The coexistence of inflammatory bowel disease(IBD)and autoimmune liver disease(AILD)has gained increasing attention in clinical practice,and there are significant increases in the prevalence rates of autoimmune hepatitis(AIH),primary sclerosing cholangitis(PSC),and AIH-PSC overlap syndrome among the patients with IBD.Several pathogenic mechanisms are shared between IBD and AILDs,including genetic susceptibility,dysregulation of the gut-liver axis,immune imbalance,and abnormal bile acid metabolism.The ECCO guidelines recommend that patients who are suspected of IBD and receive no treatment should undergo a series of liver function tests,including alanine aminotransferase,alkaline phosphatase,gamma-glutamyl transferase,and total serum bilirubin,as well as regular reexaminations during follow-up.While IBD-AILD patients have unique clinical features,there is still a lack of unified diagnosis and treatment guidelines for this comorbidity,and the selection of therapeutic goal often entails a careful balance between the intestinal tract and the liver,requiring interdisciplinary collaboration and combined therapies based on pathogenesis.Future research should focus on the dynamic regulatory networks of the gut-liver axis to develop innovative intervention strategies that ensure both efficacy and safety.

Objective To analyze causal relationship between education level and the occurrence of depression by using two sample Mendelian randomization(MR)study method.Methods The data of education level and depression were extracted from the Genome-Wide Association Study database,and the two-sample MR analysis was conducted,and sensitivity analysis was performed using the leave-one-out method.Results Ultimately,58 single nucleotide polymorphisms were successfully included.The results of bidirectional MR analysis showed that increase in education level can reduce the risk of depression(OR=0.95,95％CI:0.92-0.98,P＜0.01).MR-Egger regression and sensitivity analysis results showed that there was no horizontal pleiotropy in included single nucleotide polymorphisms(P＞0.05).Conclusion The risk of developing depression decreases with increasing education level.

Objective:To investigate the influence of cytochrome P450 2A6 (CYP2A6) gene polymorphisms on liver function injury in patients with hyperthyroidism treated with methimazole.Methods:The study selected 90 patients with hyperthyroidism who were treated with methimazole in the Department of Thyroid Surgery at the First Affiliated Hospital of Zhengzhou University from Sept. 2023 to Aug. 2024 as the research subjects. Based on the occurrence of liver injury, they were divided into a liver injury group ( n=36) and a non-liver injury group (n=54). Peripheral blood DNA was extracted from the patients, and the CYP2A6 gene genotypes (rs8192725, rs8192720, and rs28399433) were detected using the polymerase chain reaction (PCR) amplification method. The association between CYP2A6 gene polymorphisms and liver injury induced by methimazole treatment in hyperthyroidism was analyzed. Results:The comparison of genotype distribution frequencies at the rs8192725 locus between the liver injury group and the non-liver injury group showed a statistically significant difference ( P<0.05). The AG and GG genotypes at the rs8192725 locus were protective factors against liver injury in patients with hyperthyroidism (AG vs. AA, OR: 0.21; 95% CI: 0.08-0.57; P<0.05; GG vs. AA, OR: 0.24; 95% CI: 0.06-0.89; P<0.05; AG+GG vs. AA, OR: 0.22; 95% CI: 0.09-0.54; P<0.05). The frequency of the G allele of rs8192725 in the liver injury group was significantly lower than that in the non-liver injury group (G vs. A, OR: 0.36; 95% CI: 0.19-0.70; P<0.05), indicating that it is a protective factor for liver injury in hyperthyroid patients receiving methimazole treatment. Conclusions:The CYP2A6 gene polymorphism at the rs8192725 locus is associated with the occurrence of liver injury in patients with hyperthyroidism treated with methimazole. The G allele may be a protective factor against liver injury in patients with hyperthyroidism, suggesting that individualized treatment plans can be developed based on the patient's genotype.

The coexistence of inflammatory bowel disease(IBD)and autoimmune liver disease(AILD)has gained increasing attention in clinical practice,and there are significant increases in the prevalence rates of autoimmune hepatitis(AIH),primary sclerosing cholangitis(PSC),and AIH-PSC overlap syndrome among the patients with IBD.Several pathogenic mechanisms are shared between IBD and AILDs,including genetic susceptibility,dysregulation of the gut-liver axis,immune imbalance,and abnormal bile acid metabolism.The ECCO guidelines recommend that patients who are suspected of IBD and receive no treatment should undergo a series of liver function tests,including alanine aminotransferase,alkaline phosphatase,gamma-glutamyl transferase,and total serum bilirubin,as well as regular reexaminations during follow-up.While IBD-AILD patients have unique clinical features,there is still a lack of unified diagnosis and treatment guidelines for this comorbidity,and the selection of therapeutic goal often entails a careful balance between the intestinal tract and the liver,requiring interdisciplinary collaboration and combined therapies based on pathogenesis.Future research should focus on the dynamic regulatory networks of the gut-liver axis to develop innovative intervention strategies that ensure both efficacy and safety.

Objective:To investigate the influence of cytochrome P450 2A6 (CYP2A6) gene polymorphisms on liver function injury in patients with hyperthyroidism treated with methimazole.Methods:The study selected 90 patients with hyperthyroidism who were treated with methimazole in the Department of Thyroid Surgery at the First Affiliated Hospital of Zhengzhou University from Sept. 2023 to Aug. 2024 as the research subjects. Based on the occurrence of liver injury, they were divided into a liver injury group ( n=36) and a non-liver injury group (n=54). Peripheral blood DNA was extracted from the patients, and the CYP2A6 gene genotypes (rs8192725, rs8192720, and rs28399433) were detected using the polymerase chain reaction (PCR) amplification method. The association between CYP2A6 gene polymorphisms and liver injury induced by methimazole treatment in hyperthyroidism was analyzed. Results:The comparison of genotype distribution frequencies at the rs8192725 locus between the liver injury group and the non-liver injury group showed a statistically significant difference ( P<0.05). The AG and GG genotypes at the rs8192725 locus were protective factors against liver injury in patients with hyperthyroidism (AG vs. AA, OR: 0.21; 95% CI: 0.08-0.57; P<0.05; GG vs. AA, OR: 0.24; 95% CI: 0.06-0.89; P<0.05; AG+GG vs. AA, OR: 0.22; 95% CI: 0.09-0.54; P<0.05). The frequency of the G allele of rs8192725 in the liver injury group was significantly lower than that in the non-liver injury group (G vs. A, OR: 0.36; 95% CI: 0.19-0.70; P<0.05), indicating that it is a protective factor for liver injury in hyperthyroid patients receiving methimazole treatment. Conclusions:The CYP2A6 gene polymorphism at the rs8192725 locus is associated with the occurrence of liver injury in patients with hyperthyroidism treated with methimazole. The G allele may be a protective factor against liver injury in patients with hyperthyroidism, suggesting that individualized treatment plans can be developed based on the patient's genotype.

Objective To analyze causal relationship between education level and the occurrence of depression by using two sample Mendelian randomization(MR)study method.Methods The data of education level and depression were extracted from the Genome-Wide Association Study database,and the two-sample MR analysis was conducted,and sensitivity analysis was performed using the leave-one-out method.Results Ultimately,58 single nucleotide polymorphisms were successfully included.The results of bidirectional MR analysis showed that increase in education level can reduce the risk of depression(OR=0.95,95％CI:0.92-0.98,P＜0.01).MR-Egger regression and sensitivity analysis results showed that there was no horizontal pleiotropy in included single nucleotide polymorphisms(P＞0.05).Conclusion The risk of developing depression decreases with increasing education level.

Objective:To analyze clinical characteristics of primary pancreatic lymphoma (PPL) patients.Methods:Clinical features of 22 patients diagnosed as PPL admitted to Peking Union Medical College Hospital from January 2002 to May 2023 were analyzed retrospectively.Results:The median age was 56.4±13.3 years. The median time from onset to diagnosis was 1.0 (1.0, 3.0) months. The main clinical manifestations were abdominal pain (15/22), weight loss (14/22) and jaundice (10/22). Elevated lactate dehydrogenase (LDH) was observed in 15/20 (75%) patients. Only 2 (2/9, 22.2%) patients had increased CA199 levels and 2 (2/9, 22.2%) patients had increased CEA levels. The maximum tumor diameter was 5.0 (3.8, 6.9) cm. Contrast-enhanced CT mostly showed low enhancement lesions. Major pancreatic duct dilatation were rare on CT scan (4/20). Fifteen patients were confirmed by pancreatic pathology, of which 8 were obtained by surgery, 4 were obtained by CT or ultrasound-guided percutaneous biopsy, and 3 were obtained by EUS-FNA. The main pathological type was diffuse large B-cell lymphoma (14/22). 19 patients received chemotherapy, and 6 patients died with a median follow-up of 5.0 (1.5, 35.5) months.Conclusions:PPL is rare and easy to be misdiagnosed. Elevated LDH levels, normal tumor markers, and non-dilatation of main pancreatic duct are important diagnostic clues. It is important to obtain pathology by EUS-FNA and other methods for definite diagnosis.

BACKGROUND: Inflammatory bowel disease (IBD) imposes a significant economic and social burden in China. We aim to assess the epidemiological trends of IBD in China, and to predict the burden in the near future. METHODS: The incidence, mortality, prevalence, and disability-adjusted life year (DALYs) of IBD from 1990 to 2021 were obtained from Global Burden of Disease Study 2021. Estimated annual percentage change (EAPC), average annual percent change, total percent change, and age-period-cohort model were used to access trends. Bayesian age-period-cohort model was utilized to predict the risk of incidence and mortality. RESULTS: In 2021, IBD affected 168,077 people in China, with 24,941 new cases and 5640 deaths. The age-standardized rate (ASR) of incidence and death was 1.4 and 0.3, respectively. The incidence and prevalence in China were lower than the global and high socio-demographic index (SDI) regions, but the ASR of incidence and prevalence (EAPC: 2.93 and 2.54, respectively) had rapidly increased from 1990 to 2021. The ASR of death and DALYs had significantly decreased (EAPC: -3.05 and -2.93, respectively). Middle-aged and elderly populations faced a severe burden of incidence and prevalence, while the elderly population faced a severe mortality burden. It is projected that by 2035, the ASR of incidence will continue to rise, whereas the death rate will continue to decline. CONCLUSIONS The burden of IBD in China is serious and increasingly severe. Establishing a comprehensive disease management system in China will help better control the medical burden of IBD.
Humans ; China/epidemiology* ; Inflammatory Bowel Diseases/epidemiology* ; Male ; Global Burden of Disease/trends* ; Female ; Middle Aged ; Adult ; Prevalence ; Incidence ; Adolescent ; Aged ; Young Adult ; Bayes Theorem ; Disability-Adjusted Life Years ; Quality-Adjusted Life Years ; Child

Patients with bicuspid aortic valve (BAV) are characterized by asymmetric anatomy, severe calcification and combined aortic dilatation. Compared with tricuspid aortic valve stenosis patients, patients with BAV stenosis confront with greater surgical risks in transcatheter aortic valve replacement (TAVR), including paravalvular leak, aortic valve rupture, coronary artery obstruction, atrioventricular block and so on. However, with the advent of new generation of prosthetic valves and optimization of surgical strategies, several studies have shown that TAVR is safe and effective in the treatment of BAV stenosis. Therefore, we aim to provide an overview of the use of TAVR in patients with BAV stenosis.

Objective:To study the risk factors of very early recurrence (VER, within 3 months) after R 0 resection of hepatocellular carcinoma (HCC), and to establish a predictive model. Methods:Of 427 HCC patients [with 368 males, 59 females, aged (52.7±12.1) years] who developed early recurrence (within 2 years) after R 0 resection from January to December 2008 at Zhongshan Hospital, Fudan University were enrolled in the test cohort. Another 590 patients [with 525 males, 65 females, aged (54.7±11.0) years] who underwent R 0 resection from January to June 2009 were enrolled in the validation cohort. Risk factors were investigated and a predictive model was established. Results:In the test cohort, 126 patients (29.5%) developed VER and their survival outcomes were extremely poor. Serum α-fetoprotein (AFP) level >827 μg/L, multiple tumors, microvascular invasion (MVI) and tumor number were independent risk factors for VER. A new predictive model (0.809·AFP+ 1.262·tumor number+ 0.983·MVI) was established by logistic regression in predicting VER after surgery. The receiver operating characteristic curve showed that the area under the curve (AUC) in predicting VER was 0.722 (95% CI: 0.669-0.774, P<0.001). In the validation cohort, the AUC of this model was 0.785 (95% CI: 0.715-0.855, P<0.001). Conclusions:A high AFP level, multiple tumors, and MVI were independent risk factors for VER of HCC after R 0 resection. The prediction model consisting of these three factors demonstrated robustness and it has the potential in clinical application.