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Review Article Open Access
Artificial Intelligence in Breast Pathology: Recent Advances in Multimodal Models, Explainability, and Clinical Applications
Yan Hu, Alan Zhu, Robert Wesolowski, Maryam Tahir, Gary Tozbikian, Anil V. Parwani, Ziyu Su, Khalid Niazi, Zaibo Li
Published online May 20, 2026
Journal of Clinical and Translational Pathology. doi:10.14218/JCTP.2026.00007
Abstract
Artificial intelligence (AI) is increasingly reshaping diagnostic pathology, with breast pathology representing one of the most advanced and clinically impactful areas of adoption. [...] Read more.

Artificial intelligence (AI) is increasingly reshaping diagnostic pathology, with breast pathology representing one of the most advanced and clinically impactful areas of adoption. Despite rapid progress, many practicing pathologists remain unfamiliar with core AI concepts and their practical implications. This review provides a concise and accessible overview of AI in breast pathology, focusing on foundational principles, current clinical applications, and future directions.

Pertinent literature was reviewed. Personal experiences were also summarized and incorporated.

Key AI concepts, including algorithms, models, architectures, machine learning, deep learning, neural networks, and multimodal and foundational models, are introduced to establish a common framework. Important distinctions among generative, black-box, and explainable AI are highlighted, emphasizing the need for transparency and interpretability in clinical settings. The evolution of AI in breast pathology is reviewed, from early rule-based computer-assisted diagnostic systems to modern deep learning approaches leveraging large-scale whole-slide imaging datasets. Current applications span multiple domains, including detection of lymph node metastases, Nottingham grading, classification of benign and malignant lesions, and automated quantification of critical biomarkers. AI-based approaches to prognosis, risk stratification, prediction of treatment response, and analysis of the tumor microenvironment are also discussed. Finally, the review addresses challenges associated with real-world implementation, including data quality, bias, regulatory considerations, cost, infrastructure, and workflow integration.

As AI continues to evolve toward large-scale, multimodal, and explainable models, it is expected to function as an augmentative tool rather than a replacement for pathologists, supporting diagnostic accuracy, standardization, and personalized management in breast cancer care.

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Consensus Open Access
Expert Consensus on Physician–Pharmacist Co-management Model and Standardized Application of Anti-IgE Monoclonal Antibody Therapy for Allergic Asthma
Zhipeng Wang, Yingying Xiao, Jing Li, Li Wei, on behalf of the Expert Panel on Physician–Pharmacist Co-management
Published online February 9, 2026
Journal of Exploratory Research in Pharmacology. doi:10.14218/JERP.2025.00062
Abstract
This Consensus aims to establish a physician–pharmacist co-management model to standardize the rational clinical application of anti-immunoglobulin E monoclonal antibodies in the [...] Read more.

This Consensus aims to establish a physician–pharmacist co-management model to standardize the rational clinical application of anti-immunoglobulin E monoclonal antibodies in the treatment of allergic asthma. Focusing on the critical components of physician–pharmacist co-management, key issues related to anti-immunoglobulin E monoclonal antibody therapy were identified through a systematic literature review and clinical practice experience. Evidence quality was evaluated using an evidence grading system, and the Delphi method was applied to reach expert consensus. Centered on omalizumab, the Consensus presents 12 recommendations covering the work model of physician–pharmacist co-management, clinical management pathways, hierarchical diagnosis and treatment systems, as well as training and competency assessment. The Delphi process achieved a high degree of consensus (agreement >80%) on 12 key recommendations, emphasizing a 60-min observation period post-injection and quarterly follow-up evaluations. It establishes a standardized framework for the co-management of omalizumab therapy in allergic asthma. Results highlighted that co-management effectively monitors omalizumab dosage (75–600 mg) and maintains a consensus threshold of >80% for patient safety protocols. The Consensus provides a standardized framework for physician–pharmacist co-management, which is expected to facilitate rational drug use and improve patient care pathways in omalizumab therapy.

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Original Article Open Access
Genotype-specific Response to 144-week Entecavir Therapy for HBeAg-positive Chronic Hepatitis B with a Particular Focus on Histological Improvement: A Prospective Study
Lexin Liu, Qiumiao Xu, Shanshan Lin, Zehui Wei, Guoxin Huang
Published online December 31, 2025
Journal of Clinical and Translational Hepatology. doi:10.14218/JCTH.2025.00533
Abstract
Chronic hepatitis B (CHB) poses a major global health burden, with China particularly affected. Effective antiviral therapy is crucial to prevent disease progression, but responses [...] Read more.

Chronic hepatitis B (CHB) poses a major global health burden, with China particularly affected. Effective antiviral therapy is crucial to prevent disease progression, but responses may vary by Hepatitis B virus (HBV) genotype. This prospective study aimed to compare genotype-specific responses to 144-week entecavir (ETV) therapy in HBeAg-positive CHB patients, with particular emphasis on histological improvement assessed through paired liver biopsies.

We enrolled 49 treatment-naïve CHB patients (HBV DNA ≥ 20,000 IU/mL, alanine transaminase (ALT) > 2× ULN, and Scheuer system G ≥ 2) who received ETV 0.5 mg/day. HBV genotyping was performed using Polymerase Chain Reaction and fragment length analysis. The primary endpoint was histological improvement (i.e., ≥ 2-grade reduction in necroinflammatory activity without fibrosis progression), evaluated via paired biopsies (baseline and week 144) by blinded pathologists. Secondary endpoints included virological response (i.e., serum HBV DNA < 100 IU/mL), HBeAg seroconversion, and ALT normalization.

The cohort included 24 genotype B and 24 genotype C patients (one genotype A patient was excluded from genotype-specific analyses). Genotype B showed significantly higher histological improvement rates (91.3% vs. 63.2%, P = 0.027) and greater inflammation resolution (0 ≤ G < 1: 56.5% vs. 26.3%, P = 0.048). Virological suppression was excellent in both groups (100% vs. 100%). HBeAg seroconversion trended higher in genotype C (29.2% vs. 50.0%, P = 0.140). All patients achieved ALT normalization by week 48, with no safety concerns.

HBV genotype B demonstrates superior histological responses to ETV therapy compared with genotype C, supporting the clinical value of HBV genotyping for personalized CHB management. These findings highlight the importance of considering viral genotype when evaluating treatment outcomes.

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Original Article Open Access
Global Prevalence, Temporal Trends, and Associated Mortality of Bacterial Infections in Patients with Liver Cirrhosis: A Meta-analysis
Yu-Xin Tian, Bai-Yun Wu, Qi An, Yin-Ping Wu, Jing Zuo, Yee Hui Yeo, Yu-Chen Fan
Published online October 27, 2025
Journal of Clinical and Translational Hepatology. doi:10.14218/JCTH.2025.00260
Abstract
Bacterial infections (BIs) are common and severe complications in patients with liver cirrhosis, but global data are limited. Here, we aimed to evaluate the global prevalence, temporal [...] Read more.

Bacterial infections (BIs) are common and severe complications in patients with liver cirrhosis, but global data are limited. Here, we aimed to evaluate the global prevalence, temporal changes, and associated mortality risk of BIs in liver cirrhosis.

We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for eligible studies published without language restrictions until 11 August 2025. A random-effects model was used for meta-analyses, meta-regression by study year, and pooling adjusted hazard ratios.

Fifty-nine studies, including 1,191,421 patients with cirrhosis, were analyzed. The pooled prevalence of BIs (33 studies) was 35.1% (95% confidence interval (CI): 29.2–41.4). The prevalence of Escherichia coli and Streptococcus spp. was 3.8% (95% CI: 2.5–5.2) and 1.5% (95% CI: 0.8–2.6), respectively. The pooled prevalence of multidrug-resistant bacteria was 6.8% (95% CI: 4.0–11.3). The most common BI sites were the gastrointestinal tract, ascites fluid, and urinary tract. The highest prevalence of BIs was reported in Europe (38.2%; 95% CI: 24.8–53.6), followed by South America (37.5%; 95% CI: 29.7–46.1) and Asia (22.8%; 95% CI: 16.3–30.9). Patients with acute-on-chronic liver failure showed the highest prevalence of BIs (44.2%; 95% CI: 29.7–59.8). A modest increasing trend in BIs prevalence was observed over time. BIs were associated with an increased risk of mortality in patients with cirrhosis (adjusted hazard ratios 2.22, 95% CI 1.33–3.71).

BIs are prevalent in cirrhosis, especially in acute-on-chronic liver failure, with a modest upward trend and increased mortality risk.

Full article
Original Article Open Access
Terahertz Radiation-induced Remodeling of Purine Metabolism and Membrane Raft Signaling in Human Melanoma Cells: A Metabolomic and Gene Network Analysis
Stefaniya O. Lebedeva, Aelita-Luiza A. Makarova, Ekaterina A. Butikova, Nikita V. Basov, Ivan A. Razumov, Evgeny V. Gaisler, Artem D. Rogachev, Vasiliy M. Popik, Andrey G. Pokrovsky, Vladimir A. Ivanisenko
Published online January 26, 2026
Gene Expression. doi:10.14218/GE.2025.00068
Abstract
Terahertz (THz) radiation is increasingly explored for biomedical applications, however, its non-thermal effects on cellular metabolism and regulatory networks remain insufficiently [...] Read more.

Terahertz (THz) radiation is increasingly explored for biomedical applications, however, its non-thermal effects on cellular metabolism and regulatory networks remain insufficiently characterized. This study aimed to investigate how 2.3 THz radiation affects metabolic pathways and membrane-associated signaling in human melanoma cells.

SK-MEL-28 melanoma cells were exposed to 2.3 THz radiation for 45 min using the 1st Novosibirsk free-electron laser. Cell viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and trypan blue assays. Metabolic alterations were detected by targeted metabolomics using liquid chromatography–tandem mass spectrometry. Gene network analysis was performed using the ANDSystem platform to reconstruct gene and protein interaction networks linking altered metabolites to membrane receptors, lipid raft proteins, and signaling pathways. Overrepresentation analysis of biological processes was applied to identify enriched functional categories.

THz exposure did not affect cell viability but induced significant alterations in purine metabolism, pantothenate/CoA biosynthesis, and the pentose phosphate pathway. Network analysis revealed that these metabolic changes were associated with membrane raft reorganization and receptor-mediated signaling involving epidermal growth factor receptor and G-protein subunits. Additional effects were observed in pathways related to chromatin organization and post-translational regulation.

THz radiation induces coordinated remodeling of metabolic and regulatory networks in melanoma cells without cytotoxicity. These findings highlight the role of membrane-associated signaling in mediating THz-induced cellular responses and provide insight into potential biomedical applications of THz technologies.

Full article
Original Article Open Access
Metabolic Risk Factors and Clinical Presentations of Metabolic Dysfunction-associated Steatotic Liver Disease Using Data from the All of Us Research Program
Ke-Qin Hu, Seyedeh Neelufar Payrovnaziri, Argyrios Ziogas, Steven Hiek, Kuangda Shan, Tevan Luong, Jenny Fang, Hoda Anton-Culver
Published online January 27, 2026
Journal of Clinical and Translational Hepatology. doi:10.14218/JCTH.2025.00393
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) affects approximately 32% of the US adult population. The present study aimed to utilize the All of Us electronic [...] Read more.

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects approximately 32% of the US adult population. The present study aimed to utilize the All of Us electronic health record-linked large cohort to assess seven metabolic risk factors (MRFs) simultaneously, the impact by ethnicity and age, and clinical presentations of MASLD.

This study included a MASLD group (n = 15,060) and a frequency-matched control group (n = 75,300). Multivariable analyses were performed to compare the frequencies of MRFs and clinical outcomes between the two groups. Type 1 diabetes was not included in the multivariable analysis. Subgroup analyses were conducted according to race and ethnicity, as well as age.

The overall frequency of MASLD was 6.0%. Compared with the control group, individuals with MASLD had significantly higher independent frequencies of obesity (66.1% vs. 41.3%), type 2 diabetes (39.5% vs. 16.9%), hypertension (64.3% vs. 38.6%), hyperlipidemia (59.8% vs. 37.3%), obstructive sleep apnea (28.9% vs. 13.4%), and hypothyroidism (21.2% vs. 13.4%). Obesity was identified as the strongest independent MRF among Asians, Whites, and Hispanics, particularly in individuals younger than 50 years, whereas hypertension was the strongest independent MRF in Blacks. MASLD was also associated with significantly higher frequencies of cardiac events, including coronary artery disease (17.1% vs. 9.4%) and myocardial infarction (7.1% vs. 4.2%); hepatic events, including cirrhosis (7.5% vs. 1.1%) and hepatocellular carcinoma (0.5% vs. 0.1%); and elevated liver enzymes, including alanine aminotransferase (27.7% vs. 10.1%), aspartate aminotransferase (18.0% vs. 6.4%), and alkaline phosphatase (19.8% vs. 13.1%), compared with the control group.

Our study demonstrated that obesity, hypertension, hyperlipidemia, type 2 diabetes, obstructive sleep apnea, and hypothyroidism were independent MRFs for MASLD overall, but the ranking of these MRFs by odds ratios could vary by ethnicity and age. MASLD presents with significantly higher rates of alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase elevation, as well as cardiac and hepatic events.

Full article
Original Article Open Access
Consensus versus Outcome-based Definitions of Acute-on-chronic Liver Failure: Implications for Risk Stratification and Case Identification
Nipun Verma, Tingting Qi, Pratibha Garg, Arun Valsan, Gowripriya Nair, Julian Pohl, Arathi Venu, Xianbo Wang, Xin Zheng, Guohong Deng, Yan Huang, Zhongji Meng, Yanhang Gao, Zhiping Qian, Xiaobo Lu, Feng Liu, Yu Shi, Jia Shang, Yubao Zheng, Yingli He, Meiqian Hu, Changze Hong, Sina Jameie-Oskooei, Raj Mookerjee, Mohammad Mahdi Saeidinejad, Sunil Taneja, Jinjun Chen, Hai Li, Ajay Duseja, Cornelius Engelmann, Rajiv Jalan
Published online May 15, 2026
Journal of Clinical and Translational Hepatology. doi:10.14218/JCTH.2026.00267
Abstract
Acute-on-chronic liver failure (ACLF) lacks a universally accepted definition, and recent efforts have proposed consensus organ failure criteria. In this study, we aimed to compare [...] Read more.

Acute-on-chronic liver failure (ACLF) lacks a universally accepted definition, and recent efforts have proposed consensus organ failure criteria. In this study, we aimed to compare the clinical validity of a recently proposed consensus ACLF framework with the outcome-calibrated A-TANGO classification.

We performed a multinational cohort study including 2,398 patients from the TIH cohort (India) and 2,568 from the CATCH-LIFE cohort (China) who were hospitalized with acute decompensation of cirrhosis. ACLF was defined using A-TANGO and an operationalized version of the 2025 consensus framework. Outcomes were 28- and 90-day mortality. Analyses assessed case capture, overlap, mortality risk, sensitivity, specificity, and net reclassification improvement (NRI).

ACLF prevalence differed substantially by definition. In TIH, A-TANGO classified 79.2% as ACLF versus 42.3% by the consensus definition; in CATCH-LIFE, the corresponding values were 31.4% versus 5.8%, respectively. Most consensus ACLF cases were captured by A-TANGO, which additionally classified 26%–37% of patients as having ACLF. These patients had substantial mortality (28-day: 18.1%–26.9%; 90-day: 33.2%–37.9%), significantly higher than those negative by both frameworks and comparable to established ACLF risk thresholds. A-TANGO showed higher sensitivity for 28-day mortality (TIH: 94.1% vs. 67.8%; CATCH-LIFE: 76.1% vs. 25.6%), whereas consensus criteria were more specific. Reclassification analyses showed improved discrimination with A-TANGO (NRI: 17.1% in TIH; 27.4% in CATCH-LIFE). Within the consensus non-ACLF group, A-TANGO further stratified patients into distinct risk groups with stepwise increase in mortality.

In conclusion, the two frameworks identify fundamentally different populations. The consensus definition significantly reduces sensitivity and under-recognizes high-risk patients. Compared with consensus definitions, the outcome-calibrated framework better supports diagnosis, clinical decision-making, risk stratification, and trial design in ACLF.

Full article
Review Article Open Access
Molecular Docking of Resveratrol with Ovarian Cancer-associated Proteins and Its Therapeutic Benefits
Yiwei Chen, Dayi Pan, Neil Roberts, Bomeng Du, Mingzhu Zheng, Zhilin Qian, Shangwen Jin, Jixia Wei, Fang Wan, Bensheng Qiu, Yaying Li
Published online December 30, 2025
Future Integrative Medicine. doi:10.14218/FIM.2025.00025
Abstract
Ovarian cancer (OC) is a major global health problem. The main treatments are surgery and chemoradiotherapy. A drawback of the latter is that repeated treatments are likely to lead [...] Read more.

Ovarian cancer (OC) is a major global health problem. The main treatments are surgery and chemoradiotherapy. A drawback of the latter is that repeated treatments are likely to lead to cancer cells developing resistance to the drug, resulting in recurrence, development of metastases, and poor prognosis for patients. Consequently, there is interest in combining chemoradiotherapy with treatment using active components extracted from natural products. One such component is resveratrol (RVT), which is a natural anti-tumor ingredient extracted from plants. Although there are many reviews on the biological activity of RVT, only a few studies have been performed to investigate the diversity of protein binding of RVT with OC and the application of various novel drug formulations containing RVT to treat OC. The review presented here may provide some ideas for the prevention and treatment of OC.

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Original Article Open Access
Characteristic Genomic and Clinicopathologic Landscape of DNA Polymerase Epsilon Mutant Colorectal Adenocarcinomas – A Retrospective Cohort Study
Zachary Coty-Fattal, David Escobar, Juehua Gao, Jessica Nguyen, Jennifer Ju, Lawrence Jennings, Guang-Yu Yang
Published online December 30, 2025
Journal of Clinical and Translational Pathology. doi:10.14218/JCTP.2025.00035
Abstract
DNA polymerase epsilon catalytic subunit A (POLE) gene plays a crucial role in DNA repair and chromosomal replication. Mutations in the POLE gene have been linked to cancer, particularly [...] Read more.

DNA polymerase epsilon catalytic subunit A (POLE) gene plays a crucial role in DNA repair and chromosomal replication. Mutations in the POLE gene have been linked to cancer, particularly colorectal carcinoma (CRC). However, the genomic landscape and pathological significance of POLE mutant CRC remain underreported. This study aimed to characterize the clinicopathologic features and genomic landscape of CRC harboring POLE mutations and to investigate the implications of co-occurring genetic alterations.

We identified thirty-four CRC cases with POLE mutations from our institution’s database using the next-generation sequencing gene panels including 161-gene panel for the cases of 2016–2021 and the 505-gene panel for the case of 2022–2023. We collected clinicopathologic data (age, sex, tumor site, and grading) and conducted comprehensive next-generation sequencing. Survival outcomes were assessed by reviewing patients’ medical records at the time of data collection, with survival status determined based on the most recent clinical follow-up available with overall survival as the primary endpoint and a median follow-up time of 20.5 months. Statistical analyses, including chi-squared testing and CoMutation plotting, were performed using Python.

The enrolled 34 patients had a median age of 60.5 years (range: 37–84); tumors were in the colon (26 cases, 77%) and rectum (8 cases, 23%), with a mismatch repair deficiency rate of 29%. Next-generation sequencing analysis of a 505-gene panel revealed that POLE mutations were predominantly missense (89%). The mutations were distributed across various domains: 11.4% in the exonuclease domain, 25.7% in the catalytic domain, 20% in an unknown functional domain, and 42.9% in a nonfunctional domain. The average number of genomic mutations per case was 12.1 ± 12.3. CoMutation analysis identified two subsets: genomic mutation high (>5 mutations, range 6–60 mutations, n = 22) and mutation low (. Notably, TP53 mutations occurred in 55% of cases, and defects in double-stranded DNA repair proteins occurred in 47% of cases. POLE mutant CRC with co-occurring DNA repair mutations exhibited a significantly higher total number of genomic mutations (19.9 ± 14.4, range 7–60 mutations; chi-squared = 5.1, p-value = 0.02). Although a survival comparison between TP53 wild-type and TP53 mutant subgroups of POLE-mutant CRC is not statistical significant (p = 0.37), it showed a trend toward better survival in the TP53 wild-type group.

Our findings reveal unique genomic landscapes in POLE mutant CRC, particularly with co-occurring TP53 or double-stranded DNA repair mutations, which are critical in colorectal carcinogenesis. These tumors demonstrate increased genetic instability, highlighting potential for immunotherapy.

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Review Article Open Access
Repurposing SGLT2 Inhibitors for Cirrhotic Ascites: From Mechanistic Research to Clinical Exploration
Yuan Gao, Yunyi Gao, Dong Ji, Zhongjie Hu
Published online January 22, 2026
Journal of Clinical and Translational Hepatology. doi:10.14218/JCTH.2025.00465
Abstract
Cirrhotic ascites develops when portal hypertension and arterial under-filling chronically activate neuro-hormonal pathways that drive renal sodium-water retention. Augmented proximal [...] Read more.

Cirrhotic ascites develops when portal hypertension and arterial under-filling chronically activate neuro-hormonal pathways that drive renal sodium-water retention. Augmented proximal tubular sodium reabsorption, predominantly mediated by the apical sodium/hydrogen exchanger 3 (NHE3), plays a fundamental role in this process. Given the spatial coupling of NHE3 and the sodium-glucose cotransporter 2 (SGLT2), selective SGLT2 inhibition reduces NHE3 activity via functional suppression within the apical microdomain. The increased sodium chloride delivery to the macula densa augments tubuloglomerular feedback and modulates the renin–angiotensin–aldosterone system. Early clinical investigations, ranging from case reports and retrospective analyses to pilot randomized trials, indicated potential benefits in controlling ascites and reducing decompensation events. However, their limited sample size, heterogeneous endpoints, and predominantly observational design constrain the generalizability of the findings. This review concentrates on the molecular mechanisms and emerging clinical evidence supporting the therapeutic potential of SGLT2 inhibitors in the management of cirrhotic ascites.

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