Diagnostic and therapeutic role of endoscopic ultrasound in liver diseases:A systematic review and meta-analysis

BACKGROUND In hepatology,the clinical use of endoscopic ultrasound(EUS)has experienced a notable increase in recent times.These applications range from the diagnosis to the treatment of various liver diseases.Therefore,this systematic review summarizes the evidence for the diagnostic and therapeutic roles of EUS in liver diseases.AIM To examine and summarize the current available evidence of the possible roles of the EUS in making a suitable diagnosis in liver diseases as well as the therapeutic accuracy and efficacy.METHODS PubMed,Medline,Cochrane Library,Web of Science,and Google Scholar databases were extensively searched until October 2023.The methodological quality of the eligible articles was assessed using the Newcastle-Ottawa scale or Cochrane Risk of Bias tool.In addition,statistical analyses were performed using the Comprehensive Meta-Analysis software.RESULTS Overall,45 articles on EUS were included(28 on diagnostic role and 17 on therapeutic role).Pooled analysis demonstrated that EUS diagnostic tests had an accuracy of 92.4%for focal liver lesions(FLL)and 96.6%for parenchymal liver diseases.EUS-guided liver biopsies with either fine needle aspiration or fine needle biopsy had low complication rates when sampling FLL and parenchymal liver diseases(3.1%and 8.7%,respectively).Analysis of data from four studies showed that EUS-guided liver abscess had high clinical(90.7%)and technical success(90.7%)without significant complications.Similarly,EUS-guided interventions for the treatment of gastric varices(GV)have high technical success(98%)and GV obliteration rate(84%)with few complications(15%)and rebleeding events(17%).CONCLUSION EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases.

Interplays of liver fibrosis-associated microRNAs:Molecular mechanisms and implications in diagnosis and therapy

microRNAs(miRNAs)are a class of non-coding functional small RNA composed of 21e23 nucleotides,having multiple associations with liver fibrosis.Fibrosis-associated miRNAs are roughly classified into pro-fibrosis or anti-fibrosis types.The former is capable of activating hepatic stellate cells(HSCs)by modulating pro-fibrotic signaling pathways,mainly including TGF-b/SMAD,WNT/b-catenin,and Hedgehog;the latter is responsible for maintenance of the quiescent phenotype of normal HSCs,phenotypic reversion of activated HSCs(aHSCs),inhibition of HSCs proliferation and suppression of the extracellular matrix-associated gene expression.Moreover,several miRNAs are involved in regulation of liver fibrosis via alternative mechanisms,such as interacting between hepatocytes and other liver cells via exosomes and increasing autophagy of aHSCs.Thus,understanding the role of these miRNAs may provide new avenues for the development of novel interventions against hepatic fibrosis.

Does the homologous booster with the inactivated coronavirus disease 2019 vaccine work for the omicron variant?Real-world evidence from Jilin,China

To the Editor:The latest variant of concern,Omicron,has become the dominant global variant immediately after it was first reported in November 2021.[1]It contains>30 mutations in the spike protein,with 17 mutations in the receptor-binding domain,rendering it with increased transmissibility and capacity for immune evasion.[1,2]Moreover,the waning of protection has been observed over time since the coronavirus disease 2019(COVID-19)vaccination.[3]Therefore,a booster is highly recommended.A large-scale study in the UK assessing the effectiveness of the booster vaccination with either the BNT162b2 or mRNA-1273 indicated that the booster shot substantially increased protection against symptomatic infection in patients with the confirmed Omicron variant infection.[3]However,although the laboratory study has illustrated that the homologous booster with the inactivated COVID-19 vaccine could also yield potent neutralizing activity against the Omicron variant,[4]clinical evidence regarding the effectiveness of this vaccination program is limited.

流行性感冒

世界卫生组织（WHO）估算，每年约有1亿人感染流行性感冒（简称流感），超过50000人因流感死亡。最重的疾病负担多出现于儿童，而最重的严重疾病负担则出现在有基础疾病的患者、婴儿、少儿以及老年人。目前在人类中流行的流感病毒株为甲型H1N1流感、甲型H3N2流感，以及两种乙型流感——Victoria系和Yamagata系。