miRNAs in patients with alcoholic liver disease: a systematic review and meta-analysis.

INTRODUCTION: Alcoholic liver disease (ALD) encompasses a spectrum of liver conditions, including liver steatosis, alcoholic hepatitis (AH), fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). microRNAs (miRNAs) have garnered significant interest as potential biomarkers for ALD. METHODS: We searched PubMed, Embase, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL) systemically from inception to June 2024. All extracted data was stratified according to the stages of ALD. The vote-counting strategy performed a meta-analysis on miRNA expression profiles. RESULTS: We included 40 studies. In serum of individuals with alcohol-use vs. no alcohol-use, miRNA-122 and miRNA-155 were upregulated, and miRNA-146a was downregulated. In patients with ALD vs. healthy controls, miRNA-122 and miRNA-155 were also upregulated and miRNA-146a was downregulated. However, in patients with AH vs. healthy individuals, only the serum miRNA-122 level was upregulated. Due to insufficient data on diagnostic accuracy, we failed to conclude the ability of miRNAs to distinguish different stages of ALD-related liver fibrosis. The results for ALD-related HCC were also insufficient and controversial. CONCLUSIONS: Circulating miRNA-122 was the most promising biomarker to manage individuals with ALD. More studies were needed for the diagnostic accuracy of miRNAs in ALD. REGISTRATION: This protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (www.crd.york.ac.uk/prospero/) with registration number CRD42023391931.

Predictors and optimal management of tumor necrosis factor antagonist nonresponse in inflammatory bowel disease: A literature review.

Tumor necrosis factor-α (TNF-α) antagonists, the first biologics approved for treating patients with inflammatory bowel disease (IBD), are effective for the induction and maintenance of remission and significantly improving prognosis. However, up to one-third of treated patients show primary nonresponse (PNR) to anti-TNF-α therapies, and 23%-50% of IBD patients experience loss of response (LOR) to these biologics during subsequent treatment. There is still no recognized predictor for evaluating the efficacy of anti-TNF drugs. This review summarizes the existing predictors of PNR and LOR to anti-TNF in IBD patients. Most predictors remain controversial, and only previous surgical history, disease manifestations, drug concentrations, antidrug antibodies, serum albumin, some biologic markers, and some genetic markers may be potentially predictive. In addition, we also discuss the next steps of treatment for patients with PNR or LOR to TNF antagonists. Therapeutic drug monitoring plays an important role in treatment selection. Dose escalation, combination therapy, switching to a different anti-TNF drug, or switching to a biologic with a different mechanism of action can be selected based on the concentration of the drug and/or antidrug antibodies.

A case report and literature review: diagnosis and treatment of human immunodeficiency virus coinfected with visceral leishmania by metagenomic next-generation sequencing in China.

Background: human immunodeficiency virus (HIV) can disrupt the body's immune system, increasing the chance of various opportunistic infections. The risk of misdiagnosis and underdiagnosis is high for HIV and Leishmania coinfection. Visceral leishmaniasis (VL) has become a significant opportunistic infection in HIV type 1 (HIV-1)-infected patients in the epidemic region. Co-infection is difficult to diagnose, especially in non-endemic areas. Case Description: This study presents a case of VL in a middle-aged male patient with HIV coinfection, where the diagnosis was circuitous and complex. The patient was a 44-year-old male who was hospitalized due to fever. We considered common pathogen infection or hemophagocytic syndrome, so we did various etiological examinations and bone marrow biopsy smears, but no positive pathogens were found. Then we used a variety of empirical treatment, but the patient's temperature did not drop significantly. After the final diagnosis of VL using metagenomic next-generation sequencing (mNGS), we read the bone marrow smear and biopsy specimens again, and ultimately the Leishman-Donovan body and tissue intracellular pathogens were found. The patient responded well to treatment with sodium stibogluconate (SSG), his temperature gradually recovered from hyperthermia to normal, liver and spleen size gradually decreased, hemoglobin and platelet count rebounded, and weight increased by 1.5 kg after discharge from the hospital. We hope to deepen clinicians' understanding of mNGS for VL diagnosis and provide a review of the literature. Conclusions: For patients with HIV coinfection, mNGS-a test that can detect multiple pathogens simultaneously-can be used routinely when multiple pathogen tests showed no positive results, multiple empiric anti-infective therapies failed, and hospital technology and the patient's economy are adequate. While giving highly active antiretroviral therapy (HAART), liposomal amphotericin B (L-AMB) is highly recommended because of its better efficacy and lower side effects. Not only is the treatment of leishmaniasis critical but also follow-up at a later stage is essential. After discharged, the patient had no significant discomfort and no increase in body temperature, his hemoglobin and platelets increased further. He demonstrated a further reduction in liver and spleen size and a weight gain of 1.5 kg.

A case report and literature review: subcutaneous panniculitis-like T-cell lymphoma with liver failure as the main manifestation.

Background: Subcutaneous lipofuscinosis-like T-cell lymphoma (SPTCL) is a rare cutaneous lymphoma that often presents as recurrent subcutaneous nodules and may progress to hemophagocytic syndrome with fever and hepatic impairment in some patients. However, no cases of progression to hepatic failure have been reported. Here, we present a case of an adult diagnosed with fever and liver failure as the main manifestation, which was eventually confirmed as SPTCL by skin biopsy, but the patient eventually died due to disease progression. Case Description: This study retrospectively reports a rare case of SPTCL in a 34-year-old female patient who was admitted with scleral jaundice for 1 month and fever for 20 days. Examination revealed multiple small subcutaneous nodules on the skin of the chest and tibial surface and an enlarged liver and spleen. Laboratory tests revealed hepatic impairment, and common causes of liver failure (viral infection, fatty liver, immune liver damage, etc.) were excluded. We continued to refine the positron emission tomography-computed tomography (PET-CT) examination, which revealed multiple flocculent and nodular hyperdense shadows with increased metabolism in the subcutaneous fat interstices. And then, we performed a skin biopsy and the final pathological diagnosis was SPTCL, but the patient died 1 month after diagnosis due to poor treatment outcome because the disease progressed too rapidly. With this case report, we hope to improve clinicians' understanding of liver injury caused by SPTCL. A review of the literature revealed that this is the first case report in the literature of SPTCL leading to severe liver failure. Conclusions: For patients presenting with fever and liver injury, primary liver disease cannot simply be assumed, as this presentation may be a manifestation of some extra-hepatic diseases, including SPTCL. For this condition, early detection and early diagnosis may improve the prognosis of patients.