Search

Hepatitis B virus (HBV) can be completely suppressed after antiviral treatment; however, some patients with chronic hepatitis B (CHB) exhibit elevated alanine aminotransferase (ALT) levels and sustained disease progression. This study provides novel insights into the mechanism and potential predictive biomarkers of persistently elevated ALT (PeALT) in patients with CHB after complete viral inhibition. Patients having CHB with undetectable HBV DNA at least 12 months after antiviral treatment were enrolled from a prospective, observational cohort. Patients with PeALT and persistently normal ALT (PnALT) were matched 1:1 using propensity score matching. Correlations between plasma metabolites and the risk of elevated ALT were examined using multivariate logistic regression. A mouse model of carbon tetrachloride‐induced liver injury was established to validate the effect of key differential metabolites on liver injury. Of the 1238 patients with CHB who achieved complete viral suppression, 40 (3.23%) had PeALT levels during follow‐up (median follow‐up: 2.42 years). Additionally, 40 patients with PnALT levels were matched as controls. Ser‐Phe‐Ala, Lys‐Ala‐Leu‐Glu, 3‐methylhippuric acid, 3‐methylxanthine, and 7‐methylxanthine were identified as critical differential metabolites between the two groups and independently associated with PeALT risk. Ser‐Phe‐Ala and Lys‐Ala‐Leu‐Glu levels could be used to discriminate patients with PeALT from those with PnALT. Furthermore, N‐acetyl‐ l‐methionine (NALM) demonstrated the strongest negative correlation with ALT levels. NALM supplementation alleviated liver injury and hepatic necrosis induced by carbon tetrachloride in mice. Changes in circulating metabolites may contribute to PeALT levels in patients with CHB who have achieved complete viral suppression after antiviral treatment. [ABSTRACT FROM AUTHOR]

Background and Aim: There is a lack of literature comparing linear endoscopic ultrasound (EUS) and radial EUS for the prediction of the depth of invasion in early gastric cancer (EGC). The aim of this study is to evaluate the accuracy of linear EUS for the diagnosis of submucosal (SM) invasion and compare linear EUS with radial EUS in suspected EGC patients. Methods: Seventy‐two consecutive patients with suspected EGC who underwent a preoperative assessment using linear EUS or radial EUS were prospectively enrolled. The depth of invasion was categorized into mucosal to SM (< T1b) and SM or deeper (≥ T1b), and the EUS‐determined diagnosis was compared with postoperative histopathological findings. Results: Thirty‐nine patients underwent radial EUS, and 33 patients underwent linear EUS examination. The baseline characteristics between the groups were well balanced. The diagnostic accuracy was much higher for patients who underwent linear EUS compared with radial EUS (90.9% vs 69.2%, P = 0.024). The sensitivity was 92.3% (95% confidence interval [CI] 66.7–98.6%) for linear EUS and 90.9% (95% CI 62.3–98.4%) for radial EUS. The specificity was 90.0% (95% CI 69.9–97.2%) in the linear EUS group, while the specificity was 60.7% (95% CI 42.4–76.4%) in the radial EUS group. Univariate analysis showed that EUS type (odds ratio 0.225, 95% CI 0.057–0.884, P = 0.033) was an associated risk factor of incorrect T1b staging in EGC patients. The area under the receiver operating curve was 0.912 and 0.758 for linear and radial EUS, respectively. Conclusion: Linear EUS was more accurate for determining SM invasion and therapeutic strategy in suspected EGC patients compared with radial EUS. [ABSTRACT FROM AUTHOR]