AIM： To evaluate the effectiveness of ultrasonographic screening for early detection of hepatocellular carcinoma （HCC）. METHODS： The data of 14 968 patients who had ultrasonography （US） for chronic liver disease...AIM： To evaluate the effectiveness of ultrasonographic screening for early detection of hepatocellular carcinoma （HCC）. METHODS： The data of 14 968 patients who had ultrasonography （US） for chronic liver diseases were collected into a database program from June 1995 to June 2005. The risk factors for HCC were also studied. A total of 6089 patients who had repeated US were enrolled, 264 patients were diagnosed with HCC during follow-up （mean, 39 mo）. RESULTS： The detection rate of small HCC （≤ 3 cm in diameter） was 67.7%. The tumor size detected by screening at the intervals of 6 mo was significantly smaller than that at longer intervals. Only 29.3% of HCC patients had an elevated serum alpha fetoprotein （AFP） level above 400 ng/mL. The risk of HCC development during follow-up was higher in patients with liver cirrhosis （10.9%） and hepatitis C （9.0%） than in patients with chronic hepatitis （4.2%）, hepatitis B （4.9%） and non-B, non-C hepatitis （NBNC, 3.9%）. CONCLUSION： US screening at a interval of 6 mo is beneficial to high-risk patients over 40 years old and the early detection of HCC prolongs survival.展开更多
AIM: To provide the useful information for the diagnosis of liver cirrhosis by observing the morphology of peripheral hepatic vessels and the hemodynamics of microbubble arrival time in these vessels.METHODS: Twenty-o...AIM: To provide the useful information for the diagnosis of liver cirrhosis by observing the morphology of peripheral hepatic vessels and the hemodynamics of microbubble arrival time in these vessels.METHODS: Twenty-one subjects including 5 normal volunteers and 16 patients (liver cirrhosis, n=10;chronic hepatitis, n=6) were studied by contrast-enhanced coded phase inversion harmonic sonography (GE LOGIQ9 series) using a 6-8 MHz convex-arrayed wide-band transducer. The images of peripheral hepatic artery,portal and hepatic vein were observed in real-time for about 2 min after intravenous injection of Levovist. The time when microbubbles appeared in the peripheral vessels (microbubble arrival time) was also recorded. The morphologic changes of peripheral hepatic vasculature were classified as marked, slight, and no changes based on the regularity in caliber, course, ramification, and the delineation of vessels compared to normal subjects.RESULTS: The microbubble arrival time at peripheral artery, portal, and hepatic vein was shorter in cirrhotic patients than in chronic hepatitis patients and normal subjects. The marked, slight and no morphologic changes of peripheral hepatic vasculature found in 5 (5/6,83.3%), 1 (1/6, 16.7% ), and 0 (0/6, 0%) liver cirrhosis patients, respectively, and in 1 (1/10, 10%), 6 (6/10,60%), and 3 (3/10, 30%) chronic hepatitis patients,respectively. There was a significant difference between the two groups (P＜0.001).CONCLUSION: Evaluation of the hemodynamics and morphology of peripheral hepatic vasculature by contrast-enhanced coded pulse inversion harmonic sonography can provide useful information for the diagnosis of liver cirrhosis.展开更多
AIM:To investigate the effect of emodin on pancreatic claudin-5 and occludin expression,and pancreatic paracellular permeability in acute pancreatitis(AP).METHODS:Experimental pancreatitis was induced by retrograde in...AIM:To investigate the effect of emodin on pancreatic claudin-5 and occludin expression,and pancreatic paracellular permeability in acute pancreatitis(AP).METHODS:Experimental pancreatitis was induced by retrograde injection of 5% sodium taurocholate into the biliopancreatic duct.Emodin was injected via the external jugular vein 0 or 6 h after induction of AP.Rats from sham operation and AP groups were injected with normal saline at the same time.Samples of pancreas were obtained 6 or 12 h after drug administration.Pancreatic morphology was examined with hematoxylin and eosin staining.Pancreatic edema was estimated by measuring tissue water content.Tumor necrosis factor(TNF)-α and interleukin(IL)-6 level were measured by enzyme-linked immunosorbent assay.Pancreatic paracellular permeability was assessed by tissue dye extravasation.Expression of pancreatic claudin-5 and occludin was examined by immunohistology,quantitative real-time reverse transcriptase polymerase chain reaction and western blotting.RESULTS:Pancreatic TNF-α and IL-6 levels,wet/dry ratio,dye extravasation,and histological score were significantly elevated at 3,6 and 12 h following sodium taurocholate infusion;treatment with emodin prevented these changes at all time points.Immunostaining of claudin-5 and occludin was detected in rat pancreas,which was distributed in pancreatic acinar cells,ductal cells and vascular endothelial cells,respectively.Sodium taurocholate infusion significantly decreased pancreatic claudin-5 and occludin mRNA and protein levels at 3,6 and 12 h,and that could be promoted by intravenous administration of emodin at all time points.CONCLUSION:These results demonstrate that emodin could promote pancreatic claudin-5 and occludin expression,and reduce pancreatic paracellular permeability.展开更多
To evaluate the efficacy and safety of entecavir （ETV） in hepatitis Be antigen （HBeAg）-positive chronic hepatitis B （CriB） patients who had not received a nucleoside analogue and who had failed in lamivudine （...To evaluate the efficacy and safety of entecavir （ETV） in hepatitis Be antigen （HBeAg）-positive chronic hepatitis B （CriB） patients who had not received a nucleoside analogue and who had failed in lamivudine （LVD） therapy. METHODS： Sixty-one patients were divided into three groups. Forty-two patients who had not received a nucleoside analogue were randomized into two groups： group A （n = 21） received LVD 100 mg/d and group B （n -- 21） received ETV 0.5 mg/d. The remaing 19 patients treated with LVD （n = 19）, who switched to ETV 1.0 mg/d served as group C. All patients were treated for 48 wk. HBV DNA levels were measured with polimerase- chain-reaction （PCR） analysis. Liver function tests, HBV serology and safety assessments were also conducted. RESULTS： Significantly more patients in group B （52.1% and 71.4%） had undetectable HBV DNA levels than in groups A （35.8% and 38%; P 〈 0.0001） and C （10.6% and 21.1%, P 〈 0.0001） at wk 24 and 48, respectively. At wk 48, ALT levels were normalized in more patients in group B （85.7%） than in groups A （76.2%） and C （74%）. CONCLUSION： ETV had a significantly higher response rate than LVD in patients with HBeAg-positive CriB who had not previously received a nucleoside analogue; ETV can effectively inhibit the replication of HBV DNA and normalize the levels of ALT in refractory CriB patients treated with LVD; and ETV is safe in clinical application.展开更多
Decompensated cirrhosis is characterized by chronic inflammation and severe portal hypertension leading to systemic circulatory dysfunction.Albumin infusion has been widely used in decompensated cirrhosis in patients ...Decompensated cirrhosis is characterized by chronic inflammation and severe portal hypertension leading to systemic circulatory dysfunction.Albumin infusion has been widely used in decompensated cirrhosis in patients with spontaneous bacterial peritonitis,large-volume paracentesis and hepatorenal syndrome.Emerging data suggest long-term albumin infusion has both oncotic and non-oncotic properties which may improve the clinical outcomes in decompensated cirrhosis patients.We review the current literature on both the established and potential role of albumin,and specifically address the controversies of long-term albumin infusion in decompensated cirrhosis patients.展开更多
文摘AIM： To evaluate the effectiveness of ultrasonographic screening for early detection of hepatocellular carcinoma （HCC）. METHODS： The data of 14 968 patients who had ultrasonography （US） for chronic liver diseases were collected into a database program from June 1995 to June 2005. The risk factors for HCC were also studied. A total of 6089 patients who had repeated US were enrolled, 264 patients were diagnosed with HCC during follow-up （mean, 39 mo）. RESULTS： The detection rate of small HCC （≤ 3 cm in diameter） was 67.7%. The tumor size detected by screening at the intervals of 6 mo was significantly smaller than that at longer intervals. Only 29.3% of HCC patients had an elevated serum alpha fetoprotein （AFP） level above 400 ng/mL. The risk of HCC development during follow-up was higher in patients with liver cirrhosis （10.9%） and hepatitis C （9.0%） than in patients with chronic hepatitis （4.2%）, hepatitis B （4.9%） and non-B, non-C hepatitis （NBNC, 3.9%）. CONCLUSION： US screening at a interval of 6 mo is beneficial to high-risk patients over 40 years old and the early detection of HCC prolongs survival.
文摘AIM: To provide the useful information for the diagnosis of liver cirrhosis by observing the morphology of peripheral hepatic vessels and the hemodynamics of microbubble arrival time in these vessels.METHODS: Twenty-one subjects including 5 normal volunteers and 16 patients (liver cirrhosis, n=10;chronic hepatitis, n=6) were studied by contrast-enhanced coded phase inversion harmonic sonography (GE LOGIQ9 series) using a 6-8 MHz convex-arrayed wide-band transducer. The images of peripheral hepatic artery,portal and hepatic vein were observed in real-time for about 2 min after intravenous injection of Levovist. The time when microbubbles appeared in the peripheral vessels (microbubble arrival time) was also recorded. The morphologic changes of peripheral hepatic vasculature were classified as marked, slight, and no changes based on the regularity in caliber, course, ramification, and the delineation of vessels compared to normal subjects.RESULTS: The microbubble arrival time at peripheral artery, portal, and hepatic vein was shorter in cirrhotic patients than in chronic hepatitis patients and normal subjects. The marked, slight and no morphologic changes of peripheral hepatic vasculature found in 5 (5/6,83.3%), 1 (1/6, 16.7% ), and 0 (0/6, 0%) liver cirrhosis patients, respectively, and in 1 (1/10, 10%), 6 (6/10,60%), and 3 (3/10, 30%) chronic hepatitis patients,respectively. There was a significant difference between the two groups (P＜0.001).CONCLUSION: Evaluation of the hemodynamics and morphology of peripheral hepatic vasculature by contrast-enhanced coded pulse inversion harmonic sonography can provide useful information for the diagnosis of liver cirrhosis.
基金Supported by National Natural Science Foundation of China,No.30500688
文摘AIM:To investigate the effect of emodin on pancreatic claudin-5 and occludin expression,and pancreatic paracellular permeability in acute pancreatitis(AP).METHODS:Experimental pancreatitis was induced by retrograde injection of 5% sodium taurocholate into the biliopancreatic duct.Emodin was injected via the external jugular vein 0 or 6 h after induction of AP.Rats from sham operation and AP groups were injected with normal saline at the same time.Samples of pancreas were obtained 6 or 12 h after drug administration.Pancreatic morphology was examined with hematoxylin and eosin staining.Pancreatic edema was estimated by measuring tissue water content.Tumor necrosis factor(TNF)-α and interleukin(IL)-6 level were measured by enzyme-linked immunosorbent assay.Pancreatic paracellular permeability was assessed by tissue dye extravasation.Expression of pancreatic claudin-5 and occludin was examined by immunohistology,quantitative real-time reverse transcriptase polymerase chain reaction and western blotting.RESULTS:Pancreatic TNF-α and IL-6 levels,wet/dry ratio,dye extravasation,and histological score were significantly elevated at 3,6 and 12 h following sodium taurocholate infusion;treatment with emodin prevented these changes at all time points.Immunostaining of claudin-5 and occludin was detected in rat pancreas,which was distributed in pancreatic acinar cells,ductal cells and vascular endothelial cells,respectively.Sodium taurocholate infusion significantly decreased pancreatic claudin-5 and occludin mRNA and protein levels at 3,6 and 12 h,and that could be promoted by intravenous administration of emodin at all time points.CONCLUSION:These results demonstrate that emodin could promote pancreatic claudin-5 and occludin expression,and reduce pancreatic paracellular permeability.
文摘To evaluate the efficacy and safety of entecavir （ETV） in hepatitis Be antigen （HBeAg）-positive chronic hepatitis B （CriB） patients who had not received a nucleoside analogue and who had failed in lamivudine （LVD） therapy. METHODS： Sixty-one patients were divided into three groups. Forty-two patients who had not received a nucleoside analogue were randomized into two groups： group A （n = 21） received LVD 100 mg/d and group B （n -- 21） received ETV 0.5 mg/d. The remaing 19 patients treated with LVD （n = 19）, who switched to ETV 1.0 mg/d served as group C. All patients were treated for 48 wk. HBV DNA levels were measured with polimerase- chain-reaction （PCR） analysis. Liver function tests, HBV serology and safety assessments were also conducted. RESULTS： Significantly more patients in group B （52.1% and 71.4%） had undetectable HBV DNA levels than in groups A （35.8% and 38%; P 〈 0.0001） and C （10.6% and 21.1%, P 〈 0.0001） at wk 24 and 48, respectively. At wk 48, ALT levels were normalized in more patients in group B （85.7%） than in groups A （76.2%） and C （74%）. CONCLUSION： ETV had a significantly higher response rate than LVD in patients with HBeAg-positive CriB who had not previously received a nucleoside analogue; ETV can effectively inhibit the replication of HBV DNA and normalize the levels of ALT in refractory CriB patients treated with LVD; and ETV is safe in clinical application.
基金Supported by Nurturing Clinician Scientist Scheme Award by SingHealth Duke-NUS Medicine Academic Medicine Programme(Medicine ACP),Changi General Hospital Research Grant.
文摘Decompensated cirrhosis is characterized by chronic inflammation and severe portal hypertension leading to systemic circulatory dysfunction.Albumin infusion has been widely used in decompensated cirrhosis in patients with spontaneous bacterial peritonitis,large-volume paracentesis and hepatorenal syndrome.Emerging data suggest long-term albumin infusion has both oncotic and non-oncotic properties which may improve the clinical outcomes in decompensated cirrhosis patients.We review the current literature on both the established and potential role of albumin,and specifically address the controversies of long-term albumin infusion in decompensated cirrhosis patients.
