检索结果-南通市图书馆

World Journal of Gastroenterology 2022年第17期28卷 1871-1874页

作者： alla turshudzhyan Houman Rezaizadeh Department of Medicine University of ConnecticutFarmingtonCT 06030United States Department of Gastroenterology and Hepatology University of ConnecticutFarmingtonCT 06030United States

Helicobacter pylori(H.pylori)has long been believed to be the major colonizer of the stomach,but recent advances in genetic sequencing have allowed for further differentiation of the gastric microbiome and revealed the true complexity of the gastric microbiome.One of the few studies specifically evaluated the microbiome in the H.pylori negative patient population.They concluded that various stages of gastric carcinogenesis are associated with distinct bacterial taxa that could service both a predictive and diagnostic purpose.While the study has some limitations,the conclusions they make are intriguing and should prompt a larger prospective study to be done that spans multiple geographic regions.

关键词： Gastric cancer Gastric carcinogenesis Microbiome Dysplasia Intestinal metaplasia

Persistently Rising Alpha-fetoprotein in the Diagnosis of Hepatocellular Carcinoma:A Review

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Journal of Clinical and Translational Hepatology 2022年第1期10卷 159-163页

作者： alla turshudzhyan George Y.Wu Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA

Hepatocellular carcinoma(HCC),one of the most common malignant tumors worldwide,is known for its grim prognosis,with untreated life expectancy being only a matter of months after the diagnosis.The difficulty in making a diagnosis early is one of the main contributing factors to the poor prognosis.Alpha-fetoprotein(AFP)had long been used as a surveillance tool,but suboptimal specificity and sensitivity has prompted liver societies to abandon the recommendation for its universal use,even in combination with ultrasonography.Most studies have shown no obvious correlation between serum AFP level and HCC tumor size,stage,or survival post-diagnosis.However,some studies concluded that a gradual rise or persistent elevation in AFP were positive predictors for tumor development.Other studies reported a fall in AFP followed by a rise in patients with HCC as well as persistently rising AFP levels without development of HCC on follow up.Our calculation of the sensitivity and specificity of persistently rising AFP for HCC were both low,at 60%and 35.8%,respectively,indicating that the presence of persistently rising AFP per se did not offer diagnostic benefit.In addition,our calculated mean slopes of persistently rising AFP levels in HCC and non-HCC patients were numerically very different,but the difference was not statistically significant.We conclude that the published data do not support a role for rising AFP levels per se in the diagnosis of HCC.

关键词： Alpha-fetoprotein,AFP Hepatocellular carcinoma,HCC Cancer screening

Rebuilding trust in proton pump inhibitor therapy

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2022年第24期28卷 2667-2679页

作者： alla turshudzhyan Sonia Samuel Angela Tawfik Micheal Tadros Department of Medicine University of ConnecticutFarmingtonCT 06030United States Department of Medicine Albany Medical CollegeAlbanyNY 12208United States Guilderland High School Guilderland CenterAlbanyNY 12085United States Department of Gastroenterology and Hepatology Albany Medical CollegeAlbanyNY 12208United States

Introduction of proton pump inhibitor(PPI)therapy into clinical practice has revolutionized treatment approach to acid-related diseases.With its clinical success came a widespread use of PPI therapy.Subsequently,several studies found that PPIs were oftentimes overprescribed in primary care and emergency setting,likely attributed to seemingly low side-effect profile and physicians having low threshold to initiate therapy.However,now there is a growing concern over PPI side-effect profile among both patients and providers.We would like to bring more awareness to the currently available guidelines on PPI use,discuss clinical indications for PPIs and the evidence behind the reported sideeffects.We hope that increased awareness of proper PPI use will make the initiation or continuation of therapy a well informed and an evidence-based decision between patient and physician.We also hope that discussing evidence behind the reported side-effect profile will help clarify the growing concerns over PPI therapy.

关键词： Proton pump inhibitor Side-effects Gastro-esophageal reflux disease Therapy

Primary Non-HFE Hemochromatosis:A Review

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Journal of Clinical and Translational Hepatology 2023年第4期11卷 925-931页

作者： alla turshudzhyan David C.Wu George Y.Wu Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA

Iron homeostasis is a complex process in which iron uptake and use are tightly balanced.Primary Type 1 or HFE hemochromatosis results from homozygous mutations in the gene that encodes human homeostatic iron regulator(known as human factors engineering,HFE)protein,a regulator of hepcidin,and makes up approximately 90%of all hemochromatosis cases.However,four types of hemochromatosis do not involve the HFE gene.They are non-HFE hemochromatosis type 2A(HFE2,encoding HJV),type 2B(HAMP,encoding hepcidin),type 3(TFR2,encoding transferring receptor-2),and types 4A and B(SLC40A1,encoding ferroportin.NonHFE hemochromatosis is extremely rare.Pathogenic allele frequencies have been estimated to be 74/100,000 for type 2A,20/100,000 for type 2B,30/100,000 for type 3,and 90/100,000 for type 4 hemochromatosis.Current guidelines recommend that the diagnosis be made by ruling out HFE mutations,history,physical examination,laboratory values(ferritin and transferrin saturation),magnetic resonance or other imaging,and liver biopsy if needed.While less common,non-HFE hemochromatosis can cause iron overload as severe as the HFE type.In most cases,treatment involves phlebotomy and is successful if started before irreversible damage occurs.Early diagnosis and treatment are important because it prevents chronic liver disease.This review updates the mutations and their pathogenetic consequences,the clinical picture,diagnostic guidelines,and treatment of hemochromatosis.

关键词： Non-HFE Hemochromatosis Cirrhosis Iron homeostasis

Statin-induced Liver Injury Patterns: A Clinical Review

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Journal of Clinical and Translational Hepatology 2022年第3期10卷 543-552页

作者： Leon D.Averbukh alla turshudzhyan David C.Wu George Y.Wu Department of Medicine Division of Gastroenterology-HepatologyAllegheny Health NetworkPittsburghPAUSA Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA

Since their introduction in 1987,hydroxymethyl glutaryl coenzyme A reductase(HMG-CoA)inhibitors,more commonly known as statins,have become some of the most widely prescribed medications in the world.Though generally considered to be safe and well tolerated,statins have been associated with several side effects including mild liver dysfunction manifested by increases in aminotransferases.Rarely,statins have been noted to induce more serious hepatic injury,including liver injury with autoimmune features.Current literature supports statin induced liver injury presenting in either hepatocellular or cholestatic patterns,though with the former being the prevailing pattern of injury.Fortunately,severe liver injury is uncommon with statin use and is generally reversible without any intervention other than offending statin cessation.When evaluating cases of suspected statininduced liver injury,a complete medical history,laboratory tests including a complete metabolic panel,autoimmune markers,and viral panel,as well as hepatic imaging,are crucial for a complete causality analysis with validated tools such as Roussel Uclaf Causality Assessment Method.The aim of this review is to review the current evidence for statininduced liver injury and cholestasis.

关键词： Drug-induced liver injury Statin Cholestatic liver injury Hepatocellular liver injury Cholestasis Autoimmune hepatitis

Lessons learned:Preventable misses and near-misses of endoscopic procedures

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastrointestinal Endoscopy 2022年第5期14卷 302-310页

作者： alla turshudzhyan Houman Rezaizadeh Micheal Tadros Department of Medicine University of ConnecticutFarmingtonCT 06030United States Department of Gastroenterology and Hepatology University of ConnecticutFarmingtonCT 06030United States Department of Gastroenterology and Hepatology Albany Medical CollegeAlbanyNY 12208United States

Endoscopy is a complex procedure that requires advanced training and a highly skilled practitioner.The advances in the field of endoscopy have made it an invaluable diagnostic tool,but the procedure remains provider dependent.The quality of endoscopy may vary from provider to provider and,as a result,is not perfect.Consequently,11.3%of upper gastrointestinal neoplasms are missed on the initial upper endoscopy and 2.1%-5.9%of colorectal polyps or cancers are missed on colonoscopy.Pathology is overlooked if endoscopic exam is not done carefully,bypassing proper visualization of the scope’s entry and exit points or,if exam is not taken to completion,not visualizing the most distal bowel segments.We hope to shed light on this issue,establish areas of weakness,and propose possible solutions and preventative measures.

关键词： High-quality colonoscopy Esophagogastroduodenoscopy EGD Cancer screening endoscopy Missed lesions

Cautious optimism in anticipation of hepatitis B curative therapies

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Virology 2022年第4期11卷 212-215页

作者： alla turshudzhyan Micheal Tadros Department of Medicine University of ConnecticutFarmingtonCT 06030-1235United States Department of Gastroenterology and Hepatology Albany Medical CollegeAlbanyNY 12208United States

Despite relative effectiveness of current hepatitis B therapies,there is still no curative agents available.The new emerging approaches hold promise to achieve cure and loss of hepatitis B surface antigen.Studies or clinical trials investigating new therapies remain small and either focus on patients with low viral load and without hepatotoxic injury or patients with hepatitis D co-infection,which makes it challenging to assess their effectiveness and side effect profile in hepatitis B population.

关键词： Hepatitis B Hepatitis B virus Hepatitis B virus entry inhibitor Bulevirtide Transcription activator-like effector nucleases Zinc-finger nucleases Clustered regularly interspaced short palindromic repeats-associated 9 Nucleocapsid assembly modulators Hepatitis B virus transcription inhibitors Hepatitis B surface antigen release inhibitors

Serrated lesions:A challenging enemy

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2021年第34期27卷 5625-5629页

作者： Alexa Trovato alla turshudzhyan Micheal Tadros Albany Medical College AlbanyNY 12208United States Department of Medicine University of ConnecticutSchool of MedicineFarmingdaleCT 06032United States Department of Gastroenterology Albany Medical CenterAlbanyNY 12208United States

The serrated pathway accounts for 30%-35%of colorectal cancer(CRC).Unlike hyperplastic polyps,both sessile serrated lesions(SSLs)and traditional serrated adenomas are premalignant lesions,yet SSLs are considered to be the principal serrated precursor of CRCs.Serrated lesions represent a challenge in detection,classification,and removal–contributing to post-colonoscopy cancer.Therefore,it is of the utmost importance to characterize these lesions properly to ensure complete removal.A retrospective cohort study developed a diagnostic scoring system for SSLs to facilitate their detection endoscopically and subsequent removal.From the study,it can be ascertained that both indistinct border and mucus cap are essential in both recognizing and diagnosing serrated lesions.The proximal colon poses technical challenges for some endoscopists,which is why high-quality colonoscopy plays such an important role.The indistinct border of some SSLs poses another challenge due to difficult complete resection.Overall,it is imperative that gastroenterologists use the key features of mucus cap,indistinct borders,and size of at least five millimeters along with a high-quality colonoscopy and a good bowel preparation to improve the SSL detection rate.

关键词： Sessile serrated lesions Colonoscopy Polyps Colorectal cancer screening Hyperplastic polyps Traditional serrated adenomas

Ethical dilemma of colorectal screening: What age should a screening colonoscopy start and stop?

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastrointestinal Endoscopy 2021年第9期13卷 447-450页

作者： alla turshudzhyan Alexa Trovato Micheal Tadros Department of Medicine and Gastroenterology University of ConnecticutFarmingtonCT 06030United States Department of Medicine Albany Medical CollegeAlbanyNY 12208United States Department of Gastroenterology and Hepatology Albany Medical CollegeAlbanyNY 12208United States

Many advanced age patients who are diagnosed with colorectal cancer are often not offered surgical treatment due to presumed high risks of the procedure.While there is data to support surgical treatment of colorectal cancer in advanced age patients,screening colonoscopy is not currently recommended for patients older than 85 years.Moreover,recent studies concluded that the incidence of colorectal cancer in patients 80 years and older is increasing.This raises the concern that the current guidelines are withholding screening colonoscopy for healthy elderly patients.Another concern contrary to this would be the new trend of growing incidence of advanced colorectal cancer in the younger patient population.Together they raise the ethical dilemma of how to best utilize colonoscopies as well as surgical intervention,as they are limited resources.

关键词： Colonoscopy Colorectal cancer Screening Advanced age patient Screening colonoscopy