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Non-alcoholic fatty liver disease-related hepatocellular carcinoma:Is there a role for immunotherapy?

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World Journal of gastroenterology 2022年第28期28卷 3595-3607页

作者： Ângelo Z Mattos Jose D Debes Arndt Vogel Marco Arrese Xavier Revelo Tales Henrique S Pase Muriel Manica Angelo A Mattos Graduate Program in medicine:hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90050-170Brazil gastroenterology and hepatology Unit Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90050-170Brazil department of medicine University of MinnesotaMinneapolisMN 55455United States department of gastroenterology and hepatology Erasmus Medical CenterRotterdam 999025Netherlands department of gastroenterology Hepatology and EndocrinologyHannover Medical SchoolHannover 30625Germany department of gastroenterology School of Medicine and Center for Aging and RegenerationFaculty of Biological SciencesPontificia Universidad Católica de ChileSantiago 3580000Chile department of Integrative Biology and Physiology University of MinnesotaMinneapolisMN 55455United States Internal medicine Unit Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Brazil

Hepatocellular carcinoma(HCC)is among the most common cancers and it is a major cause of cancer-related ***-alcoholic fatty liver disease(NAFLD)affects approximately one fourth of individuals worldwide and it is becoming one of the most important causes of *** pathogenic mechanisms leading to NAFLD-related HCC are complex and not completely ***,metabolic,fibrogenic,oncogenic,inflammatory and immunological pathways seem to be ***-line therapy of advanced HCC has recently undergone major changes,since the combination of atezolizumab and bevacizumab was proven to increase survival when compared to *** immune-oncology drugs are also demonstrating promising results in patients with advanced HCC when compared to traditional systemic ***,initial studies raised concerns that the advantages of immunotherapy might depend on the underlying liver disease,which seems to be particularly important in NAFLD-related HCC,as these tumors might not benefit from *** article will review the mechanisms of NAFLD-related hepatocarcinogenesis,with an emphasis on its immune aspects,the efficacy of traditional systemic therapy for advanced NAFLD-related HCC,and the most recent data on the role of immunotherapy for this specific group of patients,showing that the management of this condition should be individualized and that a general recommendation cannot be made at this time.

关键词： Non-alcoholic fatty liver disease Hepatocellular carcinoma Hepatocarcinogenesis Immunology Immunotherapy Tyrosine kinase inhibitors

Spot urinary sodium for assessing dietary sodium restriction in cirrhotic ascites

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World Journal of gastroenterology 2009年第29期15卷 3631-3635页

作者： Mohammed Abdelhamid El-Bokl Bahaa Eldeen Senousy Khaled Zakaria El-Karmouty Inas El-Khedr Mohammed Sherif Monier Mohammed Sherif Sadek Shabana Hassan Shalaby department of gastroenterology and hepatology Ain Shams University school of Medicine Abbassia 11566 Cairo Egypt

AIM: To evaluate the accuracy of spot urinary Na/K and Na/creatinine (Cr) ratios as an alternative to 24-h urinary sodium in monitoring dietary compliance in patients with liver cirrhosis and ascites treated with diuretics. METHODS: The study was carried on 40 patients with liver cirrhosis and ascites treated with diuretic therapy. Patients were divided into two groups according to 24-h urinary sodium. We measured spot urine Na/K ratio, Na/ Cr ratio and 24-h urinary sodium. Student's t test was used to compare the interval variables and χ2 test to compare the nominal variables between the two groups. Receiver operator characteristic curve was used to identify the best cutoff point for Na/K and Na/Cr ratio. RESULTS: The best cutoff point for Na/K ratio was 2.5 (P < 0.001) and area under the curve (AUC) was 0.9, and for Na/Cr ratio, the best cutoff point was 35 (P < 0.001) and AUC was 0.885. Na/K ratio showed higher sensitivity and accuracy compared to Na/Cr ratio (87.5% and 87% for Na/K ratio; 81% and 85% for Na/Cr ratio, respectively). CONCLUSION: Spot urine Na/K ratio has adequate accuracy for assessment of dietary sodium restrictioncompared with 24-h urinary sodium in patients with liver cirrhosis and ascites.

关键词：饮食情况利尿剂肝硬化腹水评估现货钠特征曲线

HCC case management-related challenges:Think outside the box!

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iLIVER 2023年第3期2卷 143-145页

作者： Nourhan Badwei Lecturer in Tropical medicine Gastroenterology and HepatologyHepatoma GroupFaculty of MedicineAin Shams UniversityCairoEgypt

To the Editor,Hepatocellular carcinoma(HCC)is a common primary liver malig-nancy that mainly occurs in chronic liver disease patients with under-lying *** incidence has increased globally in the last two *** incidence is expected to increase until 2030 in certain geographical regions,namely Asia and *** increase is owing to the high endemic prevalence of viral etiologies(i.e.,hepatitis virus B/C(HBV/HCV))that result in chronic liver disease and HCC.

关键词： liver outside cirrhosis

Hepatic and gastrointestinal disturbances in Egyptian patients infected with coronavirus disease 2019: A multicentre cohort study

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World Journal of gastroenterology 2021年第40期27卷 6951-6966页

作者： Hend Ibrahim Shousha Shimaa Afify Rabab Maher Noha Asem Eman Fouad Ehab F Mostafa Mohammed A Medhat Amr Abdalazeem Hazem Elmorsy Miriam M Aziz Rateba S Mohammed Mohamed Ibrahem Hassan Elgarem Dalia Omran Mohamed Hassany Bassem Elsayed Ahmed Y Abdelaziz Mohamed El Kassas Endemic medicine Faculty of MedicineCairo UniversityCairo 11562Egypt gastroenterology department National Hepatology&Tropical Medicine Research InstituteCairo 11563Egypt hepatology department Students HospitalCairo UniversityGiza 12566Egypt The Public Health department Faculty of MedicineCairo UniversityCairo 11562Egypt Egyptian Ministry of Health and PopulationCairo 11567Egypt department of Tropical medicine and gastroenterology Faculty of MedicineAssiut UniversityAssiut 15655Egypt Endemic medicine department Faculty of MedicineHelwan UniversityCairo 13544Egypt Internal medicine 15 Mayo Smart HospitalMinistry of Health and PopulationCairo 13488Egypt Pediatrics department Faculty of MedicineCairo UniversityCairo 11562Egypt Occupational and Environmental medicine department Faculty of MedicineCairo UniversityCairo 11562Egypt Clinical Biochemistry department Faculty of medicineCairo UniversityCairo 11562Egypt Endemic medicine department Faculty of MedicineCairo UniversityCairo 11562Egypt Urology department Cairo UniversityCairo 11562Egypt

BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019(COVID-19)at variable *** studies report mild liver function disturbances correlated with COVID-19 severity,though liver failure is *** To study liver and gastrointestinal dysfunctions in Egyptian patients with COVID-19 and their relation to disease outcomes METHODS This multicentre cohort study was conducted on 547 Egyptian patients from April 15,2020 to July 29,*** polymerase chain reaction-confirmed COVID-19 cases were included from four quarantine hospitals affiliated to the Egyptian ministry of *** information,laboratory characteristics,treatments,fibrosis-4(FIB-4)index,COVID-19 severity,and outcomes were recorded and compared according to the degree of liver enzyme elevation and the presence of gastrointestinal ***-ups were conducted until discharge or *** analyses were performed to determine the independent factors affecting *** This study included 547 patients,of whom 53(9.68%)died during hospitalization and 1 was discharged upon his ***’mean age was 45.04±17.61 years,and 21.98%had severe or critical *** aminotransferase(ALT)and aspartate aminotransferase(AST)were available for 430 and 428 patients,*** total,26%and 32%of patients had elevated ALT and AST,*** liver injury with ALT or AST elevation exceeding 3-fold was recorded in 21(4.91%)and 16(3.73%)patients,*** gender,smoking,hypertension,chronic hepatitis C,and lung involvement were associated with elevated AST or *** was elevated in 50%of patients over ***-4 was significantly higher in patients admitted to the intensive care unit(ICU),those with more severe COVID-19,and *** independent variables affecting outcome were supplementary vitamin C intake(1 g daily capsules)[odds ratio(OR):0.05,95%confidence interval(CI

关键词： COVID-19 Egypt Liver injury Gastrointestinal symptoms Fibrosis-4 Liver enzymes

Pitfalls and promises of bile duct alternatives:A narrative review

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World Journal of gastroenterology 2022年第39期28卷 5707-5722页

作者： Mitsuo Miyazawa Masayasu Aikawa Junpei Takashima Hirotoshi Kobayashi Shunsuke Ohnishi Yoshito Ikada department of Surgery Teikyo University Mizonokuch HospitalKanagawa 213-8507Japan department of Surgery Saitama Medical University International Medical CenterSaitama 350-1298Japan department of gastroenterology and hepatology Hokkaido University Faculty of Medicine and Graduate School of MedicineSapporo 060-8638Japan department of Bioenvironmental medicine Nara Medical UniversityNara 634-8521Japan

Biliodigestive anastomosis between the extrahepatic bile duct and the intestine for bile duct disease is a gastrointestinal reconstruction that abolishes duodenal papilla function and frequently causes retrograde *** chronic inflammation can cause liver dysfunction,liver abscess,and even bile duct *** research has been conducted for over 100 years to directly repair bile duct defects with alternatives,no bile duct substitute(BDS)has been *** narrative review confirms our understanding of why bile duct alternatives have not been developed and explains the clinical applicability of BDSs in the near *** searched the PubMed electronic database to identify studies conducted to develop BDSs until December 2021 and identified studies in *** independent reviewers reviewed studies on large animals with 8 or more *** types of BDSs prevail:Autologous tissue,non-bioabsorbable material,bioabsorbable material,and others(decellularized tissue,3D-printed structures,etc.).In most studies,BDSs failed due to obstruction of the lumen or stenosis of the anastomosis with the native bile *** has not been developed primarily because control of bile duct wound healing and regeneration has not been elucidated.A BDS expected to be clinically applied in the near future incorporates a bioabsorbable material that allows for regeneration of the bile duct outside the BDS.

关键词： Bile duct alternative Bile duct substitute Biliary regeneration Bile duct reconstruction Peribiliary gland Bioabsorbable polymer

Serum vascular endothelial growth factor as a tumor marker for hepatocellular carcinoma in hepatitis C virus-related cirrhotic patients

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World Journal of Gastrointestinal Oncology 2021年第6期13卷 600-611页

作者： Ahmed Alzamzamy Huda Elsayed Mona Abd Elraouf Hanan Eltoukhy Tarek Megahed Ashraf Aboubakr department of gastroenterology and hepatology Military Medical AcademyCairo 11841Egypt department of gastroenterology and hepatology Maadi Armed Forces Medical ComplexCairo 11841Egypt department of Internal medicine Faculty of Medicine for GirlsAl-Azhar UniversityCairo 11311Egypt department of Clinical Pathology Military Medical AcademyCairo 11311Egypt

BACKGROUND Hepatocellular carcinoma(HCC)accounts for 8.2%of all cancer-related deaths *** a vascular tumor,vascular endothelial growth factor(VEGF)plays a vital role in HCC pathogenesis,growth,and *** To determine the accuracy of serum VEGF and VEGF/platelet(PLT)as tumor markers in the early detection of HCC cases in patients with hepatitis C virus(HCV)-related liver *** We conducted a case-control study with HCV patients from the outpatient and inpatient hepatology *** were classified into three groups:(1)HCC group;(2)Cirrhosis group;and(3)HCV without cirrhosis(control group).Patients were clinically evaluated,and blood samples were drawn for the analysis;serum VEGF levels were measured by a specific VEGF human recombinant enzyme-linked immunosorbent assay *** from the three study groups were compared by the one-way analysis of variance or Kruskal-Wallis *** operating characteristic curves were constructed to determine the optimal cut-off values of alpha fetoprotein(AFP),VEGF,and VEGF/PLT that provided the best diagnostic *** sensitivity and specificity at the optimal cut-off value of each biomarker were then *** This study included one hundred patients(HCC,cirrhosis,and control groups:n=40,30,30,respectively).HCC patients had significantly higher serum VEGF and VEGF/PLT levels than the non-HCC groups(P=0.001).Serum VEGF and VEGF/PLT showed significant positive correlations with and HCC tumor size,stage,vascular invasion,and Child-Pugh ***,a VEGF cut-off the value of 250 pg/mL provided 80%sensitivity and 81.7%specificity for discriminating HCC patient from non-HCC ***,the ratio of VEGF/PLT provided sensitivity and specificity of 77.5%and 80%,respectively which is higher than the accuracy provided by *** combination of AFP,VEGF,and VEGF/PLT increases the accuracy of diagnosing HCC to>95%.CONCLUSION In HCV patients,serum VEGF and VEGF/PLT separ

关键词： Hepatocellular carcinoma Vascular endothelial growth factor Biomarkers Diagnosis

Barriers for resuming endoscopy service in the context of COVID-19 pandemic:A multicenter survey from Egypt

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World Journal of gastroenterology 2020年第43期26卷 6880-6890页

作者： Omar Elshaarawy Sameh Aldesoky Lashen Nahed A Makhlouf Doaa Abdeltawab Mariam Salah Zaghloul Rasha M Ahmed Hayam Fathy Shimaa Afifi Muhammad Abdel-Gawad Eman Abdelsameea Sherief Abd-Elsalam Salem Youssef Mohamed Mohammed Tag-Adeen Mina Tharwat Ahmed Alzamzamy Ahmed Nasr Bekhit Alshaimaa M Eid Abeer Awad Mohamed-Naguib Wifi Mohammad Aamr Waleed A Abd El Dayem Mohamed Alboraie department of hepatology Gastroenterology and Liver TransplantationNational Liver InstituteMenoufia UniversityShebine Elkom 32511Egypt department of Internal medicine and Center of Alcohol Research and Liver Diseases Salem Medical CenterHeidelberg UniversityHeidelberg 69121Germany department of Internal medicine Faculty of MedicineUniversity of AlexandriaAlexandria 21521Egypt department of Tropical medicine and gastroenterology Faculty of MedicineAssiut UniversityAssiut 71515Egypt department of hepatology Gastroentrology and Infectious DiseasesKafrelsheikh UniversityFaculty of MedicineKafrelsheikh 33565Egypt department of Internal medicine Faculty of MedicineAssiut UniversityAssiut 71515Egypt National hepatology and Tropical medicine Research Institute Cairo 11638Egypt department of hepatology Gastroenterology and Infectious DiseasesFaculty of MedicineAl-Azhar UniversityAssiut 71524Egypt department of Tropical medicine and Infectious Diseases Faculty of MedicineTanta UniversityTanta 31527Egypt department of Internal medicine Gastroenterology and Hepatology UnitFaculty of MedicineZagazig UniversityZagazig 44519Egypt department of Internal medicine Gastroenterology UnitQena Faculty of MedicineSouth Valley UniversityQena 83523Egypt department of Tropical medicine and gastroenterology Faculty of MedicineAswan UniversityAswan 81528Egypt department of gastroenterology and hepatology Military Medical AcademyCairo 11771Egypt department of Tropical medicine Zagazig General HospitalZagazig 42511Egypt department of hepatology and gastroenterology and Infectious Disease Faculty of MedicineAlAzhar UniversityCairo 11562Egypt department of Internal medicine Faculty of MedicineCairo UniversityCairo 11759Egypt department of hepatology and Gastroentorolgy Shebin Elkom Teaching HospitalShebine Elkom 3521Egypt department of Tropical medicine Faculty of MedicineZagazig UniversityZagazig 44519Egypt department of Internal medicine Al-Azhar UniversityCairo 11651Egypt

BACKGROUND The current coronavirus disease 2019(COVID-19)pandemic has affected routine endoscopy service across the gastroenterology *** led to the suspension of service provision for elective *** To assess the potential barriers for resuming the endoscopy service in *** A national online survey,four domains,was disseminated over a period of 4 wk in August *** primary outcome of the survey was to determine the impact of the COVID-19 pandemic on the endoscopy service and barriers to the full resumption of a disabled center(s).RESULTS A hundred and thirteen Egyptian endoscopy centers participated in the *** waiting list was increased by≥50% in 44.9% of areas with clusters of COVID-19 cases(n=49)and in 35.5% of areas with sporadic cases(n=62).Thirty nine(34.8%)centers suffered from staff shortage,which was considered a barrier against service resumption by 86.4% of centers in per-protocol *** multivariate analysis,the burden of cases in the unit locality,staff shortage/recovery and the availability of separate designated rooms for COVID-19 cases could markedly affect the resumption of endoscopy practice(P=0.029,<0.001 and 0.02,respectively)and Odd’s ratio(0.15,1.8 and 0.16,respectively).CONCLUSION The COVID-19 pandemic has led to restrictions in endoscopic *** staff shortage/recovery and the availability of COVID-19 designed rooms are the most important barriers against *** working hours and dividing endoscopy staff into teams may help to overcome the current situation.

关键词： COVID-19 Endoscopy Practice Pandemic Egypt Barriers

Clinical significance of low transaminase levels in children with inflammatory bowel disease

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World Journal of Pediatrics 2019年第2期15卷 143-147页

作者： Murat Cakir Elif Sag Guzide Dogan Fatih Unal Erhun Kasirga department of Pediatric gastroenterology hepatology and Nutrition Faculty of MedicineKaradeniz Technical UniversityTrabzonTurkey department of Pediatric gastroenterology hepatology and Nutrition Faculty of MedicineManisa Celal Bayar UniversityManisaTurkey department of Pediatric gastroenterology hepatology and Nutrition BursaTurkey

Background Low alanine aminotransaminase (LALT) levels may be seen in patients with inflammatory bowel disease (IBD),but there has been no study about the frequency and its clinical *** aimed to analyze the frequency of LALT,and its clinical significance in children with *** The study included the 89 patients with IBD without hepatobiliary *** was defined as ALT levels < 5 U/*** and clinical findings and outcome of the patients with and without LALT were *** LALT was found 47.1% of the *** initial examination,it was more common in female patients (92.3 vs.41.3%,P < 0.001) and patients with CD (57.7 vs.30.2%,P=0.01).75% of the patients with penetrating Crohn's disease (CD) had LALT (P=0.002).Hemoglobin (10.4±2.1 vs.11.7± 1.9 g/dL,P=0.01),folic acid (5.2±3.3 vs.8.6±5.9 ng/mL,P =0.02) and serum albumin levels (3.6 ± 0.8 vs.4.7 ± 5 g/dL,P =0.002) were significantly low in patients with *** was associted with the disease relapse within 2 weeks in 12 of the 16 patients with LALT whereas it was seen in 16 of the 73 patients without LALT during the follow-up (75 vs.21.9%,P < 0.001).Additionally,steroid dependency was more common in patients with LALT during the follow-up (62.5 vs.12.3%,P<0.001).Conclusions LALT is common in children with IBD especially in CD and associated with low hemoglobin,albumin and folic acid *** may be a marker of relapse and steroid dependency.

关键词： Children Inflammatory bowel disease Low transaminase levels Vitamin B6

Eliminating viral hepatitis in children after liver transplants:How to reach the goal by 2030

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World Journal of gastroenterology 2022年第3期28卷 290-309页

作者： Palittiya Sintusek Kessarin Thanapirom Piyawat Komolmit Yong Poovorawan The Thai Pediatric gastroenterology Hepatology and Immunology(TPGHAI)Research UnitChulalongkorn UniversityBangkok 10330Thailand Division of gastroenterology Department of PediatricsFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkok 10330Thailand Division of gastroenterology Department of MedicineLiver Fibrosis and Cirrhosis Research UnitFaculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkok 10330Thailand Center of Excellence in Liver Diseases King Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkok 10330Thailand Center of Excellence in Clinical Virology Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand

Viral hepatitis infections are a great burden in children who have received liver *** viruses can cause liver inflammation that can develop into liver graft fibrosis and cirrhosis over the long *** reactions due to viral hepatitis infections are associated with or can mimic graft rejection,rendering the condition difficult to *** strategies using vaccinations are agreeable to patients,safe,cost-effective and ***,strategies to eliminate viral hepatitis A and B focus mainly on immunization programmes for children who have received a liver *** a vaccine has been developed to prevent hepatitis C and E viruses,its use is not licensed ***,eliminating hepatitis C and E viruses mainly involves early detection in children with suspected cases and effective treatment with antiviral *** hygiene and sanitation are also important to prevent hepatitis A and E *** blood products and liver grafts should be screened for hepatitis B,C and E in children who are undergoing liver *** research on early detection of viral hepatitis infections should include molecular techniques for detecting hepatitis B and ***,novel antiviral drugs for eradicating viral hepatitis that are highly effective and safe are needed for children who have undergone liver transplantation.

关键词： Viral hepatitis Children Adolescent Liver transplantation Infection Elimination