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World Journal of Gastroenterology 2024年第9期30卷 994-998页

作者： Nikolaos Papadopoulos Eleni-Myrto Trifylli The Second department of internal medicine 401 General Army Hospital of AthensAthens 11525Greece The First department of internal medicine 417 Share Army Fund HospitalAthens 11521Greece

In this editorial,we comment on the article by Lyu et al published in the recent issue of the World Journal of Gastroenterology(2023;2219-2840).Hepatocellular carcinoma(HCC)is a frequently encountered and highly aggressive primary liver cancer,which remains the third-commonest cause of cancer-related death despite the current therapeutic modalities.There is urgency in developing novel thera-peutic approaches,such as by manipulating extracellular vesicles,which con-stitute a highly heterogeneous nanoparticle population that contains various cargoes.These cargoes have a pivotal role in cell-to-cell communication and can modify the functional level of the recipient cells via their uptake by other recipient cells.Exosomal non-coding RNAs have particular evolving significance in HCC,such as circular RNAs,which have been found differentially expressed in normal hepatic and HCC tissues.The aberrations in their expression levels have a key role in the HCC development and progression and the overall prognosis.In this editorial,we will shed light on the emerging role of exosomal circular RNAs in HCC development and progression,focusing on the oncogenic or potentially tumor suppressive effect of mesenchymal stem cells-derived exosomal non-coding RNAs.

关键词： circular sponge progression

Ten- year follow- up investigation of stroke risk in systemic lupus erythematosus

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Stroke & Vascular Neurology 2024年第1期9卷 1-7页

作者： Jin-An Huang Ching-Heng Lin Ming-Ju Wu Yi-Hsing Chen Kuo-Cheng Chang Chung-Wei Hou Division of Neurology Neurological InstituteTaichung Veterans General HospitalTaichungTaiwan department of Health Business Administration Hungkuang UniversityTaichungTaiwan department of Medical Research Taichung Veterans General HospitalTaichungTaiwan Division of Nephrology Department of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan School of medicine Chung Shan Medical UniversityTaichungTaiwan College of medicine National Chung Hsing UniversityTaichungTaiwan Division of Allergy Immunology and RheumatologyDepartment of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan School of medicine National Yang-Ming Chiao Tung UniversityTaichungTaiwan

Background and purpose To analyse the long-term risk of ischaemic stroke and the clinical effects of antithrombotics on the risk of haemorrhagic stroke in patients with systemic lupus erythematosus(SLE).Methods A retrospective cohort study was conducted using a population-based database taken from Taiwan National Health Insurance Research Database.Patients with SLE between 2000 and 2008 were registered and matched with two controls by the index date,age,gender and Charlson Comorbidity Index(CCI).These subjects were followed until either stroke event or 31 December 2013.Adjusted HRs(aHRs)for strokes were estimated with Cox regression models,and the cumulative incidence of ischaemic stroke was analysed by log-rank test and Kaplan-Meier survival analysis.Results In total,8310 patients with SLE and 16620 patients without SLE were included.In general,patients with SLE had higher rates of ischaemic stroke(5.4%vs 3.3%)and haemorrhagic stroke(1.5%vs 0.6%)than in controls.In multivariate analysis adjusted to age,gender,CCI,urbanisation level and antithrombotics uses,aHRs of all strokes,ischaemic stroke and haemorrhagic stroke were 1.73(95%CI:1.54 to 1.94),1.65(95%CI:1.45 to 1.87)and 2.24(95%CI:1.71 to 2.95),respectively,in patients with SLE.Patients with SLE were significantly more likely to suffer ischaemic stroke than patients without SLE,even 10 years after SLE diagnosis(6.12%vs 3.50%,p<0.001).Antiplatelet use increased the risk of haemorrhagic stroke in SLE group(aHR=1.74,95%CI:1.18 to 2.57).Conclusions Patients with SLE are at greater risk of developing ischaemic stroke that lasts for 10 years.Antiplatelets should be carefully administered to prevent cardiovascular events in patients with SLE due to the risk of haemorrhagic stroke.

关键词： erythematosus diagnosis likely

Management of autoimmune hepatitis induced by hepatitis delta virus

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World Journal of Gastroenterology 2024年第8期30卷 799-805页

作者： Eleni Gigi Vasileios Lagopoulos Aris Liakos Hepatology Unit The Second Internal Medicine DepartmentAristotle University Medical SchoolHippokrateio General HospitalThessaloniki 54642Greece department of Surgical AHEPA General Hospital of ThessalonikiThessaloniki 54636Greece Clinical Research and Evidence-Based medicine Unit Second Medical DepartmentHippokratio General HospitalAristotle University ThessalonikiThessaloniki 54642Greece

Approximately 12-72 million people worldwide are co-infected with hepatitis B virus(HBV)and hepatitis delta virus(HDV).This concurrent infection can lead to several severe outcomes with hepatic disease,such as cirrhosis,fulminant hepatitis,and hepatocellular carcinoma,being the most common.Over the past few decades,a correlation between viral hepatitis and autoimmune diseases has been reported.Furthermore,autoantibodies have been detected in the serum of patients co-infected with HBV/HDV,and autoimmune features have been reported.However,to date,very few cases of clinically significant autoimmune hepatitis(AIH)have been reported in patients with HDV infection,mainly in those who have received treatment with pegylated interferon.Interestingly,there are some patients with HBV infection and AIH in whom HDV infection is unearthed after receiving treatment with immunosuppressants.Consequently,several questions remain unanswered with the challenge to distinguish whether it is autoimmune or“autoimmune-like”hepatitis being the most crucial.Second,it remains uncertain whether autoimmunity is induced by HBV or delta virus.Finally,we investigated whether the cause of AIH lies in the previous treatment of HDV with pegylated interferon.These pressing issues should be elucidated to clarify whether new antiviral treatments for HDV,such as Bulevirtide or immu-nosuppressive drugs,are more appropriate for the management of patients with HDV and AIH.

关键词： Autoimmune hepatitis Hepatitis delta virus Bulevirtide Prednisolone

Epidemiology,therapy and outcome of hepatocellular carcinoma between 2010 and 2019 in Piedmont,Italy

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 761-772页

作者： Christian Bracco Marta Gallarate Marco Badinella Martini Corrado Magnino Salvatore D'Agnano Roberta Canta Giulia Racca Remo Melchio Cristina Serraino Valentina Polla Mattiot Giovanni Gollè Luigi Fenoglio department of internal medicine Santa Croce e Carle General HospitalCuneo 12100Italy department of Medical Sciences "City of Health and Science"University HospitalTorino 10100Italy

BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy and the second leading cause of cancer deaths worldwide.It is often diagnosed at an advanced stage and therefore its prognosis remains poor with a low 5-year survival rate.HCC patients have increasingly complex and constantly changing characteristics,thus up-to-date and comprehensive data are fundamental.AIM To analyze the epidemiology and main clinical characteristics of HCC patients in a referral center hospital in the northwest of Italy between 2010 and 2019.METHODS In this retrospective study,we analyzed the clinical data of all consecutive patients with a new diagnosis of HCC recorded at"Santa Croce e Carle"Hospital in Cuneo(Italy)between 1 January 2010 and 31 December 2019.To highlight possible changes in HCC patterns over the 10-year period,we split the population into two 5-year groups,according to the diagnosis period(2010-2014 and 2015-2019).RESULTS Of the 328 HCC patients who were included(M/F 255/73;mean age 68.9±11.3 years),154 in the first period,and 174 in the second.Hepatitis C virus infection was the most common HCC risk factor(41%,135 patients).The alcoholic etiology rate was 18%,the hepatitis B virus infection etiology was 5%,and the non-viral/non-alcoholic etiology rate was 22%.The Child-Pugh score distribution of the patients was:class A 75%,class B 21%and class C 4%.The average Mayo end-stage liver disease score was 10.6±3.7.A total of 55 patients(17%)were affected by portal vein thrombosis and 158(48%)by portal hypertension.The average nodule size of the HCC was 4.6±3.1 cm.A total of 204 patients(63%)had more than one nodule<3,and 92%(305 patients)had a non-metastatic stage of the disease.The Barcelona Clinic Liver Cancer(BCLC)staging distribution of all patients was:4%very early,32%early,23%intermediate,34%advanced,and 7%terminal.Average survival rate was 1.6±0.3 years.Only 20%of the patients underwent treatment.Age,presence of ascites,BCLC stage and therapy were predictors of a better prognosis(P<0.01).A c

关键词： Hepatocellular carcinoma Hepatitis virus Alcoholic hepatitis Non-alcoholic fatty liver disease Diagnosis Etiology Treatment

Navigating the complex terrain of hepatitis B virus reactivation in the era of Bruton tyrosine kinase inhibitors

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World Journal of Gastroenterology 2024年第21期30卷 2748-2750页

作者： Wei-Nung Liu Ming-Shen Dai Felicia Lin Gen-Min Lin department of medicine Tri-Service General HospitalTaipei 114Taiwan Division of Hematology/Oncology Department of Internal MedicineNational Defense Medical CenterTaipei 114Taiwan Community Care Minnesota OncologyMinneapolisMN 55404United States department of medicine Hualien Armed Forces General HospitalHualien City 970Taiwan

In this editorial,we offer a summary of the risk associated with hepatitis B reactivation(HBVr)in the setting of both solid and hematologic malignancies treated with Bruton tyrosine kinase(BTK)inhibitors,with insights derived from current studies.Furthermore,we emphasize the critical need for a framework regarding robust risk evaluation in patients undergoing such treatments.This framework is essential for identifying those at increased risk of HBVr,enabling healthcare providers to implement proactive measures to prevent reactivation and ensure the safe administration of BTK inhibitor therapy.

关键词： Hepatitis B virus reactivation Bruton tyrosine kinase inhibitors Hematologic malignancies Solid tumors Prophylaxis guidelines

Human-induced pluripotent stem cell-derived neural stem cell exosomes improve blood-brain barrier function after intracerebral hemorrhage by activating astrocytes via PI3K/AKT/MCP-1 axis

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Neural Regeneration Research 2025年第2期20卷 518-532页

作者： Conglin Wang Fangyuan Cheng Zhaoli Han Bo Yan Pan Liao Zhenyu Yin Xintong Ge Dai Li Rongrong Zhong Qiang Liu Fanglian Chen Ping Lei department of geriatrics Tianjin Medical University General HospitalTianjinChina School of medicine Nankai UniversityTianjinChina Tianjin Neurological Institute TianjinChina

Cerebral edema caused by blood-brain barrier injury after intracerebral hemorrhage is an important factor leading to poor prognosis.Human-induced pluripotent stem cell-derived neural stem cell exosomes(hiPSC-NSC-Exos)have shown potential for brain injury repair in central nervous system diseases.In this study,we explored the impact of hiPSC-NSC-Exos on blood-brain barrier preservation and the underlying mechanism.Our results indicated that intranasal delivery of hiPSC-NSC-Exos mitigated neurological deficits,enhanced blood-brain barrier integrity,and reduced leukocyte infiltration in a mouse model of intracerebral hemorrhage.Additionally,hiPSC-NSC-Exos decreased immune cell infiltration,activated astrocytes,and decreased the secretion of inflammatory cytokines like monocyte chemoattractant protein-1,macrophage inflammatory protein-1α,and tumor necrosis factor-αpost-intracerebral hemorrhage,thereby improving the inflammatory microenvironment.RNA sequencing indicated that hiPSC-NSC-Exo activated the PI3K/AKT signaling pathway in astrocytes and decreased monocyte chemoattractant protein-1 secretion,thereby improving blood-brain barrier integrity.Treatment with the PI3K/AKT inhibitor LY294002 or the monocyte chemoattractant protein-1 neutralizing agent C1142 abolished these effects.In summary,our findings suggest that hiPSC-NSC-Exos maintains blood-brain barrier integrity,in part by downregulating monocyte chemoattractant protein-1 secretion through activation of the PI3K/AKT signaling pathway in astrocytes.

关键词： AKT astrocyte blood-brain barrier cerebral edema exosomes human-induced pluripotent stem cells intracerebral hemorrhage neural stem cells neuroinflammation PI3K

Mortality from cerebrovascular diseases in China:Exploration of recent and future trends

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Chinese Medical Journal 2024年第5期137卷 588-595页

作者： Bin Lv Ge Song Feng Jing Mingyu Li Hua Zhou Wanjun Li Jiacai Lin Shengyuan Yu Jun Wang Xiangyu Cao Chenglin Tian department of Neurology The First Medical CenterChinese PLA General HospitalBeijing 100853China department of Neurology the 305 Hospital of Chinese PLABeijing 100017China department of internal medicine Gucheng County Hospital of Traditional Chinese MedicineHengshuiHebei 253800China department of Neurology Tangshan Hospital of Traditional Chinese MedicineTangshanHebei 063000China department of Neurology Hainan Hospital of Chinese PLA General HospitalSanyaHainan 572013China

Background:Cerebrovascular disease(CVD)ranks among the foremost factors responsible for mortality on a global scale.The mortality patterns of CVDs and temporal trends in China need to be well-illustrated and updated.Methods:We collected mortality data on patients with CVD from Chinese Center for Disease Control and Prevention’s Disease Surveillance Points(CDC-DSP)system.The mortality of CVD in 2020 was described by age,sex,residence,and region.The temporal trend from 2013 to 2019 was evaluated using joinpoint regression,and estimated rates of decline were extrapolated until 2030 using time series models.Results:In 2019,the age-standardized mortality in China(ASMRC)per 100,000 individuals was 113.2.The ASMRC for males(137.7/10^(5))and rural areas(123.0/10^(5))were both higher when stratified by gender and urban/rural residence.The central region had the highest mortality(126.5/10^(5)),the western region had a slightly lower mortality(123.5/10^(5)),and the eastern region had the lowest mortality(97.3/10^(5)).The age-specific mortality showed an accelerated upward trend from aged 55-59 years,with maximum mortality observed in individuals over 85 years of age.The age-standardized mortality of CVD decreased by 2.43%(95%confidence interval,1.02-3.81%)annually from 2013 to 2019.Notably,the age-specific mortality of CVD increased from 2013 to 2019 for the age group of over 85 years.In 2020,both the absolute number of CVD cases and the crude mortality of CVD have increased compared to their values in 2019.The estimated total deaths due to CVD were estimated to reach 2.3 million in 2025 and 2.4 million in 2030.Conclusion:The heightened focus on the burden of CVD among males,rural areas,the central and western of China,and individuals aged 75 years and above has emerged as a pivotal determinant in further decreasing mortalities,consequently presenting novel challenges to strategies for disease prevention and control.

关键词： Cerebrovascular diseases Mortality Epidemiology Global Burden of Disease China COVID-19 pandemic

Exploration of cardiac rehabilitation nursing for elderly patients with myocardial infarction based on individualized cardiac rehabilitation

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World Journal of Clinical Cases 2024年第2期12卷 256-266页

作者： Hua-Ning Liu Bo Gao department of geriatrics General Hospital of the YangTze River ShippingWuhan Brain HospitalWuhan 430015Hubei ProvinceChina department of Cardiology Suizhou Central HospitalAffiliated Hospital of Hubei University of MedicineSuizhou 441300Hubei ProvinceChina

BACKGROUND Myocardial infarction is a high-risk condition prevalent among the elderly population,often leading to adverse clinical manifestations such as reduced cardiopulmonary function,anxiety,and depression post-surgery.Consequently,cardiac rehabilitation holds immense importance in mitigating these complications.AIM To evaluate the effect of individualized cardiac rehabilitation on blood pressure variability(BPV)and baroreflex sensitivity(BRS)in elderly patients with myocardial infarction.METHODS A cohort of 74 elderly patients diagnosed with myocardial infarction and admitted to our hospital between January 2021 and January 2022 were subjected to random selection.Subsequently,all patients were divided into two groups,namely the research group(n=37)and the control group(n=37),utilizing the number table method.The control group received conventional drug treatment and nursing guidance intervention,while the study group underwent individualized cardiac rehabilitation in addition to the interventions received by the control group.All patients were continuously intervened for 12 wk,and the BPV of these two groups in the 1st wk(T0),the 4th wk(T1)and the 12th wk(T2)were compared,BRS,changes in cardiopulmonary function measures,and adverse cardiovascular events.RESULTS Of 24 h diastolic BPV,24 h systolic BPV,carbon dioxide ventilation equivalent slope of the research group were lower than those of the control group at T1 and T2,BRS,peak heart rate and systolic blood pressure product,1 min heart rate recovery were higher than those of the control group,and the incidence of adverse events in the research group was lower than that of the control group,the difference was statistically significant(P<0.05).CONCLUSION In this study,we found that after individualized cardiac rehabilitation in elderly patients with myocardial infarction,BPV and BRS can be effectively improved,cardiac function is significantly enhanced,and a better prognosis is obtained.

关键词： Individualized cardiac rehabilitation Myocardial infarction Variability in blood pressure Baroreflex sensitivity

Clinical study on microscopic syndrome differentiation and traditional Chinese medicine treatment for liver stomach disharmony in chronic gastritis

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World Journal of Gastrointestinal Surgery 2024年第5期16卷 1377-1384页

作者： Chun-Yan Bai Wei Tian Qian Zhang department of Rehabilitation medicine Beijing Aerospace General HospitalBeijing 100076China department of Rehabilitation medicine People’s Hospital of HengshuiHengshui 053000Hebei ProvinceChina department of internal medicine Hebei Academy of Chinese Medicine SciencesShijiazhuang 050000Hebei ProvinceChina

BACKGROUND Chronic gastritis(CG)is a common gastrointestinal disorder characterized by inflammation of the stomach lining.Liver-stomach disharmony(LSD)syndrome is believed to contribute to CG symptoms.AIM To evaluate the efficacy and safety of microcosmic syndrome differentiation and Chinese herbal medicine(CHM)treatment in patients with CG and LSD syndrome.METHODS Sixty-four patients with CG and LSD syndrome were randomly divided into two groups:The treatment group received CHM based on microcosmic syndrome differentiation and the control group received conventional Western medicine.The treatment course lasted 12 wk.The primary outcome was improvement in dyspeptic symptoms,measured using the Nepean Dyspepsia Index.The secondary outcomes included the improvement rate of endoscopic findings,histopathological findings,and microcosmic syndrome scores and the incidence of adverse events.RESULTS After 12 wk of treatment,the treatment group showed significantly greater improvement in dyspeptic symptoms than the control group(93.75%vs 65.63%,P0.05).No serious adverse events were observed in either group.CONCLUSION Microcosmic syndrome differentiation and CHM treatment can effectively improve dyspeptic symptoms and endoscopic findings in patients with CG and LSD syndrome and have a good safety profile.Further studies with larger sample sizes and longer follow-up periods are required to confirm the long-term efficacy and mechanism of action of this treatment.

关键词： Chronic gastritis Liver-stomach disharmony Microcosmic syndrome differentiation Chinese herbal medicine Randomized controlled trial Microcosmic syndrome scores

Ferritin and mortality in hemodialysis patients with COVID-19:A systematic review and meta-analysis

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Asian Pacific Journal of Tropical medicine 2024年第1期17卷 4-11页

作者： Ni Wayan Anantika Riani I Gde Raka Widiana Yenny Kandarini Nephrology Division Department of Internal MedicineUdayana University/Udayana University HospitalBaliIndonesia Nephrology Division Department of Internal MedicineUdayana University/Prof.Dr.I.G.N.G.Ngoerah General HospitalBaliIndonesia

Objective:To investigate the difference in serum ferritin levels between deceased and surviving regular hemodialysis patients with COVID-19.Methods:We conducted a systematic search across four databases following the PRISMA statement guidelines.Studies reporting ferritin levels and mortality of regular hemodialysis patients with COVID-19 were included.Employing the random-effects model,we performed a meta-analysis to determine the mean difference in serum ferritin levels between the studied groups,along with their corresponding 95%confidence intervals.The meta-analysis was carried out using Review Manager 5.4 and Stata 16.Results:A total of 1013 patients from seven studies were included in this study.Our meta-analysis showed higher mean serum ferritin in the deceased compared to surviving regular hemodialysis patients with COVID-19,with a mean difference of 449.43 ng/mL[95%CI(244.07,654.80),P<0.0001;I2=58%,P=0.003].Conclusions:Our study found a higher mean of serum ferritin levels in the deceased compared to surviving regular hemodialysis patients with COVID-19.

关键词： Ferritin Mortality Hemodialysis COVID-19 Inflammation