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World Journal of Hepatology 2024年第4期16卷 550-565页

作者： wattana leowattana Pathomthep leowattana Tawithep leowattana Department of Clinical Tropical Medicine Mahidol UniversityRachatawee 10400BangkokThailand Department of Medicine Srinakharinwirot UniversityWattana 10110BangkokThailand

The management of hepatitis B virus(HBV)infection now involves regular and appropriate monitoring of viral activity,disease progression,and treatment *** HBV infection biomarkers are limited in their ability to predict clinical outcomes or therapeutic *** of HBV core antibodies(qAnti-HBc)is a novel non-invasive biomarker that may help with a variety of diagnostic *** was shown to correlate strongly with infection stages,hepatic inflammation and fibrosis,chronic infection exacerbations,and the presence of occult ***,qAnti-HBc levels were shown to be predictive of spontaneous or treatment-induced HBeAg and HBsAg seroclearance,relapse after medication termination,re-infection following liver transplantation,and viral reactivation in the presence of ***-HBc,on the other hand,cannot be relied on as a single diagnostic test to address all problems,and its diagnostic and prognostic potential may be greatly increased when paired with *** qAnti-HBc diagnostic kits are currently not widely *** many methodologies are only semi-quantitative,comparing data from various studies and defining universal cut-off values remains *** review focuses on the clinical utility of qAnti-HBc and qHBsAg in chronic hepatitis B management.

关键词： Quantitative hepatitis B core antibody Quantitative hepatitis B surface antigen Chronic hepatitis B management Novels viral biomarkers

Systemic treatment for advanced pancreatic cancer

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World Journal of Gastrointestinal Oncology 2023年第10期15卷 1691-1705页

Pancreatic cancer is a deadly disease with an extremely poor 5-year survival rate due to treatment resistance and late-stage *** numerous years of research and pharmaceutical development,these figures have not *** options for advanced pancreatic cancer are still *** illness is typically detected at a late stage,making curative surgical resection *** is the most commonly utilized technique for treating advanced pancreatic cancer but has poor *** therapy and immunotherapy have made significant progress in many other cancer types and have been proven to have extremely promising possibilities;these therapies also hold promise for pancreatic *** is an urgent need for research into targeted treatment,immunotherapy,and cancer *** this review,we emphasize the founda-tional findings that have fueled the therapeutic strategy for advanced pancreatic *** also address current advancements in targeted therapy,immuno-therapy,and cancer vaccines,all of which continue to improve the clinical outcome of advanced pancreatic *** believe that clinical translation of these novel treatments will improve the low survival rate of this deadly disease.

关键词： Systemic treatment Advanced pancreatic cancer Personalized medicine Biomarkers Chemotherapy Targeted therapy Immunotherapy

Potassium-competitive acid blockers and gastroesophageal reflux disease

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World Journal of Gastroenterology 2022年第28期28卷 3608-3619页

作者： wattana leowattana Tawithep leowattana Clinical Tropical Medicine Faculty of Tropical MedicineMahidol UniversityBangkok 10400Thailand Department of Medicine Faculty of MedicineSrinakharinwirot UniversityBangkok 10110Thailand

Proton pump inhibitors(PPIs),the most commonly used antisecretory medications in the management of reflux illness,virtually eliminate elective surgery for ulcer disease,and relegate anti-reflux surgery to patients with gastroesophageal reflux disease(GERD)who are inadequately managed by medical ***,PPI medications still leave some therapeutic demands of GERD ***,up to 40%-55%of daily PPI users have chronic symptoms,due to PPI ***-competitive acid blockers(P-CABs)transcend many of the problems and limits of PPIs,delivering quick,powerful,and extended acid suppression and allowing for treatment of numerous unmet ***,it has become clear that compromised mucosal integrity plays a role in the etiology of *** a result,esophageal mucosal protection has emerged as a novel and potential treatment *** increasing body of research demonstrates that when P-CABs are used as primary drugs or add-on drugs(to regular treatment),they provide a considerable extra benefit,particularly in alleviating symptoms that do not respond to PPI therapy.

关键词： Potassium-competitive acid blocker Gastroesophageal reflux disease Proton pump inhibitors Treatment outcome Proton pump inhibitor-refractory patients Esophageal mucosal resistance

Human-induced pluripotent stem cell-atrial-specific cardiomyocytes and atrial fibrillation

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World Journal of Clinical Cases 2022年第27期10卷 9588-9601页

作者： wattana leowattana Tawithep leowattana Pathomthep leowattana Department of Clinical Tropical Medicine Faculty of Tropical MedicineMahidol UniversityBangkok 10400Thailand Department of Medicine Faculty of MedicineSrinakharinwirot UniversityBangkok 10110Thailand

Patient-specific human-induced pluripotent stem cell-derived atrial cardiomyocytes(hiPSC-aCMs) may be produced,genome-edited,and differentiated into multiple cell types for regenerative medicine,disease modeling,drug testing,toxicity screening,and three-dimensional tissue *** is presently no complete model of atrial fibrillation(AF) available for studying human pharmacological responses and evaluating the toxicity of potential medication *** has been demonstrated that hiPSC-aCMs can replicate the electrophysiological disease phenotype and genotype of *** hiPSC-aCMs,however,are immature and do not reflect the maturity of a CMs in the native *** laboratories utilize a variety of methodologies and procedures to improve and promote a CM maturation,including electrical stimulation,culture duration,biophysical signals,and changes in metabolic *** review covers the current methods being explored for use in the maturation of patient-specific hiPSC-aCMs and their application towards a personalized approach to the pharmacologic therapy of AF.

关键词： Atrial fibrillation Human-induced pluripotent stem cell-derived atrial cardiomyocytes Disease modeling Maturation Pharmacologic response Personalized medicine

Circulating angiotensin converting enzyme 2 and COVID-19

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World Journal of Clinical Cases 2022年第34期10卷 12470-12483页

作者： wattana leowattana Tawithep leowattana Pathomthep leowattana Department of Clinical Tropical Medicine Faculty of Tropical MedicineMahidol UniversityBangkok 10400BangkokThailand Department of Medicine Faculty of MedicineSrinakharinwirot UniversityBangkok 10110BangkokThailand

The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has triggered a widespread outbreak since December *** SARS-CoV-2 infection-related illness has been dubbed the coronavirus disease 2019(COVID-19)by the World Health *** and subclinical infections,a severe hyperinflammatory state,and mortality are all examples of clinical *** attaching to the angiotensin converting enzyme 2(ACE2)receptor,the SARSCoV-2 virus can enter cells through membrane fusion and *** addition to enabling viruses to cling to target cells,the connection between the spike protein(S-protein)of SARS-CoV-2 and ACE2 may potentially impair the functionality of *** pressure is controlled by ACE2,which catalyzes the hydrolysis of the active vasoconstrictor octapeptide angiotensin(Ang)II to the heptapeptide Ang-(1-7)and free ***,Ang I can be broken down by ACE2 into Ang-(1-9)and metabolized into Ang-(1-7).Numerous studies have demonstrated that circulating ACE2(cACE2)and Ang-(1-7)have the ability to restore myocardial damage in a variety of cardiovascular diseases and have antiinflammatory,antioxidant,anti-apoptotic,and anti-cardiomyocyte fibrosis *** have been some suggestions for raising ACE2 expression in COVID-19 patients,which might be used as a target for the creation of novel treatment *** regard to this,SARS-CoV-2 is neutralized by soluble recombinant human ACE2(hrsACE2),which binds the viral S-protein and reduces damage to a variety of organs,including the heart,kidneys,and lungs,by lowering Ang II concentrations and enhancing conversion to Ang-(1-7).This review aims to investigate how the presence of SARS-CoV-2 and cACE2 are ***,there will be discussion of a number of potential therapeutic approaches to tip the ACE/ACE-2 balance in favor of the ACE-2/Ang-(1-7)axis.

关键词： Circulating angiotensin converting enzyme 2 Coronavirus disease 2019 Disease severity Clinical outcome Severe acute respiratory syndrome coronavirus 2 infection

Paradigm shift of chemotherapy and systemic treatment for biliary tract cancer

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World Journal of Gastrointestinal Oncology 2023年第6期15卷 959-972页

作者： wattana leowattana Tawithep leowattana Pathomthep leowattana Department of Clinical Tropical Medicine Faculty of Tropical MedicineMahidol UniversityRachatawee 10400BangkokThailand Department of Medicine Faculty of MedicineSrinakharinwirot UniversityWattana 10110BangkokThailand

Biliary tract cancers(BTC)are frequently identified at late stages and have a poor prognosis due to limited systemic treatment *** more than a decade,the combination of gemcitabine and cis-platin has served as the first-line standard *** are few choices for second-line *** treatment with fibroblast growth factor receptor 2 inhibitors,neurotrophic tyrosine receptor kinase inhibitors,and isocitrate dehydrogenase 1 inhibitors has had important *** checkpoint inhibitors(ICI)such as pembrolizumab are only used in first-line treatment for microsatellite instability high *** TOPAZ-1 trial's outcome is encouraging,and there are several trials underway that might soon put targeted treatment and ICI combos into first-line *** targets and agents for existing goals are being studied,which may represent a paradigm shift in BTC *** to a scarcity of targetable mutations and the higher toxicity profile of the current medications,the new category of drugs may occupy a significant role in BTC therapies.

关键词： Biliary tract cancers Gemcitabine and cisplatin combination Fibroblast growth factor receptor 2 inhibitors Isocitrate dehydrogenase 1 inhibitors Neurotrophic tyrosine receptor kinase gene fusion inhibitors Immune checkpoint inhibitors Microsatellite instability high Infrigatinib Pemigatinib

Systemic treatment for unresectable hepatocellular carcinoma

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World Journal of Gastroenterology 2023年第10期29卷 1551-1568页

作者： wattana leowattana Tawithep leowattana PathompThep leowattana Department of Clinical Tropical Medicine Faculty of Tropical MedicineMahidol UniversityBangkok 10400Thailand Department of Medicine Faculty of MedicineSrinakharinwirot UniversityBangkok 10110Thailand

Hepatocellular carcinoma(HCC)is most commonly found in the context of liver cirrhosis and,in rare cases,in a healthy *** prevalence has risen in recent years,particularly in Western nations,due to the increasing frequency of nonalcoholic fatty liver *** HCC has a poor *** many years,the only proven therapy for unresectable HCC(uHCC)was sorafenib,a tyrosine kinase ***,the synergistic effect of an immune checkpoint inhibitor,atezolizumab,and bevacizumab outperformed sorafenib alone in terms of survival,making it the recommended first-line *** multikinase inhibitors,lenvatinib and regorafenib,were also recommended as first and second-line drugs,***-stage HCC patients with retained liver function,particularly uHCC without extrahepatic metastasis,may benefit from trans-arterial *** current problem in uHCC is selecting a patient for the best treatment while considering the preexisting liver condition and liver ***,all study patients had a Child-Pugh class A,and the best therapy for other individuals is ***,in the absence of a medical contraindication,atezolizumab could be combined with bevacizumab for uHCC systemic *** studies are now underway to evaluate immune checkpoint inhibitors in combination with anti-angiogenic drugs,and the first findings are *** paradigm of uHCC therapy is changing dramatically,and many obstacles remain for optimum patient management in the near *** purpose of this commentary review was to give an insight into current systemic treatment options for patients with uHCC who are not candidates for surgery to cure the disease.

关键词： Hepatocellular carcinoma Unresectable hepatocellular carcinoma Nonalcoholic fatty liver disease Tyrosine kinase inhibitor Sorafenib Lenvatinib Immune checkpoint inhibitor Atezolizumab Bevacizumab

Systemic treatments for resectable carcinoma of the esophagus

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World Journal of Gastroenterology 2023年第30期29卷 4628-4641页

作者： wattana leowattana Pathomthep leowattana Tawithep leowattana Department of Clinical Tropical Medicine Faculty of Tropical MedicineMahidol UniversityRachatawee 10400BangkokThailand Department of Medicine Faculty of MedicineSrinakarinwirot UniversityWattana 10110BangkokThailand

One of the most prevalent malignancies in the world is esophageal cancer(EC).The 5-year survival rate of EC remains pitiful despite treatment *** chemoradiotherapy in conjunction with esophagectomy is the standard of care for patients with resectable *** pathological complete response rate,however,is not acceptable.A distant metastasis or a locoregional recurrence will occur in about half of the *** increase the clinical effectiveness of therapy,it is consequently vital to investigate cutting-edge and potent therapeutic *** approach to the management of resectable EC using immunotherapy has been considerably altered by immune checkpoint *** immunotherapy has recently been shown to have the potential to increase the survival of patients with resectable EC,according to growing clinical data.A combination of chemotherapy,radiation,and immunotherapy may have a synergistic antitumor impact because,according to mounting evidence,these treatments can stimulate the immune system via a number of different *** light of this,it makes sense to consider the value of neoadjuvant immunotherapy for patients with surgically treatable *** this review,we clarify the rationale for neoadjuvant immunotherapy in resectable EC patients,recap the clinical outcomes of these approaches,go through the upcoming and ongoing investigations,and emphasize the difficulties and unmet research requirements.

关键词： Systemic treatment Resectable carcinoma of the esophagus Personalized medicine Biomarkers Chemotherapy Chemoradiotherapy Immunotherapy Immune checkpoint inhibitors

Systemic treatment for metastatic colorectal cancer

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World Journal of Gastroenterology 2023年第10期29卷 1569-1588页

作者： wattana leowattana Pathomthep leowattana Tawithep leowattana Clinical Tropical Medicine Faculty of Tropical MedicineMahidol UniversityBangkok 10400Thailand Department of Medicine Faculty of MedicineSrinakharinwirot UniversityBangkok 10110Thailand

Significant progress has been achieved in the treatment of metastatic colorectal cancer(mCRC)patients during the last 20 *** are currently numerous treatments available for the first-line treatment of *** molecular technologies have been developed to reveal novel prognostic and predictive biomarkers for *** development of next-generation sequencing and wholeexome sequencing,which are strong new tools for the discovery of predictive molecular biomarkers to facilitate the delivery of customized treatment,has resulted in tremendous breakthroughs in DNA sequencing technology in recent *** appropriate adjuvant treatments for mCRC patients are determined by the tumor stage,presence of high-risk pathologic characteristics,microsatellite instability status,patient age,and performance ***,targeted therapy,and immunotherapy are the main systemic treatments for patients with *** the fact that these novel treatment choices have increased overall survival for mCRC,survival remains optimal for individuals with non-metastatic *** molecular technologies currently being used to support our ability to practice personalized medicine;the practical aspects of applying molecular biomarkers to regular clinical practice;and the evolution of chemotherapy,targeted therapy,and immunotherapy strategies for the treatment of mCRC in the front-line setting are all reviewed here.

关键词： Systemic treatment Metastatic colorectal cancer Personalized medicine Biomarkers Chemotherapy Targeted therapy Immunotherapy

COVID-19 vaccination and cardiac dysfunction

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World Journal of Cardiology 2022年第6期14卷 343-354页

The coronavirus disease 2019(COVID-19)mRNA vaccine against severe acute respiratory syndrome coronavirus 2 infections has reduced the number of symptomatic patients globally.A case series of vaccine-related myocarditis or pericarditis has been published with extensive vaccination,most notably in teenagers and young *** seem to be impacted more often,and symptoms commonly occur within 1 wk after *** clinical course is mild in the majority of *** on the evidence,a clinical framework to guide physicians to examine,analyze,identify,and report suspected and confirmed cardiac dysfunction cases is needed.A standardized workup for every patient with strongly suspicious symptoms associated with the COVID-19 mRNA vaccine comprises serum cardiac troponin measurement and a 12-lead electrocardiogram(ECG).For patients with unexplained elevation of cardiac troponin and pathologic ECG,echocardiography is *** with a cardiovascular expert and hospitalization should be considered in this group of *** is primarily symptomatic and *** a 2^(nd) dose of the COVID-19 mRNA vaccination in individuals with suspected myocarditis or pericarditis after the 1^(st) dose is suggested until further safety data become available.

关键词： Cardiac dysfunction Myocarditis Pericarditis COVID-19 mRNA vaccine Electrocardiography Echocardiography SARS-CoV-2