Yīn-Chén-Hāo decoction(YCHD) is a traditional Chinese medicine formula composed of capillaris(Artemisia capillaris), gardenia(Gardenia jasminoides), and rhubarb(Rheum rhabarbarum) that is used for the treatment...Yīn-Chén-Hāo decoction(YCHD) is a traditional Chinese medicine formula composed of capillaris(Artemisia capillaris), gardenia(Gardenia jasminoides), and rhubarb(Rheum rhabarbarum) that is used for the treatment of damp-heat jaundice. In modern clinics, YCHD is mostly used for hepatic diseases. This review summarizes the biological activities of YCHD and its medical applications. The main active compounds of YCHD are chlorogenic acid, rhein, geniposide, emodin, and scoparone. The pharmacological actions of YCHD include inhibition of hepatic steatosis, apoptosis, necrosis, anti-inflammation, and immune regulation. YCHD could be developed as a new therapeutic strategy for the treatment of hepatic diseases.展开更多
Ultrasound(US)imaging is a non-invasive,real-time,economical,and convenient imaging modality that has been widely used in diagnosing and treating hepatic diseases.Artificial intelligence(AI)technology can predict or m...Ultrasound(US)imaging is a non-invasive,real-time,economical,and convenient imaging modality that has been widely used in diagnosing and treating hepatic diseases.Artificial intelligence(AI)technology can predict or make decisions based on the experience of clinical experts and knowledge obtained from training data.This technology can help clinicians improve the detection efficiency and evaluate hepatic diseases,promote clinical treatment of the liver,and predict the response of the liver after treatment.This review summarizes the current rapid development of US technology and related AI methods in the diagnosis and treatment of hepatic diseases.Covered topics include steatosis grading,fibrosis staging,detection of focal liver lesions,US image segmentation,multimodal image registration,and other applications.At present,the field of AI in US imaging is still in its early stages.With the future progress of AI technology,AI-based US imaging can further improve diagnosis,reduce medical costs,and optimize US-based clinical workflow.This technology has broad prospects for application to hepatic diseases.展开更多
Wilson disease is an autosomal recessive disorder affecting the ATP7B gene located on chromosome 13q.This leads to copper deposition in various organs,most importantly in the liver and brain.The genetic mutations are ...Wilson disease is an autosomal recessive disorder affecting the ATP7B gene located on chromosome 13q.This leads to copper deposition in various organs,most importantly in the liver and brain.The genetic mutations are vast,well reported in the West but poorly documented in developing countries.Hence the diagnosis is made with a constellation of clinico-laboratory parameters which have significant overlap with other liver diseases and often pose a significant dilemma for clinicians.Diagnostic scoring systems are not fool-proof.The availability and affordability of chelators in developing countries impact the drug compliance of patients.While D-penicillamine is a potent drug,its side effects lead to drug discontinuation.Trientine is cost-prohibitive in developing countries.There is no single test to assess the adequacy of chelation.Exchangeable urinary copper is an essential upcoming diagnostic and prognostic tool.In the presence of cirrhosis,hypersplenism clouds the assessment of myelosuppression of drugs.Similarly,it may be difficult to distinguish disease tubulopathy from druginduced glomerulonephritis.Neurological worsening due to chelators may appear similar to disease progression.Presentation as fulminant hepatic failure requires rapid workup.There is a limited window of opportunity to salvage these patients with the help of plasmapheresis and other liver-assisted devices.This review addresses the challenges and clinical dilemmas faced at beside in developing countries.展开更多
BACKGROUND Liver disease incidence and hence demand on hepatology services is increasing.AIM To describe trends in incidence and natural history of liver diseases in Wales to inform effective provision of hepatology s...BACKGROUND Liver disease incidence and hence demand on hepatology services is increasing.AIM To describe trends in incidence and natural history of liver diseases in Wales to inform effective provision of hepatology services.METHODS The registry is populated by International Classification of Diseases-10(ICD-10)code diagnoses for residents derived from mortality data and inpatient/day case activity between 1999-2019.Pseudo-anonymised linkage of:(1)Causative diagnoses;(2)Cirrhosis;(3)Portal hypertension;(4)Decompensation;and(5)Liver cancer diagnoses enabled tracking liver disease progression.RESULTS The population of Wales in 2019 was 3.1 million.Between 1999 and 201973054 individuals were diagnosed with a hepatic disorder,including 18633 diagnosed with cirrhosis,10965 with liver decompensation and 2316 with hepatocellular carcinoma(HCC).Over 21 years the incidence of liver diseases increased 3.6 fold,predominantly driven by a 10 fold increase in non-alcoholic fatty liver disease(NAFLD);the leading cause of liver disease from 2014.The incidence of cirrhosis,decompensation,HCC,and allcause mortality tripled.Liver-related mortality doubled.Alcohol-related liver disease(ArLD),autoimmune liver disease and congestive hepatopathy were associated with the highest rates of decompensation and all-cause mortality.CONCLUSION A 10 fold increase in NAFLD incidence is driving a 3.6 fold increase in liver disease in Wales over 21 years.Liver-related morbidity and mortality rose more slowly reflecting the lower progression rate in NAFLD.Incidence of ArLD remained stable but was associated with the highest rates of liver-related and all-cause mortality.展开更多
BACKGROUND Wilson disease(WD)is the most common genetic metabolic liver disease.Some studies have shown that comorbidities may have important effects on WD.Data on hepatitis B virus(HBV)infection in patients with WD a...BACKGROUND Wilson disease(WD)is the most common genetic metabolic liver disease.Some studies have shown that comorbidities may have important effects on WD.Data on hepatitis B virus(HBV)infection in patients with WD are limited.AIM To investigate the prevalence and clinical impact of HBV infection in patients with WD.METHODS The clinical data of patients with WD were analyzed retrospectively,and the data of patients with concurrent WD and HBV infection were compared with those of patients with isolated WD.RESULTS Among a total of 915 WD patients recruited,the total prevalence of current and previous HBV infection was 2.1%[95%confidence interval(CI):1.2%-3.0%]and 9.2%(95%CI:7.3%-11.1%),respectively.The main finding of this study was the identification of 19 patients with concurrent WD and chronic hepatitis B(CHB)infection.The diagnosis of WD was missed in all but two patients with CHB infection.The mean delay in the diagnosis of WD in patients with concurrent WD and CHB infection was 32.5 mo,which was significantly longer than that in patients with isolated WD(10.5 mo).The rates of severe liver disease and mortality in patients with concurrent WD and CHB infection were significantly higher than those in patients with isolated WD(63.1%vs 19.3%,P=0.000 and 36.8%vs 4.1%,P<0.001,respectively).Binary logistic regression analysis revealed a significantly higher risk of severe liver disease at the diagnosis of WD in patients with current HBV infection[odds ratio(OR)=7.748;95%CI:2.890-20.774;P=0.000)]or previous HBV infection(OR=5.525;95%CI:3.159-8.739;P=0.000)than in patients with isolated WD.CONCLUSION The total prevalence of current HBV infection in patients with WD was 2.1%.The diagnosis of WD in CHB patients is usually missed.HBV infection is an independent risk factor for severe liver disease in WD patients.The diagnosis of WD should be ruled out in some patients with CHB infection.展开更多
Biliary cystadenocarcinoma is a very rare malignant cystic tumor of the liver,which is often misdiagnosed due to a poor recognition of it.We report a case of a 60-year-old man with biliary cystadenocarcinoma with his ...Biliary cystadenocarcinoma is a very rare malignant cystic tumor of the liver,which is often misdiagnosed due to a poor recognition of it.We report a case of a 60-year-old man with biliary cystadenocarcinoma with his real time contrast enhanced ultrasound(CEUS)characteristics compared to those of computed tomography(CT)and magnetic resonance imaging(MRI),which were correlated with the surgical and pathologic findings.Cystic wall enhancement,internal septations and intra-cystic solid portions in the arterial phase were observed on CEUS after contrast agent injection.The enhancement was washed out progressively and depicted as hypo-enhancement in the portal and late phases.CT revealed a large irregular cystic lesion in the left liver lobe with no clear septations and solid components.MRI showed an irregular cystic occupying lesion with septations.展开更多
BACKGROUND Budd-Chiari syndrome(BCS)is a challenging indication for liver transplantation(LT)due to a combination of massive liver,increased bleeding,retroperitoneal fibrosis and frequently presents with stenosis of t...BACKGROUND Budd-Chiari syndrome(BCS)is a challenging indication for liver transplantation(LT)due to a combination of massive liver,increased bleeding,retroperitoneal fibrosis and frequently presents with stenosis of the inferior vena cava(IVC).Occasionally,it may be totally thrombosed,increasing the complexity of the procedure,as it should also be resected.The challenge is even greater when performing living-donor LT as the graft does not contain the retrohepatic IVC;thus,it may be necessary to reconstruct it.CASE SUMMARY A 35-year-old male patient with liver cirrhosis due to BCS and hepatocellular carcinoma beyond the Milan criteria underwent living-donor LT with IVC reconstruction.It was necessary to remove the IVC as its retrohepatic portion was completely thrombosed,up to almost the right atrium.A right-lobe graft was retrieved from his sister,with outflow reconstruction including the right hepatic vein and the branches of segment V and VIII to the middle hepatic vein.Owing to massive subcutaneous collaterals in the abdominal wall,venovenous bypass was implemented before incising the skin.The right atrium was reached via a transdiaphragramatic approach.Hepatectomy was performed en bloc with the retrohepatic vena cava.It was reconstructed with an infra-hepatic vena cava graft obtained from a deceased donor.The patient remains well on outpatient clinic follow-up 25 mo after the procedure,under an anticoagulation protocol with warfarin.CONCLUSION Living-donor LT in BCS with IVC thrombosis is feasible using a meticulous surgical technique and tailored strategies.展开更多
Alstonia scholaris(L.)R.Br(Apocynaceae)is a well-documented medicinal plant for treating respiratory diseases,liver diseases and diabetes traditionally.The current study aimed to investigate the effects of TA on non-a...Alstonia scholaris(L.)R.Br(Apocynaceae)is a well-documented medicinal plant for treating respiratory diseases,liver diseases and diabetes traditionally.The current study aimed to investigate the effects of TA on non-alcoholic fatty liver disease(NAFLD).A NAFLD model was established using mice fed a high-fat diet(HFD)and administered with TA(7.5,15 and 30 mg/kg)orally for 6 weeks.The biochemical parameters,expressions of lipid metabolism-related genes or proteins were analyzed.Furthermore,histopathological examinations were evaluated with Hematoxylin-Eosin and MASSON staining.TA treatment significantly decreased the bodyweight of HFD mice.The concentrations of low-density lipoprotein(LDL),triglyceride(TG),aspartate aminotransferase(AST)and alanine aminotransferase(ALT)were also decreased significantly in TA-treated mice group,accompanied by an increase in high-density lipoprotein(HDL).Furthermore,TA alleviated hepatic steatosis injury and lipid droplet accumulation of liver tissues.The liver mRNA levels involved in hepatic lipid synthesis such as sterol regulatory element-binding protein 1C(SREBP-1C),regulators of liver X receptorα(LXRα),peroxisome proliferator activated receptor(PPAR)γ,acetyl-CoA carboxylase(ACC1)and stearyl coenzyme A dehydrogenase-1(SCD1),were markedly decreased,while the expressions involved in the regulation of fatty acid oxidation,PPARα,carnitine palmitoyl transterase 1(CPT1A),and acyl coenzyme A oxidase 1(ACOX1)were increased in TA-treated mice.TA might attenuate NAFLD by regulating hepatic lipogenesis and fatty acid oxidation.展开更多
Traditional medical imaging,including ultrasound,computed tomography,magnetic resonance imaging,or positron emission tomography,remains widely used diagnostic modalities for gastrointestinal diseases at present.These ...Traditional medical imaging,including ultrasound,computed tomography,magnetic resonance imaging,or positron emission tomography,remains widely used diagnostic modalities for gastrointestinal diseases at present.These modalities are used to assess changes in morphology,attenuation,signal intensity,and enhancement characteristics.Gastrointestinal tumors,especially malignant tumors,are commonly seen in clinical practice with an increasing number of deaths each year.Because the imaging manifestations of different diseases usually overlap,accurate early diagnosis of tumor lesions,noninvasive and effective evaluation of tumor staging,and prediction of prognosis remain challenging.Fortunately,traditional medical images contain a great deal of important information that cannot be recognized by human eyes but can be extracted by artificial intelligence(AI)technology,which can quantitatively assess the heterogeneity of lesions and provide valuable information,including therapeutic effects and patient prognosis.With the development of computer technology,the combination of medical imaging and AI technology is considered to represent a promising field in medical image analysis.This new emerging field is called“radiomics”,which makes big data mining and extraction from medical imagery possible and can help clinicians make effective decisions and develop personalized treatment plans.Recently,AI and radiomics have been gradually applied to lesion detection,qualitative and quantitative diagnosis,histopathological grading and staging of tumors,therapeutic efficacy assessment,and prognosis evaluation.In this minireview,we briefly introduce the basic principles and technology of radiomics.Then,we review the research and application of AI and radiomics in gastrointestinal diseases,especially diagnostic advancements of radiomics in the differential diagnosis,treatment option,assessment of therapeutic efficacy,and prognosis evaluation of esophageal,gastric,hepatic,pancreatic,and colorectal diseases.展开更多
Objective: Hepatic veno-occlusive disease(HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of...Objective: Hepatic veno-occlusive disease(HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of specific therapies. The aim of the study was to delineate the clinical characteristics and outcomes and explore the potential prognostic factors of HVOD.Methods: This was a single-center retrospective study. Eighty-nine HVOD patients were screened from the First Affiliated Hospital of Zhejiang University with an ingestion history of G. segetum before developing symptoms from January 2009 to May 2018. The enrolled patients were divided into the survivor and death groups according to the clinical follow-up that ended on September 1, 2019. The demographic variables and clinical data of the patients were recorded. A binary logistic regression analysis and receiver operating characteristic curve were conducted to identify the prognostic factors and assess the prognostic value for predicting death, and a survival analysis was performed to evaluate the clinical outcomes.Results: Sixty-four patients were eligible for further analysis. Most patients showed abdominal distension and were positive for migrating dullness in the abdomen(P = 0.740 and P = 0.732, respectively). The patients who died had higher levels of model for end-stage liver disease score, and higher prothrombin time than those who survived(both P < 0.001). All HVOD patients in both the survival and death groups showed ascites with abnormal imaging presentations of the liver parenchyma and hepatic blood vessels.Unexpectedly, we found that hydrothorax was detected in 21(65.63%) patients in the death group and 19(59.38%) patients in the survivor group during hospitalization, which was rarely mentioned in previous studies. Furthermore, international normalized ratio(INR) and creatinine are found to be potential independent prognostic factors for predicting death. Six severe patients achieved clinical improvements and survived after liver transplantation.Conclusion: HVOD can be induced by the ingestion of G. segetum, and INR combined with creatinine has prognostic value for predicting death. Liver transplantation may be an effective treatment option for severe HVOD patients.展开更多
Fulminant hepatitis is fatal in most cases and timely liver transplantation is the only effective treatment.This study evaluates the survival outcomes of patients who underwent living-donor liver transplantation(LDLT)...Fulminant hepatitis is fatal in most cases and timely liver transplantation is the only effective treatment.This study evaluates the survival outcomes of patients who underwent living-donor liver transplantation(LDLT)using right lobe liver grafts for fulminant liver failure due to hepatitis B infection.Nine cases of adult right lobe LDLT were performed in our department from September 2002 to August 2005 and the clinical and following-up data were reviewed.According to the pre-transplant Child-Pugh-Turcotte classification,the nine patients were classified as grade C.The model for end-stage liver disease(MELD)score of these patients ranged from 16 to 42.The principal complications before transplantation included abnormal renal function,hepatic coma of different degrees and alimentary tract hemorrhage.The main complications after transplantation included pulmonary infection in two cases,acute renal failure in three cases and transplantation-related encephalopathy in one case.No primary failure of vascular or biliary complications occurred.The one-year survival rate was 55.6%.There were no serious complications or deaths in donors.In general,it is extremely difficult to treat fulminant hepatitis by conservative regimen,particularly,in cases with rapid progression.Emergency adult living-donor liver transplantation is an effective treatment for fulminant hepatitis patients and is relatively safe for donors.展开更多
As obligate intracellular parasites,viruses need a host cell to provide a milieu favorable to viral replication.Consequently,viruses often adopt mechanisms to subvert host cellular signaling processes.While beneficial...As obligate intracellular parasites,viruses need a host cell to provide a milieu favorable to viral replication.Consequently,viruses often adopt mechanisms to subvert host cellular signaling processes.While beneficial for the viral replication cycle,virus-induced deregulation of host cellular signaling processes can be detrimental to host cell physiology and can lead to virus-associated pathogenesis,including,for oncogenic viruses,cell transformation and cancer progression.Included among these oncogenic viruses is the hepatitis B virus(HBV).Despite the availability of an HBV vaccine,350-500 million people worldwide are chronically infected with HBV,and a significant number of these chronically infected individuals will develop hepatocellular carcinoma(HCC).Epidemiological studies indicate that chronic infection with HBV is the leading risk factor for the development of HCC.Globally,HCC is the second highest cause of cancer-associated deaths,underscoring the need for understanding mechanisms that regulate HBV replication and the development of HBV-associated HCC.HBV is the prototype member of the Hepadnaviridae family;members of this family of viruses have a narrow host range and predominately infect hepatocytes in their respective hosts.The extremely small and compact hepadnaviral genome,the unique arrangement of open reading frames,and a replication strategy utilizing reverse transcription of an RNA intermediate to generate the DNA genome are distinguishing features of the Hepadnaviridae.In this review,the authors provide a comprehensive description of HBV biology,summarize the model systems used for studying HBV infections,and highlight potential mechanisms that link a chronic HBV-infection to the development of HCC.For example,the HBV X protein(HBx),a key regulatory HBV protein that is important for HBV replication,is thought to play a cofactor role in the development of HBV-induced HCC,and the authors highlight the functions of HBx that may contribute to the development of HBV-associated HCC.展开更多
基金Supported by the National Natural Science Foundation,No.81273729Major Project of Shanghai Municipal S and T Commission,No.15DZ1900104Innovative Research Team in Universities,Shanghai Municipal Education Commission,Shanghai Key Laboratory of Traditional Chinese Clinical Medicine and Key Disciplines of Liver and Gall Bladder Diseases of State Administration of Traditional Chinese Medicine of the People’s Republic of China
文摘Yīn-Chén-Hāo decoction(YCHD) is a traditional Chinese medicine formula composed of capillaris(Artemisia capillaris), gardenia(Gardenia jasminoides), and rhubarb(Rheum rhabarbarum) that is used for the treatment of damp-heat jaundice. In modern clinics, YCHD is mostly used for hepatic diseases. This review summarizes the biological activities of YCHD and its medical applications. The main active compounds of YCHD are chlorogenic acid, rhein, geniposide, emodin, and scoparone. The pharmacological actions of YCHD include inhibition of hepatic steatosis, apoptosis, necrosis, anti-inflammation, and immune regulation. YCHD could be developed as a new therapeutic strategy for the treatment of hepatic diseases.
基金The authors acknowledge support from the National Natural Science Foundation of China(81901844,82027807,61871251)the Beijing Municipal Natural Science Foundation(L192013,7212202,M22018).
文摘Ultrasound(US)imaging is a non-invasive,real-time,economical,and convenient imaging modality that has been widely used in diagnosing and treating hepatic diseases.Artificial intelligence(AI)technology can predict or make decisions based on the experience of clinical experts and knowledge obtained from training data.This technology can help clinicians improve the detection efficiency and evaluate hepatic diseases,promote clinical treatment of the liver,and predict the response of the liver after treatment.This review summarizes the current rapid development of US technology and related AI methods in the diagnosis and treatment of hepatic diseases.Covered topics include steatosis grading,fibrosis staging,detection of focal liver lesions,US image segmentation,multimodal image registration,and other applications.At present,the field of AI in US imaging is still in its early stages.With the future progress of AI technology,AI-based US imaging can further improve diagnosis,reduce medical costs,and optimize US-based clinical workflow.This technology has broad prospects for application to hepatic diseases.
文摘Wilson disease is an autosomal recessive disorder affecting the ATP7B gene located on chromosome 13q.This leads to copper deposition in various organs,most importantly in the liver and brain.The genetic mutations are vast,well reported in the West but poorly documented in developing countries.Hence the diagnosis is made with a constellation of clinico-laboratory parameters which have significant overlap with other liver diseases and often pose a significant dilemma for clinicians.Diagnostic scoring systems are not fool-proof.The availability and affordability of chelators in developing countries impact the drug compliance of patients.While D-penicillamine is a potent drug,its side effects lead to drug discontinuation.Trientine is cost-prohibitive in developing countries.There is no single test to assess the adequacy of chelation.Exchangeable urinary copper is an essential upcoming diagnostic and prognostic tool.In the presence of cirrhosis,hypersplenism clouds the assessment of myelosuppression of drugs.Similarly,it may be difficult to distinguish disease tubulopathy from druginduced glomerulonephritis.Neurological worsening due to chelators may appear similar to disease progression.Presentation as fulminant hepatic failure requires rapid workup.There is a limited window of opportunity to salvage these patients with the help of plasmapheresis and other liver-assisted devices.This review addresses the challenges and clinical dilemmas faced at beside in developing countries.
文摘BACKGROUND Liver disease incidence and hence demand on hepatology services is increasing.AIM To describe trends in incidence and natural history of liver diseases in Wales to inform effective provision of hepatology services.METHODS The registry is populated by International Classification of Diseases-10(ICD-10)code diagnoses for residents derived from mortality data and inpatient/day case activity between 1999-2019.Pseudo-anonymised linkage of:(1)Causative diagnoses;(2)Cirrhosis;(3)Portal hypertension;(4)Decompensation;and(5)Liver cancer diagnoses enabled tracking liver disease progression.RESULTS The population of Wales in 2019 was 3.1 million.Between 1999 and 201973054 individuals were diagnosed with a hepatic disorder,including 18633 diagnosed with cirrhosis,10965 with liver decompensation and 2316 with hepatocellular carcinoma(HCC).Over 21 years the incidence of liver diseases increased 3.6 fold,predominantly driven by a 10 fold increase in non-alcoholic fatty liver disease(NAFLD);the leading cause of liver disease from 2014.The incidence of cirrhosis,decompensation,HCC,and allcause mortality tripled.Liver-related mortality doubled.Alcohol-related liver disease(ArLD),autoimmune liver disease and congestive hepatopathy were associated with the highest rates of decompensation and all-cause mortality.CONCLUSION A 10 fold increase in NAFLD incidence is driving a 3.6 fold increase in liver disease in Wales over 21 years.Liver-related morbidity and mortality rose more slowly reflecting the lower progression rate in NAFLD.Incidence of ArLD remained stable but was associated with the highest rates of liver-related and all-cause mortality.
文摘BACKGROUND Wilson disease(WD)is the most common genetic metabolic liver disease.Some studies have shown that comorbidities may have important effects on WD.Data on hepatitis B virus(HBV)infection in patients with WD are limited.AIM To investigate the prevalence and clinical impact of HBV infection in patients with WD.METHODS The clinical data of patients with WD were analyzed retrospectively,and the data of patients with concurrent WD and HBV infection were compared with those of patients with isolated WD.RESULTS Among a total of 915 WD patients recruited,the total prevalence of current and previous HBV infection was 2.1%[95%confidence interval(CI):1.2%-3.0%]and 9.2%(95%CI:7.3%-11.1%),respectively.The main finding of this study was the identification of 19 patients with concurrent WD and chronic hepatitis B(CHB)infection.The diagnosis of WD was missed in all but two patients with CHB infection.The mean delay in the diagnosis of WD in patients with concurrent WD and CHB infection was 32.5 mo,which was significantly longer than that in patients with isolated WD(10.5 mo).The rates of severe liver disease and mortality in patients with concurrent WD and CHB infection were significantly higher than those in patients with isolated WD(63.1%vs 19.3%,P=0.000 and 36.8%vs 4.1%,P<0.001,respectively).Binary logistic regression analysis revealed a significantly higher risk of severe liver disease at the diagnosis of WD in patients with current HBV infection[odds ratio(OR)=7.748;95%CI:2.890-20.774;P=0.000)]or previous HBV infection(OR=5.525;95%CI:3.159-8.739;P=0.000)than in patients with isolated WD.CONCLUSION The total prevalence of current HBV infection in patients with WD was 2.1%.The diagnosis of WD in CHB patients is usually missed.HBV infection is an independent risk factor for severe liver disease in WD patients.The diagnosis of WD should be ruled out in some patients with CHB infection.
文摘Biliary cystadenocarcinoma is a very rare malignant cystic tumor of the liver,which is often misdiagnosed due to a poor recognition of it.We report a case of a 60-year-old man with biliary cystadenocarcinoma with his real time contrast enhanced ultrasound(CEUS)characteristics compared to those of computed tomography(CT)and magnetic resonance imaging(MRI),which were correlated with the surgical and pathologic findings.Cystic wall enhancement,internal septations and intra-cystic solid portions in the arterial phase were observed on CEUS after contrast agent injection.The enhancement was washed out progressively and depicted as hypo-enhancement in the portal and late phases.CT revealed a large irregular cystic lesion in the left liver lobe with no clear septations and solid components.MRI showed an irregular cystic occupying lesion with septations.
文摘BACKGROUND Budd-Chiari syndrome(BCS)is a challenging indication for liver transplantation(LT)due to a combination of massive liver,increased bleeding,retroperitoneal fibrosis and frequently presents with stenosis of the inferior vena cava(IVC).Occasionally,it may be totally thrombosed,increasing the complexity of the procedure,as it should also be resected.The challenge is even greater when performing living-donor LT as the graft does not contain the retrohepatic IVC;thus,it may be necessary to reconstruct it.CASE SUMMARY A 35-year-old male patient with liver cirrhosis due to BCS and hepatocellular carcinoma beyond the Milan criteria underwent living-donor LT with IVC reconstruction.It was necessary to remove the IVC as its retrohepatic portion was completely thrombosed,up to almost the right atrium.A right-lobe graft was retrieved from his sister,with outflow reconstruction including the right hepatic vein and the branches of segment V and VIII to the middle hepatic vein.Owing to massive subcutaneous collaterals in the abdominal wall,venovenous bypass was implemented before incising the skin.The right atrium was reached via a transdiaphragramatic approach.Hepatectomy was performed en bloc with the retrohepatic vena cava.It was reconstructed with an infra-hepatic vena cava graft obtained from a deceased donor.The patient remains well on outpatient clinic follow-up 25 mo after the procedure,under an anticoagulation protocol with warfarin.CONCLUSION Living-donor LT in BCS with IVC thrombosis is feasible using a meticulous surgical technique and tailored strategies.
基金Yunnan Province Innovation Team of Intestinal Microecology-Related Disease Research and Technological Transformation (202005AE160010)National Natural Science Foundation of China (81860437)+2 种基金Prominent Physician Project of Yunnan province (YNWR-MY-2019-072)Yunnan Major Science and Technology Project (2019ZF004)Digestive Endoscopy Medical Center (2019LCZXKF-XH05) for financial support.
文摘Alstonia scholaris(L.)R.Br(Apocynaceae)is a well-documented medicinal plant for treating respiratory diseases,liver diseases and diabetes traditionally.The current study aimed to investigate the effects of TA on non-alcoholic fatty liver disease(NAFLD).A NAFLD model was established using mice fed a high-fat diet(HFD)and administered with TA(7.5,15 and 30 mg/kg)orally for 6 weeks.The biochemical parameters,expressions of lipid metabolism-related genes or proteins were analyzed.Furthermore,histopathological examinations were evaluated with Hematoxylin-Eosin and MASSON staining.TA treatment significantly decreased the bodyweight of HFD mice.The concentrations of low-density lipoprotein(LDL),triglyceride(TG),aspartate aminotransferase(AST)and alanine aminotransferase(ALT)were also decreased significantly in TA-treated mice group,accompanied by an increase in high-density lipoprotein(HDL).Furthermore,TA alleviated hepatic steatosis injury and lipid droplet accumulation of liver tissues.The liver mRNA levels involved in hepatic lipid synthesis such as sterol regulatory element-binding protein 1C(SREBP-1C),regulators of liver X receptorα(LXRα),peroxisome proliferator activated receptor(PPAR)γ,acetyl-CoA carboxylase(ACC1)and stearyl coenzyme A dehydrogenase-1(SCD1),were markedly decreased,while the expressions involved in the regulation of fatty acid oxidation,PPARα,carnitine palmitoyl transterase 1(CPT1A),and acyl coenzyme A oxidase 1(ACOX1)were increased in TA-treated mice.TA might attenuate NAFLD by regulating hepatic lipogenesis and fatty acid oxidation.
文摘Traditional medical imaging,including ultrasound,computed tomography,magnetic resonance imaging,or positron emission tomography,remains widely used diagnostic modalities for gastrointestinal diseases at present.These modalities are used to assess changes in morphology,attenuation,signal intensity,and enhancement characteristics.Gastrointestinal tumors,especially malignant tumors,are commonly seen in clinical practice with an increasing number of deaths each year.Because the imaging manifestations of different diseases usually overlap,accurate early diagnosis of tumor lesions,noninvasive and effective evaluation of tumor staging,and prediction of prognosis remain challenging.Fortunately,traditional medical images contain a great deal of important information that cannot be recognized by human eyes but can be extracted by artificial intelligence(AI)technology,which can quantitatively assess the heterogeneity of lesions and provide valuable information,including therapeutic effects and patient prognosis.With the development of computer technology,the combination of medical imaging and AI technology is considered to represent a promising field in medical image analysis.This new emerging field is called“radiomics”,which makes big data mining and extraction from medical imagery possible and can help clinicians make effective decisions and develop personalized treatment plans.Recently,AI and radiomics have been gradually applied to lesion detection,qualitative and quantitative diagnosis,histopathological grading and staging of tumors,therapeutic efficacy assessment,and prognosis evaluation.In this minireview,we briefly introduce the basic principles and technology of radiomics.Then,we review the research and application of AI and radiomics in gastrointestinal diseases,especially diagnostic advancements of radiomics in the differential diagnosis,treatment option,assessment of therapeutic efficacy,and prognosis evaluation of esophageal,gastric,hepatic,pancreatic,and colorectal diseases.
基金supported by the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(Grant No. 2017-XK-A36)the Foundation of Key Research Project of Zhejiang Province for Traditional Chinese Medicine (Grant No. 2019ZZ014)。
文摘Objective: Hepatic veno-occlusive disease(HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of specific therapies. The aim of the study was to delineate the clinical characteristics and outcomes and explore the potential prognostic factors of HVOD.Methods: This was a single-center retrospective study. Eighty-nine HVOD patients were screened from the First Affiliated Hospital of Zhejiang University with an ingestion history of G. segetum before developing symptoms from January 2009 to May 2018. The enrolled patients were divided into the survivor and death groups according to the clinical follow-up that ended on September 1, 2019. The demographic variables and clinical data of the patients were recorded. A binary logistic regression analysis and receiver operating characteristic curve were conducted to identify the prognostic factors and assess the prognostic value for predicting death, and a survival analysis was performed to evaluate the clinical outcomes.Results: Sixty-four patients were eligible for further analysis. Most patients showed abdominal distension and were positive for migrating dullness in the abdomen(P = 0.740 and P = 0.732, respectively). The patients who died had higher levels of model for end-stage liver disease score, and higher prothrombin time than those who survived(both P < 0.001). All HVOD patients in both the survival and death groups showed ascites with abnormal imaging presentations of the liver parenchyma and hepatic blood vessels.Unexpectedly, we found that hydrothorax was detected in 21(65.63%) patients in the death group and 19(59.38%) patients in the survivor group during hospitalization, which was rarely mentioned in previous studies. Furthermore, international normalized ratio(INR) and creatinine are found to be potential independent prognostic factors for predicting death. Six severe patients achieved clinical improvements and survived after liver transplantation.Conclusion: HVOD can be induced by the ingestion of G. segetum, and INR combined with creatinine has prognostic value for predicting death. Liver transplantation may be an effective treatment option for severe HVOD patients.
文摘Fulminant hepatitis is fatal in most cases and timely liver transplantation is the only effective treatment.This study evaluates the survival outcomes of patients who underwent living-donor liver transplantation(LDLT)using right lobe liver grafts for fulminant liver failure due to hepatitis B infection.Nine cases of adult right lobe LDLT were performed in our department from September 2002 to August 2005 and the clinical and following-up data were reviewed.According to the pre-transplant Child-Pugh-Turcotte classification,the nine patients were classified as grade C.The model for end-stage liver disease(MELD)score of these patients ranged from 16 to 42.The principal complications before transplantation included abnormal renal function,hepatic coma of different degrees and alimentary tract hemorrhage.The main complications after transplantation included pulmonary infection in two cases,acute renal failure in three cases and transplantation-related encephalopathy in one case.No primary failure of vascular or biliary complications occurred.The one-year survival rate was 55.6%.There were no serious complications or deaths in donors.In general,it is extremely difficult to treat fulminant hepatitis by conservative regimen,particularly,in cases with rapid progression.Emergency adult living-donor liver transplantation is an effective treatment for fulminant hepatitis patients and is relatively safe for donors.
基金supported by an NIH predoctoral fellowship to RJLthe grant number is F31CA171712.
文摘As obligate intracellular parasites,viruses need a host cell to provide a milieu favorable to viral replication.Consequently,viruses often adopt mechanisms to subvert host cellular signaling processes.While beneficial for the viral replication cycle,virus-induced deregulation of host cellular signaling processes can be detrimental to host cell physiology and can lead to virus-associated pathogenesis,including,for oncogenic viruses,cell transformation and cancer progression.Included among these oncogenic viruses is the hepatitis B virus(HBV).Despite the availability of an HBV vaccine,350-500 million people worldwide are chronically infected with HBV,and a significant number of these chronically infected individuals will develop hepatocellular carcinoma(HCC).Epidemiological studies indicate that chronic infection with HBV is the leading risk factor for the development of HCC.Globally,HCC is the second highest cause of cancer-associated deaths,underscoring the need for understanding mechanisms that regulate HBV replication and the development of HBV-associated HCC.HBV is the prototype member of the Hepadnaviridae family;members of this family of viruses have a narrow host range and predominately infect hepatocytes in their respective hosts.The extremely small and compact hepadnaviral genome,the unique arrangement of open reading frames,and a replication strategy utilizing reverse transcription of an RNA intermediate to generate the DNA genome are distinguishing features of the Hepadnaviridae.In this review,the authors provide a comprehensive description of HBV biology,summarize the model systems used for studying HBV infections,and highlight potential mechanisms that link a chronic HBV-infection to the development of HCC.For example,the HBV X protein(HBx),a key regulatory HBV protein that is important for HBV replication,is thought to play a cofactor role in the development of HBV-induced HCC,and the authors highlight the functions of HBx that may contribute to the development of HBV-associated HCC.
