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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

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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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    Peritoneal carcinomatosis of colorectal origin: Incidence,prognosis and treatment options

    Yvonne LB KlaverValery EPP LemmensSimon W NienhuijsMisha DP Luyer...
    5489-5494页
    查看更多>>摘要：Peritoneal carcinomatosis (PC) is one manifestation of metastatic colorectal cancer (CRC).Tumor growth on intestinal surfaces and associated fluid accumulation eventually result in bowel obstruction and incapacitating levels of ascites,which profoundly affect the quality of life for affected patients.PC appears resistant to traditional 5-fluorouracil-based chemotherapy,and surgery was formerly reserved for palliative purposes only.In the absence of effective treatment,the historical prognosis for these patients was extremely poor,with an invariably fatal outcome.These poor outcomes likely explain why PC secondary to CRC has received little attention from oncologic researchers.Thus,data are lacking regarding incidence,clinical disease course,and accurate treatment evaluation for patients with PC.Recently,population-based studies have revealed that PC occurs relatively frequently among patients withCRC.Risk factors for developing PC have been identified:right-sided tumor,advanced T-stage,advanced N-stage,poor differentiation grade,and younger age at diagnosis.During the past decade,both chemotherapeutical and surgical treatments have achieved promising results in these patients.A chance for long-term survival or even cure may now be offered to selected patients by combining radical surgical resection with intraperitoneal instillation of heated chemotherapy.This combined procedure has become known as hyperthermic intraperitoneal chemotherapy.This editorial outlines recent advancements in the medical and surgical treatment of PC and reviews the most recent information on incidence and prognosis of this disease.Given recent progress,treatment should now be considered in every patient presenting with PC.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Diagnosis of Zollinger-Ellison syndrome: Increasingly difficult

    Tetsuhide ItoGuillaume CadiotRobert T Jensen
    5495-5503页
    查看更多>>摘要：In the present paper the increasing difficulty of diagnosis of Zollinger-Ellison syndrome (ZES) due to issues raised in two recent papers is discussed.These issues involve the difficulty and need to withdraw patients suspected of ZES from treatment with Proton Pump Inhibitors (omeprazole,esomeprazole,lansoprazole,rabeprazole,pantoprazole) and the unreliability of many gastrin radioimmunoassays.The clinical context of each of these important issues is reviewed and the conclusions in these articles commented from the perspective of clinical management.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Molecular targets in the treatment of alcoholic hepatitis

    Ashwin D DhandaRichard WL LeePeter L CollinsC Anne McCune...
    5504-5513页
    查看更多>>摘要：Alcohol related costs to health and society are high.One of the most serious complications of alcohol misuse to the individual is the development of alcoholic hepatitis (AH),a clinical syndrome of jaundice and progressive inflammatory liver injury in patients with a history of recent heavy alcohol use.It has a poor outcome and few existing successful therapies.The use of glucocorticoids in patients with severe AH is still controversial and there remains a group of patients with glucocorticoid-resistant disease.However,as our understanding of the pathogenesis of the condition improves there are opportunities to develop new targeted therapies with specific actions to control liver inflammation without having a detrimental effect on the immune system as a whole.In this article we review the molecular mechanisms of AH concentrating on the activation of the innate and adaptive immune response.We consider existing treatments including glucocorticoids,anti-tumor necrosis factor therapy and pentoxifylline and their limitations.Using our knowledge of the disease pathogenesis we discuss possible novel therapeutic approaches.New targets includepro-inflammatory cytokines such as interleukin (IL)-17,chemokines and their receptors (for example IL-8,CXCL9 and CXCR3) and augmentation of anti-inflammatory molecules such as IL-10 and IL-22.And there is also future potential to consider combination therapy to selectively modulate the immune response and gain control of disease.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Checkmate to liver biopsy in chronic hepatitis C?

    Anca TrifanCarol Stanciu
    5514-5520页
    查看更多>>摘要：Liver biopsy (LB) has traditionally been considered the gold standard for pretreatment evaluation of liver fibrosis in patients with chronic hepatitis C (CHC).However,LB is an invasive procedure with several shortcomings (intra-and interobserver variability of histopathological interpretation,sampling errors,high cost) and the risk of rare but potentially life-threatening complications.In addition,LB is poorly accepted by patients and it is not suitable for repeated evaluation.Furthermore,the prevalence of CHC makes LB unrealistic to be performed in all patients with this disease who are candidates for antiviral therapy.The above-mentioned drawbacks of LB have led to the development of noninvasive methods for the assessment of liver fibrosis.Several noninvasive methods,ranging from serum marker assays to advanced imaging techniques,have proved to be excellent tools for the evaluation of liver fibrosis in patients with CHC,whereas the value of LB as a gold standard for staging fibrosis prior to antiviral therapy has become questionable for clinicians.Despite significant resistance from those in favor of LB,noninvasive methods for pretreatment assessment of liver fibrosis in patients with CHC have become part of routine clinical practice.With protease inhibitors-based triple therapy already available and substantial improvement in sustained virological response,the time has come to move forward to noninvasiveness,with no risks for the patient and,thus,no need for LB in the assessment of liver fibrosis in the decision making for antiviral therapy in CHC.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Treatment of locally advanced rectal cancer: Controversies and questions

    Atthaphorn TrakarnsangaSuthinee IthimakinMartin R Weiser
    5521-5532页
    查看更多>>摘要：Rectal cancers extending through the rectal wall,or involving locoregional lymph nodes (T3/4 or N1/2),have been more difficult to cure.The confines of the bony pelvis and the necessity of preserving the autonomic nerves makes surgical extirpation challenging,which accounts for the high rates of local and distant relapse in this setting.Combined multimodality treatment for rectal cancer stage Ⅱ and Ⅲ was recommended from National Institute of Health consensus.Neoadjuvant chemoradiation using fluoropyrimidine-based regimen prior to surgical resection has emerged as the standard of care in the United States.Optimal time of surgery after neoadjuvant treatment remained unclear and prospective randomized controlled trial is ongoing.Traditionally,6-8 wk waiting period was commonly used.The accuracy of studies attempting to determine tumor complete response remains problematic.Currently,surgery remains the standard of care for rectal cancer patients following neoadjuvant chemoradiation,whereas observational management is still investigational.In this article,we outline trends and controversies associated with optimal pre-treatment staging,neoadjuvant therapies,surgery,and adjuvant therapy.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Experimental and clinical evidence of antioxidant therapy in acute pancreatitis

    Mukaddes Esrefoglu
    5533-5541页
    查看更多>>摘要：Oxidative stress has been shown to play an important role in the pathogenesis of acute pancreatitis (AP).Antioxidants,alone or in combination with conventional therapy,should improve oxidative-stress-induced organ damage and therefore accelerate the rate of recovery.In recent years,substantial amounts of data about the efficiency of antioxidants against oxidative damage have been obtained from experiments with rodents.Some of these antioxidants have been found beneficial in the treatment of AP in humans; however,at present there is insufficient clinical data to support the benefits of antioxidants,alone or in combination with conventional therapy,in the management of AP in humans.Conflicting results obtained from experimental animals and humans may represent distinct pathophysiological mechanisms mediating tissue injury in different species.Further detailed studies should be done to clarify the exact mechanisms of tissue injury in human AP.Herein I tried to review the existing experimental and clinical studies on AP in order to determine the efficiency of antioxidants.The use of antioxidant enriched nutrition is a potential direction of clinical research in AP given the lack of clues about the efficiency and safety of antioxidant usage in patients with AP.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Dietary copper triggers onset of fulminant hepatitis in the Long-Evans cinnamon rat model

    Ramsi SiajVanessa SauerSandra St(o)ppelerHans-Ullrich Spiegel...
    5542-5550页
    查看更多>>摘要：To investigate the impact of dietary copper given at different time paints on the onset of fulminant hepatitis.METHODS:The Long-Evans cinnamon (LEC) rat model of Wilson's disease (WD) was used to study the impact of high dietary copper (hCu) on the induction of fulminant hepatitis at early or late time points of life.High Cu diet was started in rat pups or in adults (month5) for three months.Animals that received reduced dietary copper (rCu) throughout their lifetime served as a control.Hepatitis-associated serum markers (alanine aminotransferase,aspartate transaminase,bilirubin)were analyzed in animal groups receiving hCu or rCu.Liver copper content and liver histology were revealed at sacrifice.A set of 5 marker genes previously found to be affected in injured liver and which are related to angiogenesis (Vegfa),fat metabolism (Srebf1),extracellular matrix (Timp1),oxidative stress (Hmox1),and the cell cycle (Cdkn1a) were analyzed by real-time polymerase chain reaction.RESULTS:Regardless of the time point when hCu wasstarted,LEC rats (35/36) developed fulminant hepatitis and died.Animals receiving rCu (36/36) remained healthy,did not develop hepatitis,and survived long term without symptoms of overt disease,although liver copper accumulated in adult animals (477 ± 75 lg/g).With regard to start of hCu,onset of fulminant hepatitis was significantly (P ＜ 0.001) earlier in adults (35 ± 9d)that showed pre-accumulation of liver copper as compared to the pup group (77 ± 15 d).Hepatitis-associated serum markers,liver copper and liver histology,as well as gene expression,were affected in LEC rats receiving hCu.However,except for early and rapid onset of hepatitis,biochemical and molecular markers were similar at the early and late time points of disease.CONCLUSION:Rapid onset of fulminant hepatitis in asymptomatic LEC rats with elevated liver copper suggests that there is a critical threshold of liver copper which is important to trigger the course of WD.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    MUC5AC/β-catenin expression and KRAS gene alteration in laterally spreading colorectal tumors

    Kosaburo NakaeHiroyuki MitomiTsuyoshi SaitoMichiko Takahashi...
    5551-5559页
    查看更多>>摘要：To clarify differences in mucin phenotype,proliferative activity and oncogenetic alteration among subtypes of colorectal laterally spreading tumor (LST).METHODS:LSTs,defined as superficial elevated lesions greater than 10 mm in diameter with a low vertical axis,were macroscopically classified into two subtypes:(1) a granular type (Gr-LST) composed of superficially spreading aggregates of nodules forming a flat-based lesion with a granulonodular and uneven surface; and (2) a non-granular type (NGr-LST) with a flat smooth surface and an absence of granulonodular formation.A total of 69 LSTs,comprising 36 Gr-LSTs and 33 NGr-LSTs,were immunohistochemically stained with MUC2,MUC5AC,MUC6,CD10 (markers of gastrointestinal cell lineage),p53,β-catenin and Ki-67 antibodies,and examined for alteration in exon 1 of v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) and exon 15 of v-raf murine sarcoma viral oncogene homologue B1 (BRAF) by polymerase chain reaction followed by direct sequencing.RESULTS:Histologically,15 Gr-LST samples were adenomas with low-grade dysplasia (LGD),12 were highgrade dysplasia (HGD) and 9 were adenocarcinomas invading the submucosa (INV),while 12 NGr-LSTs demonstrated LGD,14 HGD and 7 INV.In the proximal colon,MUC5AC expression was significantly higher in the Gr-type than the NGr-type.MUC6 was expressed only in NGr-LST.MUC2 or CD10 did not differ,P53 expression demonstrated a significant stepwise increment in progression through LGD-HGD-INV with both types of LST.Nuclear β-catenin expression was significantly higher in the NGr-type.Ki-67 expression was significantly higher in the Gr-type in the lower one third zone of the tumor.In proximal,but not distal colon tumors,the incidence of KRAS provided mutation was significantly higher in the Gr-type harboring a specific mutational pattern (G12V).BRAF mutations (V600E) were detected only in two Gr-LSTs.CONCLUSION:The two subtypes of LST,especially in the proximal colon,have differing phenotypes of gastrointestinal cell lineage,proliferation and activation of Wnt/β-catenin or RAS/RAF/extracellular signalregulated kinase signaling.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Software for automated classification of probe-based confocal laser endomicroscopy videos of colorectal polyps

    Barbara AndréTom VercauterenAnna M BuchnerMurli Krishna...
    5560-5569页
    查看更多>>摘要：To support probe-based confocal laser endomicroscopy (pCLE) diagnosis by designing software for the automated classification of colonic polyps.METHODS:Intravenous fluorescein pCLE imaging of colorectal lesions was performed on patients undergoing screening and surveillance colonoscopies,followed by polypectomies.All resected specimens were reviewed by a reference gastrointestinal pathologist blinded to pCLE information.Histopathology was used as the criterion standard for the differentiation between neoplastic and non-neoplastic lesions.The pCLE video sequences,recorded for each polyp,were analyzed offline by 2 expert endoscopists who were blinded to the endoscopic characteristics and histopathology.These pCLE videos,along with their histopathology diagnosis,were used to train the automated classification software which is a content-based image retrieval technique followed by k-nearest neighbor classification.The performance of the off-line diagnosis of pCLE videos established by the 2 expert endoscopists was compared with that of automated pCLE software classification.All evaluations were performed using leave-one-patient-out cross-validation to avoid bias.RESULTS:Colorectal lesions (135) were imaged in 71 patients.Based on histopathology,93 of these 135lesions were neoplastic and 42 were non-neoplastic.The study found no statistical significance for the difference between the performance of automated pCLE software classification (accuracy 89.6％,sensitivity 92.5％,specificity 83.3％,using leave-one-patient-outcross-validation) and the performance of the off-line diagnosis of pCLE videos established by the 2 expert endoscopists (accuracy 89.6％,sensitivity 91.4％,specificity 85.7％).There was very low power (＜ 6％)to detect the observed differences.The 95％ confidence intervals for equivalence testing were:-0.073 to 0.073 for accuracy,-0.068 to 0.089 for sensitivity and -0.18 to 0.13 for specificity.The classification software proposed in this study is not a "black box" but an informative tool based on the query by example model that produces,as intermediate results,visually similar annotated videos that are directly interpretable by the endoscopist.CONCLUSION:The proposed software for automated classification of pCLE videos of colonic polyps achieves high performance,comparable to that of off-line diagnosis of pCLE videos established by expert endoscopists.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Quantitation of HBsAg predicts response to entecavir therapy in HBV genotype C patients

    Etsuro OritoKei FujiwaraHiroshi KanieTesshin Ban...
    5570-5575页
    查看更多>>摘要：AIM:To analysis the factors that predict the response to entecavir therapy in chronic hepatitis patients with hepatitis B virus (HBV) genotype C.METHODS:Fifty patients [hepatitis B e antigen (HBeAg)-negative:HBeAg-positive =26:24] with HBV genotype C,who received na(i)ve entecavir therapy for ＞ 2 years,were analyzed.Patients who showed HBV DNA levels ≥3.0 log viral copies/mL after 2 years of entecavir therapy were designated as slow-responders,while those that showed ＜ 3.0 log copies/mL were termed rapidresponders.Quantitative hepatitis B surface antigen (HBsAg) levels (qHBsAg) were determined by the Architect HBsAg QT immunoassay.Hepatitis B core-related antigen was detected by enzyme immunoassay.Pre-C and Core promoter mutations were determined using by polymerase chain reaction (PCR).Drug-resistance mutations were detected by the PCR-Invader method.RESULTS:At year 2,HBV DNA levels in all patients in the HBeAg-negative group were ＜ 3.0 log copies/mL.In contrast,in the HBeAg-positive group,41.7％ were slow-responders,while 58.3％ were rapid-responders.No entecavir-resistant mutants were detected in the slow-responders.When the pretreatment factors were compared between the slow-and rapid-responders;the median qHBsAg in the slow-responders was 4.57log IU/mL,compared with 3.63 log IU/mL in the rapidresponders (P ＜ 0.01).When the pretreatment factors predictive of HBV DNA-negative status at year 2 in all 50 patients were analyzed,HBeAg-negative status,low HBV DNA levels,and low qHBsAg levels were significant (P ＜ 0.01).Multivariate analysis revealed that the low qHBsAg level was the most significant predictive factor (P =0.03).CONCLUSION:Quantitation of HBsAg could be a useful indicator to predict response to entecavir therapy.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普