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Seronegative Autoimmune Hepatitis

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Journal of Clinical and Translational Hepatology 2023年第2期11卷 459-465,F0003页

作者： Sriya A.Bhumi george y.wu Department of Medicine University of Connecticut Health CenterFarmingtonCTUSA Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA

Autoimmune hepatitis(AIH)is a relatively rare liver disease with varying worldwide incidence of from 0.7 to 2 per 100,000 *** is characterized by the presence of ***,an average of 10% of AIH cases have AIH symptoms and pathology but lack autoimmune *** such seronegative AIH(snAIH)cases,there is currently no established diagnostic algorithm for *** improper or delayed diagnosis of snAIH can lead to no or inappropriate treatment that results in progression to fulminant hepatitis or *** review aims to review the current literature and to present an update of seronegative autoimmune hepatitis,including its pathophysiology,clinical presentation,methods of diagnosis,and treatment in order to increase awareness and emphasize the necessity for timely management.

关键词： Seronegative autoimmune hepatitis Autoantibody negative Autoimmune hepatitis Cryptogenic hepatitis

HEV and HBV Dual Infection:A Review

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Journal of Clinical and Translational Hepatology 2020年第3期8卷 313-321页

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

Hepatitis E virus(HEV)is a global health problem,affecting about 20 million people *** is significant overlap of hepatitis B virus(HBV)and HEV endemicity in many Asian countries where dual infections with HEV and HBV can *** the clinical course of HEV is largely self-limited,HEV superinfection in patients with chronic hepatitis B(CHB)can result in acute exacerbation of underlying *** superinfection in patients with CHB-related cirrhosis has been identified as a risk factor for decompensated cirrhosis and an independent predictor of *** acute HEV infection in pregnancy can cause fulminant liver failure,the few studies on pregnant patients with dual HBV and HEV infection have shown a subclinical *** is a risk factor for the development of chronic HEV infection,which can be managed by decreasing the dose of immune-suppressants and administering *** for HEV has been developed and is in use in China but its efficacy in patients with CHB has yet to be established in the *** this review,we appraise studies on dual infection with HEV and HBV,including the effect of HEV superinfection and coinfection in CHB,management strategies used and the role of active vaccination in the prevention of HEV.

关键词： Hepatitis B Hepatitis E Coinfection Superinfection Chronic hepatitis B

Novel Agents in the Management of Hepatic Encephalopathy:A Review

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Journal of Clinical and Translational Hepatology 2021年第5期9卷 749-759页

作者： Leen Z.Hasan george y.wu Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA

Hepatic encephalopathy is an often devastating complication of chronic liver disease,associated with high mortality and increased burden on patients and healthcare *** agents(such as nonabsorbable disaccharides and oral antibiotics)are often only partially effective and associated with unpleasant side *** our improved understanding of the pathophysiology of hepatic encephalopathy,multiple treatment modalities have emerged with promising results when used alone or as an adjunct to standard *** mechanisms of these agents vary greatly,and include the manipulation of gut microbial composition,reduction of oxidative stress,inhibition of inflammatory mediators,protection of endothelial integrity,modulation of neurotransmitter release and function,and other novel methods to reduce blood ammonia and *** their promising results,the studies assessing these treatment modalities are often limited by study design,sample size,outcome assessment heterogeneity,and paucity of data regarding their safety *** this article,we discuss these novel agents in depth and provide the best evidence supporting their use,along with a critical look at their limitations and future directions.

关键词： Hepatic encephalopathy Liver cirrhosis Ammonia

Evidence for Viral Induction of Biliary Atresia: A Review

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Journal of Clinical and Translational Hepatology 2018年第4期6卷 410-419页

作者： Leon D.Averbukh george y.wu Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA

Biliary atresia(BA)is a childhood disease which manifests with abnormal narrowing,blockage or complete absence of bile ducts within the *** possible etiologies have been reported for the development of BA,including congenital,perinatal and acquired *** the 1970's,there has been increasing evidence linking BA development to viral perinatal *** viral vectors most commonly implicated include members of the herpesviridae family(cytomegalovirus and Epstein-Barr virus)as well as those of the reoviridae family(reovirus and rotavirus).While extensive work has been done on a murine model of disease,the current review focuses primarily on evidence from human studies of viral vectors in children afflicted with BA.

关键词： Biliary atresia Cytomegalovirus Epstein-Barr virus Reovirus Rotavirus

Primary Sclerosing Cholangitis and Inflammatory Bowel Disease: A Review

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Journal of Clinical and Translational Hepatology 2022年第3期10卷 531-542页

作者： Teresa Da Cunha Haleh Vaziri george y.wu Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA

Primary sclerosing cholangitis is a disease affecting around 0.006–0.016%of the *** these,around 75%have concomitant inflammatory bowel disease(IBD)according to the most recent epidemiological *** theories have been proposed regarding the pathogenesis of primary sclerosing cholangitis(PSC).These include changes in the function of cholangiocytes,effects of the gut microbiome,association with specific human leukocyte antigen haplotypes and dysregulation of the immune ***,these do not explain the observed association with ***,there are considerable differences in the frequency and outcomes between patients with PSC and ulcerative colitis compared with PSC and Crohn’s *** aim of this review is to appraise the most recent studies that have contributed to the epidemiology,advances in the pathophysiology,and characterization of important clinical aspects of the association of PSC and IBD.

关键词： Primary sclerosing cholangitis Cholangitis Inflammatory bowel disease Ulcerative colitis Crohn’s disease

Highlights for Dental Care as a Hepatitis C Risk Factor:A Review of Literature

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Journal of Clinical and Translational Hepatology 2019年第4期7卷 346-351页

作者： Leon D.Averbukh george y.wu Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterCTUSA

Hepatitis C(HCV)is a viral infection that affects an estimated 71 million people worldwide,with over 1 million new infec-tions *** medical treatments exist,HCV continues to be a significant public health *** prevention and transmission risk factor identification remain key in helping decrease disease *** intravenous drug use,healthcare exposure(*** transfusions and surgical care),and body modification(*** and piercings)are well accepted risk factors for HCV transmission,others remain *** dental practice is often asso-ciated with procedures and bleeding,the possibility of HCV transmission seemed reasonable to ***,we review the evidence for dental care as a potential risk factor for HCV *** identified a total of 1,180 manu-scripts related to HCV and dental care,of which 26 manu-scripts were included in the study after exclusionary criteria were *** per our review of the available literature,in the developing world,the improper use of sterile technique and lack of provider education likely increases the risk of HCV transmission during dental *** developed nations,on the other hand,general dental care does not appear to be a significant risk factor for HCV transmission in non-intravenous drug user patients;although,the improper use and reuse of anesthetics during procedures poses a rare potential risk for viral transmission.

关键词： Hepatitis C Oral care Dental care Risk factors Hepatitis

HBV-HCV Coinfection: Viral Interactions, Management, and Viral Reactivation

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Journal of Clinical and Translational Hepatology 2018年第3期6卷 296-305页

作者： Marianna G.Mavilia george y.wu Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA

Hepatitis B virus(HBV)and hepatitis C virus(HCV)coinfec-tion is a complex clinical entity that has an estimated world-wide prevalence of 1–15%.Most clinical studies have shown that progression of disease is faster in HBV-HCV coinfected patients compared to those with ***-lular carcinoma development appears to have higher rate in *** replication in coinfected cells is character-ized by a dominance of HCV over HBV *** are no established guidelines for treatment of HBV-HCV *** on interferon-based therapies and direct-acting antivirals have shown varying levels of *** reports have indicated that treatment of HCV without sup-pression of HBV increases the risk for HBV *** this review,we appraise studies on both direct-acting antivirals and interferon-based therapies to evaluate the efficacy and rates of reactivation with each *** for and prevention of coinfection are important to prevent serious HBV reactivations.

关键词： Hepatitis B virus Hepatitis C virus Coinfection Viral reactivation

Role of Biologics in the Development of Autoimmune Hepatitis: A Review

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Journal of Clinical and Translational Hepatology 2018年第4期6卷 402-409页

作者： Leon D.Averbukh george y.wu Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA

Autoimmune hepatitis(AIH)is a cause of chronic,immunemediated liver injury which without treatment may progress to end-stage liver *** disease state,characterized by elevations in liver enzymes,autoantibodies,and interface hepatitis on histology,has been noted to be induced by a wide range of ***,most commonly minocycline and nitrofurantoin,have long been established as potential inducers of ***,biologics,powerful immune-modulators,have also been reported to induce *** conclude that there is an association between administration of biologics in the development of AIH,and whether the relationship is causal will require appropriate studies in the future.

关键词： Autoimmune hepatitis TNF alpha inhibitors Biologics Hepatitis Infliximab Adalimumab Etanercept

Cytomegalovirus Hepatitis in Immunocompetent and Immunocompromised Hosts

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Journal of Clinical and Translational Hepatology 2021年第1期9卷 106-115页

作者： Teresa Da Cunha george y.wu Department of Medicine Division of Gastroenterology-HepatologyUniversity of Connecticut Health CenterFarmingtonCTUSA Department of Medicine University of Connecticut Health CenterFarmingtonCTUSA

Human cytomegalovirus (HCMV) infection is common and affects between 40–100% of the worldwide population. However, the majority of cases are asymptomatic and when severe disease occurs, it is usually restricted to immunocompromised patients. Liver involvement by HCMV differs significantly, accordingly to the immune status of the host. In immunocompromised patients, particularly liver transplant patients, it often causes clinically significant hepatitis. On the other hand, in immunocompetent patients, HCMV hepatitis requiring hospitalization is extremely rare. This review aims to appraise studies regarding the pathophysiology of HCMV hepatitis, including mechanisms of latency and reactivation and its contribution to disease development, clinical presentation, diagnostic modalities and treatment, with a focus on comparing different aspects between immunocompromised and immunocompetent hosts.

关键词： CMV hepatitis Cytomegalovirus hepatitis Cytomegalovirus hepatitis immunocompetent Cytomegalovirus hepatitis immunocompromised