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World Journal of gastroenterology 2007年第26期13卷 3575-3580页

作者： Anthony J Michaels Peter V Draganov University of Florida Department of GastroenterologyHepatology and NutritionUnited States

Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to pain management in pancreatic disease is the use of celiac plexus block (CPB) or neurolysis (CPN). Originally performed by anesthesiologists and radiologists via a posterior approach,recent advances in endoscopic ultrasonography (EUS) have made this technique an attractive alternative. EUS guided celiac plexus block/ neurolysis is simple to perform and avoids serious complications such as paraplegia or pneumothorax that are associated with the posterior approach. EUS guided CPN should be considered first line therapy in patients with pain due to pancreatic cancer. It provides superior pain control compared to traditional management with narcotics. A trend for improved survival in pancreatic cancer patients treated with CPN has been reported,but larger studies are needed to confirm this finding. At this time,the use of EUS guided CPB cannot be recommended as routine therapy for pain in chronic pancreatitis since only one-half of the patients experience pain reduction and the beneficial effect tends to be short lived. EUS guided CPB and CPN should be used as part of a multidisciplinary team approach for pain management.

关键词： Celiac plexus Celiac plexus neurolysis Celiacplexus block Endoscopic ultrasound Pain management

Diagnosis and therapy of ascites in liver cirrhosis

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World Journal of gastroenterology 2011年第10期17卷 1237-1248页

作者： Erwin Biecker department of Internal Medicine Gastroenterology and HepatologyHelios Klinikum Siegburg

Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis. It is important to distinguish noncirrhotic from cirrhotic causes of ascites to guide therapy in patients with noncirrhotic ascites. Mild to moderate ascites is treated by salt restriction and diuretic therapy. The diuretic of choice is spironolactone. A combination treatment with furosemide might be necessary in patients who do not respond to spironolactone alone. Tense ascites is treated by paracentesis, followed by albumin infusion and diuretic therapy. Treatment options for refractory ascites include repeated paracentesis and transjugular intrahepatic portosystemic shunt placement in patients with a preserved liver function. Potential complications of ascites are spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). SBP is diagnosed by an ascitic neutrophil count > 250 cells/mm3 and is treated with antibiotics. Patients who survive a first episode of SBP or with a low protein concentration in the ascitic fluid require an antibiotic prophylaxis. The prognosis of untreated HRS type 1 is grave. Treatment consists of a combination of terlipressin and albumin. Hemodialysis might serve in selected patients as a bridging therapy to liver transplantation. Liver transplantation should be considered in all patients with ascites and liver cirrhosis.

关键词： Ascites Liver cirrhosis Diuretics Sodiumbalance Spontaneous bacterial peritonitis Hepatorenalsyndrome Transjugular intrahepatic portosystemic shunt

Impact of interferon-free antivirus therapy on lipid profiles in patients with chronic hepatitis C genotype 1b

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World Journal of gastroenterology 2017年第13期23卷 2355-2364页

作者： Daisuke Endo Kenichi Satoh Noritomo Shimada Atsushi Hokari Yoshio Aizawa department of gastroenterology and hepatology Internal Medicine of Jikei University Katsushika Medical Center department of gastroenterology and hepatology Internal Medicine of Otakanomori Hospital

AIM To investigate the influence of interferon-free antivirus therapy on lipid profiles in chronic hepatitis C virus genotype 1b(HCV1b) *** Interferon-free antiviral agents were used to treat 276 patients with chronic HCV1 b infection, and changes in serum lipids of those who achieved sustained virologic response(SVR) were examined. The treatment regimen included 24 wk of daclatasvir plus asunaprevir(DCV + ASV) or 12 wk of sofosbuvir plus ledipasvir(SOF + LDV). SVR was achieved in 121(85.8%) of 141 patients treated with DCV + ASV and 132(97.8%) of 135 patients treated with SOF + LDV. In the two patient groups(DCV + ASV-SVR and SOF + LDV-SVR), serum total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), and triglycerides were measured at baseline during treatment and at 4 and 12 wk after treatment. Then, longitudinal changes in lipid profiles were *** Serum levels of TC, LDL-C, and HDL-C were significantly increased throughout the observation period in both the DCV + ASV-SVR and SOF + LDV-SVR groups. During antivirus treatment, the increases in TC and LDL-C were significantly greater in the SOF + LDVSVR group than in the DCV + ASV-SVR group(P < 0.001). At 4 and 12 wk after the therapy, serum levels of TC and LDL-C were similar between the two groups and were significantly greater than those at baseline. Approximately 75%-80% of the increase in TC was derived from an increased LDL-C. In multiple regression analysis, the difference in therapy protocol(DCA + ASV or SOF + LDV) was an independent predictor that was significantly associated with the increase in TC and LDL-C at 4 wk of *** Serum cholesterol significantly increased during SOF + LDV treatment. After treatment, HCV elimination was associated with a similar increase in cholesterol regardless of the therapy protocol.

关键词： Chronic hepatitis C Daclatasvir Asunaprevir Sofosbuvir Ledipasvir Total cholesterol Low-density lipoprotein cholesterol

Complications of endoscopic retrograde cholangiography in the post-MRCP era: A tertiary center experience

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World Journal of gastroenterology 2005年第33期11卷 5209-5212页

作者： Tze-Zen Ong Jen-Lock Khor Dede-Sutedja Selamat Khay-Guan Yeoh Khek-Yu Ho department of gastroenterology and hepatology National University Hospital Singapore

AZM： To evaluate our experience in endoscopic retrograde cholangio-pancreatography （ERCP） in terms of fulfilling the ASGE guidelines in indications, positive findings, and complications in the post-magnetic resonance cholangiopancreatography （MRCP） era. METHODS： Between November 2001 and February 2003, consecutive ERCP cases were prospectively evaluated with regard to the indications, findings, cannulation techniques, devices used during the procedure, sedation given, duration of procedure, and complications. These data were entered in a database for subsequent processing and analysis. RESULTS： Of 336 cases, 21.4% were diagnostic and 78.6% therapeutic ERCR The indications for ERCP fulfilled the ASGE guidelines in 323 cases （96.1%）. Suspected bile duct stone was the most frequent indication （26.8%）, and this was followed by cholangitis （24.4%）, dilated common bile duct （14.9%）, and cholestatic jaundice （23.4%）. Cannulation success rate was 94%. Biliary sphincterotomy was performed in 175 （52.1%） patients. Repeated ERCP was performed on 31.5% of the patients. Overall, the complication rate was 9.8% with 0.3% being procedurerelated mortality. The complications were pancreatitis （5.4%）, bleeding （0.8%）, cholangitis （2.4%） and others （1.5%）. No significant difference was observed between the complication rate and the type of ERCP performed. CONCLUSION： Our study showed that post-ERCP complication rate was comparable with the other large prospective studies and there was no difference in the complication between the diagnostic and therapeutic ERCP.

关键词： Endoscopic retrograde cholangiopancreatogram Complication Pancreatitis

Alcoholic hepatitis 2010:A clinician's guide to diagnosis and therapy

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World Journal of gastroenterology 2010年第39期16卷 4905-4912页

作者： Maziyar Amini Bruce A Runyon department of gastroenterology and hepatology Loma Linda University Medical Center

Alcoholic hepatitis(AH)remains a common and life threatening cause of liver failure,especially when it is *** the adjective"acute"is frequently used to describe this form of liver injury,it is usually subacute and has been developing for weeks to months before it becomes clinically *** with this form of alcoholic liver disease usually have a history of drinking heavily for many *** certain aspects of therapy,mainly nutritional support and abstinence are well established,significant debate has surrounded the pharmacologic treatment of AH,and many institutions practice widely varying treatment protocols. In recent years a significant amount of literature has helped focus on the details of treatment,and more data have accumulated regarding risks and benefits of pharmacologic *** particular,the efficacy of pentoxifylline has become increasingly apparent,and when compared with the risks associated with prednisolone,has brought this drug to the forefront of therapy for severe *** review will focus on the clinical and laboratory diagnosis and pharmacologic therapies that should be applied during hospitalization and continued into outpatient *** conclude that the routine use of glucocorticoids for severe AH poses significant risk with equivocal benefit,and that pentoxifylline is a better,safer and cheaper *** the full details of nutritional support lie beyond the scope of this article,nutrition is a cornerstone of therapy and must be addressed in every patient diagnosed with AH. Finally,while traditional psychosocial techniques play a major role in post-hospitalization care of alcoholics, we hope to make the medical clinician realize his or her role in reducing recidivism rates with early and frequent outpatient visits and with the use of baclofen to reduce alcohol craving.

关键词： Alcoholic hepatitis Alcoholic liver disease Pentoxifylline Baclofen

Copper toxicosis gene MURRl is not changed in Wilson disease patients with normal blood ceruloplasmin levels

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World Journal of gastroenterology 2006年第14期12卷 2239-2242页

作者： Karl Heinz Weiss Uta Merle Mark Schaefer Peter Ferenci Joachim Fullekrug Wolfgang Stremmel department of gastroenterology University of Heidelberg Germany department of gastroenterology and hepatology Medical University of Vienna Austria

AIM： To analyze our Wilson disease patient cohort （n = 106） for alterations in the gene coding for MURR1. METHODS： Patients with an established diagnosis of Wilson disease but normal ceruloplasmin blood levels were chosen for our study （n = 14）. Patients with two known disease-causing mutations in the ATPTB gene were not included. The three exons of the human MURR1 gene were sequenced after amplification of the genomic DNA by polymerase chain reaction. RESULTS： Our study did not reveal any mutations leading to an amino acid change in the MURR1 sequence of Wilson disease patients. A polymorphism at 472 bp of the coding sequence could be confirmed. CONCLUSION： The MURRI gene plays no role in the pathogenesis of Wilson disease patients with normal serum ceruloplasmin levels.

关键词： Wilson Disease ATPTB MURR1 COMMD1

Clinical value of circular RNAs and autophagy-related mi RNAs in the diagnosis and treatment of pancreatic cancer

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Hepatobiliary & Pancreatic Diseases International 2019年第6期18卷 511-516页

作者： Pei-Cheng Jiang Shu-Rui Bu department of gastroenterology and hepatology Jinshan Hospital Affiliated to Fudan University

Background:Circular RNAs(circRNAs)are a special group of long-chain and non-coding RNAs characterized by a closed-loop structure without 3’and 5’*** recent years,studies have demonstrated that circRNAs act as microRNA(miRNA)sponges to regulate the function of *** evidence indicates that circRNAs and targeted miRNAs are involved in the development,progression and metastasis of various cancers and drug resistance.A number of miRNAs are known to be associated with the pathogenesis,development and treatment of pancreatic cancer by regulating the autophagic *** sources:A comprehensive literature search was executed in PubMed and EMBASE using the medical subject headings(MeSH)terms“Pancreatic Neoplasms”,“autophagy”,“RNA,circular”and“microRNA”.We also used text terms such as“diagnosis”,“prognosis”and“biomarker”to supplement the ***:Autophagy-related miRNAs is closely related to pancreatic *** basis of the retrieval results,we summarized the synthesis,features and functions of circRNAs and analyzed the association between autophagy-related miRNAs and pancreatic ***:circRNAs act as the miRNA sponges and there is an association between miRNAs and autophagy,which provides a new concept to broaden the knowledge about the mechanisms underlying the development,progression and metastasis of pancreatic ***,clinical value of circRNAs and autophagy-related miRNAs in the diagnosis and treatment of pancreatic cancer would be further verified with in-depth researches.

关键词： Autophagy Circular RNAs miRNA sponge Pancreatic cancer

Birthplace is not a determinant of colorectal adenomas

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World Journal of gastroenterology 2014年第26期20卷 8606-8611页

作者： Fiona Tran Jenn Hian Koo department of gastroenterology and hepatology Liverpool Hospital department of gastroenterology The University of New South Wales

AIM: To examine the impact of the patient’s birthplace on the prevalence of colonic polyps and histopathological subtypes.

关键词： Ethnicity Polyps Adenomas Advanced adenomas Colorectal cancer

Hepatitis C virus therapy with peg-interferon and ribavirin in Myanmar: A resource-constrained country

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World Journal of gastroenterology 2016年第43期22卷 9613-9622页

作者： Naomi Khaing Than Hlaing Debolina Banerjee Robert Mitrani Soe Htet Arker Kyaw San Win Nyan Lin Tun Zaw Thant Khin Maung Win K Rajender Reddy department of hepatology Mandalay General Hospital Division of gastroenterology and hepatology University of Pennsylvania

AIM To investigate peg-interferon(peg-IFN) and ribavirin(RBV) therapy in Myanmar and to predict sustained virologic response(SVR).METHODS This single-center, open-label, study was conducted in Myanmar between 2009 and 2014. A total of 288 patients infected with HCV genotypes 1, 2, 3 and 6 were treated with peg-IFN alpha-2a(180 μg/wk) or alpha-2b(50 to 100 μg as a weight-based dose) and RBV as a weight-based dose(15 mg/kg/d). Treatment duration was 48 wk for genotypes 1 and 6, 24 wk for genotype 2, and 24 or 48 wk for genotype 3 based on rapid virologic response(RVR). Those co-infected with hepatitis B received 48 wk of *** Overall, SVR was achieved for 82% of patients and the therapy was well tolerated. All patients achieved SVR at equivalent rates regardless of HCV genotype(P = 0.314). Low fibrosis scores(P 96% positive predictive value for achieving SVR. Treatment duration did not significantly impact the likelihood of achieving SVR for patients infected with genotype 3 HCV(P = 0.371). The most common adverse events were fatigue(71%) and poor appetite(60%). Among patients with genotype 3 HCV, more patients in the 48-wk treatment group required erythropoietin than in the 24-wk treatment group(61.1% vs 49.2%).CONCLUSION SVR rates were high with peg-IFN and RBV therapy in Myanmar. Fibrosis scores, baseline albumin, HCV RNA levels and RVR independently predicted SVR.

关键词： Hepatitis C virus Pegylated-interferon Ribavirin Sustained virologic response Rapid virologic response

Effect of 5-HT1 agonist (sumatriptan) on anorectal function in irritable bowel syndrome patients

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World Journal of gastroenterology 2006年第10期12卷 1591-1596页

作者： Agata Mulak Leszek Paradowski department of gastroenterology and hepatology Wroclaw Medical University WroclawPoland

AIM： To evaluate the effect of sumatriptan, a selective 5-HT1 agonist, on anorectal function in irritable bowel syndrome （IBS） patients. METHODS： Twenty-two IBS patients selected according to the Rome II criteria （F 15, M 7; mean age 29.3±6.8, range 22-44 years） were examined. The study was blind, randomized and placebo-controlled with a crossover design. Anorectal manometry and rectal balloon distension test were performed before and after the administration of placebo and sumatriptan. RESULTS： The administration of sumatriptan caused a significant increase in the resting anal canal pressure from 9.2±2.0 kPa to 13.1±3.3 kPa （P〈0.0001） connected with the increase in the anal sphincter length and high pressure zone. After sumatriptan injection a remarkable increase in the threshold for the first sensation from 27±9 mL to 34±12 mL （P〈0.05） and urge sensation from 61±19 mL to 68±18 mL （P〈0.01） was observed. Sumatriptan did not affect either the volume evoking the rectoanal inhibitory reflex or the results of the straining test. CONCLUSION： 5-HT1 receptors participate in the regulation of anorectal function. Elucidation of the role of 5-HT1 receptors in the pathophysiological mechanisms of IBS may have some therapeutic implications.

关键词： Sumatriptan 5-HT receptors Irritable bowel syndrome, Anorectal function