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Palliative long-term abdominal drains vs large volume paracenteses for the management of refractory ascites in end-stage liver disease

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World Journal of Hepatology 2024年第3期16卷 428-438页

作者： Senamjit Kaur Rodrigo V Motta Bryony Chapman Victoria Wharton Jane D Collier Francesca Saffioti Oxford liver Unit Department of Gastroenterology and HepatologyOxford University Hospitals NHS Foundation TrustOxford OX39DUUnited Kingdom Oxford liver Unit and Translational Gastroenterology Unit Nuffield Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom

BACKGROUND Long-term abdominal drains(LTAD)are a cost-effective palliative measure to manage malignant ascites in the community,but their use in patients with end-stage chronic liver disease and refractory ascites is not routine *** safety and cost-effectiveness of LTAD are currently being studied in this setting,with preliminary positive *** hypothesised that palliative LTAD are as effective and safe as repeat palliative large volume paracentesis(LVP)in patients with cirrhosis and refractory ascites and may offer advantages in patients’quality of *** To compare the effectiveness and safety of palliative LTAD and LVP in refractory ascites secondary to end-stage chronic liver *** A retrospective,observational cohort study comparing the effectiveness and safety outcomes of palliative LTAD and regular palliative LVP as a treatment for refractory ascites in consecutive patients with end-stage chronic liver disease followed-up at our United Kingdom tertiary centre between 2018 and 2022 was ***’s exact tests and the Mann-Whitney U test were used to compare qualitative and quantitative variables,***-Meier survival estimates were generated to stratify time-related outcomes according to the type of *** Thirty patients had a total of 35 indwelling abdominal drains and nineteen patients underwent regular *** baseline characteristics were similar between the *** antibiotics were more frequently prescribed in patients with LTAD(P=0.012),while the incidence of peritonitis did not differ between the two groups(P=0.46).The incidence of acute kidney injury(P=0.014)and ascites/drain-related hospital admissions(P=0.004)were significantly higher in the LVP *** overall survival was similar in the two groups(log-rank P=0.26),but the endpoint-free survival was significantly shorter in the LVP group(P=0.003,P<0.001,P=0.018 for first ascites/drain-related admission,acute kidney injury and drain

关键词： Decompensated liver cirrhosis Indwelling abdominal catheter Rocket drain Palliative care Safety Quality of life

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Serum ECM1 is a promising biomarker for staging and monitoring fibrosis in patients with chronic hepatitis B

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Science China Life Sciences 2024年

作者： Lian Liu Danyan Zhang Rong Fan Shipeng Cheng Jichao Yang Liyan Ma Zhiyang Ling Yaguang Zhang Jinlin Hou Xiaomei Wang Bing Sun Junqi Niu Shanghai Institute of Biochemistry and Cell Biology Centre for Excellence in Molecular Cell Science Chinese Academy of Sciences University of Chinese Academy of Sciences School of Life Science and Technology ShanghaiTech University Department of Infectious disease Nanfang Hospital Southern Medical University Med-X Institute Centre for Immunological and Metabolic Diseases The First Affiliated Hospital of Xi'an Jiaotong University Xi'an Jiaotong University Hepatology Department Centre of Infectious Diseases and Pathogen Biology First Hospital of Jilin University

It is critical to assess the extent and progression of liver fibrosis for patients to receive suitable treatments, but its diagnostic methods remain unmet. Extracellular matrix protein 1（ECM1） has previously been reported to be a key factor in the induction and progression of liver fibrosis. However, little is known about the use of ECM1 as a biomarker to evaluate fibrosis. In a CCl4-induced mouse model of liver fibrosis, the present study demonstrated that ECM1 decreased with gradually increasing fibrosis. Using biopsy as a reference, the serum ECM1 levels decreased with increasing fibrosis stage in 247 patients with liver fibrosis, but there were no significant changes between fibrosis stage 2 and stage 0–1. To improve the performance of ECM1, age, platelet count, and ECM1 concentration were combined to calculate an EPA（ECM1-platelet-age） score（ranging from 0 to 10）. The areas under the receiver operating characteristic curve of the EPA scores for the detection of F≥2, F≥3, and F4 were 0.6801, 0.7377, and 0.8083, respectively, which showed a comparable or significantly greater diagnostic performance for assessing fibrosis than that of the AST/ALT ratio, APRI score, or FIB-4 score. In HBV patients following antiviral treatment, the dynamics of the EPA score depended on the status of liver fibrosis development. The accuracy of the EPA score in predicting fibrosis regression and progression was 66.00% and 71.43%, respectively, while that of the LSM, another useful method for monitoring hepatic fibrosis changes during treatment, was only 52.00% and 7.14%, respectively. Compared with healthy controls, there were lower levels of serum ECM1 in HBV patients and individuals with HCV infection, MAFLD, ALD, PBC, and DILI. These findings suggested that individuals with reduced ECM1 levels may have a risk of developing liver injury, and further examinations or medical care are *** conclusion, the ECM1-containing EPA score is a valuable noninvasive test for staging fibros

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liver histological changes in untreated chronic hepatitis B patients in indeterminate phase

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World Journal of Hepatology 2024年第6期16卷 920-931页

作者： De-Liang Huang Qin-Xian Cai Guang-De Zhou Hong Yu Zhi-Bin Zhu Jing-Han Peng Jun Chen Department of liver diseases The Third People’s Hospital of ShenzhenShenzhen 510000Guangdong ProvinceChina Department of Pathology Beijing Youan HospitalCapital Medical UniversityBeijing 100000China Department of Pathology National Clinical Research Centre for Infectious DiseaseThe Third People's Hospital of Shenzhen and the Second Hospital Affiliated with the Southern University of Science and TechnologyShenzhen 518112Guangdong ProvinceChina

BACKGROUND Studies with large size samples on the liver histological changes of indeterminate phase chronic hepatitis B(CHB)patients were not previously *** To assess the liver histological changes in the indeterminate phase CHB patients using liver *** The clinical and laboratory data of 1532 untreated CHB patients were collected,and all patients had least once liver biopsy from January 2015 to December *** significant differences among different phases of CHB infection were compared with t-test,and the risk factors of significant liver histological changes were analyzed by the multivariate logistic regression *** Among 1532 untreated CHB patients,814(53.13%)patients were in the indeterminate *** liver histological changes(defined as biopsy score≥G2 and/or≥S2)were found in 488/814(59.95%)CHB patients in the indete-rminate *** liver histological changes were significant differences among different age,platelets(PLTs),and alanine aminotransferase(ALT)subgroup in indeterminate *** logistic regression analysis indicated that age≥40 years old[adjust odd risk(aOR),1.44;95%confidence interval(CI):1.06-1.97;P=0.02],PLTs≤150×10^(9)/L(aOR,2.99;95%CI:1.85-4.83;Pliver histological changes in CHB patients in the indeterminate *** Our results suggested that significant liver histological changes were not rare among the untreated CHB patients in indeterminate phase,and additional strategies are urgently required for the management of these patients.

关键词： Chronic hepatitis B Indeterminate phase Gray-zone liver biopsy Pathological histology Risk factors

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The role of liver transplantation for hilar cholangiocarcinoma

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Hepatobiliary & Pancreatic diseases International 2007年第3期6卷 248-253页

作者： Durgatosh Pandey Kang-Hoe Lee Kai-Chah Tan Hepatobiliary Surgery & liver Transplantation Asian Centre for Liver Disease and Transplantation Gleneagles Hospital Singapore

BACKGROUND: Hilar cholangiocarcinoma is a devastating disease. Surgery is the only potentially curative modality. However, the results of surgical resection for hilar cholangiocarcinomas are disappointing. The introduction of liver transplantation for this condition has brought new hope for the management of this disease. The aim of this review is to discuss the role of liver transplantation in this disease. DATA SOURCES: A MEDLINE search was conducted for the articles on liver transplantation for hilar cholangiocarcinoma. Their results have been compiled and compared with the existing literature on resection for this disease. RESULTS: The earlier series on liver transplantation for hilar cholangiocarcinoma were not encouraging because of poor patient selection. The Mayo Clinic protocol of neoadjuvant chemoradiation followed by liver transplantation has shown remarkable success (survival at 1-, 3-, and 5-year post-transplantation being 92%, 82%, and 82%, respectively). With better patient selection and integration of neoadjuvant chemoradiation, the long-term survival is superior to that of the patients who undergo resection, as shown by the published literature on resection. The limitations of organ availability can be overcome by the living donor liver transplantation programme. This review article discusses the rationale, pros and cons of liver transplantation vis-à-vis resection for hilar ***: liver transplantation, especially living donor liver transplantation, is a new and exciting alternative to resection for hilar cholangiocarcinoma. Integration of neoadjuvant chemoradiation has the potential to further improve the curative potential of liver transplantation. The strategy of combining neoadjuvant chemoradiation and liver transplantation brings new hope for the treatment of this difficult disease.

关键词： liver transplantation hilar cholangiocarcinoma neoadjuvant chemoradiation.

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Metformin and pancreatic neuroendocrine tumors:A systematic review and meta-analysis

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World Journal of Gastroenterology 2024年第7期30卷 759-769页

作者： Maja Cigrovski Berkovic Alessandro Coppola Vibor Sesa Anna Mrzljak Quirino Lai Department for Sport and Exercise Medicine Faculty of Kinesiology University of ZagrebZagreb 10000Croatia Department of Surgery Sapienza University of RomeRome 00185Italy Department of Gastroenterology and Hepatology Liver Transplant CenterUniversity Hospital Centre ZagrebZagreb 10000Croatia Department of Medicine School of MedicineZagreb 10000Croatia General Surgery and Organ Transplantation Unit Department of SurgerySapienza University of RomeRome 00018Italy

BACKGROUND Most patients with advanced pancreatic neuroendocrine tumors(pNETs)die due to tumor ***,identifying new therapies with low toxicity and good tolerability to use concomitantly with the established pNET treatment is *** this perspective,metformin is emerging as a molecule of *** studies have described metformin,a widely used agent for the treatment of patients with type 2 diabetes mellitus(T2DM),to be effective in modulating different tumor-related events,including cancer incidence,recurrence and survival by inhibiting mTOR *** systematic review evaluates the role of T2DM and metformin in the insurgence and post-treatment outcomes in patients with *** To systematically analyze and summarize evidence related to the diagnostic and prognostic value of T2DM and metformin for predicting the insurgence and posttreatment outcomes of *** A systematic review of the published literature was undertaken,focusing on the role of T2DM and metformin in insurgence and prognosis of pNET,measured through outcomes of tumor-free survival(TFS),overall survival and progression free *** A total of 13 studies(5674 patients)were included in this *** of 809 pNET cases from five retrospective studies(low study heterogeneity with I^(2)=0%)confirms the correlation between T2DM and insurgence of pNET(OR=2.13,95%CI=1.56-4.55;P<0.001).The pooled data from 1174 pNET patients showed the correlation between T2DM and post-treatment TFS in pNET patients(hazard ratio=1.84,95%CI=0.78-2.90;P<0.001).The study heterogeneity was intermediate,with I^(2)=51%.A few studies limited the possibility of performing pooled analysis in the setting of metformin;therefore,results were heterogeneous,with no statistical relevance to the use of this drug in the diagnosis and prognosis of *** T2DM represents a risk factor for the insurgence of pNET and is a significant predictor of poor post-treatment TFS

关键词： Pancreatic neuroendocrine tumors Type 2 diabetes mellitus Prognosis Treatment Metformin

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Non-invasive diagnosis of advanced fibrosis and cirrhosis

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World Journal of Gastroenterology 2014年第45期20卷 16820-16830页

作者： Suraj Sharma Korosh Khalili Geoffrey Christopher Nguyen toronto centre for liver disease Toronto Western Hospital Department of Medical Imaging University Health Network Joseph and Wolf Lebovic Health Complex Mount Sinai Hospital

liver cirrhosis is a common and growing public health problem *** diagnosis of cirrhosis portends an increased risk of morbidity and *** biopsy is considered the gold standard for diagnosis of cirrhosis and staging of ***,despite its universal use,liver biopsy is an invasive and inaccurate gold standard with numerous *** order to overcome the limitations of liver biopsy,a number of non-invasive techniques have been investigated for the assessment of *** review will focus on currently available non-invasive markers of *** evidence behind the use of these markers will be highlighted,along with an assessment of diagnostic accuracy and performance characteristics of each ***-invasive markers of cirrhosis can be radiologic or *** techniques based on ultrasound,magnetic resonance imaging and elastography have been used to assess liver ***-based biomarkers of cirrhosis have also been *** are broadly classified into indirect and direct *** biomarkers reflect liver function,which may decline with the onset of *** biomarkers,reflect extracellular matrix turnover,and include molecules involved in hepatic *** the whole,radiologic and serum markers of fibrosis correlate well with biopsy scores,especially when excluding cirrhosis or excluding *** feature is certainly clinically useful,and avoids liver biopsy in many cases.

关键词： Cirrhosis Biomarker Non-invasive Fibrosis Viral Non-alcoholic fatty liver disease Primary biliary cirrhosis Autoimmune hepatitis Hepatitis B virus Hepatitis C virus

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Estimating liver weight of adults by body weight and gender

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World Journal of Gastroenterology 2006年第14期12卷 2217-2222页

作者： See Ching Chan Chi Leung Liu Chung Mau Lo Banny K Lam Evelyn W Lee Yik Wong Sheung Tat Fan centre for the Study of liver disease Department of Surgery The University of Hong Kong Pokfulam Hong Kong China centre for the Study of liver disease Department of Radiology The University of Hong Kong Pokfulam Hong Kong China

AIM： To estimate the standard liver weight for assessing adequacies of graft size in live donor liver transplantation and remnant liver in major hepatectomy for cancer. METHODS： In this study, anthropometric data of body weight and body height were tested for a correlation with liver weight in 159 live liver donors who underwent donor right hepatectomy including the middle hepatic vein. liver weights were calculated from the right lobe graft weight obtained at the back table, divided by the proportion of the right lobe on the computed tomography. RESULTS： The subjects, all Chinese, had a mean age of 35.8 ± 10.5 years, and a female to male ratio of 118：41. The mean volume of the right lobe was 710.14 ±131.46 mL and occupied 64.55%±4.47% of the whole liver on computed tomography. Right lobe weighed 598.90±117.39 g and the estimated liver weight was 927.54 ± 168.78 g. When body weight and body height were subjected to multiple stepwise linear regression analysis, body height was found to be insignificant. Females of the same body weight had a slightly lower liver weight. A formula based on body weight and gender was derived： Estimated standard liver weight （g）=218＋BW （kg）× 12.3＋gender×51 （R^2 = 0.48）（female=0, male= 1）. Based on the anthropometric data of these 159 subjects, liver weights were calculated using previously published formulae derived from studies on Caucasian, .lapanese, Korean, and Chinese. All formulae overestimated liver weights compared to this formula. The Japanese formula overestimated the estimated standard liver weight （ESLW） for adults less than 60 ***： A formula applicable to Chinese males and females is available. A formula for individual races appears necessary.

关键词： Estimated standard liver weight liver tranplantation

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Advanced brain organoids for neuroinflammation disease modeling

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Neural Regeneration Research 2024年第1期19卷 154-155页

作者： Sonia Sabate-Soler Henry Kurniawan Jens Christian Schwamborn Luxembourg centre for Systems Biomedicine University of LuxembourgEsch-sur-AlzetteLuxembourg

Brain organoids mimic closely the embryonic human brain:Over the last decade,the development of human organoid systems has evolved *** tissues have been modeled with organoids,such as the gut,lung,liver,kidney retina and *** systems have a high cellular heterogeneity,with many cell types integrated into the same ***'cellular populations interact between and amongst each other in a cellular and molecular level,which represents an advantage with respects to monolayer 2D cell culture systems.

关键词： inflammation lung kidney

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Distribution of different hepatitis C virus genotypes in patients with hepatitis C virus infection

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World Journal of Gastroenterology 2010年第16期16卷 2005-2009页

作者： Farah Bokharaei Salim Hossein Keyvani Afsaneh Amiri Fatemeh Jahanbakhsh Sef idi Ramin Shakeri Farhad Zamani Virology Department Iran University of Medical Sciences GI and liver disease Research centre Iran University of Medical Sciences Digestive disease Research centre Tehran University of Medical Sciences

AIM:To investigate the presence of mixed infection and discrepancy between hepatitis C virus(HCV) genotypes in plasma,peripheral blood mononuclear cells(PBMCs),and liver biopsy ***:From September 2008 up to April 2009,133 patients with chronic hepatitis C referred to Firouzgar Hospital for initiation of an antiviral therapy were recruited in the *** milliliters of peripheral blood was collected from each patient and liver biopsy was performed in those who gave consent or had *** genotyping was done using INNO-LiPATM HCV in serum,PBMCs,and liver biopsy specimens and then conf irmed by sequencing of 5'-UTR ***:The mean age of patients was 30.3 ± 17.1 *** transfusion was seen in 124(93.2%) of *** HCV genotypes were found in 3(2.3%) of 133 plasma samples,9(6.8%) of 133 PBMC samples,and 8(18.2%) of 44 liver biopsy *** is notable that the different genotypes found in PBMCs were not the same as those found in plasma and liver biopsy ***:Our study shows that a signif icant proportion of patients with chronic hepatitis C are affected by multiple HCV genotypes which may not be detectable only in serum of patients.

关键词： Chronic hepatitis C virus infection Mixed hepat itis C virus infection Peripheral blood mononuclear cells Hepatocyte

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Clinicopathological and prognostic implications of endoglin (CD105) expression in hepatocellular carcinoma and its adjacent non-tumorous liver

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World Journal of Gastroenterology 2005年第2期11卷 176-181页

作者： Joanna W.Ho Ronnie T.Poon Chris K.Sun Sheung-Tat Fan centre tor the Study of liver disease and Departments of Surgery and PathologyThe University of Hong KongPokfulam Hong Kong China

AIM: The expression pattern of endoglin (CD105) in hepatocellular carcinoma (HCC) has not been reported so far. We hypothesized that CD105 could differentially highlight a subset of microvessels in HCC, and intratumoral microvessel density (IMVD) by CD105 immunostaining (IMVD-CD105) could provide better prognostic information than IMVD by CD34 immunostaining (IMVD-CD34).METHODS: Paraffin blocks of tumor and adjacent nontumorous liver tissues from 86 patients who underwent curative resection of HCC were used for this study. Serial sections were stained for CD105 and CD34, respectively,to highlight the microvessels. IMVD was counted according to a standard ***: In the HCC tissues, CD105 was either negatively or positively stained only in a subset of microvessels. In contrast, CD34 showed positive and more extensive microvessel staining in all cases examined. However, in the adjacent non-tumorous liver sections, CD105 showed a diffuse pattern of microvessel staining in 20 of 86 cases,while CD34 showed negative or only focal staining of the sinusoids around portal area. Correlation with clinicopathological data demonstrated that lower scores of IMVD-CD105 were found in larger sized tumors [mean 41.4/0.74 mm2 (＞5 cm tumor) vs 65.9/0.74 mm2(≤ 5 cm tumor), P = 0.043] and more aggressive tumors,as indicated by venous infiltration [36.8/0.74 mm2 (present)vs 64.2/0.74 mm2 (absent), P = 0.020], microsatellite nodules [35.1/0.74 mm2 (present) vs 65.9/0.74 mm2(absent), P = 0.012], and advanced TNM tumor stage [38.8/0.74 mm2 (stage 3 or 4) vs 68.3/0.74 mm2 (stage 1or 2), P = 0.014]. No prognostic significance was observed when median values were used as cut-off points using either IMVD-CD105 or IMVD-CD34. However, the presence of the diffuse pattern of CD105 expression in the adjacent non-tumorous liver tissues predicted a poorer disease-free survival (median 8.6 vs 21.5 mo, P = 0.026).CONCLUSION: Our data demonstrate that a lower IMVDCD105 is associated with larger

关键词： Hepatocellular carcinoma Endoglin Intratumoral microvessel density

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