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Cancer risk in primary sclerosing cholangitis: Epidemiology,prevention, and surveillance strategies

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World Journal of Gastroenterology 2019年第6期25卷 659-671页

作者： Brian M Fung keith D lindor James H Tabibian UCLA-Olive View Internal Medicine Residency Program Olive View-UCLA Medical Center Office of the University Provost Arizona State University Division of Gastroenterology Department of MedicineOlive View-UCLA Medical Center

Primary sclerosing cholangitis(PSC) is a rare cholestatic liver disease characterized by progressive fibroinflammatory destruction of the intra-and/or extrahepatic biliary ducts. While its features and disease course can be variable,most patients with PSC have concurrent inflammatory bowel disease and will eventually develop liver cirrhosis and end-stage liver disease, with liver transplantation representing the only potentially curative option. Importantly,PSC is associated with a significantly increased risk of malignancy compared to the general population, mainly cholangiocarcinoma, gallbladder carcinoma,hepatocellular carcinoma, and colorectal cancer, with nearly 50% of deaths in patients with PSC being due to cancer. Therefore, robust surveillance strategies are needed, though uncertainty remains regarding how to best do so. In this review, we discuss the epidemiology, prevention, and surveillance of cancers in patients with PSC. Where evidence is limited, we present pragmatic approaches based on currently available data and expert opinion.

关键词： Bile duct diseases Cholangiocarcinoma Gallbladder carcinoma Hepatocellular carcinoma Colorectal cancer Chemoprotection Inflammatory bowel disease

NAFLD fibrosis score:A prognostic predictor for mortality and liver complications among NAFLD patients

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World Journal of Gastroenterology 2013年第8期19卷 1219-1229页

作者： Sombat Treeprasertsuk Einar Bjrnsson Felicity Enders Sompongse Suwanwalaikorn keith D lindor Department of Medicine Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Department of Internal Medicine Section of Gastroenterology and Hepatologythe National University Hospital of IcelandIS121 ReykjavikIceland Biostatistics and Health Sciences Research Mayo ClinicRochesterMN 55902United States Health Solutions Arizona State UniversityTempeAZ 85004United States

AIM:To study whether the severity of liver fibrosis estimated by the nonalcoholic fatty liver disease(NAFLD) fibrosis score can predict all-cause mortality,cardiac complications,and/or liver complications of patients with NAFLD over long-term ***:A cohort of well-characterized patients with NAFLD diagnosed during the period of 1980-2000 was identified through the Rochester Epidemiology *** NAFLD fibrosis score(NFS) was used to separate NAFLD patients with and without advanced liver *** used the NFS score to classify the probability of fibrosis as -1.5 to 0.67 for high *** endpoints included allcause death and cardiovascular-and/or liver-related *** the 479 patients with NAFLD assessed,302 patients(63%) greater than 18 years old were *** patients were followed,and medical charts were reviewed until August 31,2009 or the date when the first primary endpoint *** using a standardized case record form,we recorded a detailed history and physical examination and the use of statins and metformin during the follow-up ***:A total of 302/479(63%) NAFLD patients(mean age:47 ± 13 year) were included with a followup period of 12.0 ± 3.9 year.A low probability of advanced fibrosis(NFS -1.5) was found in 121 patients(40%).At the end of the follow-up period,55 patients(18%) developed primary endpoints.A total of 39 patients(13%) died during the *** leading causes of death were non-hepatic malignancy(n = 13/39;33.3%),coronary heart disease(CHD)(n = 8/39;20.5%),and liver-related mortality(n = 5/39;12.8%).Thirty patients had new-onset CHD,whereas 8 of 30 patients(27%) died from CHD-related causes during the *** a multivariate analysis,a higher NFS at baseline and the presence of new-onset CHD were si

关键词： Nonalcoholic fatty liver disease fibrosis score Prognostic predictor Mortality Liver complications

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梅奥医学院的新课程改革

中国卫生人才 2011年第5期 16-17页

作者： keith D.lindor Barbara L.Porter 陈宗禹梅奥医学院

医学院一贯以课程负担重、培养周期长而著称。随着医学知识的不断积累、医疗技术和环境的不断更新,如何提高现代医学生的综合素质已成为医学院校都在积极探索的课题。作为美国最好的医学院之一的梅奥医学院也进行了多年的课程改革探索,... 详细信息

医学院一贯以课程负担重、培养周期长而著称。随着医学知识的不断积累、医疗技术和环境的不断更新,如何提高现代医学生的综合素质已成为医学院校都在积极探索的课题。作为美国最好的医学院之一的梅奥医学院也进行了多年的课程改革探索,并且取得了不错的成绩。

关键词：医学院医学院校梅奥医学生

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消除病毒性肝炎的联合宣言

肝脏 2016年第12期21卷 1016-1016,1026页

作者： Javier Brahm Laurent Castera 侯金林 keith lindor 张新(译) 李用国(译) 拉丁美洲肝脏研究协会欧洲肝脏研究学会亚太肝脏研究协会美国肝病学会不详

一、病毒性肝炎给人类健康造成的严重负担与HIV或者疟疾这些众所周知的感染性疾病相比,病毒性肝炎常被称作＂沉默的杀手＂。

关键词：丁型肝炎病毒肝功能衰竭体液传播慢性肝病戊型肝炎病毒乙型肝炎感染性疾病经口肝细胞癌肝脏疾病

Outcome of patients with primary sclerosing cholangitis and ulcerative colitis undergoing colectomy

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2013年第3期4卷 61-68页

作者： Sombat Treeprasertsuk Einar Bjrnsson Emmanouil Sinakos Emma Weeding keith D lindor Division of Gastroenterology Department of MedicineFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Department of Internal Medicine Section of Gastroenterology and HepatologyThe National University Hospital of IcelandIS121 ReykjavikIceland Division of Gastroenterology and Hepatology Mayo ClinicRochesterMN 55905United States Health Solutions Arizona State UniversityAZ 85004United States

AIM:To study the outcomes of primary sclerosing cholangitis(PSC) patients with ulcerative colitis(UC) undergoing ***:We identified 193 patients with PSC and UC undergoing colectomy at the Mayo Clinic(Rochester,MN,United States),between January 1,1995 and December 31,2008 using a computerized record ***-nine patients were excluded due to unclear diagnosis,liver transplantation prior to colectomy,age less than 18 years,inadequate follow-up data or known cases of *** retrospectively reviewed data from patient medical *** information,date of colectomy,preoperative and follow-up liver tests and pathological findings of the colon were *** Mayo risk score at baseline was calculated to obtain survival estimates for up to 4 years of *** primary endpoint was defined by the presence of all-cause mortality and/or liver decompensation requiring liver *** patients who did not have a clinical note on December 31,2008 were considered as patients with an incomplete follow-up unless they reached a study endpoint(death or underwent liver transplantation) prior to that *** study was approved by the Institutional Review Boards of the Mayo ***:Of the 2441 patients with PSC observed in this period,104 patients(4.3%) had UC and underwent colectomy and were *** median age was 43.2 years,and 67% were *** leading indications for colectomy were severe colonic inflammation(49%),the presence of colonic dysplasia during routine surveillance(42%) and bowel perforation(3%).Twenty-six patients were lost to follow-up after a median duration of 3.9 *** remaining 78 patients included 52 patients(66.7%) who were followed for a median duration of 5.5 years and 26 patients(33.3%) who developed primary endpoints including death(n = 13) or underwent liver transplantation(n = 13) with a median follow up of 2.6 *** the secondary endpoint,the liver complications within 1 mo follow

关键词： Prognosis Colectomy Primary sclerosing cholangitis Ulcerative colitis Outcomes