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Unique Genetic Features of Lean NAFLD: A Review of Mechanisms and Clinical Implications

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Journal of Clinical and Translational Hepatology 2024年第1期12卷 70-78页

Non-alcoholic fatty liver disease(NAFLD)affects 25%of the global *** 20%have a normal body mass index(BMI)and a variant known as lean *** typical NAFLD cases associated with obesity and diabetes,lean NAFLD causes liver disease by mechanisms not related to excess weight or insulin *** disorders are among the major factors in developing lean NAFLD,and genome-wide association studies have identified several genes associated with the *** review aims to increase awareness by describing the genetic markers linked to NAFLD and the defects involved in developing lean NAFLD.

关键词： Lean nonalcoholic fatty liver disease Palatine-like phospholipase domain-containing-3 Transmembrane 6 superfamily member 2 Familial hypobetalipoproteinemia Abetalipoproteinemia

Focal Nodular Hyperplasia: A Comprehensive Review with a Particular Focus on Pathogenesis and Complications

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Journal of Clinical and Translational Hepatology 2024年第2期12卷 182-190页

作者： Jaimy Villavicencio Kim george y.wu Division of Gastroenterology-Hepatology University of Connecticut Health CenterFarmingtonCTUSA

Focal nodular hyperplasia is a benign tumor of the liver that is often found incidentally with *** purpose of this review is to discuss the pathophysiology,rare complications that can occur due to these lesions,and management options.A literature review was performed on clinical trials and case reports involving focal nodular hyperplasia complications and management of these,as well as the proposed pathogenesis underlying these *** exposure to oral contraceptive pills and endogenous hormones have been thought to play a role in the development of these lesions,this has not been *** recently,they are thought to arise as a consequence of a vascular anomaly causing alterations in the expression of angiopoietin *** are rare,but previous cases have reported associated pain,rupture and compression of nearby structures(hepatic vein,stomach,biliary system).Resection of focal nodular hyperplasia is not usually ***,if there is associated pain with no other identifiable cause or presence of a large or growing lesion with risk of causing a complication,then surgical resection,radiofrequency ablation or arterial embolization should be considered.

关键词： Focal nodular hyperplasia Oral contraceptives Liver lesion

Etiologies of Splenic Venous Hypertension:A Review

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Journal of Clinical and Translational Hepatology 2024年第6期12卷 594-606页

作者： Jasmine Tidwell Bianca Thakkar george y.wu Department of Medicine University of Connecticut Health CenterFarmingtonCTUSA Division of Gastroenterology-Hepatology University of Connecticut Health CenterFarmingtonCTUSA

Splenic venous hypertension or left-sided portal hypertension is a rare condition caused by an obstruction of the splenic ***,it presents with upper gastrointestinal bleeding in the absence of liver *** can be classified based on the mechanism of development of splenic vein hypertension:compression,stenosis,inflammation,thrombosis,and surgically decreased splenic venous *** is established by various imaging modalities and should be suspected in patients with gastric varices in the absence of esophageal varices,splenomegaly,or *** management and prognosis vary depending on the underlying etiology but generally involve reducing splenic venous *** aim of this review was to summarize the etiologies of splenic venous hypertension according to the mechanism of development.

关键词： Splenic venous hypertension Left-sided portal hypertension Sinistral portal hypertension Splenic vein thrombosis Gastric varices Hematemesis Upper gastrointestinal bleeding

Subnormal Serum Liver Enzyme Levels:A Review of Pathophysiology and Clinical Significance

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Journal of Clinical and Translational Hepatology 2024年第4期12卷 428-435页

作者： Elham M.youssef george y.wu Biochemistry Department National Research CenterCairoEgypt Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA

Subnormal levels of liver enzymes,below the lower limit of normal on local laboratory reports,can be useful *** instance,subnormal levels of aminotransferases can be observed in vitamin B6 deficiency and chronic kidney *** alkaline phosphatase levels may indicate the presence of hypophosphatasia,Wilson's disease,deficiencies of divalent ions,or *** levels of gamma glutamyl transferase may be seen in cases of acute intrahepatic cholestasis,the use of certain medications,and in bone ***,subnormal levels of 5'-nucleotidase have been reported in lead poisoning and nonspherocytic hemolytic *** aim of this review is to bring attention to the fact that subnormal levels of these enzymes should not be ignored as they may indicate pathological conditions and provide a means of early diagnosis.

关键词： Transaminases Vitamin B6 Celiac disease Renal insufficiency Hepatolenticular Degeneration Crohn disease Malnutrition Clofibrate Bone diseases Lead poisoning Anemia Hemolytic

Effects of Transjugular Intrahepatic Portosystemic Shunt on Renal and Pulmonary Function in Hepatic Decompensation with and without Hepatorenal and Hepatopulmonary Syndromes:A Review

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Journal of Clinical and Translational Hepatology 2024年第9期12卷 780-791页

作者： Ahmed H.Abdelwahed Moataz Aboeldahb george y.wu Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA Department of Gastroenterology and Hepatology Mayo ClinicRochesterMNUSA

Cirrhosis is often characterized by decreased liver function,ranging from a compensated,typically asymptomatic phase to a decompensated phase characterized by the appearance of ascites or variceal bleeding,and ultimately hepatorenal syndrome(HRS)or hepatopulmonary syndrome(HPS).The latter two complications are associated with a poor prognosis and limited treatment *** cases of ascites or variceal bleeding resistant to medical therapy,transjugular intrahepatic portosystemic shunt(TIPS)is effective and *** blood by TIPS diverts portal blood to the systemic circulation,potentially increasing systemic blood volume and benefiting renal ***,TIPS could also divert nitric oxide to the systemic circulation,potentially worsening systemic hypotension and perfusion,which could be detrimental to renal *** evidence indicates that TIPS often improves renal function in patients with portal hypertension,with or without *** studies have shown persistently decreased renal function after ***,these data are insufficient to support a recommendation for the use of TIPS specifically for *** patients without pre-existing HPS,TIPS does not appear to significantly affect pulmonary gas *** of TIPS in HPS have been inconsistent;some studies have shown improvement,but effects were *** studies have shown a persistent decline in pulmonary function after *** evidence supports the need for large randomized controlled trials to investigate the beneficial effects of TIPS for *** pulmonary function data are less clear regarding TIPS for *** aim of the current report was to review the literature regarding the effects of TIPS on renal and pulmonary function in hepatic decompensation,with or without the development of HRS or HPS.

关键词： Cirrhosis Hepatorenal syndrome Hepatopulmonary syndrome Transjugular intrahepatic portosystemic shunt

Genetics of Gallstone Disease and Their Clinical Significance: A Narrative Review

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Journal of Clinical and Translational Hepatology 2024年第3期12卷 316-326页

作者： Christopher J.Costa Minh Thu T.Nguyen Haleh Vaziri george y.wu Department of Medicine University of Connecticut Health CenterFarmingtonCTUSA Division of Gastroenterology and Hepatology University of Connecticut Health CenterFarmingtonCTUSA

Gallstone(GS)disease is common and arises from a combination of genetic and environmental *** genetic abnormalities specifically leading to cholesterol GSs are rare,there are clinically significant gene variants associated with cholesterol *** contrast,most bilirubin GSs can be attributed to genetic *** pathogenesis of cholesterol and bilirubin GSs differs *** GSs are notably influenced by genetic variants within the ABC protein superfamily,including ABCG8,ABCG5,ABCB4,and ABCB11,as well as genes from the apolipoprotein family such as ApoB100 and ApoE(especially the E3/E3 and E3/E4 variants),and members of the MUC ***,bilirubin GSs are associated with genetic variants in highly expressed hepatic genes,notably UGT1A1,ABCC2(MRP2),ABCC3(MRP3),CFTR,and MUC,alongside genetic defects linked to hemolytic anemias and conditions impacting *** genetic cases constitute a small portion of GS disease,recognizing genetic predisposition is essential for proper diagnosis,treatment,and genetic counseling.

关键词： Gallstones Cholelithiasis ATP-binding cassette transporters ABCG8 protein Human UDP-glucuronosyltransferase A1

Persistently Rising Alpha-fetoprotein in the Diagnosis of Hepatocellular Carcinoma:A Review

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Journal of Clinical and Translational Hepatology 2022年第1期10卷 159-163页

作者： Alla Turshudzhyan george y.wu Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA

Hepatocellular carcinoma(HCC),one of the most common malignant tumors worldwide,is known for its grim prognosis,with untreated life expectancy being only a matter of months after the *** difficulty in making a diagnosis early is one of the main contributing factors to the poor ***-fetoprotein(AFP)had long been used as a surveillance tool,but suboptimal specificity and sensitivity has prompted liver societies to abandon the recommendation for its universal use,even in combination with *** studies have shown no obvious correlation between serum AFP level and HCC tumor size,stage,or survival ***,some studies concluded that a gradual rise or persistent elevation in AFP were positive predictors for tumor *** studies reported a fall in AFP followed by a rise in patients with HCC as well as persistently rising AFP levels without development of HCC on follow *** calculation of the sensitivity and specificity of persistently rising AFP for HCC were both low,at 60%and 35.8%,respectively,indicating that the presence of persistently rising AFP per se did not offer diagnostic *** addition,our calculated mean slopes of persistently rising AFP levels in HCC and non-HCC patients were numerically very different,but the difference was not statistically *** conclude that the published data do not support a role for rising AFP levels per se in the diagnosis of HCC.

关键词： Alpha-fetoprotein,AFP Hepatocellular carcinoma,HCC Cancer screening

Update on Sphincter of Oddi Dysfunction: A Review

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Journal of Clinical and Translational Hepatology 2022年第3期10卷 515-521页

作者： Jaimy Villavicencio Kim george y.wu Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA

Sphincter of Oddi dysfunction(SOD)encompasses a spectrum of clinical syndromes that are not fully understood,and various diagnostic and therapeutic methods have had varying results depending on the type of *** review explored various mechanisms that might play a role in SOD and methods of diagnosis and *** is important to rule out other causes of abdominal pain with laboratory testing,imaging studies,and endoscopic *** that affect sphincter motility should be identified as *** is the gold standard for diagnosis but it is not always *** example,patients with type I SOD may have symptomatic improvement with sphincterotomy without need for a diagnostic *** scintigraphy and fatty meal sonography may also have diagnostic *** is not always effective for symptomatic improvement in type II and III *** therapies with calcium channel blockers and botulinum toxin have been studied and might be considered as options after discussing the risks and benefits with the patients.

关键词： Sphincter of Oddi Sphincter of Oddi dysfunction Common bile duct Manometry Sphincterotomy

Occult Hepatitis C Virus Infection:A Review

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Journal of Clinical and Translational Hepatology 2018年第2期6卷 155-160页

作者： Alyssa Austria george y.wu Division of Gastroenterology-Hepatology Department of MedicineUniversity of Connecticut Health CenterFarmingtonCT 06030USA

Occult hepatitis C virus(HCV)infection(OCI),first described in 2004,is defined as the presence of HCV RNA in hepatocytes or peripheral blood mononuclear cells without detectable HCV RNA in the ***,we aimed to review the epidemiology,diagnostic methods,clinical implications and potential man-agement recommendations currently described in the litera-ture,as well as the future directions for investigation of this *** and Cochrane databases were searched with combination of the following keywords:"occult","hepatitis C virus",and"occult HCV infection".There are data to support OCI as a potential culprit in cryptogenic liver *** are also consistent data demonstrating the existence of OCI in specific populations,such as dialysis,human immunodefi-ciency virus-infected and hepatitis B virus-infected patients,and also in the general *** the gold standard for diagnosis is liver biopsy,examination of peripheral blood mononuclear cells may be a reliable,safer alternative method of *** HCV infection is likely associated with liver fibrosis and progression of liver *** studies are required to determine the infectivity of OCI patients,as well as clarify the natural course and specific clinical implications of ***,studies are needed to determine whether treat-ment of OCI leads to decreased morbidity and/or mortality.

关键词： Occult hepatitis C virus OCI HCV infection