iLIVER最新文献

{"title":"Biological aging across the metabolic dysfunction–associated steatotic liver disease spectrum: A systematic review","authors":"Chukwuemeka E. Ogbu ,&nbsp;Stella C. Ogbu ,&nbsp;Chidera P. Ogbu ,&nbsp;Chinazor Umerah","doi":"10.1016/j.iliver.2026.100222","DOIUrl":"10.1016/j.iliver.2026.100222","url":null,"abstract":"<div><h3>Background and aims</h3><div>Metabolic dysfunction–associated steatotic liver disease (MASLD) is a growing global health burden. Geroscience posits that accelerated biological aging is a key driver of chronic disease. We systematically reviewed the evidence to define the role of biological aging (BA) across the MASLD disease spectrum.</div></div><div><h3>Methods</h3><div>A systematic literature search of PubMed/MEDLINE and Embase was conducted from inception through August 2025 for observational studies in adults assessing validated BA measures (phenotypic age, Klemera–Doubal method, Homeostatic Dysregulation, epigenetic clocks, telomere length) and MASLD outcomes. A narrative synthesis was performed following SWiM guidelines because of substantial methodological heterogeneity.</div></div><div><h3>Results</h3><div>Nineteen studies were included. BA was operationalized using clinical composite clocks (KDM-BA, PhenoAge, Homeostatic Dysregulation), epigenetic clocks, leukocyte telomere length, homeostatic dysregulation indices, and one machine-learning BA metric. Accelerated BA generally referred to BA higher than expected for chronological age or shorter telomere length. Across large cross-sectional studies, individuals with accelerated BA had higher odds of MASLD/nonalcoholic fatty liver disease (NAFLD), and in prospective cohorts, higher BA at baseline predicted increased hazards of incident NAFLD after multivariable adjustment, suggesting BA functions as an upstream integrator of risk rather than only a consequence of liver disease. Accelerated BA was also associated with greater fibrosis burden and with higher all-cause mortality among people with MASLD. Several studies indicated that BA mediates part of the effect of environmental toxicants on MASLD and acts as an effect modifier, with higher risk observed when accelerated BA co-occurs with unfavorable genetic profiles or environmental exposures. Mendelian randomization analyses supported a potential causal role of cellular aging in liver fibrogenesis.</div></div><div><h3>Conclusion</h3><div>Across 19 observational studies, accelerated biological aging (assessed using clinical composite indices, epigenetic clocks, and telomere length) was consistently associated with higher MASLD/NAFLD risk, greater fibrosis severity, and higher mortality. These findings support BA as potentially a clinically relevant risk integrator in MASLD spectrum diseases. However, heterogeneity in BA measures and disease definitions limits comparability and highlight the need for harmonized BA measures in longitudinal studies.</div></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"5 1","pages":"Article 100222"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313899","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}

{"title":"Development of a hybrid deep learning-based framework for liver fibrosis classification using ultrasound images","authors":"Adedotun F. Adesina ,&nbsp;Blessing O. Olorunfemi ,&nbsp;Adenike T. Adeniji-Sofoluwe ,&nbsp;Chiagoziem A. Otuechere ,&nbsp;Funmilayo Olopade ,&nbsp;Benjamin Aribisala","doi":"10.1016/j.iliver.2026.100225","DOIUrl":"10.1016/j.iliver.2026.100225","url":null,"abstract":"<div><h3>Background and aims</h3><div>Liver fibrosis is a progressive accumulation of extracellular matrix proteins with distortion of hepatic architecture and can progress to cirrhosis or hepatocellular carcinoma. Biopsy remains the diagnostic gold standard, however, its invasive nature, sampling error, and cost limit routine use. Ultrasound imaging provides a safer, more accessible option but depends on operator expertise and subjective interpretation. Existing deep learning approaches for fibrosis assessment often rely on small datasets or perform only binary classification. This study aimed to develop a hybrid deep learning model combining ResNet50 and VGG16 for automated multi-class classification (F0–F4), enhancing diagnostic accuracy, reducing biopsy reliance, and supporting affordable, interpretable liver disease assessment.</div></div><div><h3>Methods</h3><div>The total of 6323 ultrasound image samples with METAVIR system labels ranging from F0 to F4 was downloaded from Kaggle. After data preprocessing, 80:20 splits were made for training and testing. A hybrid model consisting of fine-tuned ResNet50 and VGG16 was used for classification of fibrosis stages. Model performance was statistically evaluated using sensitivity, specificity, and area under the ROC curve (AUC) for each fibrosis stage, averaging across classes to address imbalance. Robustness and reproducibility were assessed by calculating 95% confidence intervals (CI) for all performance metrics through bootstrap resampling. Grad-CAM was used to interpret the model’s predictions.</div></div><div><h3>Results</h3><div>The hybrid model was also successful in achieving the highest peak in testing accuracy, reaching 86.64%, compared to the other models (55.26% for ResNet50, 72.73% for VGG16). The classification was also high for the hybrid model, with the highest values for the macro AUC and weighted AUC at 96.79% and 97.79%, respectively. The highest predicted probabilities were seen for the F0 and F4 stages, which were correctly classified, with the Grad-CAM heatmaps showing high focus on the fibrotic regions.</div></div><div><h3>Conclusion</h3><div>The hybrid model achieved good diagnostic results with high sensitivity, specificity, and confidence. The Grad-CAM images validated that the model was focusing on significant areas, as shown by the heat map, which proves that it has potential as a non-invasive, accurate, and interpretable tool for automated liver fibrosis staging using ultrasound images.</div></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"5 1","pages":"Article 100225"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313947","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}

{"title":"Single-port robot-assisted hepatectomy of segments S4b and S5v: A case report","authors":"Xin Lan,&nbsp;Jian Feng,&nbsp;Chenglin Piao,&nbsp;Qiang Li,&nbsp;Zhenduo Si,&nbsp;Chao Zhang,&nbsp;Jianjun Leng","doi":"10.1016/j.iliver.2026.100223","DOIUrl":"10.1016/j.iliver.2026.100223","url":null,"abstract":"<div><div>We report a 63-year-old man with hepatocellular carcinoma who initially underwent transcatheter arterial chemoembolization and two cycles of targeted therapy combined with immunotherapy, which achieved a partial response. He then successfully underwent single-port robot-assisted resection of liver segments S4b and S5v using the SHURUI single-port robotic system. The surgical incision measured 4 cm, intraoperative blood loss was 200 mL, and the operation time was 240 minutes. He recovered well and was discharged on postoperative day 7.</div></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"5 1","pages":"Article 100223"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189862","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}

{"title":"Application of the Laennec approach in laparoscopic repeat liver resection","authors":"Chenfenglin Yang ,&nbsp;Shubing Wei ,&nbsp;Pinchu Chen ,&nbsp;Yao Li ,&nbsp;Weiming Ye ,&nbsp;Siyuan Dai ,&nbsp;Kejia Li ,&nbsp;Qifan Zhang","doi":"10.1016/j.iliver.2026.100221","DOIUrl":"10.1016/j.iliver.2026.100221","url":null,"abstract":"<div><div>Laparoscopic repeat liver resection (LRLR) is widely recognized as an effective therapeutic option for recurrent liver disease but is challenged by extensive adhesions and altered anatomical structures resulting from previous surgeries. The Laennec approach, which leverages the unique intrahepatic membranous structure of Laennec's capsule, has emerged as a promising surgical strategy to address these technical issues. This literature review comprehensively summarizes the anatomical basis, technical evolution, clinical applications, advantages, limitations, and prospects of the Laennec approach in LRLR. By systematically organizing evidence from clinical studies, case reports, and anatomical research, this review aims to provide a comprehensive understanding of the value of the Laennec approach in overcoming the complexities of LRLR and to provide insights for its standardized application and further research.</div></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"5 1","pages":"Article 100221"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189864","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}

{"title":"Somatostatin analog therapy in delaying progression of polycystic liver disease: A meta-analysis with trial sequential analysis","authors":"Mohammed S. Beshr ,&nbsp;Rana H. Shembesh ,&nbsp;Bisher Sawaf ,&nbsp;Shahem Abbarh ,&nbsp;Mohammed Abu-Rumaileh ,&nbsp;Monica Tincopa ,&nbsp;Muhammed Elhadi","doi":"10.1016/j.iliver.2026.100220","DOIUrl":"10.1016/j.iliver.2026.100220","url":null,"abstract":"<div><h3>Background and aims</h3><div>Polycystic liver disease (PLD) can occur independently or in association with autosomal dominant polycystic kidney disease and has no effective medical therapy. This meta-analysis evaluated whether somatostatin analog therapy slows progression of PLD.</div></div><div><h3>Methods</h3><div>The PubMed, Scopus, Web of Science, and Cochrane databases were searched through to May 1, 2025 to identify randomized controlled trials that evaluated somatostatin analogs in PLD. The primary endpoints were percentage change from baseline in total liver volume (TLV), total kidney volume (TKV), and estimated glomerular filtration rate (eGFR). Safety endpoints included cholelithiasis, cholecystitis, diarrhea, and abdominal pain. Effect sizes were estimated using mean differences (MDs) and odds ratios (ORs) within a random-effects framework. Trial sequential analysis was performed for TLV, TKV, and eGFR.</div></div><div><h3>Results</h3><div>Seven randomized controlled trials with 640 participants were included. Somatostatin analog therapy led to a significant reduction in TLV (MD −6.73%, 95% CI −8.68 to −4.78; <em>p</em> ​&lt; ​0.001; GRADE, low)]and TKV (MD −3.35%, 95% CI −4.97 to −1.74; <em>p</em> ​&lt; ​0.001; GRADE, moderate) compared with placebo. No significant effect was observed for eGFR (MD 0.32, 95% CI −4.55 to 5.19; <em>p</em> ​= ​0.90; GRADE, low). Adverse events, including cholelithiasis and cholecystitis (OR 4.66, 95% CI 1.19–18.26; <em>p</em> ​= ​0.03; GRADE, moderate), diarrhea, and abdominal pain, were more frequent in the somatostatin group. Trial sequential analysis showed good evidence of benefit for TLV and TKV and inconclusive evidence for eGFR.</div></div><div><h3>Conclusions</h3><div>Based on low-to-moderate evidence, somatostatin analogs were significantly associated with reduced TLV and TKV, but not eGFR, in patients with PLD, and with higher adverse event rates. Long-term trials are warranted to define their role in clinical management.</div><div><strong>Registration</strong>: PROSPERO, ID CRD420251045402.</div></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"5 1","pages":"Article 100220"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090143","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}

{"title":"Surgical treatment of refractory groove pancreatitis","authors":"Xin Yan ,&nbsp;Zhiyong Yang ,&nbsp;Guoliang Qiao ,&nbsp;Qian Zhu","doi":"10.1016/j.iliver.2026.100217","DOIUrl":"10.1016/j.iliver.2026.100217","url":null,"abstract":"<div><div>Groove pancreatitis is a rare form of chronic pancreatitis localized to the pancreatoduodenal groove. Diagnosis is challenging because of nonspecific symptoms and imaging findings that often mimic malignancy. Although conservative management is considered first-line therapy, surgical intervention may become necessary in refractory cases. We report a case of refractory groove pancreatitis successfully treated with laparoscopic pancreaticoduodenectomy, highlighting the role of surgery and the importance of addressing modifiable risk factors.</div></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"5 1","pages":"Article 100217"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996461","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}

{"title":"Ultrasound-guided PTCL’s successful treatment of bronchobiliary fistula and benign biliary stricture after multiple partial hepatectomy and hepaticojejunostomy: A case report and literature review","authors":"Xinyue Xia ,&nbsp;Weirong Li ,&nbsp;Gang Huang,&nbsp;Tian Tao,&nbsp;Min Hu","doi":"10.1016/j.iliver.2026.100218","DOIUrl":"10.1016/j.iliver.2026.100218","url":null,"abstract":"<div><div>Bronchobiliary fistulas (BBFs) are associated with a high mortality and morbidity rate. This article introduces a patient who had coughed up yellowish-green phlegm for two years with a history of multiple previous hepatobiliary surgeries and bronchobiliary fistulas. A preoperative chest CT revealed inflammatory exudation on the dorsal side of the right lower lung, which communicated with the terminal branch of the bronchus. An abdominal CT revealed intrahepatic bile duct dilatation with limited and narrow hilar hepatis, as well as a chaotic and unclear structure. Stones were displayed in the right posterior lobe. Based on the discussions, the patient was decided to perform ultrasound-guided percutaneous transhepatic cholangioscopic lithotony (U-PTCL) to relieve the obstruction and stone problems in the biliary tract. U-PTCL is a minimally invasive procedure. It enables the precise removal of stones, the accurate localization and dilation of the stenotic bile duct segment, and the placement of supportive drainage tubes. After U-PTCL, the patient experienced a reduction in intrahepatic bile duct stones, and the cough significantly improved. During a two-year follow-up, the patient did not complain of discomfort. This article introduces a minimally invasive method—U-PTCL—for solving bronchobiliary fistulas and benign biliary strictures after a multiple partial hepatectomy and hepaticojejunostomy.</div></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"5 1","pages":"Article 100218"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189863","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}

{"title":"Anatomy of the right portal vein and right hepatic vein for anatomical minimally invasive liver resection","authors":"Pascalia Wikana Likalamu ,&nbsp;Wenjie Yu ,&nbsp;Nan Xia ,&nbsp;Yu Zhang ,&nbsp;Linfeng Sun ,&nbsp;Xiangdong Li ,&nbsp;Xuejiao Chen ,&nbsp;Sheng Han ,&nbsp;Ziyi Wang ,&nbsp;Liyong Pu","doi":"10.1016/j.iliver.2026.100226","DOIUrl":"10.1016/j.iliver.2026.100226","url":null,"abstract":"<div><h3>Background</h3><div>Anatomical minimally invasive liver resection requires an understanding of hepatic vascular anatomy to minimize complications and optimize outcomes. This study characterized variations in right portal vein (RPV) and right hepatic vein (RHV) anatomy using three-dimensional (3D) computed tomography (CT) reconstruction and established a practical classification system to guide surgical planning.</div></div><div><h3>Methods</h3><div>Contrast-enhanced CT images from 569 patients without known liver disease were analyzed at a single Chinese tertiary center. 3D reconstructions were performed using the Hisense CAS system. RPV and RHV vascular branching patterns were systematically evaluated and classified according to their origins, bifurcation points, and relationships to Couinaud segments and Glissonean pedicles.</div></div><div><h3>Results</h3><div>We identified four distinct RPV branching patterns: Type A (68.5%) showed classical bifurcation into right anterior and posterior portal veins from a common RPV trunk; Type B (19.9%) showed direct branching from the main portal vein; Type C (3.9%) showed anomalous branching with the right anterior portal vein (RAPV) originating from the left portal vein; and Type D (7.7%) showed trifurcation. For the right hepatic vein (RHV) drainage, we identified three types, with Type A (a single dominant trunk, 68%) being the most common. Accessory RHVs were present in 49.7% of the patients, making them the most frequently observed anatomical variation.</div></div><div><h3>Conclusion</h3><div>Our study demonstrates substantial anatomical variation in right-sided hepatic vasculature, with accessory RHVs present in nearly half of our patients. 3D CT reconstruction provides accurate preoperative vascular mapping that is essential for safe anatomical minimally invasive liver resection. Our classification system enables individualized surgical planning and facilitates the craniocaudal Glissonean approach for segment-oriented liver resection.</div></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"5 1","pages":"Article 100226"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147398968","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}

{"title":"Advancing hepatology through innovation and integration: iLIVER's vision for 2026","authors":"Zu-Chao Du ,&nbsp;Ke-Chun Wang ,&nbsp;Ming-Da Wang ,&nbsp;Lei Cai ,&nbsp;Jian-Hong Zhong ,&nbsp;Tian Yang","doi":"10.1016/j.iliver.2026.100224","DOIUrl":"10.1016/j.iliver.2026.100224","url":null,"abstract":"","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"5 1","pages":"Article 100224"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147398575","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}

{"title":"Chemotherapy combined with pembrolizumab in advanced gallbladder cancer with subsequent radical resection: A case report","authors":"Yongjie Hu ,&nbsp;Yongpeng Wei ,&nbsp;Xinbo Liu ,&nbsp;Li Shen ,&nbsp;Yu Wang ,&nbsp;Jianyong Yuan","doi":"10.1016/j.iliver.2026.100219","DOIUrl":"10.1016/j.iliver.2026.100219","url":null,"abstract":"<div><div>Gallbladder cancer is often diagnosed at an advanced stage, preventing radical surgical intervention. Combined with its highly aggressive nature, this results in a generally poor prognosis. Although advancements in treatment strategies have expanded the application of conversion therapy for initially unresectable gallbladder cancer cases, achieving eligibility for radical resection remains uncommon. Here, we report a case of advanced gallbladder cancer where treatment with pembrolizumab combined with gemcitabine and cisplatin was followed by successful radical surgical resection, demonstrating a favorable therapeutic outcome. This case highlights the potential of combining immunotherapy and chemotherapy for improving treatment responses and surgical outcomes in advanced gallbladder cancer.</div></div>","PeriodicalId":100657,"journal":{"name":"iLIVER","volume":"5 1","pages":"Article 100219"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090144","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}