bluuebunny/crossref_metadata_2025_split huggingface dataset:
Liver histopathology in human immunodeficiency virus–hepatitis C virus co‐infected patients with fatal liver disease
Authors: LICHTERFELD MATHIAS , HAAS SUSANNE , FISCHER HANS‐PETER , VOIGT ESTER , ROCKSTROH JÜRGEN K , SPENGLER ULRICH 
Published: April 2005

AbstractBackground:  Liver failure is an increasing cause of death in human immunodeficiency virus–hepatitis C virus (HIV–HCV) co‐infected patients. Here, histopathological features of fatal liver disease in HIV–HCV co‐infected patients were comparatively assessed.Methods:  Liver biopsies of seven HIV–HCV co‐infected patients with clinically imminent liver death and advanced immune deficiency were studied. Biopsies of seven asymptomatic patients with stable hepatic and immune functions, who were matched according to their documented duration of HIV–HCV co‐infection, served as controls. Inflammatory and fibrotic changes as well as hepatocellular steatosis and cholestasis were assessed semiquantitatively by established scores.Results:  All patients with fatal liver disease had severe immunodeficiency and jaundice, while biliary ducts were patent. Unexpectedly, the extent of hepatic steatosis, inflammatory activity and fibrosis was strikingly similar in both study groups. Importantly, liver failure was observed even in the absence of marked fibrosis. Lobular bilirubinostasis was the only feature that significantly distinguished patients with advanced immunodeficiency and fatal liver disease from the control group.Conclusion:  Thus, rapid deterioration of liver function and death can occur in HIV–HCV co‐infected patients with advanced immunodeficiency even when liver histology does not reveal markers of end‐stage liver disease. Jaundice and marked bilirubinostasis in the absence of biliary tract obstruction seem to herald this complication of chronic hepatitis C in HIV infection.
Impaired capsaicin and neurokinin‐evoked colonic motility in inflammatory bowel disease
Authors: SMITH ALICIA S , SMID SCOTT D 
Published: April 2005

AbstractBackground:  Inflammatory bowel disease (IBD) is associated with altered sensory and motor function in the human colon. The aim of the present study was to compare neuromuscular function in normal and IBD‐affected colon in vitro, with emphasis on inhibitory enteric nerves, sensory neuropeptides and stimulation of axon collaterals.Methods:  Strips of longitudinal and circular muscle were prepared following colectomy from six patients with intestinal carcinoma (mean age 64.2 ± 4.8 years) and six patients with IBD (Crohn's disease, n = 3; ulcerative colitis, n = 3: mean age 35.8 ± 5.7 years). Responses were measured to electrical field stimulation, potassium chloride, 1,1‐dimethyl‐4‐phenylpiperazinium iodide, isoprenaline, calcitonin gene‐related peptide (CGRP), capsaicin and neurokinin (NK)‐1 and ‐2 receptor subtype‐specific agonists, alone or after muscle precontraction.Results:  The NK‐1 and CGRP receptor‐mediated relaxation was reduced in the circular (by 44%, P < 0.05) and longitudinal (by 61%, P < 0.05) muscle from IBD‐affected colon, respectively. Maximal NK‐2 receptor‐mediated contraction was also significantly decreased in both longitudinal (71%, P < 0.001) and circular (51%, P < 0.01) muscle. Capsaicin evoked relaxation in precontracted colonic longitudinal and circular muscle; this was significantly diminished in the IBD‐affected colon (by 63%, P < 0.001 and 76%, P < 0.01, respectively). Responses evoked by stimulation of enteric inhibitory nerves were not significantly altered.Conclusions:  Colonic muscle strips from patients with IBD exhibited impaired CGRP and NK‐1 receptor‐mediated relaxation and NK‐2 receptor‐mediated contraction. Capsaicin‐activated relaxation of colonic smooth muscle is deficient in IBD‐affected colon. These results suggest a discrete effect of IBD on sensory‐motor coupling and tachykinin‐mediated effects on colonic motility.
Antiviral therapy in advanced chronic liver disease due to hepatitis C virus infection: Pilot study
Authors: KUMAR RAKESH , KUMAR SUDHEER , SHARMA BARJESH CHANDER , SINGH JAGDEEP , SARIN SHIV K 
Published: April 2005

AbstractBackground:  Antiviral therapy has not been adequately evaluated in patients with hepatitis C virus (HCV)‐related advanced liver disease due to apprehensions of adverse events and intolerance. The titrable dose of interferon (IFN)‐α and ribavirin was evaluated in a flexible regimen in a pilot study.Methods:  Twenty‐five patients with HCV‐related advanced chronic liver disease received IFN‐α 1–3 MIU daily with ribavirin 200–600 mg daily for 9 months−3 years. Careful assessment of safety, tolerability and efficacy was made.Results:  Improvement in Child–Pugh score (8.4 ± 1.2 to 7.4 ± 2.0; P = 0.010) and serum albumin (3.0 ± 0.5 g/dL to 3.6 ± 0.5 g/dL; P = 0.007) occurred at follow up after antiviral therapy (median dose and duration: IFN‐α 1.5 MIU/day for 12 months and ribavirin 400 mg/day for 7.5 months) as compared to baseline. Ascites regressed in 53% of patients (11/21). Thirteen patients (52%) lost HCV‐RNA on therapy and eight (32%) achieved sustained virological response (SVR). Death occurred in three patients (12%) while on therapy, in two due to infection. No patient died in the responder group compared to five deaths (29%) in the non‐responder group. However, there was no difference in the cumulative probability of survival in the sustained virological responder versus non‐responder (P = 0.09). Adverse events were common (92%), but permanent withdrawal was required in only five patients (20%).Conclusions:  Low and titrable dose IFN‐α and ribavirin therapy in patients with HCV‐related advanced chronic liver disease achieves improvement in hepatic synthetic function, Child–Pugh score and ascites. However, close monitoring for serious adverse events is warranted.
Push enteroscopy alters management in a majority of patients with obscure gastrointestinal bleeding
Authors: NGUYEN NAM Q , RAYNER CHRISTOPHER K , SCHOEMAN MARK N 
Published: April 2005

AbstractIntroduction:  Although enteroscopy has been increasingly used to investigate occult or obscure bleeding, little is known about its impact on patient management. The aim of the present paper was to evaluate both the diagnostic yield and the impact of push enteroscopy on the management of patients referred to a tertiary Australian institution.Methods:  Data were collected prospectively in all patients undergoing push enteroscopy at Royal Adelaide Hospital. Fifty‐five patients were investigated for obscure gastrointestinal (GI) bleeding (25 women, mean age 65.6 years), the cause of which remained unknown despite previous gastroscopy and colonoscopy. The patients were divided into two groups: occult‐obscure (anemia without macroscopic blood loss) and overt‐obscure (macroscopic bleeding). Findings at enteroscopy, therapeutic procedures, and complications were recorded. Patients were followed to establish the impact of the procedure on subsequent management and clinical outcome.Results:  Enteroscopy demonstrated a potential site of bleeding in 38 patients (69%), and 38% of lesions found were within the reach of the gastroscope. The most common lesions were small intestinal angiodysplasia. Seventy‐five percent of patients with positive findings had alterations to their management. After subsequent treatment, 62% were no longer anemic and there was a significant reduction in rebleeding (P < 0.05) and transfusion requirements (P < 0.05) compared to patients with negative findings. The procedure was well tolerated and complications were rare.Conclusion:  Enteroscopy has a positive impact on patient management and clinical outcome in a majority of patients with obscure gastrointestinal bleeding.
Upregulation of transferrin receptor 2 and ferroportin 1 mRNA in the liver of patients with chronic hepatitis C
Authors: TAKEO MASAKI , KOBAYASHI YOSHINAO , FUJITA NAOKI , URAWA NAOHITO , IWASA MOTOH , HORIIKE SHINICHIRO , TANAKA HIDEAKI , KAITO MASAHIKO , ADACHI YUKIHIKO 
Published: April 2005

AbstractBackground:  Iron accumulation has been reported to be associated with progression of liver injury. The mechanism of iron accumulation in the liver is not known. In the present study, hepatic messenger RNA (mRNA) expression of transferrin receptor (TfR)1, TfR2, and ferroportin (FP)1 was measured in patients with chronic hepatitis (CH).Methods:  Eleven patients with CH‐B and 43 patients with CH‐C were enrolled. All patients underwent liver biopsy. Hepatic expression of TfR1, TfR2 and FP1 mRNA was analyzed using a real‐time polymerase chain reaction. Total hepatic iron score (THIS) was evaluated by Prussian blue staining.Results:  Serum ferritin concentration is significantly higher in CH‐C than in CH‐B. Values of THIS of ≥5 were observed only in CH‐C patients (44% of CH‐C patients). The expression level of TfR2 mRNA was 10–26‐fold higher than the TfR1 mRNA expression level. The TfR2 and FP1 mRNA expression was significantly higher in CH‐C than in CH‐B patients. Hepatic expression of TfR2 and FP1 mRNA was well correlated with THIS.Conclusions:  Hepatic iron accumulation is more severe in patients with CH‐C. Upregulation of hepatic iron transporters may contribute to the hepatic iron accumulation in CH‐C.
Severe acute respiratory syndrome‐related diarrhea
Authors: KWAN AMBROSE CHI‐PONG , CHAU TAI‐NIN , TONG WING‐LOK , TSANG OWEN TAK‐YIN , TSO EUGENE YUK‐KEUNG , CHIU MING‐CHI , YU WAI‐CHO , LAI THOMAS SIK‐TO 
Published: April 2005

AbstractBackground:  Severe acute respiratory syndrome (SARS) is an emerging infectious disease and diarrhea has been reported in up to 76% of cases. The purpose of the present paper was to carry out a retrospective study of the clinical and demographic data of SARS patients with diarrhea in Princess Margaret Hospital.Methods:  From 1 to 31 March 2003, hospital records from 240 patients with confirmed SARS were studied. Patients with watery stool of ≥3 times/day for at least 3 consecutive days were defined as the diarrhea group. Clinical and demographic data were compared between the diarrhea and non‐diarrhea groups. Chest X‐ray (CXR) scores during the peak of diarrhea period were recorded by a respiratory physician. These CXR scores were correlated with the peak frequency of diarrhea by Spearman's correlation coefficient.Results:  Diarrhea occurred in 20.4% of patients after admission. Female patients were predominant with a female to male ratio of 6:1 (P < 0.001) and 69.4% of patients were living in Amoy Gardens Estate (P = 0.01). The proportions of patients requiring ventilatory care and mortality in the diarrhea group were 8.2% and 2%, respectively, which were significantly lower than those in the non‐diarrhea group (27.6% and 16.2%, P < 0.005). The CXR scores during the peak of diarrhea were not correlated with the maximum frequency of diarrhea (r = −0.09, P = 0.5).Conclusions:  A total of 20.4% of SARS patients had the complication of diarrhea after hospital admission. Both female sex and being a resident of Amoy Gardens Estate were associated with diarrhea. The diarrhea group had a better prognosis.
Diagnosis of gastroesophageal reflux disease using a new questionnaire
Authors: SHIMOYAMA YASUYUKI , KUSANO MOTOYASU , SUGIMOTO SAYAKA , KAWAMURA OSAMU , MAEDA MASAKI , MINASHI KEIKO , KURIBAYASHI SHIKOU , HIGUCHI TATSUYA , ZAI HIROAKI , INO KYOKO , HORIKOSHI TSUTOMU , MOKI FUMITAKA , SUGIYAMA TADASHI , TOKI MUNETOSHI , OHWADA TSUNEO , MORI MASATOMO 
Published: April 2005

AbstractBackground and Aim: An early and accurate evaluation by a general practitioner is needed to screen out non‐gastroesophageal reflux disease (GERD) patients. A recent questionnaire (QUEST) highlighted problems with specificity and complexity, so the aim of the present study was to design a simplified questionnaire.Methods: When admitted to hospital to undergo an upper gastrointestinal endoscopy for suspected GERD, 333 patients completed a 50‐item questionnaire requiring ‘yes/no’ answers to different combinations of questions relating to symptoms of upper gastrointestinal tract conditions (e.g. GERD, ulcers and functional dyspepsia) and psychosomatic symptoms. The endoscopic diagnosis was then correlated with the rate of positive answers to each question.Results: Based on the analysis of the 50 items, the 8–10 questions most often answered affirmatively by each of the GERD and non‐GERD groups were chosen for the simplified questionnaire. Three draft questionnaires were compiled. After calculating the sensitivity, specificity and accuracy in relation to the diagnosis of GERD and other conditions, it was found that questionnaire B (selection of persons answering ‘yes’ to at least one of questions 1–5 and exclusion of persons answering ‘yes’ to at least three of questions 7–10) had a high sensitivity, high specificity and low false positive rate.Conclusion: A novel questionnaire was developed. It was designed to detect the symptoms of GERD while simultaneously excluding non‐GERD patients. This simplified nine‐item simplified questionnaire had a sensitivity of 79.8%, a specificity of 53.6% and an accuracy of 63.4%.
Influence of juxtapapillary diverticulum on hepatic clearance in patients after endoscopic sphincterotomy
Authors: TZENG JENG‐JIE , LAI KWOK‐HUNG , PENG NAN‐JING , LO GIN‐HO , LIN CHIUN‐KU , CHAN HOI‐HUNG , HSU PING‐I , CHENG JIN‐SHIUNG , WANG E‐MING 
Published: April 2005

AbstractBackground and Aim:  The role of juxtapapillary diverticulum ( JPD) in biliary stone formation is controversial. This study was designed to understand the relationship between the size of JPD, hepatic clearance and recurrent bile duct stones in patients after endoscopic sphincterotomy.Methods:  Five hundred and twenty patients with choledocholithiasis who had received endoscopic sphincterotomy were enrolled. They were divided into three groups: group A (n = 268) without diverticula; group B (n = 156) with small diverticula; and group C (n = 96) with large diverticula. All patients were regularly followed with interviews, liver function test and sonogram to detect the recurrent bile duct stones. Quantitative cholescintigraphy was performed in 176 cholecystectomized patients to evaluate the hepatic clearance. Sphincter of Oddi manometry was performed to exclude incomplete sphincterotomy if quantitative cholescintigraphy was abnormal.Results:  After 9–111 months of follow‐up, 76 patients had recurrent bile duct stones. There was a significant higher bile duct stone recurrence in group C than in group A (P < 0.01), but no statistical difference was noted between group B and group A (P = 0.2). Patients with JPD were older than those without (P < 0.05). Of 176 cholecystectomized patients, two were excluded because sphincter of Oddi basal pressure was more than 10 mmHg. In the remaining 174 patients, the E45′ was significantly lower in group C than in group A (41.2% ± 18.6%vs 49.1% ± 14.1%; P < 0.05), and there was no significant difference between group B and group A.Conclusions:  JPD is a predisposing factor of delayed biliary emptying and it increases the chance and incidence of recurrent bile duct stones.
Distribution of Helicobacter pylori cagA, cagE and vacA in different ethnic groups in Kuala Lumpur, Malaysia
Authors: TAN HUCK JOO , RIZAL ABDUL MANAF , ROSMADI MOHAMED‐YUSOFF , GOH KHEAN‐LEE 
Published: April 2005

AbstractBackground and Aims:  There is a geographic variation in Helicobacter pylori (HP) genotypes and virulence factors. Cytotoxin associated genes A (cagA) and E (cagE), and certain vacuolating cytotoxin (vacA) genotypes are associated with peptic ulcer disease (PUD). There is also a different prevalence of PUD among different ethnic groups in Malaysia. The present study compared the distribution of vacA alleles and cagA and cagE status in three ethnic groups residing in Kuala Lumpur, Malaysia, and their association with clinical outcome.Methods:  All patients with cultured positive HP were recruited prospectively. DNA was extracted and polymerase chain reaction was carried out to determine the cagA and cagE status and vacA alleles.Results:  The results of 127 patients (72 men and 55 women) were included. The mean age was 55.53 ± 12.52 years. The ethnic distribution was 59 Chinese, 38 Indian and 30 Malay patients. The predominant genotype was s1a among the Malay (76.6%) and Indian patients (71.0%), and s1c among the Chinese patients (66.1%). The vacA middle region sequence m1 was detected in 66.7% of Malay, 54.2% of Chinese and 76.3% of Indian patients. Of the Malay, Chinese and Indian patients, 76.6%, 86.4% and 86.8%, respectively, were cagA positive, and 70.0%, 39.0% and 81.6%, respectively, were cagE positve. HP cagA, cagE and vacA were not associated with PUD.Conclusion:  There is a distinctive difference in the HP strains among the three ethnic groups in Malaysia. There was no association between cagA, cagE or vacA genotypes and clinical outcome in the patients. None of these markers are helpful in predicting the clinical presentation of a HP infection.
Combination therapy with interferon‐α and ribavirin in patients with dual hepatitis B and hepatitis C virus infection
Authors: HUNG CHAO‐HUNG , LEE CHUAN‐MO , LU SHENG‐NAN , WANG JING‐HOUNG , TUNG HUNG‐DA , CHEN CHIEN‐HUNG , CHANGCHIEN CHI‐SIN 
Published: April 2005

AbstractBackground:  Patients with dual hepatitis B virus (HBV) and hepatitis C virus (HCV) infection have responded poorly to interferon (IFN) monotherapy. The purpose of the present paper was to assess the effect of combined IFN‐α and ribavirin therapy in patients infected with both hepatitis B and C.Methods:  Thirty‐six patients received 3 or 5 MU IFN‐α‐2b thrice weekly and oral ribavirin (800–1200 mg/day) for 24 weeks. All patients had positive hepatitis B surface antigen, antibody to HCV, and HCV‐RNA. Before treatment, one patient had positive hepatitis B e antigen. Eighteen patients had positive HBV‐DNA tested by Amplicor (Cobas Amplicor Monitor, Roche Diagnostics, Branchburg, NJ, USA), with a mean HBV‐DNA level of 3.1 ± 0.9 log copies/mL. Another 72 patients with HCV infection alone served as controls.Results:  Adverse events led to withdrawal in three patients receiving 5 MU IFN. Based on an intent‐to‐treat analysis, the biochemical response and serum HCV clearance rate at the end of 48 weeks follow up was similar in patients with dual infection and HCV infection alone (56% vs 72%; and 69% vs 71%, respectively). There was no significant difference in sustained HCV clearance rate between the 3‐MU group (n = 13) and the 5‐MU group (n = 23; 85% vs 61%). At the end of 48 weeks follow up, two (11%) of 18 pretreatment viremic patients had negative serum HBV‐DNA (<200 copies/mL), while eight of those without pretreatment viremia had reoccurrence of HBV‐DNA.Conclusions:  Combination therapy with IFN‐α and ribavirin was effective in achieving sustained HCV clearance in patients with dual HBV and HCV infection, comparable to those with hepatitis C infection alone. Combination therapy using 3 MU IFN‐α seemed as effective as 5 MU, and was well tolerated in the study population. However, large‐scale control trials are necessary to clarify these findings.
Biliary excretion of olmesartan, an anigotensin II receptor antagonist, in the rat
Authors: TAKAYANAGI MOTOE , SANO NAOYO , TAKIKAWA HAJIME 
Published: April 2005

AbstractBackground and Aim:  Olmesartan (RNH‐6270) is a newly developed anigotensin II receptor antagonist, and has been reported to be excreted into feces. To examine the mechanism of the biliary excretion of olmesartan, we studied its biliary excretion in rats.Methods:  The biliary excretion of olmesartan in Eisai hyperbilirubinemic rats (EHBR), a multidrug resistance protein 2‐deficient rat, was compared with control rats, and the effect of organic anions and cation and bile acids on the biliary excretion of olmesartan was studied in control rats.Results:  The biliary excretion of olmesartan was markedly delayed in EHBR. The biliary excretion of olmesartan was inhibited by sulfobromophthalein, cefpiramide and pravastatin, but was not inhibited by taurocholate or tauroursodeoxycholate. Vinblastine inhibited and phenothiazine treatment increased the biliary excretion of olmesartan.Conclusions:  These findings suggest that olmesartan is excreted into the bile mainly by multidrug resistance protein 2 and partly by P‐glycoprotein.
Risk factors for the development of hepatocellular carcinoma among patients with chronic hepatitis C who achieved a sustained virological response to interferon therapy
Authors: TOKITA HAJIME , FUKUI HIDEO , TANAKA AKIHISA , KAMITSUKASA HIROSHI , YAGURA MICHIYASU , HARADA HIDEHARU , OKAMOTO HIROAKI 
Published: April 2005

AbstractBackground and Aim:  Hepatitis C virus (HCV)‐infected patients who responded to interferon (IFN) treatment with clearance of serum HCV RNA may rarely develop hepatocellular carcinoma (HCC). The aim of the present study was to elucidate the risk factors for liver carcinogenesis among such patients.Methods:  In total, 126 patients with chronic hepatitis C (CHC) who achieved a sustained virological response (SVR) to IFN monotherapy, which was defined as the absence of detectable HCV RNA in the serum at 6 months after completion of treatment, were enrolled and possible risk factors for HCC were analyzed.Results:  During the observation period of 66 ± 36 months after cessation of IFN treatment, five (4.0%) of the 126 patients developed HCC. The cumulative incidence of HCC at 3, 5 and 10 years was estimated to be 0.9, 4.7 and 7.5%, respectively. The cumulative incidence of HCC was significantly higher among patients with severe fibrosis (F3 or F4) than among patients with no or mild fibrosis (F0 to F2) in the liver before treatment (P = 0.007); among patients with alcohol intake of ≥ 27 g/day than among patients with that of < 27 g/day (P = 0.015); and among patients who were ≥ 65 years old than among patients who were < 65 years old at the start of treatment (P = 0.026).Conclusions:  Patients with CHC who had severe fibrosis, who had regularly taken moderate amounts of alcohol, or who were ≥ 65 years at the start of IFN treatment should be carefully followed to detect small and controllable HCC, even after eradication of HCV.
Clinical significance of microsatellite instability in the inflamed mucosa for the prediction of colonic neoplasms in patients with ulcerative colitis
Authors: TAHARA TOSHIYUKI , INOUE NAGAMU , HISAMATSU TADAKAZU , KASHIWAGI KAZUHIRO , TAKAISHI HIROMASA , KANAI TAKANORI , WATANABE MAMORU , ISHII HIROMASA , HIBI TOSHIFUMI 
Published: April 2005

AbstractBackground and Aim:  Although molecular mechanisms underlying ulcerative colitis (UC)‐associated neoplasms have been studied for years, understanding of these mechanisms remains incomplete and no good predictable marker for development of colonic neoplasms in patients with UC has been established. The aim of this study was to assess if microsatellite instability (MSI) contributes to the development of colonic neoplasms in patients with UC.Methods:  We have examined MSI in chronic inflamed and neoplastic colonic mucosa of UC patients. We have also obtained serial biopsied colonic tissues retrospectively 2–12 years before the final diagnosis from patients with high level MSI (MSI‐H+) UC‐associated neoplasms, and analyzed MSI using them at different periods.Results:  Eight of 12 UC‐associated colon cancers (67%), four of six UC‐associated high grade dysplasias (67%), and two of six UC‐associated low grade dysplasias (33%) revealed MSI‐H+ phenotypes. In contrast, 15 of 59 lesions (25%) in inflamed UC mucosa without colonic neoplasm revealed MSI‐H +. Interestingly, all four patients with MSI‐H+ phenotypes at the final diagnosis of UC‐associated colon cancer or dysplasia had already had MSI‐H+ at the stage of chronic colitis, 2–12 years before the final diagnosis.Conclusion:  These results support the notion that MSI contributes to the carcinogenesis of UC‐associated neoplasms, and indicate that this analysis in inflamed colonic mucosa at surveillance colonoscopy is useful for identifying UC patients who have high risk for neoplastic progression.