BACKGROUND Uridine diphosphate glucuronosyltransferase 1A1(UGT1A1)plays a crucial role in metabolizing and detoxifying endogenous and exogenous substances.However,its contribution to the progression of liver damage re...BACKGROUND Uridine diphosphate glucuronosyltransferase 1A1(UGT1A1)plays a crucial role in metabolizing and detoxifying endogenous and exogenous substances.However,its contribution to the progression of liver damage remains unclear.AIM To determine the role and mechanism of UGT1A1 in liver damage progression.METHODS We investigated the relationship between UGT1A1 expression and liver injury through clinical research.Additionally,the impact and mechanism of UGT1A1 on the progression of liver injury was analyzed through a mouse model study.RESULTS Patients with UGT1A1 gene mutations showed varying degrees of liver damage,while patients with acute-onchronic liver failure(ACLF)exhibited relatively reduced levels of UGT1A1 protein in the liver as compared to patients with chronic hepatitis.This suggests that low UGT1A1 levels may be associated with the progression of liver damage.In mouse models of liver injury induced by carbon tetrachloride(CCl_(4))and concanavalin A(ConA),the hepatic levels of UGT1A1 protein were found to be increased.In mice with lipopolysaccharide or liver steatosis-mediated liver-injury progression,the hepatic protein levels of UGT1A1 were decreased,which is consistent with the observations in patients with ACLF.UGT1A1 knockout exacerbated CCl_(4)-and ConA-induced liver injury,hepatocyte apoptosis and necroptosis in mice,intensified hepatocyte endoplasmic reticulum(ER)stress and oxidative stress,and disrupted lipid metabolism.CONCLUSION UGT1A1 is upregulated as a compensatory response during liver injury,and interference with this upregulation process may worsen liver injury.UGT1A1 reduces ER stress,oxidative stress,and lipid metabolism disorder,thereby mitigating hepatocyte apoptosis and necroptosis.展开更多
BACKGROUND Alphaherpesvirus belongs to the Herpesviridae family and has large,monopartite double-stranded linear DNA.It mainly infects the skin,mucosa,and nerves,and can affect various hosts,including humans and other...BACKGROUND Alphaherpesvirus belongs to the Herpesviridae family and has large,monopartite double-stranded linear DNA.It mainly infects the skin,mucosa,and nerves,and can affect various hosts,including humans and other animals.Here,we present a case of a patient seen by the gastroenterology department at our hospital who experienced an oral and perioral herpes infection following treatment with a ven-tilator.The patient was treated with oral and topical antiviral drugs,furacilin,oral and topical antibiotics,local epinephrine injection,topical thrombin powder,and nutritional and supportive care.A wet wound healing approach was also implemented with good response.CASE SUMMARY A 73-year-old woman presented to the hospital with a chief complaint of"abdominal pain for 3 d with dizziness for 2 d."She was admitted to the intensive care unit for septic shock and spontaneous peritonitis secondary to cirrhosis and was given antiinflammatory and symptomatic supportive treatment.A ventilator was used to assist breathing for acute respiratory distress syndrome,which developed during her admission.A large area of herpes infection appeared in the perioral region 2 d following noninvasive ventilation.The patient was transferred to the gastroenterology department,at which time she had a body temperature of 37.8 C and a respiratory rate of 18/min.The patient's con-sciousness was intact,and she no longer had abdominal pain or distension,chest tightness,or asthma.At this point,the infected perioral region changed in appearance and was now accompanied by local bleeding with crusting of blood at the wounds.The surface area of the wounds measured approximately 10 cm×10 cm.A cluster blisters appeared on the patient’s right neck,and ulcers developed in her mouth.On a subjective numerical pain scale,the patient reported a pain level of 2.Overall,her diagnoses other than the oral and perioral herpes infection included:(1)Septic shock;(2)spontaneous peritonitis;(3)abdominal infection;(4)decompensated cirrhosis;and(5)hypoproteinemia.Dermatology was consulted regarding the treatment of the patient’s wounds;they suggested treatment with oral antiviral drugs,an intramuscular injection of nutritious nerve drugs,and the application of topical penciclovir and mupirocin around the lips.Stomatology was also consulted and suggested the use of nitrocilin in a local wet application around the lips.CONCLUSION Through multidisciplinary consultation,the patient’s oral and perioral herpes infection was successfully treated with the following combined approach:(1)Application of topical antviral and antibiotic treatments;(2)keeping the wound moist with a wet wound healing strategy;(3)systemic use of oral antiviral drugs;and(4)symptomatic and nutritional supportive care.The patient was discharged from the hospital after successful wound healing.展开更多
AIM:To determine the clinical effects and complications of transjugular intrahepatic portosystemic shunt(TIPS)for portal hypertension due to cirrhosis.METHODS:Two hundred and eighty patients with portal hypertension d...AIM:To determine the clinical effects and complications of transjugular intrahepatic portosystemic shunt(TIPS)for portal hypertension due to cirrhosis.METHODS:Two hundred and eighty patients with portal hypertension due to cirrhosis who underwent TIPS were retrospectively evaluated.Portal trunk pressure was measured before and after surgery.The changes in hemodynamics and the condition of the stent were assessed by ultrasound and the esophageal and fundic veins observed endoscopically.RESULTS:The success rate of TIPS was 99.3%.The portal trunk pressure was 26.8±3.6 cmH2O after surgery and 46.5±3.4 cmH2O before surgery(P<0.01).The velocity of blood flow in the portal vein increased.The internal diameters of the portal and splenic veins were reduced.The short-term hemostasis rate was100%.Esophageal varices disappeared completely in68%of patients and were obviously reduced in 32%.Varices of the stomach fundus disappeared completely in 80%and were obviously reduced in 20%of patients.Ascites disappeared in 62%,were markedly reduced in 24%,but were still apparent in 14%of patients.The total effective rate of ascites reduction was 86%.Hydrothorax completely disappeared in 100%of patients.The incidence of post-operative stent stenosis was 24%at 12 mo and 34%at 24 mo.The incidence of post-operative hepatic encephalopathy was 12%at3 mo,17%at 6 mo and 19%at 12 mo.The incidence of post-operative recurrent hemorrhage was 9%at 12mo,19%at 24 mo and 35%at 36 mo.The cumulative survival rate was 86%at 12 mo,81%at 24 mo,75%at 36 mo,57%at 48 mo and 45%at 60 mo.CONCLUSION:TIPS can effectively lower portal hypertension due to cirrhosis.It is significantly effective for hemorrhage of the digestive tract due to rupture of esophageal and fundic veins and for ascites and hydrothorax caused by portal hypertension.展开更多
AIM: To investigate the inhibitory effect of a specific small survivin interfering RNA (siRNA) on cell proliferation and the expression of survivin in human gastric carcinoma cell line SGC-7901. METHODS: To knockdown ...AIM: To investigate the inhibitory effect of a specific small survivin interfering RNA (siRNA) on cell proliferation and the expression of survivin in human gastric carcinoma cell line SGC-7901. METHODS: To knockdown survivin expression, a small interfering RNA targeting against survivin was synthesized and transfected into SGC-7901 cells with lipofectamineTM2000. The downregulation of survivin expression at both mRNA and protein levels were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis. Cell proliferation inhibition rates were determined by methyl thiazolyl tetrazolium (MTT) assay. The effect of survivin siRNA on cell cycle distribution and cell apoptosis was determined by flow cytometry (FCM). RESULTS: RNA interference could efficiently suppress the survivin expression in SGC-7901 cells. At 48 h after transfection, the expression inhibition rate was 44.52% at mRNA level detected by RT-PCR and 40.17% at protein level by Western blot analysis. Downregulation of survivin resulted in significant inhibition of tumor cell growth in vitro. The cell proliferation inhibition rates at 24, 48 and 72 h after survivin siRNA and non-siliencing siRNA transfection, were 34.06%, 47.61% and 40.36%, respectively. The apoptosis rate was 3.56% and the number of cells was increased in G0/G1 phase from 38.2% to 88.6%, and decreased in S and G2/M phase at 48 h after transfection. CONCLUSION: Downregulation of survivin results in significant inhibition of tumor growth in vitro. The inhibition of survivin expression can induce apoptosis of SGC-7901 cells. The use of survivin siRNA deserves further investigation as a novel approach to cancer therapy.展开更多
INTRODUCTIONProgramed cell death plays an important role in thegenesis of cancer.Certain cancer genes canregulate apoptosis.Recently,several proteins thatare structurally related to Bcl-2,an inhibitor ofapoptosis,have...INTRODUCTIONProgramed cell death plays an important role in thegenesis of cancer.Certain cancer genes canregulate apoptosis.Recently,several proteins thatare structurally related to Bcl-2,an inhibitor ofapoptosis,have been identified.Therefore,novel strategies and agents that target specificmolecular pathways,as well as triggering a展开更多
AIM： To explore the anti-fibrotic effect of Oxymatrine on CCl4-induced liver fibrosis in rats and its modulation on the TGFbeta-Smad signaling pathway. METHODS： One hundred healthy male SD rats were randomly divided...AIM： To explore the anti-fibrotic effect of Oxymatrine on CCl4-induced liver fibrosis in rats and its modulation on the TGFbeta-Smad signaling pathway. METHODS： One hundred healthy male SD rats were randomly divided into three groups： normal group （n = 20）, treatment group of Oxymatrine （n = 40） and CCh-induced fibrosis group （n = 40）. Experimental hepatic fibrosis was induced by subcutaneous injection of carbon tetrachloride （CCh soluted in liquid paraffin with the concentration of 300 g/L, the dosage of injection was 3 mL/kg, twice per week for 8 wk）. The treated rats received Oxymatrine via celiac injection at a dosage of 10 mg/kg twice a week at the same time. The deposition of collagen was observed with H＆E and Masson staining. The concentration of serum TGF-β1 was assayed with ELISA. The gene expression of Smads and CBP （CREB binding protein） was detected with in situ hybridization （ISH） and immunohistochemistry （IH）, respectively. All the experimental figures were scanned and analyzed with special figure-analysis software. RESULTS： A significant reduction of collagen deposition and rearrangement of the parenchyma was noted in the liver tissue of Oxymatrine-treated rats. The semi- quantitative histological scores （2.43 ± 0.47 μm^2 vs 3.76 ±0.68, P 〈 0.05） and average area of collagen/in those rats were significantly decreased when compared with hepatic cirrhosis model rats （94.41 ± 37.26 μm^2 vs 290.86 ± 89.37 μm^2, P 〈 0.05）. The gene expression of Smad 3 mRNA was considerably decreased in the treated animals. The A value of Smad 3 mRNA was lower in the treated rats than the model rats （0.034 ± 0.090 vs 0.167 ± 0.092, P 〈 0.05）. Contrarily, the A value of Smad 7 mRNA was increased considerably in the treated animals （0.175 ± 0.065 vs 0.074 vs 0.012, P 〈 0.05）. There was an obvious decrease in the expression of CBP mRNA in treated rats as illuminated by a reduction of its A value when compared with model rats （0.065±0.049 vs 0.235 ± 0.025, P 〈 0.001）. CONCLUSION： Oxymatrine is effective in reducing the production and deposition of collagen in the liver tissue of experimental rats. Oxymatrine could promote the expression of Smad 7 and inhibit the expression of Smad 3 and CBP in CCh-induced hepatic fibrosis in SD rats, could modulate the fibrogenic signal transduction of TGFβ-Smad pathway.展开更多
AIM: To describe a method for the transjugular intrahepatic portal systemic shunt(TIPS) placement performed with the aid of contrast-enhanced computed tomography(CECT) and three-dimensional reconstructed vascular imag...AIM: To describe a method for the transjugular intrahepatic portal systemic shunt(TIPS) placement performed with the aid of contrast-enhanced computed tomography(CECT) and three-dimensional reconstructed vascular images(3D RVIs), and to assess its safety and effectiveness. METHODS: Four hundred and ninety patients were treated with TIPS between January 2005 and December 2012. All patients underwent liver CECT and reconstruction of 3D RVIs of the right hepatic vein to portal vein(PV) prior to the operation. The 3D RVIs were carefully reviewed to plan the puncture path fromthe start to target points for needle pass through the PV in the TIPS procedure. R E S U LTS :The improved TIPS procedure was successful in 483(98.6%) of the 490 patients. The number of punctures attempted was one in 294(60%) patients, 2 to 3 in 147(30%) patients, 4 to 6 in 25(5.1%) patients and more than 6 in 17(3.5%) patients. Seven patients failed. Of the 490 patients, 12 had punctures into the artery, 15 into the bile duct, eight into the gallbladder, and 18 through the liver capsule. Analysis of the portograms from the 483 successful cases indicated that the puncture points were all located distally to the PV bifurcation on anteroposterior images, while the points were located proximally to the bifurcation in the three cases with intraabdominal bleeding. The complications included three cases of bleeding, of whom one died and two needed surgery. CONCLUSION: Use of CECT and 3D RVIs to plan the puncture path for TIPS procedure is safe, simple and effective for clinical use.展开更多
AIM： To investigate the relationship between Interleu- kin-8 （IL-8） and proliferation, adhesion, migration, inva- sion and chemosensitivity of gastric cancer （GC） cells.
AIM:To examine the prophylactic effect of glyceryl trinitrate on post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis and hyperamylasemia.METHODS:Patients scheduled for ERCP were randomly divided int...AIM:To examine the prophylactic effect of glyceryl trinitrate on post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis and hyperamylasemia.METHODS:Patients scheduled for ERCP were randomly divided into study group and placebo group.Patients in study group and placebo group were treated with 5 mg glyceryl trinitrate and 100 mg vitamin C,respectively,5 min before endoscopic maneuvers.RESULTS:A total of 74 patients were enrolled in the final analysis.Post-ERCP pancreatitis occurred in 3 patients(7.9%) of the study group and 9 patients(25%) in the placebo group(P = 0.012).Hyperamylasemia occurred in 8 patients of the study group(21.1%) and 13 patients(36.1%) of the placebo group(P = 0.037).CONCLUSION:Glyceryl trinitrate before ERCP can effectively prevent post-ERCP and hyperamylasemia.展开更多
BACKGROUND Irritable bowel syndrome(IBS)is a common digestive system disease with a high incidence rate and is common in women.The cause of IBS remains unclear.Some studies have shown that mental and psychological dis...BACKGROUND Irritable bowel syndrome(IBS)is a common digestive system disease with a high incidence rate and is common in women.The cause of IBS remains unclear.Some studies have shown that mental and psychological diseases are independent risk factors for IBS.At present,the treatment of IBS is mainly symptomatic treatment.Clinically,doctors also use cognitive behavioral therapy to improve patients'cognitive ability to diseases and clinical symptoms.In recent years,exercise therapy has attracted more and more attention from scholars.Improving the symptoms of IBS patients through psychosomatic treatment strategy may be a good treatment method.AIM To explore the effects of an intervention of cognitive behavioral therapy combined with exercise(CBT+E)on the cognitive bias and coping styles of patients with diarrhea-predominant irritable bowel syndrome(IBS-D);and to provide a theoretical reference for the management of IBS.METHODS Sixty IBS-D patients and thirty healthy subjects were selected.The 60 IBS-D patients were randomly divided into experimental and control groups.The experimental group was treated with the CBT+E intervention,while the control group was treated with conventional drugs without any additional intervention.The cognitive bias and coping styles of the participants were evaluated at baseline and after 6 wk,12 wk and 24 wk using the Automatic Thoughts Questionnaire(ATQ),Dysfunctional Attitudes Scale(DAS)and Pain Coping Style Questionnaire(CSQ)instruments,and the intervention effect was analyzed using SPSS 17.0 statistical software.RESULTS At baseline,the scores on the various scales showed that all subjects had cognitive bias and adverse coping styles.The IBS Symptom Severity Scale(IBSSSS)scores,ATQ total scores,DAS scores and CSQ scores of the two groups were not significantly different(P>0.05).Compared with baseline,after 6 wk of the CBT+E intervention,there were significant differences in the ATQ scores,the dependence and total scores on the DAS,and the catastrophization,distraction and prayer scores on the CSQ(P<0.05).After 12 wk,there were significant differences in the scores for perfectionism on the DAS and in the scores for reinterpretation,neglect and pain behavior on the CSQ in the experimental group(P<0.05).After 24 wk,there were significant differences in the vulnerability,dependence,perfectionism,and total scores on the DAS and in the catastrophization,distraction and prayer scores on the CSQ in the experimental group(P<0.01).The IBS-SSS scores were negatively correlated with the ATQ and DAS total scores(P<0.05)but were positively correlated with the CSQ total score(P<0.05).CONCLUSION Intervention consisting of CBT+E can correct the cognitive bias of IBS-D patients and eliminate their adverse coping conditions.CBT+E should be promoted for IBS and psychosomatic diseases.展开更多
OBJECTIVE： To analyze international research trends in hepatic encephalopathy and examine the role of neuroelectrophysiology and neuroimaging in diagnosis of hepatic encephalopathy. DATA RETRIEVAL： We performed a bi...OBJECTIVE： To analyze international research trends in hepatic encephalopathy and examine the role of neuroelectrophysiology and neuroimaging in diagnosis of hepatic encephalopathy. DATA RETRIEVAL： We performed a bibliometric analysis of studies on hepatic encephalopathy published during 2002-2011 retrieved from Web of Science. SELECTION CRITERIA： Inclusion criteria： （1） peer-reviewed published articles on hepatic encephalopathy; （2） original article, review, meeting abstract, proceedings paper, book chapter, editorial material, news items, and （3） published during 2002-2011. Exclusion criteria： （1） articles that required manual searching or telephone access; （2） documents that were not published in the public domain; and （3） corrected papers from the total number of articles. MAIN OUTCOME MEASURES： （1）Annual publication output; （2） type of publication; （3） publication by research field; （4） publication by journal; （5） publication by author; （6） publication by institution; （7） publication by country; （8） publication by institution in China; （9） most-cited papers. RESULTS： A total of 3 233 papers regarding hepatic encephalopathy were retrieved during 2002-2011. The number of papers gradually increased over the 10-year study period and was highest in 2010. Most papers appeared in journals with a focus on gastroenterology and hepatology. Among the included journals, Hepatology published the greatest number of papers regarding hepatic encephalopathy, and the published studies were highly cited. Thus, Hepatology appears to represent a key journal publishing papers on hepatic encephalopathy. Regarding distribution by country for publications on hepatic encephalopathy indexed in Web of Science during 2002-2011, the United States published highest number of papers, with China ranked ninth As per distribution by institute for publications, the University of Montreal in Canada published the highest number of papers （n = 111 ）. Among the Chinese institutes, Zhejiang University in China was the most prolific institute with 15 papers. CONCLUSION： The present bibliometric analysis on hepatic encephalopathy provides an overview of research progress, as well as identifying the most active institutes and experts in this research field during 2002-2011. Research into hepatic encephalopathy has revealed changes in neural injury and regeneration in hepatic encephalopathy. Neuroelectrophysiological and neuroimaging examinations are important for determining clinical classifications and disease severity of hepatic encephalopathy, providing a foundation for further research.展开更多
BACKGROUND As transjugular intrahepatic portosystemic shunt(TIPS)creation alters the hemodynamic status of the portal system,whether reduced portal blood supply affects the synthetic reserve function of the liver has ...BACKGROUND As transjugular intrahepatic portosystemic shunt(TIPS)creation alters the hemodynamic status of the portal system,whether reduced portal blood supply affects the synthetic reserve function of the liver has been the focus of clinical attention.Since the Viatorr stent entered the Chinese market in 2015,it has not yet been widely used in clinical practice.Further,unlike other countries,the main cause of liver cirrhosis in China is viral hepatitis.Therefore,use of the Viatorr stent to establish a TIPS channel in patients with liver cirrhosis with differing etiologies is of great clinical interest.AIM To investigate factors affecting changes in liver reserve function after TIPS Viatorr stent implantation.METHODS Clinical data from 200 patients with cirrhotic portal hypertension who received TIPS treatment from March 2016 to March 2020 were analyzed retrospectively.The patients were divided into three groups(A-C),according to their disease etiology,with post-hepatitis,autoimmune,and alcoholic cirrhosis,respectively.Preoperative and postoperative liver and renal function and coagulation data,Child-Pugh grade,and model for end-stage liver disease(MELD)scores were collected.Statistical analyses were performed using the t-test or chi-square test.The incidence and of hepatic encephalopathy and patient survival were calculated using Kaplan-Meier method.RESULTS The surgical success rate was 100%,with mean portal pressure gradient(mmHg)decreasing from 25.5±5.22 to 10.04±2.76(t=45.80;P<0.001).After 24 mo,the cumulative incidence of hepatic encephalopathy in group A was significantly lower than that in group B/C,while the cumulative survival rate was significantly higher in group A than in group B/C(P<0.05 for both).The Child-Pugh score for group A was 6.96±1.21,which was significantly better than those of groups B(7.42±0.99;t=-2.44;P=0.016)and C(7.52±1.12;t=-2.67;P=0.009).Further,the MELD score for group A(9.62±2.19)was significantly better than those for groups B(10.64±1.90;t=-2.92;P=0.004)and C(10.82±2.01;t=-3.29;P=0.001).CONCLUSION Insertion of 8 mm internal diameter Viatorr stent has no significant effects on liver reserve function.Changes of liver reserve function in the medium and long term may be related to the etiology and treatment of portal hypertension.展开更多
Bouveret's syndrome is an extremely rare type of gallstone-induced ileus with atypical clinical manifestations,such as abdominal distension and pain,nausea and vomiting,fever or even gastrointestinal bleeding,whic...Bouveret's syndrome is an extremely rare type of gallstone-induced ileus with atypical clinical manifestations,such as abdominal distension and pain,nausea and vomiting,fever or even gastrointestinal bleeding,which may easily be misdiagnosed. In the present case,a 55-year-old male was admitted to the hospital with upper gastrointestinal obstructive symptoms but without pain,fever,jaundice or melena. At first,gastrolithiasis and peptic ulcer combined with pyloric obstruction were suspected after gastroscopy revealed a large,hard stone in the duodenal bulb. A revised diagnosis of Bouveret's syndrome was made following abdominal computed tomography. Subsequently,the patient exhibited a good postoperative recovery after laparoscopic duodenotomy for gallstone removal and subtotal cholecystectomy. The condition of the patient remained stable after being followed up for 6 mo. The successful application of laparoscopic therapy to treat Bouveret's syndrome has seldom been reported. Laparoscopic enterolithotomy is safe and effective,with good patient tolerability,rapid postoperative recovery and few wound-related complications. The laparoscopic treatment of Bouveret's syndrome is worth exploring.展开更多
The effects of the balance changes of pigment epithelium growth factor（PEDF） and vascular endothelial growth factor（VEGF） in whole-body and retinal tissue on rats with oxygen-induced retinopathy were investigated....The effects of the balance changes of pigment epithelium growth factor（PEDF） and vascular endothelial growth factor（VEGF） in whole-body and retinal tissue on rats with oxygen-induced retinopathy were investigated. Forty-eight neonatal SD rats at the age of 7 days were randomly divided into 4 groups. The neonatal rats in experimental groups were exposed to 75% to 80% oxygen for 5 days and then to normal air, and those in control groups were kept feeding in normal air. At the age of 17 and 22 days, all the neonatal rats received retina angiography with FITC-dextran and the pathological changes of retinal vessels and perfusion were observed. HE staining of the tissue section and the number counting of endothelial cells extending beyond the inner limiting membrane were performed to evaluate the endothelial proliferation. Immunohistochemistry was applied to detect the expression of PEDF and VEGF in retinal tissue, and ELISA to detect their expression in serum. A hypoxic-ischemic proliferation of retina and more endothelial cells extending beyond the inner limiting membrane were found in the neonatal rats in both experimental groups of 17-day old and 22-day old as compared with those in control group with the difference being statistically significant（P〈0.01）. VEGF staining of the rats in the 17-day old experimental group was significantly stronger, with an increasing positive rate, than that of the rats in the 17-day old control group（P〈0.01）. PEDF staining of the rats of 22 days old was weaker than that of the rats of 17 days old in the experimental groups（P〈0.01）. There was no significant difference in serum VEGF concentration among all groups（P〈0.05）. The serum PEDF concentration in the rats of 17 days old in experimental group was decreased significantly as compared with that in the rats of 17 days old in control group（P〈0.01）, and in experimental groups, the serum PEDF concentration of the rats of 22 days old was increased as compared with that of the rats of 17 days old（P〈0.01）. In conclusion, the obviously decreased serum PEDF concentration and the abnormal enhanced expression of VEGF density in local retinal tissue broke down the balance of PEDF/VEGF in whole-body or local tissues, which might play an important role in retinal vascular proliferation.展开更多
BACKGROUND Portal hypertension is a major complication of cirrhosis that is associated with significant morbidity and mortality.The present gold-standard method to risk stratify and observe cirrhosis patients with por...BACKGROUND Portal hypertension is a major complication of cirrhosis that is associated with significant morbidity and mortality.The present gold-standard method to risk stratify and observe cirrhosis patients with portal hypertension is hepatic venous pressure gradient measurement or esophagogastroduodenoscopy.However,these methods are invasive,carry a risk of complications and are associated with significant patient discomfort.Therefore,non-invasive splenic parameters are of clinical interest as potential useful markers in determining the presence of portal hypertension.However,diagnostic accuracy and reproducibility remains unvalidated.AIM To assess the diagnostic accuracy of spleen stiffness,area and diameter in predicting the presence of portal hypertension.METHODS Of 50 patients with varying liver disease pathologies were prospectively recruited from the St.Mary’s Hospital Liver Unit in London;25 with evidence of portal hypertension and 25 with no evidence of portal hypertension.Liver stiffness,spleen stiffness,spleen diameter and spleen area were measured using the Philips Affiniti 70 elastography point quantification point shear wave elastography system.The aspartate aminotransferase-to-platelet-ratio-index(APRI)score was also calculated.Performance measures,univariate and multivariate logistic regression were used to evaluate demographic,clinical and elastography variables.Interclass correlation coefficient was used to determine the reproducibility of splenic area and diameter.RESULTS On univariate and individual performance,platelet count[area under the receiver operating characteristic(AUROC)0.846,P value<0.001],spleen area(AUROC 0.828,P value=0.002)and APRI score(AUROC 0.827,P value<0.001)were the most accurate variables in identifying the presence of portal hypertension.On multivariate logistic regression models constructed,the combination of spleen area greater than 57.90 cm2 and platelet count less than 126×10^9 had 63.2%sensitivity and 100%specificity,100%positive predictive value and 100%negative predictive value.An alternative combination of spleen stiffness greater than 29.99 kPa and platelet count less than 126×10^9 had 88%sensitivity,75%specificity,78.6%positive predictive value and 85.7%negative predictive value.An interclass correlation coefficient value of 0.98(95%CI:0.94-0.99,P value<0.001)and 0.96(95%CI:0.91-0.99,P value<0.001)were determined for inter-operator variability for spleen area and diameter respectively.CONCLUSION Spleen area,spleen stiffness and platelet count may be useful markers to assess the presence of portal hypertension in patients of various etiologies.展开更多
In recent years, increasingly evidences show that autophagy plays an important role in the pathogenesis and development of liver diseases, and the relationship between them has increasingly become a focus of concern. ...In recent years, increasingly evidences show that autophagy plays an important role in the pathogenesis and development of liver diseases, and the relationship between them has increasingly become a focus of concern. Autophagy refers to the process through which the impaired organelles, misfolded protein, and intruding microorganisms is degraded by lysosomes to maintain stability inside cells. This article states the effect of autophagy on liver diseases （hepatic fibrosis, fatty liver, viral hepatitis, and liver cancer）, which aims to provide a new direction for the treatment of liver diseases.展开更多
Objective: To observe the damage of mixed reflux to the rat esophageal mucosa, and investigate the preventive effects of cisapride, nabumetone and hydrotalcite on the damaged esophageal mucosa. Methods: Three hundred ...Objective: To observe the damage of mixed reflux to the rat esophageal mucosa, and investigate the preventive effects of cisapride, nabumetone and hydrotalcite on the damaged esophageal mucosa. Methods: Three hundred sixty-eight Sprague-Dawley rats were treated as esophagoduodenostomy and divided into four groups in random. Group Y: operation + saline as positive controls; Group P: operation + cisapride; Group R: operation + nabumetone; Group D: operation + hydrotalcite. Different drugs were perfused in the 1 st week after operation. The lesions of esophageal mucosa were observed in the 5th, 9th, 13th, 17th, 22nd, 28th, 35th and 40th week respectively, and evaluated the preventive effects of these drugs. Results: The lesions of esophageal mucosa in group Y were more severe than other three groups in different time (P ＜ 0.05), and the incidence of Barrett's esophagus(BE), severe atypical hyperplasia and esophageal adenocarcinoma (EAC) in group Y were higher than others. After 22 weeks, the lesions in group P were more severe than group R and D, and there were obvious differences in different time ( P ＜ 0.05); but the incidence of BE, severe atypical hyperplasia and EAC in group P had no significant difference with group R and group D( P ＞ 0.05). Conclusion: BE, severe atypical hyperplasia and EAC could occur because of severe reflux esophagitis for a long term. Cisapride, nabumetone and hydrotalcite could reduce mucosa injury in reflux esophagitis and resist the development of BE, severe atypical hyperplasia and EAC.In addition, the curative effects of nabumetone and hydrotalcite were better than cisapride.展开更多
Colonoscopy was performed in 322 children with blood in the stool aging from 2days to 14 years old during 1972 to 1986,by which 96.6 percent of the cases were accurately di-agnosed.The most common disease found was po...Colonoscopy was performed in 322 children with blood in the stool aging from 2days to 14 years old during 1972 to 1986,by which 96.6 percent of the cases were accurately di-agnosed.The most common disease found was polyps（57.7％）,next intussusception,andthen amebiasis and necrotising enteritis.In terms of diagnosis,we believe,history inquiring isvery important;rectal touch and rigid sigmidoscopy should be done as a routine;colonoscopy,especially when combined with x-ray,is a main measure;<sup>99</sup>m-Tc Scanning and selective abdomi-nal angiography are very helpful in some cases.Because hematochezia is chiefly caused by largebowel polyps,endoscopy may share both diagnosing and treating purposes.In this group,196polyps were safely excised in 168 patients.For thorny polyposis,it is recommended thatendoscopy-surgery combining therapy should be chosen.展开更多
BACKGROUND Esophageal carcinosarcoma,usually presenting as a pedunculated polypoid mass,is a rare malignancy with coexisting sarcomatoid and carcinomatous components.Its imaging and endoscopic characteristics are simi...BACKGROUND Esophageal carcinosarcoma,usually presenting as a pedunculated polypoid mass,is a rare malignancy with coexisting sarcomatoid and carcinomatous components.Its imaging and endoscopic characteristics are similar to those of leiomyosarcoma,liposarcoma and so forth.The diagnosis needs histological confirmation.Surgical resection is the traditional therapy.Endoscopic resection is minimally invasive but still controversial.This paper reports the case of a patient with a giant esophageal carsinosarcoma who underwent a palliative endoscopic resection.CA^E SUMMARY A 55-year-old male patient presented with dysphagia and weight loss for 1 mo.Imaging and endoscopy showed a gray-white,polypoid,stalk-like mass,with a bulky pedicle located in the middle and lower esophagus.The mass almost filled the whole esophageal lumen,but the endoscope could still pass through.Despite the suspicion of a malignancy,repeated biopsies indicated necrosis and inflammation.After multidisciplinary team consultation,an endoscopic resection to diagnose and relieve the obstruction was recommended.The pedicle of the mass was cut off,the bleeding was stopped,and the mass was cut into pieces and pulled out.The mass was 26 cm x 5 cm x 4 cm in size.The final diagnosis was esophageal carcinosarcoma.No postoperative complications occurred.After 1 mo,the patient gained 6 kg and endoscopic reexamination revealed no obstruction.Radical surgery with lymph node dissection was carried out successfully.This lesion was the largest endoscopically resected esophageal carcinosarcoma reported to date.CONCLUSION Endoscopic palliative resection can help obtain adequate tissue for diagnosis and relieve obstructions in patients with giant esophageal carcinosarcoma.展开更多
Objective:The aim of the study was to evaluate the efficacy and tolerability of single-agent gemcitabine in the maintenance treatment of histologically confirmed metastatic breast cancer cases.Methods:The 45 patients ...Objective:The aim of the study was to evaluate the efficacy and tolerability of single-agent gemcitabine in the maintenance treatment of histologically confirmed metastatic breast cancer cases.Methods:The 45 patients carried efficacious chemotherapy were divided into maintenance therapy group(n=23) and control group(n=22) according to the different treatment methods.Patients in the maintenance therapy group received gemcitabine therapy until 6 cycles,disease progression or adverse effect intolerance.Within the control group,the patients were given best supportive care.Follow-up was made until disease progression,death or 2 years.The short-term clinical efficacy and adverse effects,progression-free survival(PFS) and median survival of recurrence(MSR) of these two groups were compared and analyzed.Results:Compared with the control group,the experiment group had higher response rate(RR;73.9% vs 31.8%;P<0.05),and significantly progress of median PFS(13.1 vs 9.6 months;P<0.05).However,the progression of MSR had no statistically difference with the control group(23.3 vs 21.1 months;P>0.05).Most of the treatment-related adverse events were mild,and the most common adverse event was hematologic toxicity.The 3 cases occurred grades 3–4 neutropenia and 3 cases occurred grades 3–4 thrombocytopenia.The 1 patient stopped treatment because of grade 3 allergic reaction,and 4 patients required dose reduction for grade 4 adverse events.Other adverse effects were grades 1–2,and all were recovered after symptomatic treatment.There was no significant side effect which threatened the life.Conclusion:In the extension maintenance treatment,gemcitabine can consolidate the therapeutic effect in advance and significantly prolong median PFS of metastatic breast cancer patients.In conclusion,gemcitabine monotherapy with a favorable safety profile is an effective maintenance treatment in metastatic breast cancer patients.展开更多
基金the Science and Technology Research Foundations of Guizhou Province,No.QKHJC-ZK(2022)YB642Zunyi Science and Technology Plan Project,No.ZSKHHZ(2022)344,No.ZSKHHZ(2022)360,and No.ZYK160+2 种基金Hubei Province Central Leading Local Science and Technology Development Special Project,No.2022BCE030Changzhou Science and Technology Projects,No.CE20225054Bijie City Science and Planning Bureau,No.BKH(2022)8.
文摘BACKGROUND Uridine diphosphate glucuronosyltransferase 1A1(UGT1A1)plays a crucial role in metabolizing and detoxifying endogenous and exogenous substances.However,its contribution to the progression of liver damage remains unclear.AIM To determine the role and mechanism of UGT1A1 in liver damage progression.METHODS We investigated the relationship between UGT1A1 expression and liver injury through clinical research.Additionally,the impact and mechanism of UGT1A1 on the progression of liver injury was analyzed through a mouse model study.RESULTS Patients with UGT1A1 gene mutations showed varying degrees of liver damage,while patients with acute-onchronic liver failure(ACLF)exhibited relatively reduced levels of UGT1A1 protein in the liver as compared to patients with chronic hepatitis.This suggests that low UGT1A1 levels may be associated with the progression of liver damage.In mouse models of liver injury induced by carbon tetrachloride(CCl_(4))and concanavalin A(ConA),the hepatic levels of UGT1A1 protein were found to be increased.In mice with lipopolysaccharide or liver steatosis-mediated liver-injury progression,the hepatic protein levels of UGT1A1 were decreased,which is consistent with the observations in patients with ACLF.UGT1A1 knockout exacerbated CCl_(4)-and ConA-induced liver injury,hepatocyte apoptosis and necroptosis in mice,intensified hepatocyte endoplasmic reticulum(ER)stress and oxidative stress,and disrupted lipid metabolism.CONCLUSION UGT1A1 is upregulated as a compensatory response during liver injury,and interference with this upregulation process may worsen liver injury.UGT1A1 reduces ER stress,oxidative stress,and lipid metabolism disorder,thereby mitigating hepatocyte apoptosis and necroptosis.
基金Supported by the Construction Fund of Key Medical Disciplines of Hangzhou,No.OO20200265the Basic Public Welfare Research Project of Zhejiang Province,No.LGF22H250005+1 种基金General project of Hangzhou Health Science and Technology Plan,No.A20200320Zhejiang Provincial Medical and Health Technology Project,No.2020PY016.
文摘BACKGROUND Alphaherpesvirus belongs to the Herpesviridae family and has large,monopartite double-stranded linear DNA.It mainly infects the skin,mucosa,and nerves,and can affect various hosts,including humans and other animals.Here,we present a case of a patient seen by the gastroenterology department at our hospital who experienced an oral and perioral herpes infection following treatment with a ven-tilator.The patient was treated with oral and topical antiviral drugs,furacilin,oral and topical antibiotics,local epinephrine injection,topical thrombin powder,and nutritional and supportive care.A wet wound healing approach was also implemented with good response.CASE SUMMARY A 73-year-old woman presented to the hospital with a chief complaint of"abdominal pain for 3 d with dizziness for 2 d."She was admitted to the intensive care unit for septic shock and spontaneous peritonitis secondary to cirrhosis and was given antiinflammatory and symptomatic supportive treatment.A ventilator was used to assist breathing for acute respiratory distress syndrome,which developed during her admission.A large area of herpes infection appeared in the perioral region 2 d following noninvasive ventilation.The patient was transferred to the gastroenterology department,at which time she had a body temperature of 37.8 C and a respiratory rate of 18/min.The patient's con-sciousness was intact,and she no longer had abdominal pain or distension,chest tightness,or asthma.At this point,the infected perioral region changed in appearance and was now accompanied by local bleeding with crusting of blood at the wounds.The surface area of the wounds measured approximately 10 cm×10 cm.A cluster blisters appeared on the patient’s right neck,and ulcers developed in her mouth.On a subjective numerical pain scale,the patient reported a pain level of 2.Overall,her diagnoses other than the oral and perioral herpes infection included:(1)Septic shock;(2)spontaneous peritonitis;(3)abdominal infection;(4)decompensated cirrhosis;and(5)hypoproteinemia.Dermatology was consulted regarding the treatment of the patient’s wounds;they suggested treatment with oral antiviral drugs,an intramuscular injection of nutritious nerve drugs,and the application of topical penciclovir and mupirocin around the lips.Stomatology was also consulted and suggested the use of nitrocilin in a local wet application around the lips.CONCLUSION Through multidisciplinary consultation,the patient’s oral and perioral herpes infection was successfully treated with the following combined approach:(1)Application of topical antviral and antibiotic treatments;(2)keeping the wound moist with a wet wound healing strategy;(3)systemic use of oral antiviral drugs;and(4)symptomatic and nutritional supportive care.The patient was discharged from the hospital after successful wound healing.
基金Supported by The grant from Chengdu Military General Hospital,No.424121HK
文摘AIM:To determine the clinical effects and complications of transjugular intrahepatic portosystemic shunt(TIPS)for portal hypertension due to cirrhosis.METHODS:Two hundred and eighty patients with portal hypertension due to cirrhosis who underwent TIPS were retrospectively evaluated.Portal trunk pressure was measured before and after surgery.The changes in hemodynamics and the condition of the stent were assessed by ultrasound and the esophageal and fundic veins observed endoscopically.RESULTS:The success rate of TIPS was 99.3%.The portal trunk pressure was 26.8±3.6 cmH2O after surgery and 46.5±3.4 cmH2O before surgery(P<0.01).The velocity of blood flow in the portal vein increased.The internal diameters of the portal and splenic veins were reduced.The short-term hemostasis rate was100%.Esophageal varices disappeared completely in68%of patients and were obviously reduced in 32%.Varices of the stomach fundus disappeared completely in 80%and were obviously reduced in 20%of patients.Ascites disappeared in 62%,were markedly reduced in 24%,but were still apparent in 14%of patients.The total effective rate of ascites reduction was 86%.Hydrothorax completely disappeared in 100%of patients.The incidence of post-operative stent stenosis was 24%at 12 mo and 34%at 24 mo.The incidence of post-operative hepatic encephalopathy was 12%at3 mo,17%at 6 mo and 19%at 12 mo.The incidence of post-operative recurrent hemorrhage was 9%at 12mo,19%at 24 mo and 35%at 36 mo.The cumulative survival rate was 86%at 12 mo,81%at 24 mo,75%at 36 mo,57%at 48 mo and 45%at 60 mo.CONCLUSION:TIPS can effectively lower portal hypertension due to cirrhosis.It is significantly effective for hemorrhage of the digestive tract due to rupture of esophageal and fundic veins and for ascites and hydrothorax caused by portal hypertension.
文摘AIM: To investigate the inhibitory effect of a specific small survivin interfering RNA (siRNA) on cell proliferation and the expression of survivin in human gastric carcinoma cell line SGC-7901. METHODS: To knockdown survivin expression, a small interfering RNA targeting against survivin was synthesized and transfected into SGC-7901 cells with lipofectamineTM2000. The downregulation of survivin expression at both mRNA and protein levels were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis. Cell proliferation inhibition rates were determined by methyl thiazolyl tetrazolium (MTT) assay. The effect of survivin siRNA on cell cycle distribution and cell apoptosis was determined by flow cytometry (FCM). RESULTS: RNA interference could efficiently suppress the survivin expression in SGC-7901 cells. At 48 h after transfection, the expression inhibition rate was 44.52% at mRNA level detected by RT-PCR and 40.17% at protein level by Western blot analysis. Downregulation of survivin resulted in significant inhibition of tumor cell growth in vitro. The cell proliferation inhibition rates at 24, 48 and 72 h after survivin siRNA and non-siliencing siRNA transfection, were 34.06%, 47.61% and 40.36%, respectively. The apoptosis rate was 3.56% and the number of cells was increased in G0/G1 phase from 38.2% to 88.6%, and decreased in S and G2/M phase at 48 h after transfection. CONCLUSION: Downregulation of survivin results in significant inhibition of tumor growth in vitro. The inhibition of survivin expression can induce apoptosis of SGC-7901 cells. The use of survivin siRNA deserves further investigation as a novel approach to cancer therapy.
文摘INTRODUCTIONProgramed cell death plays an important role in thegenesis of cancer.Certain cancer genes canregulate apoptosis.Recently,several proteins thatare structurally related to Bcl-2,an inhibitor ofapoptosis,have been identified.Therefore,novel strategies and agents that target specificmolecular pathways,as well as triggering a
基金The Applied Basic Research of the ScientificTechnological Department of Sichuan Province, No. 05JY0492
文摘AIM： To explore the anti-fibrotic effect of Oxymatrine on CCl4-induced liver fibrosis in rats and its modulation on the TGFbeta-Smad signaling pathway. METHODS： One hundred healthy male SD rats were randomly divided into three groups： normal group （n = 20）, treatment group of Oxymatrine （n = 40） and CCh-induced fibrosis group （n = 40）. Experimental hepatic fibrosis was induced by subcutaneous injection of carbon tetrachloride （CCh soluted in liquid paraffin with the concentration of 300 g/L, the dosage of injection was 3 mL/kg, twice per week for 8 wk）. The treated rats received Oxymatrine via celiac injection at a dosage of 10 mg/kg twice a week at the same time. The deposition of collagen was observed with H＆E and Masson staining. The concentration of serum TGF-β1 was assayed with ELISA. The gene expression of Smads and CBP （CREB binding protein） was detected with in situ hybridization （ISH） and immunohistochemistry （IH）, respectively. All the experimental figures were scanned and analyzed with special figure-analysis software. RESULTS： A significant reduction of collagen deposition and rearrangement of the parenchyma was noted in the liver tissue of Oxymatrine-treated rats. The semi- quantitative histological scores （2.43 ± 0.47 μm^2 vs 3.76 ±0.68, P 〈 0.05） and average area of collagen/in those rats were significantly decreased when compared with hepatic cirrhosis model rats （94.41 ± 37.26 μm^2 vs 290.86 ± 89.37 μm^2, P 〈 0.05）. The gene expression of Smad 3 mRNA was considerably decreased in the treated animals. The A value of Smad 3 mRNA was lower in the treated rats than the model rats （0.034 ± 0.090 vs 0.167 ± 0.092, P 〈 0.05）. Contrarily, the A value of Smad 7 mRNA was increased considerably in the treated animals （0.175 ± 0.065 vs 0.074 vs 0.012, P 〈 0.05）. There was an obvious decrease in the expression of CBP mRNA in treated rats as illuminated by a reduction of its A value when compared with model rats （0.065±0.049 vs 0.235 ± 0.025, P 〈 0.001）. CONCLUSION： Oxymatrine is effective in reducing the production and deposition of collagen in the liver tissue of experimental rats. Oxymatrine could promote the expression of Smad 7 and inhibit the expression of Smad 3 and CBP in CCh-induced hepatic fibrosis in SD rats, could modulate the fibrogenic signal transduction of TGFβ-Smad pathway.
基金Supported by General Hospital of Chengdu Military Command,No.2013YG-B009
文摘AIM: To describe a method for the transjugular intrahepatic portal systemic shunt(TIPS) placement performed with the aid of contrast-enhanced computed tomography(CECT) and three-dimensional reconstructed vascular images(3D RVIs), and to assess its safety and effectiveness. METHODS: Four hundred and ninety patients were treated with TIPS between January 2005 and December 2012. All patients underwent liver CECT and reconstruction of 3D RVIs of the right hepatic vein to portal vein(PV) prior to the operation. The 3D RVIs were carefully reviewed to plan the puncture path fromthe start to target points for needle pass through the PV in the TIPS procedure. R E S U LTS :The improved TIPS procedure was successful in 483(98.6%) of the 490 patients. The number of punctures attempted was one in 294(60%) patients, 2 to 3 in 147(30%) patients, 4 to 6 in 25(5.1%) patients and more than 6 in 17(3.5%) patients. Seven patients failed. Of the 490 patients, 12 had punctures into the artery, 15 into the bile duct, eight into the gallbladder, and 18 through the liver capsule. Analysis of the portograms from the 483 successful cases indicated that the puncture points were all located distally to the PV bifurcation on anteroposterior images, while the points were located proximally to the bifurcation in the three cases with intraabdominal bleeding. The complications included three cases of bleeding, of whom one died and two needed surgery. CONCLUSION: Use of CECT and 3D RVIs to plan the puncture path for TIPS procedure is safe, simple and effective for clinical use.
基金Supported by The Fund of Nanjing Medical University Science and Technology Development,No.09NJMUZ30
文摘AIM： To investigate the relationship between Interleu- kin-8 （IL-8） and proliferation, adhesion, migration, inva- sion and chemosensitivity of gastric cancer （GC） cells.
文摘AIM:To examine the prophylactic effect of glyceryl trinitrate on post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis and hyperamylasemia.METHODS:Patients scheduled for ERCP were randomly divided into study group and placebo group.Patients in study group and placebo group were treated with 5 mg glyceryl trinitrate and 100 mg vitamin C,respectively,5 min before endoscopic maneuvers.RESULTS:A total of 74 patients were enrolled in the final analysis.Post-ERCP pancreatitis occurred in 3 patients(7.9%) of the study group and 9 patients(25%) in the placebo group(P = 0.012).Hyperamylasemia occurred in 8 patients of the study group(21.1%) and 13 patients(36.1%) of the placebo group(P = 0.037).CONCLUSION:Glyceryl trinitrate before ERCP can effectively prevent post-ERCP and hyperamylasemia.
基金Supported by the National Nature Science Foundation of China,No.81572243Scientific Research Funds Project of Liaoning Education Department,No.LJC2019ST02
文摘BACKGROUND Irritable bowel syndrome(IBS)is a common digestive system disease with a high incidence rate and is common in women.The cause of IBS remains unclear.Some studies have shown that mental and psychological diseases are independent risk factors for IBS.At present,the treatment of IBS is mainly symptomatic treatment.Clinically,doctors also use cognitive behavioral therapy to improve patients'cognitive ability to diseases and clinical symptoms.In recent years,exercise therapy has attracted more and more attention from scholars.Improving the symptoms of IBS patients through psychosomatic treatment strategy may be a good treatment method.AIM To explore the effects of an intervention of cognitive behavioral therapy combined with exercise(CBT+E)on the cognitive bias and coping styles of patients with diarrhea-predominant irritable bowel syndrome(IBS-D);and to provide a theoretical reference for the management of IBS.METHODS Sixty IBS-D patients and thirty healthy subjects were selected.The 60 IBS-D patients were randomly divided into experimental and control groups.The experimental group was treated with the CBT+E intervention,while the control group was treated with conventional drugs without any additional intervention.The cognitive bias and coping styles of the participants were evaluated at baseline and after 6 wk,12 wk and 24 wk using the Automatic Thoughts Questionnaire(ATQ),Dysfunctional Attitudes Scale(DAS)and Pain Coping Style Questionnaire(CSQ)instruments,and the intervention effect was analyzed using SPSS 17.0 statistical software.RESULTS At baseline,the scores on the various scales showed that all subjects had cognitive bias and adverse coping styles.The IBS Symptom Severity Scale(IBSSSS)scores,ATQ total scores,DAS scores and CSQ scores of the two groups were not significantly different(P>0.05).Compared with baseline,after 6 wk of the CBT+E intervention,there were significant differences in the ATQ scores,the dependence and total scores on the DAS,and the catastrophization,distraction and prayer scores on the CSQ(P<0.05).After 12 wk,there were significant differences in the scores for perfectionism on the DAS and in the scores for reinterpretation,neglect and pain behavior on the CSQ in the experimental group(P<0.05).After 24 wk,there were significant differences in the vulnerability,dependence,perfectionism,and total scores on the DAS and in the catastrophization,distraction and prayer scores on the CSQ in the experimental group(P<0.01).The IBS-SSS scores were negatively correlated with the ATQ and DAS total scores(P<0.05)but were positively correlated with the CSQ total score(P<0.05).CONCLUSION Intervention consisting of CBT+E can correct the cognitive bias of IBS-D patients and eliminate their adverse coping conditions.CBT+E should be promoted for IBS and psychosomatic diseases.
文摘OBJECTIVE： To analyze international research trends in hepatic encephalopathy and examine the role of neuroelectrophysiology and neuroimaging in diagnosis of hepatic encephalopathy. DATA RETRIEVAL： We performed a bibliometric analysis of studies on hepatic encephalopathy published during 2002-2011 retrieved from Web of Science. SELECTION CRITERIA： Inclusion criteria： （1） peer-reviewed published articles on hepatic encephalopathy; （2） original article, review, meeting abstract, proceedings paper, book chapter, editorial material, news items, and （3） published during 2002-2011. Exclusion criteria： （1） articles that required manual searching or telephone access; （2） documents that were not published in the public domain; and （3） corrected papers from the total number of articles. MAIN OUTCOME MEASURES： （1）Annual publication output; （2） type of publication; （3） publication by research field; （4） publication by journal; （5） publication by author; （6） publication by institution; （7） publication by country; （8） publication by institution in China; （9） most-cited papers. RESULTS： A total of 3 233 papers regarding hepatic encephalopathy were retrieved during 2002-2011. The number of papers gradually increased over the 10-year study period and was highest in 2010. Most papers appeared in journals with a focus on gastroenterology and hepatology. Among the included journals, Hepatology published the greatest number of papers regarding hepatic encephalopathy, and the published studies were highly cited. Thus, Hepatology appears to represent a key journal publishing papers on hepatic encephalopathy. Regarding distribution by country for publications on hepatic encephalopathy indexed in Web of Science during 2002-2011, the United States published highest number of papers, with China ranked ninth As per distribution by institute for publications, the University of Montreal in Canada published the highest number of papers （n = 111 ）. Among the Chinese institutes, Zhejiang University in China was the most prolific institute with 15 papers. CONCLUSION： The present bibliometric analysis on hepatic encephalopathy provides an overview of research progress, as well as identifying the most active institutes and experts in this research field during 2002-2011. Research into hepatic encephalopathy has revealed changes in neural injury and regeneration in hepatic encephalopathy. Neuroelectrophysiological and neuroimaging examinations are important for determining clinical classifications and disease severity of hepatic encephalopathy, providing a foundation for further research.
文摘BACKGROUND As transjugular intrahepatic portosystemic shunt(TIPS)creation alters the hemodynamic status of the portal system,whether reduced portal blood supply affects the synthetic reserve function of the liver has been the focus of clinical attention.Since the Viatorr stent entered the Chinese market in 2015,it has not yet been widely used in clinical practice.Further,unlike other countries,the main cause of liver cirrhosis in China is viral hepatitis.Therefore,use of the Viatorr stent to establish a TIPS channel in patients with liver cirrhosis with differing etiologies is of great clinical interest.AIM To investigate factors affecting changes in liver reserve function after TIPS Viatorr stent implantation.METHODS Clinical data from 200 patients with cirrhotic portal hypertension who received TIPS treatment from March 2016 to March 2020 were analyzed retrospectively.The patients were divided into three groups(A-C),according to their disease etiology,with post-hepatitis,autoimmune,and alcoholic cirrhosis,respectively.Preoperative and postoperative liver and renal function and coagulation data,Child-Pugh grade,and model for end-stage liver disease(MELD)scores were collected.Statistical analyses were performed using the t-test or chi-square test.The incidence and of hepatic encephalopathy and patient survival were calculated using Kaplan-Meier method.RESULTS The surgical success rate was 100%,with mean portal pressure gradient(mmHg)decreasing from 25.5±5.22 to 10.04±2.76(t=45.80;P<0.001).After 24 mo,the cumulative incidence of hepatic encephalopathy in group A was significantly lower than that in group B/C,while the cumulative survival rate was significantly higher in group A than in group B/C(P<0.05 for both).The Child-Pugh score for group A was 6.96±1.21,which was significantly better than those of groups B(7.42±0.99;t=-2.44;P=0.016)and C(7.52±1.12;t=-2.67;P=0.009).Further,the MELD score for group A(9.62±2.19)was significantly better than those for groups B(10.64±1.90;t=-2.92;P=0.004)and C(10.82±2.01;t=-3.29;P=0.001).CONCLUSION Insertion of 8 mm internal diameter Viatorr stent has no significant effects on liver reserve function.Changes of liver reserve function in the medium and long term may be related to the etiology and treatment of portal hypertension.
文摘Bouveret's syndrome is an extremely rare type of gallstone-induced ileus with atypical clinical manifestations,such as abdominal distension and pain,nausea and vomiting,fever or even gastrointestinal bleeding,which may easily be misdiagnosed. In the present case,a 55-year-old male was admitted to the hospital with upper gastrointestinal obstructive symptoms but without pain,fever,jaundice or melena. At first,gastrolithiasis and peptic ulcer combined with pyloric obstruction were suspected after gastroscopy revealed a large,hard stone in the duodenal bulb. A revised diagnosis of Bouveret's syndrome was made following abdominal computed tomography. Subsequently,the patient exhibited a good postoperative recovery after laparoscopic duodenotomy for gallstone removal and subtotal cholecystectomy. The condition of the patient remained stable after being followed up for 6 mo. The successful application of laparoscopic therapy to treat Bouveret's syndrome has seldom been reported. Laparoscopic enterolithotomy is safe and effective,with good patient tolerability,rapid postoperative recovery and few wound-related complications. The laparoscopic treatment of Bouveret's syndrome is worth exploring.
文摘The effects of the balance changes of pigment epithelium growth factor（PEDF） and vascular endothelial growth factor（VEGF） in whole-body and retinal tissue on rats with oxygen-induced retinopathy were investigated. Forty-eight neonatal SD rats at the age of 7 days were randomly divided into 4 groups. The neonatal rats in experimental groups were exposed to 75% to 80% oxygen for 5 days and then to normal air, and those in control groups were kept feeding in normal air. At the age of 17 and 22 days, all the neonatal rats received retina angiography with FITC-dextran and the pathological changes of retinal vessels and perfusion were observed. HE staining of the tissue section and the number counting of endothelial cells extending beyond the inner limiting membrane were performed to evaluate the endothelial proliferation. Immunohistochemistry was applied to detect the expression of PEDF and VEGF in retinal tissue, and ELISA to detect their expression in serum. A hypoxic-ischemic proliferation of retina and more endothelial cells extending beyond the inner limiting membrane were found in the neonatal rats in both experimental groups of 17-day old and 22-day old as compared with those in control group with the difference being statistically significant（P〈0.01）. VEGF staining of the rats in the 17-day old experimental group was significantly stronger, with an increasing positive rate, than that of the rats in the 17-day old control group（P〈0.01）. PEDF staining of the rats of 22 days old was weaker than that of the rats of 17 days old in the experimental groups（P〈0.01）. There was no significant difference in serum VEGF concentration among all groups（P〈0.05）. The serum PEDF concentration in the rats of 17 days old in experimental group was decreased significantly as compared with that in the rats of 17 days old in control group（P〈0.01）, and in experimental groups, the serum PEDF concentration of the rats of 22 days old was increased as compared with that of the rats of 17 days old（P〈0.01）. In conclusion, the obviously decreased serum PEDF concentration and the abnormal enhanced expression of VEGF density in local retinal tissue broke down the balance of PEDF/VEGF in whole-body or local tissues, which might play an important role in retinal vascular proliferation.
文摘BACKGROUND Portal hypertension is a major complication of cirrhosis that is associated with significant morbidity and mortality.The present gold-standard method to risk stratify and observe cirrhosis patients with portal hypertension is hepatic venous pressure gradient measurement or esophagogastroduodenoscopy.However,these methods are invasive,carry a risk of complications and are associated with significant patient discomfort.Therefore,non-invasive splenic parameters are of clinical interest as potential useful markers in determining the presence of portal hypertension.However,diagnostic accuracy and reproducibility remains unvalidated.AIM To assess the diagnostic accuracy of spleen stiffness,area and diameter in predicting the presence of portal hypertension.METHODS Of 50 patients with varying liver disease pathologies were prospectively recruited from the St.Mary’s Hospital Liver Unit in London;25 with evidence of portal hypertension and 25 with no evidence of portal hypertension.Liver stiffness,spleen stiffness,spleen diameter and spleen area were measured using the Philips Affiniti 70 elastography point quantification point shear wave elastography system.The aspartate aminotransferase-to-platelet-ratio-index(APRI)score was also calculated.Performance measures,univariate and multivariate logistic regression were used to evaluate demographic,clinical and elastography variables.Interclass correlation coefficient was used to determine the reproducibility of splenic area and diameter.RESULTS On univariate and individual performance,platelet count[area under the receiver operating characteristic(AUROC)0.846,P value<0.001],spleen area(AUROC 0.828,P value=0.002)and APRI score(AUROC 0.827,P value<0.001)were the most accurate variables in identifying the presence of portal hypertension.On multivariate logistic regression models constructed,the combination of spleen area greater than 57.90 cm2 and platelet count less than 126×10^9 had 63.2%sensitivity and 100%specificity,100%positive predictive value and 100%negative predictive value.An alternative combination of spleen stiffness greater than 29.99 kPa and platelet count less than 126×10^9 had 88%sensitivity,75%specificity,78.6%positive predictive value and 85.7%negative predictive value.An interclass correlation coefficient value of 0.98(95%CI:0.94-0.99,P value<0.001)and 0.96(95%CI:0.91-0.99,P value<0.001)were determined for inter-operator variability for spleen area and diameter respectively.CONCLUSION Spleen area,spleen stiffness and platelet count may be useful markers to assess the presence of portal hypertension in patients of various etiologies.
基金Supported by the National Natural Science Foundation of China(81373465)
文摘In recent years, increasingly evidences show that autophagy plays an important role in the pathogenesis and development of liver diseases, and the relationship between them has increasingly become a focus of concern. Autophagy refers to the process through which the impaired organelles, misfolded protein, and intruding microorganisms is degraded by lysosomes to maintain stability inside cells. This article states the effect of autophagy on liver diseases （hepatic fibrosis, fatty liver, viral hepatitis, and liver cancer）, which aims to provide a new direction for the treatment of liver diseases.
基金Supported by: Clinical Speciality Foundation of Ministry of Health of the people's Republic of China (No.20012130)
文摘Objective: To observe the damage of mixed reflux to the rat esophageal mucosa, and investigate the preventive effects of cisapride, nabumetone and hydrotalcite on the damaged esophageal mucosa. Methods: Three hundred sixty-eight Sprague-Dawley rats were treated as esophagoduodenostomy and divided into four groups in random. Group Y: operation + saline as positive controls; Group P: operation + cisapride; Group R: operation + nabumetone; Group D: operation + hydrotalcite. Different drugs were perfused in the 1 st week after operation. The lesions of esophageal mucosa were observed in the 5th, 9th, 13th, 17th, 22nd, 28th, 35th and 40th week respectively, and evaluated the preventive effects of these drugs. Results: The lesions of esophageal mucosa in group Y were more severe than other three groups in different time (P ＜ 0.05), and the incidence of Barrett's esophagus(BE), severe atypical hyperplasia and esophageal adenocarcinoma (EAC) in group Y were higher than others. After 22 weeks, the lesions in group P were more severe than group R and D, and there were obvious differences in different time ( P ＜ 0.05); but the incidence of BE, severe atypical hyperplasia and EAC in group P had no significant difference with group R and group D( P ＞ 0.05). Conclusion: BE, severe atypical hyperplasia and EAC could occur because of severe reflux esophagitis for a long term. Cisapride, nabumetone and hydrotalcite could reduce mucosa injury in reflux esophagitis and resist the development of BE, severe atypical hyperplasia and EAC.In addition, the curative effects of nabumetone and hydrotalcite were better than cisapride.
文摘Colonoscopy was performed in 322 children with blood in the stool aging from 2days to 14 years old during 1972 to 1986,by which 96.6 percent of the cases were accurately di-agnosed.The most common disease found was polyps（57.7％）,next intussusception,andthen amebiasis and necrotising enteritis.In terms of diagnosis,we believe,history inquiring isvery important;rectal touch and rigid sigmidoscopy should be done as a routine;colonoscopy,especially when combined with x-ray,is a main measure;<sup>99</sup>m-Tc Scanning and selective abdomi-nal angiography are very helpful in some cases.Because hematochezia is chiefly caused by largebowel polyps,endoscopy may share both diagnosing and treating purposes.In this group,196polyps were safely excised in 168 patients.For thorny polyposis,it is recommended thatendoscopy-surgery combining therapy should be chosen.
基金National Key Research and Development Program of China,No.2017YFC0112304.
文摘BACKGROUND Esophageal carcinosarcoma,usually presenting as a pedunculated polypoid mass,is a rare malignancy with coexisting sarcomatoid and carcinomatous components.Its imaging and endoscopic characteristics are similar to those of leiomyosarcoma,liposarcoma and so forth.The diagnosis needs histological confirmation.Surgical resection is the traditional therapy.Endoscopic resection is minimally invasive but still controversial.This paper reports the case of a patient with a giant esophageal carsinosarcoma who underwent a palliative endoscopic resection.CA^E SUMMARY A 55-year-old male patient presented with dysphagia and weight loss for 1 mo.Imaging and endoscopy showed a gray-white,polypoid,stalk-like mass,with a bulky pedicle located in the middle and lower esophagus.The mass almost filled the whole esophageal lumen,but the endoscope could still pass through.Despite the suspicion of a malignancy,repeated biopsies indicated necrosis and inflammation.After multidisciplinary team consultation,an endoscopic resection to diagnose and relieve the obstruction was recommended.The pedicle of the mass was cut off,the bleeding was stopped,and the mass was cut into pieces and pulled out.The mass was 26 cm x 5 cm x 4 cm in size.The final diagnosis was esophageal carcinosarcoma.No postoperative complications occurred.After 1 mo,the patient gained 6 kg and endoscopic reexamination revealed no obstruction.Radical surgery with lymph node dissection was carried out successfully.This lesion was the largest endoscopically resected esophageal carcinosarcoma reported to date.CONCLUSION Endoscopic palliative resection can help obtain adequate tissue for diagnosis and relieve obstructions in patients with giant esophageal carcinosarcoma.
基金Supported by a grant from Shaanxi International Cooperation Projects:Mechanism of macrophage activation in different subtypes of immuneescape in three negative breast cancer(No.2013KW-32-01)
文摘Objective:The aim of the study was to evaluate the efficacy and tolerability of single-agent gemcitabine in the maintenance treatment of histologically confirmed metastatic breast cancer cases.Methods:The 45 patients carried efficacious chemotherapy were divided into maintenance therapy group(n=23) and control group(n=22) according to the different treatment methods.Patients in the maintenance therapy group received gemcitabine therapy until 6 cycles,disease progression or adverse effect intolerance.Within the control group,the patients were given best supportive care.Follow-up was made until disease progression,death or 2 years.The short-term clinical efficacy and adverse effects,progression-free survival(PFS) and median survival of recurrence(MSR) of these two groups were compared and analyzed.Results:Compared with the control group,the experiment group had higher response rate(RR;73.9% vs 31.8%;P<0.05),and significantly progress of median PFS(13.1 vs 9.6 months;P<0.05).However,the progression of MSR had no statistically difference with the control group(23.3 vs 21.1 months;P>0.05).Most of the treatment-related adverse events were mild,and the most common adverse event was hematologic toxicity.The 3 cases occurred grades 3–4 neutropenia and 3 cases occurred grades 3–4 thrombocytopenia.The 1 patient stopped treatment because of grade 3 allergic reaction,and 4 patients required dose reduction for grade 4 adverse events.Other adverse effects were grades 1–2,and all were recovered after symptomatic treatment.There was no significant side effect which threatened the life.Conclusion:In the extension maintenance treatment,gemcitabine can consolidate the therapeutic effect in advance and significantly prolong median PFS of metastatic breast cancer patients.In conclusion,gemcitabine monotherapy with a favorable safety profile is an effective maintenance treatment in metastatic breast cancer patients.
