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Portal vein thrombosis in cirrhosis: Why a well-known complication is still matter of debate

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World Journal of gastroenterology 2019年第31期25卷 4437-4451页

作者： Mariella Faccia Maria Elena Ainora Francesca Romana Ponziani Laura Riccardi Matteo Garcovich Antonio Gasbarrini Maurizio Pompili Maria Assunta Zocco department of Internal Medicine and gastroenterology Fondazione Policlinico Universitario A.Gemelli IRCCSCatholic University

Portal vein thrombosis(PVT)represents a well-known complication during the natural course of liver cirrhosis(LC),ranging from asymptomatic cases to lifethreating conditions related to portal hypertension and hepatic *** flow stasis,complex acquired hypercoagulable disorders and exogenous factors leading to endothelial dysfunction have emerged as key factors for PVT ***,PVT occurrence remains unpredictable and many issues regarding its natural history,prognostic significance and treatment are still *** particular although spontaneous resolution or disease stability occur in most cases of PVT,factors predisposing to disease progression or recurrence after spontaneous recanalization are not clarified as ***,PVT impact on LC outcome is still debated,as PVT may represent itself a consequence of liver fibrosis and hepatic dysfunction *** and transjugular intrahepatic portosystemic shunt are considered safe and effective in this setting and are recommended in selected cases,even if the safer therapeutic option and the optimal therapy duration are still ***,their impact on mortality rates should be addressed more *** this review we present the most debated questions regarding PVT,whose answers should come from prospective cohort studies and large sample-size randomized trials.

关键词： Portal vein thrombosis Liver cirrhosis Hypercoagulability Anticoagulation Direct oral anticoagulants

Colorectal cancer in inflammatory bowel disease:The risk,pathogenesis,prevention and diagnosis

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World Journal of gastroenterology 2014年第29期20卷 9872-9881页

作者： Eun Ran Kim Dong Kyung Chang Division of gastroenterology Department of Internal MedicineSamsung Medical CenterSungkyunkwan University School of Medicine

Patients with inflammatory bowel disease(IBD)are at increased risk for developing colorectal cancer(CRC),although the overall incidence of IBD-associated CRC has been diminishing in recent decades in western *** demonstrated in previous studies,the risk of CRC in IBD increases with longer duration,extent of colitis,a familial history of CRC,coexistent primary sclerosing cholangitis,and the degree of *** pathogenesis of CRC in IBD is poorly *** to sporadic CRC,IBD-associated CRC is a consequence of sequential episodes of genomic *** inter-related pathways,including immune response by mucosal inflammatory mediators,oxidative stress,and intestinal microbiota,are also involved the pathogenesis of IBD-associated *** colonic inflammation appears to be a factor in the development of CRC;therefore,anti-inflammatory agents such as5-aminosalicylate compounds and immune modulators have been considered as potential chemopreventive *** surveillance is widely accepted as being effective in reducing the risk of IBD-associated CRC,although no clear evidence has confirmed that surveillance colonoscopy prolongs survival in patients with extensive *** traditional recommendation has been quadrantic random biopsies throughout the entire colon;however,several guidelines now have endorsed chromoendoscopy with a target biopsy because of increasing diagnostic yields and reduced workloads for endoscopists and *** technologies such as narrow band imaging,confocal endomicroscopy,and autofluorescence imaging have not yet been confirmed as surveillance strategies in IBD.

关键词： Inflammatory bowel disease Colorectal cancer Pathogenesis Chemoprevention Surveillance

Antioxidant axis Nrf2-keap1-ARE in inhibition of alcoholic liver fibrosis by IL-22

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World Journal of gastroenterology 2017年第11期23卷 2002-2011页

作者： Ya-Hui Ni Li-Juan Huo Ting-Ting Li department of gastroenterology First Hospital of Shanxi Medical UniversityTaiyuan 030001Shanxi ProvinceChina

AIM To explore the effect of interleukin(IL)-22 on in vitro model of alcoholic liver fibrosis hepatic stellate cells(HSCs), and whether this is related to regulation of *** HSC-T6 cells were incubated with 25, 50, 100, 200 and 400 μmol/L acetaldehyde. After 24 and 48 h, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT) assay was used to detect proliferation of HSCs to choose the best concentration and action time. We used the optimal concentration of acetaldehyde(200 μmol/L) to stimulate HSCs for 24 h, and treated the cells with a final concentration of 10, 20 or 50 ng/m L IL-22. The cell proliferation rate was detected by MTT assay. The cell cycle was analyzed by flow cytometry. The expression of nuclear factor-related factor(Nrf)2 and α-smooth muscle antigen was detected by western blotting and immunocytochemistry. The levels of malondialdehyde(MDA) and glutathione(GSH) were measured by spectrophotometry. RESULTS In the MTT assay, when HSCs were incubated with acetaldehyde, activity and proliferation were higher than in the control group, and were most obvious after 48 h treatment with 200 μmol/L acetaldehyde. The number of cells in G0/G1 phases was decreased and the number in S phase was increased in comparison with the control group. When treated with different concentrations of IL-22, HSC-T6 cell activity and proliferation rate were markedly decreased in a dosedependent manner, and cell cycle progression was arrested from G1 to S phase. Western blotting and immunocytochemistry demonstrated that expression of Nrf2 total protein was not significantly affected. Expression of Nrf2 nuclear protein was low in thecontrol group, increased slightly in the model group(or acetaldehyde-stimulated group), and increased more obviously in the IL-22 intervention groups. The levels of MDA and GSH in the model group were significantly enhanced in comparison with those in the control group. In cells treated with IL-22, the MDA level was attenuat

关键词： Interleukin-22 Alcoholic liver fibrosis Hepatic stellate cells Nrf2 Oxidative stress

Ten-eleven translocation-2 affects the fate of cells and has therapeutic potential in digestive tumors

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Chronic Diseases and Translational Medicine 2019年第4期5卷 267-272页

作者： Feng Wang Jing Zhang Jian Qi department of gastroenterology Zhongnan HospitalWuhan UniversityWuhanHubei 430071China

Ten-eleven translocation(TET)methylcytosine dioxygenases catalyze the oxidative reactions of 5-methylcytosine(5-mC)to 5-hydroxymethylcytosine(5-hmC),5-formylcytosine(5-fC),and 5-carboxylcytosine(5-caC),which are intermediate steps during DNA *** is reported that somatic mutations of TET2 gene are identified in a variety of human tumors,especially in hematological *** tendency and mechanism of cellular differentiation in different systems are affected by TET2 via regulation of associated gene expression or maintenance of demethylated ***2 acts as a critical driver of tumorigenesis through the conversion of 5-mC to 5-hmC and successive oxidation ***,it requires special interactions and ***,we reviewed recent advances in understanding the function of TET2 proteins in regulating cell differentiation,and its role in various tumors focusing on several digestive cancers.

关键词： Demethylation Ten-eleven translocation-2 Differentiation Digestive tumors

Utilization of access to colorectal cancer screening modalities in low-income populations after medicaid expansion

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World Journal of Gastrointestinal Oncology 2023年第9期15卷 1653-1661页

作者： Gerald Fletcher Joan Culpepper-Morgan Alvaro Genao Eric Alatevi department of gastroenterology NYC Health+Hospitals/HarlemNew YorkNY 10037United States department of gastroenterology NYC Health+Hospitals/Harlem506 Lenox AveNew YorkNY 10037United States

BACKGROUND Colorectal cancer(CRC)remains a relevant public health *** research suggests that racial,economic and geographic disparities impact *** the expansion of Medicaid eligibility as a key component of the Affordable Care Act(ACA),there is a dearth of information on the utilization of newly gained access to CRC screening by low-income *** study investigates the impact of the ACA’s Medicaid expansion on utilization of the various CRC screening modalities by low-income *** working hypothesis is that Medicaid expansion will increase access and utilization of CRC screening by low-income *** To investigate the impact of the Affordable Care Act and in particular the effect of Medicaid expansion on access and utilization of CRC screening modalities by Medicaid state expansion status across the United *** This was a quasi-experimental study design using data from the Behavioral Risk Factor Surveillance System,a large health system survey for participants across the United States and with over 2.8 million *** period of the study was from 2011 to 2016 which was dichotomized as pre-ACA Medicaid expansion(2011-2013)and post-ACA Medicaid expansion(2014-2016).The change in utilization of access to CRC screening strategies between the expansion periods were analyzed as the dependent *** analyses included stratification of the access by ethnicity/race,income,and education *** A greater increase in utilization of access to CRC screening was observed in Medicaid expansion states than in nonexpansion states[+2.9%;95%confidence interval(95%CI):2.12,3.69].Low-income participants showed a+4.02%(95%CI:2.96,5.07)change between the expansion periods compared with higher income groups+3.19%(1.70,4.67).Non-Hispanic Whites and Hispanics[+3.01%(95%CI:2.16,3.85)vs+5.51%(95%CI:2.81,8.20)]showed a statistically significant increase in utilization of access but not in Non-Hispanic Blac

关键词： Medicaid expansion Colorectal cancer screening Low-income Disparities Minorities Affordable care act

Splenic tuberculosis in an immunocompetent patient can be managed conservatively:a case report

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gastroenterology Report 2018年第1期6卷 72-74,I0003页

作者： Ashok Kumar VK Kapoor Anu Behari Sandeep Verma department of Surgical gastroenterology Sanjay Gandhi Postgraduate Institute of Medical ScienceLucknowIndia

Tuberculosis is a significant health problemin developing *** tuberculosis usually occurs as a part of miliary tuberculosis,and ranks third after lung and liver involvement,*** involvement is more common in immunocompromised patients and is very rarely found in immunocompetent *** we report a case of splenic tuberculosis in an immunocompetent patient,which was managed successfully with conservative treatment.

关键词： splenic tuberculosis immunocompetence splenectomy

Bleeding Dieulafoy's-like lesions of the gut identified by capsule endoscopy

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World Journal of gastroenterology 2013年第29期19卷 4823-4826页

作者： Lidia Ciobanu Oliviu Pascu Brindusa Diaconu Daniela Matei Cristina Pojoga Marcel Tantu Regional Institute of gastroenterology and hepatology University of Medicine and Pharmacy 400162 Cluj Romania

Dieulafoy's-like lesions (DLs-like) represent a cause of obscure gastrointestinal bleeding, enteroscopy being the main diagnostic and therapeutic procedure. Frequently, more than one enteroscopy is needed to identify the bleeding vessel. In our practice, video capsule endoscopy (VCE) identified and guided therapy in four cases of DLs-like; three of them were localized on the small bowel. We report, for the first time, a diagnosis of colonic DL-like performed by colon capsule endoscopy. Two patients presented with severe cardiovascular disorders, being hemodynamically unstable during VCE examination. Based on the VCE findings, only one invasive therapeutic procedure per patient was necessary to achieve hemostasis. VCE and enteroscopy may be regarded as complementary procedures in patients with gut DLs-like.

关键词： Obscure gastrointestinal bleeding Dieulafoy’ s-like lesion Video capsule endoscopy Enteroscopy Small bowel

Regulation of the intestinal immune system by flavonoids and its utility in chronic inflammatory bowel disease

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World Journal of gastroenterology 2018年第8期24卷 877-881页

作者： Harald Peter Hoensch Benno Weigmann Private Practice gastroenterology Marien hospital department of Medicine 1 University Medical Center

Flavonoids are phytochemicals which can regulate the activity of the intestinal immune system. In patients with chronic inflammatory bowel disease(IBD) there is an overexpression and imbalance of the components of the inflammatory immune reactions which are chronically activated. Suppression of inflammation can be achieved by anti-inflammatory drugs which are used in clinical medicine but these can cause serious side effects. Flavonoids can have natural immunosuppressive properties and inhibit the activation of immune cells and its effectors(chemokines, TNF-, cytokines). Phytochemicals such as flavonoids bind to the nuclear Ah(aryl hydrocarbon)-receptor thereby stimulating protective enzyme activities. As shown by clinical evidence in patients and by experimental work some flavonoids(apigenin, epigallocatechin gallate) were effective in the inhibition of inflammation. Instead of or additionally to anti-inflammatory drugs flavonoids can be used in IBD patients to treat the over-reactive immunologic system. This is accomplished by upregulation of the Ah-receptor. Flavonoids interact with toll-like receptors expressing on the surface of immune cells, then they were internalized to the cytosol and transferred into the nucleus, where they were attached to the Ah-receptor. The Ah-receptor binds to the Ah-R nuclear translocator and via Ah response element beneficial protective enzymes and cytokines are induced, leading to upregulation of the anti-inflammatory system.

关键词： Flavonoids Inflammatory bowel disease Ah-receptor

Chromoendoscopy of gastric adenoma using an acetic acid indigocarmine mixture

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World Journal of gastroenterology 2014年第17期20卷 5092-5097页

作者： Yoshiyasu Kono Ryuta Takenaka Yoshiro Kawahara Hiroyuki Okada Keisuke Hori Seiji Kawano Yasushi Yamasaki Koji Takemoto Takayoshi Miyake Shigeatsu Fujiki Kazuhide Yamamoto department of gastroenterology and hepatology Okayama University Graduate School of MedicineDentistry and Pharmaceutical SciencesOkayama 700-8558Japan 2~(nd) department of Internal Medicine Tsuyama Chuo HospitalOkayama 708-0841Japan department of Internal Medicine Tsuyama Chuo HospitalOkayama 708-0841Japan department of Endoscopy Okayama University HospitalOkayama 700-8558Japan department of Pathology Tsuyama Chuo HospitalOkayama 708-0841Japan

AIM: To investigate the usefulness of chromoendoscopy, using an acetic acid indigocarmine mixture (AIM), for gastric adenoma diagnosed by forceps biopsy.

关键词： Acetic acid indigocarmine mixture Early gastric cancer Gastric adenoma Reddish change Endoscopic submucosal dissection