重庆地区无偿献血者丙肝病毒感染及对献血者招募的影响(英文)

近年来,中国的献血者招募模式正在从有偿献血到单位组织献血,进而到完全无偿献血的模式转变。有关真正的无偿献血者中丙型肝炎感染的资料还较少报道。本研究对重庆地区2003年的首次献血者进行丙型肝炎感染及病毒分型的调查,共有13620份血清标本进行ELISA丙型肝炎抗体检测,其中抗体阳性标本再经RT-PCR扩增HCVRNA的核心区/E2区片段进行基因分型。结果发现,HCV抗体阳性率为0.49%(67/13620),其中在40-49岁年龄段的阳性率(0.86%)最高;高学历人群和大城市生活人群的阳性率相对为高。丙肝病毒的基因分型结果显示,在22份基因分型阳性标本中有基因型1b,2a,3a和3b等四种,分别占4(18%)、5(23%)、9(41)和4(18%),以基因型3(包括3a和3b)为流行。结论:重庆地区无偿献血人群中丙型肝炎抗体阳性率较低;由于本地及周边地区静注毒品人群中丙型肝炎感染以基因型3为主,提示可能在献血人群中有静注吸毒者的存在。因此,随着献血模式的转变,在献血者的招募中应注意排除吸毒者这一高危人群。

Cyclooxygenase-2 and epithelial growth factor receptor up-regulation during progression of Barrett's esophagus to adenocarcinoma

瞄准：在整个 Barretts 食管的前进调查 cyclooxygenase-2 (COX-2 ) 和上皮的生长因素受体(EGFR ) 的表示() 。方法：COX-2 和 EGFR 蛋白质表情被使用免疫检测组织化学的方法。详细 cytomorphological 改变的 A 是坚定的。COX-2 和 EGFR 表示的区域被使用计算机成像系统确定。结果：COX-2 和 EGFR 的表情与前进一起增加了从到食管腺癌(EAC ) 。积极关联在 COX-2 表示和 EGFR 表示之间被发现。结论：COX-2 和 EGFR 可能在逐步的前进从是合作的到 EAC，从而导致致癌作用。

Systematic review and meta-analysis of esophageal cancer in Africa:Epidemiology, risk factors, management and outcomes

BACKGROUND Esophageal cancer(EC)is associated with a poor prognosis,particularly so in Africa where an alarmingly high mortality to incidence ratio prevails for this disease.AIM To provide further understanding of EC in the context of the unique cultural and genetic diversity,and socio-economic challenges faced on the African continent.METHODS We performed a systematic review of studies from Africa to obtain data on epidemiology,risk factors,management and outcomes of EC.A non-systematic review was used to obtain incidence data from the International Agency for Research on Cancer,and the Cancer in Sub-Saharan reports.We searched EMBASE,PubMed,Web of Science,and Cochrane Central from inception to March 2019 and reviewed the list of articles retrieved.Random effects metaanalyses were used to assess heterogeneity between studies and to obtain odds ratio(OR)of the associations between EC and risk factors;and incidence rate ratios for EC between sexes with their respective 95%confidence intervals(CI).RESULTS The incidence of EC is higher in males than females,except in North Africa where it is similar for both sexes.The highest age-standardized rate is from Malawi(30.3 and 19.4 cases/year/100000 population for males and females,respectively)followed by Kenya(28.7 cases/year/100000 population for both sexes).The incidence of EC rises sharply after the age of 40 years and reaches a peak at 75 years old.Meta-analysis shows a strong association with tobacco(OR 3.15,95%CI:2.83-3.50).There was significant heterogeneity between studies on alcohol consumption(OR 2.28,95%CI:1.94-2.65)and on low socioeconomic status(OR 139,95%CI:1.25-1.54)as risk factors,but these could also contribute to increasing the incidence of EC.The best treatment outcomes were with esophagectomy with survival rates of 76.6%at 3 years,and chemo-radiotherapy with an overall combined survival time of 267.50 d.CONCLUSION Africa has high incidence and mortality rates of EC,with preventable and nonmodifiable risk factors.Men in this setting are at increased risk due to their higher prevalence of tobacco and alcohol consumption.Management requires a multidisciplinary approach,and survival is significantly improved in the setting of esophagectomy and chemoradiation therapy.

Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001

AIM: To evaluate how proximal colon polyps interpreted as hyperplastic polyps in 2001 would be interpreted by expert pathologists in 2007. METHODS: Forty consecutive proximal colon polyps ≥ 5 mm in size, removed in 2001, and originally interpreted as hyperplastic polyps by general pathologists at Indiana University, were reviewed in 2007 by 3 GI pathologists. RESULTS: The gastrointestinal (GI) pathologists interpreted 85%, 43% and 30% of the polyps as sessile serrated polyps (sessile serrated adenomas). The overall Kappa was 0.16. When diagnoses were compared in pairs, Kappa values were 0.38 and 0.25 (fair agreement) and 0.14 (slight agreement). CONCLUSION: Many polyps interpreted as hyperplastic in 2001 were considered sessile serrated lesions by GI pathologists in 2007, but there is substantial inter-observer variation amongst GI pathologists.

Routine rectal retroflexion during colonoscopy has a low yield for neoplasia

AIM: To investigate the value of retroflexion in detecting neoplasia in the distal rectum. METHODS: This was a prospective observational study performed in an academic endoscopy unit. Consecutive patients undergoing colonoscopy had careful forward viewing of the distal rectum by retroflexion. Of 1502 procedures, 1076 (72%) procedures were performed with a 140° angle of view colonoscope and 426 (28%) were performed with a 170° angle of view colonoscope. The outcome measurement was the yield of neoplasia in the distal rectum detected by forward viewing vs retroflexion. RESULTS: A total of 1502 patients, including 767 (51%) females and 735 (49%) males, with mean age of 58.8 ± 12.5 years were enrolled. Retroflexion was successful in 1411 (93.9%) patients, unsuccessful or not performed because the rectum appeared narrow in 91 (6.1%). Forty patients had a polyp detected in the distal rectal mucosa. Thirty-three were visible in both the forward and retroflexed view (25 hyperplastic, 8 adenomatous). Seven polyps were visualized only by retroflexion (6 hyperplastic sessile polyps, one 4 mm sessile tubular adenoma). There was no significant difference in information added by retroflexion with 140° vs 170° angle of view instrument. CONCLUSION: To our knowledge, this is the largest reported evaluation of retroflexion in the rectum. Routine rectal retroflexion did not detect clinically important neoplasia after a careful forward examination of the rectum to the dentate line. Since retroflexion has risks and may cause discomfort, theuse of routine retroflexion should be at the discretion of the endoscopist.

Pulmonary complications of transcatheter arterial chemoembolization for hepatocellular carcinoma

Transcatheter arterial chemoembolization(TACE) is an effective palliative intervention that is widely accepted for the management of hepatocellular carcinoma(HCC). Post-TACE pulmonary complications resulting in acute lung injury(ALI) or acute respiratory distress syndrome(ARDS) are rare events. Pulmonary complications after TACE are thought to be related to chemical injury subsequent to the migration of the infused ethiodized oil or chemotherapeutic agent to the lung vasculature, facilitated by arteriovenous(AV) shunts within the hyper-vascular HCC. We review herein the literature on pulmonary complications related to TACE for HCC. Post-TACE pulmonary complications have included pulmonary oil embolism, interstitial pneumonitis, chemical pneumonitis, ALI, ARDS, lipoid pneumonia, acute eosinophilic and neutrophilic pneumonia, bilious pleuritis, pulmonary abscess, pulmonary tumor embolism, and possibly pulmonary metastasis with HCC. The risk factors associated with post-TACE pulmonary complications identified in the literature include large hyper-vascular HCC with AV shunts, large-volume Lipiodol infusion, and embolization via the right inferior phrenic artery. However, the absence of known risk factors is not a guarantee against serious complications. An astute awareness of the potential post-TACE pulmonary complications should expedite appropriate therapeutic interventions and increase potential for early recovery.

Beta-blockers and physical frailty in patients with endstage liver disease

AIM To investigate beta-blocker(BB) use in patients with cirrhosis and determine their effects on physical frailty and overall survival.METHODS Adult outpatients with cirrhosis listed for liver transplantation underwent testing of physical frailty using the performance-based Liver Frailty Index, comprised of chair stands, grip strength, and balance testing, as well as self-reported assessments of exhaustion and physical activity. BB use was assessed from medical chart review. Univariable and multivariable logistic regression were performed to determine BB use and their association with measures of physical frailty. Competing risk analyses were performed to determine the effect of BB use on wait-list mortality, as defined by death or delisting for being too sick for transplant.RESULTS Of 344 patients, 35% were female, median age was 60, median model for end stage liver disease was 15, and 53% were prescribed a BB. Compared to those not on BB, patients on BB were similar except for percentage female(25% vs 46%; P < 0.001) and BMI(29 vs 28; P = 0.008). With respect to tests of physical frailty, BB use was not associated with increased odds of frailty(by the Liver Frailty Index), exhaustion, or low physical activity. BB use was, however, significantly associated with a decreased adjusted risk of mortality(SHR 0.55; P = 0.005).CONCLUSION In patients with cirrhosis awaiting liver transplantation, BB use is not associated with physical frailty. We confirmed the known survival benefits with BB use, and concerns about adverse effects should not deter their utilization when indicated.

Patient interest in video recording of colonoscopy:A survey

AIM:To find if patients are interested in obtaining a video recording of their colonoscopy procedure.METHODS:We conducted a survey of outpatients presenting for colonoscopy regarding their interest in obtaining a video recording of their colonoscopy.RESULTS:Two hundred and forty-eight patients(mean age 57.9 years;57% male) were surveyed.Two hundred and one patients(81%) were interested in obtaining a video recording.No significant predictors of patients' interest in the video recording were identified.After reading a brief educational paragraph explaining missed lesions during colonoscopy,135 patients(54%) were more interested in having a video recording,and none were less interested.One hundred and fifty-six patients(63%) were willing to pay for a video recording.In multivariable analyses,younger age was predictive of willingness to pay for a video recording.Prior history of colorectal cancer and a family history of colorectal cancer were predictive of willingness to pay a greater amount.CONCLUSION:Patients undergoing colonoscopy expressed substantial interest in obtaining a videorecording of their procedure.Awareness of missing lesions during colonoscopy increased interest in having a videorecording.

胱氨酸病是非肝硬化性门静脉高压症的一种病因

Cystinosis is a rare autosomal recessive storage disorder, characterized by the abnormal accumulation of cystine in cellular lysosomes. This accumulation, which can occur in any organ system, leads to crystallization of trapped cystine and ultimately cellular death. Hepatic manifestations of Cystinosis although rare, have been described in the literature. However, to our knowledge, only one other case of non- cirrhotic portal hypertension secondary to cystine accumulation in Kupffer cells has been reported. In this case and ours, portal hypertension was found in the absence of bridging fibrosis. Furthermore, in our case, for the majority of the patient’ s course, hepatic synthetic function remained normal. Cysteamine is therapeutic in this disorder, and can lead to significant removal of cystine, and thus to reversibility of disease, however, it requires high doses and must be taken regularly. Porto- systemic shunting in combination with aggressive medical therapy could potentially benefit patients who develop non- cirrhotic portal hypertension in this clinical setting.

长期白蛋白输注对不能接受TIPS的腹水患者可达到利尿效果

While transjugular intrahepatic portosystemic shunt (TIPS) is a common therapy for cirrhotic patients with diuretic- resistant or diuretic- refractory ascites, some patients are unsuitable for the procedure for technical or medical reasons. We report our experience with the use of chronic intravenous albumin infusions to achieve diuresis in this difficult patient population and review the historic experience of chronic albumin infusions as a treatment for ascites. Nineteen patients with cirrhosis and diuretic- resistant or diuretic- refractory ascites who were deemed unsuitable for TIPS received outpatient intravenous albumin infusions (50 g) weekly for at least 4 weeks. The following endpoints were retrospectively recorded: serum sodium, serum creatinine, blood urea nitrogen, hematocrit, bilirubin, albumin, international normalized ratio, body weight, and Model for End- stage Liver Disease (MELD) score. The contraindicatoins for TIPS included the following: portal vein thrombosis, two; advanced age, one; encephalopathy, nine; hyperbilirubinemia, five; and other, two. Compared to pretreatment, post treatment weight decreased in 17 patients, remained unchanged in 0 patients, and increased in 2 patients. The overall mean change in body weight (before vs. after therapy) was 8 lb (P < 0.05). The only significant change in biochemistries was an increase in serum albumin from 2.5 g/dl before therapy to 3.5 g/dl after therapy (P < 0.05). We conclude that (1) recurrent intravenous weekly albumin infusions resulted in significant loss of edema and ascites as measured by loss of body weight, and (2) clinicians may want to consider chronic albumin infusions for selected patients with refractory ascites who are not candidates for TIPS.

Key quality indicators in colonoscopy

Many quality indicators have been proposed for colonoscopy,but most colonoscopists and endoscopy groups focus on measuring the adenoma detection rate and the cecal intubation rate.Use of proper screening and surveillance intervals is another accepted key indicator but it is seldom evaluated in clinical practice.Bowel preparation efficacy and polyp resection skills are areas that are emerging as potential key or priority indicators.This review summarizes and provides an update on key performance indicators for colonoscopy quality.

A Mimic of Hepatic Encephalopathy: Two Cases of Cryptococcal Meningitis in North America

In the non-human immunodeficiency virus infected population,cryptococcosis occurs primarily in people who are functionally immunosuppressed,including patients who have undergone solid organ transplantation requiring immunosuppressive medications,are on corticosteroids,or have renal failure or cirrhosis.Cryptococcal meningitis poses a particular challenge in the setting of cirrhosis because its clinical presentation can mimic hepatic encephalopathy.Here,we describe two patients with decompensated cirrhosis,both with a known history of hepatic encephalopathy who had lumbar punctures and were found to have cryptococcal meningitis.The first patient had a subacute fluctuating change in mental status,while the second patient had progressive subacute headaches,gait disturbance,and hearing loss.Both patients were treated with amphotericin B and flucytosine induction,but only the second survived to maintenance therapy.These cases demonstrate the importance of having a high index of suspicion for cryptococcal meningitis in cirrhosis and having a low threshold for performing a lumbar puncture when altered mental status or other neurologic complaints are not fully explained by hepatic encephalopathy.We also provide a brief review of the pathobiology of cryptococcal infection in cirrhosis and highlight the challenges in therapy.

An Update on Efficacy and Safety of Emerging Hepatic Antifibrotic Agents

Liver fibrosis represents a response to chronic liver injury.Metabolic dysfunction-associated fatty liver disease and metabolic dysfunction-associated steatohepatitis are the most common chronic liver diseases,both with increasing incidence.Therefore,there is a great impetus for development of agents targeting these conditions.Accumulating data on possible treatment options for liver fibrosis are emerging in the literature.However,despite extensive research and much effort in the field,approved agents for liver fibrosis are still lacking.In this critical review,we have summarized the main data about specific treatment options for liver fibrosis gained from ongoing clinical trials,with an emphasis on efficacy and safety of these agents.

Targeting the Wnt Signaling Pathway in Liver Fibrosis for Drug Options:An Update

morbidity and mortality for healthcare systems worldwide.It imparts an enormous economic burden to societies,making continuous research and informational updates about its pathogenesis and treatment crucial.This review′s focus is on the current knowledge about the Wnt signaling path-way,serving as an important pathway in liver fibrosis development and activation of hepatic stellate cells(HSCs).Two types of Wnt pathways are distinguished,namely the ß-catenin-dependent canonical and non-canonical Ca^(2+) or planar cell polarity(PCP)-dependent pathway.The dynamic balance of physiologically healthy liver and hepatocytes is disturbed by repeated liver injuries.Activation of theß-catenin Wnt pathway prevents the regeneration of hepatocytes by the replacement of extracellular matrix(ECM),leading to the appearance of scar tissue and the formation of regenerated nodular hepatocytes,lacking the original function of healthy hepatocytes.Therefore,liver function is reduced due to the severely advanced disease.Selective inhibition ofß-catenin inhibits inflammatory processes(since chemokines and pro-inflammatory cytokines are produced during Wnt activation),reduces growth of activated HSCs and reduces collagen synthesis and angiogenesis,thereby reducing the progression of liver fibrosis in vivo.While the canonical Wnt pathway is usually inactive in a physiologically healthy liver,it shows activity during cell regeneration or renewal and in certain pathophysiological conditions,such as liver diseases and cancer.Targeted blocking of some of the basic components of the Wnt path-way is a therapeutic approach.These include the frizzled transmembrane receptor(Fz)receptors using the secreted frizzled-related protein family(sFRP),Fz-coreceptors low-density LRP 5/6 through dickkopf-related protein 1(DKK1)or niclosamide,glycogen kinase-3 beta(GSK-3β)using SB-216763,cyclic-AMP response element-binding protein(CBP)using PRI-724 and ICG-001,the lymphoid enhancer binding factor(LEF)/T cell-specific transcription factor(TCF)system as well as Wnt inhibitory factor 1(WIF1)and miR-17-5p using pinostilbene hydrate(PSH).Significant progress has been made in inhibiting Wnt and thus stopping the progression of liver fibrosis by diminishing key components for its action.Comprehending the role of the Wnt signaling pathway in liver fibrosis may lead to discovery of novel targets in liver fibrosis therapeutic strategies’development.

NOD2/CARD15突变的回肠储袋患者的自身免疫性疾病

Pouchitis is common in ulcerative colitis patients undergoing total proctocolectomy with ileal pouch-anal anastomosis,and chronic antibiotic-refractory pouchitis occurs in a subgroup of the patients.Auto-inflammatory diseases are characterized by systemic inflammation,manifesting as periodic fever,rash,arthritis,and serositis.We describe two cases with ulcerative colitis and an ileal pouch,who presented with extra-intestinal manifestations and genetic features atypical for inflammatory bowel disease alone.Case 1 had a spectrum of clinical manifestations including refractory pouchitis,intermittent fevers,polyarthralgia,and pericarditis.Case 2 presented with oral ulcers,migratory oligoarthritis,and periodic papular rash.Genetic testing in both cases revealed mutations of the NOD2/CARD15 gene,including the IVS8þ158 mutation commonly detected among patients with NOD2-associated auto-inflammatory disease.Both of the patients demonstrated clinical improvement of these diverse systemic complaints following treatment with immunosuppressive and anti-inflammatory therapies.