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Chronic hepatitis B virus infection： epidemiology, prevention, and treatment in China

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Frontiers of Medicine 2014年第2期8卷 135-144页

作者： Rui Yu Rong Fan Jinlin Hou hepatology unit and Department of Infectious Diseases Nanfang Hospital Southern Medical University Guangzhou 510515 China

Chronic hepatitis B is a major health problem in China. The universal vaccination program since 1992 has changed the epidemiology of hepatitis B virus infection in China from highly to moderately endemic. The most prevalent hepatitis B virus strains in China are genotypes B and C, whereas those in western provinces are genotypes D and C/D hybrid. Chronic hepatitis B poses a heavy burden to the society in China. Different treatment strategies have been explored to improve patient outcomes in a cost-effective manner. However, antiviral drugs with a low genetic barrier to resistance are still extensively used because of the generally low income and limited resources in China. Individualized antiviral therapy is closely associated with translational medicine, which utilizes information from studies on genomics, immune biomarkers, and fibrosis. The results of these studies are crucial in further improving treatment outcomes.

关键词： chronic hepatitis B epidemiology prevention treatment

Thrombocytopenia in chronic liver disease:Physiopathology and new therapeutic strategies before invasive procedures

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World Journal of Gastroenterology 2022年第30期28卷 4061-4074页

作者： Paolo Gallo Francesca Terracciani Giulia Di Pasquale Matteo Esposito Antonio Picardi Umberto Vespasiani-Gentilucci Clinical Medicine and hepatology unit Campus Bio-Medico UniversityRoma 00128Italy

Chronic liver disease is characterized by several hematological derangements resulting in a complex and barely rebalanced haemostatic *** is the most common abnormality observed in these patients and recent advances have led to researchers focus the attention on the multifactorial origin of thrombocytopenia and on the key role of thrombopoietin(TPO)in its *** thrombocytopenia(platelet count<50000/μL)complicates the management of patients with chronic liver disease by increasing the potential risk of bleeding for invasive procedures,which may be therefore delayed or canceled even if *** the very last years,the development of new drugs which exceed the limits of the current standard of care(platelet transfusions,either immediately before or during the procedure)paves the way to a new scenario in the management of this population of *** agents,such as the TPOreceptor agonists avatrombopag and lusutrombopag,have been developed in order to increase platelet production as an alternative to platelet *** agents have demonstrated a good profile in terms of efficacy and safety and will hopefully allow reducing limitations and risks associated with platelet transfusion,without any delay in scheduled ***,it is expected that patients with chronic liver disease will be able to face invasive procedures with one more string in their bow.

关键词： Thrombocytopenia Chronic liver disease Thrombopoietin agonists Platelet transfusions Avatrombopag Lusutrombopag

Non-cirrhotic portal hypertension with large regenerative nodules: A diagnostic challenge

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World Journal of Gastroenterology 2011年第20期17卷 2580-2584页

作者： Umberto Vespasiani Gentilucci Paolo Gallo Giuseppe Perrone Riccardo Del Vescovo Giovanni Galati Sandro Spataro Chiara Mazzarelli Adriano Pellicelli Antonella Afeltra Antonio Picardi Clinical Medicine and hepatology unit University Campus Bio-Medico of Rome Clinical Pathology University Campus Bio-Medico of Rome Department of Radiology University Campus Bio-Medico of Rome hepatology unit San Camillo-Forlanini Hospital

Non-cirrhotic portal hypertension is a poorly understood condition characterized by portal hypertension in the absence of conventional hepatic cirrhosis and described in association with blood coagulation disorders, myeloproliferative and immunological diseases and with exposure to toxic drugs. Very recently, precise classification criteria have been proposed in order to define four distinct subcategories. The present case highlights how the clinical presentation, the confounding results from imaging studies, and the difficulties in the histological evaluation often render cases of non-cirrhotic portal hypertension a real diagnostic challenge. It also underscores the classification problems which can be faced once this diagnosis is performed. Indeed, the different subcategories proposed result from the prevalent subtypes in a spectrum of hepatic regenerative responses to a variety of injuries determining microcirculatory dis-turbances. More flexibility in classification should derive from this etiopathogenic background.

关键词： Non-cirrhotic portal hypertension Large regenerative nodules Nodular regenerative hyperplasia

Cystic pancreatic lesions,the endless dilemma

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World Journal of Gastroenterology 2021年第21期27卷 2664-2680页

作者： Hussein Hassan Okasha Abeer Awad Ahmed El-meligui Reem Ezzat Ashraf Aboubakr Sameh AbouElenin Ramy El-Husseiny Ahmed Alzamzamy Department of Internal Medicine and Gastroenterology Hepatology UnitKasr Al-Aini HospitalsCairo UniversityCairo 11562Egypt Department of Internal Medicine and Gastroenterology Hepatology UnitAssuit UniversityAssuit 71515Egypt Department of Gastroenterology and hepatology Maadi Armed Forces Medical ComplexMilitary Medical AcademyCairo 11441Egypt Department of Gastroenterology and hepatology Military Medical AcademyCairo 11441Egypt Department of hepatology and Tropical Medicine National Hepatology and Tropical Medicine Research Institute(NHTMRI)Cairo 11441Egypt

Cystic pancreatic lesions involve a wide variety of pathological entities that include neoplastic and non-neoplastic *** proper diagnosis,differentiation,and staging of these cystic lesions are considered a crucial issue in planning further *** are great challenges for their diagnostic *** our time,new emerging methods for this diagnosis have been *** ultrasonography-guided fine-needle aspiration cytology with chemical and molecular analysis of cyst fluid and EUS-guided fine needlebased confocal laser endomicroscopy,through the needle microforceps biopsy,and single-operator cho-langioscopy/pancreatoscopy are promising methods that have been used in the diagnosis of cystic pancreatic *** we discuss the diagnosis of cystic pancreatic lesions and the benefits of various diagnostic models.

关键词： Pancreatic cystic lesion Endoscopic diagnosis Endoscopic ultrasonography Cyst fluid markers Endoscopic ultrasonography-guided fine needle-based confocal laser endomicroscopy Through the needle microforceps biopsy Single operator cholangioscopy/pancreatoscopy

Hepatitis C virus and metabolic disorder interactions towards liver damage and atherosclerosis

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World Journal of Gastroenterology 2014年第11期20卷 2825-2838页

作者： Umberto Vespasiani-Gentilucci Paolo Gallo Antonio De Vincentis Giovanni Galati Antonio Picardi Internal Medicine and hepatology unit University Campus Bio-Medico of Rome00128 RomeItaly

Hepatitis C virus (HCV) is one of the main causes of liver disease worldwide, and alterations of glucose metabolism have reached pandemic proportions in western countries. However, the frequent coexistence between these two conditions is more than simply coincidental, since HCV can induce insulin resistance through several mechanisms. Indeed, the virus interferes with insulin signaling both directly and indirectly, inducing the production of pro-inflammatory cytokines. Furthermore, the entire viral life cycle has strict interconnections with lipid metabolism, and HCV is responsible for a “viral” steatosis which is frequently superimposed to a “metabolic” one. Several evidences suggest that HCV-induced metabolic disorders contribute both to the evolution of liver fibrosis and, likely, to the progression of the other disorders which are typically associated with altered metabolism, in particular atherosclerosis. In the present review, we will examine in depth the links between HCV infection and insulin resistance, liver steatosis and diabetes, and analyze the impact of these interactions on the progression of liver fibrosis and atherosclerosis. Special attention will be focused on the highly debated topic of the relationship between HCV infection and cardiovascular disease. The available clinical literature on this item will be broadly reviewed and all the mechanisms possibly implied will be discussed.

关键词： Hepatitis C virus Metabolism Insulin resistance Diabetes mellitus Steatosis Fibrosis Atherosclerosis Cardiovascular risk

This year's Nobel Prize to gastroenterology:Robin Warren and Barry Marshall awarded for their discovery of Helicobacter pylori as pathogen in the gastrointestinal tract

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World Journal of Gastroenterology 2006年第19期12卷 3126-3127页

作者： Per M Hellstr(o|¨)m Department of Medicine unit of Gastroenterology and hepatology Karolinska University HospitalSolnaStockholmSweden

TO THE EDITORPeptic ulcer disease is a major health care concern in the society today, in view of personal suffering as well as economical health care costs.

关键词： Helicobacter pylori Nobel Prize Gastroenterology Helicobacter Infections History, 21st Century Humans Inflammation Peptic Ulcer Stomach Neoplasms

State-of-the-art management of dysplastic Barrett’s esophagus

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Gastroenterology Report 2022年第1期10卷 195-206页

作者： Kornpong Vantanasiri Prasad G.Iyer Barrett’s Esophagus unit Division of Gastroenterology and HepatologyMayo ClinicRochesterMNUSA

Endoscopic eradication therapy(EET)has become a standard of care for treatment of dysplastic Barrett’s esophagus(BE)and early Barrett’s *** mainly consists of removal of any visible lesions via endoscopic resection and eradication of all remaining Barrett’s mucosa using endoscopic *** mucosal resection and endoscopic submucosal dissection are the two available resection *** complete resection of all visible lesions,it is crucial to perform endoscopic ablation to ensure complete eradication of the remaining Barrett’s *** ablation can be done either with thermal techniques,including radiofrequency ablation and argon plasma coagulation,or cryotherapy *** primary end point of EET is achieving complete remission of intestinal metaplasia(CRIM)to decrease the risk of dysplastic recurrence after successful *** CRIM is achieved,a standardized endoscopic surveillance protocol needs to be implemented for early detection of BE recurrence.

关键词： Barrett’s esophagus esophageal adenocarcinoma endoscopic eradication therapy endoscopic mucosal resection endoscopic submucosal dissection

Integration of hepatitis B virus DNA into chromosomal DNA during acute hepatitis B

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World Journal of Gastroenterology 2005年第41期11卷 6416-6421页

作者： Gerald C Kimbi Anna Kramvis Michael C Kew MRC/University Molecular hepatology Research unit Department of Medicine University of the WitwatersrandParktown 2193JohannesburgSouth Africa

AIM： To examine the serum from black African patients with acute hepatitis B to ascertain if integrants of viral DNA can be detected in fragments of cellular DNA leaking from damaged hepatocytes into the circulation. METHODS： DNA was extracted from the sera of five patients with uncomplicated acute hepatitis B and one with fulminant disease. Two subgenomic PCRs designed to amplify the complete genome of HBV were used and the resulting amplicons were cloned and sequenced. RESULTS： HBV and chromosomal DNA were amplified from the sera of all the patients. In one patient with uncomplicated disease, HBV DNA was integrated into host chromosome 7 q11.23 in the WBSCR1 gene. The viral DNA comprised 200 nucleotides covering the S and X genes in opposite orientation, with a 1 169 nucleotide deletion. The right virus/host junction was situated at nucleotide 1 774 in the cohesive overlap region of the viral genome, at a preferred topoisomerase I cleavage motif. The chromosomal DNA was not rearranged. The patient made a full recovery and seroconverted to anti-HBs- and anti-HBe-positivity. Neither HBV nor chromosomal DNA could be amplified from his serum at that time. CONCLUSION： Integration of viral DNA into chromosomal DNA may occur rarely during acute hepatitis B and, with clonal propagation of the integrant, might play a role in hepatocarcinogenesis.

关键词： Hepatocellular Chronic hepatitis B infection Clonal propagation

Hepato-cardiac disorders

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World Journal of hepatology 2014年第1期6卷 41-54页

作者： Yasser Mahrous Fouad Reem Yehia Gastroenterology and hepatology unit Endemic Medicine Department Minia University

Understanding the mutual relationship between the liver and the heart is important for both hepatologists and cardiologists. Hepato-cardiac diseases can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. Differential diagnoses of liver injury are extremely important in a cardiologist's clinical practice calling for collaboration between cardiologists and hepatologists due to the many other diseases that can affect the liver and mimic haemodynamic injury. Acute and chronic heart failure may lead to acute ischemic hepatitis or chronic congestive hepatopathy. Treatment in these cases should be directed to the primary heart disease. In patients with advanced liver disease, cirrhotic cardiomyopathy may develop including hemodynamic changes, diastolic and systolic dysfunctions, reduced cardiac performance and electrophysiological abnormalities. Cardiac evaluation is important for patients with liver diseases especially before and after liver transplantation. Liver transplantation may lead to the improvement of all cardiac changes and the reversal of cirrhotic cardiomyopathy. There are systemic diseases that may affect both the liver and the heart concomitantly including congenital, metabolic and inflammatory diseases as well as alcoholism. This review highlights these hepatocardiac

关键词： Cardiac cirrhosis Ischemic hepatitis Fatty liver Liver cirrhosis Heart failure