Background: Endoscopy plays an important role in the management of acute variceal bleeding (AVB) in patients with cirrhosis. This study aimed at determining the optimal endoscopy timing for cirrhotic AVB. Methods: Patients with cirrhosis with AVB across 34 university hospitals in 30 cities from February 2013 to May 2020 who underwent endoscopy within 24 hours were included in this study. Patients were divided into an urgent endoscopy group (endoscopy <6 h after admission) and an early endoscopy group (endoscopy 6–24 h after admission). Multivariable analysis was performed to identify risk factors for treatment failure. Primary outcome was the incidence of 5-day treatment failure. Secondary outcomes included in-hospital mortality, need for intensive care unit, and length of hospital stay. A propensity score matching analysis was performed. In addition, we performed an analysis, in which we compared the 5-day treatment failure incidence and the in-hospital mortality among patients with endoscopy performed at <12 hours and 12–24 hours. Results: A total of 3319 patients were enrolled: 2383 in the urgent endoscopy group and 936 in the early endoscopy group. After propensity score matching, on multivariable analysis, Child-Pugh class was identified as an independent risk factor for 5-day treatment failure (HR, 1.61; 95% CI: 1.09–2.37). The incidence of 5-day treatment failure was 3.0% in the urgent endoscopy group and 2.9% in the early group (p = 0.90). The in-hospital mortality was 1.9% in the urgent endoscopy group and 1.2% in the early endoscopy group (p = 0.26). The incidence of need for intensive care unit was 18.2% in the urgent endoscopy group and 21.4% in the early endoscopy group (p = 0.11). The mean length of hospital stay was 17.9 days in the urgent endoscopy group and 12.9 days in the early endoscopy group (p < 0.05). The incidence of 5-day treatment failure in the <12-hour group was 2.3% and 2.2% in the 12–24 hours group (p = 0.85). The in-hospital mortality was 2.2% in the <12-hour group and 0.5% in the 12–24 hours group (p < 0.05). Conclusions: The data suggest that performance of endoscopy within 6–12 or within 24 hours of presentation among patients with cirrhosis with AVB led to similar treatment failure outcomes.

Although biologics have been revolutionizing the treatment of inflammatory bowel diseases (IBD) over the past decade, a significant number of patients still fail to benefit from these drugs. Overcoming the nonresponse to biologics is one of the top challenges in IBD treatment. In this study, we revealed that hyaluronan (HA), an extracellular matrix (ECM) component in the gut, is associated with nonresponsiveness to infliximab and vedolizumab therapy in patients with IBD. In murine colitis models, inhibition of HA synthase 2–mediated (HAS2-mediated) HA synthesis sensitized the therapeutic response to infliximab. Mechanistically, HA induced the expression of MMP3 in colonic fibroblasts by activating STAT3 signaling, thereby mediating the proteolytic cleavage of multiple IgG1 biologics. Finally, we found that macrophage-derived factors upregulated HAS2 expression in fibroblasts, thereby contributing to infliximab nonresponse. In summary, we identified a pathogenic connection between abnormal ECM remodeling and biologics nonresponse and provided insights for the precise therapy for IBD.

Aging increases the susceptibility of various diseases, including hepatocellular carcinoma (HCC). This study aimed to establish an aging-related prognostic model for HCC and to investigate the role of aging-related genes in HCC progression. Transcriptome and clinical information of HCC cases were obtained from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. Aging-related prognostic genes were identified through univariate Cox regression analysis, protein-protein interaction analysis, and least absolute shrinkage and selection operator (LASSO) analysis. An aging-related risk signature was then constructed, including LDHA, MMP12, ATAD3A, CD8A, TPI1, CST3, and TPM1. The risk score was inversely associated with the overall survival of patients with HCC and correlated well with known prognostic factors. The area under the curve of 1-, 3-, and 5-year survival in the training dataset was 0.83, 0.83, and 0.84, respectively. Univariate and multivariate cox regression analysis verified that the aging-related risk signature independently predicted the overall survival in HCC. To increase the clinical utility of the prognostic model, a nomogram was developed by incorporating the risk score with key clinical features. Finally, single-cell transcriptomes of HCC were analyzed to elucidate the expression pattern of the prognostic genes across different tissues, pathologic stages, and cell types. Collectively, the aging-related prognostic model shed light on HCC pathogenesis and held potential for optimizing the management of HCC.

Background and Aim: Chronic atrophic gastritis is a common gastric disease which shows a positive correlation with the occurrence of gastric cancer. Traditional chinese medicines have been used in the treatment of chronic atrophic gastritis. There is no solid evidence for the curative effects of traditional chinese medicines. This study aimed to investigate the clinical efficacy of Weifuchun tablets on patients with chronic atrophic gastritis. Methods 97 patients of chronic atrophic gastritis without current H. pylori infection were divided into two groups: an experiment group treated with Weifuchun and a control group treated with teprenone and folic acid for six months. Pathological examination of gastric biopsies and clinical symptoms assessment were performed for all patients before and after treatments. Primary outcome was the pathological response rate in each group evaluated by changes of histological scores.Secondary outcome was the clinical symptom scores. Results Twenty four patients in the Weifuchun group and twenty eight patients in the control group completed the study. The pathological response rates for atrophy and intestinal metaplasia were 66.7% and 45.8% in the Weifuchun group and 66.7% and 42.9% in the folic acid group, respectively, without statistical significance between groups.Clinical symptoms failed to improve after treatments in either group. Conclusions Weifuchun is effective to improve pathological changes of chronic atrophic gastritis in patients without current H. pylori infection. Monotherapy of Weifuchun had a similar efficacy to the combined therapy by teprenone and folic acid in the treatment of chronic atrophic gastritis. Trial registration: Evaluation of Weifuchun Pills on chronic atrophic gastritis, ChiCTR-IPR-17013939, Registered 15 December 2017, http://www.chictr.org.cn/ showproj.aspx?proj = 23910.

Background/Objectives: Recompensation in patients with decompensated cirrhosis has significant prognostic implications. In this study, we aimed to evaluate the incidence and predictors of recompensation in cirrhotic patients, specifically focusing on elucidating the influence of sarcopenia and visceral obesity on achieving recompensation in a cohort of decompensated individuals. Methods: We conducted a retrospective analysis of 195 patients with decompensated cirrhosis from 2021 to 2024. Body composition abnormalities were determined by the skeletal muscle index (SMI) and visceral-to-subcutaneous adipose tissue ratio (VSR) on computed tomography (CT), respectively. Factors related to recompensation, defined using the modified Baveno VII criteria, were identified using multivariate regression. Results: Patients who achieved recompensation exhibited a lower age (62 vs. 67, p < 0.05), a higher body mass index (22.8 vs. 21, p < 0.01), a lower aspartate aminotransferase level (32 vs. 39, p < 0.01), a higher albumin level (35.2 vs. 32.3, p < 0.01), a lower ascites prevalence (60% vs. 74.07%, p < 0.05), a lower Child–Pugh score (6 vs. 7, p < 0.01), and a lower End-Stage Liver Disease score (9 vs. 10, p < 0.05) compared to those with non-recompensated cirrhosis. Body composition abnormalities were significantly more prevalent in non-recompensated patients than in recompensated patients (77.04% vs. 63.33%, p < 0.05), mainly because of a significantly higher prevalence of combined sarcopenia and visceral obesity in non-recompensated individuals (28.29% vs. 6.67%, p < 0.01). Multivariate analysis indicated that combined sarcopenia and visceral obesity was the sole independent risk factor for non-recompensation in this population. Furthermore, in the subgroup of patients aged < 70 years, with normal weight and preserved liver function, differences in recompensation rates among various states of body composition abnormalities were more pronounced. Conclusions: Sarcopenic visceral obesity is an independent risk factor for non-recompensation in patients with decompensated cirrhosis, highlighting the need for targeted interventions to mitigate body composition abnormalities in this vulnerable population.