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Malignant hepatic vascular tumors in adults: Characteristics,diagnostic difficulties and current management 预览
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作者 Daniela Cornelia Laz?r Mihaela Flavia Avram +2 位作者 Ioan Romo?an Violetta V?cariu Adrian Goldi? 《世界临床肿瘤学杂志(英文版)》 2019年第3期110-135,共26页
Malignant vascular tumors of the liver include rare primary hepatic mesenchymal tumors developed in the background of a normal liver parenchyma. Most of them are detected incidentally by the increased use of performin... Malignant vascular tumors of the liver include rare primary hepatic mesenchymal tumors developed in the background of a normal liver parenchyma. Most of them are detected incidentally by the increased use of performing imaging techniques. Their diagnosis is challenging, involving clinical and imaging criteria, with final confirmation by histology and immunohistochemistry. Surgery represents the mainstay of treatment. Liver transplantation(LT) has improved substantially the prognosis of hepatic epithelioid hemangioendothelioma(HEHE), with 5-year patient survival rates of up to 81%, based on the European Liver Intestine Transplantation AssociationEuropean Liver Transplant Registry study. Unfortunately, the results of surgery and LT are dismal in cases of hepatic angiosarcoma(HAS). Due to the disappointing results of very short survival periods of approximately 6-7 mo after LT, because of tumor recurrence and rapid progression of the disease, HAS is considered an absolute contraindication to LT. Recurrences after surgical resection are high in cases of HEHE and invariably present in cases of HAS. The discovery of reliable prognostic markers and the elaboration of prognostic scores following LT are needed to provide the best therapeutic choice for each patient.Studies on a few patients have demonstrated the stabilization of the disease in a proportion of patients with hepatic vascular tumors using novel targeted antiangiogenic agents, cytokines or immunotherapy. These new approaches,alone or in combination with other therapeutic modalities, such as surgery and classical chemotherapy, need further investigation to assess their role in prolonging patient survival. Personalized therapeutic algorithms according to the histopathological features, behavior, molecular biology and genetics of the tumors should be elaborated in the near future for the management of patients diagnosed with primary malignant vascular tumors of the liver. 展开更多
关键词 HEPATIC MALIGNANT vascular tumors HEPATIC small vessel neoplasia HEPATIC perivascular EPITHELIOID cell tumor HEPATIC HEMANGIOPERICYTOMA HEPATIC EPITHELIOID HEMANGIOENDOTHELIOMA Kaposi sarcoma HEPATIC angiosarcoma DIAGNOSTIC Prognostic Treatment
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Analysis of B-ultrasound and contrast-enhanced ultrasound characteristics of different hepatic neuroendocrine neoplasm 预览
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作者 Xiao-Ning Kang Xiao-Yu Zhang +3 位作者 Jie Bai Zun-Yi Wang Wen-Jie Yin Li Li 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2019年第5期436-448,共13页
BACKGROUND Hepatic neuroendocrine neoplasm (hNEN) is a highly heterogeneous tumor. The exact identification of the source and malignant degree of hNEN is important. However, there is a lack of information regarding di... BACKGROUND Hepatic neuroendocrine neoplasm (hNEN) is a highly heterogeneous tumor. The exact identification of the source and malignant degree of hNEN is important. However, there is a lack of information regarding diagnosis of hNEN with imaging. In addition, no studies have compared the imaging between hNEN and hepatocellular carcinoma (HCC) and among different sources and malignant degrees of hNEN. AIM To compare the ultrasound characteristics between hNEN and HCC and among different sources and malignant degrees of hNEN. METHODS A total of 55 patients with hNEN were recruited and defined as the hNEN group. Among them, 35 cases of hNET were defined as the hNET group. Twenty cases of hepatic neuroendocrine carcinoma (hNEC) were defined as the hNEC group. Among the 55 lesions, 29 were transferred from the pancreas, 20 were from the gastrointestinal tract, and six were from other sites. In total, 55 patients with HCC were recruited and defined as the HCC group. The characteristic differences of Bmode ultrasound and contrast-enhanced ultrasound (CEUS) between hNEN and HCC and among different sources and malignant degrees of hNEN were compared. RESULTS In the hNEN group, the proportions of multiple liver lesions, unclear borders,and high echo lesions were higher than those in the HCC group. The proportions of non-uniform echo and peripheral acoustic halo were lower than those in the HCC group (P < 0.05). The washout to iso-enhancement time and washout to hypo-enhancement time were lower than those in the HCC group (P < 0.05). The characteristics of B-ultrasound and CEUS among different sources of hNEN were similar, and the differences were not statistically significant (P > 0.05). B-mode ultrasound characteristics of hNET and hNEC were similar. The proportions of low enhancement at portal venous phase, non-uniform enhancement forms, and combined tumor vasculature in the hNEC group were larger than those in the hNEN group (P < 0.05). CONCLUSION Compared with HCC, hNEN showed multiple intrahepatic lesions, uniform hig 展开更多
关键词 HEPATIC NEUROENDOCRINE NEOPLASM HEPATIC NEUROENDOCRINE tumor HEPATIC NEUROENDOCRINE carcinoma B-ULTRASOUND CONTRAST-ENHANCED ULTRASOUND
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Hemodynamic changes in hepatic sinusoids of hepatic steatosis mice 预览
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作者 Jing Fan Chong-Jiu Chen +3 位作者 Yu-Chen Wang Wei Quan Jian-Wei Wang Wei-Guang Zhang 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第11期1355-1365,共11页
BACKGROUND Fatty liver(FL) is now a worldwide disease. For decades, researchers have been kept trying to elucidate the mechanism of FL at the molecular level, but rarely involve the study of morphology and medical phy... BACKGROUND Fatty liver(FL) is now a worldwide disease. For decades, researchers have been kept trying to elucidate the mechanism of FL at the molecular level, but rarely involve the study of morphology and medical physics. Traditionally, it was believed that hemodynamic changes occur only when fibrosis occurs, but it has been proved that these changes already show in steatosis stage, which may help to reveal the pathogenesis and its progress. Because the pseudolobules are not formed during the steatosis stage, this phenomenon may be caused by the compression of the liver microcirculation and changes in the hemodynamics.AIM To understand the pathogenesis of hepatic steatosis and to study the hemodynamic changes associated with hepatic steatosis.METHODS Eight-week-old male C57 BL/6 mice were divided into three groups randomly(control group, 2-wk group, and 4-wk group), with 16 mice per group. A hepatic steatosis model was established by subcutaneous injection of carbon tetrachloride in mice. After establishing the model, liver tissue from mice was stained with hematoxylin and eosin(HE), and oil red O stains. Blood was collected from the angular vein, and hemorheological parameters were estimated. A two-photon fluorescence microscope was used to examine the flow properties of red blood cells in the hepatic sinusoids.RESULTS Oil red O staining indicated lipid accumulation in the liver after CCl4 treatment.HE staining indicated narrowing of the hepatic sinusoidal vessels. No significant difference was observed between the 2-wk and 4-wk groups of mice onmorphological examination. Hemorheological tests included whole blood viscosity(mPas, γ = 10 s-1/γ = 100 s-1)(8.83 ± 2.22/4.69 ± 1.16, 7.73 ± 2.46/4.22 ±1.32, and 8.06 ± 2.88/4.22 ± 1.50), red blood cell volume(%)(51.00 ± 4.00, 42.00 ±5.00, and 40.00 ± 3.00), the content of plasma fibrinase(g/L)(3.80 ± 0.50, 2.90 ±0.80, and 2.30 ± 0.70), erythrocyte deformation index(%)(44.49 ± 5.81, 48.00 ±15.29, and 44.36 ± 15.01), erythrocyte electrophoresis rate(mm/ 展开更多
关键词 HEPATIC STEATOSIS HEMODYNAMICS HEPATIC SINUSOIDS TWO-PHOTON fluorescence microscopy Carbon TETRACHLORIDE
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SGLT-2 inhibitors in non-alcoholic fatty liver disease patients with type 2 diabetes mellitus:A systematic review 预览
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作者 Henith Raj Harsh Durgia +4 位作者 Rajan Palui Sadishkumar Kamalanathan Sandhiya Selvarajan Sitanshu Sekhar Kar Jayaprakash Sahoo 《世界糖尿病杂志:英文版(电子版)》 2019年第2期114-132,共19页
BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is a common comorbidity with type 2 diabetes.The existing therapeutic options for NAFLD are not adequate.Hypocaloric diet and exercise is the cornerstone of therapy i... BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is a common comorbidity with type 2 diabetes.The existing therapeutic options for NAFLD are not adequate.Hypocaloric diet and exercise is the cornerstone of therapy in NAFLD.Pioglitazone is the only drug recommended in diabetes patients with biopsy proven non-alcoholic steatohepatitis.The frequent coexistence of NAFLD and type 2 diabetes with their combined adverse health consequences and inadequate therapeutic options makes it necessary to search for newer alternatives.AIM To assess the effect of sodium glucose cotransporter-2(SGLT-2)inhibitors on liver enzymes in type 2 diabetes patients with NAFLD.METHODS We searched PubMed/MEDLINE,Cochrane library,Google scholar,and Clinicaltrials.gov for the relevant articles to be included in this systematic review.Human studies done in type 2 diabetes patients with NAFLD treated with SGLT-2 inhibitors for at least 12 wk were included.Data from eight studies(four randomised controlled trials and four observational studies)were extracted and a narrative synthesis was done.A total of 214 patients were treated with SGLT-2 inhibitors in these studies(94 in randomised controlled trials and 120 in observational studies).RESULTS The primary outcome measure was change in serum alanine aminotransferase level.Out of eight studies,seven studies showed a significant decrease in serum alanine aminotransferase level.Most of the studies revealed reduction in serum level of other liver enzymes like aspartate aminotransferase and gamma glutamyl transferase.Five studies that reported a change in hepatic fat exhibited a significant reduction in hepatic fat content in those treated with SGLT-2 inhibitors.Likewise,among the three studies that evaluated a change in indices of hepatic fibrosis,two studies revealed a significant improvement in liver fibrosis.Moreover,there was an improvement in obesity,insulin resistance,glycaemia,and lipid parameters in those subjects taking SGLT-2 inhibitors.The studies disclosed that about 17%(30/176)of the sub 展开更多
关键词 Alanine AMINOTRANSFERASE HEPATIC fat HEPATIC fibrosis Non-alcoholic fatty liver disease Sodium-glucose cotransporter-2 inhibitor Type 2 diabetes MELLITUS
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Ursodeoxycholic acid ameliorates hepatic lipid metabolism in LO2 cells by regulating the AKT/mTOR/SREBP-1 signaling pathway 预览
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作者 Jie Hu Wei Hong +3 位作者 Kan-Nan Yao Xiao-Hong Zhu Zhi-Yun Chen Lei Ye 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第12期1492-1501,共10页
BACKGROUND Nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disease, can progress into nonalcoholic steatohepatitis (NASH), cirrhosis, and even hepatocellular carcinoma. Bile acids such as ursod... BACKGROUND Nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disease, can progress into nonalcoholic steatohepatitis (NASH), cirrhosis, and even hepatocellular carcinoma. Bile acids such as ursodeoxycholic acid (UDCA) play an essential role in the pathogenesis of NAFLD by regulating the level of sterol regulatory element-binding protein (SREBP) 1c, but the underlying regulatory mechanism remains elusive. Increased evidence indicates that the AKT/mTOR/SREBP-1 signaling pathway is a key pathway to regulate hepatic cellular lipid metabolism. UDCA may regulate the AKT/mTOR/SREBP-1 signaling pathway to ameliorate hepatic lipid metabolism. AIM To investigate the functional mechanism of UDCA in an oleic acid (OA)-induced cellular model of NAFLD. METHODS The cellular model of NAFLD was established using OA and treated with UDCA. First, the best concentration of UDCA was selected. For the best time-dependent assay, cells were stimulated with OA only or co-treated with OA and 2 mmol/L UDCA for 24 h, 48 h, and 72 h. Oil red O staining was used to observe the accumulation of intracellular lipids, while the intracellular contents of triglyceride, alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), and aspartate aminotransferase (AST) were detected by enzymatic methods. Meanwhile, the expression levels of AKT/mTOR/SREBP-1 signaling pathway-related proteins were detected by real-time PCR and Western blot.RESULTS In the NAFLD cell model established with LO2 cells induced using OA, lipid accumulation was obvious. UDCA significantly inhibited lipid accumulation at different concentrations (especially 2 mmol/L) and decreased cell growth ability at different time points. The biochemical parameters like ALT, AST, and GGT were significant improved by UDCA. UDCA treatment vividly repressed the activation of AKT, mTOR, and CRTC2 and the expression of nSREBP-1 in LO2 cells induced with OA. CONCLUSION Our findings demonstrate the effect of UDCA in improving NAFLD. UDCA attenuates OA-induced hepatic s 展开更多
关键词 Ursodeoxycholic acid HEPATIC LIPID metabolism AKT/mTOR/SREBP-1 HEPATIC STEATOSIS
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Regional gray matter abnormality in hepatic myelopathy patients after transjugular intrahepatic portosystemic shunt:a voxel-based morphometry study 预览
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作者 Kang Liu Gang Chen +9 位作者 Shu-Yao Ren Yuan-Qiang Zhu Tian-Lei Yu Ping Tian Chen Li Yi-Bin Xi Zheng-Yu Wang Jian-Jun Ye Guo-Hong Han Hong Yin 《中国神经再生研究:英文版》 SCIE CAS CSCD 2019年第5期850-857,共8页
Hepatic myelopathy is a complication seen in patients with chronic liver failure with physiologic or iatrogenic portosystemic shunting.The main symptom is progressive lower limb dyskinesia.The role of the brain motor ... Hepatic myelopathy is a complication seen in patients with chronic liver failure with physiologic or iatrogenic portosystemic shunting.The main symptom is progressive lower limb dyskinesia.The role of the brain motor control center in hepatic myelopathy is unknown.This study aimed to investigate the gray matter changes in patients with hepatic myelopathy secondary to transjugular intrahepatic portosystemic shunt and to examine their clinical relevance.This was a cross-sectional study.Twenty-three liver failure patients with hepatic myelopathy(hepatic myelopathy group),23 liver failure patients without hepatic myelopathy(non-hepatic myelopathy group)after transjugular intrahepatic portosystemic shunt,and 23 demographically matched healthy volunteers were enrolled from March 2014 to November 2016 at Xijing Hospital,Air Force Military Medical University(Fourth Military Medical University),China.High-resolution magnetization-prepared rapid gradient-echo brain imaging was acquired.Group differences in regional gray matter were assessed using voxel-based morphometry analysis.The relationship between aberrant gray matter and motor characteristics was investigated.Results demonstrated that compared with the non-hepatic myelopathy group,gray matter volume abnormalities were asymmetric,with decreased volume in the left insula(P=0.003),left thalamus(P=0.029),left superior frontal gyrus(P=0.006),and right middle cingulate cortex(P=0.021),and increased volume in the right caudate nucleus(P=0.017),corrected with open-source software.The volume of the right caudate nucleus in the hepatic myelopathy group negatively correlated with the lower limb clinical rating of the Fugl-Meyer Assessment(r=–0.53,P=0.01).Compared with healthy controls,patients with and without hepatic myelopathy exhibited overall increased gray matter volume in both thalami,and decreased gray matter volume in both putamen,as well as in the globus pallidus,cerebellum,and vermis.The gray matter abnormalities we found predominantly involved motor-related region 展开更多
关键词 portosystemic shunt HEPATIC MYELOPATHY HEPATIC encephalopathy magnetic resonance imaging gray matter lower limb FUGL-MEYER Assessment basal GANGLIA CAUDATE nucleus voxel-based MORPHOMETRY
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Hepatic gastrointestinal stromal tumor:Systematic review of an exceptional location 预览
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作者 Alba Manuel-Vázquez Raquel Latorre-Fragua +1 位作者 Roberto de la Plaza-Llamas JoséManuel Ramia 《世界荟萃分析杂志》 2019年第5期224-233,共10页
BACKGROUND A minor subset of primary gastrointestinal stromal tumors(GIST)can also arise outside the gastrointestinal tract,which is known as an extra-GIST(E-GIST).Primary GIST of the liver is an exceptional location.... BACKGROUND A minor subset of primary gastrointestinal stromal tumors(GIST)can also arise outside the gastrointestinal tract,which is known as an extra-GIST(E-GIST).Primary GIST of the liver is an exceptional location.AIM To characterize epidemiological,clinical and pathological features and options of treatments.METHODS We performed a systematic review to search for articles on primary hepatic GIST.RESULTS This review shows that right hepatic lobe was the most frequent location.Regarding pathological and immunohistochemical features,mitotic count was≥5/50 High Power Fields in more than 50%;and CD117 was negative in only 1 patient.More than 70%of patients had a lesion with high risk of malignancy.CONCLUSION The diagnosis of E-GIST must be considered in a liver mass.Rendering an accurate diagnosis is a challenge,as well as the confirmation of their primary or metastatic nature. 展开更多
关键词 GASTROINTESTINAL STROMAL TUMORS Extra-gastrointestinal STROMAL TUMOR PRIMARY HEPATIC TUMOR CD117 PRIMARY HEPATIC GASTROINTESTINAL STROMAL TUMOR PRIMARY GASTROINTESTINAL STROMAL TUMOR of the liver
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Hepatic encephalopathy:Lessons from preclinical studies 预览
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作者 Luiza Cioglia Dias Lima Aline Silva Miranda +2 位作者 Rodrigo Novaes Ferreira Milene Alvarenga Rachid Ana Cristina Simoes e Silva 《世界肝病学杂志:英文版(电子版)》 2019年第2期173-185,共13页
Hepatic encephalopathy(HE)is a major complication that is closely related to the progression of end-stage liver disease.Metabolic changes in advanced liver failure can promote cognition impairment,attention deficits a... Hepatic encephalopathy(HE)is a major complication that is closely related to the progression of end-stage liver disease.Metabolic changes in advanced liver failure can promote cognition impairment,attention deficits and motor dysfunction that may result in coma and death.HE can be subdivided according to the type of hepatic injury,namely,type A,which results from acute liver failure,type B,which is associated with a portosystemic shunting without intrinsic liver disease,and type C,which is due to chronic liver disease.Several studies have investigated the pathogenesis of the disease,and most of the mechanisms have been explored using animal models.This article aimed to review the use of preclinical models to investigate HE.The most used animal species are rats and mice.Experimental models of type A HE include surgical procedures and the administration of hepatotoxic medications,whereas models of types B and C HE are generally surgically induced lesions in liver tissue,which evolve to hepatic cirrhosis.Preclinical models have allowed the comprehension of the pathways related to HE. 展开更多
关键词 HEPATIC ENCEPHALOPATHY Acute liver failure PRECLINICAL studies HEPATIC cirrhosis NEUROINFLAMMATION HYPERAMMONEMIA
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Urotensin Ⅱ receptor antagonist reduces hepatic resistance and portal pressure through enhanced eNOS-dependent HSC vasodilatation in CCI4-induced cirrhotic rats
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作者 Ruoxi Zhang Jing Chen +1 位作者 Diangang Liu Yu Wang 《医学前沿:英文版》 CAS CSCD 2019年第3期398-408,共11页
Increased serum urotensin Ⅱ(UⅡ) levels in human cirrhotic populations have been recently shown,but the long-term effects of UⅡ receptor antagonist on the cirrhosis have not been investigated.To investigate the ther... Increased serum urotensin Ⅱ(UⅡ) levels in human cirrhotic populations have been recently shown,but the long-term effects of UⅡ receptor antagonist on the cirrhosis have not been investigated.To investigate the therapeutic effects of urotensin Ⅱ receptor (UT) antagonist palosuran on rats with carbon tetrachloride (CCI4)- induced cirrhosis,the hepatic and systemic hemodynamics,liver fibrosis,the metalloproteinase-13 (MMP-13)/ tissue inhibitor of metalloproteinase-1 (TIMP-1) ratio,hepatic Rho-kinase activity,and the endothelial nitric oxide synthase (eNOS) activity are measured in CCI4-cirrhotic rats treated with palosuran or vehicle for 4 weeks.Primary hepatic stellate cells (HSCs) are used to investigate the changes in UⅡ/UT expression and the in vitro effect of palosuran.Compared with the vehicle-treated cirrhotic rats,treatment with palosuran can reduce the portal pressure (PP),decrease the risk of liver fibrosis and the level of a smooth muscle actin,collagen-l (COL-I),and transforming growth factor β expression.However,treatment with palosuran can increase MMP-13/TIMP-1,pvasodilator- stimulated phosphoprotein (p-VASP),and p-eNOS expression.Moreover,in vitro UⅡ/UT mRNA expression increases during HSC activation.MMP-13/TIMP-1,COL-I,and p-VASP are inhibited after palosuran treatment Our data indicate that long-term administration of palosuran can decrease PP in cirrhosis,which results from decreased hepatic fibrosis and enhanced eNOS-dependent HSC vasodilatation. 展开更多
关键词 PORTAL hypertension cirriiosis UROTENSIN palosuran HEPATIC stellate cell
Roles of hepatic stellate cells in acute liver failure:From the perspective of inflammation and fibrosis 预览
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作者 Juan Li Ying-Ren Zhao Zhen Tian 《世界肝病学杂志:英文版(电子版)》 2019年第5期412-420,共9页
Acute liver failure(ALF)usually results in hepatocellular dysfunction and coagulopathy and carries a high mortality rate.Hepatic stellate cells(HSCs)are famous for their role in liver fibrosis.Although some recent stu... Acute liver failure(ALF)usually results in hepatocellular dysfunction and coagulopathy and carries a high mortality rate.Hepatic stellate cells(HSCs)are famous for their role in liver fibrosis.Although some recent studies revealed that HSCs might participate in the pathogenesis of ALF,the accurate mechanism is still not fully understood.This review focuses on the recent advances in understanding the functions of HSCs in ALF and revealed both protective and promotive roles during the pathogenesis of ALF:HSC activation participates in the maintenance of cell attachment and the architecture of liver tissue via extracellular matrix production and assists liver regeneration by producing growth factors;and HSC inflammation plays a role in relaying inflammation signaling from sinusoids to parenchyma via secretion of inflammatory cytokines.A better understanding of roles of HSCs in the pathogenesis of ALF may lead to improvements and novel strategies for treating ALF patients. 展开更多
关键词 ACUTE liver FAILURE HEPATIC stellate cells INFLAMMATION FIBROSIS
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Proton pump inhibitor use increases hepatic encephalopathy risk: A systematic review and meta-analysis 预览
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作者 Yun-Jie Ma Zong-Xun Cao +1 位作者 Yong Li Shun-Yi Feng 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第21期2675-2682,共8页
BACKGROUND Several studies have been conducted to explore the association between the use of proton pump inhibitors (PPIs) and hepatic encephalopathy (HE) risk in patients with liver cirrhosis. However, their results ... BACKGROUND Several studies have been conducted to explore the association between the use of proton pump inhibitors (PPIs) and hepatic encephalopathy (HE) risk in patients with liver cirrhosis. However, their results are controversial. AIM To perform a systematic review and meta-analysis to evaluate the HE risk among PPI users. METHODS A systematic search on PubMed, Web of Science, EMBase, and ScienceDirect databases was conducted up to December 31, 2018 for eligible studies involving PPI use and HE risk. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the fixed or random effects model. Publication bias was evaluated using Begg’s test, Egger’s test, and trim-and-fill method. RESULTS Seven studies with 4574 patients were included in the present meta-analysis. The meta-analysis results indicated a significant association between the PPI use and HE risk (OR = 1.50;95%CI: 1.25-1.75) with low heterogeneity (I2 = 14.2%, P = 0.321). Although publication bias existed when Egger’s tests were used (P = 0.005), the trim-and-fill method verified the stability of the pooled result. Sensitivity analyses suggested that the results of this meta-analysis were robust. CONCLUSION The current evidence indicates that PPI use increases HE risk in patients with liver cirrhosis. Further studies with a large data set and well-designed models are needed to validate our findings. 展开更多
关键词 PROTON PUMP INHIBITORS Hepatic ENCEPHALOPATHY META-ANALYSIS
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Association of proton pump inhibitors with risk of hepatic encephalopathy in advanced liver disease: A meta-analysis 预览
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作者 Xin-Xing Tantai Long-Bao Yang +4 位作者 Zhong-Cao Wei Cai-Lan Xiao Li-Rong Chen Jin-Hai Wang Na Liu 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第21期2683-2698,共16页
BACKGROUND Several studies have explored the association between the use of proton pump inhibitors (PPIs) and the risk of developing hepatic encephalopathy (HE) in patients with advanced liver disease. However, the ev... BACKGROUND Several studies have explored the association between the use of proton pump inhibitors (PPIs) and the risk of developing hepatic encephalopathy (HE) in patients with advanced liver disease. However, the evidence-based conclusions are controversial. We hypothesized that using PPIs may increase the risk of HE in patients with advanced liver disease. If confirmed, clinicians must strictly adhere to the indications for PPI treatment in this population. AIM To evaluate the pooled risk of HE in patients with advanced liver disease who use PPIs. METHODS Three electronic databases (PubMed, EMBASE, and the Cochrane Library) were searched from the date of database inception through January 8, 2019 to identify comparative studies evaluating the association between PPI use and the risk of HE. Data from the included studies were extracted. The random-effects model was used for pooling risk estimates and the corresponding 95% confidence intervals (CIs). Subgroup and sensitivity analyses were also performed. RESULTS In total, 4342 patients from five case-control studies and 188053 patients from four cohort studies were included in this analysis. In patients with advanced liver disease, PPI use was associated with an elevated risk of developing HE, with significant heterogeneity. The pooled odds ratio for case-control studies was 2.58 (95%CI: 1.68-3.94, I2 = 72%). The pooled RR for cohort studies was 1.67 (95%CI: 1.30-2.14, I2 = 67%). The results of the subgroup analyses suggested that the heterogeneity may be the result of differences in the study designs and the definitions of PPI use. The sensitivity and subgroup analyses did not alter our findings. CONCLUSION In patients with advanced liver disease, PPI use is associated with an elevated risk of HE. Future large prospective studies are needed to confirm this association. 展开更多
关键词 PROTON PUMP INHIBITORS CIRRHOSIS Hepatic ENCEPHALOPATHY Systematic review META-ANALYSIS
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完整与保留近端囊壁切除治疗成人Ⅰ型胆管囊肿的疗效比较
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作者 崔虎啸 邓毅磊 +2 位作者 孟松峰 侯森 赵龙栓 《中华肝胆外科杂志》 CAS CSCD 北大核心 2019年第1期40-44,共5页
目的比较完整切除囊肿与保留近端3~5 mm囊壁两种胆管囊肿处理方式治疗成人Ⅰ型胆管囊肿的临床疗效。方法回顾性分析郑州大学第一附属医院1995年12月至2017年12月手术治疗的133例成人Ⅰ型胆管囊肿患者临床资料。根据胆管囊肿近端是否保留... 目的比较完整切除囊肿与保留近端3~5 mm囊壁两种胆管囊肿处理方式治疗成人Ⅰ型胆管囊肿的临床疗效。方法回顾性分析郑州大学第一附属医院1995年12月至2017年12月手术治疗的133例成人Ⅰ型胆管囊肿患者临床资料。根据胆管囊肿近端是否保留3~5 mm的囊肿壁,将133例患者分为未保留组(85例)和保留组(48例),并对两组患者术后相关指标进行对比分析。结果两组患者发病年龄、性别比例、主要临床症状、手术时间、术中出血量、胆肠吻合口直径等差异无统计学意义(均P>0.05)。术后并发症包括切口感染、腹腔感染、胆漏、胆管炎及反流性胆管炎、胆管结石形成、胆肠吻合口狭窄发生率差异无统计学意义(均P>0.05)。保留组1例反复胆管炎患者术后33个月发现胆肠吻合口残余囊肿癌变。结论针对不同的成人Ⅰ型胆管囊肿患者选择,保留或不保留近端3~5 mm囊壁的胆肠吻合,术后临床疗效相似,近远期并发症发生率差异无统计学意义。至于近端囊肿残余是否增加癌变风险,仍需进一步观察。 展开更多
关键词 胆总管囊肿 胆管肠吻合术 手术后并发症 治疗结果
Temporal trends of cirrhosis associated conditions 预览
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作者 Tomoki Sempokuya Guangxiang Zhang Kazuma Nakagawa 《世界肝病学杂志:英文版(电子版)》 2019年第1期74-85,共12页
AIM To evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis. METHODS The publicly available Healthcare Cost and Utilization Projec... AIM To evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis. METHODS The publicly available Healthcare Cost and Utilization Project National Inpatient Sample database was utilized to examine the temporal trends of total number of discharges, mortalities and inpatient costs related to hospitalization with a primary diagnosis of HC, transjugular intrahepatic portosystemic shunt (TIPS), esophageal varices with bleeding (EV) and spontaneous bacterial peritonitis (SBP) from 2005 to 2014. The ten-year temporal trends were assessed using simple linear regressions and multiple regression analysis. Two-sided P < 0.05 was considered statistically significant. RESULTS From 2005 to 2014, the total number of discharges with cirrhosis-associated complications trended up for HC, SBP and EV (HC by 70% increase, P < 0.0001; SBP by 819% increase, P = 0.0002; EV by 9% increase, P = 0.016), but not for TIPS (P = 0.90). HC related to viral hepatitis showed faster increase by 357%(P < 0.0001) in comparison to HC not related to viral hepatitis by 33 %(P = 0.0006). Overall, in-hospital mortality rates for each condition decreased from 2005 to 2014 (HC by 29% reduction, P = 0.0024; SBP by 26% reduction, P = 0.0038; TIPS by 32% reduction, P = 0.021) except for EV (P = 0.34). After adjustment for inflation, aggregate cost of hospitalization for EV, HC, and SBP significantly increased by 20%, 86%, and 980%, respectively, from 2005 to 2014 (all P < 0.02), while TIPS had trend toward decreasing cost by 3%(P = 0.95). CONCLUSION The number of hospitalizations and costs for some of the cirrhosis-associated conditions increased. However, the inpatient mortality rates for most of these conditions decreased. 展开更多
关键词 CIRRHOSIS Hepatic ENCEPHALOPATHY Spontaneous bacterial PERITONITIS Esophageal VARICES Transjugular INTRAHEPATIC portosystemic SHUNT
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Chemical cocktails enable hepatic reprogramming of human urine-derived cells with a single transcription factor
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作者 Wei Tang Ren Guo +6 位作者 Shi-jun Shen Yang Zheng Yu-ting Lu Meng-meng Jiang Xue Cui Ci-zhong Jiang Xin Xie 《中国药理学报:英文版》 SCIE CAS CSCD 2019年第5期620-629,共10页
Human liver or hepatocyte transplantation is limited by a severe shortage of donor organs. Direct reprogramming of other adult cells into hepatic cells may offer a solution to this problem. In a previous study, we hav... Human liver or hepatocyte transplantation is limited by a severe shortage of donor organs. Direct reprogramming of other adult cells into hepatic cells may offer a solution to this problem. In a previous study, we have generated hepatocyte-like cells from mouse fibroblasts using only one transcription factor (TF) plus a chemical cocktail. Here, we show that human urine-derived epithelial-like cells (hUCs) can also be transdifferentiated into human hepatocyte-like cells (hiHeps) using one TF (Foxa3, Hnf1α, or Hnf4α) plus the same chemical cocktail CRVPTD (C, CHIR99021;R, RepSox;V, VPA;P, Parnate;T, TTNPB;and D, Dznep). These hiHeps express multiple hepatocyte-specific genes and display functions characteristic of mature hepatocytes. With the introduction of the large T antigen, these hiHeps can be expanded in vitro and can restore liver function in mice with concanavalin-A-induced acute liver failure. Our study provides a strategy to generate functional hepatocyte-like cells from hUCs by using a single TF plus a chemical cocktail. 展开更多
关键词 REPROGRAMMING HEPATIC TRANSDIFFERENTIATION human urine-derived cells CHEMICAL cocktail regenerative medicine
定量MRI评价肝泡型包虫病肝储备功能的初步探讨 预览
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作者 张茜茹 依巴努·阿不都热合曼 +2 位作者 王健 蒋奕 刘文亚 《放射学实践》 北大核心 2019年第3期306-310,共5页
目的:探讨磁共振T1-mapping、T2-mapping定量评价肝泡型包虫病(HAE)肝功能的临床应用价值。方法:搜集本院行肝脏磁共振T1-mapping及T2-mapping扫描的36例HAE患者(病例组)和20例肝脏功能正常的健康志愿者(对照组)。根据Child-Pugh分级评... 目的:探讨磁共振T1-mapping、T2-mapping定量评价肝泡型包虫病(HAE)肝功能的临床应用价值。方法:搜集本院行肝脏磁共振T1-mapping及T2-mapping扫描的36例HAE患者(病例组)和20例肝脏功能正常的健康志愿者(对照组)。根据Child-Pugh分级评分将病例组分为肝功能A级组(n=14)、B级组(n=12)和C级组(n=10)。分别测量肝泡型包虫病例组及对照组正常肝实质的弛豫时间,得到T1值和T2值,采用方差分析两两比较四组间T1、T2值。结果:对照组T1值为(338.9±95.6)ms,T2值为(42.7±3.1)ms;病例A组T1值为(393.47±158)ms,T2值为(43.74±5.3)ms;B组T1值为(351.5±84.7)ms,T2值为(57.85±7.7)ms;C组T1值为(460.9±76.0)ms,T2值为(65.9±3.0)ms。各组间T1值差异均无统计学意义(P>0.05),对照组T2值与病例A组差异无统计学意义(P>0.05),对照组与病例B组、C组及病例组A、B、C各组间差异有统计学意义(P<0.05)。结论:肝泡型包虫病例随肝功能C-P分级不同,其T2值存在差异,磁共振T2-mapping成像有望用于定量评价肝脏储备功能,为临床医师评估肝泡型包虫肝脏储备功能提供一种新的手段。T1值定量评价HAE肝功能仍需论证。 展开更多
关键词 磁共振成像 肝功能 包虫病
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Iron and liver fibrosis:Mechanistic and clinical aspects 预览
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作者 Kosha J Mehta Sebastien Je Farnaud Paul A Sharp 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第5期521-538,共18页
Liver fibrosis is characterised by excessive deposition of extracellular matrix that interrupts normal liver functionality.It is a pathological stage in several untreated chronic liver diseases such as the iron overlo... Liver fibrosis is characterised by excessive deposition of extracellular matrix that interrupts normal liver functionality.It is a pathological stage in several untreated chronic liver diseases such as the iron overload syndrome hereditary haemochromatosis,viral hepatitis,alcoholic liver disease,non-alcoholic fatty liver disease,non-alcoholic steatohepatitis and diabetes.Interestingly,regardless of the aetiology,iron-loading is frequently observed in chronic liver diseases.Excess iron can feed the Fenton reaction to generate unquenchable amounts of free radicals that cause grave cellular and tissue damage and thereby contribute to fibrosis.Moreover,excess iron can induce fibrosis-promoting signals in the parenchymal and non-parenchymal cells,which accelerate disease progression and exacerbate liver pathology.Fibrosis regression is achievable following treatment,but if untreated or unsuccessful,it can progress to the irreversible cirrhotic stage leading to organ failure and hepatocellular carcinoma,where resection or transplantation remain the only curative options.Therefore,understanding the role of iron in liver fibrosis is extremely essential as it can help in formulating iron-related diagnostic,prognostic and treatment strategies.These can be implemented in isolation or in combination with the current approaches to prepone detection,and halt or decelerate fibrosis progression before it reaches the irreparable stage.Thus,this review narrates the role of iron in liver fibrosis.It examines the underlying mechanisms by which excess iron can facilitate fibrotic responses.It describes the role of iron in various clinical pathologies and lastly,highlights the significance and potential of iron-related proteins in the diagnosis and therapeutics of liver fibrosis. 展开更多
关键词 IRON LIVER PATHOLOGIES LIVER FIBROSIS Hepatic stellate cells Cirrhosis
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Two case reports and literature review for hepatic epithelioid angiomyolipoma: Pitfall of misdiagnosis 预览
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作者 Jia-Xi Mao Fei Teng +9 位作者 Cong Liu Hang Yuan Ke-Yan Sun You Zou Jia- Yong Dong Jun-Song Ji Jun-Feng Dong Hong Fu Guo-Shan Ding Wen-Yuan Guo 《世界临床病例杂志》 2019年第8期972-983,共12页
BACKGROUND Hepatic epithelioid angiomyolipoma (HEAML) is a rare liver disease and is easily misdiagnosed. Enhanced recognition of HEAML is beneficial to the differential diagnosis of rare liver diseases. CASE SUMMARY ... BACKGROUND Hepatic epithelioid angiomyolipoma (HEAML) is a rare liver disease and is easily misdiagnosed. Enhanced recognition of HEAML is beneficial to the differential diagnosis of rare liver diseases. CASE SUMMARY We presented two cases of HEAML in Changzheng Hospital, Naval Medical University, and then collected and analyzed all reports about HEAML recorded in PubMed, MEDLINE, China Science Periodical Database, and VIP database from January 2000 to March 2018. A total of 409 cases of HEAML in 97 reports were collected, with a ratio of men to women of 1:4.84 and an age range from 12 years to 80 years (median 44 years). Among the patients with clinical symptoms mentioned, 61.93%(205/331) were asymptomatic, 34.74%(115/331) showed upper or right upper quadrant abdomen discomfort, while a few of them showed abdominal mass, gastrointestinal symptoms, low fever, or weight loss. The misdiagnosis rate of HEAML was as high as 40.34%(165/409) due to its nonspecific imaging findings. Most of the tumors were solitary and round in morphology, with clear boundaries. Ultrasound scan indicated low echo with internal nonuniformity and rich blood supply in most cases. Computer tomography/magnetic resonance imaging enhanced scan showed varied characteristics. The ratio of fast wash-in and fast wash-out, fast wash-in and slow wash-out, and delayed enhancement was roughly 4:5:1. A definite diagnosis of HEAML depended on the pathological findings of the epithelioid cells in lesions and the expression of human melanoma black 45, smooth muscle actin, melanoma antigen, and actin by immunohistochemical staining. HEAML had a relatively low malignant rate of 3.91%. However, surgical resection was the main treatment for HEAML, due to the difficulty diagnosing before operation. CONCLUSION HEAML is a rare and easily misdiagnosed disease, and it should be diagnosed carefully, taking into account clinical course, imaging, pathological ,and immunohistochemical findings. 展开更多
关键词 HEPATIC EPITHELIOID ANGIOMYOLIPOMA Imaging Pathology MISDIAGNOSIS Potentially MALIGNANT Case report
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Tibolone Reverses NAFLD in Ovariectomised Rats by Reducing Adiposity and Insulin Resistance 预览
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作者 Lilian Brites Campos-Shimada Eduardo Hideo Gilglioni +5 位作者 Danielle Aparecida Munhos Hermoso Ana Julia dos Reis Buzzo Rosangela Fernandes Garcia Elismari Rizato Martins-Maciel Emy Luiza Ishii-Iwamoto Clairce Luzia Salgueiro-Pagadigorria 《药剂与药理学:英文版》 2019年第4期148-164,共17页
This study aimed to investigate the effects of tibolone,a synthetic steroid,on several metabolic dysfunctions induced by oestrogen deficiency,in rats.Ovariectomised(OVX)rats were used as animal model of postmenopausal... This study aimed to investigate the effects of tibolone,a synthetic steroid,on several metabolic dysfunctions induced by oestrogen deficiency,in rats.Ovariectomised(OVX)rats were used as animal model of postmenopausal metabolic syndrome.The OVX rats were treated with daily doses of tibolone(0.16 mg/kg)and the results were compared with control(sham-operated)and OVX untreated rats.Tibolone reduced the adiposity and the visceral adipocyte size in OVX rats.The insulin sensitivity was also improved,and a decrease in the activity of the adipose tissue hormone-sensitive lipase enzyme was recorded.The lower lipolysis by visceral adipocytes,associated with the recovery of peroxisomalβ-oxidation by tibolone may have contributed to the reversion of NAFLD in treated OVX rats.The reduction of liver lipid contents resulted in a general improvement in the liver redox state.In addition,tibolone reduced the mitochondrial ROS generation and restored the activity of glucose-6-phosphate dehydrogenase.Tibolone also exerted antioxidant effects on inguinal adipose tissue.Tibolone exerted several beneficial effects on cellular and metabolic dysfunctions induced by ovariectomy in rats.One important mode of action of tibolone was the reduction of the visceral adipocyte size,corroborating the relationship between this one and the development and progression of several comorbidities associated with metabolic syndrome. 展开更多
关键词 TIBOLONE OVARIECTOMY hepatic STEATOSIS obesity OXIDATIVESTRESS
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儿童肝囊型包虫病腹腔镜手术治疗体会 预览
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作者 阿布都赛米·阿布都热衣木 玉苏甫 +7 位作者 叶尔番 和军 李凯 刘东 阿孜古丽 周玲 李水学 克力木 《中华肝脏外科手术学电子杂志》 CAS 2019年第1期54-57,共4页
目的探讨腹腔镜手术治疗儿童肝囊型包虫病的安全性和应用价值。方法回顾性分析2013年1月至2017年9月在新疆维吾尔自治区人民医院行腹腔镜手术的15例儿童肝囊型包虫病患者临床资料。患者家属均签署知情同意书,符合医学伦理学规定。其中... 目的探讨腹腔镜手术治疗儿童肝囊型包虫病的安全性和应用价值。方法回顾性分析2013年1月至2017年9月在新疆维吾尔自治区人民医院行腹腔镜手术的15例儿童肝囊型包虫病患者临床资料。患者家属均签署知情同意书,符合医学伦理学规定。其中男10例,女5例;年龄3~12岁,中位年龄8岁。单发包虫囊肿9例,多发囊肿6例。采用腹腔镜下内囊摘除及外囊剥除,穿刺抽液后用10%氯化钠液浸泡囊壁。观察患者围手术期及预后情况。结果15例儿童肝囊型包虫病均在腹腔镜下顺利完成手术,其中行外囊剥除6例,外囊剥除联合内囊摘除9例。手术时间中位数75(55~140)min,术中出血量6(5~15)ml。术后2例患者出现胆漏,保守治疗后治愈。术后住院时间9(5~12)d。术后口服阿苯达唑预防复发。术后随访2~9个月,未见肝脏及盆腹腔包虫复发。结论腹腔镜手术治疗儿童肝囊型包虫病是安全、可行的,手术视野清楚、创伤小、术后恢复快、切口美观、住院时间短,对学龄期儿童的上学读书影响不大,家属容易接受。 展开更多
关键词 儿童 棘球蚴病 腹腔镜
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