Effect of adipose-related parameters on mortality in patients with liver cirrhosis: a meta-analysis

BACKGROUND

Some adipose-related parameters exhibit distinct prognostic value in patients with cirrhosis. However, the magnitude and direction of the association between individual adipose parameter and mortality in patients with cirrhosis are unclear.

AIM

This study aimed to evaluate the association between individual adipose parameter and mortality in patients with cirrhosis using the meta-analysis method.

METHODS

The PubMed, Embase, Web of Science, China Biological Medicine, WanFang, and China National Knowledge Infrastructure databases were searched from inception through December 15, 2023, to identify eligible studies. The impact of each adipose parameter on mortality was assessed by the pooled unadjusted or adjusted hazard ratio (HR) with 95% confidence intervals (CIs) using the random effects model.

RESULTS

A total of 33 studies involving 9626 patients were included in our analysis, with 11 adipose parameters evaluated. The pooled prevalence of sarcopenic obesity (SO) and myosteatosis in patients with cirrhosis was 15.5% and 34.4%, respectively. In adjusted analysis, each unit increase in subcutaneous adipose tissue index (SATI) (HR: 0.99, 95% CI: 0.98-1.00) or muscle attenuation (MA) (HR: 0.94, 95% CI: 0.90-0.98) and each unit decrease in visceral-to-subcutaneous adipose tissue ratio (VSR) (HR: 1.92, 95% CI: 1.45-2.54) showed an independent association with a decreased risk of mortality. However, concurrent myosteatosis (HR: 1.88, 95% CI: 1.48-2.40) or SO (HR: 2.77, 95% CI: 1.95-3.93) significantly increased the risk of mortality in patients with cirrhosis.

CONCLUSION

Decreased SATI or MA, increased VSR, and concurrent myosteatosis or SO were independently associated with a higher risk of mortality in patients with cirrhosis.

Development and validation of an integrated model for the diagnosis of liver cirrhosis with portal vein thrombosis combined with endoscopic characters and blood biochemistry data: a retrospective propensity score matching (PSM) cohort study

BACKGROUND

Liver cirrhosis complicated by portal vein thrombosis (PVT) is a fatal complication with no specific manifestations but often misdiagnosed, it crucially increases the mortality worldwide. This study aimed to identify risk factors and establish a predictive model for diagnosis of venous thrombosis clinical by routine blood tests and endoscopic characteristics.

METHODS

Patients from Gansu Provincial Hospital from October 2019 to December 2023 were enrolled. The retrospective modelling cohort was screened by propensity score matching (PSM) at a 1:1 ratio from the baseline characteristics before endoscopic diagnosis. Variables were collected from blood test and endoscopic signs using machine learning method (ML). Logistic regression determined risk factors. The predictive performance was evaluated by receiver operation curve (ROC), calibration curve, clinical decision analysis (DCA) and influence curve (CIC). Furthermore, external cohort was used for validation, an online nomogram was established.

RESULTS

A total of 1,058 patients were enrolled, and 470 patients were included after PSM 1: 1. The model identified 7 factors, including splenectomy, blood urea nitrogen (BUN), serum sodium, activated partial thromboplastin time (APTT), thrombin time (TT), D-dimer, and degree of oesophageal varices. The area under the curve (AUC) was 0.907 (95% CI, 0.877-0.931). The calibration curve, decision and clinical impact curves showed the model demonstrated a good predictive accuracy and clinical benefits. The validation got an AUC of 0.890 (95% CI, 0.831-0.934), A nomogram tool was finally established for application.

CONCLUSION

Blood test combined endoscopic characters could preliminarily predict the liver cirrhosis with portal vein thrombosis for cirrhotic patients undergoing endoscopic examination.

Risk factors for hepatocellular carcinoma: an umbrella review of systematic review and meta-analysis

BACKGROUND

Numerous meta-analyses have identified various risk factors for hepatocellular carcinoma (HCC), prompting a comprehensive study to synthesize evidence quality and strength.

METHODS

This umbrella review of meta-analyses was conducted throughout PubMed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. Evidence strength was evaluated according to the evidence categories criteria.

RESULTS

We identified 101 risk factors throughout 175 meta-analyses. 31 risk factors were classified as evidence levels of class I, II, or III. HBV and HCV infections increase HCC risk by 12.5-fold and 11.2-fold, respectively. These risks are moderated by antiviral treatments and virological responses but are exacerbated by higher HBsAg levels, anti-HBc positivity, and co-infection. Smoking, obesity, non-alcoholic fatty liver disease, diabetes, low platelet, elevated liver enzymes and liver fluke infection increase HCC risk, while coffee consumption, a healthy diet, and bariatric surgery lower it. Medications like metformin, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), aspirin, statins, and selective serotonin reuptake inhibitors reduce HCC risk, while acid suppressive agents, particularly proton pump inhibitors, elevate it. Blood type O reduces the risk of HCC, while male gender and older age increase the risk.

CONCLUSIONS

HBV and HCV are major HCC risk factors, with risk mitigation through antiviral treatments. Lifestyle habits such as smoking and alcohol use significantly increase HCC risk, highlighting the importance of cessation. Certain drugs like aspirin, statins, GLP-1 RAs, and metformin may reduce HCC occurrence, but further research is needed to confirm these effects.

Machine learning-based analyses of contributing factors for the development of hypertension: a comparative study

OBJECTIVES

Sufficient attention has not been given to machine learning (ML) models using longitudinal data for investigating important predictors of new onset of hypertension. We investigated the predictive ability of several ML models for the development of hypertension.

METHODS

A total of 15 965 Japanese participants (men/women: 9,466/6,499, mean age: 45 years) who received annual health examinations were randomly divided into a training group (70%, n = 11,175) and a test group (30%, n = 4,790). The predictive abilities of 58 candidates including fatty liver index (FLI), which is calculated by using body mass index, waist circumference and levels of γ-glutamyl transferase and triglycerides, were investigated by statistics analogous to the area under the curve (AUC) in receiver operating characteristic curve analyses using ML models including logistic regression, random forest, naïve Bayes, extreme gradient boosting and artificial neural network.

RESULTS

During a 10-year period (mean period: 6.1 years), 2,132 subjects (19.1%) in the training group and 917 subjects (19.1%) in the test group had new onset of hypertension. Among the 58 parameters, systolic blood pressure, age and FLI were identified as important candidates by random forest feature selection with 10-fold cross-validation. The AUCs of ML models were 0.765-0.825, and discriminatory capacity was significantly improved in the artificial neural network model compared to that in the logistic regression model.

CONCLUSIONS

The development of hypertension can be simply and accurately predicted by each ML model using systolic blood pressure, age and FLI as selected features. By building multiple ML models, more practical prediction might be possible.

Factors Associated With Advanced Liver Fibrosis in a Population With Type 2 Diabetes: A Multicentric Study in Mexico City

BACKGROUND AND OBJECTIVES

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver disease, primarily due to insulin resistance and type 2 diabetes (T2D). Despite the strong link between T2D and MASLD, identifying and treating liver fibrosis in T2D patients is still poor. This study aimed to identify the factors related to advanced liver fibrosis in T2D patients.

METHODS

This retrospective observational study used medical records from four centers in Mexico City from 2018 to 2023. The study included 2000 patients with T2D. Liver fibrosis was evaluated using the Fibrosis-4 (FIB-4) index, and insulin resistance was assessed using the estimated glucose disposal rate (eGDR).

RESULTS

The mean age of the patients was 58.9 years, with 63.7% being women. The median duration of T2D was 7 years, and the mean HbA1c was 7.63%. Overall, 20.4% had advanced liver fibrosis. The multivariate logistic regression analysis showed that diabetes duration >10 years {odds ratio (OR) = 2.105 (95% confidence interval [CI] 1.321-3.355)}, fasting glucose >126 mg/dL (OR = 1.568 [95% CI 1.085-2.265]), and microalbuminuria >300 mg/24 h (OR = 2.007 [95% CI 1.134-3.552]) were associated with advanced liver fibrosis. Conversely, the eGDR (OR = 0.805 [95% CI 0.703-0.888]), statins (OR = 0.111 [95% CI 0.073-0.168]), and pioglitazone (OR = 0.082 [95% CI 0.010-0.672]) were inversely associated.

CONCLUSION

Longer diabetes duration, insulin resistance, and microalbuminuria are independently linked to advanced liver fibrosis in T2D patients. Statins and pioglitazone may protect against liver fibrosis. Enhanced screening and management strategies targeting these factors could slow fibrosis progression and reduce the global burden of MASLD.

hsa-miR-5688 inhibits FOXC1-OCT4/SOX2 feedforward loop that drives chemoresistance in breast cancer stem cells

Inherently chemotherapy-resistant breast cancer stem cells (CSCs) are responsible for tumor initiation, metastasis, and relapse. CSCs "acquire" more resistance and stemness upon chemotherapy, thereby making relapse-free survival extremely challenging. Here, we describe a novel role of FOXC1 in "acquired resistance" of breast CSCs during chemotherapy. Putative binding sites of pluripotency factors OCT4 and SOX2, but not NANOG, on FOXC1 promoter, were demonstrated by JASPAR and validated by a docking experiment. Significant decline in FOXC1 expression was noticed after OCT4 or SOX2 ablation in breast CSCs. Contrastingly, presence of putative FOXC1 binding sites on the promoters of stemness genes and drug-resistance marker ABCG2, along with downregulation of OCT4 and SOX2 in FOXC1-ablated CSCs, indicated the existence of a feedforward FOXC1-OCT4/SOX2 transactivation loop in CSCs. Chemotherapy-induced upregulation of FOXC1, stemness, as well as drug resistance in CSCs, and downregulation of the same by prior FOXC1-ablation in in-vitro and in-vivo models, endorsed the contribution of this loop in chemo-induced acquisition of stemness and drug resistance. Finally, over-expression of hsa-miR-5688 sensitized CSCs toward chemotherapy and decelerated recurrence. Accordingly, we demonstrate a hitherto unknown mechanism underpinning chemotherapy-induced resistance in breast CSCs, causing relapse and identified hsa-miR-5688 as a potential therapeutic candidate for relapse-free survival of breast cancer patients.

Prevalence and prognostic significance of cachexia diagnosed by novel definition for Asian population among Chinese cirrhotic patients

BACKGROUND & AIMS

Cachexia is a multifaceted metabolic disorder often linked to chronic illnesses, characterized by substantial weight reduction, inflammatory states, and loss of appetite. The novel diagnostic criteria concerning cachexia established by the Asian Working Group for Cachexia (AWGC) have not been fully validated in Chinese populations with cirrhosis. To assess the prognostic impact of AWGC-defined cachexia among hospitalized cirrhotic patients and explore the synergistic impact of Model for End-Stage Liver Disease 3.0 (MELD 3.0) scores with cachexia status on prognosis.

METHODS

We retrospectively analyzed clinical data from patients with decompensated cirrhosis admitted to our tertiary hospital between January 2021 and December 2023. Cachexia was identified according to AWGC criteria, and disease severity was assessed using MELD 3.0 scores. The study's primary outcome was all-cause mortality within one year.

RESULTS

A total of 368 patients were included in the analyses. The prevalence of cachexia was 61.7 %, and patients with cachexia had a significantly higher one-year all-cause mortality rate (26.4 % vs. 7.8 %, P < 0.001). Multivariate Cox regression analysis showed that cachexia (HR 2.68, 95 %CI 1.40-5.13, P = 0.003), along with MELD 3.0 (HR 1.18, 95 %CI 1.13-1.23, P < 0.001), were independent predictors of one-year mortality. The combined assessment of cachexia and MELD 3.0 scores yielded a higher discriminative ability for predicting one-year mortality compared to either metric alone.

CONCLUSIONS

AWGC-defined cachexia is a significant prognostic factor in hospitalized patients with cirrhosis. The integration of cachexia with MELD 3.0 scoring enhances prognostic prediction, underscoring the importance to introduce cachexia evaluation during clinical practice for this vulnerable setting.

The effect of thyme essential oil on duodenal toxicity induced by subacute exposure to voliam targo® insecticide in male rabbits

The increasing use of pesticides has raised concerns about their gastrointestinal toxicity, leading to the search for natural remedies such as thyme essential oil. For that, this study aimed to determine the protective effect of Thymus vulgaris essential oil (TEO) with its chemical composition against Voliam Targo-induced duodenal toxicity. Twenty male rabbits were randomly assigned to four equal groups and treated for 21 consecutive days: Control, VT insecticide group, TEO essential oil group, and VT + TEO group. The main constituent of the essential oil of T. vulgaris was carvacrol 72.9 %. The duodenal injury was assessed using biochemical, histomorphometrical, and immunohistochemical methods. The VT induced an increased number of benign intestinal tissue changes, such as hyperplasia of Brunner glands, disorganization of villi, and infiltration of inflammatory cells. The co-administration of TEO with VT restored the histological organization of the duodenum. In addition, the immunohistochemical examination of the duodenal tissues shows positive immunostaining for the expression of Ki67, P53, and BCL2 proteins in the VT group. Lower expressions were noted in the VT-TEO group compared to the control and TEO groups. The E-cadherin and β-catenin immuno-signals were significantly higher in the essential oil treatment groups' duodenal sections than in the VT group. The study suggested that VT caused duodenal toxicity and that the carvacrol chemotype of TEO could mitigate and alleviate this effect.

Gastrointestinal Symptoms and Psychological Conditions: A Literature Review with Emphasis on the Evidence in Military Personnel from China

Gastrointestinal symptoms are common in military personnel due to their special living and working environment. Notably, there is a close association between gastrointestinal symptoms and psychological conditions. Thus, it seems that psychological interventions are not only beneficial for alleviating mental stress and improving psychological health, but could also be potentially effective for preventing gastrointestinal symptoms, especially in military personnel, which could contribute to battle effectiveness. This paper aims to briefly review the prevalence and risk factors of gastrointestinal syndromes, and summarize the association of gastrointestinal syndromes with psychological conditions and possible effect of psychological interventions on the improvement of gastrointestinal syndromes, with emphasis on the evidence in military personnel from China.

Efficacy and safety of cinobufacin-based combination therapy for advanced hepatocellular carcinoma: a meta-analysis of randomized controlled trials

BACKGROUND

Primary liver cancer is one of the most common malignant tumors with a rising incidence in recent years. In China, it ranks as the fourth most prevalent malignancy. Although surgery is the primary treatment, many advanced-stage patients are ineligible due to late diagnosis, rapid progression, or other contraindications. Targeted therapy, chemotherapy, and transarterial chemoembolization (TACE) are common non-surgical approaches, but these often result in significant side effects such as gastrointestinal reactions, bone marrow suppression, and high recurrence rates. In this context, integrative treatment with traditional Chinese medicine (TCM) has shown promise. Cinobufacin, a TCM drug developed in China, has demonstrated superior efficacy and safety when combined with Western treatments in patients with advanced hepatocellular carcinoma (HCC).

METHODS

We conducted a systematic review and meta-analysis by searching PubMed, Embase, Cochrane Library, CNKI, WanFang Data, VIP, and the Chinese Biomedical Literature Database (CBM) for randomized controlled trials (RCTs) comparing cinobufacin combined with conventional Western treatments to Western treatments alone in advanced HCC patients. The search covered all databases up to December 30, 2024. Statistical analyses were performed using Stata 15.0, and Review Manager.

RESULTS

A total of 30 studies were included in the meta-analysis. Cinobufacin combination therapy significantly improved the disease control rate (DCR, OR = 2.49, 95% CI 2.01 to 3.07), reduced alpha-fetoprotein (AFP) levels (SMD = - 1.86, 95% CI - 2.58 to - 1.13), alanine aminotransferase (ALT) levels (SMD = - 1.66, 95% CI - 2.48 to - 0.83), and total bilirubin (TBIL) levels (SMD = - 1.82, 95% CI - 2.36 to - 1.28). It also increased white blood cell (WBC) counts (SMD = 0.58, 95% CI 0.06 to 1.11) and improved Karnofsky Performance Status (KPS) scores (SMD = 1.24, 95% CI 0.93 to 1.56). Funnel plots and sensitivity analyses confirmed the robustness of the results.

CONCLUSION

Cinobufacin combined with Western treatments significantly improves clinical efficacy, reduces adverse drug reactions, and enhances the quality of life for patients with advanced HCC.

Hepatic encephalopathy in cirrhosis: therapies and developments

Hepatic encephalopathy (HE) is a frequent decompensation in patients with cirrhosis, which significantly affects morbidity and mortality. Ammonia is a major neurotoxin implicated in the pathogenesis, progression, and severity of HE, and various organs including the gut, muscle, kidney, and brain are involved in its metabolism. Therefore, therapeutic management involves reducing ammonia production and increasing its elimination from the blood and the brain. Prevention of HE in patients at high risk of first and recurrent episodes is important for prolonging survival. Various anti-ammonia therapies with synergistic and complementary actions have been attempted for overt HE and for prophylaxis of the first and recurrent episodes of HE. In the current review, we summarize the currently used and under-development pharmacotherapies/procedure(s) for HE in cirrhosis and their mechanism of action. Primary and secondary prophylaxis with monotherapies and combination therapies are also discussed.

Association of alkaline phosphatase to albumin ratio with all-cause mortality in critically ill patients with cirrhosis: a retrospective study

BACKGROUND

Cirrhosis is the end stage of many chronic liver diseases, which seriously affects the quality of life of patients. The alkaline phosphatase to albumin ratio (APAR) index is a new indicator related to the prognostic risk of many diseases. This study was aimed at exploring the association between the APAR index and the risk of all-cause mortality in patients with cirrhosis.

METHODS

Patients with cirrhosis who were 18 years of age or older and admitted to the intensive care unit were included from the Medical Information Mart for Intensive Care IV (MIMIC-IV) - Version 3.0 database in this study. The primary endpoint of this study was all-cause mortality at 365- days, with secondary endpoints at 90-days and 28-days after admission. The hazard ratio (HR) and 95% CI between the APAR index and endpoints were calculated using the Cox proportional hazards model. A restricted cubic spline (RCS) regression model was created to explore the relationship between the APAR index and cirrhosis. Furthermore, we explored the predictive value of the APAR index in different populations of cirrhosis through subgroup analysis.

RESULTS

A total of 2,109 patients with cirrhosis were included from the MIMIC-IV database. After adjusting for potential covariates, APAR as a continuous variable was significantly positively associated with all-cause mortality at 28-days (HR: 2.007, 95% CI: 1.369, 2.948; P < 0.001), 90-days (HR: 2.392, 95% CI: 1.642, 3.495; P < 0.001), and 365-days (HR: 2.418, 95% CI: 1.660, 3.534; P < 0.001) in cirrhotic patients. When APAR was a categorical variable, compared with patients in the lower APAR group, the risk of 365-days all-cause mortality in patients of the higher APAR group significantly increased (HR: 1.451, 95%CI: 1.197, 1.758). APAR was linearly related to all-cause mortality at 28-days, 90-days and 365-days after admission (P for non-linearity = 0.221, 0.390, and 0.344, respectively). Subgroup analysis indicated that among patients with cirrhosis complicated with hepatorenal syndrome, those without spontaneous peritonitis or portal hypertension/esophageal varices, and those receiving human albumin infusion, elevated APAR levels were significantly associated with an increased risk of long-term death.

CONCLUSIONS

A higher APAR index is significantly associated with the risk of all-cause mortality in cirrhosis. APAR may be a potential biomarker for evaluating the long-term prognosis of critically ill patients with cirrhosis.

ISPO: An Integrated Ontology of Symptom Phenotypes for Semantic Integration of Traditional Chinese Medical Data

Symptom phenotypes are crucial for diagnosing and treating various disease conditions. However, the diversity of symptom terminologies poses a significant challenge to analyzing and sharing of symptom-related medical data, particularly in the field of traditional Chinese medicine (TCM). This study aims to construct an Integrated Symptom Phenotype Ontology (ISPO) to support data mining of Chinese electronic medical records (EMRs) and real-world studies in the TCM field.We manually annotated and extracted symptom terms from 21 classical TCM textbooks and 78,696 inpatient EMRs, and integrated them with five publicly available symptom-related biomedical vocabularies. Through a human-machine collaborative approach for terminology editing and ontology development, including term screening, semantic mapping, and concept classification, we constructed a high-quality symptom ontology that integrates both TCM and Western medical terminology.ISPO provides 3,147 concepts, 23,475 terms, and 23,363 hierarchical relationships. Compared with international symptom-related ontologies such as the Symptom Ontology, ISPO offers significant improvements in the number of terms and synonymous relationships. Furthermore, evaluation across three independent curated clinical datasets demonstrated that ISPO achieved over 90% coverage of symptom terms, highlighting its strong clinical usability and completeness.ISPO represents the first clinical ontology globally dedicated to the systematic representation of symptoms. It integrates symptom terminologies from historical and contemporary sources, encompassing both TCM and Western medicine, thereby enhancing semantic interoperability across heterogeneous medical data sources and clinical decision support systems in TCM.

Covered TIPS Created with Viatorr Versus Fluency Stent-Grafts for the Refractory Ascites in Patients with Cirrhosis: An Observational Study

RATIONALE AND OBJECTIVES

To compare the long-term clinical efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) created with Fluency versus Viatorr stent-grafts for the treatment of refractory ascites in patients with cirrhosis.

MATERIALS AND METHODS

A retrospective analysis was conducted on 118 cirrhotic patients with refractory ascites undergoing TIPS with Fluency stent-grafts (Fluency group, n=83) or Viatorr stent-grafts (Viatorr group, n=35) at two centers from January 2017 to December 2021. Competing risk analysis was used to compare the incidence of clinical outcomes between groups after adjusting for confounders.

RESULTS

During a median of 30.9 months follow-up, 31 patients (26.3%) developed portal hypertension complications (11 cases of recurrent ascites, 16 cases of variceal bleeding, and four cases of both ascites and variceal bleeding), 15 patients (12.7%) developed shunt dysfunction, 58 patients (49.15%) developed overt hepatic encephalopathy (OHE), and 74 patients (62.7%) died. After adjusting for confounding factors, the Viatorr stent was associated with a reduced OHE risk (38% vs 54% at 5 years, p=0.004) but a comparable incidence of portal hypertension complications (27% vs 27%, p=0.536), shunt dysfunction (14% vs 12%, p=0.401), and mortality (41% vs 37%; p=0.064) compared to the Fluency stents. These findings were consistent across most relevant subgroups.

CONCLUSION

In cirrhotic patients with refractory ascites undergoing TIPS, Viatorr stent-grafts were associated with lower risk of OHE while no significant differences in clinical efficacy compared to the Fluency stent-grafts.

Plasma levels of soluble PD-1, TIM-3, LAG-3 and galectin-3 and the degree of liver fibrosis in CHC and the impact of successful antiviral treatment on their levels

Chronic hepatitis C (CHC), caused by the hepatitis C virus, commonly leads to liver fibrosis. CHC is also related to T-cell exhaustion, phenotypically manifesting as overexpression of inhibitory receptors (iRs), e.g., programmed death receptor-1 (PD-1), T cell immunoglobulin and mucin domain-containing protein 3 (TIM-3) and lymphocyte activation gene 3 (LAG-3), which have corresponding plasma-soluble analogs. Galectin-3 (Gal-3) is a pro-fibrotic and pro-inflammatory molecule, but its role in CHC is controversial. The study aimed to assess the relationship between plasma levels of soluble PD-1 (sPD-1), sTIM-3, sLAG-3 and Gal-3 and the degree of fibrosis in CHC and successful CHC treatment effect on these markers. The study comprised 98 CHC patients, qualified for treatment with direct-acting antivirals. Plasma samples were collected prior to and six months post-treatment. iRs were determined by ELISA. sPD-1 levels were significantly higher in more advanced fibrosis (F2 + F3 vs. F0/1). Regardless of the degree of fibrosis, sPD-1 and sLAG-3 levels significantly decreased after therapy. sTIM-3 levels also decreased, however, mostly in patients with no or mild (i.e., F0/1) fibrosis. Furthermore, Gal-3 increased in patients with more advanced fibrosis (F2 + F3). sPD-1 is associated with liver disease stage in CHC and effective treatment is related to the iRs levels reduction.

Pien Tze Huang plus entecavir improves hepatic fibrosis in Chinese patients with chronic hepatitis B

BACKGROUND

Pien Tze Huang (PTH), a well-established traditional Chinese medicine compound, has exhibited anti-hepatic fibrosis properties both in vitro and in vivo animal models, but the randomized clinical trials to evaluate anti-hepatic fibrosis efficacy of PTH are deficient. Chronic hepatitis B (CHB) is a leading cause of hepatic fibrosis in China. Although antiviral therapies have demonstrated significant effectiveness in arresting the progression of fibrotic disease, complete regression of established fibrosis is limited to only a subset of treated patients.

PURPOSE

To assess the efficacy of PTH in improving hepatic fibrosis in CHB patients.

STUDY DESIGN

We conducted a randomized, double-blind, placebo-controlled clinical trial involving 144 CHB patients with hepatic fibrosis. This study was carried out from September 2020 to April 2023. (Clinical Trials Registration: ChiCTR2000035128) METHODS: CHB patients with an Ishak score of 2-5 points were recruited from ten hospitals across China. Participants were randomized in 1:1 ratio to receive either oral PTH (0.6 g per dose, three times/day) or placebo for 48 weeks, in addition to the standard treatment of entecavir (0.5 mg/day). The primary endpoint was the change in Ishak score. Secondary outcomes included changes in Knodell HAI score, liver stiffness measurement, AST- to -platelet ratio index, Fibrosis-4 index and hepatic function indices.

RESULTS

Of the 144 randomized patients, 142 patients (71 in the PTH group and 71 in the placebo group) were included in the primary analysis. The PTH group exhibited lower Ishak score compared to the control group (2.37 ± 0.94 vs. 2.87 ± 1.04, F = 6.072, p = 0.015). Notably, in treatment-naive patients, the PTH group showed significant improvement in Ishak score post-treatment compared with the control group (2.13 ± 0.72 vs. 2.74 ± 1.07, F = 6.336, p = 0.014). However, no significant changes were observed in these parameters among patients already receiving antiviral therapy.

CONCLUSIONS

The combination of PTH and entecavir demonstrates significant improvement in hepatic fibrosis among CHB patients, especially those who are treatment-naive patients.

The risk factors of liver cirrhosis complicated with portal vein thrombosis and the efficacy and safety of anticoagulant therapy: a meta analysis

OBJECTIVE

To evaluate the risk factors of liver cirrhosis complicated with portal vein thrombosis and the efficacy and safety of anticoagulant therapy.

METHODS

Relevant literature was searched through PubMed, Cochrane library, Embase, Web of Science, Wanfang Medical Network and CNKI databases, and eligible literature was included. QUADS scale was used to evaluate the quality of the included literatures, and Stata15.1 software was used for meta-analysis and statistical processing.

RESULTS

For risk factors analysis for cirrhosis with Portal vein thrombosis, 19 literatures were included, including 1563 patients with cirrhosis with portal vein thrombosis and 2579 patients with cirrhosis without portal vein thrombosis, all of which were not treated with anticoagulation. The results of meta-analysis showed that compared with the PVT group, there was no significant difference in creatinine(Scr,MD = 0.09,95%CI: -0.03-0.22,P = 0.132)and total bilirubin(TBIL,MD = -0.00, 95%CI: -0.10 ~ 0.09,P = 0.948).There was significant difference in albumin(ALB,MD = -0.32, 95%CI:-0.43-0.21,P = 0.000)and PLT(PLT, MD = 0.15, 95%CI: 0.05-0.26, P = 0.004).And there was also no difference in hypertension history (OR = 0.78,95%CI:0.59 ~ 1.03,P = 0.079). In the study on the anticoagulant effect and safety of liver cirrhosis complicated with portal vein thrombosis, a total of 9 literatures were included. Among them,497 patients with liver cirrhosis complicated by portal vein thrombosis are treated with Anticoagulation treatment, and 633 patients with cirrhosis complicated by portal vein thrombosis without anticoagulation treatment. The analysis results showed that the thrombus recanalization situation of liver cirrhosis complicated with portal vein thrombosis after anticoagulation treatment was better than that of patients without anticoagulation (OR = 4.052,95%CI: 2.737-6.000,P = 0.000),and there was no significant difference in the occurrence of bleeding events between patients with anticoagulation and those without anticoagulation (OR = 1.017, 95%CI:0.735-1.407,P = 0.920). The Stata15.1Egger test showed no significant publication bias for all the results(P > 0.05).

CONCLUSIONS

Patients with liver cirrhosis complicated with low platelet and low albumin are more likely to develop PVT. Anticoagulation is helpful and safe for thrombolysis in patients with liver cirrhosis complicated with PVT.

Impact of Relaxation and Music Intervention on Psychological and Gastrointestinal Health in Military Recruits: A Prospective Study

Background and aims

Gastrointestinal symptoms are closely associated with psychological problems, such as anxiety and depression. This prospective before-after study aimed to explore whether progressive muscular relaxation training combined with music intervention, which is potentially beneficial for psychological conditions, can improve gastrointestinal symptoms.

Methods

A total of 623 recruits' effective questionnaires before and after intervention were collected. They underwent progressive muscular relaxation training combined with music intervention for 4 weeks. They also completed the Self-Rating Depression Scale (SDS) and the Patient Health Questionnaire (PHQ-9) for assessment of depression, the Self-Rating Anxiety Scale (SAS) and the Generalized Anxiety Disorder-7 (GAD-7) for assessment of anxiety, the Gastrointestinal Symptom Rating Scale (GSRS) for assessment of gastrointestinal symptoms, and the Bristol Stool Form Scale (BSFS) for assessment of stool before and after interventions. Changes of psychological conditions and gastrointestinal symptoms were evaluated.

Results

The SDS (P<0.001), PHQ-9 (P<0.001), SAS (P<0.001), GAD-7 (P<0.001), and GSRS (P<0.001) scores were significantly decreased after intervention. The proportions of regurgitation (P<0.001), abdominal pain (P<0.001), dyspepsia (P<0.001), and constipation (P<0.001) evaluated by the GSRS were significantly decreased after intervention, but not diarrhea (P=0.601). The proportions of severe (P<0.001) and mild (P<0.001) constipation evaluated by the BSFS decreased after intervention, but those of severe (P=0.632) and mild (P<0.001) diarrhea evaluated by the BSFS increased.

Conclusion

Short-term progressive muscular relaxation training in combination with music intervention is potentially effective for most gastrointestinal symptoms, but not for diarrhea, in recruits.

Serum Albumin for Short-Term Poor Prognosis in Patients With Acute Pulmonary Embolism: A Clinical Study Based on a Database

The relationship between serum albumin (ALB) and short-term prognosis in patients with acute pulmonary embolism (APE) remains unclear. We investigated the predictive value of ALB for short-term prognosis in APE patients using our hospital pulmonary embolism (PE) database (384 patients consecutively collected). Logistic regression analysis and nomograms were applied to construct the predictive model, and validation was assessed. A total of 340 APE patients were included, with a 30-day all-cause mortality rate of 8.5%. The incidence of hypoalbuminemia was 15.9%. The odds ratio (OR) for short-term mortality in patients with high ALB was 0.89 (0.886, 95% CI: 0.812-0.967). Additionally, we created a nomogram for individualized mortality risk prediction. Receiver operating characteristic (ROC) curve analysis showed that the diagnostic area under the curve (AUC) of ALB was 0.758 (95% CI 0.683-0.833), and the best cut-off value was 33.85 g/L. Optimal simplified Pulmonary Embolism Severity Index (sPESI) (ALB combined sPESI) AUC was 0.835 (95% CI 0.775-0.896). Baseline hypoalbuminemia may be an independent prognostic indicator of short-term mortality in patients with APE.

Guidelines for endoscopic management of nonvariceal upper gastrointestinal bleeding (second edition)

The Japan Gastroenterological Endoscopy Society has prepared Guidelines for Endoscopic Practice in Nonvariceal Upper Gastrointestinal Bleeding as part of the initiative to develop evidence-based endoscopic practice guidelines. Hemorrhagic gastroduodenal (peptic) ulcers are the primary cause of nonvariceal upper gastrointestinal bleeding. With the advent of a super-aged society, the cases caused by Helicobacter pylori are on the decline, whereas those caused by drugs (e.g. aspirin) have been increasing. Endoscopic hemostasis is currently the first-line treatment for nonvariceal upper gastrointestinal bleeding, and various methods have been devised for this purpose. It is recommended to stabilize the vital signs of the patient before and after endoscopic hemostasis with appropriate management based on an assessment of the severity of illness, in addition to the administration of acid secretion inhibitors. These guidelines describe the evaluation and initial treatment of nonvariceal upper gastrointestinal bleeding, as well as the selection of endoscopic hemostasis for nonvariceal upper gastrointestinal bleeding and its management after endoscopic hemostasis. This is achieved by classifying nonvariceal upper gastrointestinal bleeding into two main categories, namely, peptic ulcer and other types of gastrointestinal bleeding. We prepared statements for any available literature with supporting evidence, including the levels of evidence and recommendations. New evidence has been pooled since the publication of the first edition in this area; however, the levels of evidence and recommendations mostly remain low.

Imaging of the J-pouch

Ileal pouches have drastically improved the quality of life in patients requiring total proctocolectomy. There are unique imaging characteristics of the pouch and its complications that radiologists should be familiar with. In this review, the authors discuss the anatomy of the pouch, commonly encountered complications, and the role of imaging in pouch assessment.

Risk factors and prediction for DILI in clinical practice

INTRODUCTION

Drug-induced liver injury is an important adverse effect and can be caused by various medications, including novel therapeutic agents. The risk stratification of patients susceptible to DILI is a growing field.

AREAS COVERED

The current article highlights new studies on risk stratification regarding risk factors of DILI, prediction of liver injury, and predictors of severe outcomes. Studies on patient demographic and genetic risk factors are discussed, in addition to the potential role of concomitant medications that may affect the risk of DILI.

EXPERT OPINION

Although much is known about patient risk factors for DILI, a better combination of these factors into risk scores is needed to predict which patients are particularly susceptible. Knowledge of these risk factors might determine drug treatment in the near future, as well as the need for routine monitoring of liver tests.

The relationship between anxiety symptoms and gastrointestinal symptoms in gastroenterology outpatients aged 6 to 18 years with the mediating role of sleep quality

Anxiety, a significant public health concern, frequently affects pediatric patients aged 6-18. This study seeks to examine the association between anxiety symptoms and gastrointestinal(GI) symptoms in patients within this age range who are visiting gastroenterology outpatient clinics. Additionally, we delve into whether sleep quality play a mediating role in this relationship. A cross-sectional analysis was conducted among 226 pediatric patients aged 6 and 18, who were recruited from the gastroenterology department of the Affiliated hospital of Xuzhou Medical University. Data were collected using a customized questionnaire that covered demographic information, clinical characteristics, and various self-assessment scales. To explore the association between GI symptoms and anxiety symptoms, a multivariate linear regression model was constructed. Additionally, we investigate the mediating role of sleep quality in this relationship. After accounting for key demographic and clinical factors, the intensity of GI symptoms exhibited a positive correlation with anxiety symptoms (β = 0.098, 95% CI: 0.070-0.137, p < 0.001). Furthermore, mediation analysis revealed that sleep quality partially mediated the relationship between the severity of GI symptoms and anxiety symptoms, contributing to a mediation effect of 11.13%. In pediatric patients aged 6-18, more severe GI symptoms were associated with a higher prevalence of anxiety symptoms, which in turn were linked to poorer sleep quality. It is advisable to incorporate assessments of sleep issues into the standard evaluation for pediatric patients in this age group visiting gastroenterology outpatient departments. Findings suggest that interventions targeting sleep quality may help manage GI symptoms, though longitudinal studies are needed to confirm causality.

Recent prevalence and trends of obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) among US adolescents: 1999 to 2020

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is understudied among US adolescents despite rising obesity rates.

METHODS

This study analysed the prevalence and trends of obesity and MASLD among US adolescents aged 12-17 using data from the National Health and Nutrition Examination Survey (NHANES). We developed a new screening model utilizing FibroScan-measured controlled attenuation parameter (CAP) scores, body measurements and blood chemistry data from 2017 to 2020 to assist in analysing MASLD trends from 1999 to 2020.

RESULTS

Between 2017 and 2020, the prevalence of obesity and MASLD was approximately 20%, with about 70% of obese adolescents affected by MASLD. The condition was more common in boys, particularly among Mexican American adolescents. Additionally, 97.2% of those with NAFLD also had MASLD. Adolescents with MASLD had significantly higher body weight, waist circumference, triglyceride levels and alanine transaminase (ALT) levels, along with lower high-density lipoprotein (HDL) cholesterol and an increased risk of liver fibrosis. Insufficient physical activity and poor diet quality were key risk factors for developing MASLD. From 1999 to 2020, the prevalence of MASLD rose significantly, paralleling the increasing rates of obesity.

CONCLUSIONS

The study underscores the pressing need to screen at-risk adolescents for metabolic issues associated with steatotic liver diseases, given the rising obesity rates among adolescents. The high overlap between MASLD and NAFLD diagnoses indicates that the transition from NAFLD to MASLD can be effectively integrated into paediatric practice.

Upregulation of HDAC3 mediates behavioral impairment in the bile duct ligation model of hepatic encephalopathy

Hepatic encephalopathy (HE), an outcome of chronic liver disease is characterized by behavioral impairments. The present study investigated the role of HDAC-mediated transcriptional regulation causing behavioral impairments in the bile duct ligation (BDL) model of HE. Post-BDL surgery in rats, dynamic alterations in liver function tests, liver morphology were observed. In BDL rats, histological staining in brain demonstrated reduced neuronal viability and warped neuronal architecture. Additionally, BDL animals showed impaired spatial learning, memory, and increased anxiety in the open field, Barnes maze, and Y maze tests. Further, the Golgi cox staining revealed a significantly altered spine density and spine clustering patterns of granular neuron in dentate gyrus of BDL rats. Concordantly, a significant downregulation of memory encoding genes was also observed in BDL rats that may account for aberrant behavior. Molecular analysis of modifiers, such as HDAC, showed significant changes in the expression of HDAC3 and HDAC6 in both the cortex and hippocampus of BDL rats. Upregulation of HDAC3 promoted its localization on the promoter of genes like c-Fos, NPAS4, Arc, and others, likely causing their decreased expression. Our findings suggest that increased HDAC3 activity downregulates key synaptic plasticity and memory-related genes, potentially driving neurobehavioral changes in BDL rats.

Optimal Management of the Inpatient With Decompensated Cirrhosis

Over the past several years, there has been a wealth of new data pertaining to the management of complications of cirrhosis, resulting in several important updates to best practices and consensus guidelines. Despite these advancements and numerous recent targeted quality initiatives, hospitalizations resulting from complications of cirrhosis remain frequent, costly and associated with poor patient outcomes. An emphasis on evidence-based management of hospitalized patients with decompensated cirrhosis has the potential to decrease readmission rates and length of stay while improving overall patient outcomes. Herein, we provide an updated, evidence-based overview of the optimal inpatient management of the most frequently encountered complications associated with cirrhosis.

High stent shunt flow increases the incidence of overt-hepatic encephalopathy in cirrhotic patients after transjugular intrahepatic portosystemic shunt

BACKGROUND

The incidence of hepatic encephalopathy (HE) was higher within 1 year after transjugular intrahepatic portosystemic shunt (TIPS) in cirrhosis. While some findings showed that the shunt flow correlates with HE, it remains unknown whether the stent shunt flow (SSF) is associated with overt-hepatic encephalopathy (OHE). This study, therefore, investigated the association between SSF and OHE after a TIPS.

METHODS

A digital color ultrasonic diagnostic device was used to measure stent flow velocity (SFV). The association between SSF and OHE was then examined using logistic regression and restricted cubic spline models. The predictive value of SSF for OHE was also assessed using receiver operating characteristic curve analysis.

RESULTS

Of the 91 patients, 24 (26.4%) developed OHE after TIPS within 1 year. Patients with OHE post-TIPS had higher SSF than those without [2459 (2203-2490) ml/min vs. 2190 (1968-2363) ml/min; P  = 0.001]. Multiple logistic regression showed interquartile range of SSF was associated positively with the risk of OHE after TIPS [odds ratio, 2.483; 95% confidence interval (CI), 1.407-4.383; P  = 0.002]. The Andersen-Gill model indicated SSF [hazard ratio (HR), 1.002; 95% CI, 1.001-1.004; P  < 0.05] and age (HR, 1.042; 95% CI, 1.012-1.072; P  < 0.01) were independent predictors of OHE after TIPS. SSF had higher predictive power for OHE than age, ammonia levels, Child-Pugh score, and model for end-stage liver disease score.

CONCLUSION

This study suggests high SSF may be associated closely with an increased risk of OHE in patients with cirrhosis following TIPS.

The Association Between the Albumin-Bilirubin Score and Contrast-Associated Acute Kidney Injury in Patients Undergoing Elective Percutaneous Coronary Intervention

The albumin-bilirubin (ALBI) score is considered an effective and convenient scoring system for assessing liver function. We hypothesized that the ALBI score was predictive of contrast-associated acute kidney injury (CA-AKI) and long-term mortality in patients undergoing elective percutaneous coronary intervention (PCI). We retrospectively observed 5629 patients undergoing elective PCI. Contrast-associated acute kidney injury is defined as a 50% or 0.3 mg/dl increase in baseline serum creatinine levels within 48 h of contrast exposure. The incidence of CA-AKI was 6.2% (n = 350). After adjusting for potential confounding factors, multivariate analysis showed that the ALBI score was an independent predictor of CA-AKI (P = .002). A restricted cubic spline analysis confirmed approximately linear relationships between the ALBI score and risks of CA-AKI. Furthermore, at a median follow-up of 2.8 years, multivariate Cox regression analysis indicated that the ALBI score was an independent risk factor for long-term mortality (P < .001). The ALBI score was closely related to the occurrence of CA-AKI and long-term mortality in patients who underwent elective PCI. This score might be useful for risk stratification in high-risk patient groups to predict CA-AKI.

Ethnic disparities in rapid tranquillisation use and explanations in adult mental health emergency settings? A systematic review

OBJECTIVE

Ethnicity is a frequently reported risk factor for rapid tranquillisation (RT) use in mental health. We aimed to investigate the association between ethnicity and RT use in adult mental health emergency settings and explore potential explanations for the relationship between ethnicity and RT use in these settings.

METHODS

Studies were included if they reported the association between ethnicity and RT use in adult mental health emergency settings. Searches were conducted across six databases and in grey sources and references until 15 April 2024. A narrative synthesis was performed and, in addition, a random-effects model was used for meta-analysis, with odds ratio as the measure. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to evaluate the overall certainty of evidence. Potential explanations for RT use in relation to ethnicity were also synthesised narratively.

RESULTS

Five studies from Norway (n = 1), Spain (n = 1) and the United States (n = 3) were included (14,777 individuals). Multiple classifications of ethnicity were used, with White, non-Hispanic and native-born serving as the ethnic majority group compared to ethnic minority counterparts. Overall, ethnic minorities in adult mental health emergency settings were non-statistically more likely to receive RT than ethnic majority populations. The overall certainty of evidence was deemed as low according to GRADE.

CONCLUSION

While RT use was not statistically significantly higher among ethnic minorities overall, Black individuals, as a specific ethnic group, had significantly increased odds of experiencing RT compared to ethnic majority populations. Additional research is necessary to confirm these findings and better understand the reasons behind these disparities through valid explanations.

Efficacy and safety of transjugular intrahepatic portosystemic shunt versus endoscopic variceal ligation for variceal rebleeding: a systematic review and meta-analysis

Background

Variceal bleeding is a significant cause of morbidity and mortality among patients with cirrhosis. While both transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic variceal ligation (EVL) are utilized for variceal rebleeding prevention, their comparative efficacy and safety remain debated.

Methods

A systematic review and meta-analysis were conducted to compare TIPS with EVL for variceal rebleeding prevention. A comprehensive search of electronic databases on PubMed, Embase, Scopus, and Web of Science identified 16 studies meeting inclusion criteria. Data on outcomes including gastrointestinal bleeding, variceal rebleeding, hepatic encephalopathy, treatment failure, and mortality were extracted and analyzed.

Results

TIPS was associated with significantly lower rates of gastrointestinal bleeding (RR = -0.69, 95% CI [-0.92, -0.47], P < 0.001), variceal rebleeding (RR: -0.99, 95% CI [-1.2, -0.79], P < 0.001), and bleeding from banding ulcers (RR: -1.51, 95% CI [-2.75, -0.27], P = 0.02) compared to EVL. However, TIPS was linked to higher rates of hepatic encephalopathy (RR: 0.44, 95% CI [0.18, 0.71], P < 0.001) and treatment failure (RR: -1.29, 95% CI [-2.01, -0.57], P < 0.001). No significant differences were found in mortality, liver failure, hepatocellular carcinoma, or other clinical outcomes between the two interventions.

Conclusion

TIPS demonstrates superiority over EVL in reducing variceal rebleeding and gastrointestinal bleeding. However, it is associated with higher rates of hepatic encephalopathy and treatment failure. Individualized treatment decisions should consider patient characteristics and treatment goals to optimize outcomes in variceal bleeding management. Further research is warranted to refine treatment strategies and minimize adverse events associated with both interventions.

Irreversible electroporation combined with PD-L1/IL-6 dual blockade promotes anti-tumor immunity via cDC2/CD4+T cell axis in MHC-I deficient pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) is a "cold" solid tumor with frequent Major Histocompatibility Complex I (MHC-I) deficiency, thereby making it resistant to type-1-conventional dendritic cell (cDC1)-CD8+T cell mediated anti-tumor immunity. Current studies have demonstrated the emerging compensatory role of MHC-II-mediated antigen presentation and CD4+T cell activation in anti-tumor immunity against MHC-I-deficient tumors. However, the underlying mechanism of the compensatory immune response by CD4+T cells in cancer ablation therapy remains to be elucidate. In clinical samples and murine models, we observed that irreversible electroporation (IRE) ablation therapy promoted immune infiltration and the conversion of CD4+T cells into anti-tumor IFN-γ+Th1 cells and Th17 cells in MHC-I low-expressed PDAC using scRNA-seq and flow-cytometry analyses. Furthermore, we found that PD-L1 blockade predominantly enhanced the activation of CD11b+CD103-type-2 conventional dendritic cells (cDC2s) and their antigen presentation to CD4+T cells after ablation, stimulating the anti-tumor immune response through the tumor antigen-specific IFN-γ+Th1-NK cell axis. Elevated plasma levels of IL-6 in pancreatic cancer patients receiving ablation therapy are significant indicators for impaired prognosis. IL-6 and PD-L1 dual blockade could significantly augment the ratio of IFN-γ+Th1 in CD4+T cells to boost the anti-tumor immunity of NK cells, leading to prolonged survival of mouse bearing pancreatic cancer. Collectively, we have elucidated that PD-L1 blockade activates the cDC2-CD4+T cell axis after IRE therapy, thereby playing a pivotal compensatory anti-tumor role in MHC-I low-expressed pancreatic cancer. Moreover, a combination strategy involving dual-target blockade of PD-L1/IL-6 along with ablation therapy could emerge as a novel therapeutic approach for MHC-I deficient tumors.

Small Transjugular Intrahepatic Portosystemic Shunt Plus Variceal Embolization for Gastric Varices: A Multicenter Cohort Study

BACKGROUND & AIMS

The effect of transjugular intrahepatic portosystemic shunt (TIPS) plus variceal embolization for treating gastric varices (GVs) remains controversial. This nationwide multicenter cohort study aimed to evaluate whether adding variceal embolization to a small diameter (8-mm) TIPS could reduce the rebleeding incidence in patients with different types of GVs.

METHODS

This retrospective cohort study involved 629 patients who underwent 8-mm TIPS for gastric varices at 7 medical centers. The primary endpoint was all-cause rebleeding, and the secondary endpoints included overt hepatic encephalopathy (OHE) and all-cause mortality.

RESULTS

A total of 629 patients were included. Among them, 429 (68.2%) had gastroesophageal varices type 1 (GOV1), 145 (23.1%) had gastroesophageal varices type 2 (GOV2), and 55 (8.7%) had isolated gastric varices type 1 (IGV1). In the entire cohort, adjunctive embolization reduced rebleeding (6.2% vs 13.6%; P = .005) and OHE (31.0% vs 39.4%; P = .02) compared with TIPS alone. However, no significant differences were found in mortality (12.0% vs 9.7%; P = .42). In patients with GOV2 and IGV1, TIPS plus variceal embolization reduced both rebleeding (GOV2: 7.8% vs 25.1%; P = .01; IGV1: 5.6% vs 30.8%; P = .03) and OHE (GOV2: 31.8% vs 51.5%; P = .008; IGV1: 11.6% vs 38.5%; P = .04). However, in patients with GOV1, adjunctive embolization did not reduce rebleeding (5.9% vs 8.7%; P = .37) or OHE (33.1% vs 35.3%; P = .60).

CONCLUSIONS

Compared with TIPS alone, 8-mm TIPS plus variceal embolization reduced rebleeding and OHE in patients with GOV2 and IGV1. These findings suggest that patients with GOV2 and IGV1, rather than GOV1, could benefit from embolization with TIPS.

A Rare Case of Budd-Chiari Syndrome in a Young Female

Budd-Chiari syndrome is a rare disorder characterized by hepatic vein obstruction, with an incidence of 1 in 100,000. It can be diagnosed through imaging studies and initially managed with anticoagulants. Acute Budd-Chiari syndrome can be treated with thrombolysis to dissolve blood clots obstructing hepatic veins. Venous obstructions in Budd-Chiari syndrome can be fixed through angioplasty or venous stenting to restore blood flow. Liver decompression can be achieved with TIPS, and severe cases may require liver transplantation.

Recommendations for Design, Execution, and Reporting of Studies on Experimental Thoracic Aortopathy in Preclinical Models

There is a recent dramatic increase in research on thoracic aortic diseases that includes aneurysms, dissections, and rupture. Experimental studies predominantly use mice in which aortopathy is induced by chemical interventions, genetic manipulations, or both. Many parameters should be deliberated in experimental design in concert with multiple considerations when providing dimensional data and characterization of aortic tissues. The purpose of this review is to provide recommendations on guidance in (1) the selection of a mouse model and experimental conditions for the study, (2) parameters for standardizing detection and measurements of aortic diseases, (3) meaningful interpretation of characteristics of diseased aortic tissue, and (4) reporting standards that include rigor and transparency.

Dilation of the left renal vein: an indicator of spontaneous splenorenal shunt in chronic liver disease patients

OBJECTIVES

Spontaneous splenorenal shunts (SSS) in chronic liver disease (CLD) impact liver perfusion and prognosis post-liver transplantation. This study aims to identify radiological findings that predict the presence of SSS in CLD patients and to examine the relationship between SSS and left renal vein diameter.

METHODS

A retrospective study was conducted on 150 adult patients evaluated for liver transplants from June 2018 to April 2021. The study groups included healthy controls (Group 1), CLD patients without SSS (Group 2), and those with SSS (Group 3). Multidetector CT angiography was used to measure the diameters of renal veins, portal vein, spleen size, and SSS.

RESULTS

Significant differences were found between the groups for spleen size, splenic vein diameter, portal vein diameter, left renal vein diameter, and renal vein diameter difference, except for the right renal vein diameter. A left renal vein diameter of 10.5 mm or greater and both renal veins diameter difference of 0.5 mm or more favouring the left showed good diagnostic performance for predicting SSS, with area under the curve values of 0.828 and 0.833, respectively.

CONCLUSION

Dilation of the left renal vein and a greater diameter difference between renal veins favouring the left are strong indicators of SSS in CLD patients. These findings can aid in pre-transplant assessments and potentially improve post-transplant outcomes.

ADVANCES IN KNOWLEDGE

This study establishes that an increased diameter of the left renal vein and a greater diameter difference between renal veins are reliable radiological indicators for predicting the presence of SSS in CLD patients.

Anticoagulation outcomes in cirrhotic patients with portal vein thrombosis: a tertiary center study

STUDY PURPOSE

This study assesses the efficacy and safety of direct oral anticoagulants (DOACs) compared to traditional anticoagulants in managing portal vein thrombosis (PVT), aiming to address critical gaps in both research and clinical practice.

STUDY DESIGN

We conducted a retrospective analysis at Rochester General Hospital from January 2011 to December 2023, involving 275 cirrhotic patients with PVT. The inclusion criteria included confirmed non-neoplastic PVT by imaging.

RESULTS

Analysis of 275 cirrhotic patients with PVT revealed no significant differences in age and gender between those treated with anticoagulants and those untreated. The mortality rate was significantly lower in the treated group (37.7%) compared to the untreated group (51.7%; P = 0.029). Gastrointestinal bleeding was slightly more prevalent in the treated group (60.7%) than in the untreated group (58.1%; P = 0.690), though not statistically significant. A significant reduction in intracranial hemorrhage was observed in the treated group (2.5% vs. 8.5% in the untreated group; P = 0.038). In a subgroup analysis comparing the outcomes and side effects of DOACs, Warfarin, and low molecular weight heparins (LMWH) in treated PVT patients, the DOAC group showed improved survival rates compared to traditional [vitamin K antagonists (VKA)/LMWH] treatment, a log-rank test indicated significant survival improvement (chi2 (1) = 8.27, P = 0.0040). DOACs demonstrated comparable mortality rates to VKAs (34.2% vs. 34.5%, P = 0.979) and a significant survival benefit over LMWH (33.3% vs. 60.0%, P = 0.030).

CONCLUSION

DOAC in treating PVT among patients with liver cirrhosis, demonstrating better significant survival rate when compared to traditional anticoagulation. Key message What is already known on this topic  Portal vein thrombosis (PVT) is significantly more prevalent in patients with liver cirrhosis compared to the general population, posing substantial management challenges. Previous studies have primarily focused on small cohorts and retrospective data, underscoring the need for robust, large-scale analyses to validate the efficacy and safety of direct oral anticoagulants (DOACs) versus traditional therapies. What this study adds  This study provides concrete evidence from a large cohort that DOACs not only offer a survival benefit over traditional anticoagulation therapies like Warfarin and LMWH in cirrhotic patients with PVT but also maintain comparable safety profiles. These findings bridge significant gaps in current research by comparing the outcomes of modern versus traditional anticoagulant approaches in a real-world setting. How this study might affect research, practice, or policy  The results advocate for the inclusion of DOACs in clinical guidelines for managing PVT in cirrhosis, potentially shifting clinical practice toward these agents. Furthermore, the detailed comparison and subgroup analyses provide a strong foundation for future randomized controlled trials, which could further refine anticoagulation strategies in this high-risk population.

Understanding and Treating Hepatorenal Syndrome: Insights from Recent Research

Acute kidney injury (AKI) is a critical and often fatal complication in decompensated cirrhosis, significantly affecting inpatient survival rates. Hepatorenal syndrome (HRS), a distinct subtype of AKI, develops in individuals with advanced cirrhosis and portal hypertension. It is marked by progressive kidney dysfunction, poor prognosis, and frequently causes death before liver transplantation. The pathogenesis of HRS involves vasodilation of the splanchnic vessels, leading to overactivation of the endogenous vasoactive systems, circulatory dysfunction, and reduced renal perfusion, which ultimately impairs glomerular filtration. Recent studies have highlighted the role of systemic inflammation in exacerbating renal damage. Despite these changes, renal histology in HRS usually shows no significant abnormalities, and there is typically no hematuria, proteinuria, or abnormal findings on ultrasound. Common risk factors for HRS include spontaneous bacterial peritonitis, infections, and large-volume paracentesis without albumin infusion. Diagnosing HRS is challenging, particularly in distinguishing it from acute tubular necrosis, due to the absence of specific biomarkers. Treatment primarily involves vasoconstrictors such as terlipressin and albumin, with liver transplantation being the definitive therapeutic option. This review provides an updated understanding of HRS, addressing its pathophysiology, diagnosis, management, and future challenges, based on recent expert consensus.

Effect of chewing gum combined with WeChat-enhanced instruction on bowel preparation in constipated patients: a randomized-controlled trial

Background and aims

Constipated patients have higher risk of poor bowel preparation and suffer from dysfunction of the intestinal motor. Chewing gum can stimulate gut motility and enhanced instructions can improve the quality of bowel preparation. The objective of this study was to investigate whether chewing gum combined with WeChat-enhanced instruction can increase the quality of bowel preparation in constipated patients.

Methods

This was a single-center, endoscopist-blinded, randomized-controlled trial. Patients were assigned (1:1) to the chewing gum and WeChat-enhanced instruction (CGW) group and the control group. Patients in both groups received 3 L of polyethylene glycol (PEG) before colonoscopy. Patients in the CGW group were asked to chew one piece of gum for 20 min after drinking each 1 L of PEG and received enhanced instruction via WeChat the day before colonoscopy. The quality of the bowel preparation (primary outcome), adenoma and/or polyp detection rate (ADR/PDR), number of polyps and/or adenomas, procedure time, and adverse events were compared.

Results

A total of 115 patients were finally analysed, including 60 in the CGW group and 55 in the control group. The proportion of adequate bowel preparation and the Boston Bowel Preparation Scale score were not statistically different between the two groups (76.7% vs 70.9%; 6.80 ± 1.42 vs 6.40 ± 1.78; both P > 0.05). There was no significant difference in the ADR/PDR and number of polyps and/or adenomas (both P > 0.05). However, there was a significantly higher incidence of nausea in the CGW group than in the control group (33.3% vs 16.4%, P = 0.036).

Conclusions

Chewing gum combined with WeChat-enhanced instruction does not improve the quality of bowel preparation for colonoscopy in constipated patients but does increase the incidence of nausea.

Evaluating the RESET care program: Advancing towards scalable and effective healthcare solutions for metabolic dysfunction-associated liver disease

In this article, we discuss the recently published article by Soni et al. This study explores the effectiveness of a comprehensive digital health program, RESET care, which integrates personalized dietary plans, structured exercise, and cognitive behavioral therapy delivered through a mobile app equipped with Internet of Things devices such as body composition analyzers and smartwatches. Metabolic dysfunction-associated liver disease (MASLD), a global health burden affecting approximately 25% of the population, demands sustainable lifestyle modifications as its primary management strategy. The study reports that 100% of participants in the comprehensive intervention group (diet + exercise + cognitive behavioral therapy) achieved a weight reduction ≥ 7% (6.99 ± 2.98 kg, 7.00% ± 3.39%; P = 0.002), a clinically significant threshold for MASLD improvement. In addition, participants showed a mean weight reduction of 6.99 kg (101.10 ± 17.85 vs 94.11 ± 17.38, P < 0.001) and a body mass index reduction of 2.18 kg/m² (32.90 ± 3.02 vs 30.72 ± 3.41, P < 0.001). These results underscore the potential of digital health platforms to provide scalable, evidence-based solutions for the treatment of MASLD. While these results highlight the potential of digital platforms in the scalable and personalized management of MASLD, the small study sample size and short duration of follow-up limit the generalizability of the results. Future large-scale, long-term trials are needed to confirm sustained benefits, cost-effectiveness, and broader applicability. This letter contextualizes the study within the evolving landscape of MASLD management and emphasizes the clinical implications of integrating digital technologies into standard care.

Transjugular intrahepatic portosystemic shunt and non-selective beta-blockers act as friends or foe in decompensated cirrhosis: A comparative review

The management of portal hypertension and its complications, such as variceal bleeding, in patients with cirrhosis often involves the use of nonselective beta-blockers (NSBBs) and a transjugular intrahepatic portosystemic shunt (TIPS). Both treatment modalities have demonstrated efficacy; however, each presents distinct challenges and benefits. NSBBs, including propranolol, nadolol, and carvedilol, effectively reduce portal pressure, but are associated with side effects such as bradycardia, hypotension, fatigue, and respiratory issues. Additionally, NSBBs can exacerbate conditions such as refractory ascites, hepatorenal syndrome, and hepatic encephalopathy. In contrast, TIPS effectively reduces the incidence of variceal rebleeding, controlling refractory ascites. However, it is associated with a significant risk of hepatic encephalopathy, shunt dysfunction, and procedure-related complications including bleeding and infection. The high cost of TIPS, along with the need for regular follow-up and potential re-intervention, poses additional challenges. Furthermore, patient selection for TIPS is critical, as inappropriate candidates may experience suboptimal outcomes. Future studies comparing NSBBs and TIPS should focus on refining the patient selection criteria, enhancing procedural techniques, optimising combination therapies, and conducting long-term outcome studies. Personalised treatment approaches, cost-effectiveness analyses, and improved patient education and support are essential for maximising the use of these therapies.

Incidence and efficacy of strategies for preventing hepatic encephalopathy following transjugular intrahepatic portosystemic shunt: A meta-analysis

BACKGROUND

Hepatic encephalopathy (HE) is a primary complication following transjugular intrahepatic portosystemic shunt (TIPS), but the utility of pharmacological prophylaxis for HE is unclear.

AIM

To assess the HE incidence post-TIPS across various groups and the prophylactic efficacies of various medications.

METHODS

A thorough literature search was performed in PubMed, Web of Science, EMBASE, and the Cochrane Library databases from their inception to November 24, 2024, to collect data regarding HE incidence. The main outcome was HE incidence post-TIPS. A meta-analysis using a random effects model was performed to obtain odds ratios (ORs) and 95% confidence intervals. Statistical analyses were conducted using Stata and RevMan software.

RESULTS

This meta-analysis included nine studies with 1140 patients; 647 received pharmacological agents including lactulose, rifaximin, albumin, and l-ornithin-l-aspartate, and 493 did not (controls). (1) In the single-group meta-analysis, the control group had higher short- and long-term HE rates than the drug intervention group. Among patients with and without prior HE, the non-intervention group's HE rates were also higher; (2) Pharmacological prevention post-TIPS significantly reduced HE incidence [OR = 0.59 (0.45, 0.77), P = 0.0001]. Compared with the no prophylaxis, rifaximin reduced the risk of HE after TIPS [OR = 0.52 (0.29, 0.95), P = 0.03], but lactulose did not; (3) In patients without prior HE, pharmacological prevention significantly reduced post-TIPS HE incidence [OR = 0.62 (0.41,0.95), P = 0.03]; and (4) Network meta-analysis showed no significant differences among five prevention strategies.

CONCLUSION

The HE incidence after TIPS was relatively high, and the use of drugs after TIPS may reduce the HE incidence. However, research, especially large-scale randomized controlled trials, is still lacking.

HBV activates hepatic stellate cells through RUNX2/ITGBL1 axis

BACKGROUND

Chronic hepatitis B (CHB) remains a global health challenge, with liver fibrosis serving as a critical determinant of disease progression. Despite antiviral treatments, liver fibrosis often persists in CHB patients, highlighting the need for additional biomarkers and therapeutic targets. This study investigates the molecular mechanism underlying HBV-induced liver fibrosis, focusing on the role of RUNX2 in regulating integrin beta-like 1 (ITGBL1), a key factor in fibrogenesis.

METHODS

We examined the relationship between RUNX2 and ITGBL1 in both in vitro hepatocyte models and an in vivo HBV mouse model. Using chromatin immunoprecipitation (ChIP), luciferase reporter assays, and Western blotting, we assessed RUNX2 binding to the ITGBL1 promoter and its impact on gene expression. We also evaluated the effects of RUNX2 inhibition using Vitamin D3 and CADD522 on ITGBL1 expression and hepatic stellate cell activation.

RESULTS

Our findings reveal that RUNX2 directly binds to the ITGBL1 promoter, enhancing its expression and promoting hepatic stellate cell activation. We show that HBV infection significantly upregulates both RUNX2 and ITGBL1 in liver cells. Inhibition of RUNX2 with Vitamin D3 or CADD522 significantly reduced ITGBL1 levels and blocked hepatic stellate cell activation. These results suggest that the RUNX2/ITGBL1 pathway is critical in the progression of liver fibrosis in HBV-infected patients.

CONCLUSIONS

RUNX2 promotes liver fibrosis in HBV-infected patients by upregulating ITGBL1 expression. Our findings suggest that targeting RUNX2 could be a potential therapeutic approach to mitigate liver fibrosis in chronic hepatitis B.

Mitigating gastrointestinal side effects of risedronate sodium: A study on Bletilla striata polysaccharide microneedle patches

Risedronate sodium (RIS) is a primary treatment for postmenopausal osteoporosis, but oral administration requires patients to remain upright to prevent side effects like esophagitis, gastritis, and ulcers, which can be difficult for those with fatigue or bone pain. This study developed RIS-loaded Bletilla striata polysaccharide microneedles (RIS-BMNs) with sufficient mechanical strength for effective skin penetration and drug delivery. Franz diffusion cell experiments showed that RIS-BMNs achieved 3 times higher in vitro transdermal absorption than the RIS solution and 2.6 times more than RIS patches. The stimulation test found that RIS-BMNs caused minimal skin irritation, which resolved within 12 h. RIS-BMNs also promoted cell proliferation and wound healing, as shown by in vitro cell viability and migration tests, and improved bone trabeculae and density in osteoporotic rats, according to micro-CT imaging and H&E staining. Biochemical markers (BGP, IL-6, CTX-I, TRAP, OPG, and PINP) indicated that RIS-BMNs had anti-osteoporotic effects comparable to oral RIS but without gastrointestinal side effects, as confirmed by H&E staining. Our new transdermal method for RIS could improve adherence in treating postmenopausal osteoporosis.

Homocysteine and multiple health outcomes: an outcome-wide umbrella review of meta-analyses and Mendelian randomization studies

Elevated levels of homocysteine (Hcy) are associated with various health outcomes. We aimed to systematically assess the credibility and certainty of evidence of associations of Hcy and Hcy-lowering therapies with various health outcomes. We retrieved observational meta-analyses examining the associations between Hcy and health outcomes, interventional meta-analyses investigating health outcomes related to Hcy-lowering treatments, and Mendelian Randomization (MR) studies exploring the causal associations of Hcy with health outcomes to perform an umbrella review. A total of 135 observational meta-analyses, 106 MR studies, and 26 interventional meta-analyses were included. Among observational studies, 10 associations of diseases/outcomes were classified as highly suggestive; only one outcome (digestive tract cancer) was supported by convincing evidence (class I; OR=1.27, 95% CI=1.16-1.40; P=6.79×10-7; I2=0, 95% prediction interval excluding null, >1000 cases; P>0.1 for tests of both small-study effects and excess significance bias). In MR studies, 5 outcomes associated with Hcy presented robust evidence (P<0.01, power>80%). Among 25 outcomes explored by both observational meta-analyses and MR studies, 7 had consistent results, indicating that elevated Hcy is causally associated with an increased risk for these outcomes. The 3 types of studies collectively suggested that the association of stroke with Hcy was supported by observational studies, causally by MR studies, and further validated by intervention meta-analyses showing that Hcy-lowering with folic acid significantly reduced risk of stroke. For dementia and colorectal cancer, Hcy was significantly associated in meta-analyses of observational studies and folic acid decreased disease risks in interventional meta-analyses. The current umbrella review indicates that convincing evidence for a definitive role of Hcy exposure solely exists in the context of digestive tract cancer excluding bias; however, Hcy may not be causal for this disease. All the three type of studies collectively support that Hcy is a key causal risk factor, and Hcy-lowering (specifically with folic acid) may serve as an effective intervention for stroke. REGISTRATION PROSPERO: CRD42024541335 STATEMENT OF SIGNIFICANCE: Previous systematic reviews has not been summarized and appraised evidence of meta-analyses of observational and interventional studies, and Mendelian randomization studies on associations of homocysteine or homocysteine-lowering with a range of diseases (outcomes). Our umbrella review takes full advantage of the respective strengths of meta-analyses and MR studies by combining and comparing the findings to explore and assess the potential importance and implications of homocysteine for clinical practice and public health.

Free triiodothyronine and triglyceride-glucose index interaction on metabolic dysfunction-associated steatotic liver disease risk in euthyroid individuals

Background

The link between thyroid function and insulin resistance and metabolic dysfunction-associated fatty liver disease (MASLD) is becoming increasingly recognized. The primary goal of this study was to investigate the relationship between free triiodothyronine (FT3) levels, the triglyceride-glucose index (TyG) index, and the likelihood of MASLD in euthyroid individuals.

Methods

A cross-sectional analysis of 18,298 euthyroid individuals was conducted, comparing 6,144 with MASLD to 12,154 controls. The study evaluated indicators related to clinical, metabolic, and thyroid function. The combined effect of the FT3 and TyG index on the likelihood of MASLD was assessed using logistic regression.

Results

The MASLD group presented with higher male prevalence, older age, and increased rates of hypertension and diabetes. Significant correlations were observed between FT3, TyG, and metabolic parameters. After controlling for potential confounders, FT3 remained significantly associated with increased MASLD risk (adjusted OR = 1.35, 95% CI: 1.23-1.49; P < 0.001). Similarly, the TyG index was independently associated with higher MASLD risk (adjusted OR = 3.99, 95% CI: 3.40-4.68; P < 0.001). The high FT3 (≥ 4.98 pmol/L)/high TyG (≥ 8.55) group exhibited significantly elevated MASLD risk compared to the low FT3/low TyG group (OR = 5.38, 95% CI: 4.62-6.26; P < 0.001).

Conclusion

Elevated FT3 and TyG index are independently associated with an increased risk of MASLD, and they exhibit a significant synergistic additive interaction.

From Physiology to Psychiatry: Key role of vagal interoceptive pathways in emotional control

Interoception is the awareness of bodily sensations, conveyed by both hormonal and neural signals. The vagus nerve is the primary neural interoceptive conduit, responsible for transmitting information from peripheral organs to the brain. It is widely accepted that vagal signals are essential for purely physiological functions like blood pressure maintenance, or nutrient intake homeostasis. However, a growing body of evidence, taking advantage of new technological advances, suggests that the vagus nerve also orchestrates or tunes emotions. Disruption of vagal interoceptive feedback prevents normal emotional control in rodents. Importantly, accumulating evidence indicates that pathological disruption of vagal afferent signals also occurs in humans and may constitute an important risk factor for emotional disorders. Hence, alleviating vagal interoceptive deficits may constitute a new therapeutic avenue for neurotic and affective disorders. Considering the technical and safety challenges for direct stimulation of brain regions relevant to emotionality disorders, the vagus nerve offers a safer and more practical route of potentially achieving similar outcomes. Here we will highlight the earliest studies which examined the consequences of manipulations of the vagal afferent neurons on anxiety, fear, and mood, and integrate these older findings with new research investigating the necessity of vagal afferent neurons in mediating the anxiety or mood-altering effects of physiological signals. We will also discuss the evolutionary significance of vagal control over emotional states within the boundaries of "normal" physiology and conclude by discussing the challenges of engaging the vagal interoception as novel therapeutics in mental health disorders.

A Clinical Case of Timely Diagnosis and Successful Treatment of Budd-Chiari Syndrome With Fulminant Cytolysis in the Setting of a First-time Diagnosed Myeloproliferative Disease

The article presents a clinical case of peculiarities of clinical manifestations, diagnostic and therapeutic approaches of undiagnosed chronic myeloproliferative disease, on the background of which Budd-Chiari syndrome (BCS) developed. The results of clinical course, examination, and treatment of a patient with BCS as a manifestation of the hidden course of primary myelofibrosis with the presence of somatic mutation (V617F) in Janus-tyrosine kinase-2 (JAK2) gene in myeloid cells are presented. Standard clinical and laboratory examinations, and cytomorphologic and histologic examination of bone marrow were used. The diagnosis of BCS was confirmed by ultrasound (US) Doppler examination of the portal system vessels. Symptomatic therapy resulted in insignificant positive results. The analysis of this clinical case showed that the development of BCS was due to a chronic myeloproliferative disease that was not diagnosed before the development of thrombosis. Hepatic vein thrombosis was accompanied by the development of fulminant cytolytic syndrome. Along with symptomatic therapy, patient K., female, 32 years old, underwent transjugular intrahepatic portosystemic shunting 1 month after the first symptoms of BCS appeared, which contributed to a significant clinical effect. Seven years after the installation of 4 transjugular intrahepatic portosystemic shunts, the patient's condition remains satisfactory. The uniqueness of this clinical case lies in the presence of 2 serious diseases at the same time: myeloproliferative pathology (primary myelofibrosis) JAK2-positive variant and BCS. Timely diagnosis of both hematological diseases and their complication in the form of hepatic vein thrombosis with fulminant cytolytic syndrome allowed timely prescription of adequate treatment with a good clinical response.