内镜治疗胰液收集:积极干预总是最佳选择吗?

IF 5 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Masaki Kuwatani
{"title":"内镜治疗胰液收集:积极干预总是最佳选择吗?","authors":"Masaki Kuwatani","doi":"10.1111/den.14969","DOIUrl":null,"url":null,"abstract":"<p>Good patient vitality and activity levels at the first visit positively affect clinical decision-making, particularly in the selection of diagnostic work-ups and treatments across various medical fields. Several indicators of patient vitality, such as frailty (measured by the “Frailty Risk Score”),<span><sup>1</sup></span> sarcopenia (assessed using the psoas muscle mass index/area/density), and comorbidity index,<span><sup>2</sup></span> have been reported in recent literature and are closely associated with disease prognosis. Gilbert <i>et al</i>. reported that among 202,718 patients, those with the highest Hospital Frailty Risk Scores had significantly increased odds of 30-day mortality (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.68–1.75), prolonged hospital stays (OR 6.03, 95% CI 5.92–6.10), and 30-day readmissions (OR 1.48, 95% CI 1.46–1.50) in older patients in acute care settings.<span><sup>1</sup></span> Furthermore, Farooq <i>et al</i>. found that frailty in adult patients with acute pancreatitis was associated with higher rates of local complications, such as pseudocyst and walled-off necrosis, and systemic complications including acute respiratory distress syndrome and sepsis, based on a large national database of the United States.<span><sup>3</sup></span> It is widely acknowledged that frailty and comorbidity are interrelated in the progression of many diseases. For instance, during the COVID-19 pandemic, all measures of frailty and comorbidity were associated with higher COVID-19 mortality risk, even after adjusting for age and sex, according to data from the UK Biobank, which included 2812 COVID-19 inpatients.<span><sup>4</sup></span> Furthermore, in an emergency department study of two Dutch hospitals, older adults with polypharmacy resulting from comorbidities and frailty had an increased risk of mortality (OR 2.62 and 3.92, 95% CI 1.39–4.93 and 1.95–7.90 for excessive polypharmacy).<span><sup>5</sup></span> This association is not surprising, as scoring systems for both frailty and comorbidity often include overlapping factors such as cognitive function and mobility.<span><sup>1, 2, 5</sup></span></p><p>Pancreatic fluid collections (PFCs), such as pseudocysts, walled-off necrosis, or postoperative pancreatic fistulas, can develop after acute pancreatitis or pancreatic resection. In some cases, these complications are refractory and potentially fatal despite multidisciplinary approaches. The treatment strategy for PFCs depends on the patient's condition, which is often influenced by the severity and number of comorbidities, as well as the characteristics of the PFC itself. To date, no studies have investigated the impact of comorbidity accumulation on the clinical outcomes of minimally invasive endoscopic ultrasound (EUS)-guided treatments for PFCs. However, Hamada <i>et al</i>. demonstrated that the Charlson Comorbidity Index (CCI), a measure of comorbidity burden, was significantly associated with in-hospital mortality in patients undergoing EUS-guided drainage of PFCs. The adjusted ORs for mortality compared to patients with a CCI of 0 were 0.76 (95% CI 0.22–2.54) for patients with a CCI of 1–2, 5.39 (95% CI 1.74–16.7) for those with a CCI of 3–5, and 8.77 (95% CI 2.36–32.6) for those with a CCI of ≥6 (<i>P</i><sub>trend</sub> &lt;0.001).<span><sup>6</sup></span> This association persisted after controlling for age, sex, type of PFC (pseudocyst, walled-off necrosis, or postoperative PFC), drainage route, and stent type (plastic or metal). The study was further validated by a large national cohort data in Japan for more comprehensive findings. Notably, bleeding complications after the EUS-guided procedure were not significantly increased in patients with higher CCI scores (<i>P</i><sub>trend</sub> &gt;0.34), despite a high likelihood of many participants being on antithrombotic medications (details not provided).<span><sup>6</sup></span> Future research should explore the relationship between bleeding risks and the type or number of antithrombotic agents used in these patients.</p><p>As Hamada <i>et al</i>. noted, the biological mechanisms underlying the high mortality observed in patients with higher CCI remain unclear.<span><sup>6</sup></span> Several studies offer potential insights. Jones <i>et al</i>. conducted a genome-wide meta-analysis and found that muscle weakness may be associated with genetic susceptibility.<span><sup>7</sup></span> Among 256,523 Europeans aged 60 years and older, they identified 15 loci associated with muscle weakness, including genes involved in autoimmune disease (<i>HLA-DQA1</i>), osteoarthritis (<i>GDF5, ALDH1A2, TGFA, BRSK1</i>), cell cycle and cancer protection (<i>TGFA</i>), transcription regulation (<i>RBBP6</i>, <i>ZBTB38</i>), and musculoskeletal development (<i>GDF5, DYM</i>) (European Working Group on Sarcopenia in Older People definition). Furthermore, the concept of “inflammaging” – a chronic, low-grade inflammation associated with aging – has been proposed to explain increased susceptibility to chronic morbidity, disability, frailty, and premature death in older adults.<span><sup>8</sup></span> Mechanisms behind inflammaging may include genetic factors, central obesity, increased gut permeability, altered microbiota, cellular senescence, inflammasome activation, oxidative stress, immune dysregulation, and chronic infections.<span><sup>8</sup></span> Inflammaging, frailty, and comorbidity burden can share common features, such as genetic susceptibility, chronic stress, infection, and cancer development. Notably, Hamada <i>et al</i>.<span><sup>6</sup></span> reported that approximately 20% of patients with a CCI ≥3 died from cancer when receiving EUS-guided treatment of PFCs. This finding aligns with genetic studies linking single nucleotide polymorphisms related to cellular senescence and inflammation with age-related diseases, including cancer, cardiovascular disease, and type 2 diabetes.<span><sup>9</sup></span> Furthermore, Zeng <i>et al</i>.<span><sup>10</sup></span> discovered that a single nucleotide polymorphism in the IL-6 gene was significantly associated with extreme longevity, supporting the role of IL-6 in regulating morbidity and mortality, particularly in older adults.</p><p>Elucidating the underlying mechanisms linking comorbidity burden to mortality can lead to the construction of novel treatment algorithms, not only for PFCs but also for a range of diseases influenced by inflammaging. Establishing a national biobank to systematically collect clinical data and biological specimens would facilitate multidisciplinary research on this topic, leading to more comprehensive and precise treatment strategies.</p><p>Author declares no conflict of interest for this article.</p><p>None.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"426-427"},"PeriodicalIF":5.0000,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14969","citationCount":"0","resultStr":"{\"title\":\"Endoscopic treatment for pancreatic fluid collections: Is active intervention always the optimal option?\",\"authors\":\"Masaki Kuwatani\",\"doi\":\"10.1111/den.14969\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Good patient vitality and activity levels at the first visit positively affect clinical decision-making, particularly in the selection of diagnostic work-ups and treatments across various medical fields. Several indicators of patient vitality, such as frailty (measured by the “Frailty Risk Score”),<span><sup>1</sup></span> sarcopenia (assessed using the psoas muscle mass index/area/density), and comorbidity index,<span><sup>2</sup></span> have been reported in recent literature and are closely associated with disease prognosis. Gilbert <i>et al</i>. reported that among 202,718 patients, those with the highest Hospital Frailty Risk Scores had significantly increased odds of 30-day mortality (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.68–1.75), prolonged hospital stays (OR 6.03, 95% CI 5.92–6.10), and 30-day readmissions (OR 1.48, 95% CI 1.46–1.50) in older patients in acute care settings.<span><sup>1</sup></span> Furthermore, Farooq <i>et al</i>. found that frailty in adult patients with acute pancreatitis was associated with higher rates of local complications, such as pseudocyst and walled-off necrosis, and systemic complications including acute respiratory distress syndrome and sepsis, based on a large national database of the United States.<span><sup>3</sup></span> It is widely acknowledged that frailty and comorbidity are interrelated in the progression of many diseases. For instance, during the COVID-19 pandemic, all measures of frailty and comorbidity were associated with higher COVID-19 mortality risk, even after adjusting for age and sex, according to data from the UK Biobank, which included 2812 COVID-19 inpatients.<span><sup>4</sup></span> Furthermore, in an emergency department study of two Dutch hospitals, older adults with polypharmacy resulting from comorbidities and frailty had an increased risk of mortality (OR 2.62 and 3.92, 95% CI 1.39–4.93 and 1.95–7.90 for excessive polypharmacy).<span><sup>5</sup></span> This association is not surprising, as scoring systems for both frailty and comorbidity often include overlapping factors such as cognitive function and mobility.<span><sup>1, 2, 5</sup></span></p><p>Pancreatic fluid collections (PFCs), such as pseudocysts, walled-off necrosis, or postoperative pancreatic fistulas, can develop after acute pancreatitis or pancreatic resection. In some cases, these complications are refractory and potentially fatal despite multidisciplinary approaches. The treatment strategy for PFCs depends on the patient's condition, which is often influenced by the severity and number of comorbidities, as well as the characteristics of the PFC itself. To date, no studies have investigated the impact of comorbidity accumulation on the clinical outcomes of minimally invasive endoscopic ultrasound (EUS)-guided treatments for PFCs. However, Hamada <i>et al</i>. demonstrated that the Charlson Comorbidity Index (CCI), a measure of comorbidity burden, was significantly associated with in-hospital mortality in patients undergoing EUS-guided drainage of PFCs. The adjusted ORs for mortality compared to patients with a CCI of 0 were 0.76 (95% CI 0.22–2.54) for patients with a CCI of 1–2, 5.39 (95% CI 1.74–16.7) for those with a CCI of 3–5, and 8.77 (95% CI 2.36–32.6) for those with a CCI of ≥6 (<i>P</i><sub>trend</sub> &lt;0.001).<span><sup>6</sup></span> This association persisted after controlling for age, sex, type of PFC (pseudocyst, walled-off necrosis, or postoperative PFC), drainage route, and stent type (plastic or metal). The study was further validated by a large national cohort data in Japan for more comprehensive findings. Notably, bleeding complications after the EUS-guided procedure were not significantly increased in patients with higher CCI scores (<i>P</i><sub>trend</sub> &gt;0.34), despite a high likelihood of many participants being on antithrombotic medications (details not provided).<span><sup>6</sup></span> Future research should explore the relationship between bleeding risks and the type or number of antithrombotic agents used in these patients.</p><p>As Hamada <i>et al</i>. noted, the biological mechanisms underlying the high mortality observed in patients with higher CCI remain unclear.<span><sup>6</sup></span> Several studies offer potential insights. Jones <i>et al</i>. conducted a genome-wide meta-analysis and found that muscle weakness may be associated with genetic susceptibility.<span><sup>7</sup></span> Among 256,523 Europeans aged 60 years and older, they identified 15 loci associated with muscle weakness, including genes involved in autoimmune disease (<i>HLA-DQA1</i>), osteoarthritis (<i>GDF5, ALDH1A2, TGFA, BRSK1</i>), cell cycle and cancer protection (<i>TGFA</i>), transcription regulation (<i>RBBP6</i>, <i>ZBTB38</i>), and musculoskeletal development (<i>GDF5, DYM</i>) (European Working Group on Sarcopenia in Older People definition). Furthermore, the concept of “inflammaging” – a chronic, low-grade inflammation associated with aging – has been proposed to explain increased susceptibility to chronic morbidity, disability, frailty, and premature death in older adults.<span><sup>8</sup></span> Mechanisms behind inflammaging may include genetic factors, central obesity, increased gut permeability, altered microbiota, cellular senescence, inflammasome activation, oxidative stress, immune dysregulation, and chronic infections.<span><sup>8</sup></span> Inflammaging, frailty, and comorbidity burden can share common features, such as genetic susceptibility, chronic stress, infection, and cancer development. Notably, Hamada <i>et al</i>.<span><sup>6</sup></span> reported that approximately 20% of patients with a CCI ≥3 died from cancer when receiving EUS-guided treatment of PFCs. This finding aligns with genetic studies linking single nucleotide polymorphisms related to cellular senescence and inflammation with age-related diseases, including cancer, cardiovascular disease, and type 2 diabetes.<span><sup>9</sup></span> Furthermore, Zeng <i>et al</i>.<span><sup>10</sup></span> discovered that a single nucleotide polymorphism in the IL-6 gene was significantly associated with extreme longevity, supporting the role of IL-6 in regulating morbidity and mortality, particularly in older adults.</p><p>Elucidating the underlying mechanisms linking comorbidity burden to mortality can lead to the construction of novel treatment algorithms, not only for PFCs but also for a range of diseases influenced by inflammaging. Establishing a national biobank to systematically collect clinical data and biological specimens would facilitate multidisciplinary research on this topic, leading to more comprehensive and precise treatment strategies.</p><p>Author declares no conflict of interest for this article.</p><p>None.</p>\",\"PeriodicalId\":159,\"journal\":{\"name\":\"Digestive Endoscopy\",\"volume\":\"37 4\",\"pages\":\"426-427\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2024-12-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14969\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Digestive Endoscopy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/den.14969\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestive Endoscopy","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/den.14969","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

初次就诊时良好的患者活力和活动水平对临床决策产生积极影响,特别是在选择各种医疗领域的诊断检查和治疗方法方面。患者活力的几个指标,如虚弱(用“虚弱风险评分”来衡量)、肌肉减少(用腰肌质量指数/面积/密度来评估)和合并症指数,在最近的文献中有报道,并且与疾病预后密切相关。Gilbert等人报道,在202,718例患者中,医院虚弱风险评分最高的患者在急症护理环境中30天死亡率(比值比[OR] 1.71, 95%可信区间[CI] 1.68-1.75)、住院时间延长(OR 6.03, 95% CI 5.92-6.10)和30天再入院(OR 1.48, 95% CI 1.46-1.50)的几率显著增加此外,Farooq等人根据美国的一个大型国家数据库发现,成年急性胰腺炎患者的虚弱与更高的局部并发症发生率相关,如假性囊肿和壁闭塞性坏死,以及包括急性呼吸窘迫综合征和败血症在内的全身并发症。人们普遍认为,虚弱和合并症在许多疾病的进展中是相互关联的。例如,根据英国生物银行的数据,在COVID-19大流行期间,即使在调整了年龄和性别之后,所有虚弱和合并症的指标都与更高的COVID-19死亡风险相关,其中包括2812名COVID-19住院患者此外,在两家荷兰医院的急诊科研究中,由于合并症和虚弱而服用多种药物的老年人死亡风险增加(OR为2.62和3.92,过度服用多种药物的95% CI为1.39-4.93和1.95-7.90)这种关联并不奇怪,因为虚弱和合并症的评分系统通常包括认知功能和活动能力等重叠因素。1,2,5胰液收集(pfc),如假性囊肿、壁闭塞性坏死或术后胰瘘,可在急性胰腺炎或胰腺切除术后发生。在某些情况下,这些并发症是难治性的和潜在的致命的,尽管多学科的方法。PFC的治疗策略取决于患者的病情,通常受合并症的严重程度和数量以及PFC本身特征的影响。迄今为止,还没有研究调查合并症积累对微创内镜超声(EUS)引导下治疗pfc临床结果的影响。然而,Hamada等人证明,Charlson合并症指数(CCI),一种衡量合并症负担的指标,与接受eus引导下pfc引流的患者的住院死亡率显著相关。与CCI为0的患者相比,CCI为1-2的患者调整后的死亡率or为0.76 (95% CI 0.22-2.54), CCI为3-5的患者调整后的死亡率or为5.39 (95% CI 1.74-16.7), CCI≥6的患者调整后的死亡率or为8.77 (95% CI 2.36-32.6) (Ptrend &lt;0.001)在控制了年龄、性别、PFC类型(假性囊肿、壁闭塞性坏死或术后PFC)、引流途径和支架类型(塑料或金属)后,这种相关性仍然存在。该研究得到了日本大型国家队列数据的进一步验证,以获得更全面的发现。值得注意的是,尽管许多参与者很可能正在服用抗血栓药物(细节未提供),但在CCI评分较高的患者中,eus引导手术后出血并发症并未显著增加(p趋势&gt;0.34)未来的研究应探讨出血风险与这些患者使用的抗血栓药物的类型或数量之间的关系。正如Hamada等人所指出的,在CCI较高的患者中观察到的高死亡率的生物学机制尚不清楚一些研究提供了潜在的见解。Jones等人进行了一项全基因组荟萃分析,发现肌肉无力可能与遗传易感性有关在256523名60岁及以上的欧洲人中,他们确定了15个与肌肉无力相关的基因位点,包括涉及自身免疫性疾病(HLA-DQA1)、骨关节炎(GDF5、ALDH1A2、TGFA、BRSK1)、细胞周期和癌症保护(TGFA)、转录调节(RBBP6、ZBTB38)和肌肉骨骼发育(GDF5、DYM)的基因(欧洲老年人肌肉减少症工作组定义)。此外,“炎症”的概念——一种与衰老相关的慢性、低度炎症——已被提出来解释老年人对慢性疾病、残疾、虚弱和过早死亡的易感性增加炎症背后的机制可能包括遗传因素、中枢性肥胖、肠道通透性增加、微生物群改变、细胞衰老、炎性体激活、氧化应激、免疫失调和慢性感染。 炎症、虚弱和共病负担可能具有共同特征,如遗传易感性、慢性压力、感染和癌症发展。值得注意的是,Hamada等人6报道,大约20%的CCI≥3的患者在接受eus引导的pfc治疗时死于癌症。这一发现与将细胞衰老和炎症相关的单核苷酸多态性与年龄相关疾病(包括癌症、心血管疾病和2型糖尿病)联系起来的遗传学研究相一致此外,Zeng等人发现IL-6基因的单核苷酸多态性与极端长寿显著相关,支持IL-6在调节发病率和死亡率方面的作用,特别是在老年人中。阐明将合并症负担与死亡率联系起来的潜在机制可以导致构建新的治疗算法,不仅适用于pfc,也适用于一系列受炎症影响的疾病。建立国家生物银行,系统收集临床数据和生物标本,将促进该主题的多学科研究,从而制定更全面、更精确的治疗策略。作者声明本文不存在利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Endoscopic treatment for pancreatic fluid collections: Is active intervention always the optimal option?

Good patient vitality and activity levels at the first visit positively affect clinical decision-making, particularly in the selection of diagnostic work-ups and treatments across various medical fields. Several indicators of patient vitality, such as frailty (measured by the “Frailty Risk Score”),1 sarcopenia (assessed using the psoas muscle mass index/area/density), and comorbidity index,2 have been reported in recent literature and are closely associated with disease prognosis. Gilbert et al. reported that among 202,718 patients, those with the highest Hospital Frailty Risk Scores had significantly increased odds of 30-day mortality (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.68–1.75), prolonged hospital stays (OR 6.03, 95% CI 5.92–6.10), and 30-day readmissions (OR 1.48, 95% CI 1.46–1.50) in older patients in acute care settings.1 Furthermore, Farooq et al. found that frailty in adult patients with acute pancreatitis was associated with higher rates of local complications, such as pseudocyst and walled-off necrosis, and systemic complications including acute respiratory distress syndrome and sepsis, based on a large national database of the United States.3 It is widely acknowledged that frailty and comorbidity are interrelated in the progression of many diseases. For instance, during the COVID-19 pandemic, all measures of frailty and comorbidity were associated with higher COVID-19 mortality risk, even after adjusting for age and sex, according to data from the UK Biobank, which included 2812 COVID-19 inpatients.4 Furthermore, in an emergency department study of two Dutch hospitals, older adults with polypharmacy resulting from comorbidities and frailty had an increased risk of mortality (OR 2.62 and 3.92, 95% CI 1.39–4.93 and 1.95–7.90 for excessive polypharmacy).5 This association is not surprising, as scoring systems for both frailty and comorbidity often include overlapping factors such as cognitive function and mobility.1, 2, 5

Pancreatic fluid collections (PFCs), such as pseudocysts, walled-off necrosis, or postoperative pancreatic fistulas, can develop after acute pancreatitis or pancreatic resection. In some cases, these complications are refractory and potentially fatal despite multidisciplinary approaches. The treatment strategy for PFCs depends on the patient's condition, which is often influenced by the severity and number of comorbidities, as well as the characteristics of the PFC itself. To date, no studies have investigated the impact of comorbidity accumulation on the clinical outcomes of minimally invasive endoscopic ultrasound (EUS)-guided treatments for PFCs. However, Hamada et al. demonstrated that the Charlson Comorbidity Index (CCI), a measure of comorbidity burden, was significantly associated with in-hospital mortality in patients undergoing EUS-guided drainage of PFCs. The adjusted ORs for mortality compared to patients with a CCI of 0 were 0.76 (95% CI 0.22–2.54) for patients with a CCI of 1–2, 5.39 (95% CI 1.74–16.7) for those with a CCI of 3–5, and 8.77 (95% CI 2.36–32.6) for those with a CCI of ≥6 (Ptrend <0.001).6 This association persisted after controlling for age, sex, type of PFC (pseudocyst, walled-off necrosis, or postoperative PFC), drainage route, and stent type (plastic or metal). The study was further validated by a large national cohort data in Japan for more comprehensive findings. Notably, bleeding complications after the EUS-guided procedure were not significantly increased in patients with higher CCI scores (Ptrend >0.34), despite a high likelihood of many participants being on antithrombotic medications (details not provided).6 Future research should explore the relationship between bleeding risks and the type or number of antithrombotic agents used in these patients.

As Hamada et al. noted, the biological mechanisms underlying the high mortality observed in patients with higher CCI remain unclear.6 Several studies offer potential insights. Jones et al. conducted a genome-wide meta-analysis and found that muscle weakness may be associated with genetic susceptibility.7 Among 256,523 Europeans aged 60 years and older, they identified 15 loci associated with muscle weakness, including genes involved in autoimmune disease (HLA-DQA1), osteoarthritis (GDF5, ALDH1A2, TGFA, BRSK1), cell cycle and cancer protection (TGFA), transcription regulation (RBBP6, ZBTB38), and musculoskeletal development (GDF5, DYM) (European Working Group on Sarcopenia in Older People definition). Furthermore, the concept of “inflammaging” – a chronic, low-grade inflammation associated with aging – has been proposed to explain increased susceptibility to chronic morbidity, disability, frailty, and premature death in older adults.8 Mechanisms behind inflammaging may include genetic factors, central obesity, increased gut permeability, altered microbiota, cellular senescence, inflammasome activation, oxidative stress, immune dysregulation, and chronic infections.8 Inflammaging, frailty, and comorbidity burden can share common features, such as genetic susceptibility, chronic stress, infection, and cancer development. Notably, Hamada et al.6 reported that approximately 20% of patients with a CCI ≥3 died from cancer when receiving EUS-guided treatment of PFCs. This finding aligns with genetic studies linking single nucleotide polymorphisms related to cellular senescence and inflammation with age-related diseases, including cancer, cardiovascular disease, and type 2 diabetes.9 Furthermore, Zeng et al.10 discovered that a single nucleotide polymorphism in the IL-6 gene was significantly associated with extreme longevity, supporting the role of IL-6 in regulating morbidity and mortality, particularly in older adults.

Elucidating the underlying mechanisms linking comorbidity burden to mortality can lead to the construction of novel treatment algorithms, not only for PFCs but also for a range of diseases influenced by inflammaging. Establishing a national biobank to systematically collect clinical data and biological specimens would facilitate multidisciplinary research on this topic, leading to more comprehensive and precise treatment strategies.

Author declares no conflict of interest for this article.

None.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Digestive Endoscopy
Digestive Endoscopy 医学-外科
CiteScore
10.10
自引率
15.10%
发文量
291
审稿时长
6-12 weeks
期刊介绍: Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信