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Greater Biosynthetic Liver Dysfunction in Primary Sclerosing Cholangitis Suggests Co-existent or Impending Cholangiocarcinoma

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Journal of Clinical and Translational Hepatology 2016年第1期4卷 1-4页

作者： Panagiotis Trilianos Abhishek Agnihotri enver ucbilek Ahmet Gurakar Department of Gastroenterology & Hepatology Section of Transplant Hepatology The Johns Hopkins School of MedicineBaltimore MD USA Department of Medicine MetroWest Medical Center Framingham MA USA Department of Gastroenterology & Hepatology Section of Transplant Hepatology The Johns Hopkins School of MedicineBaltimore MD USA

Background and Aim:Patients with primary sclerosing cholangitis (PSC) who develop cholangiocarcinoma (CCA)have a median survival of less than 6 *** half of cases,PSC and CCA will be diagnosed either concurrently or within a year of one *** aim of the present study is to demonstrate that the degree of biochemical liver dysfunction is associated with concomitant or impending ***:We did a chart review of patients diagnosed with PSC and CCA up to 18 months from presentation (“CCA” group) as well as patients with PSC that underwent transplantation with no sign of CCA in their explanted liver (“nCCA” group).Along with demographic data and follow-up length,we recorded their presenting liver function tests,including alanine and aspartate aminotransferases (ALT,AST),total bilirubin (TBil),alkaline phosphatase (ALP),international normalization ratio (INR),and serum Ca 19-9 *** between mean values of the two groups were analyzed with a student's ***:Twenty-four patients were *** “CCA”group consisted of eight patients,and the “non-CCA” group had 16 *** was no significant difference between the two groups in their presenting values of ALT,ALP,or serum Ca ***,the “CCA” group had significantly higher levels of AST,TBil,and ***:Patients with PSC and concurrent or impending CCA appear to exhibit significantly greater biochemical liver dysfunction than those who do not develop ***,newly-diagnosed PSC patients presenting with these findings may warrant more rigorous evaluation.

关键词： Cholestatic disease Malignancy Liver transplantation Liver function tests

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Erythrocyte Membrane Protein Band 3 Predicts Interferon Ribavirin-Induced Anemia

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Open Journal of Regenerative Medicine 2019年第2期8卷 5-16页

作者： Engin Altintas Serap Yalin Orhan Sezgin enver ucbilek Anil Tombak Arzu Kanik Department of Gastroenterology Faculty of Medicine University of Mersin Mersin Turkey Faculty of Pharmacy University of Mersin Mersin Turkey Department of Biostatistics Faculty of Medicine University of Mersin Mersin Turkey

Aim & Background: It was proposed that the differences in erythrocyte membrane protein contents—especially band 4—take a role in the serious anemia related to interferon plus ribavirin (I/R). The aim of this study is to evaluate whether the erythrocyte membrane protein contents predict anemia related to I/R or not. Methods: 180 mcg interferon α 2a once a week and weight adjusted ribavirin daily were given for 48 weeks to fifty patients with chronic hepatitis C. It was diagnosed as anemia when haemoglobin concentration was Results: Anemia developed in 17 patients (34%). The levels of erythrocyte membrane proteins were as;spectrin: 20.468 ± 2.5902, ankyrin: 4.576 ± 1.2706, B3: 19.240 ± 2.8358, B4.1: 5.628 ± 1.8832, and B4.2: 5.848 ± 1.8030. When the relation between the development of anemia and erythrocyte membrane proteins was investigated, a relation was only found at B3 which was not statistically significant (p = 0.058). When ROC analysis was performed, 95% CI p = 0.035 for B3 (0.517 - 0.792) was found. In patients whose B3 level was below 17.7%, the sensitivity of anemia development risk was calculated as 64.7% and the specificity thereof was calculated as 66.7%. Erythrocyte membrane protein contents by gender were only different at B3 (p = 0.042). Anemia developed in 17 patients (34%). 14 of these patients were of female and 3 were of male gender;the gender played a significant role in terms of anemia (p = 0.003). Conclusions: Erythrocyte membrane protein B3 is not only useful in predicting the patient under the risk of developing anemia, but also it may be useful in preventing it and it may explain why women inclined to anemia.

关键词： Anemia Erythrocyte Membrane Protein Interferon Ribavirin

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Polymorphisms in methylenetetrahydrofolate reductase gene: Their impact on liver steatosis and fibrosis of chronic hepatitis c patients

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Open Journal of Gastroenterology 2014年第2期4卷 73-80页

作者： Engin Altintas Zuhal Mert Altintas Orhan Sezgin enver ucbilek Erdinc Nayir Mehmet Emin Erdal Ayse Polat Gulhan Orekeci Department of Biostatistics Faculty of Medicine University of Mersin Mersin Turkey Department of Medical Biology and Genetic Faculty of Medicine University of Mersin Mersin Turkey Department of Pathology Faculty of Medicine University of Mersin Mersin Turkey Gastroenterology Department Faculty of Medicine University of Mersin Mersin Turkey

Aim & Background: The mechanism of steatosis in Hepatitis C virus infection is multifactorial;therefore, it is complex and unclear. The aim of this study was to investigate the effects of methylentetrahydrofolate reductase (MTHFR) gene polymorphisms on the course of chronic hepatitis C virus infection and the development of steatosis due to hepatitis C virus. Methods: This study included 109 patients with chronic hepatitis C virus infection. Necroinflammatory activity, degrees of fibrosis and steatosis and MTHFR gene polymorphisms were investigated. Polymerase chain reaction-restriction fragment length polymorphism was used to determine MTHFR C677T and A1298C polymorphisms. Results: Fibrosis was correlated with age (r = 0.336, p = 0.002), platelet (r = ?0.448, p < 0.0001), ALT (r = 0.241, p = 0.026), AST (r = 0.361) and GGT (r = 0.224, p = 0.039). Steatosis was only correlated with fibrosis. MTHFR C677T and A1298C polymorphisms did not have a significant effect on the degree of steatosis (p = 0.857, p = 0.202 respectively). There was a relation between MTHFR C677T and the degree of fibrosis but not A1298C (p = 0.014, p = 0.187 respectively). Conclusion: We found that MTHFR C677T polymorphism contributed to the development of fibrosis in patients with chronic hepatitis C virus infection.

关键词： Fibrosis Hepatitis C Gene Polymorphism Methylenetetrahydrofolate Reductase Steatosis

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Is endoscopic ultrasound a promising technique in the diagnosis and treatment of liver diseases?

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World Journal of Gastroenterology 2024年第22期30卷 2920-2922页

作者： enver Zerem Željko Puljiz Boris Zdilar Suad Kunosic Admir Kurtcehajic Omar Zerem Department of Medical Sciences The Academy of Sciences and Arts of Bosnia and HerzegovinaSarajevo 71000Sarajevo CantonBosnia and Herzegovina Department of Gastroenterology and Hepatology University Clinical Center SplitSplit 21000Croatia Department of Medicine Croatian Military AcademyZagreb 10000Croatia Department of Physics Faculty of Natural Sciences and MathematicsUniversity of TuzlaTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Gastroenterology and Hepatology Blue Medical GroupTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Internal Medicine Cantonal Hospital“Safet Mujić”MostarMostar 88000Bosnia and Herzegovina

Percutaneous ultrasound has been a longstanding method in the diagnostics and interventional procedures of liver *** some countries,its use is restricted to radiologists,limiting access for other clinicians,such as *** ultrasound,as a novel technique,plays a crucial role in diagnosis and treatment of digestive ***,its use is sometimes recommended for conditions where no clear advantage over percutaneous ultrasound exists,leaving the impression that clinicians sometimes resort to an endoscopic approach due to the unavailability of percutaneous options.

关键词： Endoscopic ultrasound Percutaneous ultrasound Liver biopsy Fine needle aspiration Focal liver lesion Liver abscess drainage

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Could near focus endoscopy,narrow-band imaging,and acetic acid improve the visualization of microscopic features of stomach mucosa?

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World Journal of Gastrointestinal Endoscopy 2024年第3期16卷 157-167页

作者： Admir Kurtcehajic enver Zerem Tomislav Bokun Ervin Alibegovic Suad Kunosic Ahmed Hujdurovic Amir Tursunovic Kenana Ljuca Department of Gastroenterology and Hepatology Blue Medical GroupTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Medical Sciences The Academy of Sciences and Arts of Bosnia and HerzegovinaSarajevo 71000Bosnia and Herzegovina Department of Gastroenterology and Hepatology University Clinical Hospital DubravaZagreb 10000Croatia Department of Gastroenterology and Hepatology University Clinical Center TuzlaTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Physics Faculty of Natural Sciences and MathematicsUniversity of TuzlaTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Internal Medicine Blue Medical GroupTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Surgery University Clinical Center TuzlaTuzla 75000Bosnia and Herzegovina School of Medicine University of TuzlaTuzla 75000Bosnia and Herzegovina

BACKGROUND Conventional magnifying endoscopy with narrow-band imaging(NBI)observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules,subepithelial capillary network,and gastric *** To evaluate the effectiveness of a new one-dual(near)focus,NBI mode in the assessment of the microscopic features of gastric body mucosa compared to conventional *** During 2021 and 2022,68 patients underwent proximal gastrointestinal endoscopy using magnification endoscopic modalities subsequently applying acetic acid(AA).The GIF-190HQ series NBI system with dual focus capability was used for the investigation of gastric *** the time of the endoscopy,the gastric body mucosa of all enrolled patients was photographed using the white light endoscopy(WLE),near focus(NF),NF-NBI,AA-NF,and AA-NF-NBI *** The WLE,NF and NF-NBI endoscopic modes for all patients(204 images)were classified in the same order into three *** images from each patient for the AA-NF and AA-NF-NBI endoscopic modes were classified in the same *** to all three observers who completed the work independently,NF magnification was significantly superior to WLE(P<0.01),and the NF-NBI mode was significantly superior to NF magnification(P<0.01).After applying AA,the three observers confirmed that AA-NF-NBI was significantly superior to AA-NF(P<0.01).Interobserver kappa values for WLE were 0.609,0.704,and 0.598,respectively and were 0.600,0.721,and 0.637,respectively,for NF *** the NF-NBI mode,the values were 0.378,0.471,and 0.553,*** AA-NF,they were 0.453,0.603,and 0.480,respectively,and for AA-NF-NBI,they were 0.643,0.506,and 0.354,*** When investigating gastric mucosa in microscopic detail,NF-NBI was the most powerful endoscopic mode for assessing regular arrangement of collecting venules,subepithelial capillary network,and gastric pits among the five endoscopic

关键词： Gastric mucosa Endoscopic microanatomy Magnifying endoscopy Near focus Narrow-band imaging Acetic acid

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Influence of Fluoride Content of Artificial Saliva on Metal Release from 17-4 PH Stainless Steel Foam for Dental Implant Applications

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Journal of Materials Science & Technology 2013年第6期29卷 582-588页

作者： Ilven Mutlu enver Oktay Department of Metallurgical and Materials Engineering Istanbul UniversityIstanbulTurkey

Highly porous 17-4 PH stainless steel foam for implant applications was produced by space holder technique. Metal release and weight loss from 17-4 PH stainless steel foams were investigated in fluoride added artificial saliva environment by static immersion test. An inductively coupled plasma-mass spectrometer was employed to measure the concentrations of various metal ions. Effects of fluoride content of artificial saliva on metal release and weight loss from the steel foams were investigated. Effects of immersion time, pH value and process parameters on the weight loss and metal release were determined. Pore morphology, pore size and mechanical properties of the 17-4 PH stainless steel foams were also characterized.

关键词： Metal release Dental implant Metal foam Fluoride Artificial saliva

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Treatment of severe acute pancreatitis and its complications

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World Journal of Gastroenterology 2014年第38期20卷 13879-13892页

作者： enver Zerem Department of Gastroenterology University Clinical Center Tuzla Department of Medical Sciences The Academy of Sciences and Arts of Bosnia and Herzegovina

Severe acute pancreatitis(SAP),which is the most serious type of this disorder,is associated with high morbidity and mortality. SAP runs a biphasic course. During the first 1-2 wk,a pro-inflammatory response results in systemic inflammatory response syndrome(SIRS). If the SIRS is severe,it can lead to early multisystem organ failure(MOF). After the first 1-2 wk,a transition from a pro-inflammatory response to an anti-inflammatory response occurs;during this transition,the patient is at risk for intestinal flora translocation and the development of secondary infection of the necrotic tissue,which can result in sepsis and late MOF. Many recommendations have been made regarding SAP management and its complications. However,despite the reduction in overall mortality in the last decade,SAP is still associated with high mortality. In the majority of cases,sterile necrosis should be managed conservatively,whereas in infected necrotizing pancreatitis,the infected non-vital solid tissue should be removed to control the sepsis. Intervention should be delayed for as long as possible to allow better demarcation and liquefaction of the necrosis. Currently,the step-up approach(delay,drain,and debride) may be considered as the reference standard intervention for this disorder.

关键词： Acute necrotizing pancreatitis Infection Sepsis Drainage Gastrointestinal endoscopy

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Ultrasound guided percutaneous treatment for splenic abscesses: The signifi cance in treatment of critically ill patients

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World Journal of Gastroenterology 2006年第45期12卷 7341-7345页

作者： enver Zerem Jacob Bergsland Interventional Ultrasonography Department University Clinical Centar Tuzla Bosnia and Herzegovina

AIM: To analyze the results of ultrasound guided percu- taneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of splenic abscess. METHODS: Thirty-six patients (14 females and 22 males, with an average age of 54.1 ± 14.1 years) with splenic abscess were treated with ultrasound guided PNA and/or PCD. Patients with splenic abscess < 50 mm in diameter were initially treated by PNA and those with abscess ≥ 50 mm and bilocular abscesses were initially treated by an 8-French catheter drainage. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, and mortality rates were analyzed. RESULTS: Twenty-seven patients had unilocular and 9 bilocular abscess. PNA was performed in 19 patients (52.8%), and 8 of them (42.1%) required PCD because of recurrence of abscess. In 17 patients (47.2%), PCD was performed initially. PCD was performed twice in six patients and three times in two. PNA was defi nitive treatment for 10 and PCD for 21 patients. One patient with PCD was referred for splenectomy, with successful outcome. In all 4 deceased patients, malignancy was the underlying condition. Twenty-one patients (58.3%) underwent 33 surgical interventions on abdomen before treatment. Cultures were positive in 30 patients (83.3%). Gram-negative bacillus predominated (46.7%). There were no complications related to the procedure. CONCLUSION: Percutaneous treatmnet of splenic abscess is an effective alternative to surgery, allowing preservation of the spleen. This treatment is especially indicative for the patients in critical condition postoperatively. We recommend PNA as primary treatment for splenic abscesses < 50 mm, and PCD for those ≥ 50 mm in diameter and for bilocular abscesses.

关键词： Interventional ultrasound Needle aspiration Catheter drainage Spleen preservation

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Comments on the article about the treatment of peripancreatic infection

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World Journal of Gastroenterology 2010年第18期16卷 2321-2322页

作者： enver Zerem Goran Imamovic The University Clinical Centre Tuzla

We read with great interest the article by Tang et al published in issue 4 of World Journal of Gastroenterology *** results of their study indicate that percutaneous catheter drainage in combination with choledochoscope-guided debridement is a simple,safe and reliable treatment procedure for peripancreatic infections secondary to severe acute ***,there are some points that need to be addressed,including data about the patients in the study and their clinical characteristics,data about infection and superinfection during the treatment and type of treatment of patients with acute necrotizing pancreatitis.

关键词： Acute pancreatitis Pancreatic necrosis Infection Non-surgical management

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Biomarkers for noninvasive biochemical diagnosis of nonalcoholic steatohepatitis:Tools or decorations?

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World Journal of Gastroenterology 2009年第34期15卷 4346-4347页

作者： Yusuf Yilmaz enver Dolar Department of Gastroenterology Marmara UniversitySchool of Medicine Department of Gastroenterology Uludag University Medical School

In light of the growing epidemics of nonalcoholic fatty liver disease(NAFLD),identification and validation of the novel biochemical surrogate markers for nonalcoholic steatohepatitis(NASH)are paramount to reduce the necessity for liver *** availability of such markers has tremendous potential to radically alter the management strategies of NAFLD patients and to monitor the disease *** current biomarkers do not entirely fulfill the many requirements for the identification of patients with NASH,they should not discourage our quest,but remind us that we need to cognize the challenges ahead.

关键词： Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Biomarkers Liver biopsy

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