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World Journal of Gastroenterology 2014年第10期20卷 2564-2577页

作者： Nora Sipeki peter Antal-Szalmas peter L Lakatos Maria Papp Institute of Medicine Department of Gastroenterology University of Debrecen H-4032 DebrecenHungary Department of Laboratory Medicine University of Debrecen H-4032 Debrecen Hungary 1st Department of Medicine Semmelweis University H-1083 Budapest Hungary

Innate and adaptive immune dysfunction,also referred to as cirrhosis-associated immune dysfunction syndrome,is a major component of cirrhosis,and plays a pivotal role in the pathogenesis of both the acute and chronic worsening of liver *** the evolution of the disease,acute decompensation events associated with organ failure(s),so-called acute-on chronic liver failure,and chronic decompensation with progression of liver fibrosis and also development of disease specific complications,comprise distinct clinical entities with different immunopathology *** bacterial translocation associated with systemic endotoxemia and increased occurrence of systemic bacterial infections have substantial impacts on both clinical *** and chronic exposure to bacteria and/or their products,however,can result in variable clinical *** immune status of patients is not constant during the illness;consequently,alterations of the balance between pro-and anti-in-flammatory processes result in very different dynamic *** this review we give a detailed overview of acquired immune dysfunction and its consequences for *** demonstrate the substantial influence of inherited innate immune dysfunction on acute and chronic inflammatory processes in cirrhosis caused by the pre-existing acquired immune dysfunction with limited compensatory ***,we highlight the current facts and future perspectives of how the assessment of immune dysfunction can assist clinicians in everyday practical decision-making when establishing treatment and care strategies for the patients with end-stage liver *** and efficient recognition of inappropriate performance of the immune system is essential for overcoming complications,delaying progression and reducing mortality.

关键词： Cirrhosis Immune dysfunction Endotoxemia

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Socio-economic status and lifestyle factors are associated with achalasia risk: A population-based case-control study

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World Journal of Gastroenterology 2016年第15期22卷 4002-4008页

作者： Helen G Coleman Ronan T Gray Kar W Lau Conall Mc Caughey peter v Coyle Liam J Murray Brian T Johnston Cancer Epidemiology and Health Services Research Group Centre for Public Health Queen’s University Belfast Regional virus Laboratory Royal Victoria Hospital Belfast Department of Gastroenterology Royal Victoria HospitalBelfast

AIM: To evaluate the association between various lifestyle factors and achalasia ***: A population-based case-control study was conducted in Northern Ireland, including n = 151 achalasia cases and n = 117 age- and sexmatched controls. Lifestyle factors were assessed via a face-to-face structured interview. The association between achalasia and lifestyle factors was assessed by unconditional logistic regression, to produce odds ratios(OR) and 95% confidence interval(CI).RESULTS: Individuals who had low-class occupations were at the highest risk of achalasia(OR = 1.88, 95%CI: 1.02-3.45), inferring that high-class occupation holders have a reduced risk of achalasia. A history of foreign travel, a lifestyle factor linked to upper socioeconomic class, was also associated with a reduced risk of achalasia(OR = 0.59, 95%CI: 0.35-0.99). Smoking and alcohol consumption carried significantly reduced risks of achalasia, even after adjustment for socio-economic status. The presence of pets in the house was associated with a two-fold increased risk of achalasia(OR = 2.00, 95%CI: 1.17-3.42). Nochildhood household factors were associated with achalasia ***: Achalasia is a disease of inequality, and individuals from low socio-economic backgrounds are at highest risk. This does not appear to be due to corresponding alcohol and smoking behaviours. An observed positive association between pet ownership and achalasia risk suggests an interaction between endotoxin and viral infection exposure in achalasia aetiology.

关键词： Achalasia Risk factors Epidemiology Lifestyle Socio-economic status

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Serological biomarkers for management of primary sclerosing cholangitis

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World Journal of Gastroenterology 2022年第21期28卷 2291-2301页

作者： David Tornai peter Laszlo ven peter Laszlo Lakatos Maria Papp Division of Gastroenterology Department of Internal MedicineFaculty of MedicineUniversity of DebrecenDebrecen H-4032Hajdu-BiharHungary European Reference Network on Hepatological Diseases ERN RARE-LIVERDebrecen H-4032Hajdu-BiharHungary The First Department of Medicine Division of GastroenterologyUniversity of PécsPécs H-7624BaranyaHungary Kálmán Laki Doctoral School of Biomedical and Clinical Sciences Faculty of MedicineUniversity of DebrecenDebrecen H-4032Hajdu-BiharHungary Division of Gastroenterology McGill University Health CentreMontreal QC H4A 3J1QuebecCanada The First Department of Medicine Semmelweis UniversityBudapest H-1083PestHungary

Clinical manifestations and progression of primary sclerosing cholangitis(PSC)are heterogeneous,and its pathogenesis is poorly *** importance of gut-liver interactions in the pathogenesis has been clinically confirmed and highlighted in different *** advances regarding biomarkers of biliarygut crosstalk may help to identify clinically relevant PSC subgroups assisting everyday clinical work-up(e.g.,diagnosis,disease stratification,or surveillance)and the exploration of potential therapeutic *** phosphatase produced by the biliary epithelium is consistently associated with ***,its level shows natural fluctuation limiting its use in individual ***,cell activation,and tissue remodeling markers have been reported to predict clinical *** immunoglobulin(Ig)G4 level is associated with a shorter transplantation-free *** type atypical perinuclear anti-neutrophil cytoplasmic antibodies(P-ANCAs)are non-specific markers of various autoimmune liver diseases and may reflect an abnormal B-cell response to gut microbial *** type atypical P-ANCA identifies PSC patients with particular clinical and genetic(for human leukocyte antigens)*** presence of IgA type anti-F-actin antibody(AAA)may predict a progressive disease course,and it is associated with enhanced mucosal immune response to various microbial antigens and enterocyte *** type anti-glycoprotein 2(GP2)antibodies identify patients with a severe disease phenotype and poor survival due to enhanced fibrogenesis or development of *** soluble vascular adhesion protein-1(svAP-1)level is associated with adverse disease outcomes in *** svAP-1 levels correlate with mucosal addressin cell adhesion molecule-1(MAdCAM-1)expression in the liver that contributes to gut activated T-cell homing to the hepatobiliary *** the present paper,we review the evidence on these possible serological ma

关键词： Primary sclerosing cholangitis Hepatobiliary Serological biomarker Immunoglobulin Inflammatory Tissue remodeling

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HBeAg negative variants and their role in the natural history of chronic hepatitis B virus infection

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World Journal of Gastroenterology 2014年第24期20卷 7644-7652页

作者： Alexra Alexopoulou peter Karayiannis 2~(nd) Department of Medicine Medical SchoolUniversity of AthensHippokration General Hospital16342 AthensGreece St George’s University of London Medical School at University of Nicosia

Molecular virology methods including polymerase chain reaction, cloning and sequencing have revolutionised our understanding of viral genome variation. In the case of hepatitis B virus (HBv), sequencing studies have identified a number of virus variants normally found during the natural course of chronic infection. The appearance of the precore stop codon (with G-for-A substitution at position 1896) and basal core promoter (BCP) (with A-for-T and G-for-A, at positions 1762 and 1764, respectively) variants which reduce or abrogate hepatitis B e antigen (HBeAg) production, heralds the initiation of the seroconversion phase from HBeAg to anti-HBe positivity. The gradual removal of the tolerogenic effect of HBeAg leads to the awakening of the immune response (immune clearance phase). Most patients after HBeAg seroconversion become “inactive HBsAg carriers”. However during the course of infection precore and/or BCP variants may emerge and be selected leading to HBeAg negative chronic hepatitis B (CHB) with high viremia levels (reactivation phase). The prevalence of HBeAg negative CHB has been increasing over the last few decades and has become the commonest type of HBv infection in many countries of the world. This probably reflects the aging of existing HBv carriers and the effective prevention measures restricting new HBv infections. Frequent acute exacerbations accompanied by high viral replication, elevated alanine aminotransferase levels and histological activity are a common feature of HBeAg negative CHB leading to cirrhosis much faster than in HBeAg positive CHB patients.

关键词： Precore stop codon variants basal core promoter variants hepatitis B e antigen negative chronic hepatitis B Re-activation Hepatitis B virus-DNA replication

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A Part as an Object of Assembly

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World Journal of Engineering and Technology 2021年第4期9卷 904-915页

作者： Štefan václav.peter Pokorný Adriana Kamenszká Institute of Production Technologies Faculty of Materials Science and Technology in Trnava Slovak University of Technology Slovakia

Assembly is currently a very important element in the production process. We can also define it as the last stage in the production process. It greatly affects the quality of the product and especially the time needed to make the final product. The presented article is a contribution to the improvement of methods in the field of technological design of the product in terms of assembly, resp. in the field of methodologies known as DFA, which in its entirety means Design of Assembly. The general objective of improving the assembly process is in most cases reducing the cost of the product. With the gradual development of the technologies coming into practice, companies are focusing mainly on improving the elements of assembled products of the assembly system. This state can be achieved, for example, by reducing the number of components, so the complexity and laboriousness of the assembly will be radically reduced. This in turn leads to a decrease in unit assembly costs. Proper assembly settings can help a company succeed in the competition and thus contribute to a stable position of the company in the market. The aim of the article is to find the other objective indicators of assembly quality evaluation.

关键词： Design for Assembly Material Properties Theory of Orientation

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Hamartomatous polyps:Diagnosis,surveillance,and management

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World Journal of Gastroenterology 2023年第8期29卷 1304-1314页

作者： Leva Gorji peter Albrecht Department of Surgery Kettering Health DaytonDaytonOH 45405United States

Hereditary polyposis syndrome can be divided into three categories:Adenomatous,serrated,and hamartomatous *** polyps,malformations of normal tissue presenting in a disorganized manner,are characterized by an autosomal dominant inheritance *** syndromes exhibit hamartomatous gastrointestinal polyps in conjunction to extra-intestinal manifestations,which require conscientious and diligent ***-Jeghers syndrome,Cowden syndrome,and juvenile polyposis syndrome are the most common displays of hamartomatous polyposis syndrome(HPS).Diagnosis can be pursued with molecular testing and endoscopic *** identification of these autosomal dominant pathologies allows to optimize malignancy surveillance,which helps reduce morbidity and mortality in both the affected patient population as well as at-risk family *** surveillance is an important pillar of prognosis and monitoring,with many patients eventually requiring surgical *** this review,we discuss the diagnosis,surveillance,and management of HPS.

关键词： Hamartomatous polyps Peutz-Jegher syndrome Cowden syndrome Juvenile polyposis syndrome

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Endoscopic management of colorectal polyps: From benign to malignant polyps

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World Journal of Gastrointestinal Endoscopy 2021年第9期13卷 356-370页

作者： April A Mathews peter v Draganov Dennis Yang Division of Pediatric Gastroenterology University of FloridaGainesvilleFL 32608United States Division of Gastroenterology Hepatology and NutritionUniversity of FloridaGainesvilleFL 32608United States

Colorectal cancer(CRC)is the third most common cancer worldwide and the second leading cause of cancer related death in the *** early detection and removal of CRC precursor lesions has been shown to reduce the incidence of CRC and cancer-related *** resection has become the first-line treatment for the removal of most precursor benign colorectal lesions and selected malignant *** lesion assessment is the first critical step in the evaluation and management of colorectal *** size,location and both macro-and micro-features provide important information regarding histological grade and endoscopic *** polyps and even malignant polyps with superficial submucosal invasion and favorable histological features can be adequately removed *** compared to surgery,endoscopic resection is associated with lower morbidity,mortality,and higher patient quality of ***,malignant polyps with deep submucosal invasion and/or high risk for lymph node metastasis will require *** a practical standpoint,the most appropriate strategy for each patient will need to be individualized,based not only on polyp-and patient-related characteristics,but also on local resources and expertise *** this review,we provide a broad overview and present a potential decision tree algorithm for the evaluation and management of colorectal polyps that can be widely adopted into clinical practice.

关键词： Colorectal cancer Colon polyps Malignant polyps Endoscopic resection Endoscopic mucosal resection Endoscopic submucosal dissection

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Are our endoscopy patients at risk for pyogenic liver abscess?

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World Journal of Gastroenterology 2017年第30期23卷 5457-5459页

作者： Herwig Cerwenka peter Schemmer Department of Surgery Medical University of Graz

This is an editorial comment on a recent publication reporting an increased rate of pyogenic liver abscesses(PLAs) after upper gastrointestinal panendoscopy. Its aim is to critically highlight the findings, limitations and potential clinical implications of this study. Issues of the mucosal barrier, the microbial flora, administration of antibiotics and underlying diseases are discussed. The probability of PLAs after endoscopies is not exactly known and the length of the "incubation period" remains unclear, but a possible causality should already suffice to make us think how to avoid them. Especially in patients with risk factors such as diabetes mellitus, end-stage renal disease, liver cirrhosis, biliary tract infection, and malignancies, the potential risk for PLAs should be considered. Unnecessary insufflation during endoscopy(causing mucosal stretching and microscopic tears) as well as mucosal damage(by direct abrasion with the scope) should be avoided in order to limit the invasiveness of the procedure as much as possible. And, in everyday routine, it should be kept in mind that in patients after endoscopy, especially in those with a breach of the mucosal barrier and significant comorbidities, PLAs can potentially develop and require timely administration of antibiotics as well as further diagnostic and therapeutic steps.

关键词： Endoscopy Pyogenic liver abscess Mucosal barrier Gastrointestinal microbial flora Comorbidities

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Introducing 3D-potting:a novel production process for artificial membrane lungs with superior blood flow design

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Bio-Design and Manufacturing 2022年第1期5卷 141-152页

作者： Fellx Hesselmann Jannls M.Focke peter C.Schlansteln NIklas B.Steuer Andreas Kaesler Sebastlan D.Relnartz Thomas Schmltz-Rode Ulrlch SteInselfer Sebastlan v.Jansen Jutta Arens Department of Cardiovascular Engineering Instituteof Applied Medical EngineeringHelmholtz.InstituteRWTH Aachen UniversityPauwelsstrasse 2052074 AachenGermany Department of Diagnostic and Interventional Radiology Uniklinik RWTH AachenPauwelsstrasse 3052074 AachenGermany Department of Biomechanical Engineering Faculty of EngineeringTechnology University of TwenteDrienerlolaan 57522 NB EnschedeThe Netherlands

Currently,artificial-membrane lungs consist of thousands of hollow fiber membranes where blood flows around the fibers and gas flows inside the fibers,achieving diffusive gas *** both ends of the fibers,the interspaces between the hollow fiber membranes and the plastic housing are filled with glue to separate the gas from the blood *** a uniaxial centrifugation process,the glue forms the“potting.”The shape of the cured potting is then determined by the centrifugation process,limiting design possibilities and leading to unfavorable stagnation zones associated with blood *** this study,a new multiaxial centrifugation process was developed,expanding the possible shapes of the potting and allowing for completely new module designs with potentially superior blood flow guidance within the potting ***-phase simulations of the process in conceptual artificial lungs were performed to explore the possibilities of a biaxial centrifugation process and determine suitable parameter sets.A corresponding biaxial centrifugation setup was built to prove feasibility and experimentally validate four conceptual designs,resulting in good agreement with the *** summary,this study shows the feasibility of a multiaxial centrifugation process allowing greater variety in potting shapes,eliminating inefficient stagnation zones and more favorable blood flow conditions in artificial lungs.

关键词： Potting process Flow design Membrane lung Artificial lung Hollow fiber membrane module Manufacturing

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Irritable bowel syndrome: Relations with functional, mental, and somatoform disorders

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World Journal of Gastroenterology 2014年第20期20卷 6024-6030页

作者： Constanze Hausteiner-Wiehle peter Henningsen Psychosomatic Consultation Service Murnau Trauma Center 82418 Murnau Germany Department of Psychosomatic Medicine and Psychotherapy Klinikum rechts der Isar Technische Universit?t München 81675 Munich Germany

This review describes the conceptual and clinical relations between irritable bowel syndrome (IBS), other functional, somatoform, and mental disorders, and points to appropriate future conceptualizations. IBS is considered to be a functional somatic syndrome (FSS) with a considerable symptom overlap with other FSSs like chronic fatigue syndrome or fibromyalgia syndrome. IBS patients show an increased prevalence of psychiatric symptoms and disorders, especially depression and anxiety. IBS is largely congruent with the concepts of somatoform and somatic symptom disorders. Roughly 50% of IBS patients complain of gastrointestinal symptoms only and have no psychiatric comorbidity. IBS concepts, treatment approaches, as well as health care structures should acknowledge its variability and multidimensionality by: (1) awareness of additional extraintestinal and psychobehavioral symptoms in patients with IBS; (2) general and collaborative care rather than specialist and separated care; and (3) implementation of “interface disorders” to abandon the dualistic classification of purely organic or purely mental disorders.

关键词： Functional somatic syndrome Somatoform disorder Somatic symptom disorder Bodily distress syndrome Interface Irritable bowel syndrome

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