World Journal of Hepatology最新文献

{"title":"Should the theory of methotrexate-induced liver toxicity be abandoned?","authors":"Yahya Al-Hammada, Sinan Sharba, Samer Al-Dury","doi":"10.4254/wjh.v18.i2.113743","DOIUrl":"10.4254/wjh.v18.i2.113743","url":null,"abstract":"<p><p>Methotrexate (MTX) remains a cornerstone therapy for chronic inflammatory diseases (<i>e.g.</i>, rheumatoid arthritis, psoriasis). However, long-standing concerns about MTX hepatotoxicity - especially liver fibrosis - have historically led to conservative monitoring and routine invasive liver biopsies at predefined cumulative dose thresholds. These practices often prompted early discontinuation of MTX therapy. These concerns originated from early liver biopsy studies in high-dose MTX patients that did not adequately account for metabolic risk factors. Emerging evidence indicates that advanced fibrosis is rare in MTX-treated patients and usually attributable to coexisting metabolic comorbidities (<i>e.g.</i>, obesity, insulin resistance) rather than the cumulative MTX dose itself. Moreover, noninvasive fibrosis assessment modalities and recent large cohort studies demonstrate that MTX at standard doses with folate supplementation seldom drives fibrogenesis independently. This review reappraises MTX-related fibrosis risk in light of contemporary data and highlights a shift from dose-driven biopsy protocols to risk-based, noninvasive monitoring strategies. Recognizing that MTX is less hepatotoxic than historically assumed can prevent unnecessary drug discontinuation and refocus management on modifiable metabolic risk factors.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"18 2","pages":"113743"},"PeriodicalIF":3.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of tenofovir amibufenamide and entecavir on estimated glomerular filtration rate in treatment-naïve patients with chronic hepatitis B.","authors":"Shi-Peng Ma, Liang Wang, Yu-Liang Zhang, Xin Wan, Qian Liu, Yu-Lun Tang, Lajpat-Rai Malhi, Shan-Fei Ge","doi":"10.4254/wjh.v18.i2.114346","DOIUrl":"10.4254/wjh.v18.i2.114346","url":null,"abstract":"<p><strong>Background: </strong>As a novel antiviral agent, the comparative renal safety of tenofovir amibufenamide (TMF) <i>vs</i> entecavir (ETV) in chronic hepatitis B (CHB) remains unclear.</p><p><strong>Aim: </strong>To compare changes in the estimated glomerular filtration rate (eGFR) between TMF and ETV in previously untreated patients with CHB over 48 weeks.</p><p><strong>Methods: </strong>We retrospectively analyzed clinical records of 187 treatment-naive patients with CHB receiving TMF or ETV for ≥ 48 weeks from June 2021 to January 2025. Patients were allocated to the TMF (<i>n</i> = 48) or ETV (<i>n</i> = 139) group based on their antiviral drug therapy. Propensity score matching (2:1) was used to balance baseline clinical characteristics. eGFR changes at 48 weeks were compared. Patients were then stratified into normal and abnormal eGFR groups, and factors associated with abnormal eGFR were analyzed.</p><p><strong>Results: </strong>After propensity score matching, 48 patients and 96 patients were stratified into the TMF and ETV group, respectively. At baseline, the two groups had comparable clinical characteristics, with no significant differences (<i>P</i> > 0.05). Baseline eGFR values were 111.83 mL/minute/1.73 m² for the TMF group and 112.50 mL/minute/1.73 m² for the ETV group (<i>P</i> = 0.712). At week 48, eGFR declined in both groups, but the ETV group experienced a significantly greater reduction relative to the TMF group (106.10 mL/minute/1.73 m² <i>vs</i> 111.01 mL/minute/1.73 m²; <i>P</i> = 0.019). In univariate analysis, the groups differed significantly in terms of age, serum albumin, triglyceride, and baseline eGFR (all <i>P</i> < 0.05). Multivariate analysis identified baseline eGFR and triglyceride as independent predictors of abnormal eGFR by 48 weeks (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>In treatment-naïve patients with CHB, ETV treatment exhibited a strong association with an increased risk of decreased eGFR levels at 48 weeks in comparison with TMF.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"18 2","pages":"114346"},"PeriodicalIF":3.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should the routine use of the 6-minute walk test be implemented in liver disease assessment: Not so fast.","authors":"Marco E Diaz-Cordova, Ishani Sharma, William Pascal, Kenji Okumura","doi":"10.4254/wjh.v18.i2.116828","DOIUrl":"10.4254/wjh.v18.i2.116828","url":null,"abstract":"<p><p>End-stage liver disease (ESLD) is a debilitating condition that often leads to death. Once diagnosed with ESLD, a patient's quality of life decreases significantly. Well-established markers, such as the model for end-stage liver disease and Child-Pugh scores, are used to diagnose, monitor, and predict survival. Another tool, the 6-minute walk test (6MWT), has shown promise as an adjunct measure but remains underutilized despite its strong results and ease of reproducibility. Previous research has demonstrated that the 6MWT, as in many other conditions, helps predict survival, mortality, and outcomes in individuals with ESLD. A recent observational study by Corrêa <i>et al</i> found that the 6MWT is a reliable measure of functional capacity in patients with liver cirrhosis. Although the study's small sample size of 20 patients limits its generalizability, the findings align with prior evidence showing that the 6MWT is an independent predictor of mortality and that poor test performance is associated with greater liver dysfunction. However, the 6MWT is a nonspecific test, and patient performance can be influenced by comorbidities such as heart failure, pulmonary disease, and frailty. Additionally, the optimal timing for administering the test has not been clearly established in the literature. Overall, although well-validated markers already exist for diagnosing and assessing outcomes in liver disease, the addition of the 6MWT-a low-cost, reliable, easily reproducible, and objective measure-may provide valuable prognostic and functional information if standardized protocols and covariates are better controlled.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"18 2","pages":"116828"},"PeriodicalIF":3.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Klebsiella pneumoniae</i> as leading cause of pyogenic liver abscess: Three years study in Southern Vietnam.","authors":"Tuong-Anh Mai-Phan, Khanh-Phat Thai, Kim-Long Le, Tri-Nhan Pham, Minh-Quang Tran, Phu-Cuong Pham, Nhu Ngoc-Quynh Duong, My-Tran Trinh, Nguyen-Khoi Le","doi":"10.4254/wjh.v18.i2.113695","DOIUrl":"10.4254/wjh.v18.i2.113695","url":null,"abstract":"<p><strong>Background: </strong>Pyogenic liver abscess (PLA) is increasingly recognized worldwide. In Asia, <i>Klebsiella pneumoniae</i> (<i>K. pneumoniae</i>) has emerged as the predominant pathogen, yet contemporary data from Vietnam remain limited.</p><p><strong>Aim: </strong>To determine the microbial spectrum of PLA and compare clinical, computed tomography (CT), management, and outcomes between <i>K. pneumoniae</i> and non-<i>K. pneumoniae</i> cases in Southern Vietnam.</p><p><strong>Methods: </strong>This retrospective cohort included adults with PLA managed at Nhan Dan Gia Dinh Hospital from June 2021 to June 2024. Of 123 cases, 17 were excluded (8 with unspecified Gram-negative bacilli, 9 without CT), leaving 106 patients (83 <i>K. pneumoniae</i>, 23 non-<i>K. pneumoniae</i>). Data on demographics, comorbidities, presentation, laboratory, imaging, microbiology, treatment, and outcomes were analyzed using standard parametric/nonparametric and <i>χ</i> ²/Fisher tests (two-sided <i>α</i> = 0.05).</p><p><strong>Results: </strong>Mean age was 59.2 years, and 67.0% were male. Diabetes was more frequent in <i>K. pneumoniae</i> (55.4% <i>vs</i> 30.4%; <i>P</i> = 0.034). C-reactive protein was higher in <i>K. pneumoniae</i> but not significant (229.9 mg/L <i>vs</i> 185.0 mg/L; <i>P</i> = 0.069). Aspartate aminotransferase was significantly elevated (<i>P</i> = 0.048) and alanine aminotransferase borderline (<i>P</i> = 0.065). On CT, <i>K. pneumoniae</i> abscesses more often had irregular margins (<i>P</i> = 0.038) and heterogeneous architecture (<i>P</i> = 0.003). <i>K. pneumoniae</i> predominated in pus (71.9%) and blood (78.6%) cultures. Source-control and hospital stay were similar. Mortality was 10.4% overall, occurring only in <i>K. pneumoniae</i> (13.3% <i>vs</i> 0%). Older age predicted poorer survival (odds ratio = 0.95; <i>P</i> = 0.029).</p><p><strong>Conclusion: </strong>In Southern Vietnam, <i>K. pneumoniae</i> predominates in PLA, characterized by distinctive CT features and higher mortality, emphasizing early recognition, pathogen-directed therapy, and timely image-guided drainage.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"18 2","pages":"113695"},"PeriodicalIF":3.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive tool for evident histological liver injury in chronic hepatitis B patients: Development and validation.","authors":"Zhong-Shang Dai, Xin Cao, Yong-Fang Jiang, Bo He","doi":"10.4254/wjh.v18.i2.113348","DOIUrl":"10.4254/wjh.v18.i2.113348","url":null,"abstract":"<p><strong>Background: </strong>Chronic hepatitis B (CHB) is a leading cause of liver-related mortality, progressing to fibrosis, cirrhosis, and hepatocellular carcinoma. Existing noninvasive tools (<i>e.g.</i>, aspartate aminotransferase to platelet ratio index, fibrosis-4 index, liver stiffness measurement) and invasive liver biopsy have limitations in assessing evident histological liver injury (EHLI), highlighting the need for novel predictive models.</p><p><strong>Aim: </strong>To develop and validate a predictive model for EHLI in CHB patients using a cohort from Hunan Province, China, to facilitate early risk identification and optimize resource allocation.</p><p><strong>Methods: </strong>This observational real-world study enrolled 223 CHB patients (August 2020 to March 2022) from the Second Xiangya Hospital, divided into development (<i>n</i> = 159) and validation (<i>n</i> = 64) cohorts (7:3 ratio). EHLI was defined as Ishak fibrosis stage ≥ 3 and/or histologic activity index ≥ 9. Variables were screened <i>via</i> univariable logistic regression and least absolute shrinkage and selection operator regression, and a multivariable logistic regression model and nomogram were constructed. Performance was evaluated using area under the curve (AUC), calibration plots, Hosmer-Lemeshow test, and decision curve analysis (DCA). Gene expression profiles were analyzed to identify immune-related pathways.</p><p><strong>Results: </strong>L59, platelet count (PLT), alanine transaminase (ALT), and aspartate transaminase (AST) were identified as independent predictors of EHLI. The model showed high discriminative ability, with AUC of 0.921 [95% confidence interval (CI): 0.880-0.963] in the development cohort and 0.959 (95%CI: 0.910-1.0) in the validation cohort, demonstrating a 20%-32% relative improvement in AUC over conventional noninvasive scores. Calibration plots demonstrated good agreement between predicted and observed EHLI, and DCA confirmed clinical utility (threshold probabilities: 20%-80%). Transcriptomic analysis identified 210 differentially expressed genes, with hub genes (<i>e.g.</i>, <i>COL1A2</i>) and transforming growth factor-β/Smad pathway involvement linked to liver injury.</p><p><strong>Conclusion: </strong>A novel nomogram incorporating L59, PLT, ALT, and AST robustly predicts EHLI in CHB patients. This model, using routinely measured variables, aids clinical decision-making and optimizes resource allocation.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"18 2","pages":"113348"},"PeriodicalIF":3.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the associations between immunosuppressant use and COVID-19 severity in patients with autoimmune hepatitis.","authors":"Krish Rai, Karla J Lindquist, John Kornak, Jin Ge","doi":"10.4254/wjh.v18.i2.114481","DOIUrl":"10.4254/wjh.v18.i2.114481","url":null,"abstract":"<p><strong>Background: </strong>Due to immunosuppression (IS) use, patients with autoimmune hepatitis (AIH) may be at high risk for poor coronavirus disease 2019 (COVID-19) outcomes.</p><p><strong>Aim: </strong>To investigate the associations between IS type and COVID-19 severity in AIH patients using the National Clinical Cohort Collaborative (N3C) COVID enclave.</p><p><strong>Methods: </strong>We identified all AIH patients with COVID-19 in the N3C COVID enclave. We used adjusted logistic regressions to determine associations between IS type and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We used Cox models to determine associations between IS type and all-cause mortality in the subset of AIH patients infected with SARS-CoV-2.</p><p><strong>Results: </strong>Of 15187 AIH patients, 5106 (33%) had IS exposure, and 1604 (11%) tested positive for SARS-CoV-2 during the study period from March 2020 through March 2025. There was an association with prednisone [odds ratio (OR): 0.81, 95%CI: 0.65-0.99, <i>P</i> = 0.04] exposure and SARS-CoV-2 test positivity. For interactions between different IS combinations and SARS-CoV-2 test positivity in the overall cohort, budesonide and azathioprine (OR: 1.88, 95%CI: 1.02-3.44, <i>P</i> = 0.04) and prednisone and tacrolimus interactions (OR: 1.99, 95%CI: 1.14-3.53, <i>P</i> = 0.02) showed significant associations. Within the subgroup finding of patients with full model for end stage liver disease data, budesonide and azathioprine interaction (OR: 4.44, 95%CI: 1.29-16.72, <i>P</i> = 0.02) also had a significant association. In our adjusted Cox regressions and corresponding subgroup analysis, we found no specific IS type that was statistically significant in association with all-cause mortality.</p><p><strong>Conclusion: </strong>Prednisone exposure was negatively associated, and statistically significant IS interactions were positively associated with testing positive for SARS-CoV-2. Further work involves determining the impact of vaccinations and advances in COVID-19 treatment on outcomes in this population.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"18 2","pages":"114481"},"PeriodicalIF":3.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and prospective validation of a machine learning model to predict mortality in cirrhosis with esophageal variceal bleeding.","authors":"Matheus Machado Rech, Leandro Luis Corso, Elisa Fioreze Dal Bó, Andressa Daiane Ferraza, Fernanda Tomé, Alana Zulian Terres, Rafael Sartori Balbinot, Raul Angelo Balbinot, Silvana Sartori Balbinot, Jonathan Soldera","doi":"10.4254/wjh.v18.i2.111099","DOIUrl":"10.4254/wjh.v18.i2.111099","url":null,"abstract":"<p><strong>Background: </strong>Acute esophageal variceal bleeding (AEVB) is a critical complication in patients with cirrhosis, associated with high mortality despite advancements in management. Traditional prognostic scores often lack predictive accuracy in this context.</p><p><strong>Aim: </strong>To develop, internally validate, and prospectively validate a machine learning (ML) model to predict 1-year mortality in patients with cirrhosis presenting with AEVB.</p><p><strong>Methods: </strong>A retrospective cohort of 94 patients treated between 2010 and 2016 was used to train ML models, incorporating 36 clinical, laboratory, and imaging variables. Four algorithms (generalized linear models, boosted generalized linear models, naive Bayes, random forests) were evaluated, and the best-performing model was prospectively validated in a cohort of 24 patients treated between 2017 and 2018. Performance metrics included the area under the curve (AUC), sensitivity, specificity, and calibration <i>via</i> Brier scores. Data preprocessing involved k-nearest neighbor imputation, one-hot encoding, and scaling.</p><p><strong>Results: </strong>The random forest model achieved the highest AUC (0.91, 95% confidence interval [CI]: 0.85-0.96) during internal validation and demonstrated robust performance in the prospective cohort (AUC 0.88, 95%CI: 0.80-0.94). Calibration was excellent, with a low Brier score (0.12). The model was deployed as an online prediction tool.</p><p><strong>Conclusion: </strong>This ML model shows promise in improving mortality prediction for AEVB, potentially aiding timely clinical interventions and decision-making. Prospective validation underscores its generalizability and clinical utility. Future research should explore external validation in diverse settings.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"18 2","pages":"111099"},"PeriodicalIF":3.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of three clinical scores for steatosis and steatohepatitis and their interaction with metabolic syndrome in obese individuals.","authors":"Giovani Schulte Farina, Bárbara Brambilla, Emanuelle Mendonça Pandolfo, Laura Kalil Nader Lazzaretti, Stéfano Mateus Schio Kuiava, Ana Maria Graciolli, Vitória Maria Kriger, Carlos Henrique Dal Bem Fistarol, Augusto Cardoso Sgarioni, Henrique Prataviera Giovanardi, Aline Caldart Tregnago, Floriano Riva, Cassiano da Silva Scholze, Daniel Cecconi Agostini, Bruno Dellamea, Arturo Tamayo, Tiago Lemos Cerqueira, Jonathan Soldera, Ben Min-Woo Illigens","doi":"10.4254/wjh.v18.i2.111962","DOIUrl":"10.4254/wjh.v18.i2.111962","url":null,"abstract":"<p><strong>Background: </strong>Non-invasive clinical scores are widely used to detect hepatic steatosis and steatohepatitis, but their accuracy in individuals with obesity is limited. Most of these tools were developed for non-obese populations and do not account for metabolic dysfunction-associated steatotic liver disease (MASLD) spectrum. Moreover, the potential modifying effect of metabolic syndrome (MetS) on the diagnostic performance of these scores remains unclear. Given the global burden of obesity and MASLD, there is a pressing need to refine diagnostic strategies for early detection. We hypothesized that diagnostic performance may vary by MetS status and can be improved with adjusted thresholds.</p><p><strong>Aim: </strong>To evaluate and optimize three clinical scores for steatosis and metabolic dysfunction-associated steatohepatitis (MASH), including assessment by MetS status.</p><p><strong>Methods: </strong>This cross-sectional study included 95 individuals undergoing bariatric surgery at a hospital in Brazil. Clinical scores [non-alcoholic fatty liver disease liver fat score (NLFS), hepatic steatosis index (HSI), and fatty liver index (FLI)] were calculated from preoperative data. Liver biopsy was used as the reference standard to assess steatosis and MASH. Diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve, and optimal cut-offs were determined by Youden's index. Logistic regression with interaction terms assessed whether MetS modified the diagnostic performance of each score across histological outcomes.</p><p><strong>Results: </strong>Sixty-six individuals (69.5%) had steatosis, and fifteen (15.8%) had moderate-to-severe steatosis and MASH. The area under the receiver operating characteristic curves for any steatosis was 0.676 (NLFS), 0.540 (HSI), and 0.468 (FLI); for moderate-to-severe steatosis, 0.671 (NLFS), 0.659 (HSI), and 0.700 (FLI); and for MASH, 0.671 (NLFS), 0.625 (HSI), and 0.639 (FLI). Standard cut-offs performed poorly; optimized thresholds improved both sensitivity and specificity. NLFS outperformed FLI for any steatosis (<i>P</i> = 0.021). No significant interactions were found between MetS and any score (all <i>P</i> > 0.05), indicating that diagnostic accuracy did not significantly differ by MetS status.</p><p><strong>Conclusion: </strong>NLFS, HSI, and FLI show limited accuracy in obese individuals. Adjusting thresholds improves performance. Diagnostic utility remains consistent regardless of MetS, supporting their use across the MASLD spectrum.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"18 2","pages":"111962"},"PeriodicalIF":3.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental considerations in hepatitis E virus transmission: Is there a missing link?","authors":"Ross Campbell, Cerys Russell, Jacques Izopet, Kamar Nassim, Mark Sonderup, Sven Pischke, Sebastian J Wallace, Richie G Madden","doi":"10.4254/wjh.v18.i2.112467","DOIUrl":"10.4254/wjh.v18.i2.112467","url":null,"abstract":"<p><p>Hepatitis E virus (HEV) is a zoonotic infection that varies according to genotype and geographical location. The full environmental and public health impact of hepatitis E remains uncertain. In this review, we aim to synthesise the evidence regarding HEV circulation in the environment. A literature search was conducted regarding HEV transmission and findings in environmental context, and this was synthesised to propose a hypothesis and identify gaps in our current understanding. Environmental spillover occurs due to increased interactions at the human-animal-environmental interface, with multiple causative factors. HEV genotypes 3 and 4 have been documented in pigs, deer, chicken, rat, mongoose, rabbit, dolphin, cats, dogs and horses. Other HEV genotypes 1,2 and 5-7 have been found in bandicoot, musk shrew, mink, moose, fish and camel. HEV seropositivity has also been identified in ruminant species without HEV - related sequences being identified. HEV has been found in fruit, shellfish and crops irrigated with infected water. This leads to environmental contamination. HEV circulates in the environment <i>via</i> the asymptomatic wild animal host with episodes of spillover into domestic animal populations with increasing burden within the everchanging 'virosphere'. Through domestic animal amplification, the spillover effect from both wild and domestic animal populations leads to human amplification causing disease with high morbidity and mortality in certain patient populations. Further research is required to consider the viral determinants for HEV cross-species infection and how this relates to HEV-contaminated food products and its impact on environment and human health.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"18 2","pages":"112467"},"PeriodicalIF":3.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatigue and circadian rhythm in non-cirrhotic primary biliary cholangitis: An exploratory comparison with primary sclerosing cholangitis and healthy controls.","authors":"Armando Curto, Michele Tanturli, Rocco Gabriele Iamello, Pietro Rossi, Giulia Mengozzi, Leonardo Dei, Tommaso Mello, Tommaso Innocenti, Gabriele Dragoni, Andrea Galli, Erica Nicola Lynch","doi":"10.4254/wjh.v18.i2.114206","DOIUrl":"10.4254/wjh.v18.i2.114206","url":null,"abstract":"<p><strong>Background: </strong>Fatigue is common and debilitating in primary biliary cholangitis (PBC) without clear relation to disease stage; mechanisms remain unclear. Circadian disruption is reported in end-stage liver disease, but evidence in non-cirrhotic PBC, and links to fatigue, is scarce.</p><p><strong>Aim: </strong>To investigate the severity and phenotype of fatigue, daytime sleepiness, and chronotype in non-cirrhotic PBC, and compare findings with matched healthy controls (HC) and non-cirrhotic primary sclerosing cholangitis (PSC).</p><p><strong>Methods: </strong>Participants completed the Fatigue Impact Scale, Epworth Sleepiness Scale, and Morningness-Eveningness Questionnaire Self-Assessment. Demographics, sleep habits, employment, and fatigue subtype (mental <i>vs</i> muscular) were recorded. In PBC/PSC, PBC-40 fatigue/itch domains and disease characteristics were analyzed. Group comparisons and multivariable models evaluated associations of fatigue phenotype and chronotype with demographic/disease variables.</p><p><strong>Results: </strong>We enrolled 152 individuals: 61 PBC, 30 PSC, and 61 HC. Global fatigue scores did not differ across groups. Muscular fatigue predominated in PBC/PSC, whereas HC more often reported mental fatigue; this pattern persisted after stratifying by employment and sex. In adjusted analyses, HC had lower odds of muscular fatigue than PBC [odd ratio (OR) = 0.30, 95% confidence interval (CI): 0.14-0.63; <i>P</i> = 0.002]; PSC did not differ from PBC (OR = 1.25, 95%CI: 0.44-3.71; <i>P</i> = 0.681). Older age independently increased the odds of muscular fatigue (OR = 1.04 per year, 95%CI: 1.01-1.07; <i>P</i> = 0.016). Daytime sleepiness was low and similar between groups. Morningness-Eveningness Questionnaire Self-Assessment scores clustered in the intermediate range; age, not disease, predicted greater morningness.</p><p><strong>Conclusion: </strong>In non-cirrhotic PBC, fatigue shows a predominantly muscular phenotype independent of demographics/occupation and decoupled from conventional disease metrics. Chronotype and daytime alertness appear largely preserved, with age driving modest morningness. Findings support integrating fatigue phenotyping into assessment, prioritizing muscle-targeted interventions, and using carefully selected controls and objective endpoints in future studies.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"18 2","pages":"114206"},"PeriodicalIF":3.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}