bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long‐term follow‐up of patients with hepatitis B e antigen negative chronic hepatitis B
Authors: Bekku Dan , Arai Makoto , Imazeki Fumio , Yonemitsu Yutaka , Kanda Tatsuo , Fujiwara Keiichi , Fukai Kenichi , Sato Kenichi , Itoga Sakae , Nomura Fumio , Yokosuka Osamu 
Published: March 2010

AbstractBackground and Aim:  After hepatitis B virus (HBV) e antigen (HBeAg) seroconversion, HBV‐DNA continues to replicate, and HBeAg‐negative patients still face the risk of liver disease progression. We investigated the predictive factors for alanine aminotransferase (ALT) elevation, antiviral drug use, and hepatocellular carcinoma (HCC) occurrence in HBeAg‐negative patients.Methods:  Age, sex, ALT, platelet counts, HBV‐DNA levels, genotype, antidiabetic drug use, body mass index, smoking, and alcohol consumption were analyzed for a total of 244 HBV carriers who were HBeAg‐negative.Results:  Of 244 HBeAg‐negative patients, 158 (64.8%) showed normal ALT levels at baseline. Multivariate Cox hazard regression analysis identified high HBV‐DNA levels and high ALT at baseline as independent risk factors for ALT elevation in the patients with normal ALT at baseline. The threshold ALT and HBV‐DNA levels were determined to be 31 IU/L and 5.3 logcopies/mL, respectively. Seventeen (7.0%) patients used antiviral drugs. Multivariate Cox hazard regression analysis identified high HBV‐DNA levels (threshold, 5.7 log copies/mL), the use of antidiabetic drugs, and daily alcohol consumption at baseline as an independent risk factor for the use of antiviral drugs in HBeAg‐negative patients. In 10 patients (4.1%), HCC was detected, and a low platelet count (threshold, 10.0 × 104/mm3) was associated with the occurrence of HCC.Conclusion:  This study identified predictors of future active liver disease in HBeAg‐negative patients, i.e. ALT elevation, unavoidable use of antiviral drugs, and occurrence of HCC.
Acute allograft rejection in human liver transplant recipients is associated with signaling through toll‐like receptor 4
Authors: Testro Adam G , Visvanathan Kumar , Skinner Narelle , Markovska Vesna , Crowley Peter , Angus Peter W , Gow Paul J 
Published: March 2010

AbstractBackground and Aims:  Toll‐like receptor (TLR) signaling is a crucial step in initiating adaptive immune responses. In addition to recognizing endotoxin, TLR4 also recognizes endogenous ligands (‘damage‐associated structures’), which are released into the circulation in the peri‐transplantation period. TLR2 to a lesser extent also recognizes these endogenous ligands. Multiple studies involving solid organ transplants demonstrate a clear association between TLR4 and allograft rejection. In the present study we assessed whether an association exists between TLR4 and TLR2‐dependent responses and acute liver allograft rejection.Methods:  The sample included 26 liver transplant recipients. Blood was taken pre‐transplant and at multiple points over the first 14 days post‐transplant. Monocytes were stimulated with TLR4 and TLR2 ligands, lipopolysaccharide and Pam‐3‐Cys, respectively. Monocyte TLR expression was determined using flow cytometry; enzyme‐linked immunosorbent assays measured tumor necrosis factor‐α (TNF‐α) and interleukin‐6 (IL‐6) production.Results:  Nine (34.6%) patients experienced rejection. No differences existed in age, sex, disease or immunosuppression between rejectors and non‐rejectors. Baseline TLR4 expression was significantly higher in rejectors (1.36 vs 1.02, P = 0.01). There was no difference in TLR2 expression. In rejectors, baseline TLR4‐ and TLR2‐dependent production of TNF‐α and IL‐6 was also significantly increased. Post‐transplant, the two groups differed with regard to TLR4‐dependent TNF‐α production, with rejectors demonstrating progressive downregulation over the first week.Conclusions:  Prior to liver transplantation, patients who subsequently experience rejection demonstrate robust TLR4‐dependent immune responses, which are not seen in those who do not reject. This supports the theory that damage‐associated structures signaling through TLR4 may be responsible for the early activation of alloimmune T‐cells, favoring allograft rejection.
Spleen stiffness measurement using fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients
Authors: Stefanescu Horia , Grigorescu Mircea , Lupsor Monica , Procopet Bogdan , Maniu Anca , Badea Radu 
Published: March 2010

AbstractBackground and Aim:  Splenomegaly in a common finding in liver cirrhosis that should determine changes in the spleen's density because of portal and splenic congestion and/or because of tissue hyperplasia and fibrosis. These changes might be quantified by elastography, so the aim of the study was to investigate whether spleen stiffness measured by transient elastography varies as liver disease progresses and whether this would be a suitable method for the noninvasive evaluation of the presence of esophageal varices.Patients and Methods:  One hundred and ninety‐one patients (135 liver cirrhosis, 39 chronic hepatitis and 17 healthy controls) were evaluated by transient elastography for measurements of spleen and liver stiffness. Cirrhotic patients also underwent upper endoscopy for the diagnosis of esophageal varices.Results:  Spleen stiffness showed higher values in liver cirrhosis patients as compared with chronic hepatitis and with controls: 60.96 vs 34.49 vs 22.01 KPa (P < 0.0001). In the case of liver cirrhosis, spleen stiffness was significantly higher in patients with varices as compared with those without (63.69 vs 47.78 KPa, P < 0.0001), 52.5 KPa being the best cut‐off value, with an area under the receiver operating characteristic of 0.74. Using both liver and spleen stiffness measurement we correctly predicted the presence of esophageal varices with 89.95% diagnostic accuracy.Conclusion:  Spleen stiffness can be assessed using transient elastography, its value increasing as the liver disease progresses. In liver cirrhosis patients spleen stiffness can predict the presence, but not the grade of esophageal varices. Esophageal varices' presence can be better predicted if both spleen and liver stiffness measurements are used.
Reversal of hepatic steatosis by omega‐3 fatty acids measured non‐invasively by 1H‐magnetic resonance spectroscopy in a rat model
Authors: Marsman Hendrik A , Heger Michal , Kloek Jaap J , Nienhuis Syert L , van Werven Jochem R , Nederveen Aart J , ten Kate Fiebo JW , Stoker Jaap , van Gulik Thomas M 
Published: March 2010

AbstractBackground and Aim:  Living donors with marked (> 33%) macrovesicular steatosis (MaS) are excluded from living donor liver transplantation procedures. Experimental studies have shown that the development of steatosis can be prevented by supplementation with omega‐3 fatty acids (FA), but no studies have investigated the reduction of steatosis using omega‐3 FA. The aim of the present study was to investigate whether administration of omega‐3 FA is effective in reducing steatosis.Methods:  After fatty liver (FL) induction by a 3‐week methionine/choline‐deficient (MCD) diet, male Wistar rats were daily administered per gavage omega‐3 FA (FL+Omega‐3), omega‐3‐poor lipid solution (FL+Lipid), or NaCl (FL+NaCl) during 2 weeks. Control animals received standard chow without treatment. Determination of steatosis degree was performed before, during, and after treatment by clinical 3.0T 1H‐magnetic resonance spectroscopy (1H‐MRS) and by histology and gas chromatography at the end of the 2‐week treatment period.Results:  Hepatic fat content (1H‐MRS) was significantly reduced after 1 and 2 weeks of omega‐3 FA treatment. Histological analysis revealed a mild (5–33%) MaS degree in omega‐3‐treated animals vs severe (> 66%) MaS in the FL+Lipid and FL+NaCl groups. Hepatic omega‐6 : 3 FA ratio and total FA content were reduced in the FL+Omega‐3 group. Furthermore, de novo lipogenesis (C16, C16 : 1ω7, C18 : 1ω9) was also lowered. The reduction in hepatic fat content was associated with decreased lobular inflammation and hepatic tumor necrosis factor‐ α and interleukin levels as well as an increased antioxidative capacity.Conclusion:  Omega‐3 FA are capable of reversing severe hepatic MaS and ameliorating pathophysiological features of non‐alcoholic steatohepatitis such as hepatocellular damage, lobular inflammation, and a reduced antioxidative capacity.
Epimorphin protects hepatocytes from oxidative stress by inhibiting mitochondrial injury
Authors: Kinoshita Nobukatsu , Horie Yasuo , Ohshima Shigetoshi , Hirai Yohei , Dohmen Takahiro , Jin Mario , Matsuhashi Tamotsu , Sasaki Junko , Sasaki Takehiko , Iizuka Masahiro , Ohnishi Hirohide 
Published: March 2010

AbstractBackground and Aims:  Many investigations have demonstrated that cell injuries caused by generation of reactive oxygen species (ROS) is a common mechanism of various hepatic disorders. Recently, we have demonstrated that epimorphin, originally cloned as a mesenchymal protein, protects cultured intestinal epithelial cells from ROS. We therefore examine whether epimorphin protects primary cultured hepatocytes from ROS‐induced cell injury.Methods:  We explored the cell viability and the intracellular ROS levels of purified murine hepatocytes after exposure to 0.5 mM H2O2 with or without pretreatment of epimorphin. Then, we observed mitochondrial permeability transition (MPT) and depolarization using confocal microscopy to make clear the mechanism that epimorphin inhibited cell injuries after exposure to H2O2. In addition, to clarify the signaling pathways related to cell survival, we carried out Western blotting analysis with phosphorylated stress‐activated protein kinase/c‐Jun N‐terminal kinase (SAPK/JNK) polyclonal antibody to evaluate the inhibition of JNK by epimorphin. Finally, we evaluated the cell viability in hepatocytes administered JNK inhibitor.Results:  Epimorphin protected primary cultured hepatocytes from H2O2‐induced cell injuries independent of intracellular ROS levels. Epimorphin also inhibited onset of MPT, depolarization of the mitochondrial membrane potential, and eventually cell killing. The cell protective function of epimorphin after exposure to H2O2 was not dependent on Akt signaling but on JNK signaling.Conclusion:  Epimorphin can protect hepatocytes from MPT‐dependent cell injury induced by ROS. Since hepatic disorders could be caused by MPT‐dependent cell injuries with excessive ROS, epimorphin might open a new therapeutic avenue for hepatic disorders.
Prospective validation of the Chinese University Prognostic Index and comparison with other staging systems for hepatocellular carcinoma in an Asian population
Authors: Chan Stephen L , Mo Frankie K F , Johnson Philip J , Liem Giok S , Chan Tung C , Poon Ming C , Ma Brigette B Y , Leung Thomas W T , Lai Paul B S , Chan Anthony T C , Mok Tony S K , Yeo Winnie 
Published: March 2010

AbstractBackground and Aim:  Hepatitis B viral (HBV) infection is the predominant etiology of hepatocellular carcinoma (HCC) in Asia. Our group previously reported a staging system known as the Chinese University Prognostic Index (CUPI) for HCC populations of which HBV infection is the predominant etiology. This study aims to validate CUPI and compare with other published staging systems.Methods:  We analyzed a prospective cohort of patients with newly diagnosed HCC from 2003 to 2005. All patients were staged with CUPI, Barcelona Clinic Liver Cancer Classification (BCLC), Cancer of the Liver Italian Program score (CLIP), tumor‐node‐metastasis (TNM) and Okuda systems at diagnosis. They were followed with survival data and the performance of each staging system (in terms of homogeneity, discriminatory ability and monotonicity of gradient) were analyzed and compared.Results:  A total of 595 patients (80.2% with chronic HBV infection) were analyzed. The median follow‐up was 41.4 months and the median survival was 6.6 months. Multivariate analyses identified symptomatic disease, ascites, vascular involvement, Child‐Pugh‐stage, alpha‐fetoprotein and treatment to be the independent prognostic factors. CUPI could identify three groups with statistically significant survival difference (P < 0.0001). Both CUPI and CLIP had the most favorable performance in terms of discriminatory ability, homogeneity and monotonicity. CUPI performed the best in predicting 3‐month survival while CLIP performed better in predicting the outcome of 6‐ and 12‐month survival rate. BCLC was inferior to CLIP and CUPI in the overall performance.Conclusion:  We have validated CUPI in a population composed of predominant HBV‐related HCC. CUPI is an appropriate staging system for HBV‐related HCC. In patients with advanced HCC, both CUPI and CLIP offer good risk stratification.
Agreement of invasive versus non‐invasive blood pressure in preterm neonates is not dependent on birth weight or gestational age
Authors: Meyer Sascha , Sander Julia , Gräber Stefan , Gottschling Sven , Gortner Ludwig 
Published: March 2010

Purpose:  Blood pressure constitutes an important parameter in the assessment of the cardiovascular status in preterm infants. Invasive arterial blood pressure (IBP) is considered the ‘gold‐standard’, but non‐invasive blood pressure (NIBP) is used frequently in preterm infants. The aim of this prospective study was to compare mean IBP and mean NIBP arterial blood pressure measurements in three subsets of preterm infants (>1500 g; 1000–1500 g, and <1000 g, and >31 weeks, 28–31 weeks, and <28 weeks of gestation).Methods:  Prospective, simultaneous assessment of both IBP and NIBP measurements in 50 preterm neonates at 6, 12, 18, 24 h after birth in a tertiary University centre.Results:  Mean gestational age was 26.7 ± 2.2 (24–32) in group I (n= 18), 29.6 ± 2.0 (27–34) in group II (n= 19) and 32.2 ± 1.9(30–36) weeks in group III (n= 13), respectively; mean birth weight was 777 ± 161 (495–995), 1251 ± 154 (1010–1490) and 2010 ± 332 (1590–2550) g. Mean IBP and mean NIBP increased significantly during the first 24 h of life in all three sub‐groups (P < 0.01); IBP and NIBP measurements were significantly correlated, and showed good agreement, irrespective of birth weight and gestational age.Conclusions:  Although IBP monitoring is considered the ‘gold standard’, NIBP values showed good agreement with those obtained invasively irrespective of gestational age and birth weight. We conclude that NIBP monitoring constitutes an important parameter in the assessment of the cardiovascular status even in extremely low birth weight infants.
Improving compliance with pulse oximetry alarm limits for very preterm infants?
Authors: Mills Bernice A , Davis Peter G , Donath Susan M , Clucas Luisa M , Doyle Lex W 
Published: March 2010

Objective:  To determine if participation in a randomised controlled trial of different oxygen saturation targets improved compliance with oximeter alarm limit guidelines.Design:  Eligible infants were born after the commencement of the BOOST II trial. Data on alarm limits were collected on all infants <32 weeks' gestational age or birth weight <1500 g, who were born at The Royal Women's Hospital, Melbourne between February and June 2007, and receiving supplemental oxygen at the time of the audit. The proportions of infants in oxygen with correct alarm limits (upper 94%; lower 85% or 86%) were compared, between those in the BOOST II trial and those who were not, and with an earlier audit.Results:  Of 100 infants surveyed, 56 had received oxygen (mean gestational age at birth 26.7 weeks, mean birth weight 913 g). Compliance with lower limits was good in both periods, irrespective of post‐menstrual age or participation in the trial. Compliance with upper limits improved after trial commencement, but only for infants enrolled in the trial and only whilst they were <36 weeks' post‐menstrual age.Conclusions:  Starting a clinical trial of oxygen targeting was associated with improved compliance with upper alarm limits for participants receiving supplemental oxygen, but only whilst they were <36 weeks; with little effect outside the trial.
Delayed diagnosis of anorectal malformations: are current guidelines sufficient?
Authors: Wilson Brooke E , Etheridge Claire E , Soundappan Soundappan VS , Holland Andrew JA 
Published: March 2010

Aim:  To determine the frequency and presenting features of infants with delayed diagnosis of anorectal malformations (ARM) referred to an Australian tertiary paediatric institution.Methods:  Infants referred to our institution with a final diagnosis of ARM were retrospectively reviewed between 2001 and 2009. The first cohort consisted of patients that were referred between November 2001 and November 2006 with the diagnosis of an ARM that had been delayed for more than 48 h. The second cohort was those referred between December 2006 and May 2009 with whom the diagnosis of ARM had not been made within 24 h of birth.Results:  Nineteen infants were referred with delayed diagnosis of an ARM over the 7.5 years of the study. Of 44 patients referred to our institution between December 2006 and May 2009, diagnosis of an ARM was delayed more than 24 h in 14 (32%). There was no difference in gender, birth weight, prematurity, type of malformation or presence of associated anomalies between those with timely and delayed diagnosis of their ARM. A significantly greater proportion of those with a delayed diagnosis presented with obstructive symptoms (86% vs. 27%, P < 0.001), including abdominal distension (57%) and delayed passage of meconium or stool (29%). Despite undergoing neonatal examination, the diagnosis of ARM was missed in 12 patients overall.Conclusion:  Delayed diagnosis of an ARM appears to be common, occurring in approximately 32% of patients referred to our institution over the last 2.5 years. Current guidelines appear insufficient to ensure prompt diagnosis of ARM.
Update on tuberculous pleural effusion
Authors: LIGHT Richard W. 
Published: March 2010

ABSTRACTThe possibility of tuberculous pleuritis should be considered in every patient with an undiagnosed pleural effusion, for if this diagnosis is not made the patient will recover only to have a high likelihood of subsequently developing pulmonary or extrapulmonary tuberculosis Between 3% and 25% of patients with tuberculosis will have tuberculous pleuritis. The incidence of pleural tuberculosis is higher in patients who are HIV positive. Tuberculous pleuritis usually presents as an acute illness with fever, cough and pleuritic chest pain. The pleural fluid is an exudate that usually has predominantly lymphocytes. Pleural fluid cultures are positive for Mycobacterium tuberculosis in less than 40% and smears are virtually always negative. The easiest way to establish the diagnosis of tuberculous pleuritis in a patient with a lymphocytic pleural effusion is to generally demonstrate a pleural fluid adenosine deaminase level above 40 U/L. Lymphocytic exudates not due to tuberculosis almost always have adenosine deaminase levels below 40 U/L. Elevated pleural fluid levels of γ‐interferon also are virtually diagnostic of tuberculous pleuritis in patients with lymphocytic exudates. In questionable cases the diagnosis can be established by demonstrating granulomas or organisms on tissue specimens obtained via needle biopsy of the pleura or thoracoscopy. The chemotherapy for tuberculous pleuritis is the same as that for pulmonary tuberculosis.
Interventional radiology of the thorax
Authors: DUNCAN Mark , WIJESEKERA Nevin , PADLEY Simon 
Published: March 2010

ABSTRACTInterventional radiology of the thorax encompasses an expanding variety of procedures, ranging from simple diagnostic pleural fluid aspiration to complex therapeutic procedures such as bronchial artery embolization and radiofrequency ablation of lung tumours. Physicians of many specialties will encounter patients undergoing such procedures and knowledge of possible complications is therefore desirable. We aim to briefly outline the role of the most commonly undertaken radiological thoracic interventions and review the associated complications, their subsequent management and the steps that can be taken to minimize the risk of these complications occurring.
LONG‐TERM OUTCOME OF ENDOSCOPIC PAPILLOTOMY FOR CHOLEDOCHOLITHIASIS WITH CHOLECYSTOLITHIASIS
Authors: Fujimoto Tatsuya , Tsuyuguchi Toshio , Sakai Yuji , Sugiyama Harutoshi , Miyakawa Kaoru , Eto Reiko , Yasui Shin , Ishihara Takeshi , Yokosuka Osamu 
Published: March 2010

Aim:  To assess long‐term outcome of endoscopic papillotomy alone without subsequent cholecystectomy in patients with choledocholithiasis and cholecystolithiasis.Methods:  Retrospective review of clinical records of patients treated for choledocholithiasis and cholecystolithiasis from 1976 to 2006. Of 564 patients subjected to endoscopic papillotomy and endoscopic stone extraction, 522 patients (279 men, 243 women; mean age 66.2 years) were followed up and predisposing risk factors for late complications were analyzed.Results:  The mean duration of follow up was 5.6 years. Cholecystitis and recurrent choledocholithiasis occurred in 39 (7.5%) and 60 (11.5%) patients, respectively. Cholecystitis, including one severe case, resolved with conservative treatment. Recurrent choledocholithiasis was successfully treated endoscopically except in one case. Pneumobilia was found to be a significant risk factor for cholecystitis (P = 0.019) and recurrent choledocholithiasis (P = 0.013). Biliary tract cancer occurred in 16 patients; gallbladder cancer in 13 and bile duct cancer in three. Gallbladder cancer developed within 2 years after endoscopic papillotomy in seven of the 13 patients (53.8%).Conclusion:  Pneumobilia was the only significant risk factor for cholecystitis and recurrent choledocholithiasis in our study population. As for the long‐term outcome, it was unclear whether endoscopic papillotomy contributed to the occurrence of biliary tract cancer.
ENDOSCOPIC IDENTIFICATION OF HELICOBACTER PYLORI GASTRITIS IN CHILDREN
Authors: Hidaka Nao , Nakayama Yoshiko , Horiuchi Akira , Kato Sawako , Sano Kenji 
Published: March 2010

Aim:  The role of endoscopic findings in deciding whether to biopsy the gastric mucosa of children remains unclear. The present study attempted, for the first time, to identify the value of endoscopic features for diagnosis of Helicobacter pylori (Hp) infection in children.Methods:  Hp status of consecutive children receiving esophagogastroduodenoscopy (EGD) was established by combinations of histology, 13C‐urea breath test, and serum Hp immunoglobulin (Ig)G antibody. After routine EGD using a conventional endoscope, the presence of RAC (regular arrangement of collecting venules) was scored by close observation, which was carried out at two sites of lower corpus lesser curvature and upper corpus greater curvature. RAC‐positive was defined as the presence of minute red points in a regular pattern. Antral nodularity was also scored as present/absent.Results:  Eighty‐seven consecutive children (38 boys, median age 13 years, range 9–15 years) were evaluated; 25 (29%) were Hp positive. Antral nodularity was seen in 21 (84%) all of whom were Hp positive. The RAC‐negative pattern based on examination of the upper and lower corpus yielded a sensitivity, specificity, positive predictive value and negative predictive value for the presence of Hp infection of 100%, 90%, 81%, and 100%. Magnifying endoscopy confirmed that the RAC pattern corresponded to collecting venules in the gastric corpus.Conclusions:  The absence of RAC pattern suggests that gastric mucosa biopsies should be taken despite otherwise normal‐appearing gastric mucosa for the diagnosis of Hp infection in children.