Gastro hep advances最新文献_第3页

Current State Analysis of Malnutrition Screening for Ambulatory Patients With Inflammatory Bowel Disease Reveals Low Screening Rates and Telehealth as a Risk Factor 炎症性肠病门诊患者营养不良筛查现状分析显示低筛查率和远程医疗是一个危险因素

Gastro hep advances

Pub Date : 2026-01-01 DOI: 10.1016/j.gastha.2025.100870

Bita Shahrvini , Andrew Chang , Alexandra C. Greb , Mark Baniqued , Divya P. Prajapati , Rhett Harmon , Sureya F. Hussani , Nirupama Bonthala , Gaurav Syal , Jenny S. Sauk , Folasade P. May , Berkeley N. Limketkai

Background and Aims

Patients with inflammatory bowel disease (IBD) are at increased risk of malnutrition, which is associated with worse outcomes and has prompted recommendations for regular nutrition screening. This study details a current state analysis of outpatient gastroenterology (GI) malnutrition screening practices for patients with IBD and evaluates risk factors for lack of screening.

Methods

This retrospective cohort study included adults with IBD on advanced therapies seen at the University of California, Los Angeles, between 2018 and 2024. Patient data were abstracted from outpatient GI encounters via electronic medical records. A root cause analysis for lack of malnutrition screening was created using a Gemba walk and stakeholder interviews. Multivariable logistic regression evaluated risk factors for lack of screening.

Results

Of 283 included patients, the mean age was 44.4, mean body mass index was 25.9, 53.7% were female, 62.9% were White, and 50.0% had Crohn’s disease. Most (70.7%) had their GI encounters via telehealth. Malnutrition screening was performed at 56% of encounters. When patients were screened, a validated screening tool was used in 12% of encounters. Screening identified malnutrition risk in 11% of encounters and prompted ordering of registered dietician referrals 44% and nutrition labs 56% of the time. Malnutrition screening was less likely if the encounter was via telehealth (vs in-person, odds ratio 0.43, confidence interval [0.23–0.80]).

Conclusion

Improved malnutrition screening among GI physicians for IBD patients is needed. Given telehealth visits were strongly associated with lack of screening, strategies to address this care gap are needed since telehealth has become more common.

背景和目的炎症性肠病（IBD）患者营养不良的风险增加，这与较差的预后相关，因此建议定期进行营养筛查。本研究详细分析了IBD患者门诊胃肠病学（GI）营养不良筛查实践的现状，并评估了缺乏筛查的危险因素。方法：这项回顾性队列研究纳入了2018年至2024年间在加州大学洛杉矶分校接受先进治疗的IBD成年患者。通过电子病历从门诊胃肠道就诊中提取患者数据。通过玄叶散步和利益相关者访谈，对缺乏营养筛查的根本原因进行了分析。多变量logistic回归评估缺乏筛查的危险因素。结果283例患者平均年龄44.4岁，平均体重指数25.9，女性53.7%，白人62.9%，克罗恩病50.0%。大多数（70.7%）是通过远程医疗就诊的。在56%的接触者中进行了营养不良筛查。当对患者进行筛查时，12%的患者使用了经过验证的筛查工具。筛查在11%的就诊中发现了营养不良风险，并在44%的情况下促使注册营养师转介，56%的情况下促使营养实验室。通过远程医疗进行营养不良筛查的可能性较低（相对于面对面，优势比0.43，可信区间[0.23-0.80]）。结论需要改进胃肠道医生对IBD患者的营养不良筛查。鉴于远程保健就诊与缺乏筛查密切相关，由于远程保健变得越来越普遍，因此需要采取战略来解决这一保健差距。

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引用次数: 0

Single-Cell Lineage Trajectory Defines Cyclin-Dependent Kinase Inhibitor–Sensitive Cells-of-Origin in Esophageal Squamous Cell Carcinoma 单细胞谱系轨迹定义食管鳞状细胞癌中周期蛋白依赖性激酶抑制剂敏感细胞的起源

Gastro hep advances

Pub Date : 2026-01-01 DOI: 10.1016/j.gastha.2025.100874

Kyung-Pil Ko , Jie Zhang , Sohee Jun , Jae-Il Park

Background and Aims

Understanding the cells of origin is essential for overcoming therapy resistance and improving early intervention strategies in esophageal squamous cell carcinoma (ESCC). Despite recent advances in genomic profiling, the precise cellular hierarchies and molecular programs driving ESCC initiation remain poorly defined.

Methods

We utilized machine learning-based single-cell trajectory analysis on 4-nitroquinoline 1-oxide–induced murine models and genetically engineered organoids to identify cellular lineages during tumorigenesis. Combined with gene regulatory network analysis, we identified transcriptional drivers of tumor initiation and employed transcriptome-based drug repurposing to predict compounds targeting these initiating populations.

Results

Our analyses revealed multiple distinct epithelial clusters that function as cellular origins of ESCC, exhibiting diverse stem and progenitor signatures. Gene regulatory network analysis of these populations indicated activation of stem/progenitor cell regulators, including CEBPβ and TFAP2A/C. Translating these findings, a transcriptome-based drug repurposing screen identified 5 chemical candidates, 4 of which are potent cyclin-dependent kinase inhibitors, aligning with the frequent loss-of-function mutations in TP53 and CDKN2A observed in ESCC. Notably, CDK inhibitors markedly inhibit ESCC cell proliferation.

Conclusion

This research delineates the potential cellular origins of ESCC and their key regulons, thereby pioneering a single-cell-derived therapeutic strategy that exposes vulnerabilities in tumor-initiating cells.

背景与目的了解食管鳞状细胞癌（ESCC）的细胞起源对于克服治疗耐药和改善早期干预策略至关重要。尽管最近在基因组分析方面取得了进展，但驱动ESCC起始的精确细胞等级和分子程序仍然不清楚。方法利用基于机器学习的单细胞轨迹分析方法对4-硝基喹啉1-氧化物诱导的小鼠模型和基因工程类器官进行肿瘤发生过程中的细胞谱系鉴定。结合基因调控网络分析，我们确定了肿瘤起始的转录驱动因素，并采用基于转录组的药物再利用来预测靶向这些起始人群的化合物。结果我们的分析揭示了多种不同的上皮簇作为ESCC的细胞起源，表现出不同的干细胞和祖细胞特征。基因调控网络分析表明，这些群体激活了干细胞/祖细胞调控因子，包括CEBPβ和TFAP2A/C。翻译这些发现，基于转录组的药物再利用筛选确定了5种候选化学物质，其中4种是有效的细胞周期蛋白依赖性激酶抑制剂，与ESCC中观察到的TP53和CDKN2A频繁的功能丧失突变一致。CDK抑制剂明显抑制ESCC细胞增殖。本研究揭示了ESCC的潜在细胞起源及其关键调控，从而开创了单细胞衍生的治疗策略，揭示了肿瘤启动细胞的脆弱性。

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引用次数: 0

Gas-forming Pyogenic Liver Abscess Mimicking Gastric Perforation in a Patient With Diabetic Ketoacidosis and Subsequent Rupture: A Case Report 糖尿病酮症酸中毒致胃穿孔型肝脓肿并发破裂1例

Gastro hep advances

Pub Date : 2025-11-26 DOI: 10.1016/j.gastha.2025.100851

Tairyu Sato , Koki Yamada , Akira Nishio , Yuki Tokuda , Chihiro Yamanaka , Keishi Oka , Kanako Morita , Chihiro Tarumi , Kazuna Hazu , Yuki Nishiura , Kumi Higashihara , Shogo Nagahama , Takayuki Matsumae , Tadashi Kegasawa , Aya Ishimi , Satoshi Hiyama , Katsumi Yamamoto , Nobuyuki Tatsumi , Osakuni Morimoto , Akira Kaneko

A 53-year-old man with uncontrolled diabetes presented with fever and diabetic ketoacidosis. Computed tomography revealed a large hepatic lesion containing mottled gas, but the origin was uncertain, delaying drainage and raising concern for gastric perforation. Next-morning computed tomography showed hepatic gas and free intraperitoneal air, yet abdominal findings were minimal. During percutaneous drainage planning, he developed sudden abdominal pain and septic shock, illustrating the rapid, life-threatening course of gas-forming pyogenic liver abscess. Urgent laparoscopy confirmed rupture; Klebsiella pneumoniae was isolated. This case highlights diagnostic challenges and need for prompt reassessment and source control. Uncontrolled diabetes and ketoacidosis likely accelerated gas-forming pyogenic liver abscess rupture.

53岁男性，糖尿病未控制，表现为发热和糖尿病酮症酸中毒。计算机断层扫描显示一个大的肝脏病变，含有斑状气体，但来源不明，延迟引流和引起对胃穿孔的关注。第二天早上的计算机断层扫描显示肝脏气体和游离腹膜内空气，但腹部的发现很少。在经皮引流计划期间，他突然出现腹痛和感染性休克，说明了形成气体的化脓性肝脓肿的快速，危及生命的过程。紧急腹腔镜确认破裂；分离出肺炎克雷伯菌。该病例突出了诊断方面的挑战和及时重新评估和源头控制的必要性。未控制的糖尿病和酮症酸中毒可能加速气体形成化脓性肝脓肿破裂。

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引用次数: 0

Recurrent Jejunal Diverticulitis: A Rare Cause of Acute Abdomen 复发性空肠憩室炎：一种罕见的急腹症

Gastro hep advances

Pub Date : 2025-11-22 DOI: 10.1016/j.gastha.2025.100849

Osamah Al-obaidi , Sheila Cheng , Emily Nash

引用次数: 0

Association of Cirrhosis Etiology With Outcomes after Transjugular Intrahepatic Portosystemic Shunt: A National Cohort Study 经颈静脉肝内门静脉系统分流术后肝硬化病因与预后的关系：一项国家队列研究

Gastro hep advances

Pub Date : 2025-11-22 DOI: 10.1016/j.gastha.2025.100850

Gurmehr Brar , Brian P. Lee

Background and Aims

It is unknown whether outcomes after transjugular intrahepatic portosystemic shunt (TIPS) differ across cirrhosis etiologies, particularly metabolic dysfunction–associated steatotic liver disease (MASLD). We aimed to (i) characterize outcomes by cirrhosis etiology at 90 days and 1 year post–TIPS and (ii) identify features associated with post–TIPS outcomes.

Methods

Using a national health system database between 2008 and 2023, we identified adults with cirrhosis who underwent TIPS and performed cumulative incidence function and multivariable competing risk analysis by cirrhosis etiology with primary outcome of mortality and competing risk of transplant.

Results

In total, 2846 patients with cirrhosis underwent TIPS (median age 63[interquartile range 56–71], 61% male, 74% non–Hispanic White). Probability of unadjusted transplant–free survival post–TIPS was 84.3% (95% confidence interval [CI] 80.3–88.3) at 90 days and 72.1% (95% CI 67.2–77.0) at 1 year with MASLD, versus alcohol (78.5% [95% CI 76.7–80.3] at 90 days, 68.7% [95% CI 66.7–70.8] at 1 year), viral (78.5% [95% CI 75.6–81.4] at 90 days, 69.1% [95% CI 62.8–75.5] at 1 year), and other etiologies (76.4% [95% CI 73.5–79.4] at 90 days, 62.7% [95% CI 57.7–67.8] at 1 year). In multivariable competing risk regression, MASLD (vs alcohol) was associated with decreased mortality at 90 days (subdistribution hazard ratio 0.59 [95% CI 0.42–0.83]) and 1 year (subdistribution hazard ratio 0.76 [95% CI 0.60, 0.97]) post–TIPS, and similar to viral and other etiologies. Younger age and more recent TIPS were associated with improved survival, whereas pre–TIPS ascites, hepatic encephalopathy, and increasing Charlson Comorbidity Index were associated with increased mortality at 90 days and 1 year post–TIPS.

Conclusion

MASLD cirrhosis has excellent short– and long–term survival post–TIPS. Etiology, age, decompensation profile, and comorbidity meaningfully inform risk and should guide counseling and pre– and post–TIPS care.

背景和目的目前尚不清楚经颈静脉肝内门体分流术（TIPS）的预后是否因肝硬化病因而异，特别是代谢功能障碍相关的脂肪变性肝病（MASLD）。我们的目的是(i)在tips后90天和1年的肝硬化病因特征和（ii）确定与tips后结果相关的特征。方法使用2008年至2023年间的国家卫生系统数据库，我们确定了接受TIPS治疗的肝硬化成人，并根据肝硬化病因进行累积发病率函数和多变量竞争风险分析，主要结局是死亡率和移植竞争风险。结果共有2846例肝硬化患者接受了TIPS治疗（中位年龄63岁[四分位数范围56-71]，61%为男性，74%为非西班牙裔白人）。tips后MASLD 90天未调整无移植生存的概率为84.3%(95%可信区间[CI] 80.3-88.3)， 1年为72.1% (95% CI 67.2-77.0)，而酒精（90天为78.5% [95% CI 76.7-80.3]， 1年为68.7% [95% CI 66.7-70.8]），病毒（90天为78.5% [95% CI 75.6-81.4]， 1年为69.1% [95% CI 62.8-75.5]）和其他病因（90天为76.4% [95% CI 73.5-79.4]， 1年为62.7% [95% CI 57.7-67.8]）。在多变量竞争风险回归中，MASLD（相对于酒精）与tips后90天（亚分布风险比0.59 [95% CI 0.42-0.83]）和1年（亚分布风险比0.76 [95% CI 0.60, 0.97]）死亡率降低相关，与病毒和其他病因相似。年龄较小和最近的TIPS与生存率提高有关，而TIPS前腹水、肝性脑病和增加的Charlson合并症指数与TIPS后90天和1年的死亡率增加有关。结论tips术后masld肝硬化具有良好的短期和长期生存。病因、年龄、失代偿情况和合并症对风险有重要意义，并应指导tips治疗前后的咨询和护理。

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引用次数: 0

Intravascular Hepatocyte Lipid Droplets Are Commonly Present in Hepatic Sinusoids, Portal Venules, and Central Veins in MASH 血管内肝细胞脂滴常见于肝窦、门静脉和中央静脉

Gastro hep advances

Pub Date : 2025-11-17 DOI: 10.1016/j.gastha.2025.100848

George N. Ioannou , Christopher Savard , Joseph L. Dempsey , Rotonya M. Carr , Sum P. Lee

引用次数: 0

Adequacy and Safety of Liver Biopsy Performed During Cardiac Catheterization in Patients With Fontan and Non-Fontan Heart Disease Fontan和非Fontan心脏病患者心导管插入术中肝活检的充分性和安全性

Gastro hep advances

Pub Date : 2025-11-08 DOI: 10.1016/j.gastha.2025.100841

Edward Cytryn , Peizi Li , Maria Isabel Fiel , Barry A. Love , Ali N. Zaidi , Thomas D. Schiano , Lauren T. Grinspan

Background and Aims

Liver biopsy is the gold standard for diagnosis of hepatic fibrosis. Biopsy performed during cardiac catheterization is a unique approach performed at few centers. It allows for simultaneous hepatic and cardiac assessment and may be useful in the surveillance of Fontan-associated liver disease, a recognized complication in Fontan patients. This study reviews the indications, outcomes, and adequacy of liver biopsy performed during cardiac catheterization, with special attention to patients with Fontan-associated liver disease.

Methods

A multidisciplinary, retrospective review of patients at a single quaternary-care center who underwent liver biopsy during right heart catheterization was performed. One hundred thirty liver biopsies taken between December 2011 and October 2022 were analyzed.

Results

There were 80 biopsies in non-Fontan patients and 50 in Fontan patients. Between the non-Fontan and Fontan cohorts, indications for cardiac catheterization were clinically warranted hemodynamic assessment or assessment of Fontan circulation (50% vs 88%), new or progressive heart failure symptoms (46.2% vs 8%), and arrhythmia (3.8% vs 4%). There were fewer average number of biopsy passes during the Fontan patients’ procedures, 2.9 vs 3.5 (P = .046), though average fluoroscopy time was longer, 12.4 vs 6.3 minutes (P < .001). In total, 88.5% of biopsies were classified as “adequate," 9.2% were “limited,” and 2.3% were “inadequate.” A definitive histopathologic diagnosis was reached in 99.2% of biopsies, with the only undiagnosed specimen in the Fontan group.

Conclusion

Liver biopsy during a clinically warranted cardiac catheterization can be safely performed with adequate yield and minimal complication risk. It may be useful in Fontan patients undergoing catheterization to assess Fontan-associated liver disease development.

背景和目的银活检是诊断肝纤维化的金标准。在心导管插入术中进行活检是一种独特的方法，在少数中心进行。它允许同时进行肝脏和心脏评估，可能有助于监测Fontan相关的肝脏疾病，这是Fontan患者公认的并发症。本研究回顾了心导管插入术中肝活检的适应症、结果和充分性，特别关注丰坦相关肝病患者。方法采用多学科回顾性分析方法，对同一家四级护理中心右心导管置管期间行肝活检的患者进行回顾性分析。对2011年12月至2022年10月期间进行的130例肝脏活检进行了分析。结果非Fontan患者活检80例，Fontan患者活检50例。在非Fontan和Fontan队列中，心导管的指征是临床需要的血流动力学评估或Fontan循环评估（50%对88%），新发或进展性心力衰竭症状（46.2%对8%）和心律失常（3.8%对4%）。在Fontan患者的手术过程中，平均活检次数较少，为2.9次对3.5次（P = 0.046），尽管平均透视时间更长，为12.4分钟对6.3分钟（P < .001）。总的来说，88.5%的活检被归类为“充分”，9.2%被归类为“有限”，2.3%被归类为“不充分”。在99.2%的活检中，组织病理学诊断是明确的，Fontan组中唯一未确诊的标本。结论经临床证实的心导管置入术中肝活检可安全进行，手术成功率高，并发症风险低。它可能是有用的Fontan患者接受导管评估Fontan相关的肝脏疾病的发展。

{"title":"Adequacy and Safety of Liver Biopsy Performed During Cardiac Catheterization in Patients With Fontan and Non-Fontan Heart Disease","authors":"Edward Cytryn , Peizi Li , Maria Isabel Fiel , Barry A. Love , Ali N. Zaidi , Thomas D. Schiano , Lauren T. Grinspan","doi":"10.1016/j.gastha.2025.100841","DOIUrl":"10.1016/j.gastha.2025.100841","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Liver biopsy is the gold standard for diagnosis of hepatic fibrosis. Biopsy performed during cardiac catheterization is a unique approach performed at few centers. It allows for simultaneous hepatic and cardiac assessment and may be useful in the surveillance of Fontan-associated liver disease, a recognized complication in Fontan patients. This study reviews the indications, outcomes, and adequacy of liver biopsy performed during cardiac catheterization, with special attention to patients with Fontan-associated liver disease.</div></div><div><h3>Methods</h3><div>A multidisciplinary, retrospective review of patients at a single quaternary-care center who underwent liver biopsy during right heart catheterization was performed. One hundred thirty liver biopsies taken between December 2011 and October 2022 were analyzed.</div></div><div><h3>Results</h3><div>There were 80 biopsies in non-Fontan patients and 50 in Fontan patients. Between the non-Fontan and Fontan cohorts, indications for cardiac catheterization were clinically warranted hemodynamic assessment or assessment of Fontan circulation (50% vs 88%), new or progressive heart failure symptoms (46.2% vs 8%), and arrhythmia (3.8% vs 4%). There were fewer average number of biopsy passes during the Fontan patients’ procedures, 2.9 vs 3.5 (<em>P</em> = .046), though average fluoroscopy time was longer, 12.4 vs 6.3 minutes (<em>P</em> < .001). In total, 88.5% of biopsies were classified as “adequate,\" 9.2% were “limited,” and 2.3% were “inadequate.” A definitive histopathologic diagnosis was reached in 99.2% of biopsies, with the only undiagnosed specimen in the Fontan group.</div></div><div><h3>Conclusion</h3><div>Liver biopsy during a clinically warranted cardiac catheterization can be safely performed with adequate yield and minimal complication risk. It may be useful in Fontan patients undergoing catheterization to assess Fontan-associated liver disease development.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 2","pages":"Article 100841"},"PeriodicalIF":0.0,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Efficacy and Safety of Anti-PD-(L)1 Treatments: A Systematic Review and Meta-Analysis of Asian vs Non-Asian Patients with Esophageal Squamous Cell Carcinoma 抗pd -(L)1治疗的有效性和安全性：亚洲与非亚洲食管鳞状细胞癌患者的系统评价和荟萃分析

Gastro hep advances

Pub Date : 2025-11-07 DOI: 10.1016/j.gastha.2025.100843

Jaffer Ajani , Lin Zhan , Alysha Kadva , Ken Kato , Julian Kretz , Filippo Pietrantonio , Ronan J. Kelly , Xiaowei Zhang , Sylvie Lorenzen

Background and Aims

Esophageal squamous cell carcinoma (ESCC) is prevalent in Asia. Since 2019, anti-programmed cell death protein-1 or programmed death-ligand 1 (anti-PD-[L]1s) have become a mainstay of ESCC treatment. However, many randomized controlled trials (RCTs) of anti-PD-(L)1s were conducted in Asian populations; thus, the applicability of these data to non-Asian cohorts is uncertain. To address this, we conducted a meta-analysis across first- (1L) and second-line (2L) RCTs in advanced/metastatic ESCC.

Methods

RCTs were identified from 2 systematic literature reviews, targeting adults receiving anti-PD-(L)1s at 1L and 2L. Three meta-analyses were performed, testing for heterogeneity and treatment effect (overall survival [OS] or progression-free survival) in the overall population; the third examined Asian vs non-Asian subgroups. Results stability was assessed in sensitivity analyses.

Results

Twelve RCTs were included in the primary meta-analysis; 13 RCTs in the sensitivity analyses. Among patients with ESCC receiving 1L or 2L anti-PD-(L)1s, OS was consistent across RCTs and there was no statistically significant difference between Asian (hazard ratio [HR], 0.70 [95% confidence interval, 0.66–0.75]) and non-Asian (HR, 0.73 [95% confidence interval, 0.63–0.85]) subgroups. For the overall population, no baseline characteristics had a significant impact on the OS HR, and neither line of therapy nor PD-(L)1 expression was shown to be a significant factor in OS heterogeneity. Progression-free survival meta-analyses were not performed due to a lack of data.

Conclusion

This meta-analysis indicates that there is no significant difference in OS between Asian and non-Asian ESCC patients receiving 1L or 2L anti-PD-(L)1 treatment. Results may support regulatory and health technology assessment decision making. In addition, they may encourage wider guideline consideration for anti-PD-(L)1s.

背景和目的食管鳞状细胞癌（ESCC）在亚洲很常见。自2019年以来，抗程序性细胞死亡蛋白-1或程序性死亡配体1 （anti-PD-[L]1s）已成为ESCC治疗的主要药物。然而，许多抗pd -(L) 15的随机对照试验（RCTs）是在亚洲人群中进行的；因此，这些数据在非亚洲人群中的适用性是不确定的。为了解决这个问题，我们对晚期/转移性ESCC的一线（1L）和二线（2L） rct进行了荟萃分析。方法从2篇系统文献综述中筛选srct，针对在1L和2L时接受抗pd -(L)1s治疗的成人。进行了三项荟萃分析，测试总体人群的异质性和治疗效果（总生存期[OS]或无进展生存期）；第三个研究调查了亚洲人和非亚洲人。结果敏感性分析评价了稳定性。结果共纳入12项随机对照试验；敏感性分析纳入13项随机对照试验。在接受1L或2L抗pd -(L)1s治疗的ESCC患者中，各rct的OS一致，亚洲亚组（风险比[HR]， 0.70[95%可信区间，0.66-0.75]）与非亚洲亚组（HR， 0.73[95%可信区间，0.63-0.85]）之间的OS差异无统计学意义。对于总体人群而言，基线特征对OS HR没有显著影响，治疗方案和PD-(L)1表达均未被证明是OS异质性的显著因素。由于缺乏数据，未进行无进展生存meta分析。结论本荟萃分析显示，接受1L或2L抗pd -(L)1治疗的亚洲和非亚洲ESCC患者的OS无显著差异。结果可支持监管和卫生技术评估决策。此外，它们可能鼓励更广泛地考虑抗pd -(L)1s的指南。

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引用次数: 0

Caloric Restriction Is Associated With Enhanced Clinical Outcomes in Hospitalized Patients With Ulcerative Colitis 热量限制与溃疡性结肠炎住院患者的临床预后增强相关

Gastro hep advances

Pub Date : 2025-11-07 DOI: 10.1016/j.gastha.2025.100842

Tomoyuki Nagai, Yoriaki Komeda, Saki Yoshida, Kohei Handa, Sho Masaki, Masashi Kono, Hajime Honjo, Shigenaga Matsui, Naoko Tsuji, Hiroshi Kashida, Masatoshi Kudo

Background and Aims

Ulcerative colitis (UC) is a chronic inflammatory bowel disease with a relapsing-remitting course that often requires hospitalization during flares. While prolonged fasting has traditionally led to high-calorie intravenous nutrition, excessive caloric intake may induce hyperglycemia, increase infection risk, and inhibit autophagy. This study aimed to evaluate the impact of a short-term, calorie-restricted regimen (≤400 kcal/day), designed to promote autophagy, on clinical outcomes in hospitalized patients with UC.

Methods

A retrospective analysis was conducted on 38 patients admitted for UC exacerbation between January 2022 and December 2024. Patients were categorized into a calorie-restricted group (≤400 kcal/day) or a standard nutrition group (>400 kcal/day) based on their total caloric intake. The calorie-restricted group received only intravenous fluids and noncaloric beverages. The primary endpoint was clinical remission at day 14, while secondary endpoints included the length of hospital stay and incidence of adverse events.

Results

The clinical remission at day 14 following treatment initiation was significantly higher in the calorie-restricted group (86% [12/14]) compared to the standard nutrition group (42% [10/24]) (P < .05). The mean duration of hospitalization was also significantly shorter in the calorie-restricted group (11.0 ± 3.3 days) compared to the standard nutrition group (22.1 ± 8.9 days) (P < .01). The calorie-restricted group experienced mild, transient adverse events but no serious complications. In contrast, the standard nutrition group experienced serious adverse events such as catheter-related infections and myocarditis.

Conclusion

Caloric restriction during hospitalization for UC exacerbation may be associated with increased clinical remission and a shorter hospital stay. That nutritional strategy offers a potentially novel and cost-effective approach distinct from conventional bowel rest. Further prospective, multicenter studies are warranted to validate these findings.

背景和目的溃疡性结肠炎（UC）是一种慢性炎症性肠病，病程复发缓解，经常需要住院治疗。虽然长期禁食传统上导致高热量静脉营养，但过量的热量摄入可能导致高血糖，增加感染风险，并抑制自噬。本研究旨在评估旨在促进自噬的短期卡路里限制方案（≤400 kcal/天）对UC住院患者临床结果的影响。方法对我院2022年1月至2024年12月收治的38例UC加重患者进行回顾性分析。根据患者的总热量摄入，将患者分为热量限制组（≤400千卡/天）和标准营养组（>；400千卡/天）。热量限制组只接受静脉输液和无热量饮料。主要终点是第14天的临床缓解，而次要终点包括住院时间和不良事件的发生率。结果在治疗开始后第14天，热量限制组的临床缓解率（86%[12/14]）明显高于标准营养组（42% [10/24]）（P < 0.05）。热量限制组的平均住院时间（11.0±3.3天）也明显短于标准营养组（22.1±8.9天）（P < 0.01）。卡路里限制组经历了轻微的、短暂的不良事件，但没有严重的并发症。相比之下，标准营养组经历了严重的不良事件，如导管相关感染和心肌炎。结论UC加重住院期间限制热量摄入可能与临床缓解增加和住院时间缩短有关。这种营养策略提供了一种潜在的新颖和具有成本效益的方法，与传统的肠道休息不同。需要进一步的前瞻性多中心研究来验证这些发现。

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引用次数: 0

Hepatitis B Surface Antigen Loss and Improved Clinical Outcomes in Asians with Chronic Hepatitis B Virus Infection 慢性乙型肝炎病毒感染的亚洲人乙型肝炎表面抗原丢失和改善的临床结果

Gastro hep advances

Pub Date : 2025-11-06 DOI: 10.1016/j.gastha.2025.100844

Wallis Lau , Myriam Drysdale , Eleonora Morais , Luis Antunes , Loey Mak , Christopher Lee , Catarina Camarinha , Xiaohui Sun , Adrienne Y.L. Chan , May Lam , Vera Gielen , Dickens Theodore , Ian C.K. Wong , Iain A. Gillespie

Background and aims

Chronic hepatitis B virus (HBV) infection accounts for substantial disease burden and mortality due to liver complications. Hepatitis B surface antigen (HBsAg) loss is a key component of functional cure when assessing treatment efficacy. However, the impact of HBsAg loss on clinical outcomes deserves further exploration.

Methods

This population-based cohort study used electronic health record data from a territory-wide database in Hong Kong to identify patients with chronic HBV infection (2005–2019). The association between HBsAg loss and outcomes was assessed: compensated cirrhosis, decompensated liver disease (DLD), hepatocellular carcinoma (HCC), and all-cause mortality (ACM). A marginal structural model using inverse probability weighting was used to estimate hazard ratios (HRs; 95% confidence interval [CI]) adjusted for time-fixed and time-varying confounders. Health-care resource utilization before and after loss was evaluated.

Results

The study population comprised 71,077 patients accruing 348,379 person-years; 1639 (2.3%) experienced HBsAg loss, which occurred with a mean (standard deviation) of 74.63 (37.5) months after chronic HBV index date. HBsAg loss was associated with a reduced risk of DLD (74%; HR 0.26 [95% CI 0.08–0.83]), HCC (66%; 0.34 [0.19–0.61]), and ACM (26%; 0.74 [0.57–0.97]). The HR for compensated cirrhosis was 0.57 (0.30–1.14). Each additional month of HBsAg loss was associated with decreased risk of HCC and ACM. Of those experiencing HBsAg loss, cumulative probability of persistence at 24 and 60 months was 99% and 97%, respectively. Hospital admission, inpatient days, and drug prescribing were higher before HBsAg loss versus 6, 12, and 24 months post-HBsAg loss.

Conclusion

In this large population-based study with extended follow-up in Hong Kong, HBsAg loss was associated with reduced risk of DLD, HCC, and ACM.

背景和目的慢性乙型肝炎病毒（HBV）感染是由肝脏并发症引起的大量疾病负担和死亡率。乙型肝炎表面抗原（HBsAg）丢失是评估治疗效果时功能性治愈的关键组成部分。然而，HBsAg损失对临床结果的影响值得进一步探讨。方法本以人群为基础的队列研究使用来自香港全区数据库的电子健康记录数据来识别慢性HBV感染患者（2005-2019）。评估了HBsAg损失与结局之间的关系：代偿性肝硬化、失代偿性肝病（DLD）、肝细胞癌（HCC）和全因死亡率（ACM）。使用反概率加权的边际结构模型来估计经时间固定和时变混杂因素调整后的风险比（hr； 95%置信区间[CI]）。评估损失前后的卫生保健资源利用情况。研究人群包括71,077例患者，累计348,379人年；1639例（2.3%）患者出现HBsAg损失，平均（标准差）为74.63（37.5）个月。HBsAg损失与DLD （74%; HR 0.26 [95% CI 0.08-0.83]）、HCC（66%; 0.34[0.19-0.61]）和ACM（26%; 0.74[0.57-0.97]）的风险降低相关。代偿性肝硬化的HR为0.57（0.30-1.14）。每增加一个月的HBsAg损失与HCC和ACM的风险降低相关。在经历HBsAg损失的患者中，持续24个月和60个月的累积概率分别为99%和97%。与HBsAg丢失后6、12和24个月相比，HBsAg丢失前的住院率、住院天数和药物处方更高。结论：在香港进行的一项大规模人群随访研究中，HBsAg损失与DLD、HCC和ACM风险降低相关。

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