Journal of Clinical and Experimental Hepatology最新文献

{"title":"Overlap Syndromes and Associated Immunoglobulin-G4-Related Liver Diseases","authors":"Sayan Malakar,&nbsp;Sanjit Kumar,&nbsp;Akash Roy,&nbsp;Suprabhat Giri,&nbsp;Sumit Rungta,&nbsp;Mayank Agarwal,&nbsp;Amandeep Singh,&nbsp;Nitesh Bassi,&nbsp;Arghya Samanta,&nbsp;Uday C. Ghoshal,&nbsp;Virendra Singh","doi":"10.1016/j.jceh.2026.103564","DOIUrl":"10.1016/j.jceh.2026.103564","url":null,"abstract":"<div><div>Overlap syndromes (OS) are mixed hepatitic-cholestatic variants of autoimmune liver diseases (AILD), characterized by features of autoimmune hepatitis (AIH), bile duct injury, and circulating autoantibodies related to primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC). Few cases of PBC-PSC have also been reported. Following the recognition of immunoglobulin G4-related diseases (IgG4-RD), IgG4-hepatopathy, IgG4-AIH, and PSC-with high serum IgG4-related disorders are being increasingly identified. Patients with this group of disorders often present like OS. High serum IgG4 levels in patients with PSC have been associated with worse overall survival. Hence, treatment and prognosis may differ between patients with IgG4-AIH and those with IgG4-hepatopathy. Early recognition and management of OS and related cholestatic diseases may improve outcomes and extend transplant-free survival. This review aims to formulate strategies for the diagnosis and management of OS based on current evidence. It also delves into the intricate relationship between the IgG4-related disease and AILD.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 4","pages":"Article 103564"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345424","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":"Candesartan Cilexetil Restores Renal Endothelial Function Through Modulation of the ADMA–DDAH–eNOS Pathway in Experimental ACLF-Associated Renal Dysfunction","authors":"Balasubramaniyan Vairappan,&nbsp;Ravikumar T.S.,&nbsp;Sundhar Mohandas,&nbsp;Gavin Wright","doi":"10.1016/j.jceh.2026.103585","DOIUrl":"10.1016/j.jceh.2026.103585","url":null,"abstract":"<div><h3>Background/Aims</h3><div>Renal dysfunction is a frequent and life-threatening complication of advanced cirrhosis and is particularly common in acute-on-chronic liver failure (ACLF), where it is associated with high mortality and poor clinical outcomes. This study aimed to (1) elucidate the role of the renal asymmetric dimethylarginine (ADMA)–dimethylarginine dimethylaminohydrolase (DDAH)–endothelial nitric oxide synthase (eNOS) axis in cirrhosis ± superimposed inflammation (mimicking ACLF) with renal dysfunction, and (2) evaluate the effects of CC on this pathway.</div></div><div><h3>Methods</h3><div>Male Wistar rats were administered carbon tetrachloride (15% v/v in corn oil, 0.5 mL/kg, twice weekly for 14 weeks) to induce cirrhosis with renal dysfunction. After 14 weeks, rats were randomized to receive CC (8 mg/kg orally for 2 weeks) before an acute lipopolysaccharide (LPS) challenge. All animals were sacrificed at week 16.</div></div><div><h3>Results</h3><div>CCl₄-induced cirrhotic rats showed decreased mean arterial pressure (MAP), renal blood flow (RBF), and increased renal vascular resistance (RVR), and elevated kidney injury markers neutrophil gelatinase-associated lipocalin, blood urea nitrogen , and kidney injury molecule-1 along with heightened renal inflammation. Acute LPS administration further exacerbated these abnormalities. CC treatment markedly reduced renal injury and inflammatory markers in cirrhotic ± LPS-challenged rats, although MAP, RBF, and RVR remained unchanged. In ACLF rats with renal dysfunction, CC significantly lowered renal ADMA levels and increased phosphorylated eNOS and DDAH-1 expression, while DDAH-2 expression decreased. CC also restored renal nitric oxide (NO) levels, enhanced antioxidant enzyme activity, and reduced oxidative stress.</div></div><div><h3>Conclusion</h3><div>This study provides the first evidence that CC enhances renal NO bioavailability by upregulating DDAH-1 and eNOS expression and reducing ADMA accumulation, thereby improving renal endothelial function in cirrhosis with renal dysfunction. Targeting DDAH-1–mediated NO restoration may represent a promising therapeutic strategy for managing renal dysfunction in cirrhosis.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 4","pages":"Article 103585"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436512","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":"Magnetic Resonance Elastography Versus Shear Wave Elastography for Staging and Prognostication of Patients With Chronic Liver Disease","authors":"Thomas Reiberger,&nbsp;Ahmed Ba-Ssalamah,&nbsp;Christian Sebesta","doi":"10.1016/j.jceh.2026.103611","DOIUrl":"10.1016/j.jceh.2026.103611","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 4","pages":"Article 103611"},"PeriodicalIF":3.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148730566","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":"Retraction Notice to “A Comparative Study of Terlipressin Infusion Versus Intermittent Bolus Dosing in Patients Having Hepatorenal Syndrome” [J Clin Exp Hepatol 15 (1) (2025) 102832]","authors":"Manasvi Kalra,&nbsp;Priyank Dhiman,&nbsp;Neelkanth Issar,&nbsp;Manasvi Kalra,&nbsp;Priyank Dhiman,&nbsp;Neelkanth Issar","doi":"10.1016/j.jceh.2026.103528","DOIUrl":"10.1016/j.jceh.2026.103528","url":null,"abstract":"<div><div>This article has been retracted: please see Elsevier Policy on Article Withdrawal (<span><span>https://www.elsevier.com/about/policies-and-standards/article-withdrawal</span><svg><path></path></svg></span>).</div><div>This article has been retracted at the request of the <strong>Editor-in-Chief</strong>.</div><div>The authors have plagiarized a paper that had already been published in the journal, <em>Clinical and Experimental Hepatology</em>, 2023, Volume 9, 4: 351–358: <span><span>https://doi.org/10.5114/ceh.2023.132813</span><svg><path></path></svg></span>. As per the journal’s submission guidelines, authors are required to declare explicitly that their work is original and has not appeared in a publication elsewhere. Re-use of any data should be appropriately cited. Due to these significant ethical concerns, the editor-in-chief has decided that the article must be retracted. The authors have been notified of this decision.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 3","pages":"Article 103528"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148241701","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":"Hepatitis A Virus–related Acute Liver Failure—A Cause for Concern?","authors":"Sagnik Biswas,&nbsp;Shalimar","doi":"10.1016/j.jceh.2026.103551","DOIUrl":"10.1016/j.jceh.2026.103551","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 3","pages":"Article 103551"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147858646","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":"Burden of Minimal Hepatic Encephalopathy in Literate Cirrhotics Aged 15–50 Years: Time to Switch to Digital Diagnostic Tools?","authors":"Saubhik Ghosh ,&nbsp;Tryambak Samanta ,&nbsp;Subhadip Rakshit ,&nbsp;Kalidas Biswas ,&nbsp;Pushpak Das ,&nbsp;Manoj K. Gupta ,&nbsp;Sanjay K. Mandal","doi":"10.1016/j.jceh.2026.103472","DOIUrl":"10.1016/j.jceh.2026.103472","url":null,"abstract":"<div><h3>Background</h3><div>Minimal hepatic encephalopathy (MHE) is a frequent but underdiagnosed entity associated with impaired quality of life and progression to overt hepatic encephalopathy. The Psychometric Hepatic Encephalopathy Score (PHES) remains the conventional diagnostic modality, but digital tools such as Stroop test (EncephalApp) and Critical Flicker Frequency (CFF) offer promising alternatives.</div></div><div><h3>Methods</h3><div>In this cross-sectional study (July 2022–June 2025), 316 cirrhotics with formal education ≥10 years in the age group of 15–50 years underwent PHES, Stroop, and CFF testing. MHE was diagnosed using a PHES score of ≤−5.</div></div><div><h3>Results</h3><div>Ninety-five patients (30.06%) were diagnosed with MHE. On multivariate logistic regression analysis, Model for End Stage Liver Disease-Sodium (MELD-Na) and presence of Low Hand-grip Strength (probable sarcopenia) were found to be significant predictors of presence of MHE. The internally validated cutoff 212 s of OffTime+OnTime had the best discriminative ability (AUC 0.95) among the measures of Stroop test. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Stroop and CFF as diagnostic tools were 92.63%, 91.85%, 83.02%, 96.67% and 78.95%, 88.69%, 75.00%, 90.74% respectively. The correlation(ρ) of PHES with Stroop test timings, PHES with CFF Hz, and Stroop test timings with CFF Hz was −0.93, 0.92, and −0.86, respectively, with substantial agreement between the 3 diagnostic tools [Fleiss’ Kappa(κ) 0.69]. The time to complete the session in minutes for patients was the shortest with the Stroop test [Median(IQR): 9.90 (8.50–10.33)] and patient acceptance rated on a 10-point scale was highest for CFF tool [Median(IQR): 8.47 (8.21–8.63)].</div></div><div><h3>Conclusion</h3><div>Stroop and CFF diagnostic modalities are reasonably accurate and better accepted alternatives to PHES in younger literate cirrhotics. Their integration into clinical practice may enable wider screening and timely management of MHE.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 3","pages":"Article 103472"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146193157","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":"Issue Highlights","authors":"","doi":"10.1016/S0973-6883(26)00102-7","DOIUrl":"10.1016/S0973-6883(26)00102-7","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 3","pages":"Article 103570"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148241694","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":"Blood Product Transfusion for Acute Variceal Bleeding in Liver Cirrhosis: Friend or Foe?","authors":"Cosmas R. Adithya Lesmana","doi":"10.1016/j.jceh.2026.103554","DOIUrl":"10.1016/j.jceh.2026.103554","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 3","pages":"Article 103554"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147951392","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":"Assessment of Usability and Acceptability of Blood-based Hepatitis C Virus Self-testing Among Residents of Urban Slums in Northern India: A Cross-sectional Study","authors":"Ajeet S. Bhadoria ,&nbsp;Amrita Mehndiratta ,&nbsp;Kathirvel Soundappan ,&nbsp;Rajesh Somvanshi ,&nbsp;Muhammad S. Jamil ,&nbsp;Niklas Luhmann","doi":"10.1016/j.jceh.2025.103432","DOIUrl":"10.1016/j.jceh.2025.103432","url":null,"abstract":"<div><h3>Background/Aims</h3><div>Globally, only 36% of people with hepatitis C are aware of their infection, and just 20% of those diagnosed receive treatment, highlighting a significant diagnosis and treatment gap. The World Health Organization recommends hepatitis C virus self-testing (HCVST) as an additional strategy to increase access to diagnosis.</div></div><div><h3>Methods</h3><div>From July 2023 to April 2024, we conducted a cross-sectional study nested within a larger cluster randomized control trial (RCT) (CTRI/2023/07/054590) in urban slums of Haridwar. A total of 465 participants were recruited from community and urban primary health center settings. Under observation, participants performed hepatitis C virus (HCV) self-testing, allowing assessment of usability by tracking errors using standardized checklists, user-reported difficulties, and inter-reader concordance (self vs. trained personnel interpretation). For acceptability, a pre-tested questionnaire collected socio-demographic data, risk factors for HCV, participant experiences, and responses to hypothetical test results. Additionally, 35 ELISA-positive individuals were recruited to assess the sensitivity and specificity of the self-testing kit.</div></div><div><h3>Results</h3><div>Participants, mostly aged 26–35 years with primary education, demonstrated high usability, over 90% correctly performed critical steps like finger pricking, and 96% interpreted results accurately. Participants with education beyond high school had better interpretation accuracy (98.8% vs. 94.4%, <em>P</em> = 0.02). The process was reported as significantly easier by males (85.2% vs. 71.9%), participants under 46 years (82.4% vs. 66.1%), and those with higher education (90.1% vs. 71.6%, <em>P</em> &lt; 0.001). Satisfaction was high (94.2%), and 95.4% trusted the test's accuracy. Inter-reader concordance was 95.9% (Cohen's Kappa = 0.25; 95% confidence interval [CI]: 0.07–0.43). Sensitivity and specificity were 97.4% and 99.6%, respectively.</div></div><div><h3>Conclusion</h3><div>The HCV self-testing was highly usable and acceptable among residents of urban slums. While participants valued privacy and convenience, challenges with blood collection, instructions, and the absence of counseling were noted. HCV self-testing, if scaled up through targeted rollout and linked to counselling and treatment services, could substantially narrow the diagnostic gap and accelerate India's progress toward HCV elimination.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 2","pages":"Article 103432"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837968","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":"From Adults to Children: Rethinking Albumin Therapy in Pediatric Cirrhosis","authors":"Vipul Gautam ,&nbsp;Subhash Gupta","doi":"10.1016/j.jceh.2025.103441","DOIUrl":"10.1016/j.jceh.2025.103441","url":null,"abstract":"<div><div>Albumin is a multifunctional protein with pivotal physiological roles, including maintenance of oncotic pressure, ligand binding and transport, antioxidant activity, immunomodulation, antithrombotic effects, and detoxification. Liver disease leads to quantitative as well as qualitative reduction in albumin concentrations. Oxidized albumin increases with cirrhosis severity, reducing its function and effective concentration. Recently, some studies have shown the presence of abnormal albumin isoforms in cirrhotic children. Reversibly oxidized human non-mercaptalbumin-1 (HNA1) and irreversibly oxidized human non-mercaptalbumin-2 (HNA2) have been shown to predict morbidity and mortality. Albumin dysfunction in addition to hypoalbuminemia introduces the concept of effective albumin concentration, a potential predictor of poor outcomes in pediatric cirrhosis. Long-term albumin infusion in adults with cirrhosis remains controversial as evidenced by large randomized controlled trials. As in adults, the therapeutic indications for albumin therapy in children with cirrhosis are complex and not straightforward. This review article analyses the basic albumin structure, versatile physiological functions of albumin, the implications of its abnormal forms in liver disease, and its therapeutic potential and challenges in albumin infusion therapy. The large number of ongoing studies and clinical trials for optimal use of albumin underscores its paramount position in the management of complications related to liver disorders and in improving patient outcomes.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 2","pages":"Article 103441"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921878","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}