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Risk factors for liver fibrosis among human immunodeficiency virus monoinfected patients using the FIB4 index in Morocco

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World Journal of hepatology 2013年第10期5卷 584-588页

作者： Mohamed Tahiri Mustapha Sodqi Fatima Ez Zahra Lahdami Latifa Marih Hassan Lamdini Wafaa Hliwa Ahd Oulad Lahcen Wafaa Badre Fouad Haddad Abdelfetah Chakib Ahmed Bellabah Rhimou Alaoui Kamal Marhoum El Filali Department of Hepato-gastro-enterology Ibn Rochd Hospital University Center Department of Infectious Diseases Ibn Rochd Hospital University Center

AIM: To study the prevalence and risk factors of significant hepatic fibrosis in Moroccan human immunodeficiency virus(HIV) monoinfected ***: We conducted a cross-sectional study among HIV monoinfected patients(negative for hepatitis B surface antigen and hepatitis C antibody). Clinical and laboratory data were collected from the data base of the Infectious Diseases Unit in Ibn Rochd Hospital Center [age, gender, duration of HIV infection, CD4 T lymphocyte count, HIV viral load, glycemia and current or prior use of antiretroviral and antiretroviral therapy(ART) duration]. The primary outcome was a FIB4score > 1.45. Multivariable logistic regression identifiedindependent risk factors for FIB4 > ***: A FIB4 score > 1.45 was identified in 96among 619(15.5%). HIV monoinfected patients followed up between September 1990 and September2012. Multivariate analysis showed that only a viral load > 75(OR = 2.23, 95%CI: 1.36-3.67), CD4 > 200cells/mm3(OR = 0.39, 95%CI: 0.21-0.72) and age at FIB4 index calculation(OR = 1.10, 95%CI: 1.07-1.13)were independently associated with the occurrence of FIB4 index(> 1.45). Gender, duration of HIV infection,glycemia, use of antiretroviral therapy and ART duration were not associated with significant fibrosis by ***: FIB4 score > 1.45 was found in 15.5%of Moroccan HIV monoinfected patients. Age, HIV viremia > 75 copies/mL and CD4 count > 200 cells/mm3are associated with liver fibrosis. Further studies are needed to explore mechanisms for fibrosis in HIV monoinfected patients.

关键词： Human immunodeficiency virus FIB4 Liver Monoinfected Risk factors

Poorly expandable common bile duct with stones on endoscopic retrograde cholangiography

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World Journal of gastroenterology 2012年第19期18卷 2396-2401页

作者： Chi-Liang Cheng Yung-Kuan Tsou Cheng-Hui Lin Jui-Hsiang Tang hien-Fu Hung Kai-Feng Sung Ching-Song Lee Nai-Jen Liu Division of Therapeutic Endoscopy Department of Gas-troenterology and Hepatology Chang Gung Memorial HospitalCollege of Medicine Chang Gung University Taoyuan 333Taiwan China Division of Radiology Department of Gastro-enterology and Hepatology College of Medicine Chang GungUniversity Taoyuan 333 Taiwan China

AIM： To describe characteristics of a poorly expandable （PE） common bile duct （CBD） with stones on en- doscopic retrograde cholangiography.METHODS： APE bile duct was characterized by a rigid and relatively narrowed distal CBD with retro- grade dilatation of the non-PE segment. Between 2003 and 2006, endoscopic retrograde cholangiography （ERC） images and chart reviews of 1213 patients with newly diagnosed CBD stones were obtained from the computer database of Therapeutic Endoscopic Centerin Chang Gung Memoria acteristic PE bile duct on Hospital. Patients with char ERC were identified from the database. Data of the patients as well as the safety and technical success of therapeutic ERC were collected and analyzed retrospectively.RESULTS： A total of 30 patients with CBD stones and characteristic PE segments were enrolled in this study. The median patient age was 45 years （range, 20 to 92 years）; 66.7% of the patients were men. The di ameters of the widest non-PE CBD segment, the PE segment, and the largest stone were 14.3 ± 4.9 mm, 5.8±1.6 mm, and 11.2±4.7 mm, respectively. The length of the PE segment was 39.7±15.4 mm （range, 12.3 mm to 70.9 mm）. To remove the CBD stone（s） completely, mechanical lithotripsy was required in 25 （83.3%） patients even though the stone size was not as large as were the difficult stones that have been described in the literature. The stone size and stone/ PE segment diameter ratio were associated with the need for lithotripsy. Post-ERC complications occurred in 4 cases： pancreatitis in 1, cholangitis in 2, and an im- pacted Dormia basket with cholangitis in 1. Two （6.7%） of the 28 patients developed recurrent CBD stones at follow-up （50±14 mo） and were successfully managed with therapeutic ERC.CONCLUSION： Patients with a PE duct frequently require mechanical lithotripsy for stones extraction, To retrieve stones successfully and avoid complications, these patients should be identified during ERC,

关键词： Common bile duct stone Difficult stone Endoscopic retrograde cholangiography Mechanicallithotripsy

Conjugated hyperbilirubinemia presenting in first fourteen days in term neonates

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World Journal of hepatology 2017年第26期9卷 1108-1114页

作者： Fang Kuan Chiou Christina Ong Kong Boo Phua Fares Chedid Ajmal Kader gastro-enterology Service Paediatric Medicine KK Women’s and Children’s Hospital Neonatal Medicine Al Jalila Children’s Specialty Hospital Pediatric gastroenterology Dubai Hospital

AIM To describe the etiology and characteristics of earlyonset conjugated hyperbilirubinemia(ECHB) presenting within 14 d of life in term *** Retrospective review was performed of term infants up to 28-d-old who presented with conjugated hyperbilirubinemia(CHB) at a tertiary center over a 5-year period from January 2010 to December 2014. CHB is defined as conjugated bilirubin(CB) fraction greater than 15% of total bilirubin and CB greater or equal to 25 μmol/L. ECHB is defined as CHB detected within 14 d of life. "Late-onset" CHB(LCHB) is detected at 15-28 d of life and served as the comparison *** Total of 117 patients were recruited: 65 had ECHB, 52had LCHB. Neonates with ECHB were more likely to be clinically unwell(80.0% vs 42.3%, P < 0.001) and associated with non-hepatic causes(73.8% vs 44.2%, P = 0.001) compared to LCHB. Multifactorial liver injury(75.0%) and sepsis(17.3%) were the most common causes of ECHB in clinically unwell infants, majority(87.5%) had resolution of CHB with no progression to chronic liver disease. Inborn errors of metabolism were rare(5.8%) but associated with high mortality(100%) in our series. In the subgroup of clinically well infants(n = 13) with ECHB, biliary atresia(BA) was the most common diagnosis(61.5%), all presented initially with normal stools and decline in total bilirubin but with persistent CHB. CONCLUSION Secondary hepatic injury is the most common reason for ECHB. BA presents with ECHB in well infants without classical symptoms of pale stools and deep jaundice.

关键词： Conjugated hyperbilirubinemia Biliary atresia Cholestasis Direct hyperbilirubinemia Neonatal jaundice

Characteristics of Clostridium difficile infection in patients hospitalized with myelodysplastic syndrome or acute myelogenous leukemia

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World Journal of Clinical Oncology 2017年第5期8卷 398-404页

作者： Kamini Shah Bryan F Curtin Christopher Chu Daniel Hwang Mark H Flasar Erik von Rosenvinge Division of Infectious Diseases Department of MedicineUniversity of Maryland School of Medicine Digestive Diseases Branch National Institute of Diabetes and Digestive and Kidney Diseases Department of Medicine University of Maryland School of Medicine Division of gastro-enterology and hepatology Department of MedicineUniversity of Maryland School of Medicine and VA Maryland Health Care System

AIM To evaluate factors associated with Clostridium difficile infection (CDI) and outcomes of CDI in the myelodysplastic syndrome(MDS) and acute myeloid leukemia (AML) *** After IRB approval,all MDS/AML patients hospitalized at the University of Maryland Greenebaum Comprehensive Cancer Center between August 2011 and December 2013 were *** charts were reviewed for demographics,clinical information,development of CDI,complications of CDI,and *** with CDI,defined as having a positive stool PCR done for clinical suspicion of CDI,were compared to those without CDI in order to identify predictors of disease.A t-test was used for comparison of continuous variables and chisquare or Fisher's exact tests were used for categorical variables,as *** Two hundred and twenty-three patients (60.1% male,mean age 61.3 years,13% MDS,87% AML) had 594 unique hospitalizations during the study *** patients (15.2%) were diagnosed with *** significantly associated with CDI included lower albumin at time of hospitalization (P < 0.0001),prior diagnosis of CDI (P < 0.0001),receipt of cytarabine-based chemotherapy (P = 0.015),total days of neutropenia (P = 0.014),and total days of hospitalization (P = 0.005).Gender (P = 0.10),age (P = 0.77),proton-pump inhibitor use (P = 0.73),receipt of antibiotics (P = 0.66),and receipt of DNA hypomethylating agent-based chemotherapy (P = 0.92) were not significantly associated with *** CDI is common in the MDS/AML *** significantly associated with CDI in this population include low albumin,prior CDI,use of cytarabine-based chemotherapy,and prolonged *** this study,we have identified a subset of patients in which prophylaxis studies could be targeted.

关键词： Clostridium difficile Acute myeloid leukemia Cytarabine-based chemotherapy Myelodysplastic syndrome Neutropenia

Characterization of CD133^+ parenchymal cells in the liver:Histology and culture

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World Journal of gastroenterology 2009年第39期15卷 4896-4906页

作者： Seiichi Yoshikawa Yoh Zen Takahiko Fujii Yasunori Sato Tetsuo Ohta Yutaka Aoyagi Yasuni Nakanuma Department of Human Pathology Kanazawa University Graduate School of Medicine Division of gastro-enterology and hepatology Niigata University Graduate School of Medical and Dental Sciences Division of Pathology Kanazawa University Hospital Department of gastrointestinal Surgery Kanazawa University Graduate School of Medicine

AIM： To reveal the characteristics of CD133^＋ cells in the liver, METHODS： This study examined the histological characteristics of CD133^＋ cells in non-neoplastic and neoplastic liver tissues by immunostaining, and also analyzed the biological characteristics of CD133^＋ cells derived from human hepatocellular carcinoma （HCC） or cholangiocarcinoma cell lines. RESULTS： Immunostaining reveated constant expression of CD133 in non-neoplastic and neoplastic biliary epithelium, and these cells had the immunophenotype CD133^＋/CK19^＋/HepPar-1. A small number of CD133^＋/CK19/HepPar-1^＋ cells were also identified in HCC and combined hepatocellular and cholangiocarcinoma. In addition, small ductal structures, resembling the canal of Hering, partly surrounded by hepatocytes were positive for CD133. CD133 expression was observed in three HCC （HUH7, PLC5 and HepG2） and two cholangiocarcinoma cell lines （HuCCT1 and CCKS1）. Fluorescence-activated cell sorting （FACS） revealed that CD133^＋ and CD133 cells derived from HuH7 and HuCCT1 cells similarly produced CD133^＋ and CD133 cells during subculture. To examine the relationship between CD133^＋ cells and the side population （SP） phenotype, FACS was performed using Hoechst 33342 and a monoclonal antibody against CD133. The ratios of CD133^＋/CD133 cells were almost identical in the SP and non-SP in HUH7. In addition, four different cellular populations （SP/CD133^＋, SP/CD133, nonP/CD133^＋, and non- SP/CD133） could similarly produce CD133^＋ and CD133- cells during subculture. CONCLUSION： This study revealed that CD133 could be a biliary and progenitor cell marker in vivo. However, CD133 alone is not sufficient to detect tumor-initiating cells in cell lines.

关键词： Cholangiocarcinoma Hepatocellular carcinoma Keratins Stem cells

Hepatitis delta virus:Making the point from virus isolation up to 2014

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World Journal of hepatology 2015年第22期7卷 2389-2395页

作者： Raffaella Romeo Riccardo Perbellini 1st Division of gastro-enterology IRCCS Fondazione Cà Granda Ospedale Maggiore PoliclinicoUniversity of Milan

Chronic infection with hepatitis delta virus(HDV) has lately regained clinical importance because of the recent evidence of increasing prevalence in several European countries,due to immigration from highly endemic areas. HDV requires the mandatory presence ofhepatitis B virus(HBV) for propagation to hepatocytes. It is transmitted by the same routes of HBV and it can be acquired either by co-infection(simultaneous transmission of the two viruses) or super-infection(acquisition of HDV by an already chronic carrier of HBV). As a consequence,every HBV carrier is potentially at risk for HDV superinfection. Since the clinical course of superinfection can be severe,early diagnosis of HDV infection is necessary.

关键词： Hepatitis delta virus Epidemiology Natural history

Hepatitis B virus reactivation with a rituximab-containing regimen

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World Journal of hepatology 2015年第21期7卷 2344-2351页

作者： Yutaka Tsutsumi Yoshiya Yamamoto Shinichi Ito Hiroyuki Ohigashi Souichi Shiratori Hirohito Naruse Takanori Teshima Department of Hematology Hakodate Municipal Hospital Department of gastro-enterology Hakodate Municipal Hospital Department of Hematology Hokkaido University Graduate School of Medicine

Rituximab is currently used not only in the treatment of B-cell lymphoma but also for various other diseases, including autoimmune diseases, post-transplant graft vs host disease, and rejection following kidney transplants. Due to rituximab's widespread use, great progress has been made regarding research into complications that arise from its use, one of the most serious being the reactivation of hepatitis B virus(HBV), and efforts continue to establish guidelines for preventive treatment against this occurrence. This report discusses preventive measures against rituximab-induced HBV reactivation and future objectives.

关键词： Rituximab Hepatitis B virus Reactivation Nucleosid

Alpha-fetoprotein and des-gamma-carboxy-prothrombin at twenty-four weeks after interferon-based therapy predict hepatocellular carcinoma development

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World Journal of hepatology 2015年第27期7卷 2757-2764页

作者： Satoshi Shakado Shotaro Sakisaka Kazuaki Chayama Takeshi Okanoue Joji Toyoda Namiki Izumi Akihiro Matsumoto Tetsuo Takehara Akio Ido Yoichi Hiasa Kentaro Yoshioka Hideyuki Nomura Yoshiyuki Ueno Masataka Seike Hiromitsu Kumada Department of gastro-enterology and Medicine Faculty of Medicine Fukuoka University Department of gastroenterology and Metabolism Applied Life Sciences Graduate School of Biome-dical and Health SciencesHiroshima University Center of gastroenterology and hepatology Saiseikai Suita Hospital Department of gastroenterology and hepatology Sapporo Kousei Hospital Department of gastroenterology and hepatology Musashino Red-Cross Hospital Department of Medicine Shinshu University School of Medicine Department of gastroenterology and Hepa-tology Osaka University Graduate School of Medicine Department of gastroenterology and hepatology Kagoshima University Department of gastroenterology and Metabology Ehime University Graduate School of Medicine Department of Liver Biliary Tract and Pancreas Diseases Fujita Health University the Center for Liver Disease Shin-Kokura Hospital Department of gastroenterology Yamagata University Department of gastroenterology Faculty of Medicine Oita University Department of hepatology Toranomon Hospital

AIM: To investigate risk factors for development of hepatocellular carcinoma(HCC) in patients with hepatitis C virus-related liver cirrhosis(LC-C).METHODS: To evaluate the relationship between clinical factors including virological response and the development of HCC in patients with LC-C treated with interferon(IFN) and ribavirin, we conducted a multicenter, retrospective study in 14 hospitals in Japan. All patients had compensated LC-C with clinical or histological data available. HCC was diagnosed by the presence of typical hypervascular characteristics on computed tomography and/or magnetic resonance ***: HCC was diagnosis in 50(21.6%) of 231 LC-C patients during a median observation period of 3.8 years after IFN and ribavirin therapy. Patients who developed HCC were older(P = 0.018) and had higher serum levels of pretreatment alpha-fetoprotein(AFP)(P = 0.038). Multivariate analysis revealed the following independent risk factors for HCC development: history of treatment for HCC [P < 0.001, odds ratio(OR) = 15.27, 95%CI: 4.98-59.51], AFP levels of ≥ 10 ng/m L(P = 0.009, OR = 3.89, 95%CI: 1.38-11.94), and des-γ-carboxy prothrombin(DCP) levels of ≥ 40 m AU/mL at 24 wk after the completion of IFN and ribavirin therapy(P < 0.001, OR = 24.43, 95%CI: 4.11-238.67).CONCLUSION: We suggested that the elevation of AFP and DCP levels at 24 wk after the completion of IFN and ribavirin therapy were strongly associated with the incidence of HCC irrespective of virological response among Japanese LC-C patients.

关键词： Des-γ-carboxy prothrombin Hepatocellular carcinoma

Predictors of mortality and endoscopic intervention in patients with upper gastrointestinal bleeding in the intensive care unit

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gastroenterology Report 2020年第4期8卷 299-305,I0002页

作者： Vijaya L.Rao Nina Gupta Eric Swei Thomas Wagner Andrew Aronsohn KGautham Reddy Neil Sengupta section of gastroenterology Hepatology and NutritionDepartment of Internal MedicineUniversity of Chicago MedicineChicagoILUSA Department of Internal Medicine University of Chicago MedicineChicagoILUSA

Background:The outcomes of patients undergoing esophagogastroduodenoscopy(EGD)in the intensive care unit(ICU)for upper gastrointestinal bleeding(UGIB)are not well *** aims were to determine predictors of 30-day mortality and endoscopic intervention,and assess the utility of existing clinical-prediction tools for UGIB in this ***:Patients hospitalized in an ICU between 2008 and 2015 who underwent EGD were identified using a validated,machine-learning *** regression was used to determine factors associated with 30-day mortality and endoscopic *** under receiver-operating characteristics(AUROC)analysis was used to evaluate established UGIB scoring systems in predicting mortality and endoscopic intervention in patients who presented to the hospital with ***:A total of 606 patients underwent EGD for UGIB while admitted to an *** median age of the cohort was 62 years and 55.9%were *** analysis revealed that predictors associated with 30-day mortality included American Society of Anesthesiologists(ASA)class(odds ratio[OR]4.1,95%confidence interval[CI]2.2-7.9),Charlson score(OR 1.2,95%CI 1.0-1.3),and duration from hospital admission to EGD(OR 1.04,95%CI 1.01-1.07).Rockall,Glasgow-Blatchford,and AIMS65 scores were poorly predictive of endoscopic intervention(AUROC:0.521,0.514,and 0.540,respectively)and in-hospital mortality(AUROC:0.510,0.568,and 0.506,respectively).Conclusions:Predictors associated with 30-day mortality include ASA classification,Charlson score,and duration in the hospital prior to *** risk tools are poorly predictive of clinical outcomes,which highlights the need for a more accurate risk-stratification tool to predict the benefit of intervention within the ICU population.

关键词： upper gastrointestinal bleeding esophagogastroduodenoscopy intensive care unit