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Transjugular Intrahepatic Portosystemic Shunt Linked to Increased Risk of Hepatocellular Carcinoma:A va Matched Cohort Study

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Journal of Clinical and Translational Hepatology 2024年第5期12卷 534-538页

作者： Shalini Bansal Tamar Taddei Rebecca Wells marina Serper Theresa Bittermann Nadim Mahmud David E.Kaplan Sidney Kimmel Medical College at Thomas Jefferson University PhiladelphiaPAUSA Division of Gastroenterology and Hepatology Perelman School of Medicine University of PennsylvaniaPhiladelphiaPAUSA Corporal Michael J.Crescenz va Medical Center PhiladelphiaPAUSA Division of Gastroenterology and Hepatology Yale University School of MedicineNew HavenCTUSA va Connecticut Healthcare System West HavenCTUSA

Hepatocellular carcinoma(HCC)is the most common primary tumor of the liver and often evolves from regenerating nodules in liver *** there have been significant advances in the treatment of HCC,the overall prognosis in patients with a large tumor burden,vascular invasion,or extrahepatic spread remains poor.1 The magnitude of liver stiffness in cirrhosis has been consistently associated with an increased risk of development of HCC.

关键词： Carcinoma invasion cirrhosis

Endoscopic ultrasound guided gallbladder drainage - is it ready for prime time？

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2018年第6期9卷 47-54页

作者： UmeshaBoregowda Chandraprakash Umapathy Arpitha Nanjappa Helen Wong Madhav Desai marina Roytman Thimmaiah Theethira Shreyas Saligram Department of Gastroenterology and Hepatology University of California San Francisco Fresno CA 93721 United States Department of Gastroenterology and Hepatology VA Central California Healthcare System Fresno CA 93703 United States Department of Gastroenterology and Hepatology Kansas University Medical Center Kansas City Kansas 66160 United States

Management of acute cholecystitis includes initial sta-bilization and antibiotics. However, the most definitive treatment is cholecystectomy. A small percentage of patients who are not suitable for surgery due to the severity of cholecystitis or comorbidities will require a temporary measure as a bridge to surgery or permanent nonoperative management to decrease the mortality and morbidity. Most of these patients who require conservative management were managed with percutaneous transhepatic cholecystostomy or trans-papillary drainage of gallbladder drainage with cystic duct stenting through endoscopic retrograde cholangiopancreaticography （ERCP）. Although, these conservative measures are effective, they can cause signifcant discomfort to the patients especially if used as a long-term measure. In view of this, there is a need for further minimally invasive procedures, which is safe, effective and comfortable to patients. Endoscopic ultrasound （EUS） guided gallbladder drainage is a novel method of gallbladder drainage frst described in 2007[1]. Over the last decade, EUS guided gallbladder drainage has evolved as an effective alternative to percutaneouscholecystostomy and trans-papillary gallbladder drai-nage. Our goal is to review available literature regarding the scope of EUS guided gallbladder drainage as a viable alternative to percutaneous cholecystostomy or cystic duct stenting through ERCP among patients who are not suitable for cholecystectomy.

关键词： Acute cholecystitis Acute acalculous cholecystitis Endoscopic ultrasound guided gallbladder drainage Percutaneous cholecystostomy Trans-papillary gallbladder drainage

Do Dental Self-Care Habits Correlate with Oral Health？

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Journal of Health Science 2014年第9期2卷 428-435页

作者： Am H. Eliasson Georgia G. Rogers Mariam D. Kashani marina N. Vernalis Integrative Cardiac Health Project Walter Reed National Military Medical Center Bethesda 20889 MD USA Surgeon General for Dental Public Health Office of the Surgeon General US Army Falls Church 21010 VA USA

Research evidence substantiating benefits of dental self-care habits is surprisingly limited. This study evaluated associations between dental self-care behaviors and oral health, specifically toothbrushing, flossing, rinsing, chewing xylitol gum, and diet. Soldiers recently deployed to Iraq and Afghanistan had dental examinations and answered questionnaires on dental self-care habits. The DoD Oral Health and Readiness Classification System was used to categorize oral health （see manuscript for definitions）. Correlations were assessed between self-care habits and dental classification. Of 266 soldiers, 43 （16%） were Class 1 （excellent）, 191 （72%） Class 2 （acceptable）, 18 （7%） Class 3 （poor）, and 14 （5%） Class 4 （unknown）. Only 63% of soldiers brushed twice or more per day and only half flossed once or more per day. Dental classification improved with toothbrushing （P = 0.05） and adherence to a Mediterranean diet （P = 0.04）. Flossing trended toward correlation （P = 0.11）. Dental classification did not correlate with mouth rinse or xylitol chewing gum. These research findings help fill an evidence gap that toothbrushing and flossing in addition to a healthful eating pattem are associated with improved oral health.

关键词： Dental self-care oral health toothbrushing demal floss diet.

Update on the management of gastrointestinal varices

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2019年第1期10卷 1-21页

作者： Umesha Boregowda Chandraprakash Umapathy Nasir Halim Madhav Desai Arpitha Nanjappa Subramanyeswara Arekapudi Thimmaiah Theethira Helen Wong marina Roytman Shreyas Saligram Department of Gastroenterology and Hepatology University of California San Francisco Department of Gastroenterology and Hepatology Kansas University Medical Center Department of Medicine VA Central California Healthcare System Department of Gastroenterology and Hepatology VA Central California Healthcare System

Cirrhosis of liver is a major problem in the western world. Portal hypertension is a complication of cirrhosis and can lead to a myriad of pathology of which include the development of porto-systemic collaterals. Gastrointestinal varices are dilated submucosal veins, which often develop at sites near the formation of gastroesophageal collateral circulation. The incidence of varices is on the rise due to alcohol and obesity. The most significant complication of portal hypertension is life-threatening bleeding from gastrointestinal varices, which is associated with substantial morbidity and mortality. In addition, this can cause a significant burden on the health care facility. Gastrointestinal varices can happen in esophagus, stomach or ectopic varices. There has been considerable progress made in the understanding of the natural history, pathophysiology and etiology of portal hypertension. Despite the development of endoscopic and medical treatments, early mortality due to variceal bleeding remains high due to significant illness of the patient. Recurrent variceal bleed is common and in some cases, there is refractory variceal bleed. This article aims to provide a comprehensive review of the management of gastrointestinal varices with an emphasis on endoscopic interventions, strategies to handle refractory variceal bleed and newer endoscopic treatment modalities. Early treatment and improved endoscopic techniques can help in improving morbidity and mortality.

关键词： Portal hypertension Esophageal varices Gastric varices Ectopic varices Endoscopy