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世界胃肠病学杂志（英文版）
世界胃肠病学杂志（英文版）

潘伯荣

周刊

1007-9327

wjg@wjgnet.com

010-85381901-628

100025

北京市朝阳区东四环中路62号楼远洋国际中心D座903室

世界胃肠病学杂志（英文版）/Journal World Journal of GastroenterologyCSCDCSTPCDSCI
查看更多>>主要报道和刊登国内外、特别是我国消化病学者具有创造性的、有较高学术水平的基础和临床研究论文、研究快报等. 对具有中国特色的研究论文, 如食管癌、胃癌、肝癌、大肠癌、病毒性肝炎、幽门螺杆菌、中医中药、中西医结合和基于作者自己研究工作为主的综述性论文, 将优先发表. 读者对象为基础研究或临床研究的消化专业工作者。
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    Radiofrequency ablation or percutaneous ethanol injection for the treatment of liver tumors

    Daniel AnsariRoland Andersson
    1003-1008页
    查看更多>>摘要：The liver is a common location of both primary and secondary malignancies.For unresectable liver cancer,many local ablative therapies have been developed.These include e.g.,percutaneous ethanol injection (PEI),percutaneous acetic acid injection,radiofrequency ablation (RFA),cryoablation,microwave ablation,laser-induced thermotherapy,and high-intensity focused ultrasound.RFA has recently gained interest and is the most widely applied thermoablative technique.RFA allows more effective tumor control in fewer treatment sessions compared with PEI,but with a higher rate of complications.However,there are certain circumstances where PEI therapy represents a better strategy to control liver tumors than RFA,especially in situations where RFA is difficult,for example when large vessels surround the tumor.In the context of hepatocellular carcinoma (HCC),both RFA and PEI are feasible and of benefit in non-operable patients.RFA seems superior to PEI in HCC ＞ 2 cm,and the combination of inter-ventions may be of benefit in selected patients.Liver resection is superior to RFA for patients with HCC meeting the Milan criteria,but RFA can be employed in tumors ≤ 3 cm and where there is an increased expected operative mortality.In addition,some lines of evidence indicate that RFA and PEI can be employed as a bridge to liver transplantation.The use of RFA in colorectal liver metastases is currently limited to unresectable disease and for patients unfit for surgery.The aim of this article is to summarize the current status of RFA in the management of liver tumors and compare it to the cheap and readily available technique of PEI.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Neuroendocrine liver metastases: Contributions of endoscopy and surgery to primary tumor search

    Herwig Cerwenka
    1009-1014页
    查看更多>>摘要：Neuroendocrine tumors (NETs) are diagnosed with increasing frequency and patients often present with liver metastases at the time of diagnosis.Apart from treatment of the metastases,resection of the primary tumor at an early phase is recommended to prevent complications,although it may be difficult to locate,especially in patients with functionally inactive NETs.Small and multifocal tumors in the jejunum and ileum represent a particular challenge.Primary hepatic neuroendocrine carcinoma is extremely rare and is diagnosed only after exclusion of other primary tumors.Therefore,some uncertainty may remain,as small non-hepatic primary tumors may escape detection.Diagnostic work-up in these patients includes biochemical assays and imaging modalities (also comprising specific techniques of scintigraphy and positron emission tomography).This editorial highlights the contributions of endoscopy and operative exploration to the search for the primary tumor.Besides esophagogastro-duodenoscopy,endoscopic ultrasonography,colonoscopy and bronchoscopy,special endoscopic techniques such as balloon enteroscopy or capsule endoscopy are used with growing experience.Compared with balloon enteroscopy,capsule endoscopy is noninvasive and better tolerated,but it cannot localize a lesion precisely and does not allow biopsy or removal of lesions.Before proceeding to surgery,a discussion of the findings by a tumor board should be a standard procedure.Improvements in diagnostic tools have created new perspectives for the detection of obscure primary tumors in patients with neuroendocrine liver metastases,and these searches are best coordinated by a multidisciplinary team.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Strategy to differentiate autoimmune pancreatitis from pancreas cancer

    Kensuke TakumaTerumi KamisawaRajesh GopalakrishnaSeiichi Hara...
    1015-1020页
    查看更多>>摘要：Autoimmune pancreatitis (AIP) is a newly described entity of pancreatitis in which the pathogenesis appears to involve autoimmune mechanisms.Based on histological and immunohistochemical examinations of various organs of AIP patients,AIP appears to be a pancreatic lesion reflecting a systemic "IgG4-related sclerosing disease".Clinically,AIP patients and patients with pancreatic cancer share many features,such as preponderance of elderly males,frequent initial symptom of painless jaundice,development of new-onset diabetes mellitus,and elevated levels of serum tumor markers.It is of uppermost importance not to misdiagnose AIP as pancreatic cancer.Since there is currently no diagnostic serological marker for AIP,and approach to the pancreas for histological examination is generally difficult,AIP is diagnosed using a combination of clinical,serological,morphological,and histopathological features.Findings suggesting AIP rather than pancreatic cancer include:fluctuating obstructive jaundice; elevated serum IgG4 levels; diffuse enlargement of the pancreas; delayed enhancement of the enlarged pancreas and presence of a capsule-like rim on dynamic computed tomography; low apparent diffusion coefficient values on diffusion-weighted magnetic resonance image; irregular narrowing of the main pancreatic duct on endoscopic retrograde cholangiopancreatography; less upstream dilatation of the main pancreatic duct on magnetic resonance cholangiopancreatography,presence of other organ involvement such as bilateral salivary gland swelling,retroperitoneal fibrosis and hilar or intrahepatic sclerosing cholangitis;negative work-up for malignancy including endoscopic ultrasound-guided fine needle aspiration; and steroid responsiveness.Since AIP responds dramatically to steroid therapy,accurate diagnosis of AIP can avoid unnecessary laparotomy or pancreatic resection.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Botulinum toxin for chronic anal fissure after biliopancreatic diversion for morbid obesity

    Serafino VanellaGiuseppe BrisindaGaia MarnigaAnna Crocco...
    1021-1027页
    查看更多>>摘要：AIM:To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity.METHODS:Fifty-nine symptomatic adults with chronic anal fissure developed after BPD were enrolled in an open label study.The outcome was evaluated clinically and by comparing the pressure of the anal sphincters before and after treatment.All data were analyzed in univariate and multivariate analysis.RESULTS:Two months after treatment,65.4％ of the patients had a healing scar.Only one patient had mild incontinence to flatus that lasted 3 wk after treatment,but this disappeared spontaneously.In the multivariate analysis of the data,two registered months after the treatment,sex (P =0.01),baseline resting anal pressure (P =0.02) and resting anal pressure 2 mo after treatment (P ＜ 0.0001) were significantly related to healing rate.CONCLUSION:Botulinum toxin,despite worse results than in non-obese individuals,appears the best alternative to surgery for this group of patients with a high risk of incontinence.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    15-PGDH is reduced and induces apoptosis and cell cycle arrest in gastric carcinoma

    Li-Hong LouDa-Dao JingYue-Xing LaiYing-Ying Lu...
    1028-1037页
    查看更多>>摘要：AIM:To investigate the expression of 15-hydroxypros-taglandin dehydrogenase (15-PGDH) in human gastric cancer and it's mechanism in apoptosis and cell cycle arrest.METHODS:Expression of 15-PGDH mRNA and proteinwas examined by immunohistochemistry,immunocytochemistry,reverse transcriptase polymerase chain reaction (RT-PCR) and Western blotting in tissue from human gastric cancer,gastric precancerous state (gastric polyps and atrophic gastritis),normal stomach,and gastric cancer cell lines.The relationship between gastric cancer,gastric precancerous state and 15-PGDH expression was determined.The association between expression of 15-PGDH and various clinicopathological parameters in gastric cancer was evaluated.Human gastric cancer cell line SGC-7901 was transfected with 15-PGDH expression plasmids.The effect of 15-PGDH on the cell cycle was examined by flow cytometry.The effect of 15-PGDH on apoptosis was examined by transmission electron microscopy,flow cytometry and transferase mediated nick end labeling (TUNEL) assay.Expression of cell cycle (p21,p27,p16 and p53) and apoptosis (Survivin,BCL-2,BCL-XL,BAK and BAX) genes was analyzed by RT-PCR.RESULTS:Expression of 15-PGDH mRNA and protein in human gastric cancer tissues was significantly lower than in normal gastric tissues (P ＜ 0.01).Expression in human gastric cancer cell lines MKN-28 and MKN-45 was reduced,and absent in SGC-7901 cells (P ＜ 0.05).Reduction of 15-PGDH expression was also found in precancerous tissues,such as gastric polyps and atrophic gastritis (P ＜ 0.01).There was a significant difference in expression of 15-PGDH among various gastric cancer pathological types (P ＜ 0.05),with or without distant metastasis (P ＜ 0.05) and different TNM stage (P ＜ 0.01).Flow cytometry demonstrated a significant increase in apoptotic cells in SGC-7901 cells transfected with pcDNA3/15-PGDH plasmid for 24 h and 48 h (P ＜ 0.01),and an increased fraction of sub-G1 phase after transfection (P ＜ 0.05).TUNEL assay showed an increased apoptotic index in cells overexpressing 15-PGDH (P ＜ 0.01).After transfection,expression of proapoptotic genes,such as BAK (P ＜ 0.05),BAX and p53 (P ＜ 0.01),was increased.Expression of antiapoptotic genes was decreased,such as Survivin,BCL-2 and BCL-XL (P ＜ 0.01).Expression of cyclin-dependent kinase inhibitors p21 and p16 (P ＜ 0.01) was significantly upregulated in cells overexpressing 15-PGDH.CONCLUSION:Reduction of 15-PGDH is associated with carcinogenesis and development of gastric carcinoma.15-PGDH induces apoptosis and cell cycle arrest in SGC-7901 cells.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Chronic bile duct hyperplasia is a chronic graft dysfunction following liver transplantation

    Jian-Wen JiangZhi-Gang RenGuang-Ying CuiZhao Zhang...
    1038-1047页
    查看更多>>摘要：AIM:To investigate pathological types and influential factors of chronic graft dysfunction (CGD) following liver transplantation (LT) in rats.METHODS:The whole experiment was divided into three groups:(1) normal group (n =12):normal BN rats without any drug or operation; (2) syngeneic transplant group (SGT of BN-BN,n =12):both donors and recipients were BN rats; and (3) allogeneic transplant group (AGT of LEW-BN,n =12):Donors were Lewis and recipients were BN rats.In the AGT group,all recipients were subcutaneously injected by Cyclosporin A after LT.Survival time was observed for 1 year.All the dying rats were sampled,biliary tract tissues were performed bacterial culture and liver tissues for histological study.Twenty-one day after LT,8rats were selected randomly in each group for sampling.Blood samples from caudal veins were collected for measurements of plasma endotoxin,cytokines and metabonomic analysis,and faeces were analyzed for intestinal microflora.RESULTS:During the surgery of LT,no complications of blood vessels or bile duct happened,and all rats in each group were still alive in the next 2 wk.The long term observation revealed that a total of 8 rats in the SGT and AGT groups died of hepatic graft diseases,5 rats in which died of chronic bile duct hyperplasia.Compared to the SGT and normal groups,survival ratio of rats significantly decreased in the AGT group (P＜ 0.01).Moreover,liver necrosis,liver infection,and severe chronic bile duct hyperplasia were observed in the AGT group by H and E stain.On 21 d after LT,compared with the normal group (25.38 ± 7.09 ng/L)and SGT group (33.12 ± 10.26 ng/L),plasma endotoxin in the AGT group was remarkably increased (142.86± 30.85 ng/L) (both P ＜ 0.01).Plasma tumor necrosis factor-α and interleukin-6 were also significantly elevated in the AGT group (593.6 ± 171.67 pg/mL,323.8 ± 68.30 pg/mL) vs the normal (225.5 ± 72.07pg/mL,114.6 ± 36.67 pg/mL) and SGT groups (321.3± 88.47 pg/mL,205.2 ± 53.06 pg/mL) (P ＜ 0.01).Furthermore,Bacterial cultures of bile duct tissues revealed that the rats close to death from the SGT and AGT groups were strongly positive,while those from the normal group were negative.The analysis of intestinal microflora was performed.Compared to the normal group (7.98 ± 0.92,8.90 ± 1.44) and SGT group (8.51 ± 0.46,9.43 ± 0.69),the numbers of Enterococcus and Enterobacteria in the AGT group (8.76± 1.93,10.18 ± 1.64) were significantly increased (both P ＜ 0.01).Meanwhile,compared to the normal group (9.62 ± 1.60,9.93 ± 1.10) and SGT group (8.95 ± 0.04,9.02 ± 1.14),the numbers of Bifidobacterium and Lactobacillus in the AGT group (7.83 ± 0.72,8.87 ± 0.13)were remarkably reduced (both P ＜ 0.01).In addition,metabonomics analysis showed that metabolic profiles of plasma in rats in the AGT group were severe deviated from the normal and SGT groups.CONCLUSION:Chronic bile duct hyperplasia is a pathological type of CGD following LT in rats.The mechanism of this kind of CGD is associated with the alterations of inflammation,intestinal barrier function and microflora as well as plasma metabolic profiles.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Intravenous injection of mesenchymal stem cells is effective in treating liver fibrosis

    Wei ZhaoJun-Jie LiDa-Yong CaoXiao Li...
    1048-1058页
    查看更多>>摘要：AIM:To compare the influence of different transplant sites in bone marrow mesenchymal stem cell (MSC)-based therapy for liver fibrosis.METHODS:MSCs isolated from Sprague Dawley (SD) rats were induced into hepatocyte-like cells.Liver fibrosis in SD rats was induced with carbon tetrachloride.Following hepatocyte induction in vitro,4',6-diamidino2-phenylindole (DAPI)-labeled MSCs were transplanted by intravenous,intrahepatic,and intraperitoneal injection.Histopathological staining,immunohistochemistry,and biochemical analysis were used to compare the morphological and functional liver regeneration among different MSC injection modalities.The expression di-ferences of interleukins,growth factor,extracellular matrix,matrix metalloproteinases,and tissue inhibitor of metalloproteinase were examined by real-time reverse transcription-polymerase chain reaction (RT-PCR) and enzyme linked immunosorbent assay (ELISA).RESULTS:Four days after exposure to hepatocyte differentiation medium,MSCs that did not express hepatocyte markers could express α-fetoprotein,albumin,and cytokeratin 18.The results of histopathological staining,immunohistochemistry,and biochemical analysis indicated that intravenous injection is more effective at rescuing liver failure than other injection modalities.DAPI-labeled cells were found around liver lobules in all three injection site groups,but the intravenous group had the highest number of cells.PCR and ELISA analysis indicated that interleukin-10 (IL-10)was highest in the intravenous group,whereas il1β,il6,tnfα and tgfβ,which can be regulated by IL10 and are promoters of liver fibrosis,were significantly lower than in the other groups.CONCLUSION:MSC administration is able to protect against liver fibrosis.Intravenous injection is the most favorable treatment modality through promotion of IL10 expression.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Rebamipide suppresses diclofenac-induced intestinal permeability via mitochondrial protection in mice

    Lei DiaoQiao MeiJian-Ming XuXiao-Chang Liu...
    1059-1066页
    查看更多>>摘要：AIM:To investigate the protective effect and mechanism of rebamipide on small intestinal permeability induced by diclofenac in mice.METHODS:Diclofenac (2.5 mg/kg) was administered once daily for 3 d orally.A control group received the vehicle by gavage.Rebamipide (100 mg/kg,200 mg/kg,400 mg/kg) was administered intragastrically once a day for 3 d 4 h after diclofenac administration.Intestinal permeability was evaluated by Evans blue and the FITC-dextran method.The ultrastructure of the mucosal barrier was evaluated by transmission electron microscopy (TEM).Mitochondrial function including mitochondrial swelling,mitochondrial membrane potential,mitochondrial nicotinamide adenine dinucleotide-reduced (NADH) levels,succinate dehydrogenase (SDH) and ATPase activities were measured.Small intestinal mucosa was collected for assessment of malondialdehyde (MDA) content and myeloperoxidase (MPO) activity.RESULTS:Compared with the control group,intestinal permeability was significantly increased in the diclofenac group,which was accompanied by broken tight junctions,and significant increases in MDA content and MPO activity.Rebamipide significantly reduced intestinal permeability,improved inter-cellular tight junctions,and was associated with decreases in intestinal MDA content and MPO activity.At the mitochondrial level,rebamipide increased SDH and ATPase activities,NADH level and decreased mitochondrial swelling.CONCLUSION:Increased intestinal permeability induced by diclofenac can be attenuated by rebamipide,which partially contributed to the protection of mitochondrial function.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Differential diagnosis in patients with suspected bile acid synthesis defects

    Dorothea HaasHongying Gan-SchreierClaus-Dieter LanghansTilman Rohrer...
    1067-1076页
    查看更多>>摘要：AIM:To investigate the clinical presentations associated with bile acid synthesis defects and to describe identification of individual disorders and diagnostic pitfalls.METHODS:Authors describe semiquantitative determination of 16 urinary bile acid metabolites by electrospray ionization-tandem mass spectrometry.Sample preparation was performed by solid-phase extraction.The total analysis time was 2 min per sample.Authors determined bile acid metabolites in 363 patients with suspected defects in bile acid metabolism.RESULTS:Abnormal bile acid metabolites were found in 36 patients.Two patients had bile acid synthesis defects but presented with atypical presentations.In 2 other patients who were later shown to be affected by biliary atresia and cystic fibrosis the profile of bile acid metabolites was initially suggestive of a bile acid synthesis defect.Three adult patients suffered from cerebrotendinous xanthomatosis.Nineteen patients had peroxisomal disorders,and 10 patients had cholestatic hepatopathy of other cause.CONCLUSION:Screening for urinary cholanoids should be done in every infant with cholestatic hepatopathy as well as in children with progressive neurological disease to provide specific therapy.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Evaluation of acoustic radiation force impulse imaging for determination of liver stiffness using transient elastography as a reference

    Gerald KircheisAbdurrahman SagirChristoph VogtStephan vom Dahl...
    1077-1084页
    查看更多>>摘要：AIM:To evaluate cut-off values and performance of acoustic radiation force impulse imaging (ARFI) using transient elastography [FibroScan(C) (FS)] as a reference.METHODS:Six hundred and six patients were enrolled in this study.All patients underwent liver stiffness measurement with FS (FS-LS) and ARFI (with shear wave velocity quantification; ARFI-SWV) and the performance of ARFI in comparison to FS was determined.Sixtyeight patients underwent liver biopsy.RESULTS:Significantly higher success rates for the determination of liver stiffness were found using ARFI as compared to FS [604/606 (99.7％) vs 482/606 (79.5％),P ＜ 0.001].ARFI-SWV correlated significantly with FS-LS (r =0.920,P ＜ 0.001).ARFI-SWV increased significantly with the stage of fibrosis (1.09 ± 0.13 m/s for patients with no significant fibrosis (FS-LS ＜ 7.6 kPa); 1.46±0.27 m/s for patients with significant liver fibrosis (7.6 ＜ FS-LS ≤ 13.0 kPa); and 2.55 ± 0.77 m/s for patients with liver cirrhosis (FS-LS ＞ 13.0 kPa)).ARFI-SWV cut-off values were identified for no significant fibrosis (1.29 m/s; sensitivity 91.4％ and specificity 92.6％) and for liver cirrhosis (1.60 m/s; sensitivity 92.3％ and specificity 96.5％).The optimal cut-off value for predicting liver fibrosis (F ≥ 2) was 1.32 m/s (sensitivity 87.0％ and specificity 80.0％) and for liver cirrhosis (F4) 1.62 m/s (sensitivity 100％ and specificity 85.7％),for patients who underwent liver biopsy.An excellent inter-and intraobserver reproducibility was observed for ARFI-SWV determinations.CONCLUSION:An ARFI-SWV cut-off value of 1.29 m/s seems to be optimal for patients with no significant liver fibrosis and 1.60 m/s for patients with liver cirrhosis.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普