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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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    New approach to anal cancer: Individualized therapy based on sentinel lymph node biopsy

    Paola De NardiMichele CarvelloCarlo Staudacher
    6349-6356页
    查看更多>>摘要：Oncological treatment is currently directed toward a tailored therapy concept.Squamous cell carcinoma of the anal canal could be considered a suitable platform to test new therapeutic strategies to minimize treatment morbidity.Standard of care for patients with anal canal cancer consists of a combination of radiotherapy and chemotherapy.This treatment has led to a high rate of local control and a 60％ cure rate with preservation of the anal sphincter,thus replacing surgical abdominoperineal resection.Lymph node metastases represent a critical independent prognostic factor for local recurrence and survival.Mesorectal and iliac lymph nodes are usually included in the radiation field,whereas the inclusion of inguinal regions still remains controversial because of the subsequent adverse side effects.Sentinel lymph node biopsies could clearly identify inguinal node-positive patients eligible for therapeutic groin irradiation.A sentinel lymph node navigation procedure is reported here to be a feasible and effective method for establishing the true inguinal node status in patients suffering from anal canal cancer.Based on the results of sentinel node biopsies,a selective approach could be proposed where node-positive patients could be selected for inguinal node irradiation while node-negative patients could take advantage of inguinal sparing irradiation,thus avoiding toxic side effects.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Intestinal mucosal atrophy and adaptation

    Darcy ShawKartik GohilMarc D Basson
    6357-6375页
    查看更多>>摘要：Mucosal adaptation is an essential process in gut homeostasis.The intestinal mucosa adapts to a range of pathological conditions including starvation,short-gut syndrome,obesity,and bariatric surgery.Broadly,these adaptive functions can be grouped into proliferation and differentiation.These are influenced by diverse interactions with hormonal,immune,dietary,nervous,and mechanical stimuli.It seems likely that clinical outcomes can be improved by manipulating the physiology of adaptation.This review will summarize current understanding of the basic science surrounding adaptation,delineate the wide range of potential targets for therapeutic intervention,and discuss how these might be incorporated into an overall treatment plan.Deeper insight into the physiologic basis of adaptation will identify further targets for intervention to improve clinical outcomes.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Advanced gastric cancer: Is there enough evidence to call second-line therapy standard?

    Hendrik-Tobias ArkenauMatilde SaggeseCharlotte Lemech
    6376-6378页
    查看更多>>摘要：Gastric cancer and cancer of the gastro-oesophageal junction (GOJ) are the 4th most common cancer diagnoses worldwide with regional differences in incidence rates.The treatment of gastric and GOJ cancers is complex and requires multimodality treatment including chemotherapy treatment,surgery,and radiotherapy.During the past decade considerable improvements were achieved by advanced surgical techniques,tailored chemotherapies/radiotherapy and technical innovations in clinical diagnostics.In patients with advanced or metastatic gastric/GOJ cancer systemic chemotherapy with fluoropyrimidine/platinum-based regimens (+/-human epidermal growth factor receptor-2 antibody) is the mainstay of treatment.Despite these improvements,the clinical outcome for patients with advanced or metastatic disease is generally poor with 5-year survival rates ranging between 5％-15％.These poor survival rates may to some extent be related that standard therapies beyond first-line therapies have never been defined.Considering that this patient population is often not fit enough to receive further treatments there is an increasing body of evidence from phase-2 studies that in fact second-line therapies may have a positive impact in terms of overall survival.Moreover two recently published phase-3 studies support the use of second-line chemotherapy.A South Korean study compared either,irinotecan or docetaxel with best supportive care and a German study compared irinotecan with best supportive care-both studies met their primary endpoint overall survival.In this "Field of Vision" article,we review these recently published phase-3 studies and put them into the context of clinical prognostic factors helping to guide treatment decisions in patients who most likely benefit.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Dietary supplementation of some antioxidants against hypoxia

    Sanaa Ahmed AliHanan Farouk AlyLilla Mohammed FaddahZeenat F Zaidi...
    6379-6386页
    查看更多>>摘要：The present study aims to clarifythe protective effect of supplementation with some antioxidants,such as idebenone (200 mg/kg,ip),melatonin (10 mg/kg,ip) and arginine (200 mg/kg,ip) and their combination,on liver function (T.protein,albumin,alanine aminotransferase,aspartate aminotransferase and alkaline phosphatase),energetic parameters (adenosine triphosphate,adenosine diphosphate,adenosine monophosphate,inorganic phosphate,total adenylate,adenylate energy charge and potential phosphate).The effect on glycolytic and glycogenolytic enzymes (glucose,glycogen,glycogen phosphorylase,pyruvate kinase and phosphofructokinase against hypoxia) was also studied.The drugs were administered 24 and 1 h prior sodium nitrite intoxication.All biochemical parameters were estimated 1 h after sodium nitrite injection.Injection of sodium nitrite (75 mg/kg,sc) produced a significant disturbance in all biochemical parameters of liver function,energetic parameters and glycolytic and glycogenolytic enzymes.Hepatic damage was confirmed by histopathological examination of the liver as compared to controls.The marked changes in hepatic cells induced by sodium nitrite were completely abolished by pretreatment with the drug combination,suggesting potential protection against sodium nitrite-induced hypoxia.It could be concluded that a combination of both idebenone and melatonin or idebenone and arginine provides potential protection against sodium nitrite-induced hypoxia by improving biochemical parameters and preserving liver histology.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Expression and function of renal and hepatic organic anion transporters in extrahepatic cholestasis

    Anabel BrandoniMaría Herminia HazelhoffRomina Paula BulacioAdriana Mónica Torres...
    6387-6397页
    查看更多>>摘要：Obstructive jaundice occurs in patients suffering from cholelithiasis and from neoplasms affecting the pancreas and the common bile duct.The absorption,distribution and elimination of drugs are impaired during this pathology.Prolonged cholestasis may alter both liver and kidney function.Lactam antibiotics,diuretics,non-steroidal anti-inflammatory drugs,several antiviral drugs as well as endogenous compounds are classified as organic anions.The hepatic and renal organic anion transport pathways play a key role in the pharmacokinetics of these compounds.It has been demonstrated that acute extrahepatic cholestasis is associated with increased renal elimination of organic anions.The present work describes the molecular mechanisms involved in the regulation of the expression and function of the renal and hepatic organic anion transporters in extrahepatic cholestasis,such as multidrug resistanceassociated protein 2,organic anion transporting polypeptide 1,organic anion transporter 3,bilitranslocase,bromosulfophthalein/bilirubin binding protein,organic anion transporter 1 and sodium dependent bile salt transporter.The modulation in the expression of renal organic anion transporters constitutes a compensatory mechanism to overcome the hepatic dysfunction in the elimination of organic anions.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Current concepts in hepatic resection for hepatocellular carcinoma in cirrhotic patients

    Alessandro CucchettiMatteo CesconFranco TrevisaniAntonio Daniele Pinna...
    6398-6408页
    查看更多>>摘要：Hepatocellular carcinoma (HCC) is one of the most frequent neoplasms worldwide and in most cases it is associated with liver cirrhosis.Liver resection is considered the most potentially curative therapy for HCC patients when liver transplantation is not an option or is not immediately accessible.This review is aimed at investigating the current concepts that drive the surgical choice in the treatment of HCC in cirrhotic patients;Eastern and Western perspectives are highlighted.An extensive literature review of the last two decades was performed,on topics covering various aspects of hepatic resection.Early post-operative and long-term outcome measures adopted were firstly analyzed in an attempt to define an optimal standardization useful for research comparison.The need to avoid the development of post-hepatectomy liver failure represents the "conditio sine qua non" of surgical choice and the role of the current tools available for the assessment of liver function reserve were investigated.Results of hepatic resection in relationship with tumor burden were compared with those of available competing strategies,namely,radiofrequency ablation for early stages,and trans-arterial chemoembolization for intermediate and advanced stages.Finally,the choice for anatomical versus non-anatomical,as well as the role of laparoscopic approach,was overviewed.The literature review suggests that partial hepatectomy for HCC should be considered in the context of multi-disciplinary evaluation of cirrhotic patients.Scientific research on HCC has moved,in recent years,from surgical therapy toward non-surgical approaches and most of the literature regarding topics debated in the present review is represented by observational studies,whereas very few well-designed randomized controlled trials are currently available; thus,no robust recommendations can be derived.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Eosinophil associated genes in the inflammatory bowel disease 4 region: Correlation to inflammatory bowel disease revealed

    Kristin BlomJenny RubinJonas HalfvarsonLeif T(o)rkvist...
    6409-6419页
    查看更多>>摘要：AIM:To study the association between inflammatory bowel disease (IBD) and genetic variations in eosinophil protein X (EPX) and eosinophil cationic protein (ECP).METHODS:DNA was extracted from ethylene diamine tetraacetic acid blood of 587 patients with Crohn's disease (CD),592 with ulcerative colitis (UC) and 300healthy subjects.The EPX405 (G ＞ C,rs2013109),ECP434 (G ＞ C,rs2073342) and ECP562 (G ＞ C,rs2233860) gene polymorphisms were analysed,by the 5'-nuclease alleiic discrimination assay.For determination of intracellular content of EPX and ECP in granulocytes,39 blood samples was collected and extracted with a buffer containing cetyltrimethylammonium bromide.The intracellular content of EPX was analysed using an enzyme-linked immunosorbent assay.The intracellular content of ECP was analysed with the UniCAP(R) system as described by the manufacturer.Statistical tests for calculations of results were x2 test,Fisher's exact test,ANOVA,Student-Newman-Keuls test,and Kaplan-Meier survival curve with Log-rank test for trend,the probability values of P ＜ 0.05 were considered statistically significant.RESULTS:The genotype frequency for males with UC and with an age of disease onset of ≥ 45 years (n =57) was for ECP434 and ECP562,GG =37％,GC =60％,CC =4％ and GG =51％,GC =49％,CC =0％respectively.This was significantly different from the healthy subject's genotype frequencies of ECP434 (GG =57％,GC =38％,CC =5％; P =0.010) and ECP562(GG =68％,GC =29％,CC =3％; P =0.009).The genotype frequencies for females,with an age of disease onset of ≥ 45 years with CD (n =62),was for the ECP434 and ECP562 genotypes GG =37％,GC =52％,CC =11％ and GG =48％,GC =47％ and CC=5％ respectively.This was also statistically different from healthy controls for both ECP434 (P =0.010) and ECP562 (P =0.013).The intracellular protein concentration of EPX and ECP was calculated in μg/106 eosinophils and then correlated to the EPX 405 genotypes.The protein content of EPX was highest in the patients with the CC genotype of EPX405 (GG =4.65,GC =5.93,and CC =6.57) and for ECP in the patients with the GG genotype of EPX405 (GG =2.70,GC =2.47and CC =1.90).ANOVA test demonstrated a difference in intracellular protein content for EPX (P =0.009) and ECP (P =0.022).The age of disease onset was linked to haplotypes of the EPX405,ECP434 and ECP562genotypes.Kaplan Mlaier curve showed a difference between haplotype distributions for the females with CD (P =0.003).The highest age of disease onset was seen in females with the EPX405CC,ECP434GC,ECP562CC haplotype (34 years) and the lowest in females with the EPX405GC,ECP434GC,ECP562GG haplotype (21years).For males with UC there was also a difference between the highest and lowest age of the disease onset (EPX405CC,ECP434CC,ECP562CC,mean 24 years vs EPX405GC,ECP434GC,ECP562GG,mean 34 years,P =0.0009).The relative risk for UC patients with ECP434 or ECP562-GC/CC genotypes to develop dysplasia/cancer was 2.5 (95％CI:1.2-5.4,P =0.01) and 2.5 (95％CI:1.1-5.4,P =0.02) respectively,compared to patients carrying the GG-genotypes.CONCLUSION:Polymorphisms of EPX and ECP are associated to IBD in an age and gender dependent manner,suggesting an essential role of eosinophils in the pathophysiology of IBD.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Glucose-responsive artificial promoter-mediated insulin gene transfer improves glucose control in diabetic mice

    Jaeseok HanEung-Hwi KimWoohyuk ChoiHee-Sook Jun...
    6420-6426页
    查看更多>>摘要：AIM:To investigate the effect of insulin gene therapy using a glucose-responsive synthetic promoter in type 2 diabetic obese mice.METHODS:We employed a recently developed novel insulin gene therapy strategy using a synthetic promoter that regulates insulin gene expression in the liver in response to blood glucose level changes.We intravenously administered a recombinant adenovirus expressing furin-cleavable rat insulin under the control of the synthetic promoter (rAd-SP-rINSfur) into diabetic Leprdb/db mice.A recombinant adenovirus expressing β-galactosidase under the cytomegalovirus promoter was used as a control (rAd-CMV-βgal).Blood glucose levels and body weights were monitored for 50 d.Glucose and insulin tolerance tests were performed.Immunohistochemical staining was performed to investigate islet morphology and insulin content.RESULTS:Administration of rAd-SP-rINSfur lowered blood glucose levels and normoglycemia was maintained for 50 d,whereas the rAd-CMV-βgal control virus-injected mice remained hyperglycemic.Glucose tolerance tests showed that rAd-SP-rINSfur-treated mice cleared exogenous glucose from the blood more efficiently than control virus-injected mice at 4 wk [area under the curve (AUC):21 508.80 ± 2248.18 vs 62 640.00 ± 5014.28,P ＜ 0.01] and at 6 wk (AUC:29 956.60 ± 1757.33 vs 60 016.60 ± 3794.47,P ＜ 0.01).In addition,insulin sensitivity was also significantly improved in mice treated with rAd-SP-rINSfur compared with rAd-CMV-βgal-treated mice (AUC:9150.17±1007.78 vs 11 994.20 ± 474.40,P ＜ 0.05).The islets from rAd-SP-rINSfur-injected mice appeared to be smaller and to contain a higher concentration of insulin than those from rAd-CMV-βgal-injected mice.CONCLUSION:Based on these results,we suggest that insulin gene therapy might be one therapeutic option for remission of type 2 diabetes.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Diagnostic role of 18F-fluorodeoxyglucose positron emission tomography for follicular lymphoma with gastrointestinal involvement

    Masaya IwamuroHiroyuki OkadaKatsuyoshi TakataKatsuji Shinagawa...
    6427-6436页
    查看更多>>摘要：AIM:To investigate the capacity for 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)to evaluate patients with gastrointestinal lesions of follicular lymphoma.METHODS:This retrospective case series consisted of 41 patients with follicular lymphoma and gastrointestinal involvement who underwent 18F-FDG-PET and endoscopic evaluations at ten different institutions between November 1996 and October 2011.Data for endoscopic,radiological,and biological examinations performed were retrospectively reviewed from clinical records.A semi-quantitative analysis of 18F-FDG uptake was performed for each involved area by calculating the maximum standardized uptake value (SUVmax).Based on the positivity of 18F-FDG uptake in the gastrointestinal lesions analyzed,patients were subdivided into two groups.To identify potential predictive factors for 18F-FDG positivity,these two groups were compared with respect to gender,age at diagnosis of lymphoma,histopathological grade,pattern of follicular dendritic cells,mitotic rate,clinical stage,soluble interleukin-2 receptor levels detected by 18F-FDG-PET,lactate dehydrogenase (LDH) levels,hemoglobin levelsbone marrow involvement,detectability of gastrointestinal lesions by computed tomography (CT) scanningand follicular lymphoma international prognostic index (FLIPI) risk.RESULTS:Involvement of follicular lymphoma in the stomach,duodenum,jejunum,ileum,cecum,colon,and rectum was identified in 1,34,6,3,2,3,and 6patients,respectively.No patient had esophageal involvement.In total,19/41 (46.3％) patients exhibited true-positive 18F-FDG uptake in the lesions present in their gastrointestinal tract.In contrast,false-negative 18F-FDG uptake was detected in 24 patients (58.5％),while false-positive 18F-FDG uptake was detected in 5 patients (12.2％).In the former case,2/19 patients had both 18F-FDG-positive lesions and 18F-FDG-negative lesions in the gastrointestinal tract.In patients with 18F-FDG avidity,the SUVmax value of the involved gastrointestinal tract ranged from 2.6 to 17.4 (median:4.7).For the 18F-FDG-negative (n =22) and-positive (n =19) groups,there were no differences in the male to female ratios (10/12 vs 4/15,P =0.186),patient age (63.6 ± 2.4 years vs 60.1 ± 2.6 years,P =0.323),presence of histopathological grade 1 vs 2 (20/2 and 17/2,P =1.000),follicular dendritic cell pattern (duodenal/nodal:13/5 vs10/3,P =1.000),mitotic rate (low/partly high,14/1 vs 10/3,P =0.311),clinical stage according to the Ann Arbor system (stages Ⅰ E and Ⅱ E/other,15/7 vs 15/4,P =0.499),clinical stage according to the Lugano system (stages Ⅰ and Ⅱ-1/other,14/8 vs 14/5,P =0.489),soluble interleukin-2 receptor levels (495 ± 78 vs 402 ± 83,P =0.884),LDH levels (188 ±7 vs 183 ± 8,P =0.749),hemoglobin levels (13.5 ± 0.3vs 12.8 ± 0.4,P =0.197),bone marrow involvement (positive/negative,1/8 vs 1/10,P =1.000),detectability by CT scanning (positive/negative,1/16 vs 4/13,P =0.335),and FLIPI risk (low risk/other,16/6 vs13/6,P =0.763),respectively in each case.CONCLUSION:These findings indicate that it is not feasible to predict 18F-FDG-avidity.Therefore,18F-FDG-PET scans represent a complementary modality for the detection of gastrointestinal involvements in follicular lymphoma patients,and surveillance of the entire gastrointestinal tract by endoscopic examinations is required.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Clonal evolution of hepatitis B virus polymerase gene mutations during lamivudine-adefovir combination treatment

    Soon Young KoByung Kook KimSo Young KwonKyun-Hwan Kim...
    6437-6446页
    查看更多>>摘要：AIM:To identify hepatitis B virus polymerase gene mutations during antiviral therapy using lamivudineadefovir sequential monotherapy followed by lamivudine-adefovir combination therapy.METHODS:The patient cohort included four adult chronic hepatitis B patients who had undergone sequential monotherapy,first with lamivudine (LMV)and then,after developing viral breakthrough,with adefovir (ADV) therapy.All of the patients had non-response or viral breakthrough after LMV-ADV sequential monotherapy,which resulted in the switching of their antiviral regimen to LMV-ADV combination therapy.Eleven serum samples from the four patients who showed non-response to rescue LMV-ADV combination therapy were collected sequentially at a time before the antiviral treatment and then during the LMV monotherapy,ADV monotherapy,and LMV-ADV combination therapy.For the genotypic analysis,the whole 1310-bp polymerase gene region was amplified,cloned and sequenced.RESULTS:All patients had been previously treated with 100 mg of LMV once daily for a 15-to 26-mo period.The emergence of resistance mutations to LMV,such as rtM204V/I and/or rtL180M,were found in all patients.Their antiviral regimens were switched to ADV monotherapy as the second line treatment.All patients had viral breakthrough or non-response after the LMV-ADV sequential monotherapy.ADV-resistant mutations were detected after 13 to 19 mo of LMV-ADV sequential monotherapy.The rtA181V/T mutations were predominantly identified during the ADV treatment in the LMV-resistant patients.Twenty-seven of 38 clones were combined with an amino acid change at rt181;three clones had mutations in rt236 and one clone had a combined mutation.The rtA181V/T mutations were not suppressed by the LMV-ADV combination therapy.Thirty-nine of 64 clones showed an rtA181V/T mutation and six clones showed combined mutations in rt181 and rt236.Mutations in rt204 re-emerged during the combination treatment.The rt181 and rt204 mutations did not co-exist in one clone.CONCLUSION:Add-on lamivudine therapy with adefovir for adefovir resistance may not suppress the pre-existing adefovir-resistant mutation that develops during lamivudine-adefovir sequential monotherapy.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普