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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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    Metabolic syndrome after liver transplantation: Preventable illness or common consequence?

    Eric R Kallwitz
    3627-3634页
    查看更多>>摘要：The metabolic syndrome is common after liver transplant being present in approximately half of recipients.It has been associated with adverse outcomes such as progression of hepatitis C and major vascular events.As the United States population ages and the rate of obesity increases,prevention of the metabolic syndrome in the post-transplant population deserves special consideration.Currently,the metabolic syndrome after transplant appears at least two times more common than observed rates in the general population.Specific guidelines for patients after transplant does not exist,therefore prevention rests upon knowledge of risk factors and the presence of modifiable elements.The current article will focus on risk factors for the development of the metabolic syndrome after transplant,will highlight potentially modifiable factors and propose potential areas for intervention.As in the non-transplant population,behavioral choices might have a major role.Opportunities exist in this regard for health prevention studies incorporating lifestyle changes.Other factors such as the need for immunosuppression,and the changing characteristics of wait listed patients are not modifiable,but are important to know in order to identifypersons at higher risk.Although immunosuppression after transplant is unavoidable,the contribution of different agents to the development of components of the metabolic syndrome is also discussed.Ultimately,an increased risk of the metabolic syndrome after transplant is likely unavoidable,however,there are many opportunities to reduce the prevalence.
      原文链接:
    • NETL
    • NSTL
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    • 维普

    Cellular and molecular mechanisms of intestinal fibrosis

    Silvia SpecaIlaria GiustiFlorian RiederGiovanni Latella...
    3635-3661页
    查看更多>>摘要：Fibrosis is a chronic and progressive process characterized by an excessive accumulation of extracellular matrix (ECM) leading to stiffening and/or scarring of the involved tissue.Intestinal fibrosis may develop in several different enteropathies,including inflammatory bowel disease.It develops through complex cell,extracellular matrix,cytokine and growth factor interactions.Distinct cell types are involved in intestinal fibrosis,such as resident mesenchymal cells (fibroblasts,myofibroblasts and smooth muscle cells) but also ECM-producing cells derived from epithelial and endothelial cells (through a process termed epithelial-and endothelial-mesenchymal transition),stellate cells,pericytes,local or bone marrow-derived stem cells.The most important soluble factors that regulate the activation of these cells include cytokines,chemokines,growth factors,components of the renin-angiotensin system,angiogenic factors,peroxisome proliferator-activated receptors,mammalian target of rapamycin,and products of oxidative stress.It soon becomes clear that although inflammation is responsible for triggering the onset of the fibrotic process,it only plays a minor role in the progression of this condition,as fibrosis may advance in a self-perpetuating fashion.Definition of the cellular and molecular mechanisms involved in intestinal fibrosis may provide the key to developing new therapeutic approaches.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Current knowledge on esophageal atresia

    Paulo Fernando Martins PinheiroAna Cristina Sim(o)es e SilvaRegina Maria Pereira
    3662-3672页
    查看更多>>摘要：Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus.The improvement of survival observed over the previous two decades is multifactorial and largely attributable to advances in neonatal intensive care,neonatal anesthesia,ventilatory and nutritional support,antibiotics,early surgical intervention,surgical materials and techniques.Indeed,mortality is currently limited to those cases with coexisting severe life-threatening anomalies.The diagnosis of EA is most commonly made during the first 24 h of life but may occur either antenatally or may be delayed.The primary surgical correction for EA and TEF is the best option in the absence of severe malformations.There is no ideal replacement for the esophagus and the optimal surgical treatment for patients with long-gap EA is still controversial.The primary complications during the postoperative period are leak and stenosis of the anastomosis,gastro-esophageal reflux,esophageal dysmotility,fistula recurrence,respiratory disorders and deformities of the thoracic wall.Data regarding long-term outcomes and follow-ups are limited for patients following EA/TEF repair.The determination of the risk factors for the complicated evolution following EA/TEF repair may positively impact long-term prognoses.Much remains to be studied regarding this condition.This manuscript provides a literature review of the current knowledge regarding EA.
      原文链接:
    • NETL
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    Intraductal neoplasm of the intrahepatic bile duct:Clinicopathological study of 24 cases

    Yoshiki NaitoHironori KusanoOsamu NakashimaEiji Sadashima...
    3673-3680页
    查看更多>>摘要：AIM:To investigate the clinicopathological features of intraductal neoplasm of the intrahepatic bile duct (INihB).METHODS:Clinicopathological features of 24 cases of INihB,which were previously diagnosed as biliary papilIomatosis or intraductal growth of intrahepatic biliary neoplasm,were reviewed.Mucin immunohistochemistry was performed for mucin (MUC)1,MUC2,MUC5AC and MUC6.Ki-67,P53 and β-catenin immunoreactivity were also examined.We categorized each tumor as adenoma (low grade),borderline (intermediate grade),and malignant (carcinoma in situ,high grade including tumors with microinvasion).RESULTS:Among 24 cases of INihB,we identified 24 tumors.Twenty of 24 tumors (83％) were composed of a papillary structure; the same feature observed in intraductal papillary neoplasm of the bile duct (IPNB).In contrast,the remaining four tumors (17％) showed both tubular and papillary structures.In three of the four tumors (75％),macroscopic mucin secretion was limited but microscopic intracellular mucin was evident.Histologically,16 tumors (67％) were malignant,three (12％) were borderline,and five (21％) were adenoma.Microinvasion was found in four cases (17％).Immunohistochemical analysis revealed that MUC1 was not expressed in the borderline/adenoma group but was expressed only in malignant lesions (P =0.0095).Ki-67 labeling index (LI) was significantly higher in the malignant group than in the borderline/adenoma group (22.2± 15.5 vs 7.5 ± 6.3,P ＜ 0.01).In the 16 malignant cases,expression of MUC5AC showed borderline significant association with high Ki-67 LI (P =0.0622).Nuclear expression of β-catenin was observed in two (8％)of the 24 tumors,and these two tumors also showed MUC1 expression.P53 was negative in all tumors.CONCLUSION:Some cases of INihB have a tubular structure,and are subcategorized as IPNB with tubular structure.MUC1 expression in INihB correlates positively with degree of malignancy.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Study of human B7 homolog 1 expression in patients with hepatitis B virus infection

    Wen-Jin ZhangHai-Yang XieXin DuanYun-Le Wan...
    3681-3695页
    查看更多>>摘要：AIM:To further investigate the role of human B7 homolog 1 (B7-H1) in the mechanism of persistent hepatitis B virus (HBV) infection.METHODS:Peripheral and intra-hepatic B7-H1 expression were compared by flow cytometry and immunochemical staining between two 2 distinct groups,one being chronic HBV tolerance patients (CHB-T) and the other being acute hepatitis B patients (AHB).B7-H1 mRNA expression level was also compared by real time polymerase chain reaction between CHB-T and AHB patients.The location of intra-hepatic B7-H1 and CD40 expression were analyzed by immunofluorescence.The levels of B7-H1 and CD40 expression on cultured myeloid dendritic ceils (mDCs) with or without hepatitis B surface antigen (HBsAg) treatment were analyzed dynamically by flow cytometry.Intracellular interferon-γ (IFN-γ) staining and the stimulatory capacity of mDC of cultured mDC with or without HBsAg treatment were also compared by flow cytometry.RESULTS:Peripheral B7-H1 expression on mDCs was increased significantly in AHB compared to CHB-T patients (P ＜ 0.05).In the liver tissues from CHB-T patients,B7-H1 positive cells were almost absent despite a persistently elevated serum HBsAg load.In contrast,there were indeed increased B7-H1-positive cells in situ in the liver tissue from AHB.In vitro analysis showed the parallel upregulation of B7-H1 and CD40 on CD11c+ mDCs after the onset of stimulation.Addition of recombinant hepatitis B surface antigen (rHBsAg)significantly decreased CD40 expression (P ＜ 0.05 at 16 h,20 h and 24 h time points).B7-H1 expression was also inhibited by rHBsAg,and the inhibition rate of CD40 was greater than that of B7-H1.This preferential inhibition of CD40 expression on mDCs by rHBsAg resulted in the dysfunction of mDCs and T cells in the mixed leucocyte reaction (MLR) system.With rHBsAg pretreatment,in a carboxyfluorescein diacetate succinimidyl ester (CFSE) labeled MLR system at a ratio of 1∶5responder cell-stimulator cell (R/S),the CFSEdim percentage of T cells decreased from 85.1％ to 25.4％ and decreased from 30.3％ to 12.0％ at 1:10 R/S.IFN-γ,production by CD8+ T cells,in the MLR system,was reduced significantly by HBsAg pretreatment.At ratios of 1:5 R/S,the percentage of IFN-γ,and CD8 dual positive T cells decreased from 55.2％ ± 5.3％ to 15.1％ ±3.1％ (P ＜ 0.001),and decreased from 35.0％ ± 5.1％to 7.3％ ± 2.7％ at ratios of 1:10 R/S (P ＜ 0.001).CONCLUSION:B7-H1 is not a signature of immune dysfunction,but an inflammation marker.HBsAg regulate immune response by tipping the balance between B7-H1 and CD40.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Lentiviral vector-mediated down-regulation of IL-17A receptor in hepatic stellate cells results in decreased secretion of IL-6

    Sheng-Chu ZhangYi-Hu ZhengPan-Pan YuTan Hooi Min...
    3696-3704页
    查看更多>>摘要：AIM:To investigate the mechanism of interleukin (IL)-6 secretion through blocking the IL-17A/IL-17A receptor (IL-17RA) signaling pathway with a short hairpin RNA (shRNA) in hepatic stellate cells (HSCs) in vitro.METHODS:HSCs were derived from the livers of adult male Sprague-Dawley rats.IL-6 expression was evaluated using real-time quantitative polymerase chain reaction and enzyme linked immunosorbent assay.The phosphorylation activity of p38 mitogen activated protein kinases (MAPK) and extracellular regulated protein kinases (ERK) 1/2 upon induction by IL-17A and suppression by IL-17RA shRNA were examined using Western blotting.RESULTS:IL-6 expression induced by IL-17A was sig-nificantly increased compared to control in HSCs (P ＜0.01 in a dose-dependent manner).Suppression of IL-17RA using lentiviral-mediated shRNA inhibited IL-6 expression induced by IL-17A compared to group with only IL-17A treatment (1.44 ± 0.17 vs 4.07 ± 0.43,P ＜ 0.01).IL-17A induced rapid phosphorylation of p38 MAPK and ERK1/2 after 5 min exposure,and showed the strongest levels of phosphorylation of p38 MAPK and ERK1/2 at 15 min in IL-17A-treated HSCs.IL-6 mRNA expression induced by IL-17A (100 ng/mL) for 3 h exposure was inhibited by preincubation with specific inhibitors of p38 MAPK (SB-203580) and ERK1/2 (PD-98059) compared to groups without inhibitors preincubation (1.67 ± 0.24,2.01 ± 0.10 vs 4.08 ±0.59,P ＜ 0.01).Moreover,Lentiviral-mediated IL-17RA shRNA 1 inhibited IL-17A-induced IL-6 mRNA expression compared to random shRNA in HSCs (1.44 ±0.17 vs 3.98 4-0.68,P ＜ 0.01).Lentiviral-mediated IL-17RA shRNA 1 inhibited phosphorylation of p38 MAPK and ERK1/2 induced by 15 min IL-17A (100 ng/mL) exposure.CONCLUSION:Down-regulation of the IL-17RA receptor by shRNA decreased IL-6 expression induced by IL-17A via p38 MAPK and ERK1/2 phosphorylation in HSCs.Suppression of IL-17RA expression may be a strategy to reduce the inflammatory response induced by IL-17A in the liver.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    ERCP for the treatment of bile leak after partial hepatectomy and fenestration for symptomatic polycystic liver disease

    Nayantara Coelho-PrabhuDavid M NagorneyTodd H Baron
    3705-3709页
    查看更多>>摘要：AIM:TO describe endoscopic treatment of bile leaks in these patients and to identify risk factors in these patients which can predict the development of bile leaks.METHODS:Retrospective case-control study examining consecutive patients who underwent partial hepatectomy for polycystic liver disease (PLD) and developed a postoperative bile leak managed endoscopically over a ten year period.Each case was matched with two controls with PLD who did not develop a postoperative bile leak.RESULTS:Ten cases underwent partial hepatectomy with fenestration for symptoms including abdominal distention,pain and nausea.Endoscopic retrograde cholangiopancreatography (ERCP) showed anatomic abnormalities in 1 case.A biliary sphincterotomy was performed in 4 cases.A plastic biliary stent was placed with the proximal end at the site of the leak in 9 cases;in 1 case two stents were placed.The overall success rate of ERCP to manage the leak was 90％.There were no significant differences in age,gender,comorbidities,duration of symptoms,history of previous surgery or type of surgery performed between cases and controls.CONCLUSION:ERCP with stent placement is safe and effective for management of post-hepatectomy bile leak in patients with PLD.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Physical activity, obesity and gastroesophageal reflux disease in the general population

    Therese Dj(a)rvAnna WikmanHelena NordenstedtAsif Johar...
    3710-3714页
    查看更多>>摘要：AIM:To clarify the association between physical activity and gastroesophageal reflux disease (GERD) in nonobese and obese people.METHODS:A Swedish population-based cross-sectional survey was conducted.Participants aged 40-79 years were randomly selected from the Swedish Registry of the Total Population.Data on physical activity,GERD,body mass index (BMI) and the covariates age,gender,comorbidity,education,sleeping problems,and tobacco smoking were obtained using validated questionnaires.GERD was self-reported and defined as heartburn or regurgitation at least once weekly,and having at least moderate problems from such symptoms.Frequency of physical activity was categorized into three groups:(1)"high" (several times/week); (2) "intermediate" (approximately once weekly); and (3) "low" (1-3 times/mo or less).Analyses were stratified for participants with "normal weight" (BMI ＜ 25 kg/m2),"overweight" (BMI 25 to ≤ 30 kg/m2) and "obese" (BMI ＞ 30 kg/m2).Multivariate logistic regression was used to calculate odds ratios (ORs) with 95％ confidence intervals (CIs),adjusted for potential confounding by covariates.RESULTS:Of 6969 eligible and randomly selected individuals,4910 (70.5％) participated.High frequency of physical activity was reported by 2463 (50％) participants,GERD was identified in 472 (10％) participants,and obesity was found in 680 (14％).There were 226 (5％) individuals with missing information about BMI.Normal weight,overweight and obese participants were similar regarding distribution of gender and tobacco smoking status,while obese participants were on average slightly older,had fewer years of education,more comorbidity,slightly more sleeping problems,lower frequency of physical activity,and higher occurrence of GERD.Among the 2146 normal-weight participants,crude point estimates indicated a decreased risk of GERD among individuals with high frequency of physical activity (OR:0.59,95％ CI:0.39-0.89),compared to low frequency of physical activity.However,after adjustment for potential confounding factors,neither intermediate (OR:1.30,95％ CI:0.75-2.26) nor high (OR:0.99,95％ CI:0.62-1.60) frequency of physical activity was followed by decreased risk of GERD.Sleeping problems and high comorbidity were identified as potential confounders.Among the 1859 overweight participants,crude point estimates indicated no increased or decreased risk of GERD among individuals with intermediate or high frequency of physical activity,compared to low frequency.After adjustment for confounding,neither intermediate (OR:0.75,95％ CI:0.46-1.22) nor high frequency of physical activity were followed by increased or decreased risk of GERD compared to low frequency among nonobese participants.Sleeping problems and high comorbidity were identified as potential confounders for overweight participants.In obese individuals,crude ORs were similar to the adjusted ORs and no particular confounding factors were identified.Intermediate frequency of physical activity was associated with a decreased occurrence of GERD compared to low frequency of physical activity (adjusted OR:0.41,95％ CI:0.22-0.77).CONCLUSION:Intermediate frequency of physical activity might decrease the risk of GERD among obese individuals,while no influence of physical activity on GERD was found in non-obese people.
      原文链接:
    • NETL
    • NSTL
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    • 维普

    Irritable bowel syndrome: Physicians' awareness and patients' experience

    Linda Bjork OlafsdottirHallgrímur GudjonssonHeidur Hrund JonsdottirJon Steinar Jonsson...
    3715-3720页
    查看更多>>摘要：AIM:TO study if and how physicians use the irritable bowel syndrome (IBS) diagnostic criteria and to assess treatment strategies in IBS patients.METHODS:A questionnaire was sent to 191 physicians regarding IBS criteria,diagnostic methods and treatment.Furthermore,94 patients who were diagnosed with IBS underwent telephone interview.RESULTS:A total of 80/191 (41.9％) physicians responded to the survey.Overall,13 patients were diagnosed monthly with IBS by specialists in gastroenterology (SGs) and 2.5 patients by general practitioners (GPs).All the SGs knew of the criteria to diagnose IBS,as did 46/70 (65.7％) GPs.Seventy-nine percent used the patient's history,38％ used a physical examination,and 38％ exclusion of other diseases to diagnose IBS.Only 18/80 (22.5％) physicians used specific IBS criteria.Of the patients interviewed,5g/94 (62.8％) knew they had experienced IBS.Two out of five patients knew IBS and had seen a physician because of IBS symptoms.Half of those received a diagnosis of IBS.A total of 13％ were satisfied with treatment.IBS affected daily activities in 43％ of cases.CONCLUSION:Half of the patients with IBS who consuited a physician received a diagnosis.Awareness and knowledge of diagnostic criteria for IBS differ between SGs and GPs.
      原文链接:
    • NETL
    • NSTL
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    • 维普

    Assessment of the validity of the clinical pathway for colon endoscopic submucosal dissection

    Takaya AokiTakeshi NakajimaYutaka SaitoTakahisa Matsuda...
    3721-3726页
    查看更多>>摘要：AIM:To determine the effective hospitalization period as the clinical pathway to prepare patients for endoscopic submucosal dissection (ESD).METHODS:This is a retrospective observational study which included 189 patients consecutively treated by ESD at the National Cancer Center Hospital from May 2007 to March 2009.Patients were divided into 2 groups; patients in group A were discharged in 5 d and patients in group B included those who stayed longer than 5 d.The following data were collected for both groups:mean hospitalization period,tumor site,median tumor size,post-ESD rectal bleeding requiring urgent endoscopy,perforation during or after ESD,abdominal pain,fever above 38 ℃,and blood test results positive for inflammatory markers before and after ESD.Each parameter was compared after data collection.RESULTS:A total of 83％ (156/189) of all patients could be discharged from the hospital on day 3 postESD.Complications were observed in 12.1％ (23/189)of patients.Perforation occurred in 3.7％ (7/189) of patients.All the perforations occurred during the ESD procedure and they were managed with endoscopic clipping.The incidence of post-operative bleeding was 2.6％ (5/189); all the cases involved rectal bleeding.We divided the subjects into 2 groups:tumor diameter ≥ 4 cm and ＜ 4 cm; there was no significant difference between the 2 groups (P =0.93,x2 test with Yates correction).The incidence of abdominal pain was 3.7％ (7/189).All the cases occurred on the day of the procedure or the next day.The median white blood cell count was 6800 ± 2280 (cells/μL; ± SD) for group A,and 7700 ± 2775 (cells/μL; ± SD) for group B,showing a statistically significant difference (P =0.023,t-test).The mean C-reactive protein values the day after ESD were 0.4 ± 1.3 mg/dL and 0.5 ± 1.3 mg/dL for groups A and B,respectively,with no significant difference between the 2 groups (P =0.54,t-test).CONCLUSION:One-day admission is sufficient in the absence of complications during ESD or early postoperative bleeding.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普