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1AGNP精神科治疗药物监测共识指南:2011显示文摘治疗药物监测(Therapeutic drug monitoring,TDM),如通过定量测定血清或血浆药物浓度指导用药剂量优化,已经成为对患者进行精神药物治疗的很有价值的工具。在患者用药依从性难以判断、药物耐受性不佳、治疗剂量下无效以及可能存在药代动力学药物-药物相互作用等情况下,测定药物浓度是很有用的。在精神科,有可能明显获益于TDM的主要患者群体包括儿童、孕妇、老年患者、智力障碍患者、涉及司法的患者、已知或怀疑携带药代动力学相关基因变异的患者,以及合并躯体疾病影响药代动力学的患者。然而,只有将TDM充分整合到临床治疗过程中去,才能发挥其优化药物治疗的潜在优势。为了促进TDM的合理应用,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了精神药物治疗药物监测指南。之后,随着知识不断更新,又有许多可能需要进行TDM的新药上市。因此,本次更新将神经精神药物的种类扩展到了128种,并将其TDM必要性划分为从'强烈推荐'到'可能有用'的四个等级。经过大量细致且全面的文献检索与分门别类的汇总整理,将基于循证医学理念的'治疗参考浓度范围'和'剂量相关参考浓度范围'呈现给大家。本共识指南引入了'实验室警戒浓度'的新概念,即实验室需要马上告知治疗医生的药物浓度上限。本共识指南还给出了诸如药物作为细胞色素P450酶的底物和抑制剂的性质,代谢物与母药浓度比值的常见范围,以及与结果解释相关的内容,还提供了何时将TDM与遗传药理学检测相结合的建议。遵循本指南,有助于改善许多患者精神药物治疗的效果,特别是那些存在药代动力学异常的患者。TDM是一门交叉学科,有时针对看起来不一致的数据,需要多学科坦诚地讨论,只有这样,患者才能从这种合作中获益。Hiemke C Baumann P Bergemann N Conca A Dietmaier O Egberts K Fric M Gerlach M Greiner C Gründer G Haen E Havemann-Reinecke U Jaquenoud Sirot E Kirchherr H Laux G Lutz UC Messer T Müller MJ Pfuhlmann B Rambeck B Riederer P Schoppek B Stingl J Uhr M Ulrich S Waschgler R Zernig G 李文标(译) 果伟(译) 阮灿军(译) 贺静(译) 汤宜朗(审校) 王传跃(审校) 2016实用药物与临床2016,19,10:37
2福林酚试剂法测定蛋白质显示文摘自1922年Wu(吴)提出用福林酚(Folin-酚)试剂测定蛋白质含量[1],已有许多采用这一试剂的改良分析操作进行血清陆”、抗原-抗体沉淀物[7-9]和胰岛素[10]中蛋白质含量测定的报道。虽然这一试剂以其灵敏度高和操作简便得到推荐,但并不适合普遍的生物化学应用。Lowry O H Rosebrough N J Farr A L Randall R J 陈祥娥 2011食品与药品2011,13,3:34
3正交异性钢桥面板冷维护技术及评价方法显示文摘为保证正交异性钢桥面板使用安全,合理延长其使用寿命与维护周期,在剖析疲劳损伤传统热维护技术方法不足的基础上,提出冷连接钢板、超高性能纤维混凝土组合层等具有零损伤或微损伤维护技术特征的冷维护方法,对钢桥面板疲劳开裂细节进行加固;开展正交异性钢桥面板足尺模型疲劳试验研究,分别采用止裂孔和粘贴钢板法维护纵肋拼接细节疲劳裂纹,将冷维护方法应用于某钢箱梁斜拉桥正交异性钢桥面板,对横隔板挖孔细节、纵肋与横隔板连接细节采用等边角钢进行加固,分别采用车辆加载测试、运营监测和数值断裂力学模拟等方法,对实桥正交异性钢桥面板冷维护效果进行评价。试验结果表明:止裂孔无法阻止裂纹扩展,而采用冷维护后钢板与纵肋协同工作状态良好,纵肋拼接细节疲劳寿命延长70%以上;实桥加载测试结果表明冷维护后疲劳裂纹尖端测试应力降低40.4%;根据动应变监测数据和S-N曲线评估结果,24h内横隔板开裂细节疲劳损伤降低79.6%;数值断裂力学分析表明冷维护后裂尖应力强度因子幅小于裂纹扩展的应力强度因子幅阈值,疲劳裂纹不再扩展;正交异性钢桥面板疲劳损伤冷维护技术工程可实施性强、安全可靠,可实现对原结构进行零损伤或微损伤维护的技术目标,为钢桥面板疲劳维护提供了新的技术选择。王春生 翟慕赛 HOUANKPO T N O 唐友明 2016中国公路学报2016,29,8:32
4Complications of hip fractures: A review显示文摘Nowadays, fracture surgery represents a big part of the orthopedic surgeon workload, and usually has associated major clinical and social cost implications. These fractures have several complications. Some of these are medical, and other related to the surgical treatment itself. Medical complications may affect around 20% of patients with hip fracture. Cognitive and neurological alterations, cardiopulmonary affections(alone or combined), venous thromboembolism, gastrointestinal tract bleeding, urinary tract complications, perioperative anemia, electrolytic and metabolic disorders, and pressure scars are the most important medical complications after hip surgery in terms of frequency, increase of length of stay and perioperative mortality. Complications arising from hip fracture surgery are fairly common, and vary depending on whether the fracture is intracapsular or extracapsular. The main problems in intracapsular fractures are biological: vascularization of the femoral head, and lack of periosteum-a major contributor to fracture healing- in the femoral neck. In extracapsularfractures, by contrast, the problem is mechanical, and relates to load-bearing. Early surgical fixation, the role of anti-thromboembolic and anti-infective prophylaxis, good pain control at the perioperative, detection and management of delirium, correct urinary tract management, avoidance of malnutrition, vitamin D supplementation, osteoporosis treatment and advancement of early mobilization to improve functional recovery and falls prevention are basic recommendations for an optimal maintenance of hip fractured patients.Pedro Carpintero Jose Ramón Caeiro Rocío Carpintero Angela Morales Samuel Silva Manuel Mesa 2014World Journal of Orthopedics2014,5,4:31
5尿钠排泄、血压、心血管病与死亡率的关系:社区前瞻性流行病学队列研究显示文摘WHO建议人群钠摄人<2 g/d作为预防心血管病的措施之一,但这一目标在任何国家都没有实现。该建议主要基于短期血压试验的个体水平数据,没有来自随机试验或观察性研究的关于低钠摄入与降低心血管事件的数据。前瞻性城市农村流行病学研究目前正在21个国家进行。该文对其中18个国家的数据进行分析,其中包含了临床结果数据。Mente A O'Donnell M Rangarajan S McQueen M Dagenais G Wielgosz A Lear S Ah STL Wei L Diaz R Avezum A Lopez-Jaramillo P Lanas F Mony P Szuba A Iqbal R Yusuf R Mohammadifard N Khatib R Yusoff K Ismail N Gulec S Rosengren A Yusufali A Kruger L Tsolekile LP Chifamba J Dans A Alhabib KF Yeates K Teo K Yusuf S 刘莉 叶鹏 2018中华高血压杂志2018,26,12:29
6正交异性钢桥面板典型细节疲劳强度研究显示文摘为合理确定正交异性钢桥面板疲劳强度,该文对国内外疲劳试验成果进行分析,确定有效的钢桥面板疲劳试验数据,结合典型细节疲劳开裂机理,提出适应于中国抗疲劳设计与建造水平的钢桥面板疲劳强度等级(200万次循环对应的疲劳强度)。研究结果表明:顶板与纵肋连接细节疲劳强度受焊缝型式影响较大,采用角焊缝连接时疲劳强度为50级,采用部分熔透焊缝连接时为60级;纵肋与横隔板连接细节横隔板焊趾处疲劳强度为70级,纵肋腹板焊趾处为55级;横隔板挖孔细节疲劳强度为70级;纵肋拼接细节疲劳强度与拼装间隙密切相关,拼装间隙小于3 mm时疲劳强度为40级,拼装间隙4 mm^6 mm时疲劳强度为70级,拼装间隙8 mm^12 mm时疲劳强度为100级。纵肋与横隔板连接细节横隔板焊趾处、横隔板挖孔细节和纵肋拼接细节疲劳强度与现行中国JTG D64规范一致,而顶板与纵肋连接细节、纵肋与横隔板连接细节纵肋腹板焊趾处疲劳强度低于JTG D64中的疲劳强度等级。在进行正交异性钢桥面板抗疲劳设计或疲劳评估时,应综合考虑细节构造、制造质量以及实际使用状况等因素,采用合理的疲劳强度等级。王春生 翟慕赛 HouankpoT O N 2020工程力学2020,37,8:30
72018加拿大心境障碍与焦虑障碍治疗协作组/国际双相障碍学会指南:双相障碍的管理显示文摘加拿大心境障碍与焦虑障碍治疗协作组(Canadian Network for Mood and Anxiety Treatments,CANMAT)曾于2005年发布了第1版双相障碍管理指南,并分别于2007、2009和2013年对该指南进行了更新,其中最近的2次更新是与国际双相障碍学会(International Society for Bipolar Disorders,ISBD)合作完成。2018版CANMAT/ISBD双相障碍治疗指南(以下简称指南)反映了自2005年首版指南发表以来本领域取得的重大进展,包括疾病诊断与疾病管理的更新以及药物治疗与心理治疗的近期研究进展。这些前沿进展中综合考虑了循证证据的级别,并基于治疗疗效、临床实践经验、安全性、耐受性和药物导致的转相风险等,对一线、二线及三线治疗方案进行了简明而清晰的推荐。本指南中新增内容涵盖了双相Ⅰ型障碍(BD-Ⅰ)的躁狂发作急性期、抑郁发作急性期和双相障碍维持期的一线及二线治疗推荐等级划分。这种对治疗推荐等级的划分综合考虑了治疗方法对双相障碍不同时相的影响,将进一步帮助临床医生做出基于循证证据的治疗决策。锂盐、喹硫平、双丙戊酸盐、阿塞那平、阿立哌唑、帕利哌酮、利培酮和卡利拉嗪单药或联合使用被推荐为躁狂发作急性期的一线治疗选择。BD-Ⅰ抑郁期的一线治疗选择包括喹硫平、鲁拉西酮、锂盐、拉莫三嗪单药,鲁拉西酮联合锂盐或双丙戊酸盐或拉莫三嗪辅助治疗。尽管急性期治疗有效的药物通常应继续用于BD-Ⅰ的维持期治疗,但也存在一些特殊情况(例如抗抑郁药)。现有数据表明,锂盐、喹硫平、双丙戊酸盐、拉莫三嗪、阿塞那平和阿立哌唑单药或联合治疗应被视为维持治疗的初始或更换治疗方案时的一线选择。除了探讨BD-Ⅰ的相关问题外,本指南中还对双相Ⅱ型障碍(BD-Ⅱ)的临床管理进行了系统回顾并给予治疗推荐,同时针对特殊人群也有相关推荐,如处于各个生殖周期的女性、儿童、青少年和老年人。此外,本指南中还讨论了特定精神疾病及共病(如物质滥用、焦虑障碍和代谢性疾病)的影响。最后,本指南中概述了安全性和药物监测的相关问题。CANMAT/ISBD工作组希望本指南能够成为全球临床医生的实用工具。Lakshmi N Yatham Sidney H Kennedy Sagar V Parikh Ayal Sehaffer David J Bond Benicio N Frey Verinder Sharma Benjamin I Goldstein Soham Rej Serge Beaulieu Martin Alda Glenda MaeQueen Roumen V Milev Arun Ravindran Claire O'Donovan Diane Mclntosh Raymond W Lam Gustavo Vazquez Flavio Kapczinski Roger S Melntyre Jan Kozicky Shigenobu Kanba Beny Lafer Trisha Suppes Joseph R Calabrese Eduard Vieta Gin Malhi Robert M Post Michael Berk 胡晨(译) 王刚(译) 2019中华精神科杂志2019,52,1:25
8OPTICAL PROPERTIES OF GeO_2 AND Ge NANOCRYSTALS显示文摘he co m pound m aterial of n m size particles Ge O2 Si O2 w as synthesied through hydrolysis of Si( O C2 H4) and Ge Cl4 . A heat treatm ent w as carried out for the sa m ples at 100 ~1200 ℃in air . Its optical property w as deter mined by U V Vis spectur m . We have found that theabsorption edge of spectru m shifted progressively to longer w avelengths . The quantu m size ef fect of nanocrystals appears because crystals gro w and energy of optical band gap reduces d ueto the influence of te m perature . By the analysis of X ray diffraction w e have observed theprocess in w hich the structure of particles changed fro m disorder into order .Y.H.Zhou 1) ,Y.Y.Feng 2) and H.Y.Lu 2) 1)Department of Physics Nanjing Normal University, Nanjing 210097,China 2)Physics and Ch寁O P T I C A L P R O P E R T I E S O F Ge O2 A N D Ge N A N O C R Y S T A L S Y. H. Zhou1) , Y. Y. Feng2) 1999Acta Metallurgica Sinica(English Letters)1999,12,5:22
9Depression in patients with irritable bowel syndrome in Jos,Nigeria显示文摘AIM: To study the brain-gut interaction and the effect of behavioral or psychiatric conditions on irritable bowel syndrome (IBS) in an African population. METHODS: IBS was diagnosed using the Rome Ⅱ diagnostic criteria. The entry of each patient was confirmed following detailed explanations of the questions. Four hundred and eighteen patients were studied. Subjects satisfying the Rome Ⅱ criteria for IBS were physically examined and stool microscopy was done to identify the presence of “alarm factors”. Depression was diagnosed using the symptom-check list adapted from the Research Diagnostic Criteria (DSM-Ⅳ) of the American Psychiatric Association. RESULTS: Seventy-five (56.8%) of the 132 IBS patients were depressed whereas only 54 (20.1%) of the 268 non-IBS patients were depressed. There was a significant relationship between IBS and depression (χ2 = 54.29, Odds ratio = 5.21, 56.8 ± 8.4 vs 20.1 ± 5.2, P = 0.001). Even though constipation predominant IBS patients were more likely to be depressed, no significant relationship was found between the subtype of IBS and depression (χ2 = 0.02, OR = 0.95, P = 0.68). CONCLUSION: IBS is significantly associated with major depression but not gender and bowel subtypes of the patients. Patients with IBS need to be evaluated for depression due to the highly significant relationship between the two conditions.Nimzing G Ladep Taiwo J Obindo Moses D Audu Edith N Okeke Abraham O Malu 2006World Journal of Gastroenterology2006,12,48:22
10血管性认知障碍的诊断标准:国际血管性行为与认知障碍学会的申明显示文摘长期以来,脑血管病(CVD)就被认为是认知损害的一个重要原因,但是有关脑血管病后认知障碍的概念化却有着一段多变的历史。'动脉变硬'或脑的动脉粥样硬化是'老化'的原因,是存在已久的观点,在20世纪60年代受到了来自英格兰纽卡斯尔的神经病理学研究的质疑。这些研究表明,血管性痴呆(vascular dementia,Va D)与超过一定程度的多发性脑梗死有关。徐岩 郭起浩 Sachdev P Kalaria R O'Brien J Skoog I Alladi S Black SE Blacker D Blazer DG Chen C Chui H Ganguli M Jellinger K Jeste DV Pasquier F Paulsen J Prins N Rockwood K Roman G Scheltens P 2014神经病学与神经康复学杂志2014,11,3:19
11Platelet count/spleen diameter ratio to predict esophageal varices in Mexican patients with hepatic cirrhosis显示文摘AIM:To validate whether the platelet count/spleen size ratio can be used to predict the presence of esophageal varices in Mexican patients with hepatic cirrhosis.METHODS:This was an analytical cross-sectional study to validate the diagnostic test for hepatic cirrhosis and was performed between February 2010 and December 2011.Patients with a diagnosis of hepatic cirrhosis were included and stratified using their ChildPugh score.Biochemical parameters were evaluated,and ultrasound was used to measure the longest diameter of the spleen.The platelet count/spleen diameter ratio was calculated and analyzed to determine whether it can predict the presence of esophageal varices.Upper gastrointestinal endoscopy was used as the gold standard.Sensitivity and specificity,positive and negative predictive values,and positive and negative likelihood ratios were determined,with the cutoff points determined by receiver-operating characteristic curves.RESULTS:A total of 91 patients were included.The mean age was 53.75±12 years;50(54.9%)were men,and 41(45.0%)women.The etiology of cirrhosis included alcohol in 48(52.7%),virally induced in24(26.3%),alcoholism plus hepatitis C virus in three(3.2%),cryptogenic in nine(9.8%),and primary biliary cirrhosis in seven(7.6%).Esophageal varices were present in 73(80.2%)patients.Child-Pugh classification,17(18.6%)patients were classified as class A,37(40.6%)as class B,and 37(40.6%)as class C.The platelet count/spleen diameter ratio to detect esophageal varices independent of the grade showed using a cutoff value of≤884.3,had 84%sensitivity,70%specificity,and positive and negative predictive values of 94%and 40%,respectively.CONCLUSION:Our results suggest that the platelet count/spleen diameter ratio may be a useful tool for detecting esophageal varices in patients with hepatic cirrhosis.Alejandro González-Ojeda Gabino Cervantes-Guevara Manuela Chávez-Sánchez Carlos Dávalos-Cobián Susana Ornelas-Cázares Michel Dassaejv Macías-Amezcua Mariana Chávez-Tostado Kenia Militzi Ramírez-Campos Anaís del Rocío Ramírez-Arce Clotilde Fuentes-Orozco 2014World Journal of Gastroenterology2014,20,8:18
12幽门螺杆菌感染处理的当前观念——MaastrichtⅢ共识报告显示文摘名词缩写欧洲幽门螺杆菌研究小组:European Helicobacter Study Group,EHSG胃食管反流病:gastro-esophageal reflux disease。P Malfertheiner F Megraud C O'Morain F Bazzoli E El-Omar D Graham R Hunt T Rokkas N Vakil EJ Kuipers 朱琦 2007胃肠病学2007,12,3:15
13ApoB-100, ApoE and CYP7A1 gene polymorphisms in Mexican patients with cholesterol gallstone disease显示文摘AIM: To determine the possible association of the ApoB100 (Xba Ⅰ ), ApoE (Hha Ⅰ ) and CYP7A1 (Bsa Ⅰ ) gene polymorphisms, with the development of cholesterol gallstone disease (GD) in a Mexican population. METHODS: The polymorphisms were analyzed by polymerase chain reaction followed by restriction fragment length polymorphism, in two groups matched by ethnicity, age and sex: patients with GD (n = 101) and stone-free control subjects (n = 101). RESULTS: Allelic frequencies in patients and controls were: 34.16% vs 41.58% (P = 0.124) for X+of ApoB-100; 4.46% vs 5.94% (P = 0.501) for E2, 85.64% vs 78.22% (P = 0.052) for E3, 9.90% vs 15.84% (P = 0.075) for E4 of ApoE; and 25.74% vs 27.72% (P = 0.653) for C of CYP7A1. Differences in genotypic frequencies between the studied groups were not significant (P < 0.05). CONCLUSION: These results demonstrated that no association exists between the studied polymorphisms and cholelithiasis in this high prevalent population.Sánchez-Cuén Jaime Aguilar-Medina Maribel Arámbula-Meraz Eliakym Romero-Navarro José Granados Julio Sicairos-Medina Laura Ramos-Payán Rosalío 2010World Journal of Gastroenterology2010,16,37:14
14Efficacy of neoadjuvant therapy and surgical rescue for locally advanced hepatoblastomas:10 year single-center experience and literature review显示文摘AIM:To report our experience with long-term outcomes after multimodal management therapy.METHODS:An observational retrospective study was performed containing seven patients with hepatoblastoma(Hbl)treated in our institution,a tertiary referral center,from 2003 to 2011.Demographic,preoperative,surgical,and outcome variables were collected.A survival analysis and a review of the current literature related to combination neoadjuvant chemotherapy and surgical resection on Hbl were performed.RESULTS:The median age at surgery was 14.4 mo,with a male to female ratio of 4:3.Pretext staging at diagnosis was as follows:stageⅠ,4 cases;stageⅡ,2 patients;and stageⅢ,1 case.Mean pretreatment tumor volume was 735 cm3.Five out of seven patients received neoadjuvant chemotherapy according to SIOPEL-3 or SIOPEL-6 protocols.Tumor volume and alphafetoprotein levels significantly dropped after neoadjuvant therapy.Surgical procedures performed included hemihepatectomies,segmentectomies and atypical resection.All patients received chemotherapy after surgery.Median postoperative hospital stay was 8 d.All patients were alive and disease-free after a median follow-up period of 23 mo.With regards to the literature review,seventeen articles were found that were related to our search.CONCLUSION:Our series shows how multimodal management of Hbl,exhaustive control and a meticulous surgical approach leads to almost 100%complete resection with optimal postoperative results.Dolores Ayllon Teran Oscar Gómez Beltran Rubén Ciria Bru Elena Mateos González María José Pea Rosa Antonio Luque Molina Pedro López Cillero Javier Briceo Delgado 2014World Journal of Gastroenterology2014,20,29:12
15Interplay between nitric oxide and VIP in CCK-8-induced phasic contractile activity in the rabbit sphincter of Oddi显示文摘AIM: The sphincter of Oddi (SO) plays an important role in delivery of bile into the duodenum. To establish whether vasoactive intestinal polypeptide (VIP) and nitric oxide (NO) were involved in phasic contractile activity of the rabbit SO stimulated by cholecystokinin-octapeptide (CCK-8).METHODS: Isolated SO muscle rings were cleaned of fat and mounted horizontally on two small L-shaped hooksone of which was connected to a force transducer for the measurement of isometric tension. The experiments were carried out in a thermostatically controlled (37±0.2℃)organ bath (5 mL) containing Krebs solution. The organ fluid was gassed with 95% O2 and 50 mL/L CO2 to keep the pH at 7.40±0.05. Contractile responses to CCK-8 (1μmol/L) were evaluated in the presence and absence of N^G-nitro-L-arginine (LNNA), an inhibitor of NO synthase (100μmol/L), and (p-chloro-D-Phe^6-Leu^17)-VIP (VIPa,30μmol/L), a VIP receptor antagonist.RESULTS: CCK-8 stimulated the phasic activity of the SO.NO synthase inhibition increased the frequency and amplitude of contractions with a slight increase in developed tension.Pre-incubation with VIPa also attenuated this CCK-8 effect.The combined application of LNNA and VIPa abolished the phasic activity of the muscle rings with a marked increase in tension in response to CCK-8.CONCLUSION: VIP and NO together contribute to an increase in phasic activity of SO.Attila Pálv(o|¨)lgyi Réka Sári József Németh Annamária Szabolcs István Nagy Péter Hegyi János Lonovics Zoltán Szilvássy 2005World Journal of Gastroenterology2005,11,21:11
16Cyclooxygenase-2 polymorphisms and the risk of esophageal adeno-or squamous cell carcinoma显示文摘AIM:To determine whether-1195 A→G and/or-765 G→C polymorphisms in Cyclooxygenase-2(COX-2 ) may have a risk modifying effect on the development of esophageal carcinoma in a Dutch Caucasian population.METHODS:Two study groups were recruited, 252 patients with esophageal carcinoma and 240 healthy controls, matched for race, age, gender and recruiting area.DNA was isolated from whole blood and used for genotyping.PCR products were digested with restriction enzymes and products were analyzed by agarose gel electrophoresis.Odds ratios(OR) and 95% confldence intervals(CI) were estimated.RESULTS:The distribution of the-1195 A→G polymorphism was signif icantly different in esophageal cancer patients compared to controls.The-1195 GG genotype resulted in a higher risk of developing esophageal adenocarcinoma(OR = 3.85, 95% CI:1.45-10.3) compared with the-1195 AA genotype as a reference.The-765 G→C genotype distribution was not different between the two groups.The GG/ GG haplotype was present more often in esophageal adenocarcinoma patients than in controls(OR = 3.45, 95% CI:1.24-9.58;with AG/AG as a reference).The same trends were observed in patients with squamous cell carcinomas, however, the results did not reach statistical signif icance.CONCLUSION:Presence of the COX-2-1195 GG genotype and of the GG/GG haplotype may result in a higher risk of developing esophageal carcinoma.Jón O Kristinsson Paul van Westerveld Rene HM te Morsche Hennie MJ Roelofs T Wobbes Ben JM Witteman Adriaan CITL Tan Martijn GH van Oijen Jan BMJ Jansen Wilbert HM Peters 2009World Journal of Gastroenterology2009,15,28:11
17Passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes显示文摘AIM To assess for passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts(TIPS) and compare outcomes with maximally dilated TIPS.METHODS Polytetrafluoroethylene covered TIPS(Viatorr) from July 2002 to December 2013 were retrospectively reviewed at two hospitals in a single institution. Two hundred and thirty patients had TIPS maximally dilated to 10 mm(m TIPS), while 43 patients who were at increased risk for hepatic encephalopathy(HE), based on clinical evaluation or low pre-TIPS portosystemic gradient(PSG), had 10 mm TIPS sub-maximally dilated to 8 mm(sm TIPS). Group characteristics(age, gender, Model for End-Stage Liver Disease score, post-TIPS PSG and clinical outcomes were compared between groups, including clinical success(ascites or varices), primary patency,primary assisted patency, and severe post-TIPS HE. A subset of fourteen patients with sm TIPS underwent follow-up computed tomography imaging after TIPS creation, and were grouped based on time of imaging(< 6 mo and > 6 mo). Change in diameter and crosssectional area were measured with 3D imaging software to evaluate for passive expansion.RESULTS Patient characteristics were similar between the sm TIPS and m TIPS groups, except for pre-TIPS portosystemic gradient, which was lower in the sm TIPS group(19.4 mm Hg ± 6.8 vs 22.4 mm Hg ± 7.1, P = 0.01). Primary patency and primary assisted patency between sm TIPS and m TIPS was not significantly different(P = 0.64 and 0.55, respectively). Four of the 55 patients(7%) with sm TIPS required TIPS reduction for severe refractory HE, while this occurred in 6 of the 218 patients(3%) with m TIPS(P = 0.12). For the 14 patients with follow-up computed tomography(CT) imaging, the median imaging follow-up was 373 d. There was an increase in median TIPS diameter, median percent diameter change, median area, and median percent area change in patients with CT follow-up greater than 6 mo after TIPS placement compared to follow-up within 6 mo(8.45 mm, 5.58%, 56.04 mm^2, and 11.48%, respectively, P = 0.01).CONCLUSION Passive expansion of sm TIPS does occur but clinical outcomes of sm TIPS and m TIPS were similar. Sub-maximal dilation can prevent complications related to overshunting in select patients.Michael C Hsu Charles N Weber S William Stavropoulos Timothy W Clark Scott O Trerotola Richard D Shlansky Goldberg Michael C Soulen Gregory J Nadolski 2017World Journal of Hepatology2017,9,12:11
18Metabolic complications in liver transplant recipients显示文摘The metabolic syndrome(MS), which includes obesity,dyslipidaemia, hypertension and hyperglycaemia according to the most widely accepted definitions now used, is one of the most common post-transplant complications, with a prevalence of 44%-58%. The MS, together with the immunosuppression, is considered the main risk factor for the development of cardiovascular disease(CVD) in transplant recipients, which in turn accounts for 19%-42% of all deaths unrelated to the graft. The presence of MS represents a relative risk for the development of CVD and death of 1.78. On the other hand, non-alcoholic fatty liver disease(NAFLD), considered as the manifestation of the MS in the liver, is now the second leading reason for liver transplantation in the United States after hepatitis C and alcohol. NAFLD has a high rate of recurrence in the liver graft and a direct relation with the worsening of other metabolic disorders, such as insulin resistance or diabetes mellitus. Consequently, it is vitally important to identify and treat as soon as possible such modifiable factors as hypertension, overweight, hyperlipidaemia or diabetes in transplanted patients to thus minimise the impact on patient survival. Additionally, steroid-free regimens are favoured, with minimal immunosuppression to limit the possible effects on the development of the MS.Miguel Jiménez-Pérez Rocío González-Grande Edith Omonte Guzmán Víctor Amo Trillo Juan Miguel Rodrigo López 2016World Journal of Gastroenterology2016,22,28:10
19Portal vein thrombosis with protein C-S deficiency in a noncirrhotic patient显示文摘There are several conditions that can lead to portal vein thrombosis(PVT), including including infection, malignancies, and coagulation disorders. Anew condition of interest is protein C and S deficiencies, associated with hypercoagulation and recurrent venous thromboembolism. We report the case of a non-cirrhotic 63-year-old male diagnosed with acute superior mesenteric vein thrombosis and PVT and combined deficiencies in proteins C and S, recanalized by short-term low molecular heparin plus oral warfarin therapy.Gustavo A Rodríguez-Leal Segundo Morán Roberto Corona-Cedillo Rocío Brom-Valladares 2014World Journal of Hepatology2014,6,7:10
20Epigenetic mechanisms in non-alcoholic fatty liver disease:An emerging field显示文摘Non-alcoholic fatty liver disease(NAFLD) is an emerging health concern in both developed and non-developed world, encompassing from simple steatosis to nonalcoholic steatohepatitis(NASH), cirrhosis and liver cancer. Incidence and prevalence of this disease are increasing due to the socioeconomic transition and change to harmful diet. Currently, gold standard method in NAFLD diagnosis is liver biopsy, despite complications and lack of accuracy due to sampling error. Further, pathogenesis of NAFLD is not fully understood, but is well-known that obesity, diabetes and metabolic derangements played a major role in disease development and progression. Besides, gut microbioma and host genetic and epigenetic background could explain considerable interindividual variability. Knowledge that epigenetics, heritable events not caused by changes in DNA sequence, contribute to development of diseases has been a revolution in the last few years. Recently, evidences are accumulating revealing the important role of epigenetics in NAFLD pathogenesis and in NASH genesis. Histone modifications, changes in DNA methylation and aberrant profiles or micro RNAs could boost development of NAFLD and transition into clinical relevant status. PNPLA3 genotype GG has been associated with a more progressive disease and epigenetics could modulate this effect. The impact of epigenetic on NAFLD progression could deserve further applications on therapeutic targets together with future non-invasive methods useful for the diagnosis and staging of NAFLD.Rocío Gallego-Durán Manuel Romero-Gómez 2015World Journal of Hepatology2015,7,24:8
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