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Increased fibrosis progression rates in hepatitis C patients carrying the prothrombin G20210A mutation

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World Journal of Gastroenterology 2011年第45期17卷 5007-5013页

作者： Nitsan Maharshak Philippe Halfon Varda Deutsch Hava Peretz Shlomo Berliner Sigal Fishman Shira Zelber-Sagi Uri Rozovski Moshe Leshno Ran Oren Department of Gastroenterology and Liver diseases Tel Aviv Sourasky Medical Center aff iliated to the Sackler School of Medicine Tel Aviv University Department of Virology Laboratoire Alphabio 23 Rue de Friedland Hpital Ambroise Paré The Hematology Institute Tel Aviv Sourasky Medical Center affi liated to the Sackler School of Medicine Tel Aviv University Clinical Biochemistry Laboratory Tel Aviv Sourasky Medical Center affiliated to the Sackler School of Medicine Tel Aviv University internal medicine "E" Tel Aviv Sourasky Medical Center affi liated to the Sackler School of Medicine Tel Aviv University

AIM: To examine whether hepatitis C virus (HCV)-infected patients who carry hypercoagulable mutationssuffer from increased rates of liver fi brosis. METHODS: We analyzed DNA samples of 168 HCV patients for three common hypercoagulable gene mutations: prothrombin 20210 (PT20210), factor V Leiden (FV Leiden) and methylene tetrahydrofolate reductase (MTHFR). The patients were consecutively recruited as part of the prospective "Fibroscore Study" in France. The effect of the various mutations on the rate of fi-brosis was analyzed statistically and was correlated with epidemiological, clinical and biochemical data such as grade and stage of liver biopsies, patients' risk factors for liver cirrhosis, and timing of infection. RESULTS: Fifty two of the patients were categorized as "fast fi brosers" and 116 as "slow fi brosers"; 13% of the "fast fi brosers" carried the PT20210 mutation as compared with 5.5% of the "slow fi brosers", with an odds ratio of 4.76 (P = 0.033; 95% CI: 1.13-19.99) for "fast" liver fibrosis. Carriage of MTHFR or FV Leiden mutations was not associated with enhanced liver fi brosis. CONCLUSION: Carriage of the PT20210 mutation is related to an increased rate of liver fi brosis in HCV patients.

关键词： Hepatitis C virus Liver fi brosis Hyperco-agulation Prothrombin 20210

Effect of patient COVID-19 vaccine hesitancy on hospital care team perceptions

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World Journal of Clinical Cases 2023年第4期11卷 821-829页

作者： Inbar Caspi Ophir Freund Omer Pines Odelia Elkana Jacob N Ablin Gil Bornstein internal medicine Department B Tel-Aviv Sourasky Medical Center and Sackler Faculty of MedicineTel Aviv UniversityTel Aviv 6423906Israel Behavioral Sciences Department Academic College of Tel Aviv-YaffoTel Aviv 6818211Israel internal medicine Department H Tel Aviv Sourasky Medical Center and Sackler School of MedicineTel Aviv 6423906Israel

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic posed new challenges in patient care ***,which have proven efficacious in lowering the COVID-19 hospital burden,are still avoided by large ***,therefore,hypothesized that hospital care teams would have worse perceptions regarding the characteristics and care of patients with vaccine *** To evaluate whether patient vaccine hesitancy affected the hospital care team(HCT)*** We performed a prospective clinical study using structured *** approached physicians and nurses with previous experience caring for COVID-19patients from 11 medical centers across Israel during the fourth COVID-19 surge(September and October 2021).The participants completed a questionnaire with the following parts:(1)Sociodemographic characteristics;(2)Assessment of anger(STAXI instrument)and chronic workplace stress(Shirom-Melamed burnout measure);and(3)Three tools to assess the effect of patient vaccine hesitancy on the HCT perceptions(the difficult doctor-patient relation questionnaire,the medical staff perception of patient’s responsibility questionnaire and the characterological derogation questionnaire).Results were evaluated according to each part of the questionnaire and the questionnaire as a *** between HCT perceptions and their baseline characteristics,anger or chronic workplace stress were *** The HCT experienced their relationship with unvaccinated patients as more difficult(Pmedical condition(P<0.001,d=1.39)and perceived vaccinated patients as having a higher character value(P<0.001,d=1.03).Unvaccinated patients were considered selfish(P<0.001),less mature(P<0.001)and less satisfying to care for(P<0.001).The relationship with unvaccinated patients was more difficult among HCT with higher burnout(r=0.37,n=66,P=0.002).No correlations with baseline characte

关键词： COVID-19 Vaccination Hesitancy Patient care Doctor-patient relationship Attitudes

Emergency department electric scooter injuries after the introduction of shared e-scooter services: A retrospective review of 3,331 cases

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World Journal of Emergency medicine 2022年第1期13卷 5-10页

作者： Ittai Shichman Or Shaked Shai Factor Ahuva Weiss-Meilik Amal Khoury Division of Orthopedics Tel-Aviv Sourasky Medical CenterAffi liated to the Sackler Faculty of Medicine Tel-Aviv UniversityTel Aviv 64239Israel Head of I-Medata AI center Tel-Aviv Sourasky Medical CenterAffi liated to the Sackler Faculty of Medicine Tel-Aviv UniversityTel Aviv 64239Israel

BACKGROUND: To determine the frequency, characteristics, and use of resources related to electric scooter(e-scooter) injuries in the emergency department(ED) of a major metropolitan area ***: We performed a retrospective review of all ED presentations related to e-scooter injuries at a level I trauma center between May 2017 and February 2020. We identified ED presentation data, injury-related data, patients’ clinical course after evaluation, injury diagnosis, surgical procedures, and ED ***: A total of 3,331 patients with e-scooter injuries presented to the ED over a 34-month period. There was a 6-fold increase in e-scooter-related injuries presenting to the ED, from an average of 26.9 injuries per month before the introduction of shared e-scooter services in August 2018 to an average of 152.6 injuries per month after its introduction. The average injury rate during weekdays was 3.27 per day, with the majority of injuries occurring in the afternoon. The most common mechanism of injury was rider fall(79.1%). There were a total of 2,637 orthopedic injuries, of which 599(22.7%) were fractures. A total of 296(8.9%) patients were hospitalized following the initial ED admission, and 462 surgeries were performed within 7 days of ED ***: The introduction of the shared e-scooter services is associated with a dramatic increase in e-scooter injuries presenting to the ED. E-scooter use carries considerably underestimated injury risks of high-energy trauma and misunderstood mechanisms of injuries. These injuries challenge the healthcare system, with a major impact on both EDs and surgical departments.

关键词： E-scooter Scooter Emergency department

Gastroesophageal reflux disease symptoms:Prevalence,sociodemographics and treatment patterns in the adult Israeli population

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World Journal of Gastroenterology 2011年第10期17卷 1332-1335页

作者： Menachem Moshkowitz Noya Horowitz Zamir Halpern Erwin Santo Department of Gastroenterology Tel-Aviv Sourasky Medical Center and the Sackler Faculty of MedicineTel-Aviv University

AIM： To evaluate the prevalence and sociodemographics of gastroesophageal reflux disease （GERD） symptoms and to identify treatment patterns among GERD patients. METHODS： A telephone survey of a representative sample of the adult Israeli population was conducted. The questionnaire included detailed sociodemographics, history of GERD symptoms and the various treatments used. RESULTS： The survey included 2027 subjects. Twice weekly, once weekly and monthly GEP, D symptoms were reported by 8.4%, 12.5% and 21.5% of subjects, respectively. There was no difference in prevalence between men and woman; however, GERD symptoms were significantly more prevalent within the older age group and lower socioeconomic status. Among those reporting weekly symptoms, a quarter did not use any kind of therapy and another quarter used various traditional remedies （e.g. soda, milk, almonds, etc.）. Antacids were used by 35.1%, H2 blockers by 13.2% and PPIs by 17.5%. CONCLUSION： We found that 12.5% of the adult Israeli population experience weekly GERD symptoms. GERD prevalence and sociodemographics are similar to those described in other Western countries, and treatment is still suboptimal.

关键词： Gastroesophageal reflux disease Prevalence Sociodemographics

Targeting late SV40 factor: Is the achilles heel of hepatocarcinogenesis revealed?

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World Journal of Gastroenterology 2012年第46期18卷 6709-6711页

作者： Amir Shlomai Institute of Gastroenterology and Liver Diseases Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel-Aviv University

Hepatocellular carcinoma (HCC) is a dreadful cancer and a major cause of death among patients with chronic liver disease and cirrhosis. The apparent alterations in a diversity of intracellular pathways found in HCC has set the rational for developing molecular-directed drugs that simultaneously inhibit multiple pathways, such as the multi-kinase inhibitor Sorafenib. However, recently this concept has been challenged by showing that HCC is heavily dependent on a single oncogene designated late SV-40 factor (LSF), a transcription factor that is over-expressed in liver cancer cells and that its expression is strongly correlated with tumor grade and aggressiveness. Furthermore, using an intensive screening for drugs that inhibit LSF activity, Grant et al have found a molecule designated factor quinolinone inhibitor 1 that can specifically block the ability of LSF to bind its target promoters, resulting in a massive death of HCC cells both in vitro and in vivo. The innovative findings of HCC representing "oncogene addiction" to LSF and the ability of a single molecule to block the activity of this oncogene resulting in tumor abolishment are encouraging and provide us with the hope that the "Achilles heel" of HCC has been found.

关键词： Oncogene addiction Hepatocellular carcinoma Late SV40 factor Transcription factor Multikinase inhibit

Hepatocellular carcinoma in the post-hepatitis C virus era: Should we change the paradigm?

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World Journal of Gastroenterology 2019年第29期25卷 3929-3940页

作者： Hadar Meringer Oren Shibolet Liat Deutsch Department of Gastroenterology and Hepatology Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine Tel Aviv University

Hepatocellular carcinoma (HCC) is a common and deadly malignancy. The disease usually develops on a background of chronic liver disease. Until recently, the most common etiology was infection with the hepatitis C virus (HCV). The advent of direct-acting antiviral (DAA) therapies has been a major breakthrough in HCV treatment. Sustained virologic response can now be achieved in almost all treated patients, even in patients with a high risk for the development of HCC, such as the elderly or those with significant fibrosis. Early reports raised concerns of a high risk for HCC occurrence after DAA therapy both in patients with previous resection of tumors and those without previous tumors. As the World Health Organization’s goals for eradication of HCV are being endorsed worldwide, the elimination of HCV seems feasible. Simultaneous to the decrease in the burden of cirrhosis from HCV, non-alcoholic fatty liver disease (NAFLD) incidence has been increasing dramatically including significant increased incidence of cirrhosis and HCC in these patients. Surprisingly, a substantial proportion of patients with NAFLD were shown to develop HCC even in the absence of cirrhosis. Furthermore, HCC treatment and potential complications are known to be influenced by liver steatosis. These changes in etiology and epidemiology of HCC suggest the beginning of a new era: The post–HCV era. Changes may eventually undermine current practices of early detection, surveillance and management of HCC. We focused on the risk of HCC occurrence and recurrence in the post–HCV era, the surveillance needed after DAA therapy and current studies in HCC patients with NAFLD.

关键词： Hepatocellular carcinoma Hepatitis C virus Direct-acting antivirals Nonalcoholic fatty liver disease Non-alcoholic steatohepatitis

The effect of sildenafil on retinal blood velocity in healthy subjects

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Eye and Vision 2018年第1期5卷 269-274页

作者： Asaf Achiron Idan Hecht Chen Juza Adiel Barak Zvia Burgansky-Eliash Department of Ophthalmology Edith Wolfson Medical Center62 Halochamim St58100 HolonIsrael Sackler School of medicine Tel Aviv UniversityTel AvivIsrael Department of Urology Tel Aviv Sourasky Medical CenterTel AvivIsrael Department of Ophthalmology Tel Aviv Sourasky Medical CenterTel AvivIsrael

Purpose:It has been suggested that Sildenafil may have beneficial therapeutic effects in the treatment of neurodegenerative *** retinal circulation is of significant interest as a marker of cerebral vascular disease since the retinal and cerebral vasculatures share many morphological and physiological properties,yet only the retinal circulation can be directly ***,our aim was to assess the change induced by Sildenafil on retinal blood ***:Retinal flow velocity was measured 0.5,3 and 6 h following administration of 100 mg of Sildenafil using the Retinal Function ***:No clinical change in either systemic blood pressure or retinal flow velocities were ***,when controlling for heart rate and blood pressure,a significant drop in venous flow velocity 6 h following treatment(mean drop 0.3±0.07;95%CI:0.44–0.56,P=0.023)was ***:In healthy volunteers,retinal venous flow velocity was significantly reduced at the 6-h time point following Sildenafil *** effect was observed on arterial retinal flow velocity.

关键词： Sildenafil Retinal function imager Autoregulation

Effect of brimonidine tartrate on basophil activation in glaucoma patients

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International Journal of Ophthalmology(English edition) 2020年第3期13卷 509-512页

作者： Eldar Rosenfeld Dana Barequet Gilad Rabina Sheila Langier Moshe Lazar Gabi Shemesh Shimon Kurtz Shmuel Kivity Division of Ophthalmology Sourasky Medical CenterSackler School of MedicineTel Aviv UniversityTel Aviv 6423906Israel Department of Allergy and Immunology Sourasky Medical CenterSackler School of MedicineTel Aviv UniversityTel Aviv 6423906Israel

AIM:To evaluate the mechanism of which brimonidine tartrate 0.15%causes clinical ***:A prospective case-control study comparing 8 glaucoma patients with clinical hypersensitivity to brimonidine to a control group consisting 13 healthy *** samples were stimulated with brimonidine 0.15%,timolol 0.5%or brimonidine tartrate/timolol maleate 0.2%/0.5%.Premixed antibodies(CD63/FITC and aIgE/PE)were added for direct staining and whole-blood samples were lysed,fixed and analyzed by a flow *** basophil population was defined by high IgE cell *** was identified by the expression of the activation molecule ***:Basophil activation was not significant when comparing percent of activated basophils of patients and healthy controls after exposure to brimonidine(2.58%,2.45%,respectively,P=0.72).There was a significant suppression of basophil activation when a combination of brimonidine-timolol(0.87%)was compared to timolol(2.27%;P=0.012)and to brimonidine alone(2.58%;P=0.017).CONCLUSION:The results of our study do not support the hypothesis that brimonidine induces an immediate allergic *** activation was suppressed by the presence ofβ-blockers in patients hypersensitive to brimonidine and in healthy *** finding indicates that timolol suppress brimonidine drug reaction by a different mechanism.

关键词： glaucoma allergy hypersensitivity brimonidine timolol basophils

Short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy for failed Ahmed glaucoma valve

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International Journal of Ophthalmology(English edition) 2022年第6期15卷 947-953页

作者： Bar Davidov Shimon Kurtz Ilona Mohilevtseva Michael Waisbourd Rony Rachmiel Glaucoma center Department of OphthalmologyTel Aviv Sourasky Medical CenterAffiliated to the Sackler Faculty of MedicineTel Aviv UniversityTel Aviv 64239Israel

AIM: To report short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy(ERC) after Ahmed glaucoma valve(AGV) ***: Patients who underwent ERC procedures between January 2017 and December 2019 with a minimum follow-up of 6mo were evaluated retrospectively for indications of AGV and AGV implantation to ERC *** number of anti-glaucoma medications(AGMs),intraocular pressure(IOP) and best corrected visual acuity(BCVA) were recorded at baseline, 1, 7, 30, 90, and ***-and postoperative complications were also *** outcome was defined as IOP≤21 mm Hg with or without ***: Fourteen eyes [14 patients, median age 69.5y, interquartile range(IQR) 61.3-80] were *** glaucoma(n=5, 36%) was the most common form of glaucoma. The median AGV implantation to ERC interval was 8.8mo(IQR 3.91-43.67). At 6mo, the median number of AGMs decreased from 3.0(IQR 3.0-4.0)to 2.0(IQR 1.5-3), the median IOP decreased from 26 mm Hg(IQR 22-29) to 16.5 mm Hg(IQR 13.75-20) and there was no significant change in BCVA. The success rate at 6mo was 92.9%. The Kaplan-Meier cumulative probability of survival was 93%, 79%, 64%, and 64% at 1wk, and 1,3, and 6mo, respectively. No intraoperative complications were identified. Postoperative complications were identified in 5 eyes(36%), which were resolved spontaneously during the first week following ***: ERC has a high success rate for shortterm management of AGV failure. A longer follow-up study is required to determine long-term cumulative failure rates.

关键词： glaucoma Ahmed bleb capsulectomy mitomycin C