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Clinical significance of occult hepatitis B virus infection

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World Journal of Gastroenterology 2011年第12期17卷 1549-1552页

作者： miriam romero Antonio madejón conrado fernández-r.dr.guez Javier García-Samaniego Hepatology Unit Hospital Carlos ⅢCIBERehd28029 MadridSpain Service of Gastroenterology Hospital Universitario Fundación AlcorcónAv Budapest-128922 AlcorcónMadridSpain

Occult hepatitis B virus(HBV) infection(OBI) is defined as the presence of HBV DNA in the liver(with or without detectable HBV DNA in serum) for individuals testing HBV surface antigen *** recently,the clinical effect of OBI was unclear on the progression of liver disease;on the development of hepatocellular carcinoma;and on the risk for reactivation or transmission of HBV *** studies suggest a high prevalence of OBI among patients with cryptogenic chronic liver disease,but its role in the progression to cirrhosis remains *** OBI has been well documented in human immunodeficiency virus(HIV) -positive patients,especially among those coinfected with hepatitis C virus,further studies are needed to determine its current clinical impact in HIV setting.

关键词： Occult hepatitis B virus infection Liver dis-ease Cryptogenic cirrosis Hepatitis B virus coinfection Human immunodeficiency virus

Acute-on-chronic liver failure:Pathogenesis,prognostic factors and management

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World Journal of Gastroenterology 2015年第42期21卷 12125-12140页

作者： Sara Blasco-Algora José masegosa-Ataz maría Luisa Gutiérrez-García Sonia Alonso-López conrado m fernández-r.dr.guez Service of Gastroenterology Hospital Universitario Fundación

Acute-on-chronic liver failure(ACLF) is increasingly recognized as a complex syndrome that is reversiblein many cases. It is characterized by an acute deterioration of liver function in the background of a pre-existing chronic liver disease often associated with a high short-term mortality rate. Organ failure(OF) is always associated, and plays a key role in determining the course, and the outcome of the disease. The definition of ACLF remains controversial due to its overall ambiguity, with several disparate criteria among various associations dedicated to the study of liver diseases. Although the precise pathogenesis needs to be clarified, it appears that an altered host response to injury might be a contributing factor caused by immune dysfunction, ultimately leading to a pro-inflammatory status, and eventually to OF. The PIrO concept(Predisposition, Insult, response and Organ Failure) has been proposed to better approach the underlying mechanisms. It is accepted that ACLF is a different and specific form of liver failure, where a precipitating event is always involved, even though it cannot always be ascertained. According to several studies, infections and active alcoholism often trigger ACLF. Viral hepatitis, gastrointestinal haemorrhage, or drug induced liver injury, which can also provoke the syndrome. This review mainly focuses on the physiopathology and prognostic aspects. We believe these features are essential to further understanding and providing the rationale for improveddisease management strategies.

关键词： Acute on-chronic liver failure Immune dysfunction

Prevention of hepatocellular carcinoma in patients with chronic hepatitis B

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2014年第3期5卷 175-182页

作者： conrado m fernández-r.dr.guez maría Luisa Gutiérrez-García Jefe de la Unidad de Aparato Digestivo Hospital Universitario Fundación Alcorcón28922 AlcorcónMadridSpain Unidad de Aparato Digestivo Hospital Universitario Fundacion Alcorcón28922 AlcorcónMadridSpain

Patients with chronic hepatitis B are at significant risk for hepatocellular carcinoma(HCC). Globally,over half a million people each year are diagnosed with HCC,with marked geographical variations. Despite overwhelming evidence for a causal role of hepatitis B virus(HBV) infection in the development of HCC and a well-established relationship between high baseline hepatitis B viral load and cumulative risk of HCC,the molecular basis for this association has not been fully elucidated. In addition,a beneficial role for antiviral therapy in preventing the development of HCC has been difficult to establish. This review examines the biological and molecular mechanisms of HBV-related hepatocarcinogenesis,recent results on the effect of modern nucleos(t)ides on the rate of HCC development in high risk HBV cohorts and the potential mechanisms by which long-term antiviral therapy with potent inhibitors of HBV replication might reduce the risk of HCC in patients with chronic hepatitis B. Although evidence from randomized controlled trials shows the favourable effects of antiviral agentsin achieving profound and durable suppression of HBV DNA levels while improving liver function and histology,robust evidence of other long-term clinical outcomes,such as prevention of HCC,are limited.

关键词： Chronic hepatitis B Entecavir Hepatitis B virus Hepatocellular carcinoma Hepatocarcinogenesis Nucleoside analogues risk reduction

Contrast-enhanced ultrasound in diagnosis and characterization of focal hepatic lesions

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World Journal of radiology 2010年第12期2卷 455-462页

作者： Inés Gómez molins Juan manuel fernández Font Juan Carrero álvaro Jose Luís Lledó Navarro marta fernández Gil conrado m fernández r.dr.guez Department of Gastroenterology Hospital Universitario Fundación Alcorcón Department of radiology Hospital Universitario Fundación Alcorcón

The extensive use of imaging techniques in differential diagnosis of abdominal conditions and screening of hepatocellular carcinoma in patients with chronic hepatic diseases,has led to an important increase in identification of focal liver *** development of contrastenhanced ultrasound(CEUS) opens a new window in the diagnosis and follow-up of these *** technique offers obvious advantages over the computed tomography and magnetic resonance,without a decrease in its sensitivity and *** new second generation contrast agents,due to their intravascular distribution,allow a continuous evaluation of the enhancement pattern,which is crucial in characterization of liver *** dual blood supply in the liver shows three different phases,namely arterial,portal and late *** enhancement during portal and late phases can give important information about the lesion's *** liver lesion has a different enhancement pattern that makes possible an accurate approach to their *** role of emerging techniques as a contrastenhanced three-dimensional US is also *** this article,the advantages,indications and technique employed during CEUS and the different enhancement patterns of most benign and malignant focal liver lesions are discussed.

关键词： Focal liver lesion Ultrasound Contrast sonography Contrast-enhanced ultrasound Liver mass Hepatocellular carcinoma