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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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    Enhanced recovery programme in colorectal surgery: Does one size fit all?

    Alison LyonChristopher J PayneGraham J MacKay
    5661-5663页
    查看更多>>摘要：Enhanced recovery after surgery (ERAS) employs a multimodal perioperative care pathway with the aim of attenuating the stress response to surgery and accelerating recovery.It has been difficult to determine the relative importance of some of the individual components of these pathways such as epidural analgesia and laparoscopic colorectal surgery.Some argue that only a rigid adherence to the published ERAS protocol can achieve the proposed benefits of fast-track surgery.In this article,we explore some of the areas where the evidence base may be changing and ask whether a more flexible and individualised approach should be considered.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Role of Smad7 in inflammatory bowel diseases

    Giovanni MonteleoneRoberta CarusoFrancesco Pallone
    5664-5668页
    查看更多>>摘要：Crohn's disease and ulcerative colitis,the major forms of inflammatory bowel diseases (IBD) in man,are complex diseases in which genetic and environmental factors interact to promote an excessive mucosal immune response directed against normal components of the bacterial microflora.There is also evidence that the pathologic process is due to defects in counter-regulatory mechanisms,such as those involving the immunosuppressive cytokine transforming growth factor (TGF)-β1.Indeed,studies in human IBD tissues and murine models of colitis have documented a disruption of TGF-β1 signalling marked by a block in the phosphorylation of Smad3,a signalling molecule associated with the activated TGF-β receptor,due to up-regulation of Smad7,an intracellular inhibitor of Smad3 phosphorylation.Knock-down of Smad7 with a specific antisense oligonucleotide restores TGF-β1/Smad3 signalling,thus resulting in a marked suppression of inflammatory cytokine production and attenuation of mutine colitis.These findings together with the demonstration that Smad7 antisense oligonucleotide is not toxic when administered in mice have paved the way for the development of a Smad7 antisense oligonucleotide-based pharmaceutical compound that is now ready to enter the clinics.In this article we review the available data supporting the pathogenic role of Smad7 in IBD and discuss whether and how Smad7 antisense therapy could help dampen the ongoing inflammation in IBD.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Levofloxacin/amoxicillin-based schemes vs quadruple therapy for Helicobacter pylori eradication in second-line

    Simona Di CaroLucia FiniYayha DaoudFabio Grizzi...
    5669-5678页
    查看更多>>摘要：Worldwide prevalence of Helicobacter pylori (H.pylori)infection is approximately 50％,with the highest being in developing countries.We compared cure rates and tolerability (SE) of second-line anti-H,pylori levofloxacin/amoxicillin (LA)-based triple regimens vs standard quadruple therapy (QT).An English language literature search was performed up to October 2010.A meta-analysis was performed including randomized clinical trials comparing 7-or 10-d LA with 7-d QT.In total,10 articles and four abstracts were identified.Overall eradication rate in LA was 76.5％ (95％CI:64.4％-97.6％).When only 7-d regimens were included,cure rate was 70.6％ (95％ CI:40.2％-99.1％),whereas for 10-d combinations,cure rate was significantly higher (88.7％; 95％ CI:56.1％-109.9％;P ＜ 0.05).Main eradication rate for QT was 67.4％ (95％ CI:49.7％-67.9％).The 7-d LA and QT showed comparable efficacy [odds ratio (OR):1.09; 95％ CI:0.63-1.87],whereas the 10-d LA regimen was significantly more effective than QT (OR:5.05; 95％ CI:2.74-9.31; P ＜ 0.001;I2 =75％).No differences were reported in QT eradication rates among Asian and European studies,whereas LA regimens were more effective in European populations (78.3％ vs 67.7％; P =0.05).Incidence of SE was lower in LA therapy than QT (OR:0.39; 95％ CI:0.18-0.85; P =0.02).A higher rate of side effects was reported in Asian patients who received QT.Our findings support the use of 10-d LA as a simple second-line treatment for H.pylori eradication with an excellent eradication rate and tolerability.The optimal second-line alternative scheme might differ among countries depending on quinolone resistance.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Multimodality approach for locally advanced esophageal cancer

    Khaldoun AlmhannaJonathan R Strosberg
    5679-5687页
    查看更多>>摘要：Carcinoma of the esophagus is an aggressive and lethal malignancy with an increasing incidence world-wide.Incidence rates vary internationally,with the highest rates found in Southern and Eastern Africa and Eastern Asia,and the lowest in Western and Middle Africa and Central America.Patients with locally advanced disease face a poor prognosis,with 5-year survival rates ranging from 15％-34％.Recent clinical trials have evaluated different strategies for management of locoregional cancer; however,because of stage migration and changes in disease epidemiology,applying these trials to clinical practice has become a daunting task.We searched Medline and conference abstracts for randomized studies published in the last 3 decades.We restricted our search to articles published in English.Neoadjuvant chemoradiotherapy followed by surgical resection is an accepted standard of care in the United States.Esophagectomy remains an essential component of treatment and can lead to improved overall survival,especially when performed at high volume institutions.The role of adjuvant chemotherapy following curative resection is still unclear.External beam radiation therapy alone is considered palliative and is typically reserved for patients with a poor performance status.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Regulatory T cells in inflammatory bowel diseases and colorectal cancer

    Gy(o)rgyi MüzesBéla MolnárFerenc Sipos
    5688-5694页
    查看更多>>摘要：Regulatory T cells (Tregs) are key elements in immunological self-tolerance.The number of Tregs may alter in both peripheral blood and in colonic mucosa during pathological circumstances.The local cellular,microbiological and cytokine milieu affect immunophenotype and function of Tregs.Forkhead box P3+ Tregs function shows altered properties in inflammatory bowel diseases (IBDs).This alteration of Tregs function can furthermore be observed between Crohn's disease and ulcerative colitis,which may have both clinical and therapeutical consequences.Chronic mucosal inflammation may also influence Tregs function,which together with the intestinal bacterial flora seem to have a supporting role in colitis-associated colorectal carcinogenesis.Tregs have a crucial role in the immunoevasion of cancer cells in sporadic colorectal cancer.Furthermore,their number and phenotype correlate dosely with the clinical outcome of the disease,even if their contribution to carcinogenesis has previously been controversial.Despite knowledge of the clinical relationship between IBD and colitis-associated colon cancer,and the growing number of immunological aspects encompassing sporadic colorectal carcinogenesis,the molecular and cellular links amongst Tregs,regulation of the inflammation,and cancer development are still not well understood.In this paper,we aimed to review the current data surrounding the role of Tregs in the pathogenesis of IBD,colitis-associated colon cancer and sporadic colorectal cancer.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Incidence of port-site metastasis after undergoing robotic surgery for biliary malignancies

    Quan-Da LiuJun-Zhou ChenXiao-Ya XuTao Zhang...
    5695-5701页
    查看更多>>摘要：AIM:To investigate the incidence of clinically detected port-site metastasis (PSM) in patients who underwent robotic surgery for biliary malignancies.METHODS:Using a prospective database,the patients undergoing fully robotic surgery for biliary malignancies between January 2009 and January 2011 were included.Records of patients with confirmed malignancy were reviewed for clinicopathological data and information about PSM.RESULTS:Sixty-four patients with biliary tract cancers underwent robotic surgery,and sixty patients met the inclusion criteria.The median age was 67 year (range:40-85 year).During a median 15-mo follow-up period,two female patients were detected solitary PSM after robotic surgery.The incidence of PSM was 3.3％.Patient 1 underwent robotic anatomatic left hemihepatectomy and extraction of biliary tumor thrombi for an Klatskin tumor.She had a subcutaneous mass located at the right lateral abdominal wall near a trocar scar.Patient 2 underwent robotic pancreaticoduodenectomy for distal biliary cancer.She had two metachronous subcutaneous mass situated at the right lateral abdominal wall under a same trocar scar at 7 and 26 mo.The pathology of the excised PSM masses confirmed metastatic biliary adenocarcinoma.COMCLUSION:The incidence of PSMs after robotic surgery for biliary malignancies is relatively low,and biliary cancer can be an indication of robotic surgery.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess

    Chen WangJin-Gen LuYong-Qing CaoYi-Bo Yao...
    5702-5708页
    查看更多>>摘要：AIM:To evaluate the efficacy and safety of traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess.METHODS:Sixty patients with intersphincteric or transsphincteric anal fistulas with secondary tracks and abscess were randomly divided into study group [suture dragging combined with pad compression (SDPC)] and control group [fistulotomy (FSLT)].In the SDPC group,the internal opening was excised and incisions at external openings were made for drainage.Silk sutures were put through every two incisions and knotted in loose state.The suture dragging process started from the first day after surgery and the pad compression process started when all sutures were removed as wound tissue became fresh and without discharge.In the FSLT group,the internal opening and all tracts were laid open and cleaned by normal saline postoperatively till all wounds healed.The time of healing,postoperative pain score (visual analogue scale),recurrence rate,patient satisfaction,incontinence evaluation and anorectal manometry before and after the treatment were examined.RESULTS:There were no significant differences between the two groups regarding age,gender and fistulae type.The time of healing was significantly shorter (24.33 d in SDPC vs 31.57 d in FSLT,P ＜ 0.01) and the patient satisfaction score at 1 mo postoperative follow-up was significantly higher in the SDPC group (4.07 in SDPC vs 3.37 in FSLT,P ＜ 0.05).The mean maximal postoperative pain scores were 5.83 ± 2.5 in SDPC vs 6.37 ± 2.33 in FSLT and the recurrence rates were 3.33 in SDPC vs 0 in FSLT.None of the patients in the two groups experienced liquid and solid fecal incontinence and lifestyle alteration postoperatively.The Wexner score after treatment of intersphincter fistulae were 0.17 ± 0.41 in SDPC vs 0.40 ± 0.89 in FSLT and transsphincter fistulae were 0.13 ± 0.45 in SDPC vs 0.56 ±1.35 in FSLT.The maximal squeeze pressure and resting pressure declined after treatment in both groups.The maximal anal squeeze pressures after treatment were reduced (23.17 ± 3.73 Kpa in SDPC vs 22.74 ±4.47 Kpa in FSLT) and so did the resting pressures (12.36 ± 2.15 Kpa in SDPC vs 11.71 ± 1.87 Kpa in FSLT),but there were neither significant differences between the two groups and nor significant differences before or after treatment.CONCLUSION:Traditional Chinese surgical treatment SDPC for anal fistulae with secondary tracks and abscess is safe,effective and less invasive.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Ethyl pyruvate protects against experimental acute-on-chronic liver failure in rats

    Lu-Wen WangLi-Kun WangHui ChenCheng Fan...
    5709-5718页
    查看更多>>摘要：AIM:To investigate the protective effects of ethyl pyruvate (EP) on acute-on-chronic liver failure (ACLF) in METHODS:An ACLF model was established in rats,and animals were randomly divided into normal,model and EP treatment groups.The rats in EP treatment group received EP (40 mg/kg) at 3 h,6 h,12 h and 24 h after induction of ACLF.Serum endotoxin,high mobility group box-1 (HMGB1),alanine transaminase (ALT),tumor necrosis factor-α (TNF-α),interferon-α (IFN-y),interleukin (IL)-10 and IL-18 levels,changes of liver histology and HMGB1 expressions in liver tissues were detected at 48 h after induction of ACLF.The effects of EP on the survival of ACLF rats were also observed.RESULTS:Serum levels of endotoxin (0.394 ± 0.066 EU/mL vs 0.086 ± 0.017 EU/mL,P ＜ 0.001),HMGB1 (35.42 ± 10.86 μg/L vs 2.14 ± 0.27 μg/L,P ＜ 0.001),ALT (8415.87 ± 3567.54 IU/L vs 38.64 ± 8.82 IU/L,P ＜ 0.001),TNF-α (190.77 ± 12.34 ng/L vs 124.40 ± 4.12 ng/L,P ＜ 0.001),IFN-γ (715.38 ± 86.03 ng/L vs 398.66 ± 32.91 ng/L,P ＜ 0.001),IL-10 (6.85 ± 0.64ng/L vs 3.49 ± 0.24 ng/L,P ＜ 0.001) and IL-18 (85.19± 3.49 ng/L vs 55.38 ± 1.25 ng/L,P ＜ 0.001) were significantly increased,and liver tissues presented severe pathological injury in the model group compared with the normal group.However,EP administration significantly improved hepatic histopathology and reduced the serum levels of endotoxin (0.155 ± 0.045 EU/mL vs 0.394-0.066 EU/mL,P ＜ 0.001) and inflammatory cytokines (11.13 ± 2.58 μg/L vs 35.42± 10.86 μg/L for HMGB1,3512.86 ± 972.67 IU/L vs 8415.87 ± 3567.54 IU/L for ALT,128.55 ± 5.76 ng/L vs 190.77-12.34 ng/L for TNF-α,438.16 ± 38.10 ng/L vs 715.38 ± 86.03 ng/L for IFN-y,3.55 ± 0.36 ng/L vs 6.85 ± 0.64 ng/L for IL-10,and 60.35 ± 1.63ng/L vs 85.19 ± 3.49 ng/L for IL-18,respectively,P ＜ 0.001),and the levels of HMGB1 in liver tissues regardless of treatment time after induction of ACLF.EP treatment at the four time points prolonged the median survival time of ACLF rats (60 h) to 162 h,120 h,102 h and 78 h,respectively (x2 =41.17,P ＜ 0.0001).CONCLUSION:EP administration can protect against ACLF in rats,and is a potential and novel therapeutic agent for severe liver injury.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Exogenous carbon monoxide attenuates inflammatory responses in the small intestine of septic mice

    Xu WangJie CaoBing-Wei SunDa-Dong Liu...
    5719-5728页
    查看更多>>摘要：AIM:To determine whether the carbon monoxide (CO)-releasing molecules (CORM)-liberated CO suppress infiammatory responses in the small intestine of septic mice.METHODS:The C57BL/6 mice (male,n =36; weight 20 ± 2 g) were assigned to four groups in three respective experiments.Sepsis in mice was induced by cecal ligation and puncture (CLP) (24 h).Tricarbonyldichlororuthenium (Ⅱ) dimer (CORM-2) (8 mg/kg,i.v.)was administrated immediately after induction of CLP.The levels of inflammatory cytokines [interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α)] in tissue homogenates were measured with enzyme-linked immunosorbent assay.The levels of malondialdehyde (MDA) in the tissues were determined.The levels of nitric oxide (NO) in tissue homogenate were measured and the expression levels of intercellular adhesion molecule 1 (ICAM-1) and inducible nitric oxide synthase (iNOS) in the small intestine were also assessed.NO and IL-8 levels in the supernatants were determined after the human adenocarcinoma cell line Caco-2 was stimulated by lipopolysaccharide (LPS) (10 g/mL) for 4 h in vitro.RESULTS:At 24 h after CLP,histological analysis showed that the ileum and jejunum from CLP mice induced severe edema and sloughing of the villous tips,as well as infiltration of inflammatory cells into the mucosa.Semi-quantitative analysis of histological samples of ileum and jejunum showed that granulocyte infiltration in the septic mice was significantly increased compared to that in the sham group.Administration of CORM-2 significantly decreased granulocyte infiltration.At 24 h after CLP,the tissue MDA levels in the midileum and mid-jejunum significantly increased compared to the sham animals (103.68 ± 23.88 nmol/mL vs 39.66 ± 8.23 nmol/mL,89.66 ± 9.98 nmol/mL vs 32.32 ± 7.43 nmol/mL,P ＜ 0.01).In vitro administration of CORM-2,tissue MDA levels were significantly decreased (50.65-11.46 nmol/mL,59.32 ± 6.62nmol/mL,P ＜ 0.05).Meanwhile,the tissue IL-1β and TNF-α levels in the mid-ileum significantly increased compared to the sham animals (6.66 ± 1.09 pg/mL vs 1.67 ± 0.45 pg/mL,19.34 ± 3.99 pg/mL vs 3.98 ± 0.87pg/mL,P ＜ 0.01).In vitro administration of CORM-2,tissue IL-1β and TNF-α levels were significantly decreased (3.87 ± 1.08 pg/mL,10.45 ± 2.48 pg/mL,P ＜0.05).The levels of NO in mid-ileum and mid-jejunum tissue homogenate were also decreased (14.69 ±2.45 nmol/mL vs 24.36 ± 2.97 nmol/mL,18.47 ± 2.47nmol/mL vs 27.33 ± 3.87 nmol/mL,P ＜ 0.05).The expression of iNOS and ICAM-1 in the mid-ileum of septic mice at 24 h after CLP induction significantly increased compared to the sham animals.In vitro administration of CORM-2,expression of iNOS and ICAM-1 were significantly decreased.In parallel,the levels of NO and IL-8 in the supernatants of Caco-2 stimulated by LPS was markedly decreased in CORM-2-treated Caco-2 cells (2.22 ± 0.12 nmol/mL vs 6.25 ± 1.69 nmol/mL,24.97 ± 3.01 pg/mL vs 49.45 ± 5.11 pg/mL,P ＜ 0.05).CONCLUSION:CORM-released CO attenuates the inflammatory cytokine production (IL-1β and TNF-α),and suppress the oxidative stress in the small intestine during sepsis by interfering with protein expression of ICAM-1 and iNOS.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Intramuscular vs intradermal route for hepatitis B booster vaccine in celiac children

    Salvatore LeonardiAndrea Domenico PraticòElena LionettiMassimo Spina...
    5729-5733页
    查看更多>>摘要：AIM:To compare intradermal (ID) and intramuscular (IM) booster doses,which have been used in healthy and high risk subjects,such as healthcare workers,haemodialysis patients,human immunodeficiency virus patients,and renal transplant recipients unresponsive to initial hepatitis B vaccination,in celiac individuals.METHODS:We conducted our study on 58 celiac patients,vaccinated in the first year of life,whose blood analysis had showed the absence of protective hepatitis B virus (HBV) antibodies.All patients had received the last vaccine injection at least one year before study enrolment and they had been on a gluten free diet for at least 1 year.In all patients we randomly performed an HBV vaccine booster dose by ID or IM route.Thirty celiac patients were revaccinated with recombinant hepatitis B vaccine (Engerix B) 2 μg by the ID route,while 28 celiac patients were revaccinated with Engerix B 10 μg by the IM route.Four weeks after every booster dose,the anti-hepatitis B surface (HBs) antibody titer was measured by an enzyme-linked immuneadsorbent assay.We performed a maximum of three booster doses in patients with no anti-HBs antibodies after the first or the second vaccine dose.The cut off value for a negative anti-HBs antibody titer was 10 IU/L.Patients with values between 10 and 100 JU/L were considered "low responders" while patients with an antibody titer higher than 1000 IU/L were considered "high responders".RESULTS:No significant difference in age,gender,duration of illness,and years of gluten intake was found between the two groups.We found a high percentage of "responders" after the first booster dose (ID =76.7％,IM =78.6％) and a greater increase after the third dose (ID =90％,IM =96.4％) of vaccine in both groups.Moreover we found a significantly higher number of high responders (with an anti-HBs antibody titer ＞ 1000 IU/L) in the ID (40％) than in the IM (7.1％)group,and this difference was evident after the first booster dose of vaccination (P ＜ 0.01).No side effects were recorded in performing delivery of the vaccine by either the ID or IM route.CONCLUSION:Our study suggests that both ID and IM routes are effective and safe options to administer a booster dose of HBV vaccine in celiac patients.However the ID route seems to achieve a greater number of high responders and to have a better cost/benefit ratio.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普