Anabolic androgenic steroids(AASs)are a group of molecules including endogenous testosterone and synthetic derivatives that have both androgenic and anabolic effects.These properties make them therapeutically benefici...Anabolic androgenic steroids(AASs)are a group of molecules including endogenous testosterone and synthetic derivatives that have both androgenic and anabolic effects.These properties make them therapeutically beneficial in medical conditions such as hypogonadism.However,they are commonly bought illegally and misused for their anabolic,skeletal muscle building,and performanceenhancing effects.Supraphysiologic and long-term use of AASs affects all organs,leading to cardiovascular,neurological,endocrine,gastrointestinal,renal,and hematologic disorders.Hepatotoxicity is one of the major concerns regarding AASs treatment and abuse.Testosterone and its derivatives have been most often shown to induce a specific form of cholestasis,peliosis hepatis,and hepatic benign and malignant tumors.It is currently believed that mechanisms of pathogenesis of these disorders include disturbance of antioxidative factors,upregulation of bile acid synthesis,and induction of hepatocyte hyperplasia.Most toxicity cases are treated with supportive measures and liver function normalizes with discontinuation of AAS.However,some long-term consequences are irreversible.AAS-induced liver injury should be taken in consideration in patients with liver disorders,especially with the increasing unintentional ingestion of supplements containing AAS.In this paper,we review the most current knowledge about AAS-associated adverse effects on the liver,and their clinical presentations,prevalence,and pathophysiological mechanisms.展开更多
Liver injury secondary to vaccination is a rare adverse event that has recently come under attention thanks to the continuous pharmacovigilance following the widespread implementation of coronavirus disease 2019(COVID...Liver injury secondary to vaccination is a rare adverse event that has recently come under attention thanks to the continuous pharmacovigilance following the widespread implementation of coronavirus disease 2019(COVID-19)vaccination protocols.All three most widely distributed severe acute respiratory syndrome coronavirus 2 vaccine formulations,e.g.,BNT162b2,mRNA-1273,and ChAdOx1-S,can induce liver injury that may involve immune-mediated pathways and result in autoimmune hepatitis-like presentation that may require therapeutic intervention in the form of corticosteroid administration.Various mechanisms have been proposed in an attempt to highlight immune checkpoint inhibition and thus establish causality with vaccination.The autoimmune features of such a reaction also prompt an in-depth investigation of the newly employed vaccine technologies.Novel vaccine delivery platforms,e.g.,mRNA-containing lipid nanoparticles and adenoviral vectors,contribute to the inflammatory background that leads to an exaggerated immune response,while patterns of molecular mimicry between the spike(S)protein and prominent liver antigens may account for the autoimmune presentation.Immune mediators triggered by vaccination or vaccine ingredients per se,including autoreactive antibodies,cytokines,and cytotoxic T-cell populations,may inflict hepatocellular damage through wellestablished pathways.We aim to review available data associated with immunemediated liver injury associated with COVID-19 vaccination and elucidate potential mechanisms underlying its pathogenesis.展开更多
目的探讨药物性肝损伤(DILI)患者临床转归的影响因素,构建列线图模型并进行内部验证。方法回顾性分析哈尔滨工业大学附属黑龙江省医院2017年1月—2022年12月收治的188例DILI患者的一般资料和实验室数据,根据患者临床转归分为结局良好组(...目的探讨药物性肝损伤(DILI)患者临床转归的影响因素,构建列线图模型并进行内部验证。方法回顾性分析哈尔滨工业大学附属黑龙江省医院2017年1月—2022年12月收治的188例DILI患者的一般资料和实验室数据,根据患者临床转归分为结局良好组(n=146)和不良结局组(n=42)。正态分布计量资料两组间比较采用成组t检验;非正态分布计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ^(2)检验。通过单因素和多因素Logistic回归分析筛选DILI患者临床转归相关的独立影响因素。R Studio 4.1.2软件构建列线图模型,通过校准曲线、受试者工作特征曲线(ROC曲线)和决策曲线分析(DCA)对模型进行内部验证。结果单因素Logistic回归分析结果显示,肝活检诊断DILI、PLT、ChE、Alb、PTA、IgM和IgG与DILI患者不良结局相关(P值均<0.05)。多因素Logistic回归分析结果显示,肝活检诊断DILI(OR=0.072,95%CI:0.022~0.213,P<0.001)、临床分型(OR=0.463,95%CI:0.213~0.926,P=0.039)、ALT(OR=0.999,95%CI:0.998~1.000,P=0.025)、PTA(OR=0.973,95%CI:0.952~0.993,P=0.011)和Ig M(OR=1.456,95%CI:1.082~2.021,P=0.015)是DILI患者临床转归的独立影响因素。构建列线图,经验证校准曲线接近参考曲线,ROC曲线下面积为0.829,决策曲线分析显示该模型具有良好的临床净收益。结论构建的列线图模型对评估DILI患者的临床转归具有较好的临床校准度、鉴别能力和应用价值。展开更多
Background and Aims:The effect of ginsenoside Rb1 on D-galactosamine(D-GalN)/lipopolysaccharide(LPS)-induced acute liver injury(ALI)is unknown.The aim of this study was to evaluate the effect of ginsenoside Rb1 on ALI...Background and Aims:The effect of ginsenoside Rb1 on D-galactosamine(D-GalN)/lipopolysaccharide(LPS)-induced acute liver injury(ALI)is unknown.The aim of this study was to evaluate the effect of ginsenoside Rb1 on ALI and its underlying mechanisms.Methods:Mice were pretreated with ginsenoside Rb1 by intraperitoneal injection for 3 days before D-GalN/LPS treatment,to induce ALI.The survival rate was monitored every hour for 24 h,and serum biochemical parameters,hepatic index and histopathological analysis were evaluated to measure the degree of liver injury.ELISA was used to detect oxidative stress and inflammatory cytokines in hepatic tissue and serum.Immunohistochemistry staining,RT-PCR and western blotting were performed to evaluate the expression of toll-like receptor 4(TLR4),nuclear factorkappa B(NF-κB),and NLR family,pyrin domain-containing 3 protein(NLRP3)in liver tissue and Kupffer cells(KCs).Results:Ginsenoside Rb1 improved survival with D-GalN/LPS-induced ALI by up to 80%,significantly ameliorated the increased alanine and aspartate transaminase,restored the hepatic pathological changes and reduced the levels of oxidative stress and inflammatory cytokines altered by D-GalN/LPS.Compared to the control group,the KCs were increased in the D-GalN/LPS groups but did not increase significantly with Rb1 pretreatment.D-GalN/LPS could upregulate while Rb1 pretreatment could downregulate the expression of interleukin(IL)-1β,IL-18,NLRP3,apoptosis associated specklike protein containing CARD(ASC)and caspase-1 in isolated KCs.Furthermore,ginsenoside Rb1 inhibited activation of the TLR4/NF-κB signaling pathway and NLRP3 inflammasome induced by D-GalN/LPS administration.Conclusions:Ginsenoside Rb1 protects mice against D-GalN/LPS-induced ALI by attenuating oxidative stress and the inflammatory response through the TLR4/NF-κB signaling pathway and NLRP3 inflammasome activation.展开更多
文摘Anabolic androgenic steroids(AASs)are a group of molecules including endogenous testosterone and synthetic derivatives that have both androgenic and anabolic effects.These properties make them therapeutically beneficial in medical conditions such as hypogonadism.However,they are commonly bought illegally and misused for their anabolic,skeletal muscle building,and performanceenhancing effects.Supraphysiologic and long-term use of AASs affects all organs,leading to cardiovascular,neurological,endocrine,gastrointestinal,renal,and hematologic disorders.Hepatotoxicity is one of the major concerns regarding AASs treatment and abuse.Testosterone and its derivatives have been most often shown to induce a specific form of cholestasis,peliosis hepatis,and hepatic benign and malignant tumors.It is currently believed that mechanisms of pathogenesis of these disorders include disturbance of antioxidative factors,upregulation of bile acid synthesis,and induction of hepatocyte hyperplasia.Most toxicity cases are treated with supportive measures and liver function normalizes with discontinuation of AAS.However,some long-term consequences are irreversible.AAS-induced liver injury should be taken in consideration in patients with liver disorders,especially with the increasing unintentional ingestion of supplements containing AAS.In this paper,we review the most current knowledge about AAS-associated adverse effects on the liver,and their clinical presentations,prevalence,and pathophysiological mechanisms.
文摘Liver injury secondary to vaccination is a rare adverse event that has recently come under attention thanks to the continuous pharmacovigilance following the widespread implementation of coronavirus disease 2019(COVID-19)vaccination protocols.All three most widely distributed severe acute respiratory syndrome coronavirus 2 vaccine formulations,e.g.,BNT162b2,mRNA-1273,and ChAdOx1-S,can induce liver injury that may involve immune-mediated pathways and result in autoimmune hepatitis-like presentation that may require therapeutic intervention in the form of corticosteroid administration.Various mechanisms have been proposed in an attempt to highlight immune checkpoint inhibition and thus establish causality with vaccination.The autoimmune features of such a reaction also prompt an in-depth investigation of the newly employed vaccine technologies.Novel vaccine delivery platforms,e.g.,mRNA-containing lipid nanoparticles and adenoviral vectors,contribute to the inflammatory background that leads to an exaggerated immune response,while patterns of molecular mimicry between the spike(S)protein and prominent liver antigens may account for the autoimmune presentation.Immune mediators triggered by vaccination or vaccine ingredients per se,including autoreactive antibodies,cytokines,and cytotoxic T-cell populations,may inflict hepatocellular damage through wellestablished pathways.We aim to review available data associated with immunemediated liver injury associated with COVID-19 vaccination and elucidate potential mechanisms underlying its pathogenesis.
文摘目的探讨药物性肝损伤(DILI)患者临床转归的影响因素,构建列线图模型并进行内部验证。方法回顾性分析哈尔滨工业大学附属黑龙江省医院2017年1月—2022年12月收治的188例DILI患者的一般资料和实验室数据,根据患者临床转归分为结局良好组(n=146)和不良结局组(n=42)。正态分布计量资料两组间比较采用成组t检验;非正态分布计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ^(2)检验。通过单因素和多因素Logistic回归分析筛选DILI患者临床转归相关的独立影响因素。R Studio 4.1.2软件构建列线图模型,通过校准曲线、受试者工作特征曲线(ROC曲线)和决策曲线分析(DCA)对模型进行内部验证。结果单因素Logistic回归分析结果显示,肝活检诊断DILI、PLT、ChE、Alb、PTA、IgM和IgG与DILI患者不良结局相关(P值均<0.05)。多因素Logistic回归分析结果显示,肝活检诊断DILI(OR=0.072,95%CI:0.022~0.213,P<0.001)、临床分型(OR=0.463,95%CI:0.213~0.926,P=0.039)、ALT(OR=0.999,95%CI:0.998~1.000,P=0.025)、PTA(OR=0.973,95%CI:0.952~0.993,P=0.011)和Ig M(OR=1.456,95%CI:1.082~2.021,P=0.015)是DILI患者临床转归的独立影响因素。构建列线图,经验证校准曲线接近参考曲线,ROC曲线下面积为0.829,决策曲线分析显示该模型具有良好的临床净收益。结论构建的列线图模型对评估DILI患者的临床转归具有较好的临床校准度、鉴别能力和应用价值。
基金Supported by Clinical Research Plan of SHDC(No.SHDC2020CR4067)Shanghai Science and Technology Commission(No.20S31905300 and No.20Y11900900)+1 种基金Anti-COVID-19 grant from ZhongShan Hospital,Fudan University(No.002 and No.008)National Natural Science Foundation of China(No.82072131 and No.J1924010).
文摘Background and Aims:The effect of ginsenoside Rb1 on D-galactosamine(D-GalN)/lipopolysaccharide(LPS)-induced acute liver injury(ALI)is unknown.The aim of this study was to evaluate the effect of ginsenoside Rb1 on ALI and its underlying mechanisms.Methods:Mice were pretreated with ginsenoside Rb1 by intraperitoneal injection for 3 days before D-GalN/LPS treatment,to induce ALI.The survival rate was monitored every hour for 24 h,and serum biochemical parameters,hepatic index and histopathological analysis were evaluated to measure the degree of liver injury.ELISA was used to detect oxidative stress and inflammatory cytokines in hepatic tissue and serum.Immunohistochemistry staining,RT-PCR and western blotting were performed to evaluate the expression of toll-like receptor 4(TLR4),nuclear factorkappa B(NF-κB),and NLR family,pyrin domain-containing 3 protein(NLRP3)in liver tissue and Kupffer cells(KCs).Results:Ginsenoside Rb1 improved survival with D-GalN/LPS-induced ALI by up to 80%,significantly ameliorated the increased alanine and aspartate transaminase,restored the hepatic pathological changes and reduced the levels of oxidative stress and inflammatory cytokines altered by D-GalN/LPS.Compared to the control group,the KCs were increased in the D-GalN/LPS groups but did not increase significantly with Rb1 pretreatment.D-GalN/LPS could upregulate while Rb1 pretreatment could downregulate the expression of interleukin(IL)-1β,IL-18,NLRP3,apoptosis associated specklike protein containing CARD(ASC)and caspase-1 in isolated KCs.Furthermore,ginsenoside Rb1 inhibited activation of the TLR4/NF-κB signaling pathway and NLRP3 inflammasome induced by D-GalN/LPS administration.Conclusions:Ginsenoside Rb1 protects mice against D-GalN/LPS-induced ALI by attenuating oxidative stress and the inflammatory response through the TLR4/NF-κB signaling pathway and NLRP3 inflammasome activation.
