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Atrial fibrillation and gastroesophageal reflux disease:From the cardiologist perspective

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World Journal of Gastroenterology 2015年第10期21卷 3154-3156页

作者： Mariana Floria Vasile Liviu Drug Gr.T.Popa University of Medicine and Pharmacy Institute of Gastroenterology and Hepatology of Sf. Spiridon University Hospital Gr. T. Popa University of Medicine and Pharmacy

We have read with interest the paper by Roman C.and colleagues discussing the relationship between gastroesophageal reflux disease and atrial fibrillation.The review is presenting the available evidence for the common pathogenic mechanisms.However,from a cardiologist perspective,some available data were not highlighted in the review,cardiovascular involvement in gastroesophageal reflux is less assessed.Hypertension,obesity or diabetes mellitus are substrate for left atrial remodeling that initiate and sustained atrial fibrillation development.One of the pathophysiologic mechanisms in atrial fibrillation is the presence of a trigger.Gastroesophageal reflux could be only a trigger for this arrhythmia.We believe that atrial fibrillation should be considered as possible extraesophageal syndrome in the gastroesophageal reflux classification.

关键词： Atrial fibrillation Gastroesophageal reflux diseas

Heartburn and regurgitation have different impacts on life quality of patients with gastroesophageal reflux disease

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World Journal of Gastroenterology 2014年第34期20卷 12277-12282页

作者： Shou-Wu Lee Han-Chung Lien Teng-Yu Lee Sheng-Shun Yang Hong-Jeh Yeh Chi-Sen Chang Division of Gastroenterology and Hepatology Department of Internal MedicineTaichung Veterans General Hospital Department of Medicine Chung Shan Medical University Department of Medicine Yang Ming University School of Medicine

AIM:To investigate the impact of heartburn and regurgitation on the quality of life among patients with gastroesophageal reflux disease(GERD).METHODS:Data from patients with GERD,who were diagnosed according to the Montreal definition,were collected between January 2009 and July 2010.The enrolled patients were assigned to a heartburn or a regurgitation group,and further assigned to an erosive esophagitis(EE)or a non-erosive reflux disease(NERD)subgroup,depending on the predominant symptoms and endoscopic findings,respectively.The general demographic data,the scores of the modified Chinese version of the GERDQ and the Short-form 36(SF-36)questionnaire scores of these groups of patients were compared.RESULTS:About 108 patients were classified in the heartburn group and 124 in the regurgitation group.The basic characteristics of the two groups were similar,except for male predominance in the regurgitation group.Patients in the heartburn group had more sleep interruptions(22.3%daily vs 4.8%daily,P=0.021),more eating or drinking problems(27.8%daily vs 9.7%daily,P=0.008),more work interferences(11.2%daily vs none,P=0.011),and lower SF-36 scores(57.68 vs64.69,P=0.042),than patients in the regurgitation group did.Individuals with NERD in the regurgitation group had more impaired daily activities than those with EE did.CONCLUSION:GERD patients with heartburn or regurgitation predominant had similar demographics,but those with heartburn predominant had more severely impaired daily activities and lower general health scores.The NERD cases had more severely impaired daily activity and lower scores than the EE ones did.

关键词： Erosive esophagitis Gastroesophageal reflux diseas

Optimal initiation of Helicobacter pylori eradication in patients with peptic ulcer bleeding

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World Journal of Gastroenterology 2015年第8期21卷 2497-2503页

作者： Hyuk Yoon Dong Ho Lee Eun Sun Jang Jaihwan Kim Cheol Min Shin Young Soo Park Jin-Hyeok Hwang Jin-Wook Kim Sook-Hayng Jeong Nayoung Kim Departments of Internal Medicine Seoul National University Bundang Hospital

AIM:To evaluate when Helicobacter pylori(H.pylori)eradication therapy(ET)should be started in patients with peptic ulcer bleeding(PUB).METHODS:Clinical data concerning adults hospitalizedwith PUB were retrospectively collected and analyzed.Age,sex,type and stage of peptic ulcer,whether endoscopic therapy was performed or not,methods of H.pylori detection,duration of hospitalization,and specialty of the attending physician were investigated.Factors influencing the confirmation of H.pylori infection prior to discharge were determined using multiple logistic regression analysis.The H.pylori eradication rates of patients who received ET during hospitalization and those who commenced ET as outpatients were compared.RESULTS:A total of 232 patients with PUB were evaluated for H.pylori infection by histology and/or rapid urease testing.Of these patients,53.7%(127/232)had confirmed results of H.pylori infection prior to discharge.In multivariate analysis,duration of hospitalization and ulcer stage were factors independently influencing whether H.pylori infection was confirmed before or after discharge.Among the patients discharged before confirmation of H.pylori infection,13.3%(14/105)were lost to follow-up.Among the patients found to be H.pylori-positive after discharge,41.4%(12/29)did not receive ET.There was no significant difference in the H.pylori eradication rate between patients who received ET during hospitalization a n d t h o s e w h o c o m m e n c e d E T a s o u t p a t i e n t s[intention-to-treat:68.8%(53/77)vs 60%(12/20),P=0.594;per-protocol:82.8%(53/64)vs 80%(12/15),P=0.723].CONCLUSION:Because many patients with PUB who were discharged before H.pylori infection status was confirmed lost an opportunity to receive ET,we should confirm H.pylori infection and start ET prior to discharge.

关键词： Helicobacter pylori Peptic ulcer hemorrhage diseas

Zebrafish as a disease model for studying human hepatocellular carcinoma

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World Journal of Gastroenterology 2015年第42期21卷 12042-12058页

作者： Jeng-Wei Lu Yi-Jung Ho Yi-Ju Yang Heng-An Liao Shih-Ci Ciou Liang-In Lin Da-Liang Ou Department of Clinical Laboratory Sciences and Medical Biotechnology College of Medicine National Taiwan University Institute of Preventive Medicine National Defense Medical Center Graduate Institute of Life Sciences National Defense Medical Center Institute of Biotechnology National Tsing Hua University Department of Laboratory Medicine National Taiwan University Hospital Graduate Institute of Oncology College of Medicine National Taiwan University

Liver cancer is one of the world's most common cancers and the second leading cause of cancer deaths. Hepatocellular carcinoma(HCC), a primary hepatic cancer, accounts for 90%-95% of liver cancer cases. The pathogenesis of HCC consists of a stepwise process of liver damage that extends over decades, due to hepatitis, fatty liver, fibrosis, and cirrhosis before developing fully into HCC. Multiple risk factors are highly correlated with HCC, including infection with the hepatitis B or C viruses, alcohol abuse, aflatoxin exposure, and metabolic diseases. Over the last decade, genetic alterations, which include the regulation of multiple oncogenes or tumor suppressor genes and the activation of tumorigenesis-related pathways, have also been identified as important factors in HCC. Recently, zebrafish have become an important living vertebrate model organism, especially for translational medical research. In studies focusing on the biology of cancer, carcinogen induced tumors in zebrafish were found to have many similarities to human tumors. Several zebrafish models have therefore been developed to provide insight into the pathogenesis of liver cancer and the related drug discovery and toxicology, and to enable the evaluation of novel smallmolecule inhibitors. This review will focus on illustrativeexamples involving the application of zebrafish models to the study of human liver disease and HCC, through transgenesis, genome editing technology, xenografts,drug discovery, and drug-induced toxic liver injury.

关键词： Cancer model Hepatocellular carcinoma Liver diseas

An association between the location of white matter changes and the behavioral and psychological symptoms of dementia in Alzheimer's disease patients

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Translational Neuroscience and Clinics 2016年第1期2卷 8-16页

作者： Tzuchou Lin Yihui Lin Linli Kao Yihui Kao Yuanhan Yang Pingsong Chou Mengni Wu Department of Neurology Kaohsiung Medical University Hospital Department of Neurology "National Taiwan University Hospital Yun-Lin Branch" Department of Neurology Kaohsiung Municipal Ta‐Tung Hospital Kaohsiung Medical University Department of Master’s Program in Neurology Faculty of Medicine Kaohsiung Medical University

Objective:The frontal lobe may be involved in circuits associated with depression,apathy,aggression,and other psychiatric symptoms.Although white matter changes(WMC)are related to the severity of behavioral and psychological symptoms of dementia(BPSD)in patients with Alzheimer’s disease(AD),it is unclear which part of the WMC may play the most important role in BPSD.This study was designed to investigate the relationship between the location of WMC and the severity of BPSD in AD patients.Methods:Among patients diagnosed with Alzheimer’s disease between 2009 and2014,387 patients were retrospectively reviewed after those with pre‐existing organic brain syndrome,psychiatric diseases,or toxic‐metabolic encephalopathy were excluded.Patients’demographic and laboratory data,WMC measured with brain computed tomography and scored using the age‐related white matter changes(ARWMC)scale,and neuropsychological tests,including the cognitive abilities screening instrument(CASI),the Mini‐Mental State Examination(MMSE),the clinical dementia rating scale with sum‐box(CDR‐SB),and the neuropsychiatric inventory(NPI)were analyzed.Results:There was no significant difference in the NPI between patients with and without a history of stroke,hypertension,and diabetes.No significant difference in the NPI was identified between different sexes or different Apolipoprotein E(APOE)alleles.The NPI score was significantly correlated with the duration of education(r=–0.4515,P=0.0172),CASI(r=–0.2915,P<0.0001),MMSE(r=–0.8476,P<0.0001),and CDR‐SB(r=2.2839,P<0.0001).WMC in the right frontal lobe showed a significant difference in NPI in comparison to those without WMC(P=0.0255).After adjusting for age,duration of education,and CASI,WMC in the right frontal lobe remained significantly associated with the NPI score(β=3.8934,P=0.042).Conclusions:WMC involving the right frontal lobe may play an important role in the BPSD in AD patients during their dementia diagnosis.Further studies are necessary to confirm whether controlling the risk factors of WMC can

关键词： Alzheimer’s diseas white matter changes leukoaraiosis behavioral and psychological symptoms of dementia

Cardioprotection by remote ischemic conditioning: Mechanisms and clinical evidences

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World Journal of Cardiology 2015年第10期7卷 621-632页

作者： Alberto Aimo Chiara Borrelli Alberto Giannoni Luigi Emilio Pastormerlo Andrea Barison Gianluca Mirizzi Michele Emdin Claudio Passino Institute of Life Sciences Scuola Superiore Sant’Anna Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio

In remote ischemic conditioning(RIC), several cycles of ischemia and reperfusion render distant organ and tissues more resistant to the ischemia-reperfusion injury. The intermittent ischemia can be applied before the ischemic insult in the target site(remote ischemic preconditioning), during the ischemic insult(remote ischemic perconditioning) or at the onset of reperfusion(remote ischemic postconditioning). The mechanisms of RIC have not been completely defined yet; however, these mechanisms must be represented by the release of humoral mediators and/or the activation of a neural reflex. RIC has been discovered in the heart, and has been arising great enthusiasm in the cardiovascular field. Its efficacy has been evaluated in many clinical trials, which provided controversial results. Our incomplete comprehension of the mechanisms underlying the RIC could be impairing the design of clinical trials and the interpretation of their results. In the present review we summarize current knowledge about RIC pathophysiology and the data about its cardioprotective efficacy.

关键词： Remote ischemic conditioning Ischemic heart diseas

Assessing cardiovascular risk in hepatitis C: An unmet need

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World Journal of Hepatology 2015年第19期7卷 2214-2219页

作者： Javier Ampuero Manuel Romero-Gómez Intercentre Unit of Digestive diseases Virgen Macarena - Virgen del Rocio University Hospitals

Chronic hepatitis C virus(HCV) is associated with significant morbidity and mortality, as a result of the progression towards cirrhosis and hepatocellular carcinoma. Additionally, HCV seems to be an independent risk factor for cardiovascular diseases(CVD) due to its association with insulin resistance, diabetes and steatosis. HCV infection represents an initial step in the chronic inflammatory cascade, showing a direct rolein altering glucose metabolism. After achieving sustained virological response, the incidence of insulin resistance and diabetes dramatically decrease. HCV core protein plays an essential role in promoting insulin resistance and oxidative stress. On the other hand, atherosclerosis is a common disease in which the artery wall thickens due to accumulation of fatty deposits. The main step in the formation of atherosclerotic plaques is the oxidation of low density lipoprotein particles, together with the increased production of proinflammatory markers [tumor necrosis factor-α, interleukin(IL)-6, IL-18 or C-reactive protein]. The advent of new direct acting antiviral therapy has dramatically increased the sustained virological response rates of hepatitis C infection. In this scenario, the cardiovascular risk has emerged and represents a major concern after the eradication of the virus. Consequently, the number of studies evaluating this association is growing. Data derived from these studies have demonstrated the strong link between HCV infection and the atherogenic process, showing a higher risk of coronary heart disease, carotid atherosclerosis, peripheral artery disease and, ultimately, CVD-related mortality.

关键词： Hepatitis C Atherosclerosis Coronary artery diseas