[JOURNAL] HEPATOLOGY
Sun
200 papers
Narcotic bowel syndrome misdiagnosed as somatoform pain disorder and presenting with opioid use disorder - A case report.
Varadharajan N, Selvan JJB
Indian J Psychiatry · 2026 Jun · PMID 42396426 · Full text
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Gastric Adenocarcinoma Missed at the Incisura Angularis During Initial Endoscopy: A Case Report.
Attieh P, Derbas B, El Mustapha W … +2 more , Karam K, Fiani E
Clin Med Insights Case Rep · 2026 · PMID 42396373 · Full text
BACKGROUND: Gastric adenocarcinoma remains a major cause of cancer-related morbidity and mortality worldwide. Early detection is crucial for improving prognosis; however, early lesions may be overlooked during esophagoga...
BACKGROUND: Gastric adenocarcinoma remains a major cause of cancer-related morbidity and mortality worldwide. Early detection is crucial for improving prognosis; however, early lesions may be overlooked during esophagogastroduodenoscopy (EGD), particularly in anatomically challenging areas such as the incisura angularis. This region is considered a high-risk site for gastric neoplasia and may act as a blind spot during routine endoscopic evaluation. CASE SUMMARY: A 38-year-old female with a history of chronic gastroesophageal reflux disease presented with worsening reflux symptoms, postprandial epigastric pain, and recurrent vomiting. Nine months prior, the patient had undergone an EGD for similar symptoms, which showed no significant abnormalities. Despite treatment with proton pump inhibitors, her symptoms progressively worsened and were accompanied by early satiety and an 8-kg unintentional weight loss. A repeat EGD was performed and revealed suspicious ulcerative lesions at the level of the incisura angularis. Multiple biopsies were obtained, and histopathological examination confirmed gastric adenocarcinoma. The patient was subsequently referred for multidisciplinary management and oncological evaluation. CONCLUSION: This case highlights the potential for gastric adenocarcinoma to be missed during initial endoscopic examination, particularly at the incisura angularis. Careful mucosal inspection and appropriate retroflexion during EGD are essential for improving lesion detection in this high-risk anatomical region.
Quercetin Delivered by Mesenchymal Stem Cell-Derived Exosomes Improves Liver Fibrosis via the PI3K/Akt Signaling Pathway.
Fang D, Zhang J, Zhao Q … +10 more , Fan Y, Lin X, Liang D, Zhong L, Zhang Y, Yan S, Shen T, Meng Y, Zhao X, Zuo S
ACS Omega · 2026 Jun · PMID 42395946 · Full text
Liver fibrosis represents a critical stage in the progression of chronic liver diseases to cirrhosis and hepatocellular carcinoma; however, effective therapeutic options remain limited. Although quercetin, a natural flav...
Liver fibrosis represents a critical stage in the progression of chronic liver diseases to cirrhosis and hepatocellular carcinoma; however, effective therapeutic options remain limited. Although quercetin, a natural flavonol, possesses potent antifibrotic properties, its clinical utility is severely hindered by poor aqueous solubility and low bioavailability. To address this limitation, we developed a nanoparticle-based drug delivery system using quercetin-loaded human umbilical cord mesenchymal stem cell (hUC-MSC)-derived exosomes (hUC-MSC-exo-Que). Leveraging the innate biocompatibility and targeting capability of exosomes, this strategy aims to improve the pharmacokinetic limitations of quercetin and amplify its therapeutic efficacy. Our results demonstrate that hUC-MSC-exo-Que significantly attenuates liver fibrosis in a carbon tetrachloride-induced mouse model, outperforming free quercetin at the equivalent dose. This enhanced efficacy is attributed to the superior inhibition of hepatic stellate cell activation, as confirmed by in vitro studies. The engineered exosomes exhibited a sustained drug release profile (up to 48 h) and maintained excellent stability for at least 1 week. Integrating network pharmacology with experimental validation, we identify the antifibrotic mechanism involving potent inhibition of the PI3K/Akt signaling pathway, with hUC-MSC-exo-Que achieving markedly greater pathway suppression than free quercetin. By successfully transforming a potent but poorly bioavailable phytochemical into a targeted nanotherapeutic, we present a promising preclinical strategy for liver fibrosis treatment and demonstrate a proof-of-concept platform for hydrophobic drug delivery.
Estimated preventable fraction of chronic disease attributed to long-term physical activity and diet quality, independent of body weight: a prospective cohort study of three US cohorts.
Bever AM, Du M, Eliassen AH … +7 more , Giovannucci E, Liang L, Stampfer MJ, Rimm E, Willett W, Hu FB, Song M
Lancet Reg Health Am · 2026 Sep · PMID 42395933 · Full text
BACKGROUND: Body mass index (BMI) is often treated as a proxy for lifestyle, but this may discourage people with higher BMI from adopting risk-reducing behaviors and lead those with lower BMI-including individuals achiev...
BACKGROUND: Body mass index (BMI) is often treated as a proxy for lifestyle, but this may discourage people with higher BMI from adopting risk-reducing behaviors and lead those with lower BMI-including individuals achieving weight reduction through pharmacotherapy-to overlook the value of lifestyle. We aimed to estimate incidence of chronic disease preventable through physical activity and diet quality, independent of BMI. METHODS: We followed 142,041 adults (80% [113,727] female, mean baseline age 50 years, 96% [136,998] non-Hispanic White) from the Nurses' Health Study, Nurses' Health Study II, and Health Professionals Follow-up Study. Physical activity was assessed as metabolic equivalent of task (MET) hours per week, and diet quality as modified Alternative Healthy Eating Index. Chronic disease included type 2 diabetes, major atherosclerotic cardiovascular disease, and cancer. Regression models adjusted for BMI at multiple life stages allowed estimation of effects for sustained adulthood habits and midlife changes, independent of prior BMI and lifestyle. FINDINGS: Participants in the highest deciles of physical activity and diet quality had 46% (95% confidence interval [CI], 40-52%) lower risk of chronic disease for sustained habits and 34% (95% CI, 26-41%) for midlife changes. Results were similar among women (44% lower risk [95% CI, 35-51%] sustained habits, 32% [95% CI, 20-41%] midlife changes) and men (54% lower risk [95% CI, 41-64%] sustained habits, 48% [95% CI, 33-60%] midlife changes). The proportion of cases potentially preventable was 34% (95% CI, 27-41%), or 1.1 million cases annually (95% CI, 906,000-1,376,000), for sustained habits and 26% (95% CI, 18-34%), or 873,000 cases annually (95% CI, 604,000-1,141,000), for midlife changes. INTERPRETATION: Higher physical activity and diet quality were associated with substantially reduced chronic disease risk regardless of BMI. These findings support public health strategies that promote healthy behaviors independent of body weight. FUNDING: US National Institutes of Health, Prevent Cancer Foundation.
A highly sensitive Au@Pd NRs SERS microarray chip based on electrophoretic deposition for detection of GSH in the serum of colorectal cancer patients.
Xie C, Zhang D, Wu Y … +3 more , He Y, Ge Y, Deng B
RSC Adv · 2026 Jul · PMID 42395697 · Full text
In this study, a highly sensitive surface-enhanced Raman scattering (SERS) microarray chip was developed for the detection of reduced glutathione (GSH) in the serum of colorectal cancer (CRC) patients. Gold-palladium nan...
In this study, a highly sensitive surface-enhanced Raman scattering (SERS) microarray chip was developed for the detection of reduced glutathione (GSH) in the serum of colorectal cancer (CRC) patients. Gold-palladium nanorods (Au@Pd NRs) with peroxidase-like activity were synthesized and assembled into holes on the polydimethylsiloxane (PDMS)-indium tin oxide (ITO) glass substrate electrophoretic deposition (EPD). The Au@Pd NRs catalyze the oxidation of 3,3',5,5'-tetramethylbenzidine (TMB) to oxidized TMB (oxTMB) in the presence of hydrogen peroxide (HO), producing a characteristic SERS peak at 1605 cm. Prior to detection, a thiolated GSH aptamer was immobilized on the microarray chip to specifically capture GSH, effectively avoiding interference from other reducing substances in the complex serum matrix. The captured GSH then reduces oxTMB back to TMB, causing signal attenuation proportional to GSH concentration. The limit of detection (LOD) reached 93 pmol L, with a relative standard deviation (RSD) of 6.36% for reproducibility. Clinical serum analysis of 30 healthy individuals and 30 CRC patients demonstrated results consistent with the gold standard testing method of high-performance liquid chromatography (HPLC) (relative error < 8%), confirming the potential of this approach for the effective detection of GSH and early CRC diagnosis.
High-sensitivity photoelectric sensing of apatinib for recurrent hepatocellular carcinoma in TACE.
Yang S, Deng Z
RSC Adv · 2026 Jul · PMID 42395694 · Full text
Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality, with transcatheter arterial chemoembolization (TACE) being a widely used treatment for intermediate-stage patients. However, TACE is oft...
Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality, with transcatheter arterial chemoembolization (TACE) being a widely used treatment for intermediate-stage patients. However, TACE is often associated with high recurrence rates, necessitating reliable methods for early detection and prediction of tumor recurrence. Current diagnostic tools rely heavily on imaging techniques and biomarkers, which often lack sensitivity and specificity, particularly in the early stages of disease progression. To address these challenges, we developed an innovative integrated platform combining a high-sensitivity photoelectric sensor based on Bi/h-BiTe heterostructures with machine learning models for the detection and prediction of HCC recurrence following TACE. The photoelectric sensor exhibits exceptional sensitivity and stability, enabling precise detection of apatinib, a key therapeutic agent used in HCC management. The machine learning models demonstrated superior performance in predicting HCC recurrence, with an area under the receiver operating characteristic curve (AUC) of 0.840, accuracy of 78.0%, sensitivity of 72.4%, and specificity of 80.3% on the independent test set. Overall, this work establishes a practical materials-informatics framework that links sensitive therapeutic drug monitoring (LOD = 0.08 µM) with individualized recurrence risk stratification after TACE, providing a promising route toward precision management of HCC.
Alpha-1-microglobulin as an early biomarker in renal extrahepatic manifestations of hepatitis C virus infection.
Alkareemy EAR, Azoz NM, Abdelnaiem GS … +3 more , Gadelkareem RA, Saleh KA, Abdel Aziz EM
World J Nephrol · 2026 Jun · PMID 42395679 · Full text
BACKGROUND: Hepatitis C virus (HCV)-related nephropathy often progresses silently and is commonly underrecognized until chronic kidney disease or acute kidney injury occurs. Urinary alpha-1-microglobulin (Uα1M) is a prom...
BACKGROUND: Hepatitis C virus (HCV)-related nephropathy often progresses silently and is commonly underrecognized until chronic kidney disease or acute kidney injury occurs. Urinary alpha-1-microglobulin (Uα1M) is a promising early biomarker of proximal tubule dysfunction. It may help detect the subclinical renal extrahepatic manifestations of HCV earlier than traditional markers such as serum creatinine (SCr). The early renal manifestations of HCV include microalbuminuria, hematuria, tubular injury, and immune-mediated glomerulopathy. AIM: To evaluate the efficacy of Uα1M in identifying the early kidney involvement in patients with HCV infection. METHODS: A case-control study was conducted from February 2022 to February 2024 at the Clinic of Nephrology Outpatient, Department of Internal Medicine, and Clinic of El-Rajhy Hepatitis Outpatient at Assiut University Hospitals. This study involved 158 patients aged ≥ 18 years, divided into HCV and control groups. The HCV group included 79 patients diagnosed as HCV-positive by HCV + antibodies and positive real-time polymerase chain reaction for HCV-RNA. The control group included 79 participants who were age-matched and sex-matched, and HCV-negative healthy individuals. The primary outcome was the rate of increased level of Uα1M. RESULTS: The two groups were comparable in age and sex distribution. The mean hemoglobin level and platelet count were significantly lower in HCV patients than in controls, respectively. Blood urea nitrogen (BUN), SCr, and estimated glomerular filtration rate (eGFR) showed no significant differences. The urinary albumin/creatinine ratio was significantly higher in HCV-positive patients, with increased prevalence of microalbuminuria and macroalbuminuria. Uα1M levels were markedly elevated in the HCV group. It correlated positively with BUN and SCr, and negatively with eGFR, aspartate aminotransferase, and alanine aminotransferase. Uα1M levels were significantly higher in patients with hematuria ( = 0.007) and those with impaired eGFR ( < 0.001) than those without these disorders. Only five HCV-positive patients underwent renal biopsy, and all showed membranoproliferative glomerulonephritis. The Uα1M levels higher than the 3.52 mg/L cutoff had strong diagnostic ability to distinguish HCV-positive from HCV-negative subjects, with an area under the curve of 0.864 (95% confidence interval: 0.801-0.913), 77.0% accuracy, 60.0% sensitivity, 93.7% specificity, 90.4% positive predictive value, and 69.8% negative predictive value ( < 0.001). CONCLUSION: Uα1M served as a valuable early renal tubular biomarker for detecting subclinical kidney involvement in chronic HCV patients. It showed a moderate correlation to BUN and mild correlation to SCr and eGFR, with membranoproliferative glomerulonephritis pathology predominance in biopsied cases. In addition, it had a strong diagnostic accuracy at levels higher than a cutoff of 3.52 mg/L, reinforcing its potential for early diagnosis of renal involvement by HCV infection.
Epidemiology of chronic kidney disease in young patients in developing countries.
Tommy A, Soldera J
World J Nephrol · 2026 Jun · PMID 42395678 · Full text
BACKGROUND: Chronic kidney disease (CKD) is an important but under-recognized cause of morbidity in young people living in low- and middle-income countries (LMICs), where epidemiological data in this age group are limite...
BACKGROUND: Chronic kidney disease (CKD) is an important but under-recognized cause of morbidity in young people living in low- and middle-income countries (LMICs), where epidemiological data in this age group are limited and fragmented. LMICs, as defined by the World Bank, have a gross national income per capita between United States dollar 1136 and United States dollar 13845 (2024). AIM: To summarize the prevalence of CKD among individuals aged ≤ 25 years in LMICs and to explore sources of between-study variability. METHODS: We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, EMBASE, Cochrane Library, and Google Scholar were searched for original studies reporting CKD prevalence in LMIC populations aged 0-25 years. Study-level proportions were pooled using a random intercept logistic regression model (generalized linear mixed model) with logit transformation. Heterogeneity was quantified using , , and statistics. Prespecified subgroup analyses stratified studies by world region and study setting (community-based, hospital/clinic-based, CKD/end-stage renal disease registries, and specific disease cohorts). Random-effects meta-regression examined the contribution of region and setting to heterogeneity. Sensitivity analyses excluding registry and high-risk cohorts were undertaken to approximate prevalence in more general populations. RESULTS: Nineteen studies from 17 countries (339940 participants; 96674 CKD cases) were included. The overall pooled prevalence was 11.7% (95% confidence interval: 5.5%-23.3%), with a prediction interval spanning 0.3%-84% and extreme heterogeneity ( = 3.41; = 99.9%). Subgroup analyses showed a clear gradient by setting, from lowest prevalence in community-based samples to highest in registries and disease-specific cohorts. Meta-regression indicated that setting explained 36.8% and region 28.2% of between-study variance, while both combined explained 61.4%. In sensitivity analyses restricted to more general populations, pooled prevalence was in the 4%-5% range (random-effects 95% confidence interval: 2%-9%), although heterogeneity remained high. CONCLUSION: CKD in young people in LMICs is common and highly variable, largely reflecting differences in study setting and geography, and warrants targeted early detection and surveillance strategies.
Is the metabolic dysfunction-associated steatotic liver disease a predictor of chronic kidney disease?
Azoz NM, Shehata MA, Abbas WA … +2 more , Gadelkareem RA, Abdel Aziz EM
World J Nephrol · 2026 Jun · PMID 42395676 · Full text
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a multisystem disorder strongly associated with metabolic dysfunction. Emerging evidence suggests a close associa...
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a multisystem disorder strongly associated with metabolic dysfunction. Emerging evidence suggests a close association between MASLD and chronic kidney disease (CKD). However, the magnitude and determinants of renal involvement remain inconsistent across studies, particularly in relation to diabetes mellitus (DM) and hepatic fibrosis. AIM: To assess the association between CKD and MASLD and identify the predictors of renal impairment in patients with MASLD. METHODS: A case-control study was conducted in the Internal Medicine Department, Faculty of Medicine, Assiut University, Egypt, between March 2024 and March 2025. It included 150 participants recruited from outpatient clinics. Participants were divided into three groups: Those with MASLD and type 2 DM ( = 50), those with MASLD without DM ( = 50), and healthy controls ( = 50). All participants underwent clinical and laboratory evaluation. Additionally, they were assessed for insulin resistance using Homeostasis Model Assessment of Insulin Resistance, abdominal ultrasound, and FibroScan. CKD was defined based on the estimated glomerular filtration rate and albuminuria. Multivariate logistic regression was used to assess the factors associated with CKD in patients with MASLD. RESULTS: The three groups were similar in terms of mean age ( = 0.102) and gender ( = 0.553) distribution of the participants. However, the incidence of hypertension and ischemic heart disease was significantly higher in patients with MASLD than in those without. Patients with MASLD exhibited significantly higher serum creatinine, urea, and albuminuria levels, along with lower estimated glomerular filtration rate ( < 0.001). Advanced hepatic fibrosis was more prevalent in MASLD with DM, with F3-F4 fibrosis observed in 50% of patients compared to 14% in those with MASLD without DM. The severity of fibrosis and steatosis increased progressively with advancing CKD stage ( < 0.001). Factors associated with CKD included hepatic fibrosis score [odds ratio (OR) = 5.61], steatosis score (OR = 4.17), Homeostasis Model Assessment of Insulin Resistance (OR = 4.15), DM (OR = 3.10), and obesity (OR = 2.37). CONCLUSION: MASLD is associated with CKD, particularly in patients with DM and advanced hepatic fibrosis. Incorporating non-invasive liver fibrosis assessment may aid in the early identification of patients with MASLD who are at a high risk of renal disease.
Prognostic nutritional indices and long-term survival after endoscopic submucosal dissection for early gastric cancer in elderly patients: a systematic review and meta-analysis.
Li H, Fu XZ, Chen J … +2 more , Huang XF, Long H
Front Nutr · 2026 · PMID 42395630 · Full text
BACKGROUND: Nutritional risk and host vulnerability may influence long-term outcomes in elderly patients with early gastric cancer (EGC) undergoing endoscopic submucosal dissection (ESD). The prognostic nutritional index...
BACKGROUND: Nutritional risk and host vulnerability may influence long-term outcomes in elderly patients with early gastric cancer (EGC) undergoing endoscopic submucosal dissection (ESD). The prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) are simple nutritional and prognostic indices, but their prognostic value in this population has not been systematically evaluated. METHODS: We conducted a systematic review and meta-analysis of studies assessing the association between PNI or GNRI and long-term survival in elderly patients (≥ 65 years) treated with ESD for EGC. PubMed, Embase, and Web of Science were searched up to December 28, 2025. Hazard ratios (HRs) or comparable multivariable estimates with 95% confidence intervals (CIs) were synthesized using fixed- or random-effects models. Subgroup and sensitivity analyses were conducted to assess consistency and heterogeneity. RESULTS: studies involving 1,453 elderly patients were included. Low PNI was associated with poorer overall survival (pooled HR 2.91, 95% CI 2.12-3.99), with low heterogeneity. Lower GNRI was also associated with poorer survival outcomes (pooled estimate 2.87, 95% CI 1.36-6.02). Subgroup and sensitivity analyses supported the direction and robustness of the association for PNI. CONCLUSION: Lower PNI and GNRI were associated with poorer survival outcomes in elderly patients with EGC treated by ESD. These findings highlight the potential clinical relevance of nutritional risk assessment and may help inform risk stratification, but further prospective studies are needed to validate their clinical utility and assess whether targeted interventions can modify outcomes. SYSTEMATIC REVIEW REGISTRATION: identifier: CRD420251270408.
Recurrent Acute Pancreatitis Secondary to Untreated Hyperparathyroidism: A Case Report and Literature Review.
Patoni C, Popescu SI, Gheorghe C
Cureus · 2026 Jul · PMID 42395586 · Full text
Acute pancreatitis (AP) is a common gastrointestinal disease with diverse etiologies, among which hyperparathyroidism represents a rare but well-established cause. While a single episode of AP can often be managed suppor...
Acute pancreatitis (AP) is a common gastrointestinal disease with diverse etiologies, among which hyperparathyroidism represents a rare but well-established cause. While a single episode of AP can often be managed supportively, failure to definitively treat the underlying hyperparathyroidism significantly increases the risk of recurrence. We present the case of a 63-year-old woman admitted for moderate AP with documented hypercalcemia (total calcium 11.11 mg/dL). She was subsequently referred to endocrinology, where parathyroid hormone (PTH) was found to be 238 pg/mL, and parathyroid scintigraphy with 99mTc-sestamibi showed equivocal focal uptake at the upper pole of the right thyroid lobe, consistent with a possible right superior parathyroid adenoma. Despite confirmed biochemical hyperparathyroidism and a recent history of AP, the clinical recommendation was watchful waiting, with follow-up at three months, without surgical referral. Three years later, at the age of 66, she was re-admitted with a second episode of mild AP. PTH had risen to 777.5 pg/mL with total calcium 12.12 mg/dL, supporting hyperparathyroidism as the likely underlying etiology. Given the patient's underlying chronic kidney disease, tertiary hyperparathyroidism could not be excluded, although the patient's relatively stable renal function favored primary hyperparathyroidism. This case highlights two important clinical lessons for the management of hyperparathyroidism-associated pancreatitis. First, it is essential to routinely assess serum calcium and PTH levels in all patients with AP of unknown origin. Second, the decision to perform a parathyroidectomy should be based on clinical and biochemical evidence and should not be postponed due to inconclusive imaging results. A review of the current literature emphasizes that parathyroidectomy is the only definitive treatment for symptomatic hyperparathyroidism. Early detection, prompt surgical referral, and effective communication with patients are vital for preventing recurrence in this manageable condition.
Intelligent responsive alloy scaffold temporally regulates the immune-osteogenic axis for the treatment of infectious bone defects.
Ruan D, Li Z, Deng X … +9 more , Jiang H, Lan X, Chen X, Qiu C, Liao F, Zhu J, Yu M, Xu J, Luo J
Bioact Mater · 2026 Dec · PMID 42395337 · Full text
Excessive immune activation induced by persistent bacterial infection, which further impairs osteogenic function, is a crucial factor contributing to the poor healing of infectious bone defects. Therapeutic strategies ta...
Excessive immune activation induced by persistent bacterial infection, which further impairs osteogenic function, is a crucial factor contributing to the poor healing of infectious bone defects. Therapeutic strategies targeting a single link often yield limited efficacy. Therefore, we developed an alloy scaffold bone graft (TCMP) with pH-responsive sequential regulation of the immuno-osteogenic axis. During the infection phase, the scaffold mainly releases copper ions to exert potent antibacterial activity, and simultaneously releases -derived exosome-like nanovesicles (PELNs) in a pH-responsive manner, thereby effectively suppressing the early inflammatory cytokine storm. In the osteogenesis phase, the scaffold switches its release pattern to sustained magnesium ion release, accompanied by low-level sustained release of PELNs, which targets mesenchymal stem cells, vascular endothelial cells and macrophages to promote the directional recruitment and migration of stem cells, accelerate their osteogenic differentiation, improve the inflammatory immune microenvironment and enhance angiogenesis; consistent with the physiological characteristics of extremely scarce osteoclasts in the early stage of implantation, Mg exerts no regulatory effect on osteoclasts in this study. Mechanistically, TCMP mediates dual-pathway synergistic therapy for infectious bone defects by inhibiting the advanced glycation end products/receptor for advanced glycation end products/nuclear factor-κB (AGEs/RAGE/NF-κB) pathway and activating the hypoxia-inducible factor-1 (HIF-1) signaling pathway. In conclusion, the developed TCMP alloy scaffold integrates the "trinity" functions of antibacterial activity, anti-inflammation, and osteogenesis, comprehensively breaking the vicious cycle of bacterial infection-excessive inflammatory activation-impaired osteogenic capacity, and providing a therapeutic strategy with excellent translational potential for clinical practice.
ACTIVE involvement in alcohol care: a community case study in coproduction.
Best V, Bryan L, Edmunds S … +11 more , Kitch N, Sastre E, Wells K, McNeice M, Owens L, Smith M, Menghani R, Sharp H, Richardson P, Garner J, McKeown M
Front Public Health · 2026 · PMID 42395278 · Full text
This is a descriptive case study of a public engagement group of people who have used alcohol care services. Involvement of people with lived and living experience is increasingly recognized as essential in health and so...
This is a descriptive case study of a public engagement group of people who have used alcohol care services. Involvement of people with lived and living experience is increasingly recognized as essential in health and social care policy. However, in alcohol care services, such involvement remains underdeveloped and sometimes tokenistic. This community case study outlines the establishment, development, and impact of the ACTIVE (Alcohol Care Team InVolvement and Engagement) group-a pioneering public and patient involvement and engagement (PPIE) initiative in alcohol care services across Merseyside and Cheshire (UK). The group was established through collaboration between the Programme for Alcohol Care and Treatment (PROACT, a regional public health network bringing together all alcohol care providers), public health commissioners (Champs Public Health Collaborative), and the Comensus PPIE model at the University of Lancashire. It was designed to create safe spaces for meaningful coproduction and deliberative democratic communication between people with lived experience, practitioners, and commissioners. ACTIVE has contributed to service design and evaluation. Additional impacts include supporting digital innovation, strengthening regional networks, influencing innovation, and enhancing workforce education. Members reported enhanced confidence, sense of value, and shared ownership of service development. The approach illustrates the replicable potential of sustained, well-resourced involvement of people with lived experience in alcohol care, having implications for policy, research, innovation, and service delivery nationally and internationally. The case study has been collectively authored utilizing notes of meetings and drawing upon contributions within a series of reflective meetings and exchanges of drafts.
Standing Up to Deconditioning: A Multidisciplinary Two-Cycle Audit to Enhance Patient Mobilization in Elderly Inpatients.
San MM, San S, Hanspal S … +2 more , Abdelrahman H, Bartlett T
Cureus · 2026 Jun · PMID 42395236 · Full text
Background Deconditioning is a common and preventable cause of functional decline among hospitalized elderly patients, contributing to prolonged recovery, increased dependence, and hospital-associated complications. Desp...
Background Deconditioning is a common and preventable cause of functional decline among hospitalized elderly patients, contributing to prolonged recovery, increased dependence, and hospital-associated complications. Despite this, early mobilization is often limited by ward routines, invasive devices, and competing clinical priorities. Objectives This two-cycle audit aimed to evaluate whether low-cost, multidisciplinary interventions could improve early mobilization among elderly inpatients and reduce the risk of deconditioning. Methods A baseline audit was conducted on an elderly inpatient ward to assess the proportion of eligible patients mobilizing out of bed by 11:00 a.m. daily. Findings informed two sequential Plan-Do-Study-Act (PDSA) cycles. Cycle 1 focused on promoting early mobilization during morning handovers and minimizing unnecessary barriers such as intravenous lines and urinary catheters. Cycle 2 introduced sit-out charts and educational posters to improve documentation and sustain engagement. Data were collected daily at a fixed time point, excluding patients receiving end-of-life care or those who were permanently bedbound. Results At baseline, a mean of 7.73 patients (30%) were mobilizing out of bed daily. Following PDSA Cycle 1, this increased to a mean of 14.71 patients (57%). During Cycle 2, improvement was sustained, with a mean of 13.14 patients (51%) mobilizing daily. Staff feedback indicated improved awareness and shared responsibility for patient mobility. Conclusion This two-cycle audit demonstrates that simple, low-cost, multidisciplinary interventions embedded into routine ward practice can sustainably improve early mobilization among elderly inpatients. Early mobilization should be considered a core marker of quality inpatient care and a key strategy in reducing the risk of hospital-associated deconditioning.
Pruritus as the First Clue: Early Diagnostic Workup Uncovering an Ampullary Adenoma.
Calegari L, Korman A, Raval S … +2 more , Garg A, Poroski R
Cureus · 2026 Jun · PMID 42395213 · Full text
Ampullary adenomas are uncommon lesions with malignant potential and may present with nonspecific symptoms, making diagnosis challenging. This is the case of a 64-year-old woman who presented with diffuse pruritus, right...
Ampullary adenomas are uncommon lesions with malignant potential and may present with nonspecific symptoms, making diagnosis challenging. This is the case of a 64-year-old woman who presented with diffuse pruritus, right upper quadrant discomfort, and a cholestatic liver pattern injury, posteriorly found to have an ampullary lesion causing biliary obstruction. Initial endoscopic evaluation and biopsy suggested low-grade dysplasia, with temporary improvement after biliary decompression. However, persistent symptoms prompted repeat intervention with endoscopic papillectomy, and final pathology demonstrated high-grade dysplasia with positive margins, raising concern for an underlying malignancy not identified on the initial biopsy. This case highlights the variable clinical presentation of ampullary adenomas and emphasizes the limitations of superficial tissue sampling, underscoring the importance of complete histologic evaluation and close follow-up in suspicious ampullary lesions.
Surgical Resection for Colorectal Liver Metastasis in Elderly Patients Aged ≥ 80: A Retrospective Nationwide Cohort Survey in Japan With Propensity Score Matching.
Sugimoto K, Saiura A, Nojiri S … +5 more , Kobayashi H, Honda G, Kawai K, Hasegawa K, Takahashi K
Ann Gastroenterol Surg · 2026 Jul · PMID 42395149 · Full text
BACKGROUND: As the aging of the global population increases, the number of elderly patients with colorectal liver metastasis (CRLM) is expected to increase. The aim of this study was to clarify the long-term oncological...
BACKGROUND: As the aging of the global population increases, the number of elderly patients with colorectal liver metastasis (CRLM) is expected to increase. The aim of this study was to clarify the long-term oncological outcomes and treatment of CRLM in elderly patients aged ≥ 80. METHODS: Patients with CRLM were identified from the Japanese database of Liver Metastases Survey of Colorectal Cancer, collected from 145 centers. Two thousand four hundred nine patients with liver resection were eligible for analysis. This cohort was divided into two groups aged < 80 (group Y (younger); = 2194) and ≥ 80 (group E (elderly); = 215). We compared the long-term outcomes after liver resection of patients with CRLM aged ≥ 80 and < 80 years after adjustment using propensity score matching (PSM), and we identified the reasons for differences in these outcomes. RESULTS: After PSM, group E showed a comparable recurrence-free survival to that in group Y (hazard ratio (HR): 1.20, = 0.16). However, group E had significantly worse cancer-specific survival (CSS) (HR: 1.77, = 0.002) and overall survival (OS) (HR: 1.80, = 0.0004). Treatment for recurrence was given at a significantly lower rate in group E (80/130 (61.5%) vs. 1148/1329 (86.4%), < 0.0001). CONCLUSIONS: Surgical resection seems to be as effective in elderly patients aged ≥ 80 as in nonelderly patients. The significantly worse CSS and OS may have resulted from a lower rate of treatment for recurrence in elderly patients aged ≥ 80. Physicians should keep this finding in mind with regard to limitations of treatments for recurrence after initial liver resection in elderly patients aged ≥ 80 with CRLM.
Multifactor Risk Stratification for Post-Transplant Alcohol Relapse Using Abstinence, Psychosocial, and Socioeconomic Factors.
Obana A, Montgomery G, Akabane M … +7 more , Hamilton M, Singh N, Alebrahim M, Schenk A, Black S, Washburn K, Mumtaz K
Ann Gastroenterol Surg · 2026 Jul · PMID 42395134 · Full text
AIM: Post-liver transplant (LT) alcohol relapse complicates long-term outcomes and organ allocation. The traditional "six-month abstinence rule" remains widely used, but relapse risk is also shaped by psychosocial, socio...
AIM: Post-liver transplant (LT) alcohol relapse complicates long-term outcomes and organ allocation. The traditional "six-month abstinence rule" remains widely used, but relapse risk is also shaped by psychosocial, socioeconomic, and psychiatric factors. We examined the impact of pre-LT abstinence duration on post-LT alcohol relapse and developed a multivariable risk model integrating abstinence, psychosocial assessment, and socioeconomic status. METHODS: In this single-center retrospective study, 383 adults undergoing LT for alcohol-related liver disease were included. RESULTS: Any post-LT alcohol relapse occurred in 20.9% ( = 80). Relapse phenotypes were non-mutually exclusive: sustained alcohol use (77.5%), harmful drinking (68.8%), and recurrent ALD (46.3%). On multivariable analysis, shorter pre-LT abstinence, higher Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) scores, and higher educational attainment were independently associated with relapse. Each additional month of abstinence reduced relapse odds by 4%, whereas each one-point increase in SIPAT increased relapse odds by 3%. Cumulative risk curves demonstrated a non-linear relationship between abstinence duration and relapse, with risk peaking around 9 months and declining thereafter across all relapse phenotypes. A prediction model combining abstinence duration, SIPAT score, and education achieved an area under the receiver operating characteristic curve (AUC) of 0.70, with consistent performance on fivefold cross-validation. CONCLUSION: These findings support a multifactorial approach to relapse risk stratification that goes beyond a fixed 6-month abstinence rule. Incorporating abstinence duration together with structured psychosocial assessment and education level may better inform both transplant listing decisions and the intensity of post-LT addiction care for patients.
A Machine Learning Model for Predicting Posthepatectomy Liver Failure After Hepatectomy With Extrahepatic Bile Duct Resection for Perihilar Cholangiocarcinoma: With and Without Indocyanine Green.
Homma Y, Ohya H, Matsuyama R … +9 more , Hosokawa I, Takayashiki T, Ome Y, Uemura S, Higuchi R, Honda G, Kawakami E, Ohtsuka M, Endo I
Ann Gastroenterol Surg · 2026 Jul · PMID 42395130 · Full text
AIM: Posthepatectomy liver failure (PHLF) is a serious complication of major hepatectomy and is closely related to perioperative mortality. Whether or not indocyanine green (ICG) is used to measure liver function varies...
AIM: Posthepatectomy liver failure (PHLF) is a serious complication of major hepatectomy and is closely related to perioperative mortality. Whether or not indocyanine green (ICG) is used to measure liver function varies by country. Using machine learning, we aimed to develop two highly accurate, user-friendly models for predicting PHLF depending on whether ICG data were used. METHODS: This was a retrospective, three-center study. SHapley Additive exPlanations (SHAP) evaluated the feature importance of Random Forest (RF) analysis. SHAP quantitatively assessed the impact of each feature on model predictions and identified the three most important features in both ICG-used and ICG-unused models. A Decision Tree (DT) model was constructed using two of these three key features to enhance clinical interpretability. PHLF was defined as Grade B or C according to the International Study Group of Liver Surgery. RESULTS: Feature importance was calculated using the SHAP analysis, in the ICG-used model the ICG clearance rate (ICGK) multiplied by the percentage of remaining liver measured by CT volumetry (ICGK-F), CRP, and operative procedure were identified as the three highest factors, whereas the predicted liver resection rate, CRP, and total bilirubin were identified as the most important features in the ICG-unused model. In the constructed DT model, we categorized the cases into negative and positive, and the negative cases were further classified into three categories based on their risks. CONCLUSION: These models may offer a simple and practical approach for predicting the risk of PHLF and hold promise for future clinical application.
Extralevator Abdominoperineal Excision Improves Overall Survival Compared to Standard Abdominoperineal Excision: A Systematic Review and Meta-Analysis.
Kávási SB, Floria DE, Rancz A … +5 more , Veres DS, Faluhelyi N, Miheller P, Hegyi P, Ábrahám S
Ann Gastroenterol Surg · 2026 Jul · PMID 42395128 · Full text
BACKGROUND: In advanced low rectal cancer, the surgical technique chosen can affect long-term oncological outcomes. Extralevator abdominoperineal excision (ELAPE) was developed to improve radicality compared with standar...
BACKGROUND: In advanced low rectal cancer, the surgical technique chosen can affect long-term oncological outcomes. Extralevator abdominoperineal excision (ELAPE) was developed to improve radicality compared with standard abdominoperineal excision (APE). Although earlier analyses suggested reduced local recurrence and mortality with ELAPE, its survival benefit remains debated, and concerns about wound complications persist. This meta-analysis compared ELAPE and APE, focusing on oncological outcomes. METHODS: The protocol was registered on PROSPERO (CRD42023412308). A systematic search of PubMed, Embase, and CENTRAL was performed (April 14, 2023). Comparative studies of ELAPE versus APE were included. Data were synthesized using random-effects models. For overall survival (OS), disease-free survival (DFS), and local recurrence-free survival (LRFS), hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, with individual patient data extracted from Kaplan-Meier curves. RESULTS: Thirty-eight studies, including over 5000 patients, were analyzed. ELAPE reduced mortality by 46% (HR 0.54, 95% CI 0.40-0.73) and achieved a 5-year OS of 83% (CI 0.53-0.95) versus 69% (CI 0.40-0.88) for APE. ELAPE improved DFS (HR 0.74, 95% CI 0.55-0.99), with a 5-year DFS of 87% (CI 0.50-0.98) compared with 65% (CI 0.24-0.92) for APE. LRFS favored ELAPE but was not significant (HR 0.67, 95% CI 0.45-1.00). Rates of perineal wound complications did not differ (OR 1.39, 95% CI 0.81-2.40). CONCLUSION: ELAPE improves OS and DFS compared with APE without increasing wound complications. These findings support the broader application of ELAPE in rectal cancer treatment.
Survival Outcomes of Gemcitabine-Cisplatin-S-1 Versus Gemcitabine-Cisplatin in Unresectable Biliary Tract Cancer: A Multicenter Retrospective Study With a Focus on Conversion Surgery.
Kosaka H, Kinoshita M, Yasuda S … +25 more , Kakizaki S, Sugimoto R, Sakata J, Yamai K, Hatanaka T, Yamamoto Y, Sato T, Ishikawa T, Morikawa T, Hanaoka J, Mori H, Toyoda H, Sanuki T, Yokoi M, Shibata H, Fukuda K, Kawata K, Amaya K, Ito T, Hidaka M, Naganuma A, Sugimachi K, Toshiyama S, Yamasaki M, Kaibori M
Ann Gastroenterol Surg · 2026 Jul · PMID 42395119 · Full text
BACKGROUND: Gemcitabine plus cisplatin (GC) has been the global standard for advanced biliary tract cancer (BTC). The triplet regimen gemcitabine-cisplatin-S-1 (GCS) demonstrated superiority in the MITSUBA trial, but its...
BACKGROUND: Gemcitabine plus cisplatin (GC) has been the global standard for advanced biliary tract cancer (BTC). The triplet regimen gemcitabine-cisplatin-S-1 (GCS) demonstrated superiority in the MITSUBA trial, but its real-world effectiveness remains unclear. We compared survival outcomes of GCS versus GC, focusing on conversion surgery (CS). METHODS: We retrospectively analyzed 542 patients with unresectable BTC treated between 2017 and 2024 at 19 Japanese institutions. Patients received GC ( = 310) or GCS ( = 232). Survival was evaluated using multivariable Cox regression, 90-day landmark analysis, and propensity score matching (PSM) to adjust for baseline imbalances. RESULTS: Patients treated with GCS achieved greater tumor shrinkage (median -23.0% vs. -10.0%, = 0.014) and a higher CS rate (16.4% vs. 4.5%, < 0.001) than GC. Median progression-free survival was 8.6 versus 5.4 months ( = 0.002), and median overall survival (OS) was 17.2 versus 11.6 months ( = 0.006). In multivariable analysis, GCS was associated with a lower risk of death (HR 0.80, 95% CI 0.65-0.98, = 0.035), with consistent results after PSM. Fifty-two patients underwent CS, with comparable perioperative safety and R0 resection rates between regimens. Patients who underwent CS achieved markedly longer OS; in the overall cohort, median OS was 31.0 months in the GCS with CS group and not reached in the GC with CS group ( = 0.131). CONCLUSIONS: Treatment with GCS was associated with longer survival compared with GC in unresectable BTC, alongside a higher rate of conversion surgery, which was associated with favorable long-term outcomes.
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