric Submucosal Tumors Removal: A Single-Center Experience (with Video). 夹圈套法与预环技术用于胃粘膜下肿瘤切除的可行性和安全性:单中心经验(带视频)。
IF 2.7 4区 医学 Q2 Medicine Pub Date : 2022-08-17 eCollection Date: 2022-01-01 DOI: 10.1155/2022/7957877
Qi Tang, Rui-Yue Shi, Jun Yao, Li-Sheng Wang, De-Feng Li

Aim: This study compared the efficacy and safety of endoscopic submucosal dissection (ESD) combined with clip-and-snare method and a prelooping technique (CSM-PLT) with ESD alone for the treatment of gastric submucosal tumors (gSMTs).

Methods: We retrospectively enrolled a matched group of 86 patients who received ESD combined with CSM-PLT or ESD alone from July 2010 to July 2020. The primary outcomes included complete resection, en bloc resection, and R0 resection.

Results: Eighty-six patients with gSMTs were enrolled in ESD combined with CSM-PLT group and ESD group, respectively. There were no significant differences in gender, age, tumor size, tumor location, and tumor origin between the two groups. The complete resection, en bloc resection, and R0 resection rates were comparable between two groups (P=1, P=0.31, and P=0.25, respectively). There were no significant differences in terms of hospital stays, hospitalization cost, postoperative complications, and residual rate (P=0.42, P=0.74, P=0.65, and P=1, respectively) between the two groups. However, the ESD combined with CSM-PLT was associated with a shorter procedure duration and fewer intraoperative complications (P < 0.001 and P=0.024, respectively). In addition, the incidence of intraoperative bleeding in ESD combined with CSM-PLT group was significantly lower than that in ESD group (P=0.04).

Conclusion: Both ESD combined with CSM-PLT and ESD were effective and safe modalities for the treatment of gSMTs. However, ESD combined with CSM-PLT was associated with a shorter procedure duration and fewer intraoperative complications.

目的:比较内镜下粘膜剥离术(ESD)联合夹子-圈套法和预环技术(CSM-PLT)与单纯内镜下粘膜剥离术(ESD)治疗胃粘膜下肿瘤(gSMTs)的疗效和安全性。方法:2010年7月至2020年7月,我们回顾性地招募了86名匹配组的患者,这些患者接受了ESD联合CSM-PLT或单独ESD。主要结果包括完全切除、整体切除和R0切除。结果:86例gsmt患者分别被纳入ESD联合CSM-PLT组和ESD组。两组患者在性别、年龄、肿瘤大小、肿瘤位置、肿瘤来源等方面均无统计学差异。两组之间的完全切除、整体切除和R0切除率具有可比性(P=1、P=0.31和P=0.25)。两组患者住院时间、住院费用、术后并发症、残留率差异均无统计学意义(P=0.42、P=0.74、P=0.65、P=1)。然而,ESD联合CSM-PLT的手术时间更短,术中并发症更少(P < 0.001和P=0.024)。ESD联合CSM-PLT组术中出血发生率显著低于ESD组(P=0.04)。结论:ESD联合CSM-PLT和ESD治疗gsmt均是安全有效的治疗方法。然而,ESD联合CSM-PLT的手术时间更短,术中并发症更少。
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引用次数: 0
Application of Overlap Gastroduodenostomy in Billroth I Anastomosis after Totally Laparoscopic Distal Gastrectomy for Gastric Cancer. 胃十二指肠重叠吻合术在腹腔镜胃癌远端切除术后Billroth I型吻合中的应用。
IF 2.7 4区 医学 Q2 Medicine Pub Date : 2022-08-12 eCollection Date: 2022-01-01 DOI: 10.1155/2022/9094934
Guojun Chen, Wenhuan Li, Weihua Yu, Dong Cen, Xianfa Wang, Peng Luo, Jiafei Yan, Guofu Chen, Yiping Zhu, Linhua Zhu

Delta-shaped gastroduodenostomy (DSGD) and overlap gastroduodenostomy (OGD) are the two most widely used intracorporeal Billroth I anastomosis methods after distal gastrectomy. In this study, we compared the short-term outcomes of DSGD and OGD in total laparoscopic distal gastrectomy (TLDG). In a retrospective cohort study, we examined 92 gastric cancer patients who underwent TLDG performed by the same surgeon between January 2014 and June 2018. All patients underwent Billroth I reconstruction (OGD, n = 45; DSGD, n = 47) and D2 lymph node dissection. We retrospectively reviewed the surgical outcomes, clinical pathological results, and endoscopy results. Laparoscopic surgery was successfully performed in both groups without conversion to open surgery. The demographic and clinical characteristics were similar between the two groups (P > 0.05). There were no significant differences between the two groups in operation time (158.9 ± 13.6 min vs. 158.8 ± 14.8 min, P=0.955), anastomotic time (19.4 ± 3.0 min vs. 18.8 ± 2.9 min, P=0.354), intraoperative blood loss (88.9 ± 25.4 mL vs. 83.7 ± 24.3 mL, P=0.321), number of lymph node dissections (31.0 ± 7.1 vs. 29.2 ± 7.5, P=0.229), length of hospital stay (8.8 ± 2.7 days vs. 9.1 ± 3.0 days, P=0.636), fluid intake time (3.1 ± 0.7 days vs. 3.2 ± 0.7 days, P=0.914), and morbidity of postoperative complications (6.7% [3/45] vs. 10.6% [5/47], P=0.499). Endoscopy performed 6 months postoperatively showed that the residual food (P=0.033), gastritis (P=0.029), and bile (P=0.022) classification score significantly decreased in the OGD group, and there were no significant differences 12 months postoperatively. OGD is a safe and effective reconstruction technique with comparable postoperative surgical outcomes and endoscopy results when compared with those of DSGD.

三角型胃十二指肠吻合术(DSGD)和重叠型胃十二指肠吻合术(OGD)是胃远端切除术后最广泛应用的两种胃内Billroth I吻合方法。在本研究中,我们比较了DSGD和OGD在腹腔镜胃远端全切除术(TLDG)中的短期疗效。在一项回顾性队列研究中,我们调查了2014年1月至2018年6月期间由同一外科医生进行TLDG手术的92名胃癌患者。所有患者均行Billroth I期重建(OGD, n = 45;DSGD, n = 47)和D2淋巴结清扫。我们回顾了手术结果、临床病理结果和内窥镜检查结果。两组均成功行腹腔镜手术,未转开腹手术。两组患者人口学及临床特征比较,差异无统计学意义(P > 0.05)。两组之间没有显著差异操作时间(158.9±13.6分钟和158.8±14.8分钟,P = 0.955),吻合的时间(19.4±3.0分钟和18.8±2.9分钟,P = 0.354),术中失血(88.9±25.4毫升和83.7±24.3毫升,P = 0.321),数量的淋巴结解剖(31.0±7.1和29.2±7.5,P = 0.229),住院时间(8.8±2.7天、9.1±3.0天,P = 0.636),液体摄入量时间(3.1±0.7天、3.2±0.7天,P = 0.914),术后并发症发生率(6.7% [3/45]vs. 10.6% [5/47], P=0.499)。术后6个月内镜检查显示,OGD组残食(P=0.033)、胃炎(P=0.029)、胆汁(P=0.022)分级评分明显降低,术后12个月差异无统计学意义。OGD是一种安全有效的重建技术,与DSGD相比,其术后手术效果和内镜检查结果相当。
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引用次数: 1
Insulin Resistance Markers to Detect Nonalcoholic Fatty Liver Disease in a Male Hispanic Population. 在西班牙裔男性人群中检测非酒精性脂肪肝的胰岛素抵抗标志物
IF 2.7 4区 医学 Q2 Medicine Pub Date : 2022-08-03 eCollection Date: 2022-01-01 DOI: 10.1155/2022/1782221
Maritza Pérez-Mayorga, Jose P Lopez-Lopez, Maria A Chacon-Manosalva, Maria G Castillo, Johanna Otero, Daniel Martinez-Bello, Diego Gomez-Arbelaez, Daniel D Cohen, Patricio Lopez-Jaramillo

Background: Nonalcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease and is closely associated with cardiometabolic disorders, being insulin resistance (IR) the common pathogenic mechanism. The triglycerides/glucose (TyG) index and triglycerides/HDL-c (TG/HDL) ratio are markers correlated with IR. We compared the capacity of these two indexes, alongside IR, to detect NAFLD.

Methods: In a cross-sectional cohort study, we examined 263 active military personnel from the Colombian Air Force, aged between 29 and 54 years. Anthropometric measurements and biochemical determinations (glycemia, lipid profile, and insulin) were obtained, and ultrasound studies were performed to evaluate the presence of NAFLD. HOMA-IR index was calculated as (fasting insulin (µIU/mL) × fasting glucose (mmol/L)/22.5), the TyG index as Ln (triglycerides (mg/dL) × fasting glucose (mg/dL)/2), and the TG/HDL ratio as (triglycerides (mg/dL)/HDL-c (mg/dL)).

Results: NAFLD ultrasound criteria were met in 70 individuals (26.6%). Subjects with NAFLD had significantly higher values of HOMA-IR (2.55 ± 1.36 vs. 1.51 ± 0.91), TyG (9.17 ± 0.53 vs. 8.7 ± 0.51), and TG/HDL (6.6 ± 4.54 vs. 3.52 ± 2.32) compared to those without NAFLD (p < 0.001). A TyG cutoff point of 8.92 showed an AUC of 0.731, while cutoff points of 3.83 for TG/HDL and 1.68 for HOMA-IR showed an AUC of 0.766 and 0.781, respectively.

Conclusion: Our study shows that novel and lower-cost markers of IR are useful for detecting NALFD, with a performance comparable to the HOMA-IR index. These markers should be used as the first step when screening patients for NAFLD.

背景:非酒精性脂肪性肝病(NAFLD)是慢性肝病的主要病因之一,与心脏代谢紊乱密切相关,是胰岛素抵抗(IR)的常见致病机制。甘油三酯/葡萄糖(TyG)指数和甘油三酯/HDL-c (TG/HDL)比值是与IR相关的标志物。我们比较了这两个指标以及IR检测NAFLD的能力。方法:在横断面队列研究中,我们调查了263名来自哥伦比亚空军的现役军人,年龄在29至54岁之间。获得人体测量和生化测定(血糖、血脂和胰岛素),并进行超声检查以评估NAFLD的存在。计算HOMA-IR指数为(空腹胰岛素(µIU/mL) ×空腹葡萄糖(mmol/L)/22.5), TyG指数为Ln(甘油三酯(mg/dL) ×空腹葡萄糖(mg/dL)/2), TG/HDL比值为(甘油三酯(mg/dL)/HDL-c (mg/dL))。结果:70例(26.6%)符合NAFLD超声诊断标准。NAFLD患者的HOMA-IR值(2.55±1.36比1.51±0.91)、TyG值(9.17±0.53比8.7±0.51)、TG/HDL值(6.6±4.54比3.52±2.32)均显著高于非NAFLD患者(p < 0.001)。TyG的截断点为8.92,AUC为0.731;TG/HDL的截断点为3.83,HOMA-IR的截断点为1.68,AUC分别为0.766和0.781。结论:我们的研究表明,新的低成本IR标记物可用于检测NALFD,其性能可与HOMA-IR指数相媲美。这些标志物应作为筛查NAFLD患者的第一步。
{"title":"Insulin Resistance Markers to Detect Nonalcoholic Fatty Liver Disease in a Male Hispanic Population.","authors":"Maritza Pérez-Mayorga,&nbsp;Jose P Lopez-Lopez,&nbsp;Maria A Chacon-Manosalva,&nbsp;Maria G Castillo,&nbsp;Johanna Otero,&nbsp;Daniel Martinez-Bello,&nbsp;Diego Gomez-Arbelaez,&nbsp;Daniel D Cohen,&nbsp;Patricio Lopez-Jaramillo","doi":"10.1155/2022/1782221","DOIUrl":"https://doi.org/10.1155/2022/1782221","url":null,"abstract":"<p><strong>Background: </strong>Nonalcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease and is closely associated with cardiometabolic disorders, being insulin resistance (IR) the common pathogenic mechanism. The triglycerides/glucose (TyG) index and triglycerides/HDL-c (TG/HDL) ratio are markers correlated with IR. We compared the capacity of these two indexes, alongside IR, to detect NAFLD.</p><p><strong>Methods: </strong>In a cross-sectional cohort study, we examined 263 active military personnel from the Colombian Air Force, aged between 29 and 54 years. Anthropometric measurements and biochemical determinations (glycemia, lipid profile, and insulin) were obtained, and ultrasound studies were performed to evaluate the presence of NAFLD. HOMA-IR index was calculated as (fasting insulin (<i>µ</i>IU/mL) × fasting glucose (mmol/L)/22.5), the TyG index as Ln (triglycerides (mg/dL) × fasting glucose (mg/dL)/2), and the TG/HDL ratio as (triglycerides (mg/dL)/HDL-c (mg/dL)).</p><p><strong>Results: </strong>NAFLD ultrasound criteria were met in 70 individuals (26.6%). Subjects with NAFLD had significantly higher values of HOMA-IR (2.55 ± 1.36 vs. 1.51 ± 0.91), TyG (9.17 ± 0.53 vs. 8.7 ± 0.51), and TG/HDL (6.6 ± 4.54 vs. 3.52 ± 2.32) compared to those without NAFLD (<i>p</i> < 0.001). A TyG cutoff point of 8.92 showed an AUC of 0.731, while cutoff points of 3.83 for TG/HDL and 1.68 for HOMA-IR showed an AUC of 0.766 and 0.781, respectively.</p><p><strong>Conclusion: </strong>Our study shows that novel and lower-cost markers of IR are useful for detecting NALFD, with a performance comparable to the HOMA-IR index. These markers should be used as the first step when screening patients for NAFLD.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":" ","pages":"1782221"},"PeriodicalIF":2.7,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9365587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40614108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Biologic Agents in Crohn's Patients Reduce CD4+ T Cells Activation and Are Inversely Related to Treg Cells. 克罗恩病患者的生物制剂降低CD4+ T细胞活化,并与Treg细胞呈负相关。
IF 2.7 4区 医学 Q2 Medicine Pub Date : 2022-07-31 eCollection Date: 2022-01-01 DOI: 10.1155/2022/1307159
Eliane Aparecida Rosseto-Welter, Leticia D'argenio-Garcia, Filipa Blasco Tavares Pereira Lopes, Ana Eduarda Zulim Carvalho, Fernando Flaquer, Vanessa Severo-Lemos, Claudia Concer Viero Nora, Flavio Steinwurz, Lucas Pires Garcia Oliveria, Thiago Aloia, Luiz Vicente Rizzo, Cristóvão Luis Pitangueira Mangueira, Karina Inacio Carvalho

Crohn's disease (CD) is a chronic inflammatory disease with a complex interface of broad factors. There are two main treatments for Chron's disease: biological therapy and nonbiological therapy. Biological agent therapy (e.g., anti-TNF) is the most frequently prescribed treatment; however, it is not universally accessible. In fact, in Brazil, many patients are only given the option of receiving nonbiological therapy. This approach prolongs the subsequent clinical relapse; however, this procedure could be implicated in the immune response and enhance disease severity. Our purpose was to assess the effects of different treatments on CD4+ T cells in a cohort of patients with Crohn's disease compared with healthy individuals. To examine the immune status in a Brazilian cohort, we analyzed CD4+ T cells, activation status, cytokine production, and Treg cells in blood of Crohn's patients. Patients that underwent biological therapy can recover the percentage of CD4+CD73+ T cells, decrease the CD4+ T cell activation/effector functions, and maintain the peripheral percentage of regulatory T cells. These results show that anti-TNF agents can improve CD4+ T cell subsets, thereby inducing Crohn's patients to relapse and remission rates.

克罗恩病(CD)是一种慢性炎症性疾病,具有多种因素的复杂界面。慢性疾病有两种主要的治疗方法:生物治疗和非生物治疗。生物制剂治疗(如抗肿瘤坏死因子)是最常用的治疗方法;然而,它并不是普遍可用的。事实上,在巴西,许多患者只能选择接受非生物治疗。这种方法延长了随后的临床复发;然而,这一过程可能与免疫反应有关,并增加疾病的严重程度。我们的目的是评估不同治疗方法对克罗恩病患者CD4+ T细胞的影响,并与健康个体进行比较。为了检查巴西队列中的免疫状态,我们分析了克罗恩病患者血液中的CD4+ T细胞、激活状态、细胞因子产生和Treg细胞。接受生物治疗的患者可以恢复CD4+CD73+ T细胞百分比,降低CD4+ T细胞活化/效应功能,维持外周调节性T细胞百分比。这些结果表明,抗tnf药物可以改善CD4+ T细胞亚群,从而诱导克罗恩病患者的复发和缓解率。
{"title":"Biologic Agents in Crohn's Patients Reduce CD4<sup>+</sup> T Cells Activation and Are Inversely Related to Treg Cells.","authors":"Eliane Aparecida Rosseto-Welter,&nbsp;Leticia D'argenio-Garcia,&nbsp;Filipa Blasco Tavares Pereira Lopes,&nbsp;Ana Eduarda Zulim Carvalho,&nbsp;Fernando Flaquer,&nbsp;Vanessa Severo-Lemos,&nbsp;Claudia Concer Viero Nora,&nbsp;Flavio Steinwurz,&nbsp;Lucas Pires Garcia Oliveria,&nbsp;Thiago Aloia,&nbsp;Luiz Vicente Rizzo,&nbsp;Cristóvão Luis Pitangueira Mangueira,&nbsp;Karina Inacio Carvalho","doi":"10.1155/2022/1307159","DOIUrl":"https://doi.org/10.1155/2022/1307159","url":null,"abstract":"<p><p>Crohn's disease (CD) is a chronic inflammatory disease with a complex interface of broad factors. There are two main treatments for Chron's disease: biological therapy and nonbiological therapy. Biological agent therapy (e.g., anti-TNF) is the most frequently prescribed treatment; however, it is not universally accessible. In fact, in Brazil, many patients are only given the option of receiving nonbiological therapy. This approach prolongs the subsequent clinical relapse; however, this procedure could be implicated in the immune response and enhance disease severity. Our purpose was to assess the effects of different treatments on CD4<sup>+</sup> T cells in a cohort of patients with Crohn's disease compared with healthy individuals. To examine the immune status in a Brazilian cohort, we analyzed CD4<sup>+</sup> T cells, activation status, cytokine production, and Treg cells in blood of Crohn's patients. Patients that underwent biological therapy can recover the percentage of CD4<sup>+</sup>CD73<sup>+</sup> T cells, decrease the CD4<sup>+</sup> T cell activation/effector functions, and maintain the peripheral percentage of regulatory T cells. These results show that anti-TNF agents can improve CD4<sup>+</sup> T cell subsets, thereby inducing Crohn's patients to relapse and remission rates.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":" ","pages":"1307159"},"PeriodicalIF":2.7,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9357708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40704170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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: 1
Pretransplant Evaluation and Liver Transplantation Outcome in PBC Patients. PBC 患者移植前评估和肝移植结果
IF 2.7 4区 医学 Q2 Medicine Pub Date : 2022-07-22 eCollection Date: 2022-01-01 DOI: 10.1155/2022/7831165
Maja Mijic, Ivona Saric, Bozena Delija, Milos Lalovac, Nikola Sobocan, Eva Radetic, Dora Martincevic, Tajana Filipec Kanizaj

Primary biliary cholangitis (PBC) is an autoimmune chronic cholestatic liver disease characterized by progressive cholangiocyte and bile duct destruction leading to fibrosis and finally to liver cirrhosis. The presence of disease-specific serological antimitochondrial antibody (AMA) together with elevated alkaline phosphatase (ALP) as a biomarker of cholestasis is sufficient for diagnosis. Ursodeoxycholic acid (UDCA) is the first treatment option for PBC. Up to 40% of patients have an incomplete response to therapy, and over time disease progresses to liver cirrhosis. Several risk scores are proposed for better evaluation of patients before and during treatment to stratify patients at increased risk of disease progression. GLOBE score and UK PBC risk score are used for the evaluation of UDCA treatment and Mayo risk score for transplant-free survival. Liver transplantation (LT) is the only treatment option for end-stage liver disease. More than 10 years after LT, 40% of patients experience recurrence of the disease. A liver biopsy is required to establish rPBC (recurrent primary biliary cholangitis). The only treatment option for rPBC is UDCA, and data show biochemical and clinical improvement, plus potential beneficial effects for use after transplantation for the prevention of rPBC development. Additional studies are required to assess the full impact of rPBC on graft and recipient survival and for treatment options for rPBC.

原发性胆汁性胆管炎(PBC)是一种自身免疫性慢性胆汁淤积性肝病,其特点是胆管细胞和胆管进行性破坏,导致纤维化,最终导致肝硬化。出现疾病特异性血清学抗线粒体抗体(AMA)以及作为胆汁淤积症生物标志物的碱性磷酸酶(ALP)升高即可确诊。熊去氧胆酸(UDCA)是治疗 PBC 的首选药物。多达 40% 的患者对治疗反应不完全,随着时间的推移,病情会发展为肝硬化。为了在治疗前和治疗期间对患者进行更好的评估,对疾病进展风险增加的患者进行分层,提出了几种风险评分。GLOBE 评分和英国 PBC 风险评分用于评估 UDCA 治疗,梅奥风险评分用于评估无移植生存率。肝移植(LT)是终末期肝病的唯一治疗方案。肝移植 10 年后,40% 的患者病情会复发。要确定复发性原发性胆汁性胆管炎(rPBC),需要进行肝活检。目前治疗 rPBC 的唯一方法是 UDCA,数据显示该药可改善生化和临床症状,并可在移植后用于预防 rPBC 的发生。要评估 rPBC 对移植物和受体存活率的全面影响以及 rPBC 的治疗方案,还需要进行更多的研究。
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引用次数: 0
ERCP-Related Adverse Events in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis. 原发性硬化性胆管炎的 ERCP 相关不良事件:系统回顾与元分析》。
IF 2.7 4区 医学 Q2 Medicine Pub Date : 2022-07-21 eCollection Date: 2022-01-01 DOI: 10.1155/2022/2372257
Navneet Natt, Faith Michael, Hope Michael, Sacha Dubois, Ahmed Al Mazrou'i

Background and aims: While endoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic tool in primary sclerosing cholangitis (PSC), there is conflicting data on associated adverse events. The aims of this systematic review and meta-analysis are to (1) compare ERCP-related adverse events in patients with and without PSC and (2) determine risk factors for ERCP-related adverse events in PSC.

Methods: Embase, PubMed, and CENTRAL were searched between January 1, 2000, and May 12, 2021. Eligible studies included adults with PSC undergoing ERCP and reported at least one ERCP-related adverse event (cholangitis, pancreatitis, bleeding, and perforation) or an associated risk factor. The risk of bias was assessed with the Newcastle-Ottawa scale and Cochrane Risk of Bias 2. Raw event rates were used to calculate odds ratios (ORs) and then pooled using random-effects models.

Results: Twenty studies met eligibility criteria, of which four were included in a meta-analysis comparing post-ERCP adverse events in patients with PSC (n = 715) to those without PSC (n = 9979). We found a significant threefold increase in the 30-day odds of cholangitis in PSC compared to those without (OR 3.263, 95% CI 1.076-9.896; p=0.037). However, there were no significant differences in post-ERCP pancreatitis (PEP), bleeding, or perforation. Due to limitations in primary data, only risk factors contributing to PEP could be analyzed. Accidental passage of the guidewire into the pancreatic duct (OR 7.444, 95% CI 3.328-16.651; p < 0.001; I 2 = 65.0%) and biliary sphincterotomy (OR 4.802, 95% CI 1.916-12.033; p=0.001; I 2 = 73.1%) were associated with higher odds of PEP in a second meta-analysis including five studies.

Conclusions: In the context of limited comparative data and heterogeneity, PSC patients undergoing ERCP have higher odds of cholangitis despite the majority receiving antibiotics. Additionally, accidental wire passage and biliary sphincterotomy increased the odds of PEP. Future studies on ERCP-related risks and preventive strategies are needed.

背景和目的:虽然内镜逆行胰胆管造影术(ERCP)是原发性硬化性胆管炎(PSC)的重要诊断和治疗工具,但相关不良事件的数据却相互矛盾。本系统综述和荟萃分析的目的是:(1)比较原发性硬化性胆管炎患者和非原发性硬化性胆管炎患者发生的ERCP相关不良事件;(2)确定原发性硬化性胆管炎患者发生ERCP相关不良事件的风险因素:方法:检索了 2000 年 1 月 1 日至 2021 年 5 月 12 日期间的 Embase、PubMed 和 CENTRAL。符合条件的研究纳入了接受ERCP治疗的PSC成人患者,并报告了至少一起ERCP相关不良事件(胆管炎、胰腺炎、出血和穿孔)或相关风险因素。采用纽卡斯尔-渥太华量表和 Cochrane Risk of Bias 2 评估偏倚风险。原始事件发生率用于计算几率比(OR),然后采用随机效应模型进行汇总:20项研究符合资格标准,其中4项纳入荟萃分析,比较了PSC患者(n = 715)与非PSC患者(n = 9979)的ERCP后不良事件。我们发现,与无 PSC 患者相比,PSC 患者 30 天内发生胆管炎的几率明显增加了三倍(OR 3.263,95% CI 1.076-9.896;P=0.037)。但是,ERCP 术后胰腺炎 (PEP)、出血或穿孔方面没有明显差异。由于原始数据的限制,只能对导致 PEP 的风险因素进行分析。在包括五项研究的第二次荟萃分析中,导丝意外进入胰管(OR 7.444,95% CI 3.328-16.651;P < 0.001;I 2 = 65.0%)和胆道括约肌切开术(OR 4.802,95% CI 1.916-12.033;P = 0.001;I 2 = 73.1%)与较高的 PEP 发生几率相关:结论:在比较数据有限且存在异质性的情况下,接受ERCP的PSC患者发生胆管炎的几率较高,尽管大多数患者接受了抗生素治疗。此外,意外通过导线和胆道括约肌切开术会增加 PEP 的几率。今后需要对ERCP相关风险和预防策略进行研究。
{"title":"ERCP-Related Adverse Events in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis.","authors":"Navneet Natt, Faith Michael, Hope Michael, Sacha Dubois, Ahmed Al Mazrou'i","doi":"10.1155/2022/2372257","DOIUrl":"10.1155/2022/2372257","url":null,"abstract":"<p><strong>Background and aims: </strong>While endoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic tool in primary sclerosing cholangitis (PSC), there is conflicting data on associated adverse events. The aims of this systematic review and meta-analysis are to (1) compare ERCP-related adverse events in patients with and without PSC and (2) determine risk factors for ERCP-related adverse events in PSC.</p><p><strong>Methods: </strong>Embase, PubMed, and CENTRAL were searched between January 1, 2000, and May 12, 2021. Eligible studies included adults with PSC undergoing ERCP and reported at least one ERCP-related adverse event (cholangitis, pancreatitis, bleeding, and perforation) or an associated risk factor. The risk of bias was assessed with the Newcastle-Ottawa scale and Cochrane Risk of Bias 2. Raw event rates were used to calculate odds ratios (ORs) and then pooled using random-effects models.</p><p><strong>Results: </strong>Twenty studies met eligibility criteria, of which four were included in a meta-analysis comparing post-ERCP adverse events in patients with PSC (<i>n</i> = 715) to those without PSC (<i>n</i> = 9979). We found a significant threefold increase in the 30-day odds of cholangitis in PSC compared to those without (OR 3.263, 95% CI 1.076-9.896; <i>p</i>=0.037). However, there were no significant differences in post-ERCP pancreatitis (PEP), bleeding, or perforation. Due to limitations in primary data, only risk factors contributing to PEP could be analyzed. Accidental passage of the guidewire into the pancreatic duct (OR 7.444, 95% CI 3.328-16.651; <i>p</i> < 0.001; <i>I</i> <sup>2</sup> = 65.0%) and biliary sphincterotomy (OR 4.802, 95% CI 1.916-12.033; <i>p</i>=0.001; <i>I</i> <sup>2</sup> = 73.1%) were associated with higher odds of PEP in a second meta-analysis including five studies.</p><p><strong>Conclusions: </strong>In the context of limited comparative data and heterogeneity, PSC patients undergoing ERCP have higher odds of cholangitis despite the majority receiving antibiotics. Additionally, accidental wire passage and biliary sphincterotomy increased the odds of PEP. Future studies on ERCP-related risks and preventive strategies are needed.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":" ","pages":"2372257"},"PeriodicalIF":2.7,"publicationDate":"2022-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9334029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40658129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Delineating Molecular Subtypes through Gene Set Variation Analysis Confers Therapeutic and Prognostic Capability in Gastric Cancer. 通过基因集变异分析描绘分子亚型赋予胃癌的治疗和预后能力。
IF 2.7 4区 医学 Q2 Medicine Pub Date : 2022-07-15 eCollection Date: 2022-01-01 DOI: 10.1155/2022/5415758
Yuzhang Zhu, Ting Sun, Lei Zhang, Faming Fei, Yi Bao, Zhenzhen Gao

To claim the features of nontumor tissue in gastric cancer patients, especially in those who have undergone gastrectomy, and to identify the molecular subtypes, we collected the immunogenic and hallmark gene sets from gene set enrichment analysis. The activity changes of these gene sets between tumor (375) and nontumor (32) tissues acquired from the Cancer Genome Atlas (TCGA-STAD) were calculated, and the novel molecular subtypes were delineated. Subsequently, prognostic gene sets were determined using least absolute shrinkage and selection operator (lasso) regression prognostic method. In addition, functional analysis was conducted. Totally, three subtypes were constructed in the present study, and there were differences in survival among three groups. Functional analysis showed genes from normal gene set were related to cell adhesion, and genes from tumor gene set were associated with focal adhesion, PI3K-Akt signaling pathway, regulation of actin cytoskeleton, and VEGF signaling pathway. Our study created lasting value beyond molecular subtypes and underscored the significance of normal tissues in gastric cancer development, which drawn a novel prognostic model for gastric treatment.

为了了解胃癌患者,特别是胃切除术患者非肿瘤组织的特征,并确定分子亚型,我们从基因集富集分析中收集了免疫原性和标志基因集。计算了从肿瘤基因组图谱(TCGA-STAD)中获得的肿瘤(375)和非肿瘤(32)组织中这些基因组的活性变化,并描绘了新的分子亚型。随后,使用最小绝对收缩和选择算子(套索)回归预测方法确定预后基因集。此外,还进行了功能分析。本研究共构建了三种亚型,三组间生存率存在差异。功能分析显示,正常基因集的基因与细胞粘附相关,肿瘤基因集的基因与局灶性粘附、PI3K-Akt信号通路、肌动蛋白细胞骨架调控、VEGF信号通路相关。我们的研究创造了超越分子亚型的持久价值,强调了正常组织在胃癌发展中的重要性,为胃癌治疗建立了新的预后模型。
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引用次数: 0
qHBsAg for the Identification of Liver Histological Abnormalities in HBeAg-Negative Chronic Hepatitis B Patients with Normal and Mildly Elevated ALT Levels. qHBsAg对hbeag阴性慢性乙型肝炎患者ALT水平正常和轻度升高的肝脏组织学异常的识别
IF 2.7 4区 医学 Q2 Medicine Pub Date : 2022-07-14 eCollection Date: 2022-01-01 DOI: 10.1155/2022/8695196
Qinyi Gan, Yan Huang, Chuanwu Zhu, Shuang Zhao, Haoshuang Fu, Minghao Cai, Jiexiao Wang, Chenxi Zhang, Simin Guo, Zhujun Cao, Qing Xie

Backgrounds: Noninvasive detection of histological abnormalities remains challenging in patients with HBeAg-negative chronic HBV infection with normal or mildly elevated levels of alanine aminotransferase (ALT). This study aimed to assess the utility of serum quantitative hepatitis B surface antigen (qHBsAg) in identifying significant histological lesions in this population.

Methods: This is a single-center study with retrospective analysis of 392 treatment-naive patients of HBeAg-negative chronic HBV infection with normal or mildly elevated levels of ALT.

Results: In this cohort, significant necroinflammation and fibrosis were found in 69.4% and 61.5% of patients, respectively. Patients with qHBsAg >1000 IU/mL (N = 236) had more hepatic inflammation of ≥G2 (75.4% vs. 60.9%, P < 0.01) or fibrosis ≥ S2 (66.1% vs. 54.5%, P < 0.05) compared to those without (N = 156). Serum HBsAg (cutoff point = 1000 IU/mL), aspartate aminotransferase (AST) level (cutoff point = 25 IU/L), age (cutoff point = 40 years), and HBV family history were identified as independent predictors of significant histological abnormalities in multivariate logistic analysis.

Conclusions: A significantly higher proportion of patients with histological abnormalities were found in patients with qHBsAg >1000 IU/mL than those without. The qHBsAg level together with age, AST, and family history of HBV infection could be used as an algorithm to help noninvasive patient selection for antiviral therapy.

背景:在hbeag阴性的慢性HBV感染且丙氨酸转氨酶(ALT)水平正常或轻度升高的患者中,无创检测组织学异常仍然具有挑战性。本研究旨在评估血清定量乙型肝炎表面抗原(qHBsAg)在该人群中识别重要组织学病变的效用。方法:这是一项单中心研究,回顾性分析了392例初诊hbeag阴性慢性HBV感染,alt水平正常或轻度升高的患者。结果:在该队列中,分别有69.4%和61.5%的患者发现显著的坏死性炎症和纤维化。qHBsAg >1000 IU/mL的患者(N = 236)的肝炎症≥G2 (75.4% vs. 60.9%, P < 0.01)或纤维化≥S2 (66.1% vs. 54.5%, P < 0.05)的发生率高于无qHBsAg患者(N = 156)。在多因素logistic分析中,血清HBsAg(临界值= 1000 IU/mL)、天冬氨酸转氨酶(AST)水平(临界值= 25 IU/L)、年龄(临界值= 40岁)和HBV家族史被确定为显著组织学异常的独立预测因素。结论:qHBsAg >1000 IU/mL的患者出现组织学异常的比例明显高于未出现组织学异常的患者。qHBsAg水平与年龄、AST和HBV感染家族史可作为一种算法,帮助患者进行无创抗病毒治疗的选择。
{"title":"qHBsAg for the Identification of Liver Histological Abnormalities in HBeAg-Negative Chronic Hepatitis B Patients with Normal and Mildly Elevated ALT Levels.","authors":"Qinyi Gan,&nbsp;Yan Huang,&nbsp;Chuanwu Zhu,&nbsp;Shuang Zhao,&nbsp;Haoshuang Fu,&nbsp;Minghao Cai,&nbsp;Jiexiao Wang,&nbsp;Chenxi Zhang,&nbsp;Simin Guo,&nbsp;Zhujun Cao,&nbsp;Qing Xie","doi":"10.1155/2022/8695196","DOIUrl":"https://doi.org/10.1155/2022/8695196","url":null,"abstract":"<p><strong>Backgrounds: </strong>Noninvasive detection of histological abnormalities remains challenging in patients with HBeAg-negative chronic HBV infection with normal or mildly elevated levels of alanine aminotransferase (ALT). This study aimed to assess the utility of serum quantitative hepatitis B surface antigen (qHBsAg) in identifying significant histological lesions in this population.</p><p><strong>Methods: </strong>This is a single-center study with retrospective analysis of 392 treatment-naive patients of HBeAg-negative chronic HBV infection with normal or mildly elevated levels of ALT.</p><p><strong>Results: </strong>In this cohort, significant necroinflammation and fibrosis were found in 69.4% and 61.5% of patients, respectively. Patients with qHBsAg >1000 IU/mL (<i>N</i> = 236) had more hepatic inflammation of ≥<i>G</i>2 (75.4% vs. 60.9%, <i>P</i> < 0.01) or fibrosis ≥ <i>S</i>2 (66.1% vs. 54.5%, <i>P</i> < 0.05) compared to those without (<i>N</i> = 156). Serum HBsAg (cutoff point = 1000 IU/mL), aspartate aminotransferase (AST) level (cutoff point = 25 IU/L), age (cutoff point = 40 years), and HBV family history were identified as independent predictors of significant histological abnormalities in multivariate logistic analysis.</p><p><strong>Conclusions: </strong>A significantly higher proportion of patients with histological abnormalities were found in patients with qHBsAg >1000 IU/mL than those without. The qHBsAg level together with age, AST, and family history of HBV infection could be used as an algorithm to help noninvasive patient selection for antiviral therapy.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":" ","pages":"8695196"},"PeriodicalIF":2.7,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9303505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40620968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Serum Glial Cell Line-Derived Neurotrophic Factor (sGDNF) Is a Novel Biomarker in Predicting Cirrhosis in Patients with Chronic Hepatitis B. 血清胶质细胞系衍生神经营养因子(sGDNF)是预测慢性乙型肝炎患者肝硬化的一种新的生物标志物。
IF 2.7 4区 医学 Q2 Medicine Pub Date : 2022-07-09 eCollection Date: 2022-01-01 DOI: 10.1155/2022/1048104
Guangyue Yang, Liping Zhuang, Tiantian Sun, Yee Hui Yeo, Le Tao, Wei Zhang, Wenting Ma, Liu Wu, Zongguo Yang, Yanqin Yang, Dongying Xue, Jie Zhang, Rilu Feng, Ebert Matthias P, Steven Dooley, Ekihiro Seki, Ping Liu, Cheng Liu

Objectives: We assessed the potential of glial cell line-derived neurotrophic factor (GDNF) as a useful biomarker to predict cirrhosis in chronic hepatitis B (CHB) patients.

Methods: A total of 735 patients from two medical centers (385 CHB patients and 350 healthy controls) were included to determine the association of serum and tissue GDNF levels with biopsy-proven cirrhosis. The diagnostic accuracy of serum GDNF (sGDNF) was estimated and compared with other indices of cirrhosis.

Results: We showed significantly higher levels of sGDNF in CHB patients with fibrosis (28.4 pg/ml vs. 11.6 pg/ml in patients without) and patients with cirrhosis (33.8 pg/ml vs. 23.5 pg/ml in patients without). The areas under receiver operating curve (AUROCs) of sGDNF were 0.83 (95% confidence interval (CI): 0.80-0.87) for predicting liver fibrosis and 0.84 (95% CI: 0.79-0.89) for cirrhosis. Findings from the serum protein level and hepatic mRNA expression were consistent. Using the best cutoff to predict cirrhosis, we categorized the patients into sGDNF-high and sGDNF-low groups. The sGDNF-high group had significantly larger Masson's trichrome and reticulin staining-positive area, higher Scheuer score, and METAVIR fibrosis stage (all p < 0.001) but not steatosis. On multivariable regression, sGDNF was independently associated with cirrhosis with an odds ratio of 6.98 (95% CI: 1.10-17.94). Finally, we demonstrated that sGDNF outperformed AST to platelet ratio index, FIB-4, fibroscore, forn index, and fibrometer in differentiating F4 vs. F3.

Conclusion: Using serum, tissue mRNA, and biopsy data, our study revealed a significant potential of sGDNF as a novel noninvasive biomarker for cirrhosis in CHB patients.

目的:我们评估了神经胶质细胞系来源的神经营养因子(GDNF)作为预测慢性乙型肝炎(CHB)患者肝硬化的有用生物标志物的潜力。方法:共纳入来自两个医疗中心的735例患者(385例慢性乙型肝炎患者和350例健康对照),以确定血清和组织GDNF水平与活检证实的肝硬化的关系。评估血清GDNF (sGDNF)诊断肝硬化的准确性,并与其他肝硬化指标进行比较。结果:我们发现伴有纤维化的CHB患者(无纤维化患者为28.4 pg/ml,无纤维化患者为11.6 pg/ml)和肝硬化患者(无纤维化患者为33.8 pg/ml,无肝硬化患者为23.5 pg/ml)中sGDNF水平显著升高。sGDNF预测肝纤维化的受试者工作曲线下面积(auroc)为0.83(95%可信区间(CI): 0.80-0.87),预测肝硬化的受试者工作曲线下面积(auroc)为0.84 (95% CI: 0.79-0.89)。血清蛋白水平和肝脏mRNA表达结果一致。使用最佳截断值预测肝硬化,我们将患者分为高sgdnf组和低sgdnf组。高sgdnf组的马松三色和网状蛋白染色阳性面积显著增大,Scheuer评分较高,METAVIR纤维化分期(均p < 0.001),但无脂肪变性。在多变量回归中,sGDNF与肝硬化独立相关,比值比为6.98 (95% CI: 1.10-17.94)。最后,我们证明sGDNF在区分F4与F3方面优于AST与血小板比率指数、FIB-4、纤维评分、形态指数和纤维计。结论:利用血清、组织mRNA和活检数据,我们的研究揭示了sGDNF作为慢性乙型肝炎患者肝硬化的一种新的无创生物标志物的巨大潜力。
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引用次数: 1
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Canadian Journal of Gastroenterology and Hepatology
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