BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD)and metabolic dysfunction-associated steatohepatitis(MASH)are a growing health burden across a significant portion of the global patient popula...BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD)and metabolic dysfunction-associated steatohepatitis(MASH)are a growing health burden across a significant portion of the global patient population.However,these conditions seem to have disparate rates and outcomes between different ethnic populations.The combination of MASLD/MASH and type 2 diabetes increases the risk of hepatocellular carcinoma(HCC),and Hispanic patients experience the greatest burden,particularly those in South Texas.AIM To compare outcomes between Hispanic and non-Hispanic patients in the United States,while further focusing on the Hispanic population within Southeast Texas to determine whether the documented disparity in outcomes is a function of geographical circumstance or if there is a more widespread reason that all clinicians must account for in prognostic consideration.METHODS This cohort analysis was conducted with data obtained from TriNetX,LLC(“TriNetX”),a global federated health research network that provides access to deidentified medical records from healthcare organizations worldwide.Two cohort networks were used:University of Texas Medical Branch(UTMB)hospital and the United States national database collective to determine whether disparities were related to geographic regions,like Southeast Texas.RESULTS This study findings revealed Hispanics/Latinos have a statistically significant higher occurrence of HCC,type 2 diabetes mellitus,and liver fibrosis/cirrhosis in both the United States and the UTMB Hispanic/Latino groups.Allcause mortality in Hispanics/Latinos was lower within the United States group and not statistically elevated in the UTMB cohort.CONCLUSION This would appear to support that Hispanic patients in Southeast Texas are not uniquely affected compared to the national Hispanic population.展开更多
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD), especially nonalcoholic steatohepatitis, is a recognized risk factor for hepatocellular carcinoma (HCC). However, detailed analysis of the clinical features in pat...BACKGROUND: Nonalcoholic fatty liver disease (NAFLD), especially nonalcoholic steatohepatitis, is a recognized risk factor for hepatocellular carcinoma (HCC). However, detailed analysis of the clinical features in patients with NAFLD and their association with HCC is lacking. This study aimed to update the clinical features of patients with NAFLD-associated HCC. DATA SOURCES: The clinical data of patients with NAFLD- associated HCC from 25 studies published between 1990 and 2010 in the Pubmed database were comprehensively reviewed. RESULTS: In a total of 169 patients with NAFLD-associated HCC, 72.8% were male. The median age at abnormal liver function tests and diagnosis of NAFLD and HCC was 60, 64 and 67 years, respectively. Most patients were obese (75%) and diabetic (59.8%), 32.3% had dyslipidemia, and 53% had hypertension. Nearly all patients (98.6%, 71/72) were complicated with at least one metabolic disorder. The majority (76%) of the HCC patients had a solitary tumor nodule, with the tumor size ranging from 0.8 to 20 cm in diameter (mean 3.4 cm). Most (61.1%) of the patients had moderately-differentiated HCC. In 40.2% of the patients, HCC occurred in the absence of cirrhosis. Among 130 patients, 57.7% underwent hepatectomy and 14.6% received liver transplantation. The mean follow-up of the treated patients for 25 months showed that 32.4% (24/74) died and 18.8% (9/48) had recurrence. CONCLUSIONS: Patients with NAFLD-associated HCC are usually accompanied with metabolic disorders. Regular surveillance in patients with NAFLD for HCC is necessary, especially for elderly men with metabolic syndrome.展开更多
Helicobacter pylori(H. pylori) is an ancient microorganism that has co-evolved with humans for over 60000 years. This bacterium typically colonizes the human stomach and it is currently recognized as the most common i...Helicobacter pylori(H. pylori) is an ancient microorganism that has co-evolved with humans for over 60000 years. This bacterium typically colonizes the human stomach and it is currently recognized as the most common infectious pathogen of the gastroduodenal tract. Although its chronic infection is associated with gastritis, peptic ulcer, dysplasia, neoplasia, MALT lymphoma and gastric adenocarcinoma, it has been suggested the possible association of H. pylori infection with several extragastric effects including hepatobiliary and pancreatic diseases. Since a microorganism resembling H. pylori was detected in samples from patients with hepatobiliary disorders, several reports have been discussed the possible role of bacteria in hepatic diseases as hepatocellular carcinoma, cirrhosis and hepatic encephalopathy, nonalcoholic fatty liver disease and fibrosis. Additionally, studies have reported the possible association between H. pylori infection and pancreatic diseases, especially because it has been suggested that this infection could change the pancreatic physiology. Some of them have related a possible association between the microorganism and pancreatic cancer. H. pylori infection has also been suggested to play a role in the acute and chronic pancreatitis pathogenesis, autoimmune pancreatitis, diabetes mellitus and metabolic syndrome. Considering that association of H. pylori to liver and pancreas diseases needs further clarification, our work offers a review about the results of some investigations related to the potential pathogenicity of H. pylori in these extragastric diseases.展开更多
Background:We investigated whether and to what extent the ratio between circulating fibrinogen (Fg) and its degradation products (FDP)reflects the severity of coronary artery disease (CAD) in type 2 diabetic patients....Background:We investigated whether and to what extent the ratio between circulating fibrinogen (Fg) and its degradation products (FDP)reflects the severity of coronary artery disease (CAD) in type 2 diabetic patients.Methods:Plasma levels of Fg and FDP were determined,and Fg/FDP ratio was calculated in 344 consecutive patients with type 2 diabetes and chest pain on exertion undergoing coronary angiography.The severity of CAD was evaluated by the number of significant CAD (＞50％ luminal diameter narrowing) and Gensini score.Results:Plasma Fg was higher,but Fg/FDP ratio was lower in patients with significant CAD (n =255) compared with those without (n =89),due to a disproportionate increase in FDP.Fg and FDP correlated positively,while Fg/FDP ratio negatively,with the number of diseased coronary arteries and the tertile of Gensini score (all P values for trend ＜ 0.01).After adjusting for age,sex,risk factors for CAD,lipid profiles,glycosylated hemoglobin A1c,creatinine,leukocyte count,and high-sensitivity C-reactive protein,Fg/FDP ratio remained an independent determinant for multivessel coronary disease (MVD) (odds ratio [OR],0.869; 95％ confidence interval [CI],0.788-0.958,P =0.005) and high tertile of Gensini score (OR,0.797,95％ CI,0.682-0.930,P =0.004).The area under the curve of Fg/FDP ratio was larger than that of Fg for predicting the presence of MVD (0.647 vs.0.563,P =0.048) and Gensini score ≥ 30 (0.656 vs.0.53 8,P =0.026).Conclusions:Elevated plasma Fg and FDP level and reduced Fg/FDP ratio are associated with presence of CAD,and Fg/FDP ratio is superior to Fg in reflecting severe coronary atherosclerosis for patients with type 2 diabetes.展开更多
The intersection between metabolic-associated steatotic liver disease(MASLD)and chronic hepatitis B virus(HBV)infection is an emerging area of research with significant implications for public health and clinical prac...The intersection between metabolic-associated steatotic liver disease(MASLD)and chronic hepatitis B virus(HBV)infection is an emerging area of research with significant implications for public health and clinical practice.Wang et al’s study highlights the complexities of managing patients with concurrent MASLD and HBV.The findings revealed that patients with concurrent MASLD-HBV exhibited more severe liver inflammation and fibrosis,whereas those with HBV alone pre-sented a better lipid profile.The growing recognition of metabolic dysfunction in liver disease,reflected in the shift from nonalcoholic liver disease to MASLD,demands updates to clinical guidelines,particularly for patients with dual etio-logies.Understanding the biological interactions between MASLD and HBV could lead to novel therapeutic approaches,emphasizing the need for personalized treatment strategies.The coexistence of MASLD and HBV presents therapeutic challenges,particularly in managing advanced fibrosis and cirrhosis,which are more likely in these patients.The aim of this editorial is to analyze the interaction between MASLD and HBV,highlight the pathophysiological mechanisms that exacerbate liver disease when both conditions coexist,and discuss the clinical implications of the findings of Wang et al.展开更多
Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer with a high mortality rate. While chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent the leading risk factors worl...Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer with a high mortality rate. While chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent the leading risk factors worldwide, the spreading of metabolic disorders, such as diabetes, obesity and non-alcoholic fatty liver disease (NAFLD) justifies the increasing attention on their oncogenic mechanisms. This review discusses about the main pathogenic mechanisms implicated in occurrence of HCC in presence of viral and metabolic diseases. Additionally, it points to the importance of clinical surveillance for those patients considered at risk of HCC and highlights the strategical role of serum markers, such as alfa-fetoprotein (αFP) and Protein Induced by Vitamin K Absence or Antagonist II (PIVKA-II), which, in association to a strictly instrumental follow-up, contribute to the early detection of hepatic nodules with a better prognosis for affected patients.展开更多
基金Supported by Institute for Translational Sciences at the University of Texas Medical Branch,supported in part by a Clinical and Translational Science Award from the National Center for Advancing Translational Sciences at the National Institutes of Health,UL1TR001439Moody Endowment Grant,2014-07.
文摘BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD)and metabolic dysfunction-associated steatohepatitis(MASH)are a growing health burden across a significant portion of the global patient population.However,these conditions seem to have disparate rates and outcomes between different ethnic populations.The combination of MASLD/MASH and type 2 diabetes increases the risk of hepatocellular carcinoma(HCC),and Hispanic patients experience the greatest burden,particularly those in South Texas.AIM To compare outcomes between Hispanic and non-Hispanic patients in the United States,while further focusing on the Hispanic population within Southeast Texas to determine whether the documented disparity in outcomes is a function of geographical circumstance or if there is a more widespread reason that all clinicians must account for in prognostic consideration.METHODS This cohort analysis was conducted with data obtained from TriNetX,LLC(“TriNetX”),a global federated health research network that provides access to deidentified medical records from healthcare organizations worldwide.Two cohort networks were used:University of Texas Medical Branch(UTMB)hospital and the United States national database collective to determine whether disparities were related to geographic regions,like Southeast Texas.RESULTS This study findings revealed Hispanics/Latinos have a statistically significant higher occurrence of HCC,type 2 diabetes mellitus,and liver fibrosis/cirrhosis in both the United States and the UTMB Hispanic/Latino groups.Allcause mortality in Hispanics/Latinos was lower within the United States group and not statistically elevated in the UTMB cohort.CONCLUSION This would appear to support that Hispanic patients in Southeast Texas are not uniquely affected compared to the national Hispanic population.
基金supported by grants from the National Natural Science Foundation of China (81070322)the Science and Technology Commission of Shanghai Municipality (10411956300 and 09140903500)the National Basic Research Program of China (973 Program, 2012CB517501)
文摘BACKGROUND: Nonalcoholic fatty liver disease (NAFLD), especially nonalcoholic steatohepatitis, is a recognized risk factor for hepatocellular carcinoma (HCC). However, detailed analysis of the clinical features in patients with NAFLD and their association with HCC is lacking. This study aimed to update the clinical features of patients with NAFLD-associated HCC. DATA SOURCES: The clinical data of patients with NAFLD- associated HCC from 25 studies published between 1990 and 2010 in the Pubmed database were comprehensively reviewed. RESULTS: In a total of 169 patients with NAFLD-associated HCC, 72.8% were male. The median age at abnormal liver function tests and diagnosis of NAFLD and HCC was 60, 64 and 67 years, respectively. Most patients were obese (75%) and diabetic (59.8%), 32.3% had dyslipidemia, and 53% had hypertension. Nearly all patients (98.6%, 71/72) were complicated with at least one metabolic disorder. The majority (76%) of the HCC patients had a solitary tumor nodule, with the tumor size ranging from 0.8 to 20 cm in diameter (mean 3.4 cm). Most (61.1%) of the patients had moderately-differentiated HCC. In 40.2% of the patients, HCC occurred in the absence of cirrhosis. Among 130 patients, 57.7% underwent hepatectomy and 14.6% received liver transplantation. The mean follow-up of the treated patients for 25 months showed that 32.4% (24/74) died and 18.8% (9/48) had recurrence. CONCLUSIONS: Patients with NAFLD-associated HCC are usually accompanied with metabolic disorders. Regular surveillance in patients with NAFLD for HCC is necessary, especially for elderly men with metabolic syndrome.
文摘Helicobacter pylori(H. pylori) is an ancient microorganism that has co-evolved with humans for over 60000 years. This bacterium typically colonizes the human stomach and it is currently recognized as the most common infectious pathogen of the gastroduodenal tract. Although its chronic infection is associated with gastritis, peptic ulcer, dysplasia, neoplasia, MALT lymphoma and gastric adenocarcinoma, it has been suggested the possible association of H. pylori infection with several extragastric effects including hepatobiliary and pancreatic diseases. Since a microorganism resembling H. pylori was detected in samples from patients with hepatobiliary disorders, several reports have been discussed the possible role of bacteria in hepatic diseases as hepatocellular carcinoma, cirrhosis and hepatic encephalopathy, nonalcoholic fatty liver disease and fibrosis. Additionally, studies have reported the possible association between H. pylori infection and pancreatic diseases, especially because it has been suggested that this infection could change the pancreatic physiology. Some of them have related a possible association between the microorganism and pancreatic cancer. H. pylori infection has also been suggested to play a role in the acute and chronic pancreatitis pathogenesis, autoimmune pancreatitis, diabetes mellitus and metabolic syndrome. Considering that association of H. pylori to liver and pancreas diseases needs further clarification, our work offers a review about the results of some investigations related to the potential pathogenicity of H. pylori in these extragastric diseases.
基金the grants from Chinese Natural Science Foundation，Shanghai Science and Technology Key Project
文摘Background:We investigated whether and to what extent the ratio between circulating fibrinogen (Fg) and its degradation products (FDP)reflects the severity of coronary artery disease (CAD) in type 2 diabetic patients.Methods:Plasma levels of Fg and FDP were determined,and Fg/FDP ratio was calculated in 344 consecutive patients with type 2 diabetes and chest pain on exertion undergoing coronary angiography.The severity of CAD was evaluated by the number of significant CAD (＞50％ luminal diameter narrowing) and Gensini score.Results:Plasma Fg was higher,but Fg/FDP ratio was lower in patients with significant CAD (n =255) compared with those without (n =89),due to a disproportionate increase in FDP.Fg and FDP correlated positively,while Fg/FDP ratio negatively,with the number of diseased coronary arteries and the tertile of Gensini score (all P values for trend ＜ 0.01).After adjusting for age,sex,risk factors for CAD,lipid profiles,glycosylated hemoglobin A1c,creatinine,leukocyte count,and high-sensitivity C-reactive protein,Fg/FDP ratio remained an independent determinant for multivessel coronary disease (MVD) (odds ratio [OR],0.869; 95％ confidence interval [CI],0.788-0.958,P =0.005) and high tertile of Gensini score (OR,0.797,95％ CI,0.682-0.930,P =0.004).The area under the curve of Fg/FDP ratio was larger than that of Fg for predicting the presence of MVD (0.647 vs.0.563,P =0.048) and Gensini score ≥ 30 (0.656 vs.0.53 8,P =0.026).Conclusions:Elevated plasma Fg and FDP level and reduced Fg/FDP ratio are associated with presence of CAD,and Fg/FDP ratio is superior to Fg in reflecting severe coronary atherosclerosis for patients with type 2 diabetes.
文摘The intersection between metabolic-associated steatotic liver disease(MASLD)and chronic hepatitis B virus(HBV)infection is an emerging area of research with significant implications for public health and clinical practice.Wang et al’s study highlights the complexities of managing patients with concurrent MASLD and HBV.The findings revealed that patients with concurrent MASLD-HBV exhibited more severe liver inflammation and fibrosis,whereas those with HBV alone pre-sented a better lipid profile.The growing recognition of metabolic dysfunction in liver disease,reflected in the shift from nonalcoholic liver disease to MASLD,demands updates to clinical guidelines,particularly for patients with dual etio-logies.Understanding the biological interactions between MASLD and HBV could lead to novel therapeutic approaches,emphasizing the need for personalized treatment strategies.The coexistence of MASLD and HBV presents therapeutic challenges,particularly in managing advanced fibrosis and cirrhosis,which are more likely in these patients.The aim of this editorial is to analyze the interaction between MASLD and HBV,highlight the pathophysiological mechanisms that exacerbate liver disease when both conditions coexist,and discuss the clinical implications of the findings of Wang et al.
文摘Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer with a high mortality rate. While chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent the leading risk factors worldwide, the spreading of metabolic disorders, such as diabetes, obesity and non-alcoholic fatty liver disease (NAFLD) justifies the increasing attention on their oncogenic mechanisms. This review discusses about the main pathogenic mechanisms implicated in occurrence of HCC in presence of viral and metabolic diseases. Additionally, it points to the importance of clinical surveillance for those patients considered at risk of HCC and highlights the strategical role of serum markers, such as alfa-fetoprotein (αFP) and Protein Induced by Vitamin K Absence or Antagonist II (PIVKA-II), which, in association to a strictly instrumental follow-up, contribute to the early detection of hepatic nodules with a better prognosis for affected patients.
