Clinics and research in hepatology and gastroenterology最新文献

{"title":"Non-Bioartificial Artificial Liver Support System in Acute Liver Failure: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Ruizhi Shi, Xu Hui, Ting Tong, Junfeng Li, Liting Zhang, Kehu Yang","doi":"10.1016/j.clinre.2025.102527","DOIUrl":"https://doi.org/10.1016/j.clinre.2025.102527","url":null,"abstract":"<p><strong>Background: </strong>Acute liver failure (ALF) poses a significant threat to patient health with high mortality rates. While Non-Bioartificial Artificial Liver Support system (NBALSS) has been utilized as a transitional intervention to liver transplant, its efficacy remains uncertain, It is also used as a last-line treatment for patients who are not candidates for liver transplantation.</p><p><strong>Objective: </strong>The aim of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of NBALSS in treating acute liver failure (ALF). The primary outcome was overall survival (OS), while the secondary outcome focused on inflammatory factor levels.</p><p><strong>Methods: </strong>We conducted a comprehensive search across various databases, including PubMed, EMbase, The Cochrane Library, Web of Science, CBM, Wanfang Database, VIP database, and CNKI database. The search spanned from the inception of the databases to July 2023. Two independent reviewers screened literature, extracted data, assessed bias risk in the selected studies and used GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) to rate the certainty of evidence. Random and fixed effects meta-analyses were used to determine the average effect of the interventions on ALF. The sensitivity analysis was conducted using the leave-one-out test. Additionally, subgroup analyses were carried out based on a singular NBALSS treatment or combined treatment of two NBALSS and follow-up duration.</p><p><strong>Results: </strong>Twelve RCTs involving 824 patients were identified. The use of NBALSS was associated with a significantly improved overall survival (OS) [RR=1.42, 95%CI (1.26, 1.61), low certainty] and notable reductions in total bilirubin (TBIL) [MD=-57.60, 95%CI (-79.60, -35.59), moderate certainty], alanine aminotransferase (ALT) [MD=-48.28, 95%CI (-76.57, -19.98), low certainty], tumor necrosis factor (TNF-α) [MD=-1.49, 95%CI (-2.24, -0.73), very low certainty], and interleukin 6 (IL-6) [MD=-178.72, 95%CI (-277.37, -80.06), very low certainty]. However, the effects of NBALSS on interleukin-2 (IL-2) [MD=1.33, 95%CI (-0.33, 3.00), very low certainty], interleukin-8 (IL-8) [MD=-44.75, 95%CI (-163.04, 73.55), very low certainty], and Sequential Organ Failure Score (SOFA) [MD=-4.06, 95%CI (-8.92, 0.80), very low certainty] remained uncertain.</p><p><strong>Conclusions: </strong>Moderate to very low certainty of evidence indicates that NBALSS may improve OS and biochemical indexes, cytokines in patients with ALF. However, the certainty of evidence is limited by risk of bias, incositency and imprecision. High-quality and larger trials are needed to better determine the effect of NBALSS on patient-important outcomes.</p>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":" ","pages":"102527"},"PeriodicalIF":2.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitochondrial dysfunction in drug-induced hepatic steatosis: recent findings and current concept.","authors":"Annie Borgne-Sanchez, Bernard Fromenty","doi":"10.1016/j.clinre.2025.102529","DOIUrl":"https://doi.org/10.1016/j.clinre.2025.102529","url":null,"abstract":"<p><p>Mitochondrial activity is necessary for the maintenance of many liver functions. In particular, mitochondrial fatty acid oxidation (FAO) is required for energy production and lipid homeostasis. This key metabolic pathway is finely tuned by the mitochondrial respiratory chain (MRC) activity and different transcription factors such as peroxisome proliferator-activated receptor α (PPARα). Many drugs have been shown to cause mitochondrial dysfunction, which can lead to acute and chronic liver lesions. While severe inhibition of mitochondrial FAO would eventually cause microvesicular steatosis, hypoglycemia, and liver failure, moderate impairment of this metabolic pathway can induce macrovacuolar steatosis, which can progress in the long term to steatohepatitis and cirrhosis. Drugs can impair mitochondrial FAO through several mechanisms including direct inhibition of FAO enzymes, sequestration of coenzyme A and L-carnitine, impairment of the activity of one or several MRC complexes and reduced PPARα expression. In drug-induced macrovacuolar steatosis, non-mitochondrial mechanisms can also be involved in lipid accumulation including increased de novo lipogenesis and reduced very-low-density lipoprotein secretion. Nonetheless, mitochondrial dysfunction and subsequent oxidative stress appear to be key events in the progression of steatosis to steatohepatitis. Patients suffering from metabolic dysfunction-associated steatotic liver disease (MASLD) and treated with mitochondriotoxic drugs should be closely monitored to reduce the risk of acute liver injury or a faster transition of steatosis to steatohepatitis. Therapies based on the mitochondrial cofactor L-carnitine, the antioxidant N-acetylcysteine, or thyromimetics might be useful to prevent or treat drug-induced mitochondrial dysfunction, steatosis, and steatohepatitis.</p>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":" ","pages":"102529"},"PeriodicalIF":2.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catching the STING: Unlocking senescence and PD-L1 in PBC.","authors":"Pierre-Antoine Soret, Jérémie Gautheron","doi":"10.1016/j.clinre.2025.102526","DOIUrl":"10.1016/j.clinre.2025.102526","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":" ","pages":"102526"},"PeriodicalIF":2.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Liver Failure: Beyond the Guidelines, the Challenge of Liver Support Therapies.","authors":"Faouzi Saliba","doi":"10.1016/j.clinre.2025.102528","DOIUrl":"https://doi.org/10.1016/j.clinre.2025.102528","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":" ","pages":"102528"},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Hepatocellular Carcinosarcoma: A Case Series and Literature Review.","authors":"Haodong Qiao, Huaibin Guo, Ze Liang, Lin Kang, Wanxing Zhang","doi":"10.1016/j.clinre.2024.102520","DOIUrl":"https://doi.org/10.1016/j.clinre.2024.102520","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatocellular carcinosarcoma (HCS) is a rare and aggressive liver tumor with limited clinical evidence due to its infrequency. This case series aimed to enrich the existing knowledge on the diagnosis and clinical management of HCS.</p><p><strong>Methods: </strong>Four patients with HCS were evaluated, focusing on their symptoms, diagnoses, treatments, and outcomes. The imaging characteristics and tumorigenesis of HCS were also investigated, highlighting the role of p53 mutations.</p><p><strong>Results: </strong>This case series found that timely surgery and localized chemotherapy are crucial in managing HCS. Despite the promising results of targeted therapy, its limitations were observed in some patients. The onset and progression of HCS were found to be significantly correlated with the presence of p53 mutations.</p><p><strong>Conclusions: </strong>This case series underscores the need for further research to improve the diagnosis and treatment of HCS and emphasizes the importance of timely surgery and localized chemotherapy in mitigating tumor side effects and potentially prolonging survival.</p>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":" ","pages":"102520"},"PeriodicalIF":2.6,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to Care and the Hispanic Paradox Among Hispanic Patients with Hepatocellular Carcinoma.","authors":"Patrick L Quinn, Fode Tounkara, Marcel Grau Rodríguez, Kunika Chahal, Shah Saiyed, Goutam Gutta, Connor Hannon, Angela Sarna, Alex Kim, Jordan M Cloyd, Yamilé Molina, Jan Kitajewski, Aslam Ejaz","doi":"10.1016/j.clinre.2024.102519","DOIUrl":"https://doi.org/10.1016/j.clinre.2024.102519","url":null,"abstract":"<p><strong>Purpose: </strong>Despite the disproportionate impact of hepatocellular carcinoma (HCC) on Hispanic patients, reported outcomes are limited, particularly among subpopulations. Our study aimed to evaluate outcomes in access to care and survival among racial and ethnic Hispanic subpopulations.</p><p><strong>Methods: </strong>The National Cancer Database was then utilized to identify patients diagnosed with HCC between 2004 and 2020. The independent variables of interest were racial/ethnic groups, with the Hispanic population disaggregated by race and Hispanic heritage. The primary outcomes were the presentation of early versus late-stage HCC, undergoing a curative-intent procedure, time to treatment, and overall survival. Logistic regression was performed with adjustments made for demographic, clinical, and socioeconomic variables.</p><p><strong>Results: </strong>Among 211,988 patients with HCC identified, 12.3% (n=26,085) were classified as Hispanic. In comparison with NHW patients, South/Central American patients had the lowest odds of early-stage presentation (OR=0.91; p=0.1), Cuban patients had the lowest odds of undergoing a curative-intent procedure (OR=0.72; p=0.04), and Mexican patients had the highest odds of delayed treatment (OR=1.45; p<0.001). Hispanics had a longer median survival at 19 months than NHW patients (15 months, p<0.001), with Hispanic Black (HR 0.59, p<0.001) and Dominican (HR 0.56, p<0.001) patients having the lowest mortality risk among Hispanic subpopulations.</p><p><strong>Discussion: </strong>Despite decreased resection rates and increased likelihood of delayed treatment, Hispanics had improved survival across its subpopulations in comparison to NHW patients, further highlighting the Hispanic paradox.</p>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":" ","pages":"102519"},"PeriodicalIF":2.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"α-L-Fucosidase: A potential biomarker for differential diagnosis of autoimmune hepatitis and drug-induced autoimmune hepatitis.","authors":"Yingying Lin, Xinyu Cui, Yanyan Li, Na Zhu, Xin Li","doi":"10.1016/j.clinre.2024.102517","DOIUrl":"10.1016/j.clinre.2024.102517","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":" ","pages":"102517"},"PeriodicalIF":2.6,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring gender disparities in hepatocellular carcinoma: Insights from a French study.","authors":"Héloïse Giudicelli, Manon Allaire","doi":"10.1016/j.clinre.2024.102518","DOIUrl":"10.1016/j.clinre.2024.102518","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":" ","pages":"102518"},"PeriodicalIF":2.6,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telomere-methylation genes: Novel prognostic biomarkers for hepatocellular carcinoma.","authors":"Jia-Wen Xie, Hui-Ling Wang, Ling-Qing Lin, Yin-Feng Guo, Mao Wang, Xiao-Zhen Zhu, Jian-Jun Niu, Li-Rong Lin","doi":"10.1016/j.clinre.2024.102516","DOIUrl":"10.1016/j.clinre.2024.102516","url":null,"abstract":"<p><strong>Background: </strong>Since telomere length and DNA methylation both correlate with hepatocellular carcinoma (HCC) prognosis, telomere-methylation genes could be novel prognostic markers for HCC.</p><p><strong>Method: </strong>This study first investigated the interaction between telomere length and DNA methylation in HCC through Mendelian randomization analysis. Then, this study identified telomere-methylation genes in HCC by employing the TCGA-LIHC cohort, and explored the expression patterns of these genes in the tumor microenvironment of HCC and potential underlying mechanisms. Finally, the HCC risk-scoring model and prognostic model based on these genes were established, and the performance of the model was assessed.</p><p><strong>Result: </strong>The findings revealed a bidirectional relationship between telomere length and DNA methylation in HCC. Fifty telomere-methylation genes were identified, and the prognosis-related telomere-methylation genes were closely associated with Treg and Tprolif cell subsets within the HCC tumor microenvironment. Telomere-methylation genes could potentially impact the prognosis of HCC patients by modulating chromosome stability and regulating the cell cycle. Additionally, the constructed risk scoring model and prognostic prediction model showcased compelling clinical applicability, as evidenced by the receiver operating characteristic curve, the decision curve analysis, and the calibration curves.</p><p><strong>Conclusion: </strong>This study elucidated the potential of telomere-methylation genes as prognostic biomarkers for HCC and paves the way for novel approaches in prognostication and treatment management for HCC patients.</p>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":" ","pages":"102516"},"PeriodicalIF":2.6,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive factors of spontaneous common bile duct clearance and unnecessary ERCP in patients with choledocholithiasis.","authors":"Fábio Pereira Correia, Henrique Coelho, Mónica Francisco, Gonçalo Alexandrino, Joana Carvalho Branco, Jorge Canena, David Horta, Luís Carvalho Lourenço","doi":"10.1016/j.clinre.2024.102515","DOIUrl":"10.1016/j.clinre.2024.102515","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line procedure for choledocholithiasis treatment. However, it is associated with a 10 % rate of adverse events. Spontaneous migration of common bile duct (CBD) stones occurs in 6-33 % of choledocholithiasis cases, making ERCP avoidable. This study aimed to identify predictors of spontaneous CBD stones' migration.</p><p><strong>Methods: </strong>Retrospective study including patients diagnosed with choledocholithiasis and submitted to ERCP. Patients were divided into 2 groups considering spontaneous stone migration (i.e.: the absence of CBD stones on ERCP). Data on patients' characteristics, imaging findings, biochemical analysis, and ERCP procedure were analyzed to identify predictors of spontaneous migration of CBD stones.</p><p><strong>Results: </strong>334 patients with a mean age of 71.7 years were included in the study: 76.6 % without and 23.4 % with spontaneous migration of CBD stones. Although some patients' features (gender and clinical presentation), imaging findings (diameters of the largest stone and CBD), biochemical analysis (bilirubin levels at diagnosis and pre-ERCP), and ERCP procedure characteristics (time from diagnosis to ERCP) were different between groups, only three variables were defined as predictors: the absence of acute cholangitis, the largest stone diameter ≤5 mm, and the bilirubin levels pre-ERCP ≤ 2mg/dL. When using those variables together there was a chance of 81-86 % to correctly distinguishing patients with and without spontaneous CBD stone migration.</p><p><strong>Conclusion: </strong>The size of the largest stone at diagnosis was validated as a predictor of CBD stones' spontaneous migration. Furthermore, two new predictors were identified: bilirubin levels pre-ERCP ≤ 2 mg/dL, and no acute cholangitis at the clinical presentation of choledocholithiasis. EUS and ERCP in the same session should be considered in patients with factors predictive of stone migration, especially when combined, to minimize unnecessary ERCP and possible complications.</p>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":" ","pages":"102515"},"PeriodicalIF":2.6,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}