Metabolic dysfunction-associated fatty liver disease(MAFLD)is the most prevalent chronic liver condition worldwide.Current liver enzyme-based screening methods have limitations that may missed diagnoses and treatment ...Metabolic dysfunction-associated fatty liver disease(MAFLD)is the most prevalent chronic liver condition worldwide.Current liver enzyme-based screening methods have limitations that may missed diagnoses and treatment delays.Regarding Chen et al,the risk of developing MAFLD remains elevated even when alanine aminotransferase levels fall within the normal range.Therefore,there is an urgent need for advanced diagnostic techniques and updated algorithms to enhance the accuracy of MAFLD diagnosis and enable early intervention.This paper proposes two potential screening methods for identifying individuals who may be at risk of developing MAFLD:Lowering these thresholds and promoting the use of noninvasive liver fibrosis scores.展开更多
AIM： To evaluate the arguments for and against the possible roles of H pylori in hepatocellular carcinoma （HCC）. METHODS： We performed a systematic review of all relevant studies published in the literature. A tot...AIM： To evaluate the arguments for and against the possible roles of H pylori in hepatocellular carcinoma （HCC）. METHODS： We performed a systematic review of all relevant studies published in the literature. A total of 103 clinical trials and reports were identified, but only 10 trials qualified under our selection criteria. A metaanalysis was carried out by a biostatistician according to the Cochrane Reviewers＇ Handbook recommended by The Cochrane Collaboration. RESULTS： Nine case-control studies and one retrospective cross sectional study were included in the final analysis. Overall the prevalence of H pylori infection was 53.3% （129 of 242） in cases and 10.4% （29 of 280） in controls, and the summary odds ratio for the association of H pylori infection with the risk for HCC （using the fixed-effects model, which accounted for the homogeneity across the 10 studies） was determined to be 13.63 （95% CI, 7.90-23.49）. CONCLUSION： Our analysis showed a positive association between F1 pylori infection and the risk of HCC, with an indication of possible publication bias and possible confounders due to study designs that showed results of less pronounced associations.展开更多
The low perioperative morbidity and shorter hospital stay associated with laparoscopic hepatectomy have made it an often-used option at many liver centers, despite the fact that many patients with hepatocellular carci...The low perioperative morbidity and shorter hospital stay associated with laparoscopic hepatectomy have made it an often-used option at many liver centers, despite the fact that many patients with hepatocellular carcinoma have cirrhosis, which makes the procedure more difficult and dangerous. Type of surgical procedure proves not to be a primary risk factor for poor outcomes after hepatic resection for hepatocellular carcinoma, the available evidence clearly shows that laparoscopic hepatectomy is an effective alternative to the open procedure for patients with early-stage hepatocellular carcinoma, even in the presence of cirrhosis. Whether the same is true for patients with intermediate or advanced disease is less clear, since laparoscopic major hepatectomy remains a technically demanding procedure.展开更多
Background: Nonalcoholic fatty liver disease(NAFLD) is one of the main liver diseases, and its pathologic profile includes nonalcoholic fatty liver(NAFL) and nonalcoholic steatohepatitis(NASH). However, there is no re...Background: Nonalcoholic fatty liver disease(NAFLD) is one of the main liver diseases, and its pathologic profile includes nonalcoholic fatty liver(NAFL) and nonalcoholic steatohepatitis(NASH). However, there is no reliable non-invasive parameter in distinguishing NASH from NAFL in clinical practice. The present study was to find a non-invasive way to differentiate these two categories of NAFLD via lipidomic analysis. Methods: Lipidomic analysis was used to determine the changes of lipid moieties in blood from 20 NAFL and 10 NASH patients with liver biopsy. Liver histology was evaluated after hematoxylin and eosin staining and Masson’s trichrome staining. The profile of lipid metabolites in correlation with steatosis, inflammation, hepatocellular necroptosis, fibrosis, and NAFLD activity score(NAS) was analyzed. Results: Compared with NAFL patients, NASH patients had higher degree of steatosis, ballooning degeneration, lobular inflammation. A total of 434 different lipid molecules were identified, which were mainly composed of various phospholipids and triacylglycerols. Many lipids, such as phosphatidylcholine(PC)(P-22:0/18:1), sphingomyelin(SM)(d14:0/18:0), SM(d14:0/24:0), SM(d14:0/22:0), phosphatidylethanolamine(PE)(18:0/22:5), PC(O-22:2/12:0), and PC(26:1/11:0) were elevated in the NASH group compared to those in the NAFL group. Specific analysis revealed an overall lipidomic profile shift from NAFL to NASH, and identified valuable lipid moieties, such as PCs [PC(14:0/18:2), PE(18:0/22:5) and PC(26:1/11:0)] or plasmalogens [PC(O-22:0/0:0), PC(O-18:0/0:0), PC(O-16:0/0:0)], which were significantly altered in NASH patients. In addition, PC(14:0/18:2), phosphatidic acid(18:2/24:4) were positively correlated with NAS;whereas PC(18:0/0:0) was correlated positively with fibrosis score. Conclusions: The present study revealed overall lipidomic profile shift from NAFL to NASH, identified valuable lipid moieties which may be non-invasive biomarkers in the categorization of NAFLD. The correlations between lipid moieties and NAS and fibrosis scores indicate that these lipid biomarkers may be used to predict the severity of the disease.展开更多
Objective: To explore the indications and the value ofendoscopic retrograde cholangiopancreatography(ERCP)in perioperative phase of laparoscopic cholecystecto-my.Methods: From January 1998 to April 1999, a total of150...Objective: To explore the indications and the value ofendoscopic retrograde cholangiopancreatography(ERCP)in perioperative phase of laparoscopic cholecystecto-my.Methods: From January 1998 to April 1999, a total of1500 consecutive laparoscopic cholecystectomies wereanalyzed. The indications for preoperative group (n=33) included elevated bilirubin level and alkalinephosphatase level, jaundice, pancreatitis, abnormalliver function, dilated bile duct and/or stones on ul-trasound or CT. The indications for postoperativegroup (n=20) included clinical signs or symptoms aswell as common bile duct stones demonstrated by in-traoperative cholangiography.Results: Preoperative ERCP for 32 patients (2.1%)showed abnormalities in 12 (37%). Postoperative ER-CP for 20 patients(1.3%) demonstrated abnormalitiesin 14 (70%). Super-selected criteria for preoperativeERCP would predict more than 66% ductal stones.Endoscopic sphincterectomy and duct stones clearancewere performed in all 16 patients with documentedcommon bile duct stones. The morbidity was confinedin 2 patients with self-limited pancreatitis (3%).Conclusions: Using super-selected creteria to selectpatients for preoperative ERCP can avoid unnecessaryERCP. As soon as postoperative patients have clinicalsigns or symptoms, endoscopic treatment should beperformed.展开更多
Objective: To investigate the effect of flexible ureteroscope lithotripsy and percutaneous nephrolithotomy on levels of serum inflammatory factors, oxidative stress and stress hormone in patients with renal calculi. M...Objective: To investigate the effect of flexible ureteroscope lithotripsy and percutaneous nephrolithotomy on levels of serum inflammatory factors, oxidative stress and stress hormone in patients with renal calculi. Methods: A total of 97 cases of renal calculi patients were chosen as the research objects, based on the random data table, they were divided into the control group (n=49) and the observation group (n=48), patients in the control group underwent percutaneous nephrolithotomy (PCNL) treatment, while the observation group patients were treated with flexible ureteroscope lithotripsy (FURL), before and after 1 d ,the levels of inflammatory factors [interleukin-10 (IL-10), C reactive protein (CRP), white blood cell (WBC)], stress hormone [cortisol (COR), adrenocorticotropic hormone (ACTH), norepinephrine (NE)] and oxidative stress [malondialdehyde (MDA), superoxide dismutase (SOD) ] of the two groups were compared. Results: There were no significant differences in IL-10, CRP, WBC, COR, ACTH, NE, MDA and SOD levels between the two groups preoperative;Compared with the preoperative level in the group, the 1 d post-operation levels of IL-10, CRP, WBC, COR, ACTH, NE and MDA in the two groups were significantly increased, and the level of the observation group was significantly lower than that in the control group;The levels of SOD in the two groups 1 d post-operation were significantly lower than those in the same group preoperative, and the control group (85.65±9.95) U/mL was significantly lower than that of the control group (94.71±7.63) U/mL. Conclusion: Compared with percutaneous nephrolithotomy, flexible ureteroscopic lithotripsy for renal calculi is less stressful and more favorable for postoperative recovery, has an important clinical value.展开更多
Background:We examined the comparative associations between non-alcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated steatotic liver disease(MASLD)definitions with risk of developing chronic kidney...Background:We examined the comparative associations between non-alcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated steatotic liver disease(MASLD)definitions with risk of developing chronic kidney disease(CKD)and abnormal albuminuria.Methods:We conducted a cohort study of 214,145 Korean adults with normal kidney function at baseline who underwent liver ultrasonography.Participants were further subdivided into no steatotic liver disease(no-SLD),NAFLD-only,MASLD-only,both NAFLD and MASLD,and SLD not categorized as NAFLD or MASLD groups.Cox proportional hazards models were used to analyze the risk of incident CKD and albuminuria.Results:Compared with either the no-NAFLD or no-MASLD groups,the NAFLD and MASLD groups were associated with a higher risk of incident CKD(NAFLD:adjusted hazard ratio(HR),1.18[95%CI,1.01-1.38];MASLD:adjusted HR,1.21[95%CI,1.04-1.39]).Among the five subgroups,both NAFLD and MASLD group had the strongest association with risk of incident CKD(adjusted HR,1.21[95%CI,1.04-1.42]).The MASLD-only group had the strongest association with incident abnormal albuminuria,with an adjusted HR comparable to that of the both NAFLD and MASLD group(adjusted HR 1.96[95%CI,1.44-2.67]for the MASLD-only,and adjusted HR 1.98[95%CI,1.58-2.49]for the both NAFLD and MASLD group versus the no-SLD group).The NAFLD-only group was not independently associated with risk of CKD or abnormal albuminuria.Conclusions:These findings suggest that MASLD definition identifies individuals at high risk of developing incident CKD or abnormal albuminuria better than NAFLD definition.展开更多
Metabolic dysfunction-associated fatty liver disease(MAFLD)is a complex,heterogenous and progressive disease that is characterised by substantial phenotypic variability,which results in disparate clinical presentation...Metabolic dysfunction-associated fatty liver disease(MAFLD)is a complex,heterogenous and progressive disease that is characterised by substantial phenotypic variability,which results in disparate clinical presentations and outcomes(1-4).Notably,only a proportion of patients with MAFLD progress to the more advanced stages of the disease.Therefore,the identification of the subgroups that have a high risk of disease progression is of paramount importance for clinical care,as well as drug development and clinical trials(5).展开更多
The Korean Republic nationwide cohort study by Yun et al.reveals a stepwise increase in hepatocellular carcinoma(HCC)risk,progressing from“pure”metabolic dysfunction-associated steatotic liver disease(MASLD)to MASLD...The Korean Republic nationwide cohort study by Yun et al.reveals a stepwise increase in hepatocellular carcinoma(HCC)risk,progressing from“pure”metabolic dysfunction-associated steatotic liver disease(MASLD)to MASLD with increased alcohol intake(MetALD)and then to alcohol-associated liver disease[1].These data also highlight the significant impact of age and gender,underscoring the importance of tailoring prevention strategies to address not only metabolic dysfunction but also alcohol consumption in liver disease management[1].This Korean cohort study also illustrates the characteristics of MASLD-related HCC,providing new insights into the natural history of this liver disease.展开更多
Background:With the rising global prevalence of fatty liver disease related to metabolic dysfunction,the association of this common liver condition with chronic kidney disease(CKD)has become increasingly evident.In 20...Background:With the rising global prevalence of fatty liver disease related to metabolic dysfunction,the association of this common liver condition with chronic kidney disease(CKD)has become increasingly evident.In 2020,the more inclusive term metabolic dysfunction-associated fatty liver disease(MAFLD)was proposed to replace the term non-alcoholic fatty liver disease(NAFLD).The observed association between MAFLD and CKD and our understanding that CKD can be a consequence of underlying metabolic dysfunction support the notion that individuals with MAFLD are at higher risk of having and developing CKD compared with those without MAFLD.However,to date,there is no appropriate guidance on CKD in individuals with MAFLD.Furthermore,there has been little attention paid to the link between MAFLD and CKD in the Nephrology community.Methods and Results:Using a Delphi-based approach,a multidisciplinary panel of 50 international experts from 26 countries reached a consensus on some of the open research questions regarding the link between MAFLD and CKD.Conclusions:This Delphi-based consensus statement provided guidance on the epidemiology,mechanisms,management and treatment of MAFLD and CKD,as well as the relationship between the severity of MAFLD and risk of CKD,which establish a framework for the early prevention and management of these two common and interconnected diseases.展开更多
Background:There is an unmet need for accurate non-invasive methods to diagnose non-alcoholic steatohepatitis(NASH).Since impedance-based measurements of body composition are simple,repeatable and have a strong associ...Background:There is an unmet need for accurate non-invasive methods to diagnose non-alcoholic steatohepatitis(NASH).Since impedance-based measurements of body composition are simple,repeatable and have a strong association with non-alcoholic fatty liver disease(NAFLD)severity,we aimed to develop a novel and fully automatic machine learning algorithm,consisting of a deep neural network based on impedance-based measurements of body composition to identify NASH[the bioeLectrical impEdance Analysis foR Nash(LEARN)algorithm].Methods:A total of 1,259 consecutive subjects with suspected NAFLD were screened from six medical centers across China,of which 766 patients with biopsy-proven NAFLD were included in final analysis.These patients were randomly subdivided into the training and validation groups,in a ratio of 4:1.The LEARN algorithm was developed in the training group to identify NASH,and subsequently,tested in the validation group.Results:The LEARN algorithm utilizing impedance-based measurements of body composition along with age,sex,pre-existing hypertension and diabetes,was able to predict the likelihood of having NASH.This algorithm showed good discriminatory ability for identifying NASH in both the training and validation groups[area under the receiver operating characteristics(AUROC):0.81,95%CI:0.77-0.84 and AUROC:0.80,95%CI:0.73-0.87,respectively].This algorithm also performed better than serum cytokeratin-18 neoepitope M30(CK-18 M30)level or other non-invasive NASH scores(including HAIR,ION,NICE)for identifying NASH(P value<0.001).Additionally,the LEARN algorithm performed well in identifying NASH in different patient subgroups,as well as in subjects with partial missing body composition data.Conclusions:The LEARN algorithm,utilizing simple easily obtained measures,provides a fully automated,simple,non-invasive method for identifying NASH.展开更多
Metabolic dysfunction-associated fatty liver disease(MAFLD),previously termed non-alcoholic fatty liver disease,is one of the most common causes of chronic liver disease,affecting around 30%of the world’s adults(1).M...Metabolic dysfunction-associated fatty liver disease(MAFLD),previously termed non-alcoholic fatty liver disease,is one of the most common causes of chronic liver disease,affecting around 30%of the world’s adults(1).MAFLD encompasses a spectrum of liver conditions,ranging from simple steatosis to metabolic dysfunction-associated steatohepatitis(MASH),which can progress to cirrhosis and hepatocellular carcinoma(HCC)(2,3).展开更多
A history of cigarette smoking is present in approximately 40%of patients with chronic liver diseases and there is considerable interest in better understanding if and how cigarette smoking may affect chronic liver di...A history of cigarette smoking is present in approximately 40%of patients with chronic liver diseases and there is considerable interest in better understanding if and how cigarette smoking may affect chronic liver diseases[1].Non-alcoholic fatty liver disease(NAFLD)is currently the most common cause of chronic liver disease,affecting up to 30%of the world’s adults[2].Genetic and environmental factors contribute to the development and progression of NAFLD,and increasing evidence shows that smoking is associated with more severe liver disease in NAFLD[3,4].Despite convincing evidence of this association between smoking and liver disease,the underlying mechanism(s)linking smoking with NAFLD is still poorly understood.展开更多
Background:Animal organ meat(offal)is a food with high nutrient density that is popular in different parts of the world,but its relationship with nonalcoholic steatohepatitis(NASH)is unclear.We aimed to examine whethe...Background:Animal organ meat(offal)is a food with high nutrient density that is popular in different parts of the world,but its relationship with nonalcoholic steatohepatitis(NASH)is unclear.We aimed to examine whether daily animal organ meat consumption is associated with the presence of NASH in individuals with nonalcoholic fatty liver disease(NAFLD).Methods:A total of 136 Chinese adults with biopsy-proven NAFLD were included.Definite NASH was defined as NAFLD activity score≥4 and at least one point for steatosis,ballooning,and lobular inflammation.Daily animal organ meat consumption was estimated using a self-administered validated food frequency questionnaire.Logistic regression analysis was performed to assess the association between animal organ meat intake and liver disease severity.Results:The 136 participants(80.9%men)of the study had a mean±standard deviation(SD)age of 39.0±12.5 years and body mass index of 27.4±3.6 kg/m2.Prevalence of definite NASH was 65.4%.Daily median organ meat consumption was 1.30 g/1,000 kcal.Animal organ meat consumption was inversely associated with the presence of NASH even after adjustment of demographics,lifestyle variables,metabolic and dietary factors,as well as liver fibrosis stage;adjusted-odds ratios(95%confidence intervals)for NASH were 0.15(0.03,0.69)for the highest tertile and 0.18(0.05,0.70)for the medium tertile,compared to the lowest(reference)tertile of animal organ meat intake(P value for trend=0.024).Conclusions:Our results suggest for the first time that higher animal organ meat consumption is associated with a lower prevalence of NASH in Chinese individuals with biopsy-proven NAFLD.展开更多
The term non-alcoholic fatty liver disease(NAFLD)was coined in 1980 to characterize a disease similar to alcoholic fatty liver disease that developed in patients without a history of excessive alcohol intake.[1]Morpho...The term non-alcoholic fatty liver disease(NAFLD)was coined in 1980 to characterize a disease similar to alcoholic fatty liver disease that developed in patients without a history of excessive alcohol intake.[1]Morphologically,NAFLD is characterized by excess fatty infiltration of the liver in the absence of known causes of liver disease(eg,alcohol,autoimmune liver disease,viral hepatitis,etc).The clinical manifestations of NAFLD(both hepatic and extrahepatic)depend on the outcome of complex interactions between its primary drivers including poor lifestyle habits and diet,a dysfunctional microbiota,genetic predisposition,and environmental cues that result in metabolic dysfunction and liver disease.However,bringing all patients with their markedly different clinical courses under the NAFLD umbrella belies its complexity and implies a homogeneous disease state that then negatively impacts clinical management and a deeper understanding of pathogenesis.With advances in current knowledge on the spectrum of fatty liver diseases,it is apparent that the fourdecade-old outdated term NAFLD can no longer serve to usefully describe a highly heterogeneous disease.The disease as we understand it today not only impacts patients who consume alcohol and those who do not,but also potentially impacts all patients with any form of liver disease,by acting as a disease modifier.[2]展开更多
The emergence of non-alcoholic fatty liver disease(NAFLD)as the leading chronic liver disease worldwide raises some concerns.In particular,NAFLD is closely tied to sedentary lifestyle habits and associated with other ...The emergence of non-alcoholic fatty liver disease(NAFLD)as the leading chronic liver disease worldwide raises some concerns.In particular,NAFLD is closely tied to sedentary lifestyle habits and associated with other metabolic diseases,such as obesity and diabetes.At the end of the disease spectrum,non-alcoholic steatohepatitis(NASH)may progress to cirrhosis and hepatocellular carcinoma(HCC),representing a serious health problem to modern society.Recently,an increasing number of HCC cases originating from this progressive disease spectrum have been identified,with different levels of severity and complications.Updating the current guidelines by placing a bigger focus on this emerging cause and highlighting some of its unique features is necessary.Since,the drivers of the disease are complex and multifactorial,in order to improve future outcomes,having a better understanding of NASH progression into HCC may be helpful.The risks that can promote disease progression and currently available management strategies employed to monitor and treat NASH-related HCC make up the bulk of this review.展开更多
The outbreak of coronavirus disease 2019(COVID-19),caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has attracted increasing worldwide attention.Cases of liver damage or dysfunction(mainly cha...The outbreak of coronavirus disease 2019(COVID-19),caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has attracted increasing worldwide attention.Cases of liver damage or dysfunction(mainly characterized by moderately elevated serum aspartate aminotransferase lev-els)have been reported among patients with COVID-19.However,it is currently uncertain whether the COVID-19-related liver damage/dysfunction is due mainly to the viral infection per se or other coexisting conditions,such as the use of potentially hepatotoxic drugs and the coexistence of sys-temic inflammatory response,respiratory distress syndrome-induced hypoxia,and multiple organ dysfunction.Based on the current evidence from case reports and case series,this review article focuses on the demographic and clinical characteristics,potential mechanisms,and treatment options for COVID-19-related liver dysfunction.This review also describes the geo-graphical and demographic distribution of COVID-19-related liver dysfunction,as well as possible underlying mechanisms linking COVID-19 to liver dysfunction,in order to facilitate future drug development,prevention,and control measures for COVID-19.展开更多
Non-alcoholic fatty liver disease(NAFLD)is estimated to affect approximately 25%of the adult population worldwide.[1]NAFLD encompasses a histopathological spectrum of progressive pathologic conditions ranging from non...Non-alcoholic fatty liver disease(NAFLD)is estimated to affect approximately 25%of the adult population worldwide.[1]NAFLD encompasses a histopathological spectrum of progressive pathologic conditions ranging from non-alcoholic fatty liver(NAFL)to steatohepatitis(NASH)and cirrhosis.展开更多
Hepatitis B virus (HBV) infection remains a worldwide health problem,and is the major cause of hepatitis,liver cirrhosis,and hepatocellular carcinoma.The innate and adaptive immune responses of the HBV-infected host c...Hepatitis B virus (HBV) infection remains a worldwide health problem,and is the major cause of hepatitis,liver cirrhosis,and hepatocellular carcinoma.The innate and adaptive immune responses of the HBV-infected host contribute greatly to the development and pathogenesis of chronic HBV infection,and often affect the efficacy of anti-HBV drugs.Interleukin (IL)-22 is a newly identified cytokine that is involved in the pathogenesis of liver disease,but its role in liver inflammation in patients with HBV infection remains controversial.In this report,we summarize the production and function of IL-22 in inflammatory environments,and review the current research into IL-22 biology in HBV infection.A better understanding of the intrahepatic micro-environments that directly influence the activity of IL-22 will be important for the development of new immunotherapeutic approaches that target IL-22-producing cells or IL-22 itself.展开更多
Metabolic-associated fatty liver disease(MAFLD)(1),formerly known as non-alcoholic fatty liver disease,is a major causes of liver cirrhosis(2).MAFLD represents a growing global health and economic burden since approxi...Metabolic-associated fatty liver disease(MAFLD)(1),formerly known as non-alcoholic fatty liver disease,is a major causes of liver cirrhosis(2).MAFLD represents a growing global health and economic burden since approximately one in four people have the disease(3).As a consequence,MAFLD-related cirrhosis is expected to become the leading cause for liver failure and liver cancer,and the major indication for liver transplantation this century(3).展开更多
基金the National Natural Science Foundation of China,No.82070588 and No.82370577.
文摘Metabolic dysfunction-associated fatty liver disease(MAFLD)is the most prevalent chronic liver condition worldwide.Current liver enzyme-based screening methods have limitations that may missed diagnoses and treatment delays.Regarding Chen et al,the risk of developing MAFLD remains elevated even when alanine aminotransferase levels fall within the normal range.Therefore,there is an urgent need for advanced diagnostic techniques and updated algorithms to enhance the accuracy of MAFLD diagnosis and enable early intervention.This paper proposes two potential screening methods for identifying individuals who may be at risk of developing MAFLD:Lowering these thresholds and promoting the use of noninvasive liver fibrosis scores.
文摘AIM： To evaluate the arguments for and against the possible roles of H pylori in hepatocellular carcinoma （HCC）. METHODS： We performed a systematic review of all relevant studies published in the literature. A total of 103 clinical trials and reports were identified, but only 10 trials qualified under our selection criteria. A metaanalysis was carried out by a biostatistician according to the Cochrane Reviewers＇ Handbook recommended by The Cochrane Collaboration. RESULTS： Nine case-control studies and one retrospective cross sectional study were included in the final analysis. Overall the prevalence of H pylori infection was 53.3% （129 of 242） in cases and 10.4% （29 of 280） in controls, and the summary odds ratio for the association of H pylori infection with the risk for HCC （using the fixed-effects model, which accounted for the homogeneity across the 10 studies） was determined to be 13.63 （95% CI, 7.90-23.49）. CONCLUSION： Our analysis showed a positive association between F1 pylori infection and the risk of HCC, with an indication of possible publication bias and possible confounders due to study designs that showed results of less pronounced associations.
文摘The low perioperative morbidity and shorter hospital stay associated with laparoscopic hepatectomy have made it an often-used option at many liver centers, despite the fact that many patients with hepatocellular carcinoma have cirrhosis, which makes the procedure more difficult and dangerous. Type of surgical procedure proves not to be a primary risk factor for poor outcomes after hepatic resection for hepatocellular carcinoma, the available evidence clearly shows that laparoscopic hepatectomy is an effective alternative to the open procedure for patients with early-stage hepatocellular carcinoma, even in the presence of cirrhosis. Whether the same is true for patients with intermediate or advanced disease is less clear, since laparoscopic major hepatectomy remains a technically demanding procedure.
基金supported by grants from the Ministry of Science&Technology of China(2016YFE0107400)the National Natural Science Foundation of China(81272436,81572356,81871997,81500665 and 82070588)+1 种基金High Level Creative Talents from Department of Public Health in Zhejiang Province(S2032102600032)Project of New Century 551 Talent Nurturing in Wenzhou。
文摘Background: Nonalcoholic fatty liver disease(NAFLD) is one of the main liver diseases, and its pathologic profile includes nonalcoholic fatty liver(NAFL) and nonalcoholic steatohepatitis(NASH). However, there is no reliable non-invasive parameter in distinguishing NASH from NAFL in clinical practice. The present study was to find a non-invasive way to differentiate these two categories of NAFLD via lipidomic analysis. Methods: Lipidomic analysis was used to determine the changes of lipid moieties in blood from 20 NAFL and 10 NASH patients with liver biopsy. Liver histology was evaluated after hematoxylin and eosin staining and Masson’s trichrome staining. The profile of lipid metabolites in correlation with steatosis, inflammation, hepatocellular necroptosis, fibrosis, and NAFLD activity score(NAS) was analyzed. Results: Compared with NAFL patients, NASH patients had higher degree of steatosis, ballooning degeneration, lobular inflammation. A total of 434 different lipid molecules were identified, which were mainly composed of various phospholipids and triacylglycerols. Many lipids, such as phosphatidylcholine(PC)(P-22:0/18:1), sphingomyelin(SM)(d14:0/18:0), SM(d14:0/24:0), SM(d14:0/22:0), phosphatidylethanolamine(PE)(18:0/22:5), PC(O-22:2/12:0), and PC(26:1/11:0) were elevated in the NASH group compared to those in the NAFL group. Specific analysis revealed an overall lipidomic profile shift from NAFL to NASH, and identified valuable lipid moieties, such as PCs [PC(14:0/18:2), PE(18:0/22:5) and PC(26:1/11:0)] or plasmalogens [PC(O-22:0/0:0), PC(O-18:0/0:0), PC(O-16:0/0:0)], which were significantly altered in NASH patients. In addition, PC(14:0/18:2), phosphatidic acid(18:2/24:4) were positively correlated with NAS;whereas PC(18:0/0:0) was correlated positively with fibrosis score. Conclusions: The present study revealed overall lipidomic profile shift from NAFL to NASH, identified valuable lipid moieties which may be non-invasive biomarkers in the categorization of NAFLD. The correlations between lipid moieties and NAS and fibrosis scores indicate that these lipid biomarkers may be used to predict the severity of the disease.
文摘Objective: To explore the indications and the value ofendoscopic retrograde cholangiopancreatography(ERCP)in perioperative phase of laparoscopic cholecystecto-my.Methods: From January 1998 to April 1999, a total of1500 consecutive laparoscopic cholecystectomies wereanalyzed. The indications for preoperative group (n=33) included elevated bilirubin level and alkalinephosphatase level, jaundice, pancreatitis, abnormalliver function, dilated bile duct and/or stones on ul-trasound or CT. The indications for postoperativegroup (n=20) included clinical signs or symptoms aswell as common bile duct stones demonstrated by in-traoperative cholangiography.Results: Preoperative ERCP for 32 patients (2.1%)showed abnormalities in 12 (37%). Postoperative ER-CP for 20 patients(1.3%) demonstrated abnormalitiesin 14 (70%). Super-selected criteria for preoperativeERCP would predict more than 66% ductal stones.Endoscopic sphincterectomy and duct stones clearancewere performed in all 16 patients with documentedcommon bile duct stones. The morbidity was confinedin 2 patients with self-limited pancreatitis (3%).Conclusions: Using super-selected creteria to selectpatients for preoperative ERCP can avoid unnecessaryERCP. As soon as postoperative patients have clinicalsigns or symptoms, endoscopic treatment should beperformed.
文摘Objective: To investigate the effect of flexible ureteroscope lithotripsy and percutaneous nephrolithotomy on levels of serum inflammatory factors, oxidative stress and stress hormone in patients with renal calculi. Methods: A total of 97 cases of renal calculi patients were chosen as the research objects, based on the random data table, they were divided into the control group (n=49) and the observation group (n=48), patients in the control group underwent percutaneous nephrolithotomy (PCNL) treatment, while the observation group patients were treated with flexible ureteroscope lithotripsy (FURL), before and after 1 d ,the levels of inflammatory factors [interleukin-10 (IL-10), C reactive protein (CRP), white blood cell (WBC)], stress hormone [cortisol (COR), adrenocorticotropic hormone (ACTH), norepinephrine (NE)] and oxidative stress [malondialdehyde (MDA), superoxide dismutase (SOD) ] of the two groups were compared. Results: There were no significant differences in IL-10, CRP, WBC, COR, ACTH, NE, MDA and SOD levels between the two groups preoperative;Compared with the preoperative level in the group, the 1 d post-operation levels of IL-10, CRP, WBC, COR, ACTH, NE and MDA in the two groups were significantly increased, and the level of the observation group was significantly lower than that in the control group;The levels of SOD in the two groups 1 d post-operation were significantly lower than those in the same group preoperative, and the control group (85.65±9.95) U/mL was significantly lower than that of the control group (94.71±7.63) U/mL. Conclusion: Compared with percutaneous nephrolithotomy, flexible ureteroscopic lithotripsy for renal calculi is less stressful and more favorable for postoperative recovery, has an important clinical value.
文摘Background:We examined the comparative associations between non-alcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated steatotic liver disease(MASLD)definitions with risk of developing chronic kidney disease(CKD)and abnormal albuminuria.Methods:We conducted a cohort study of 214,145 Korean adults with normal kidney function at baseline who underwent liver ultrasonography.Participants were further subdivided into no steatotic liver disease(no-SLD),NAFLD-only,MASLD-only,both NAFLD and MASLD,and SLD not categorized as NAFLD or MASLD groups.Cox proportional hazards models were used to analyze the risk of incident CKD and albuminuria.Results:Compared with either the no-NAFLD or no-MASLD groups,the NAFLD and MASLD groups were associated with a higher risk of incident CKD(NAFLD:adjusted hazard ratio(HR),1.18[95%CI,1.01-1.38];MASLD:adjusted HR,1.21[95%CI,1.04-1.39]).Among the five subgroups,both NAFLD and MASLD group had the strongest association with risk of incident CKD(adjusted HR,1.21[95%CI,1.04-1.42]).The MASLD-only group had the strongest association with incident abnormal albuminuria,with an adjusted HR comparable to that of the both NAFLD and MASLD group(adjusted HR 1.96[95%CI,1.44-2.67]for the MASLD-only,and adjusted HR 1.98[95%CI,1.58-2.49]for the both NAFLD and MASLD group versus the no-SLD group).The NAFLD-only group was not independently associated with risk of CKD or abnormal albuminuria.Conclusions:These findings suggest that MASLD definition identifies individuals at high risk of developing incident CKD or abnormal albuminuria better than NAFLD definition.
基金supported by the National Health and Medical Research Council of Australia(NHMRC)Program and Investigator Grants(Nos.2008983,1053206,and 1149976)Project and Ideas Grants(Nos.1107178,1108422,and 2001692).
文摘Metabolic dysfunction-associated fatty liver disease(MAFLD)is a complex,heterogenous and progressive disease that is characterised by substantial phenotypic variability,which results in disparate clinical presentations and outcomes(1-4).Notably,only a proportion of patients with MAFLD progress to the more advanced stages of the disease.Therefore,the identification of the subgroups that have a high risk of disease progression is of paramount importance for clinical care,as well as drug development and clinical trials(5).
基金supported by grants from the Young Talent Support Program of Xi'an City Association for Science and Technology[959202413081]Scientific Research Plan Project of Shaanxi Provincial Department of Education[23JK0646]+1 种基金Shaanxi Province“Fourteenth Five-Year Plan”educational scientific planning project[SGH23Y2464]supported in part by the Southampton National Institute for Health and Care Research,Biomedical Research Centre[NIHR203319].
文摘The Korean Republic nationwide cohort study by Yun et al.reveals a stepwise increase in hepatocellular carcinoma(HCC)risk,progressing from“pure”metabolic dysfunction-associated steatotic liver disease(MASLD)to MASLD with increased alcohol intake(MetALD)and then to alcohol-associated liver disease[1].These data also highlight the significant impact of age and gender,underscoring the importance of tailoring prevention strategies to address not only metabolic dysfunction but also alcohol consumption in liver disease management[1].This Korean cohort study also illustrates the characteristics of MASLD-related HCC,providing new insights into the natural history of this liver disease.
文摘Background:With the rising global prevalence of fatty liver disease related to metabolic dysfunction,the association of this common liver condition with chronic kidney disease(CKD)has become increasingly evident.In 2020,the more inclusive term metabolic dysfunction-associated fatty liver disease(MAFLD)was proposed to replace the term non-alcoholic fatty liver disease(NAFLD).The observed association between MAFLD and CKD and our understanding that CKD can be a consequence of underlying metabolic dysfunction support the notion that individuals with MAFLD are at higher risk of having and developing CKD compared with those without MAFLD.However,to date,there is no appropriate guidance on CKD in individuals with MAFLD.Furthermore,there has been little attention paid to the link between MAFLD and CKD in the Nephrology community.Methods and Results:Using a Delphi-based approach,a multidisciplinary panel of 50 international experts from 26 countries reached a consensus on some of the open research questions regarding the link between MAFLD and CKD.Conclusions:This Delphi-based consensus statement provided guidance on the epidemiology,mechanisms,management and treatment of MAFLD and CKD,as well as the relationship between the severity of MAFLD and risk of CKD,which establish a framework for the early prevention and management of these two common and interconnected diseases.
基金supported by grants from the National Natural Science Foundation of China(82070588)High Level Creative Talents from Department of Public Health in Zhejiang Province(S2032102600032)+2 种基金Project of New Century 551 Talent Nurturing in Wenzhousupported in part by grants from the University School of Medicine of Verona,Verona,Italysupported in part by the Southampton NIHR Biomedical Research Centre(IS-BRC-20004),UK.
文摘Background:There is an unmet need for accurate non-invasive methods to diagnose non-alcoholic steatohepatitis(NASH).Since impedance-based measurements of body composition are simple,repeatable and have a strong association with non-alcoholic fatty liver disease(NAFLD)severity,we aimed to develop a novel and fully automatic machine learning algorithm,consisting of a deep neural network based on impedance-based measurements of body composition to identify NASH[the bioeLectrical impEdance Analysis foR Nash(LEARN)algorithm].Methods:A total of 1,259 consecutive subjects with suspected NAFLD were screened from six medical centers across China,of which 766 patients with biopsy-proven NAFLD were included in final analysis.These patients were randomly subdivided into the training and validation groups,in a ratio of 4:1.The LEARN algorithm was developed in the training group to identify NASH,and subsequently,tested in the validation group.Results:The LEARN algorithm utilizing impedance-based measurements of body composition along with age,sex,pre-existing hypertension and diabetes,was able to predict the likelihood of having NASH.This algorithm showed good discriminatory ability for identifying NASH in both the training and validation groups[area under the receiver operating characteristics(AUROC):0.81,95%CI:0.77-0.84 and AUROC:0.80,95%CI:0.73-0.87,respectively].This algorithm also performed better than serum cytokeratin-18 neoepitope M30(CK-18 M30)level or other non-invasive NASH scores(including HAIR,ION,NICE)for identifying NASH(P value<0.001).Additionally,the LEARN algorithm performed well in identifying NASH in different patient subgroups,as well as in subjects with partial missing body composition data.Conclusions:The LEARN algorithm,utilizing simple easily obtained measures,provides a fully automated,simple,non-invasive method for identifying NASH.
基金supported by grants from the National Natural Science Foundation of China (No.82070588,No.82370577)supported in part by grants from the School of Medicine,University of Verona,Verona,Italysupported in part by the Southampton NIHR Biomedical Research Centre,UK (NIHR203319).
文摘Metabolic dysfunction-associated fatty liver disease(MAFLD),previously termed non-alcoholic fatty liver disease,is one of the most common causes of chronic liver disease,affecting around 30%of the world’s adults(1).MAFLD encompasses a spectrum of liver conditions,ranging from simple steatosis to metabolic dysfunction-associated steatohepatitis(MASH),which can progress to cirrhosis and hepatocellular carcinoma(HCC)(2,3).
文摘A history of cigarette smoking is present in approximately 40%of patients with chronic liver diseases and there is considerable interest in better understanding if and how cigarette smoking may affect chronic liver diseases[1].Non-alcoholic fatty liver disease(NAFLD)is currently the most common cause of chronic liver disease,affecting up to 30%of the world’s adults[2].Genetic and environmental factors contribute to the development and progression of NAFLD,and increasing evidence shows that smoking is associated with more severe liver disease in NAFLD[3,4].Despite convincing evidence of this association between smoking and liver disease,the underlying mechanism(s)linking smoking with NAFLD is still poorly understood.
基金supported by grants from the National Natural Science Foundation of China(No.82070588)High Level Creative Talents from Department of Public Health in Zhejiang Province(No.S2032102600032)+1 种基金Project of New Century 551 Talent Nurturing in Wenzhou,Wenzhou Science and Technology Bureau(No.Y20190530)the University School of Medicine of Verona in Italy to GT and in part by the Southampton NIHR Biomedical Research Centre in UK(No.IS-BRC-20004 to CDB).
文摘Background:Animal organ meat(offal)is a food with high nutrient density that is popular in different parts of the world,but its relationship with nonalcoholic steatohepatitis(NASH)is unclear.We aimed to examine whether daily animal organ meat consumption is associated with the presence of NASH in individuals with nonalcoholic fatty liver disease(NAFLD).Methods:A total of 136 Chinese adults with biopsy-proven NAFLD were included.Definite NASH was defined as NAFLD activity score≥4 and at least one point for steatosis,ballooning,and lobular inflammation.Daily animal organ meat consumption was estimated using a self-administered validated food frequency questionnaire.Logistic regression analysis was performed to assess the association between animal organ meat intake and liver disease severity.Results:The 136 participants(80.9%men)of the study had a mean±standard deviation(SD)age of 39.0±12.5 years and body mass index of 27.4±3.6 kg/m2.Prevalence of definite NASH was 65.4%.Daily median organ meat consumption was 1.30 g/1,000 kcal.Animal organ meat consumption was inversely associated with the presence of NASH even after adjustment of demographics,lifestyle variables,metabolic and dietary factors,as well as liver fibrosis stage;adjusted-odds ratios(95%confidence intervals)for NASH were 0.15(0.03,0.69)for the highest tertile and 0.18(0.05,0.70)for the medium tertile,compared to the lowest(reference)tertile of animal organ meat intake(P value for trend=0.024).Conclusions:Our results suggest for the first time that higher animal organ meat consumption is associated with a lower prevalence of NASH in Chinese individuals with biopsy-proven NAFLD.
基金the Robert W.Storr Bequest to the Sydney Medical Foundation,University of Sydneya National Health and Medical Research Council of Australia(NHMRC)Program Grant(No.APP1053206 and APP1149976)+2 种基金Project grants(No.APP1107178 and APP1108422)Ming-Hua Zheng is supported by grants from the National Natural Science Foundation of China(No.81500665)High Level Creative Talents from Department of Public Health in Zhejiang Province and Project of New Century 551 Talent Nurturing in Wenzhou.
文摘The term non-alcoholic fatty liver disease(NAFLD)was coined in 1980 to characterize a disease similar to alcoholic fatty liver disease that developed in patients without a history of excessive alcohol intake.[1]Morphologically,NAFLD is characterized by excess fatty infiltration of the liver in the absence of known causes of liver disease(eg,alcohol,autoimmune liver disease,viral hepatitis,etc).The clinical manifestations of NAFLD(both hepatic and extrahepatic)depend on the outcome of complex interactions between its primary drivers including poor lifestyle habits and diet,a dysfunctional microbiota,genetic predisposition,and environmental cues that result in metabolic dysfunction and liver disease.However,bringing all patients with their markedly different clinical courses under the NAFLD umbrella belies its complexity and implies a homogeneous disease state that then negatively impacts clinical management and a deeper understanding of pathogenesis.With advances in current knowledge on the spectrum of fatty liver diseases,it is apparent that the fourdecade-old outdated term NAFLD can no longer serve to usefully describe a highly heterogeneous disease.The disease as we understand it today not only impacts patients who consume alcohol and those who do not,but also potentially impacts all patients with any form of liver disease,by acting as a disease modifier.[2]
基金supported by grants from the National Natural Science Foundation of China(No.82070588)High Level Creative Talents from the Department of Public Health in Zhejiang Province(No.S2032102600032)Project of New Century 551 Talent Nurturing in Wenzhou.This work is a part of the PERSONS study.
文摘The emergence of non-alcoholic fatty liver disease(NAFLD)as the leading chronic liver disease worldwide raises some concerns.In particular,NAFLD is closely tied to sedentary lifestyle habits and associated with other metabolic diseases,such as obesity and diabetes.At the end of the disease spectrum,non-alcoholic steatohepatitis(NASH)may progress to cirrhosis and hepatocellular carcinoma(HCC),representing a serious health problem to modern society.Recently,an increasing number of HCC cases originating from this progressive disease spectrum have been identified,with different levels of severity and complications.Updating the current guidelines by placing a bigger focus on this emerging cause and highlighting some of its unique features is necessary.Since,the drivers of the disease are complex and multifactorial,in order to improve future outcomes,having a better understanding of NASH progression into HCC may be helpful.The risks that can promote disease progression and currently available management strategies employed to monitor and treat NASH-related HCC make up the bulk of this review.
基金supported by grants from the National Natural Science Foundation of China(81500665)High Level Creative Talents from Department of Public Health in Zhejiang Province and Project of New Century 551 Talent Nurturing in Wenzhou+1 种基金GT is supported in part by grants from the University School of Medicine of Verona,Verona,ItalyCDB is supported in part by grants from the Southampton National Institute for Health Research Biomedical Research Centre(IS-BRC-20004),UK.
文摘The outbreak of coronavirus disease 2019(COVID-19),caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has attracted increasing worldwide attention.Cases of liver damage or dysfunction(mainly characterized by moderately elevated serum aspartate aminotransferase lev-els)have been reported among patients with COVID-19.However,it is currently uncertain whether the COVID-19-related liver damage/dysfunction is due mainly to the viral infection per se or other coexisting conditions,such as the use of potentially hepatotoxic drugs and the coexistence of sys-temic inflammatory response,respiratory distress syndrome-induced hypoxia,and multiple organ dysfunction.Based on the current evidence from case reports and case series,this review article focuses on the demographic and clinical characteristics,potential mechanisms,and treatment options for COVID-19-related liver dysfunction.This review also describes the geo-graphical and demographic distribution of COVID-19-related liver dysfunction,as well as possible underlying mechanisms linking COVID-19 to liver dysfunction,in order to facilitate future drug development,prevention,and control measures for COVID-19.
基金Ming-Hua Zheng is supported by grants from the National Natural Science Foundation of China(No.81500665)High Level Creative Talents from Department of Public Health in Zhejiang Province,and Project of New Century 551 Talent Nurturing in Wenzhou.Giovanni Targher is supported in part by grants from the School of Medicine,University of Verona,Verona,Italy.Christopher D.Byrne is supported in part by the Southampton National Institute for Health Research Biomedical Research Centre,UK(IS-BRC-20004)。
文摘Non-alcoholic fatty liver disease(NAFLD)is estimated to affect approximately 25%of the adult population worldwide.[1]NAFLD encompasses a histopathological spectrum of progressive pathologic conditions ranging from non-alcoholic fatty liver(NAFL)to steatohepatitis(NASH)and cirrhosis.
基金grants from National Natural Science Foundation of China(81201287)Beijing Nova Program of China(Z121107002512071)
文摘Hepatitis B virus (HBV) infection remains a worldwide health problem,and is the major cause of hepatitis,liver cirrhosis,and hepatocellular carcinoma.The innate and adaptive immune responses of the HBV-infected host contribute greatly to the development and pathogenesis of chronic HBV infection,and often affect the efficacy of anti-HBV drugs.Interleukin (IL)-22 is a newly identified cytokine that is involved in the pathogenesis of liver disease,but its role in liver inflammation in patients with HBV infection remains controversial.In this report,we summarize the production and function of IL-22 in inflammatory environments,and review the current research into IL-22 biology in HBV infection.A better understanding of the intrahepatic micro-environments that directly influence the activity of IL-22 will be important for the development of new immunotherapeutic approaches that target IL-22-producing cells or IL-22 itself.
基金ME and JG are supported by the Robert W.Storr Bequest to the Sydney Medical Foundation,University of Sydneya National Health and Medical Research Council of Australia(NHMRC)Program Grant(APP1053206,APP1149976)+3 种基金Project grants(APP1107178 and APP1108422)MHZ is supported by grants from the National Natural Science Foundation of China(82070588)High Level Creative Talents from Department of Public Health in Zhejiang Province(S2032102600032)Project of New Century 551 Talent Nurturing in Wenzhou.
文摘Metabolic-associated fatty liver disease(MAFLD)(1),formerly known as non-alcoholic fatty liver disease,is a major causes of liver cirrhosis(2).MAFLD represents a growing global health and economic burden since approximately one in four people have the disease(3).As a consequence,MAFLD-related cirrhosis is expected to become the leading cause for liver failure and liver cancer,and the major indication for liver transplantation this century(3).
