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Urgent ERCP for acute cholangitis reduces mortality and hospital stay in elderly and very elderly patients

Hepatobiliary & Pancreatic Diseases International 2016年第6期15卷 619-625页

作者： Chan Sun Park Hee Seok Jeong Ki Bae Kim Joung-Ho Han Hee Bok Chae Sei Jin Youn Seon Mee Park Department of internal medicine Chungbuk National University College of Medicine

BACKGROUND： Acute cholangitis in old people is a cause of mortality and prolonged hospital stay. We evaluated the effects of methods and timing of biliary drainage on the outcomes of acute cholangitis in elderly and very elderly patients. METHODS： We analyzed 331 patients who were older than 75 years and were diagnosed with acute calculous cholangitis. They were admitted to our hospital from 2009 to 2014. Patients＇ demographics, severity grading, methods and timing of biliary drainage, mortality, and hospital stay were retrospectively obtained from medical records. Clinical parameters and outcomes were compared between elderly （75-80 years, n= 156） and very elderly （≥81 years, n=175） patients. We analyzed the effects of methods [none, endoscopic retrograde cholangio- pancreatography （ERCP）, percutaneous transhepatic biliary drainage, or failure] and timing （urgent or early） of biliary drainage on mortality and hospital stay in these patients. RESULTS： Acute cholangitis in older patients manifested as atypical symptoms characterized as infrequent Charcot＇s triad （4.2%） and comorbidity in one-third of the patients. Patients were graded as mild, moderate, and severe cholangitis in 104 （31.4%）, 175 （52.9%）, and 52 （15.7%）, respectively. Urgent bili-ary drainage （≤24 hours） was performed for 80.5% （247/307） of patients. Very elderly patients tended to have more severe grades and were treated with sequential procedures of transient hiliary drainage and stone removal at different sessions. Hospital stay was related to methods and timing of biliary drainage. Mortality was very low （1.5%） and not related to patient age but rather to the success or failure of biliary drainage and severity grading of the acute cholangitis. CONCLUSIONS： The methods and timing used for biliary drainage and severity of cholangitis are the major determinants of mortality and hospital stay in elderly and very elderly patients with acute cholangitis. Urgent successful ERCP is mandatory for favorable

关键词： acute cholangitis biliary drainage prognosis elderly very elderly

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Aortoduodenal fistula and aortic aneurysm secondary to biliary stent-induced retroperitoneal perforation

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World Journal of Gastroenterology 2008年第19期14卷 3095-3097页

作者： Tae Hoon Lee Do Hyun Park Ji-Young Park Suck-Ho Lee Il-Kwun Chung Hong Soo Kim Sang-Heum Park Sun-Joo Kim Division of Gastroenterology Department of Internal MedicineSoonchunhyang University College of Medicine Division of Gastroenterology Department of Internal MedicineUniversity of Ulsan College of Medicine

Duodenal perforations caused by biliary prostheses are not uncommon, and they are potentially life threatening and require immediate treatment. We describe an unusual case of aortic aneurysm and rupture which occurred after retroperitoneal aortoduodenal fistula formation as a rare complication caused by biliary metallic stent-related duodenal perforation. To our knowledge, this is the first report describing a lethal complication of a bleeding, aortoduodenal fistula and caused by biliary metallic stent-induced perforation.

关键词： Stents Retroperitoneal perforation Aorticaneurysm Fistula

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Comparison between combination therapy of percutaneous ethanol injection and radiofrequency ablation and radiofrequency ablation alone for patients with hepatocellular carcinoma

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World Journal of Gastroenterology 2005年第10期11卷 1426-1432页

作者： Kazutaka Kurokohchi Seishiro Watanabe Tsutomu Masaki Naoki Hosomi Yoshiaki Miyauchi Takashi Himoto Yasuhiko Kimura Seiji Nakai Akihiro Deguchi Hirohito Yoneyama Shuhei Yoshida Shigeki Kuriyama Third Department of internal medicine

AIM: In the present study, the characteristics of PEI-RFA treatment were further elucidated by analyzing the relationship between the volume of coagulated necrosis and the energy requirement for ablation or the amount of ethanol injected into ***: The volume of coagulated necrosis, total energy requirement and energy requirement for coagulation of per unit volume were examined in the groups of PEI-RFA and RFA alone using the Cool-tip RF ***: The results showed that the volume of coagulated necrosis induced was significantly larger in PEI-RFA group than in routine RFA group, when the total energy administered was comparable in both *** PEI-RFA, enlargement of coagulated necrosis was admitted in 3 dimensions and the amount of energy requirement per unit volume of coagulated necrosis was negatively correlated with the amount of ethanol injected into ***: These results suggest that, compared to RFA alone, PEI-RFA enables to induce comparable coagulated necrosis with smaller energy requirement, and that PEI-RFA is likely to be less invasive than RFA alone irrespective of inducing enhanced coagulated ***, simple prior injection of ethanol may make RFA treatment more effective and less invasive for the treatment of patients with HCC.

关键词： Combination therapy Percutaneous ethanol injection Radiofrequency ablation Energy requirement

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Comparative effects of artemisia vulgaris and charcoal moxa stimulating Zhongwan(CV 12) on body temperature in healthy participants:a cross-over single-blind randomized study

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Journal of Traditional Chinese medicine 2015年第5期35卷 551-557页

作者： Ho-Yeon Go Ju Ah Lee Sunyoung Park Sunju Park Jeong-Su Park Chunhoo Cheon Seong-Gyu Ko Kyung-Hwan Kong Chan-yong Jun Jong-hyeong Park Mi-Ran Shin Se-Hoon Lee Department of internal medicine College of Korean MedicineSemyung University Department of Public Health The Catholic University of Korea Medical Research Division Korea Institute of Oriental Medicine Department of Physiology College of Korean MedicineSemyung University Department of preventive medicine College of Korean MedicineDaejeon University Center for Clin ical Research and Genomics College of Oriental Medicine and Institu te of Oriental MedicineKyung Hee University Department of internal medicine College of Korean MedicineGachon University Department of Sasang Constitutional medicine College of Korean MedicineSemyung University

OBJECTIVE:To evaluate the efficacy,safety,satisfaction,discomfort and patient preference of moxa cones of artemisia vulgaris and charcoal ***:This comparative study of moxibustion treatment with Artemisia vulgaris and charcoal moxa cone stimulating Zhongwan(CV 12) is a cross-over single-blinded,randomized clinical trial.A total of 40 healthy subjects(24 males and 16females) participated in this *** subjects dropped out of the ***-eight subjects were treated with Artemisia vulgaris and charcoal moxa cones for 30 min in a cross-over *** treatment,the patients underwent a 30 minute waiting period,and then the temperatures at Tanzhong(CV 17),Zhongwan(CV 12) and Guanyuan(CV 4) were measured using digital infrared thermal ***:After the use of Artemisia vulgaris moxa,the patients' body temperatures were slightly lowered at Tanzhong(CV 17),Zhongwan(CV 12)and Guanyuan(CV 4),but the changes were not statistically *** the use of charcoal moxa,the patients' body temperatures were somewhat increased at Zhongwan(CV 12) and Guanyuan(CV 4),but the changes were not statistically *** Artemisia vulgaris moxa use,the body temperature difference between Zhongwan(CV 12) and Guanyuan(CV 4)was significantly *** charcoal moxa use,the body temperature difference between Tanzhong(CV 17) and Zhongwan(CV 12) was significantly decreased in males and in the whole *** change was caused by the difference in the moxibustion type and by gender ***:This pilot study found that moxibustion did not raise the body temperature,but temperature differences between acupoints were *** large-scale randomized controlled trials are needed for the effect of moxibustion on body temperature.

关键词： Moxibustion Point CV12(Zhongwan) Artemisia Body temperature Cross-over studies Single-blind method Randomized controlled trial

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High circulating N-terminal pro-brain natriuretic peptide and tumor necrosis factor-α in mixed cryoglobulinemia

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World Journal of Gastroenterology 2009年第40期15卷 5074-5079页

作者： Alessandro Antonelli Clodoveo Ferri Silvia Martina Ferrari Fabio Galetta Ferdinando Franzoni Gino Santoro Salvatore De Marco Emiliano Ghiri Poupak Fallahi Department of internal medicine University of PisaSchool of Medicine Department of internal medicine Rheumatology UnitUniversity of Modena & Reggio E.School of Medicine Division of medicine V Cisanello Hospital

AIM: To evaluate serum levels of N-terminal pro-brain natriuretic peptide (NTproBNP) and tumor necrosis factor α (TNF-α) in a large series of patients with hepatitis C associated with mixed cryoglobulinemia (MC+HCV).METHODS: Serum NTproBNP and TNF-α levels were assayed in 50 patients with MC+HCV, and in 50 sex- and age-matched controls. RESULTS: Cryoglobulinemic patients showed signifi cantly higher mean NTproBNP and TNF-α levels than controls (P < 0.001; Mann-Whitney U test). By defining high NTproBNP level as a value higher than 125 pg/mL (the single cut-off point for outpatients under 75 years of age), 30% of MC+HCV and 6% of controls had high NTproBNP (χ2, P < 0.01). With a cut-off point of 300 pg/mL (used to rule out heart failure (HF) in patients under 75 years of age), 8% of MC+HCV and 0 controls had high NTproBNP (χ2, P < 0.04). With a cut-off point of 900 pg/mL (used for ruling in HF in patients aged 50-75 years; such as thepatients of our study), 6% of MC+HCV and 0 controls had high NTproBNP (χ2, P = 0.08).CONCLUSION: The study demonstrates high levels of circulating NTproBNP and TNF-α in MC+HCV patients. The increase of NTproBNP may indicate the presence of a subclinical cardiac dysfunction.

关键词： NTProBNP, Tumor necrosis factor α Hepatitis C Mixed cryoglobulinemia Heart failure

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Celiac disease in Middle Eastern and North African countries:A new burden?

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World Journal of Gastroenterology 2010年第12期16卷 1449-1457页

作者： Kassem Barada Abbas Bitar Mohamad Abdul-Razak Mokadem Jana Ghazi Hashash Peter Green Division of Gastroenterology Department of Internal MedicineAmerican University of Beirut Medical Center Department of internal medicine American University of Beirut Medical Center Department of internal medicine Indiana University School of Medicine Department of internal medicine University of Pittsburgh Medical Center Division of Gastroenterology Department of Internal MedicineColumbia University College of Physicians and Surgeons

Celiac disease(CD) is now recognized as a common disorder among Middle Eastern(ME) and North African(NA) *** aim of this review is to assess the available data regarding CD in the ME and NA and to compare this information with that of Western countries.A literature review was performed using the electronic databases PubMed and Medline(1950-2008) as search engines,and "celiac disease" was used as a Mesh *** search was limited to ME and NA *** prevalence of CD in ME and NA countries among low risk populations is similar to that of Western countries,but is higher in high risk populations such as those with type 1 *** is underestimated because of lack of clinical suspicion and lack of patient *** presentations in term of gastrointestinal,hematologic,skeletal,and liver manifestations are similar between both populations except for a high prevalence of short stature in some ME and NA *** studies have addressed atypical or silent *** in the West,diagnosis is initially made by serological tests and is confirmed by small intestinal ***-free diet is the main mode of treatment with a higher apparent adherence rate than in the *** disease complications result from *** disease is strongly associated with HLA DQ2 and to a lesser extent with HLA DQ8 *** conclusion,CD prevalence is underestimated,with little data available about its malignant *** parameters in the ME and NA are otherwise similar to those in Western countries.

关键词： Celiac disease Gluten-free diet Insulin dependent diabetes mellitus Iron defi ciency anemia Middle East

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Upregulation of 25-hydroxyvitamin D_3-1α-hydroxylase by butyrate in Caco-2 cells

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World Journal of Gastroenterology 2005年第45期11卷 7136-7141页

作者： Oliver Schr(o|¨)der Sinan Turak Carolin Daniel Tanja Gaschott Jürgen Stein Ⅰst Department of internal medicine

AIM： To investigate the possible involvement of 25-hydroxyvitamin D3-1cx-hydroxylase [1α-25（OH）2D3] in butyrate-induced differentiation in human intestinal cell line Caco-2 cells. METHODS： Caco-2 cells were incubated either with 3 mmol/L butyrate and 1 umol/L 25（OH）2D3 or with 1 umol/L 1α-25（OH）2D3 for various time intervals ranging from 0 to 72 h. Additionally, cells were co-incubated with butyrate and either 25（OH）2D3 or 1α-25（OH）2D3. 1α-25（OH）2D3 mRNA was determined semi-quantitatively using the fluorescent dye PicoGreen. Immunoblotting was used for the detection of 1α-25（OH）2D3 protein. Finally, enzymatic activity was measured by ELISA. RESULTS： Both butyrate and 1α-25（OH）2D3 stimulated differentiation of Caco-2 cells after a 48 h incubation period, while 25（OH）2D3 had no impact on cell differentiation. Synergistic effects on differentiation were observed when cells were co-incubated with butyrate and vitamin D metabolite. Butyrate transiently upregulated 1α-25（OH）2D3 mRNA followed by a timely delayed protein upregulation. Coincidently, enzymatic activity was enhanced significantly. The induction of the enzyme allowed for comparable differentiating effects of both vitamin D metabolites. CONCLUSION： Our experimental data provide a further mechanism for the involvement of the vitamin D signaling pathway in colonic epithelial cell differentiation by butyrate. The enhancement of 1α-25（OH）2D3 followed by antiproliferative effects of the vitamin D prohormone in the Caco-2 cell line suggest that 25（OH）2D3 in combination with butyrate may offer a new therapeutic approach forthe treatment of colon cancer.

关键词： 25-Hydroxyvitamin D3-1α-hydroxylase Butyrate Caco-2 cells Colon cancer Differentiation Vitamin D

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Quantification of HBsAg:Basic virology for clinical practice

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World Journal of Gastroenterology 2011年第3期17卷 283-289页

作者： Jung Min Lee Sang Hoon Ahn Department of internal medicine Yonsei University College of Medicine Department of internal medicine Institute of GastroenterologyYonsei University College of Medicine Liver Cirrhosis Clinical Research Center

Hepatitis B surface antigen (HBsAg) is produced and secreted through a complex mechanism that is still not fully understood. In clinical fields, HBsAg has long served as a qualitative diagnostic marker for hepatitis B virus infection. Notably, advances have been made in the development of quantitative HBsAg assays, which have allowed viral replication monitoring, and there is an opportunity to make maximal use of quantitative HBsAg to elucidate its role in clinical fields. Yet, it needs to be underscored that a further understanding of HBsAg, not only from clinical point of view but also from a virologic point of view, would enable us to deepen our insights, so that we could more widely expand and apply its utility. It is also important to be familiar with HBsAg variants and their clinical consequences in terms of immune escape mutants, issues resulting from overlap with corresponding mutation in the P gene, and detection problems for the HBsAg variants. In this article, we review current concepts and issues on the quantification of HBsAg titers with respect to their biologic nature, method principles, and clinically relevant topics.

关键词： Hepatitis B virus Hepatitis B surface antigen Quantitative assay Virology

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Effect of "Yang-warming and kidney essence-replenishing" herbal paste on cold-related asthma exacerbation

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Journal of Traditional Chinese medicine 2013年第4期33卷 468-472页

作者： Binqing Tang Kehua Shi Xiaoqi Li Hongchang Wang Hong Fang Bidan Xiong Yingen Wu Emergency Department Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Department of Respiratory medicine Shanghai Hospital of Traditional Chinese Medicine Department of internal medicine Tianshan Hospital of Traditional Chinese Medicine Department of internal medicine Fenglin Community Health Service Center preventive Treatment of Disease Center Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Department of Respiratory medicine Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine

OBJECTIVE: To observe the effect of "Yang-warming and kidney essence-replenishing" herbal paste on cold-related asthma exacerbation. METHODS: One hundred and fifty one patients with moderate to severe persistent asthma were randomly divided into a treatment group (n=74) and a control group (n=69). Both groups were given basic treatment according to the Global Initiative for Asthma scheme. The treatment group was also treated with herbal paste in the winter. The frequency of asthma exacerbation, cold and cold-re-lated asthma exacerbation, scores of the asthma control test (ACT), and kidney-deficiency syndrome during the one-year follow-up in each group were recorded. RESULTS: Compared with the control group, the onset frequencies of catching cold, asthma exacerbation, cold-related asthma exacerbation, and kidney-deficiency syndrome score were significantly reduced. There was no significant difference in scores of ACT between the two groups. CONCLUSION: "Yang-warming and kidney essence-replenishing" herbal paste could reduce cold-related asthma exacerbation.

关键词： Yang-warming and kidney essence-replenishing Herbal paste Asthma Cold-related asthma exacerbation

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A case of hepatocellular carcinoma arising within large focal nodular hyperplasia with review of the literature

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World Journal of Gastroenterology 2006年第40期12卷 6567-6571页

作者： Theodoros Petsas Athanasios Tsamandas Irene Tsota Dionisios Karavias Chrysoula Karatza Vassilios Vassiliou Dimitrios Kardamakis departments of Radiology Histopath-ology Surgery Internal Medicine and Radiotherapy University of Patras Medical School 26500 Rion Greece

Focal nodular hyperplasia （FNH） is a relatively rare benign hepatic tumor, usually presenting as a solitary lesion; however, multiple Iocalizations have also been described. The association of FNH with other hepatic lesions, such as adenomas and haemangiomas has been reported by various authors. We herein report a case of a hepatocellular carcinoma arising within a large focal nodular hyperplasia, in a young female patient.

关键词： Focal nodular hyperplasia Hepatocellular carcinoma Liver tumors

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