Hepatocellular carcinoma(HCC)is a prevalent and aggressive liver malignancy.The interplay between bile acids(BAs)and the gut microbiota has emerged as a critical factor in HCC development and progression.Under normal ...Hepatocellular carcinoma(HCC)is a prevalent and aggressive liver malignancy.The interplay between bile acids(BAs)and the gut microbiota has emerged as a critical factor in HCC development and progression.Under normal conditions,BA metabolism is tightly regulated through a bidirectional interplay between gut microorganisms and BAs.The gut microbiota plays a critical role in BA metabolism,and BAs are endogenous signaling molecules that help maintain liver and intestinal homeostasis.Of note,dysbiotic changes in the gut microbiota during pathogenesis and cancer development can disrupt BA homeostasis,thereby leading to liver inflammation and fibrosis,and ultimately contributing to HCC development.Therefore,understanding the intricate interplay between BAs and the gut microbiota is crucial for elucidating the mechanisms underlying hepatocarcinogenesis.In this review,we comprehensively explore the roles and functions of BA metabolism,with a focus on the interactions between BAs and gut microorganisms in HCC.Additionally,therapeutic strategies targeting BA metabolism and the gut microbiota are discussed,including the use of BA agonists/antagonists,probiotic/prebiotic and dietary interventions,fecal microbiota transplantation,and engineered bacteria.In summary,understanding the complex BA-microbiota crosstalk can provide valuable insights into HCC development and facilitate the development of innovative therapeutic approaches for liver malignancy.展开更多
Chronic hepatitis B(CHB)virus infection is a global public health problem,affecting more than 400 million people worldwide.The clinical spectrum is wide,ranging from a subclinical inactive carrier state,to progressive...Chronic hepatitis B(CHB)virus infection is a global public health problem,affecting more than 400 million people worldwide.The clinical spectrum is wide,ranging from a subclinical inactive carrier state,to progressive chronic hepatitis,cirrhosis,decompensation,and hepatocellular carcinoma.However,complications of hepatitis B virus(HBV)-related chronic liver disease may be reduced by viral suppression.Current international guidelines recommend first-line treatment of CHB infection with pegylated interferon,entecavir,or tenofovir,but the optimal treatment for an individualpatient is controversial.The indications for treatment are contentious,and increasing evidence suggests that HBV genotyping,as well as serial on-treatment measurements of hepatitis B surface antigen and HBV DNA kinetics should be used to predict antiviral treatment response.The likelihood of achieving a sustained virological response is also increased by extending treatment duration,and using combination therapy.Hence the paradigm for treatment of CHB is constantly evolving.This article summarizes the different indications for treatment,and systematically reviews the evidence for the efficacy of various antiviral agents.It further discusses the shortcomings of current guidelines,use of rescue therapy in drug-resistant strains of HBV,and highlights the promising clinical trials for emerging therapies in the pipeline.This concise overview presents an updated practical approach to guide the clinical management of CHB.展开更多
Epstein-Barr virus(EBV)-associated gastric carcinoma(EBVaGC)comprises nearly 10%of gastric carcinoma cases worldwide.Recently,it was recognised to have unique clinicopathologic characteristics,including male predomina...Epstein-Barr virus(EBV)-associated gastric carcinoma(EBVaGC)comprises nearly 10%of gastric carcinoma cases worldwide.Recently,it was recognised to have unique clinicopathologic characteristics,including male predominance,lower rates of lymph node involvement,and better prognosis.EBVaGC is further characterised by abnormal hypermethylation of tumour suppressor gene promoter regions,causing down-regulation of their expression.In the present review,we critically discuss the role of EBV in gastric carcinogenesis,summarising the role of viral proteins and microRNAs with respect to aberrant methylation in EBVaGC.Given the role of epigenetic dysregulation in tumourigenesis,epigenetic modifiers may represent a novel therapeutic strategy.展开更多
Emerging evidence suggests that microbial dysbiosis plays vital roles in many human cancers.However,knowledge of whether the microbial community in thyroid tumor is related to tumorigenesis remains elusive.In this stu...Emerging evidence suggests that microbial dysbiosis plays vital roles in many human cancers.However,knowledge of whether the microbial community in thyroid tumor is related to tumorigenesis remains elusive.In this study,we aimed to explore the microbial community in thyroid tissues and its contribution to papillary thyroid cancer(PTC).In parallel,we performed microbial profiling and transcriptome sequencing in the tumor and adjacent normal tissues of a large cohort of 340 PTC and benign thyroid nodule(BTN)patients.Distinct microbial signatures were identified in PTC,BTN,and their adjacent nontumor tissues.Intra-thyroid tissue bacteria were verified by means of bacteria staining,fluorescence in situ hybridization,and immunoelectron microscopy.We found that 17 bacterial taxa were differentially abundant in PTC compared with BTN,which included enrichment in PTC of the pathobionts Rhodococcus,Neisseria,Streptococcus,Halomonas,and Devosia,and depletion of the beneficial bacteria Amycolatopsis.These differentially abundant bacteria could differentiate PTC tumor tissues(PTC-T)from BTN tissues(BTN-T)with an area under the curve(AUC)of 81.66%.Microbial network analysis showed increased correlation strengths among the bacterial taxa in PTC-T in comparison with BTN-T.Immunefunction-corresponding bacteria(i.e.,Erwinia,Bacillus,and Acinetobacter)were found to be enriched in PTC with Hashimoto’s thyroiditis.Moreover,our integrative analysis revealed that the PTC-enriched bacteria had a positive association with key PTC-oncogenic pathway-related genes,including BRAF,KRAS,IRAK4,CTNNB1,PIK3CA,MAP3K7,and EGFR.In conclusion,our results suggest that intratumor bacteria dysbiosis is associated with the thyroid tumorigenesis and oncogenic signaling pathways of PTC.展开更多
The outcome after curative resection for hepatocellular carcinoma(HCC)remains unsatisfactory due to the high recurrence rate after surgery.In patients with hepatitis B virus(HBV)-related HCC,which is the majority of p...The outcome after curative resection for hepatocellular carcinoma(HCC)remains unsatisfactory due to the high recurrence rate after surgery.In patients with hepatitis B virus(HBV)-related HCC,which is the majority of patients with HCC in Asia,a high viral load is a strong risk factor for HCC recurrence.It is logical to believe that antiviral therapy may improve the postoperative outcome by promoting viral clearance and hepatocyte regeneration,as well as improving residual liver volume in HCC patients with hepatitis B.However,the effect of antiviral therapy on clinical outcomes after liver resection in patients with HBV-related HCC remains to be established.There are two main groups of antiviral treatment for HBV-oral nucleos(t)ide analogues and interferon.Interferon treatment reduces the overall incidence of HBV-related HCC in sustained re-sponders.However,side effects may limit its long-term clinical application.Nucleos(t)ide analogues carry fewer side effects and are potent in terms of viral suppression when compared to interferon and are typically implemented for patients with more advanced liver diseases.They may also improve the outcome after curative resection for HBV-related HCC.There are increasing evidence to suggest that antiviral therapy could suppress HBV,decrease the perioperative reactivation of viral replication,reduce liver injury,preserve the liver function before and after operation,and may lower the risk of HCC recurrence.After all,antiviral therapy may improve the survival after liver resection by reducing recurrence and delaying the liver damage by the virus,resulting in a higher chance of receiving aggressive salvage therapy during HCC recurrence.展开更多
Chronic hepatitis B(CHB)-related hepatocellular carcinoma(HCC)is a major health problem in AsianPacific regions.Antiviral therapy reduces,but does not eliminate the risk of HCC.It would be a heavy financial burden in ...Chronic hepatitis B(CHB)-related hepatocellular carcinoma(HCC)is a major health problem in AsianPacific regions.Antiviral therapy reduces,but does not eliminate the risk of HCC.It would be a heavy financial burden in most low and middle economic countries if all CHB patients received antiviral therapy and HCC surveillance.Thus,there is a need for accurate risk prediction to assist prognostication,decisions on the need for antiviral therapy and HCC surveillance.A few wellestablished risk factors for HCC,namely advanced age,male gender,high viral load,cirrhosis etc.,are the core components of three HCC risk scores:CU-HCC,GAGHCC and REACH-B scores.These 3 scores were confirmed to be accurate in predicting HCC up to 10 years in treatment-na ve patients.Their validity and applicability have recently been demonstrated in a large cohort of entecavir treatment patients.A decrease in risk scores after antiviral therapy translates to a lower risk of HCC.These findings support the application of HCC risk scores in all CHB patients.Different levels of care and different intensities of HCC surveillance should be offered according to the risk profile of patients.Patients at risk of HCC should undergo regular HCC surveillance,even when they are receiving antiviral treatment.展开更多
@Yun Qian$Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China$Institute of Gastroenterology, Zhejiang University!Hangzhou 3...@Yun Qian$Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China$Institute of Gastroenterology, Zhejiang University!Hangzhou 310016, Zhejiang Province, China@Chi-Chun Wong$Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, the Chinese University of Hong Kong!Hong Kong, China@San-Chuan Lai$Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China$Institute of Gastroenterology, Zhejiang University!Hangzhou 310016, Zhejiang Province, China@Zheng-Hua Lin$Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China$Institute of Gastroenterology, Zhejiang University!Hangzhou 310016, Zhejiang Province, China@Wei-Liang Zheng$Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China@Hui Zhao$Emergency Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China@Kong-Han Pan$Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China@Shu-Jie Chen$Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China$Institute of Gastroenterology, Zhejiang University!Hangzhou 310016, Zhejiang Province, China@Jian-Min Si$Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China$Institute of Gastroenterology, Zhejiang University!Hangzhou 310016, Zhejiang Province,展开更多
The outbreak of coronavirus disease 2019 (COVID-19) has resulted in significant morbidity and mortality worldwide. Vaccination against coronavirus disease 2019 is a use-ful weapon to combat the virus. Patients with ch...The outbreak of coronavirus disease 2019 (COVID-19) has resulted in significant morbidity and mortality worldwide. Vaccination against coronavirus disease 2019 is a use-ful weapon to combat the virus. Patients with chronic liver diseases (CLDs), including compensated or decompensated liver cirrhosis and noncirrhotic diseases, have a decreased immunologic response to coronavirus disease 2019 vaccines. At the same time, they have increased mortality if infected. Current data show a reduction in mortality when patients with chronic liver diseases are vaccinated. A suboptimal vac-cine response has been observed in liver transplant recipi-ents, especially those receiving immunosuppressive therapy, so an early booster dose is recommended to achieve a better protective effect. Currently, there are no clinical data com-paring the protective efficacy of different vaccines in patients with chronic liver diseases. Patient preference, availability of the vaccine in the country or area, and adverse effect profiles are factors to consider when choosing a vaccine. There have been reports of immune-mediated hepatitis after coronavi-rus disease 2019 vaccination, and clinicians should be aware of that potential side effect. Most patients who developed hepatitis after vaccination responded well to treatment with prednisolone, but an alternative type of vaccine should be considered for subsequent booster doses. Further prospec-tive studies are required to investigate the duration of immu-nity and protection against different viral variants in patients with chronic liver diseases or liver transplant recipients, as well as the effect of heterologous vaccination.展开更多
We report a case of sigmoid colon perforation in a patient with Crohn's disease undergoing computed-tomographic (CT) colonography. A 70-year-old patient with Crohn's disease with terminal ileitis and sigmoid s...We report a case of sigmoid colon perforation in a patient with Crohn's disease undergoing computed-tomographic (CT) colonography. A 70-year-old patient with Crohn's disease with terminal ileitis and sigmoid stricture underwent CT colonography after incomplete conventional colonoscopy. During the procedure, the colon was inflated by air insufflation and the patient developed abdominal pain with radiological evidence of retroperitoneal and intraperitoneal free gas. Hartmann's operation was performed. This case highlights that CT colonography is not risk-free. The risk of perforation may be higher in patients with inflammatory bowel disease.展开更多
Hepatitis E virus(HEV)is a major cause of viral hepatitis globally.There is growing concern about transfusion-transmitted HEV(TT-HEV)as an emerging global health problem.HEV can potentially result in chronic infection...Hepatitis E virus(HEV)is a major cause of viral hepatitis globally.There is growing concern about transfusion-transmitted HEV(TT-HEV)as an emerging global health problem.HEV can potentially result in chronic infection in immunocompromised patients,leading to a higher risk of liver cirrhosis and even death.Between 0.0013%and 0.281%of asymptomatic blood donors around the world have HEV viremia,and 0.27%to 60.5%have anti-HEV immunoglobulin G.HEV is infectious even at very low blood concentrations of the virus.Immunosuppressed patients who develop persistent hepatitis E infection should have their immunosuppressant regimen reduced;ribavirin may be considered as treatment.Pegylated interferon can be considered in those who are refractory or intolerant to ribavirin.Sofosbuvir,a nucleotide analog,showed modest antiviral activity in some clinical studies but sustained viral response was not achieved.Therefore,rescue treatment remains an unmet need.The need for HEV screening of all blood donations remains controversial.Universal screening has been adopted in some countries after consideration of risk and resource availability.Various pathogen reduction methods have also been proposed to reduce the risk of TT-HEV.Future studies are needed to define the incidence of transmission through transfusion,their clinical features,outcomes and prognosis.展开更多
A recent study published in Nature by Dominik Pfister et al.1 unveiled a darker side of immune checkpoint blockade(ICB)immunotherapy in the context of nonalcoholic steatohepatitis-associated hepatocellular carcinoma(N...A recent study published in Nature by Dominik Pfister et al.1 unveiled a darker side of immune checkpoint blockade(ICB)immunotherapy in the context of nonalcoholic steatohepatitis-associated hepatocellular carcinoma(NASH-HCC),whereby anti-PD1 treatment paradoxically accelerates hepatocarcinogenesis.展开更多
Human gastrointestinal tract harbors trillions of commensal microbes including bacteria,viruses,and fungi to form an ecological community,commonly known as the gut microbiome.Being the second most dominant taxonomic k...Human gastrointestinal tract harbors trillions of commensal microbes including bacteria,viruses,and fungi to form an ecological community,commonly known as the gut microbiome.Being the second most dominant taxonomic kingdom in the gut(5.8%of total microbiome DNA),enteric viruses are increasingly acknowledged for their roles in shaping the overall composition of the gut microbiome and maintaining human health.[1,2]Recent advancements in metagenomic sequencing have brought breakthrough in deciphering the features and functions of the gut virome.展开更多
A recent study published in Nature by Delannoy-Bruno et al.1 described the role of formulated fibre snacks on the obese gut microbiome utilizing mouse-human co-clinical trial,and demonstrated that precise dietary fibr...A recent study published in Nature by Delannoy-Bruno et al.1 described the role of formulated fibre snacks on the obese gut microbiome utilizing mouse-human co-clinical trial,and demonstrated that precise dietary fibre intervention directed at the obese gut microbiome modulates the host’s physiological state.Epidemiological and observational studies2 have long linked a diet rich in fibre to protection against chronic diseases.Dietary fibre functions as a prebiotic that can be utilized by gut microbes.Given accumulating evidence showing roles of gut microbes in health and disease,there is renewed interest in harnessing fibre as a prebiotic to promote a healthy gut microbiome.Dietary fibres are safe,inexpensive,and readily incorporated into our diet.However,the development of evidenced-based fibre preparations that selectively induce the abundance of desirable gut microbes pose a huge challenge,as fibre and the gut microbiome are complex identities that remain poorly characterized.This is confounded by their dynamic interactions and inter-and intra-personal variations.展开更多
基金supported by Fujian Provincial Natural Science(2020J01122587)National Natural Science Foundation of China(82103355,82102255,and 82222901)+1 种基金RGC Theme-based Research Scheme(T12-703/19-R)Research grants Council-General Research Fund(14117422 and 14117123)。
文摘Hepatocellular carcinoma(HCC)is a prevalent and aggressive liver malignancy.The interplay between bile acids(BAs)and the gut microbiota has emerged as a critical factor in HCC development and progression.Under normal conditions,BA metabolism is tightly regulated through a bidirectional interplay between gut microorganisms and BAs.The gut microbiota plays a critical role in BA metabolism,and BAs are endogenous signaling molecules that help maintain liver and intestinal homeostasis.Of note,dysbiotic changes in the gut microbiota during pathogenesis and cancer development can disrupt BA homeostasis,thereby leading to liver inflammation and fibrosis,and ultimately contributing to HCC development.Therefore,understanding the intricate interplay between BAs and the gut microbiota is crucial for elucidating the mechanisms underlying hepatocarcinogenesis.In this review,we comprehensively explore the roles and functions of BA metabolism,with a focus on the interactions between BAs and gut microorganisms in HCC.Additionally,therapeutic strategies targeting BA metabolism and the gut microbiota are discussed,including the use of BA agonists/antagonists,probiotic/prebiotic and dietary interventions,fecal microbiota transplantation,and engineered bacteria.In summary,understanding the complex BA-microbiota crosstalk can provide valuable insights into HCC development and facilitate the development of innovative therapeutic approaches for liver malignancy.
基金Supported by Collaborative Research Fund(CUHK3/CRF/12RHKU3/CRF11R)of the Research Grant Council Hong Kong+2 种基金National Basic Research Program of China,973 Program,No.2013CB531401CUHK Focused Investments Scheme B to HY LanTheme-based Research Scheme of the Hong Kong Re-search Grants Council,No.T12-403-11
文摘Chronic hepatitis B(CHB)virus infection is a global public health problem,affecting more than 400 million people worldwide.The clinical spectrum is wide,ranging from a subclinical inactive carrier state,to progressive chronic hepatitis,cirrhosis,decompensation,and hepatocellular carcinoma.However,complications of hepatitis B virus(HBV)-related chronic liver disease may be reduced by viral suppression.Current international guidelines recommend first-line treatment of CHB infection with pegylated interferon,entecavir,or tenofovir,but the optimal treatment for an individualpatient is controversial.The indications for treatment are contentious,and increasing evidence suggests that HBV genotyping,as well as serial on-treatment measurements of hepatitis B surface antigen and HBV DNA kinetics should be used to predict antiviral treatment response.The likelihood of achieving a sustained virological response is also increased by extending treatment duration,and using combination therapy.Hence the paradigm for treatment of CHB is constantly evolving.This article summarizes the different indications for treatment,and systematically reviews the evidence for the efficacy of various antiviral agents.It further discusses the shortcomings of current guidelines,use of rescue therapy in drug-resistant strains of HBV,and highlights the promising clinical trials for emerging therapies in the pipeline.This concise overview presents an updated practical approach to guide the clinical management of CHB.
基金Supported by Research Grants of National Basic Research Program of China (973 Program, 2010CB529305)Innovation and Technology Support Programme, Hong Kong (ITS/214/12)
文摘Epstein-Barr virus(EBV)-associated gastric carcinoma(EBVaGC)comprises nearly 10%of gastric carcinoma cases worldwide.Recently,it was recognised to have unique clinicopathologic characteristics,including male predominance,lower rates of lymph node involvement,and better prognosis.EBVaGC is further characterised by abnormal hypermethylation of tumour suppressor gene promoter regions,causing down-regulation of their expression.In the present review,we critically discuss the role of EBV in gastric carcinogenesis,summarising the role of viral proteins and microRNAs with respect to aberrant methylation in EBVaGC.Given the role of epigenetic dysregulation in tumourigenesis,epigenetic modifiers may represent a novel therapeutic strategy.
基金supported by the National Natural Science Foundation of China(81772850 and 82273300)。
文摘Emerging evidence suggests that microbial dysbiosis plays vital roles in many human cancers.However,knowledge of whether the microbial community in thyroid tumor is related to tumorigenesis remains elusive.In this study,we aimed to explore the microbial community in thyroid tissues and its contribution to papillary thyroid cancer(PTC).In parallel,we performed microbial profiling and transcriptome sequencing in the tumor and adjacent normal tissues of a large cohort of 340 PTC and benign thyroid nodule(BTN)patients.Distinct microbial signatures were identified in PTC,BTN,and their adjacent nontumor tissues.Intra-thyroid tissue bacteria were verified by means of bacteria staining,fluorescence in situ hybridization,and immunoelectron microscopy.We found that 17 bacterial taxa were differentially abundant in PTC compared with BTN,which included enrichment in PTC of the pathobionts Rhodococcus,Neisseria,Streptococcus,Halomonas,and Devosia,and depletion of the beneficial bacteria Amycolatopsis.These differentially abundant bacteria could differentiate PTC tumor tissues(PTC-T)from BTN tissues(BTN-T)with an area under the curve(AUC)of 81.66%.Microbial network analysis showed increased correlation strengths among the bacterial taxa in PTC-T in comparison with BTN-T.Immunefunction-corresponding bacteria(i.e.,Erwinia,Bacillus,and Acinetobacter)were found to be enriched in PTC with Hashimoto’s thyroiditis.Moreover,our integrative analysis revealed that the PTC-enriched bacteria had a positive association with key PTC-oncogenic pathway-related genes,including BRAF,KRAS,IRAK4,CTNNB1,PIK3CA,MAP3K7,and EGFR.In conclusion,our results suggest that intratumor bacteria dysbiosis is associated with the thyroid tumorigenesis and oncogenic signaling pathways of PTC.
文摘The outcome after curative resection for hepatocellular carcinoma(HCC)remains unsatisfactory due to the high recurrence rate after surgery.In patients with hepatitis B virus(HBV)-related HCC,which is the majority of patients with HCC in Asia,a high viral load is a strong risk factor for HCC recurrence.It is logical to believe that antiviral therapy may improve the postoperative outcome by promoting viral clearance and hepatocyte regeneration,as well as improving residual liver volume in HCC patients with hepatitis B.However,the effect of antiviral therapy on clinical outcomes after liver resection in patients with HBV-related HCC remains to be established.There are two main groups of antiviral treatment for HBV-oral nucleos(t)ide analogues and interferon.Interferon treatment reduces the overall incidence of HBV-related HCC in sustained re-sponders.However,side effects may limit its long-term clinical application.Nucleos(t)ide analogues carry fewer side effects and are potent in terms of viral suppression when compared to interferon and are typically implemented for patients with more advanced liver diseases.They may also improve the outcome after curative resection for HBV-related HCC.There are increasing evidence to suggest that antiviral therapy could suppress HBV,decrease the perioperative reactivation of viral replication,reduce liver injury,preserve the liver function before and after operation,and may lower the risk of HCC recurrence.After all,antiviral therapy may improve the survival after liver resection by reducing recurrence and delaying the liver damage by the virus,resulting in a higher chance of receiving aggressive salvage therapy during HCC recurrence.
文摘Chronic hepatitis B(CHB)-related hepatocellular carcinoma(HCC)is a major health problem in AsianPacific regions.Antiviral therapy reduces,but does not eliminate the risk of HCC.It would be a heavy financial burden in most low and middle economic countries if all CHB patients received antiviral therapy and HCC surveillance.Thus,there is a need for accurate risk prediction to assist prognostication,decisions on the need for antiviral therapy and HCC surveillance.A few wellestablished risk factors for HCC,namely advanced age,male gender,high viral load,cirrhosis etc.,are the core components of three HCC risk scores:CU-HCC,GAGHCC and REACH-B scores.These 3 scores were confirmed to be accurate in predicting HCC up to 10 years in treatment-na ve patients.Their validity and applicability have recently been demonstrated in a large cohort of entecavir treatment patients.A decrease in risk scores after antiviral therapy translates to a lower risk of HCC.These findings support the application of HCC risk scores in all CHB patients.Different levels of care and different intensities of HCC surveillance should be offered according to the risk profile of patients.Patients at risk of HCC should undergo regular HCC surveillance,even when they are receiving antiviral treatment.
基金Supported by the National Natural Science Foundation of China,No.81372623the Zhejiang Province Key Science and Technology Innovation Team,No.2013TD13
文摘@Yun Qian$Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China$Institute of Gastroenterology, Zhejiang University!Hangzhou 310016, Zhejiang Province, China@Chi-Chun Wong$Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, the Chinese University of Hong Kong!Hong Kong, China@San-Chuan Lai$Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China$Institute of Gastroenterology, Zhejiang University!Hangzhou 310016, Zhejiang Province, China@Zheng-Hua Lin$Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China$Institute of Gastroenterology, Zhejiang University!Hangzhou 310016, Zhejiang Province, China@Wei-Liang Zheng$Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China@Hui Zhao$Emergency Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China@Kong-Han Pan$Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China@Shu-Jie Chen$Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China$Institute of Gastroenterology, Zhejiang University!Hangzhou 310016, Zhejiang Province, China@Jian-Min Si$Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University!Hangzhou 310016, Zhejiang Province, China$Institute of Gastroenterology, Zhejiang University!Hangzhou 310016, Zhejiang Province,
文摘The outbreak of coronavirus disease 2019 (COVID-19) has resulted in significant morbidity and mortality worldwide. Vaccination against coronavirus disease 2019 is a use-ful weapon to combat the virus. Patients with chronic liver diseases (CLDs), including compensated or decompensated liver cirrhosis and noncirrhotic diseases, have a decreased immunologic response to coronavirus disease 2019 vaccines. At the same time, they have increased mortality if infected. Current data show a reduction in mortality when patients with chronic liver diseases are vaccinated. A suboptimal vac-cine response has been observed in liver transplant recipi-ents, especially those receiving immunosuppressive therapy, so an early booster dose is recommended to achieve a better protective effect. Currently, there are no clinical data com-paring the protective efficacy of different vaccines in patients with chronic liver diseases. Patient preference, availability of the vaccine in the country or area, and adverse effect profiles are factors to consider when choosing a vaccine. There have been reports of immune-mediated hepatitis after coronavi-rus disease 2019 vaccination, and clinicians should be aware of that potential side effect. Most patients who developed hepatitis after vaccination responded well to treatment with prednisolone, but an alternative type of vaccine should be considered for subsequent booster doses. Further prospec-tive studies are required to investigate the duration of immu-nity and protection against different viral variants in patients with chronic liver diseases or liver transplant recipients, as well as the effect of heterologous vaccination.
文摘We report a case of sigmoid colon perforation in a patient with Crohn's disease undergoing computed-tomographic (CT) colonography. A 70-year-old patient with Crohn's disease with terminal ileitis and sigmoid stricture underwent CT colonography after incomplete conventional colonoscopy. During the procedure, the colon was inflated by air insufflation and the patient developed abdominal pain with radiological evidence of retroperitoneal and intraperitoneal free gas. Hartmann's operation was performed. This case highlights that CT colonography is not risk-free. The risk of perforation may be higher in patients with inflammatory bowel disease.
文摘Hepatitis E virus(HEV)is a major cause of viral hepatitis globally.There is growing concern about transfusion-transmitted HEV(TT-HEV)as an emerging global health problem.HEV can potentially result in chronic infection in immunocompromised patients,leading to a higher risk of liver cirrhosis and even death.Between 0.0013%and 0.281%of asymptomatic blood donors around the world have HEV viremia,and 0.27%to 60.5%have anti-HEV immunoglobulin G.HEV is infectious even at very low blood concentrations of the virus.Immunosuppressed patients who develop persistent hepatitis E infection should have their immunosuppressant regimen reduced;ribavirin may be considered as treatment.Pegylated interferon can be considered in those who are refractory or intolerant to ribavirin.Sofosbuvir,a nucleotide analog,showed modest antiviral activity in some clinical studies but sustained viral response was not achieved.Therefore,rescue treatment remains an unmet need.The need for HEV screening of all blood donations remains controversial.Universal screening has been adopted in some countries after consideration of risk and resource availability.Various pathogen reduction methods have also been proposed to reduce the risk of TT-HEV.Future studies are needed to define the incidence of transmission through transfusion,their clinical features,outcomes and prognosis.
基金This work was supported by the National Key R&D Program of China(No.2020YFA0509200/2020YFA0509203)RGC-CRF Hong Kong(C4041-17GF+1 种基金C7026-18G)RGC Theme-based Res Scheme Hong Kong(T12-703/19-R).
文摘A recent study published in Nature by Dominik Pfister et al.1 unveiled a darker side of immune checkpoint blockade(ICB)immunotherapy in the context of nonalcoholic steatohepatitis-associated hepatocellular carcinoma(NASH-HCC),whereby anti-PD1 treatment paradoxically accelerates hepatocarcinogenesis.
文摘Human gastrointestinal tract harbors trillions of commensal microbes including bacteria,viruses,and fungi to form an ecological community,commonly known as the gut microbiome.Being the second most dominant taxonomic kingdom in the gut(5.8%of total microbiome DNA),enteric viruses are increasingly acknowledged for their roles in shaping the overall composition of the gut microbiome and maintaining human health.[1,2]Recent advancements in metagenomic sequencing have brought breakthrough in deciphering the features and functions of the gut virome.
基金This work was supported by RGC Theme-based Research Scheme Hong Kong(T21-705/20-N)RGC-CRF Hong Kong(C4039-19GF)+2 种基金RGC-GRF(24100520,14101917,14108718)Heath and Medical Research Fund(06170686,08190706)Vice-Chancellor’s Discretionary Fund Chinese University of Hong Kong.
文摘A recent study published in Nature by Delannoy-Bruno et al.1 described the role of formulated fibre snacks on the obese gut microbiome utilizing mouse-human co-clinical trial,and demonstrated that precise dietary fibre intervention directed at the obese gut microbiome modulates the host’s physiological state.Epidemiological and observational studies2 have long linked a diet rich in fibre to protection against chronic diseases.Dietary fibre functions as a prebiotic that can be utilized by gut microbes.Given accumulating evidence showing roles of gut microbes in health and disease,there is renewed interest in harnessing fibre as a prebiotic to promote a healthy gut microbiome.Dietary fibres are safe,inexpensive,and readily incorporated into our diet.However,the development of evidenced-based fibre preparations that selectively induce the abundance of desirable gut microbes pose a huge challenge,as fibre and the gut microbiome are complex identities that remain poorly characterized.This is confounded by their dynamic interactions and inter-and intra-personal variations.
