Clinics and research in hepatology and gastroenterology最新文献

{"title":"Construction and validation of a machine learning-based prediction model for short-term mortality in critically ill patients with liver cirrhosis","authors":"ZhanJin Wang ,&nbsp;Fu Yuan Li ,&nbsp;JunJie Cai ,&nbsp;ZhangTuo Xue ,&nbsp;Ying Zhou ,&nbsp;Zhan Wang","doi":"10.1016/j.clinre.2024.102507","DOIUrl":"10.1016/j.clinre.2024.102507","url":null,"abstract":"<div><h3>Objective</h3><div>Critically ill patients with liver cirrhosis generally have a poor prognosis due to complications such as multiple organ failure. This study aims to develop a machine learning-based prediction model to forecast short-term mortality in critically ill cirrhotic patients in the intensive care unit (ICU), thereby assisting clinical decision-making for intervention and treatment.</div></div><div><h3>Methods</h3><div>Machine learning models were developed using clinical data from critically ill cirrhotic patients in the MIMIC database, with multicenter validation performed using data from the eICU database and Qinghai University Affiliated Hospital(QUAH). Various machine learning models, including a Stacking ensemble model, were employed, with the SHAP method used to enhance model interpretability.</div></div><div><h3>Results</h3><div>The Stacking ensemble model demonstrated superior predictive performance through internal and external validation, with AUC and AP values surpassing those of individual algorithms. The AUC values were 0.845 in the internal validation set, 0.819 in the eICU external validation, and 0.761 in the QUAH validation set. Additionally, the SHAP method highlighted key prognostic variables such as INR, bilirubin, and urine output. The model was ultimately deployed as a web-based calculator for bedside decision-making.</div></div><div><h3>Conclusion</h3><div>The machine learning model effectively predicts short-term mortality risk in critically ill cirrhotic patients in the ICU, showing strong predictive performance and generalizability. The model's robust interpretability and its deployment as a web-based calculator suggest its potential as a valuable tool for assessing the prognosis of cirrhotic patients.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102507"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766912","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}

{"title":"A heterogeneous subtype of biliary epithelial senescence may be involved in the pathogenesis of primary biliary cholangitis","authors":"Motoko Sasaki ,&nbsp;Yasunori Sato ,&nbsp;Yasuni Nakanuma","doi":"10.1016/j.clinre.2024.102512","DOIUrl":"10.1016/j.clinre.2024.102512","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Biliary epithelial senescence is involved in the pathogenesis of primary biliary cholangitis (PBC). We hypothesized that a unique subtype of programmed death-ligand 1 (PD-L1)-positive senescent biliary epithelial cells (BECs) may be related to the pathogenesis of PBC in association with cyclic GMP-AMP synthase (cGAS)- stimulator of interferon genes (STING) pathway.</div></div><div><h3>Approach &amp; results</h3><div>The expression of PD-L1, STING and their association with senescent markers p16^INK4a and p21^WAF1/Cip1 were immunohistochemically determined in livers taken from the patients with PBC (<em>n</em> = 87) and 97 diseased and normal control livers. The expression of PD-L1 was significantly increased in a part of senescent BECs with p21^WAF1/Cip1 expression in BECs in the damaged small bile ducts in PBC, compared to control livers (<em>p</em> &lt; 0.01). In contrast, PD-L1 was not expressed in BECs in ductular reactions. The expression of STING was significantly increased in BECs in small bile ducts and ductular reactions in PBC, compared to control livers (<em>p</em> &lt; 0.01). The expression of PD-L1, STING and senescence associated secretory phenotypes (SASPs) including interferon (IFN)-beta was significantly increased in senescent BECs induced by a treatment with serum depletion or glycochenodeoxycholic acid (GCDC) for 4–7 days (<em>p</em> &lt; 0.01) and the increase was significantly suppressed by a knockdown of STING using <em>si</em>RNA (<em>p</em> &lt; 0.01). Induction of cellular senescence induced by a treatment with serum depletion or GCDC was significantly suppressed by a knockdown of STING in BECs. (<em>p</em> &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>A unique subtype of senescent BECs with PD-L1 expression associated with cGAS-STING pathway may be involved in the pathogenesis of PBC.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102512"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812274","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 ,&nbsp;Xinyu Cui ,&nbsp;Yanyan Li ,&nbsp;Na Zhu ,&nbsp;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":"49 1","pages":"Article 102517"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","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":"An ileo-anal pouch doing the twist (with video)","authors":"Flore de Castelbajac,&nbsp;Nicolas Billet,&nbsp;Laurence Monnier-Chollet,&nbsp;Aziz Zaanan,&nbsp;Philippe Seksik,&nbsp;Xavier Dray","doi":"10.1016/j.clinre.2024.102511","DOIUrl":"10.1016/j.clinre.2024.102511","url":null,"abstract":"<div><div>A 37-year-old female patient had a past history of proctocolectomy for Crohn's disease, with ileal J-pouch-anal anastomosis. She was admitted for acute obstructive symptoms. CT scan revealed a 180 twisted ileo-anal anastomosis without signs of severe ischemia (<span><span>Fig. 1</span></span> <strong>and video</strong>), prompting urgent endoscopic treatment. Lower endoscopy showed a complete spiral of the J-pouch which was easily untwisted and passed. Aspiration followed by placement of a multiperforated Faucher tube allowed immediate symptoms relief. The tube was withdrawn 2 days later and the patient was discharged on the same evening. Although the patient was warned for recurrences, no further episode had occurred at last (60 days) follow-up.</div><div>The term \"twisted syndrome\" refers to the twisting of the ileal pouch around its mesenteric axis, creating a volvulus, possibly leading to acute intestinal obstruction. It is often caused by insufficient adhesion of the ileum to the pelvis or to excessive length of the mesentery. If untreated, the twist can disrupt vascularization, leading to pouch ischemia and necrosis. The treatment typically involves emergency endoscopy to untwist the pouch whereas redo pouch-surgery should be discussed to prevent future episodes. Other mechanisms of pouch obstruction include prolapse (also known as “floppy pouch complex”) [2], inflammation, fibrosis, dysplasia or cancer related to inflammatory bowel disease, or rare extraluminal causes.</div><div>This case highlights the importance of combining emergency CT-scan and endoscopy to diagnose various pouch complications, to untwist the pouch in case of a volvulus, and to enhance the strategy for pouch salvage. Three-dimensional CT-based pouchography is also an advanced option to better guide decisions [3].</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102511"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794542","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":"The flaming and pulled up anorectal line: Ulcerative colitis-associated squamous metaplasia of the lower rectum","authors":"Vincent Zimmer","doi":"10.1016/j.clinre.2024.102513","DOIUrl":"10.1016/j.clinre.2024.102513","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102513"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812275","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":"Prognostic role of tumor-infiltrating lymphocytes in gastric cancer: A systematic review and meta-analysis","authors":"Xiaoqing Cao ,&nbsp;Yurou Kang ,&nbsp;Ping Tai,&nbsp;Pei Zhang,&nbsp;Xin Lin,&nbsp;Fei Xu,&nbsp;Zhenlin Nie,&nbsp;Bangshun He","doi":"10.1016/j.clinre.2024.102510","DOIUrl":"10.1016/j.clinre.2024.102510","url":null,"abstract":"<div><h3>Background</h3><div>To analyze the relationship between tumor-infiltrating lymphocytes (TILs) subtypes and infiltration locations and the prognosis of gastric cancer (GC) patients.</div></div><div><h3>Methods</h3><div>Eligible articles were obtained through systematic retrieval and rigorous screening, collecting study information and extracting hazard ratio (HR), 95 % confidence interval (CI) for pooled analyses of disease-free survival (DFS) and overall survival (OS).</div></div><div><h3>Results</h3><div>Higher CD4⁺ TILs were correlated with favorable OS (HR=0.79, 95 %CI: 0.66–0.94, <em>P</em> = 0.009), the similar results were observed in tumor center and in infiltration margin. Higher CD8⁺ TILs prolonged DFS (HR=0.69, 95 %CI: 0.51–0.95, <em>P</em> = 0.02) and OS (HR=0.96, 95 %CI: 0.94–0.99, <em>P</em> = 0.006); For OS, tumor center and infiltration margin groups showed positive results. Neither the overall analysis nor the subgroup analyses indicated that the level of FOXP3⁺ TILs was associated with prognosis (DFS: HR=0.89, 95 %CI: 0.66–1.19, <em>P</em> = 0.42; OS: HR=0.98, 95 %CI: 0.85–1.13, <em>P</em> = 0.75). Pooled results revealed that higher CD3⁺ TILs were correlated with favorable DFS (HR=0.69, 95 %CI: 0.56–0.84, <em>P</em> = 0.0003) but not OS (HR=1.00, 95 %CI: 0.99–1.01, <em>P</em> = 0.48).</div></div><div><h3>Conclusions</h3><div>High infiltrating CD3⁺, CD4⁺, CD8⁺ T cells prolong survival, and FOXP3⁺ subset is not related to prognosis in GC. For CD4⁺ and CD8⁺, positive correlations between the infiltration level and OS were present in tumor center and infiltration margin groups.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102510"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766915","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,&nbsp;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":"49 1","pages":"Article 102518"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","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 ,&nbsp;Hui-Ling Wang ,&nbsp;Ling-Qing Lin ,&nbsp;Yin-Feng Guo ,&nbsp;Mao Wang ,&nbsp;Xiao-Zhen Zhu ,&nbsp;Jian-Jun Niu ,&nbsp;Li-Rong Lin","doi":"10.1016/j.clinre.2024.102516","DOIUrl":"10.1016/j.clinre.2024.102516","url":null,"abstract":"<div><h3>Background</h3><div>Since telomere length and DNA methylation both correlate with hepatocellular carcinoma (HCC) prognosis, telomere-methylation genes could be novel prognostic markers for HCC.</div></div><div><h3>Method</h3><div>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.</div></div><div><h3>Result</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102516"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","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 ,&nbsp;Henrique Coelho ,&nbsp;Mónica Francisco ,&nbsp;Gonçalo Alexandrino ,&nbsp;Joana Carvalho Branco ,&nbsp;Jorge Canena ,&nbsp;David Horta ,&nbsp;Luís Carvalho Lourenço","doi":"10.1016/j.clinre.2024.102515","DOIUrl":"10.1016/j.clinre.2024.102515","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102515"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary hepatic large B-cell lymphoma","authors":"Dan-Lei Han ,&nbsp;Jian Zha ,&nbsp;Lin-Yan Wan ,&nbsp;Wei Liu","doi":"10.1016/j.clinre.2024.102506","DOIUrl":"10.1016/j.clinre.2024.102506","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 1","pages":"Article 102506"},"PeriodicalIF":2.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695277","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}