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A Population-Based Cross-Sectional Study of the Association between Liver Enzymes and Lipid Levels. 一项基于人群的肝酶和脂质水平之间关系的横断面研究。
IF 1.8 Q3 Medicine Pub Date : 2018-06-03 eCollection Date: 2018-01-01 DOI: 10.1155/2018/1286170
Subrata Deb, Prasanth Puthanveetil, Prashant Sakharkar

Background: To examine the association between low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels and liver enzyme functions.

Methods: The National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2012 was used to examine the association between liver enzymes and lipid levels amongst adults in the United States.

Results: Sixteen percent adults had ALT > 40 U/L, 11% had AST > 40 U/L, and 96% had ALP > 120 U/L. Age, gender, and race/ethnicity showed significant association with LDL, HDL, and triglycerides levels. LDL greater than borderline high was associated with little over two times higher odds of elevated ALT (OR: 2.33, 95% CI: 2.17, 2.53, p ≤ 0.001) and AST (OR: 2.79, 95% CI: 2.55, 3.06, p ≤ 0.001). High HDL was associated with 50% higher odds for elevated ALT (OR: 1.51, 95% CI: 1.39, 1.64, p ≤ 0.001) and over two-and-half fold elevated AST (OR: 2.77, 95% CI: 2.47, 3.11, p ≤ 0.001). LDL-C, HDL-C, and triglycerides were found to be good predictor of elevated ALT, AST, and ALP levels. Similarly, old age and female gender were significant predictor of elevated ALT and AST (p ≤ 0.001).

Conclusions: Underlying hepatic pathophysiology from dyslipidemia deserves further exploration due to its potential effects on hepatic drug metabolism/detoxification.

背景:研究低密度脂蛋白(LDL)和高密度脂蛋白(HDL)水平与肝酶功能之间的关系。方法:使用1999年至2012年美国国家健康与营养调查(NHANES)的数据来研究美国成年人肝酶和脂质水平之间的关系。结果:成人ALT > 40 U/L占16%,AST > 40 U/L占11%,ALP > 120 U/L占96%。年龄、性别和种族/民族与低密度脂蛋白、高密度脂蛋白和甘油三酯水平显著相关。LDL高于临界高与ALT升高(OR: 2.33, 95% CI: 2.17, 2.53, p≤0.001)和AST升高(OR: 2.79, 95% CI: 2.55, 3.06, p≤0.001)的几率增加略高于2倍。高HDL与ALT升高的几率增加50% (OR: 1.51, 95% CI: 1.39, 1.64, p≤0.001)和超过2.5倍的AST升高相关(OR: 2.77, 95% CI: 2.47, 3.11, p≤0.001)。LDL-C、HDL-C和甘油三酯被发现是ALT、AST和ALP水平升高的良好预测因子。同样,年龄和女性是ALT和AST升高的显著预测因子(p≤0.001)。结论:血脂异常对肝脏药物代谢/解毒的潜在影响值得进一步探讨。
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引用次数: 12
Amelioration of Single Clove Black Garlic Aqueous Extract on Dyslipidemia and Hepatitis in Chronic Carbon Tetrachloride Intoxicated Swiss Albino Mice. 单瓣黑蒜水提物对慢性四氯化碳中毒瑞士白化小鼠血脂异常和肝炎的改善作用。
IF 1.8 Q3 Medicine Pub Date : 2018-05-02 eCollection Date: 2018-01-01 DOI: 10.1155/2018/9383950
Gia-Buu Tran, Sao-Mai Dam, Nghia-Thu Tram Le

Single clove garlic is the product of atypical bulbing process of garlic under specific conditions. Therefore, the number of researches on single clove garlic bioactivity is limited. Recently, the hepatoprotective effect of single clove garlic has been demonstrated. In this study, we investigated amelioration of single clove black garlic aqueous extract, a processed product from single clove garlic, on dyslipidemia and hepatitis induced by chronic administration of CCl4. Mice were randomly divided into four groups: control, extract control, CCl4 intoxication, and coadministrated CCl4 and extract group. Mice were orally given a dose of 1 ml/kg body weight of CCl4 for 28 days twice a week to establish chronic liver injury model. To evaluate the hepatoprotective effect of single clove black garlic, mice were cotreated with CCl4 and single clove black garlic extract (200 mg/kg body weight) via gastric gauge for 30 days. Cotreatment with CCl4 and extract could improve the changes of body weight, liver weight, and relative liver weight as compared to CCl4 intoxicated mice. Single clove black garlic ameliorated dyslipidemia and the elevation of ALT and AST levels induced by chronic CCl4 intoxication. Histological studies revealed that single clove black garlic could prevent mononuclear cells infiltration and hepatocyte necrosis.

单瓣大蒜是大蒜在特定条件下非典型成球过程的产物。因此,对单瓣大蒜生物活性的研究数量有限。最近,单瓣大蒜的保肝作用得到了证实。本研究探讨了单瓣黑蒜水提物对慢性CCl4诱导的血脂异常和肝炎的改善作用。将小鼠随机分为4组:对照组、提取物对照组、CCl4中毒组和CCl4与提取物共给药组。小鼠按1 ml/kg体重口服CCl4 28 d,每周2次,建立慢性肝损伤模型。为评价单瓣黑蒜的肝保护作用,采用胃计法将CCl4与单瓣黑蒜提取物(200 mg/kg体重)共处理30 d。与CCl4中毒小鼠相比,CCl4与提取物共处理可改善小鼠体重、肝脏重量和相对肝脏重量的变化。单瓣黑蒜可改善慢性CCl4中毒引起的血脂异常及ALT和AST水平升高。组织学研究表明,单瓣黑蒜具有预防单核细胞浸润和肝细胞坏死的作用。
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引用次数: 25
A Seven-Year Retrospective Study on the Surveillance of Hepatitis B in Laos. 老挝乙型肝炎监测7年回顾性研究。
IF 1.8 Q3 Medicine Pub Date : 2018-04-01 eCollection Date: 2018-01-01 DOI: 10.1155/2018/9462475
Phimpha Paboriboune, Thomas Vial, François Chassagne, Philavanh Sitbounlang, Sengaloun Soundala, Stéphane Bertani, Davone Sengmanothong, Francois-Xavier Babin, Nicolas Steenkeste, Paul Dény, Pascal Pineau, Eric Deharo

Objective: Lao PDR is one of the most highly endemic countries for hepatitis B in Asia and the second country for liver cancer incidence. Therefore, the follow-up of infected individuals through predictive serological markers is of utmost importance to monitor the progression of the pathology and take the decision on treatment.

Methods: A retrospective-descriptive cohort study was conducted on 3,857 HBV-infected patients. Information about infection status (viral load, VL), liver function (aminotransferases), and treatments was recorded.

Results: M/F sex ratio was 1.77 for a median age of 37. Patients under 37 displayed higher VL than older ones and men had higher VL than women. Initial VL ranged from <50 IU/mL to 2.5 1013 IU/mL. Median aminotransferase values were 45.5 U/L for ALAT and 44 U/L for ASAT, ranging from <8 to >2,000 U/L. Men had higher aminotransferase than women. Globally 20% of patients received treatment (mainly immunostimulant and reverse-transcriptase inhibitors); 11% had high levels of VL and liver enzymes, but only 2% of them were treated.

Conclusion: Public health decisions should be taken urgently to rationalise vaccination and provide fair access to early diagnosis and treatment; otherwise the burden of HBV-associated diseases will be overwhelming for Laos in the near future.

目的:老挝人民民主共和国是亚洲乙型肝炎高发国家之一,也是肝癌发病率第二高的国家。因此,通过预测血清学标志物对感染者进行随访,对于监测病理进展和决定治疗至关重要。方法:对3857例hbv感染患者进行回顾性描述队列研究。记录感染状态(病毒载量、VL)、肝功能(转氨酶)和治疗情况。结果:男/女性别比为1.77,中位年龄37岁。37岁以下的患者VL高于年龄较大的患者,男性VL高于女性。初始VL为13 IU/mL。ALAT的中位转氨酶值为45.5 U/L, ASAT的中位转氨酶值为44 U/L,范围为2000 U/L。男性的转氨酶高于女性。全球20%的患者接受了治疗(主要是免疫刺激剂和逆转录酶抑制剂);11%的人有高水平的VL和肝酶,但只有2%的人得到了治疗。结论:应紧急作出公共卫生决定,使疫苗接种合理化,并提供公平的早期诊断和治疗机会;否则,在不久的将来,乙肝病毒相关疾病的负担将使老挝不堪重负。
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引用次数: 8
Sofosbuvir Plus Daclatasvir in Treatment of Chronic Hepatitis C Genotype 4 Infection in a Cohort of Egyptian Patients: An Experiment the Size of Egyptian Village. 索非布韦加达卡他韦治疗埃及慢性丙型肝炎基因型 4 型感染:埃及村庄大小的实验。
IF 1.8 Q3 Medicine Pub Date : 2018-03-20 eCollection Date: 2018-01-01 DOI: 10.1155/2018/9616234
Ossama Ashraf Ahmed, Eslam Safwat, Mohamed Omar Khalifa, Ahmed I Elshafie, Mohamed Hassan Ahmed Fouad, Mohamed Magdy Salama, Gina Gamal Naguib, Mohamed Mahmoud Eltabbakh, Ahmed Fouad Sherief, Sherief Abd-Elsalam

Background and aims: As indicated by the World Health Organization (WHO), Egypt is positioned as the country with the world's highest prevalence of Hepatitis C virus (HCV). HCV is transmitted through unexamined blood transfusions, different employments of syringes, and poor cleansing, as per the WHO. Our study aimed at screening and management of chronic hepatitis C genotype 4 infected patients in Bardeen village, Sharkeya Governorate, Egypt, with Sofosbuvir plus Daclatasvir, as well as estimating the safety and efficacy of that regimen.

Methods: Screening of adult patients in Bardeen village was done from March 2016 till November 2016 using hepatitis C virus antibodies by third-generation ELISA testing. Positive results were confirmed by PCR. Patients eligible for treatment received Sofosbuvir 400 mg and Daclatasvir 60 mg daily for 12 weeks and were assessed for sustained virologic response at 12 weeks following the end of treatment (SVR 12).

Results: Out of 2047 subjects screened for hepatitis C virus, 249 (12.2%) showed positive results. 221 out of those 249 subjects (88.7%) had detectable RNA by PCR. Treatment of eligible patients (183 patients) with Sofosbuvir plus Daclatasvir for 12 weeks resulted in 96% achievement of sustained virologic response at week 12. Adverse events were tolerable.

Conclusion: Sofosbuvir plus Daclatasvir regimen is safe and effective for treatment of chronic hepatitis C Genotype 4 infected patients with minimal adverse events. HCV eradication program implemented in Egypt can be a model for other countries with HCV and limited resources. The availability of generic drugs in Egypt will help much in eradication of the virus.

背景和目的:世界卫生组织(WHO)指出,埃及是世界上丙型肝炎病毒(HCV)感染率最高的国家。世卫组织指出,丙型肝炎病毒(HCV)通过未经检查的输血、使用不同的注射器以及清洁不善等途径传播。我们的研究旨在用索非布韦加达卡他韦对埃及沙尔基亚省 Bardeen 村的慢性丙型肝炎基因 4 型感染者进行筛查和治疗,并评估该治疗方案的安全性和有效性:2016年3月至2016年11月,通过第三代ELISA检测丙型肝炎病毒抗体,对Bardeen村的成年患者进行筛查。阳性结果通过 PCR 进行确认。符合治疗条件的患者每天接受索非布韦 400 毫克和达卡他韦 60 毫克的治疗,为期 12 周,并在治疗结束后 12 周进行持续病毒学应答评估(SVR 12):在接受丙型肝炎病毒筛查的 2047 名受试者中,有 249 人(12.2%)结果呈阳性。在这 249 名受试者中,有 221 人(88.7%)通过 PCR 检测到了 RNA。索非布韦联合达卡他韦治疗符合条件的患者(183人)12周后,96%的患者在第12周时获得了持续病毒学应答。不良反应可以耐受:索非布韦加达卡他韦方案治疗慢性丙型肝炎基因型 4 感染者安全有效,不良反应极少。埃及实施的根除丙型肝炎病毒计划可为其他感染丙型肝炎病毒且资源有限的国家树立典范。非专利药物在埃及的供应将大大有助于根除病毒。
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引用次数: 0
Hepatotoxicity of Nonsteroidal Anti-Inflammatory Drugs: A Systematic Review of Randomized Controlled Trials. 非甾体抗炎药的肝毒性:随机对照试验的系统评价。
IF 1.8 Q3 Medicine Pub Date : 2018-01-15 eCollection Date: 2018-01-01 DOI: 10.1155/2018/5253623
Pajaree Sriuttha, Buntitabhon Sirichanchuen, Unchalee Permsuwan

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most widely used medication in several countries, including Thailand. NSAIDs have been associated with hepatic side effects; however, the frequency of these side effects is uncertain.

Aim of the review: To systematically review published literature on randomized, controlled trials that assessed the risk of clinically significant hepatotoxicity associated with NSAIDs.

Methods: Searches of bibliographic databases EMBASE, PubMed, and the Cochrane Library were conducted up to July 30, 2016, to identify randomized controlled trials of ibuprofen, naproxen, diclofenac, piroxicam, meloxicam, mefenamic acid, indomethacin, celecoxib, and etoricoxib in adults with any disease that provide information on hepatotoxicity outcomes.

Results: Among the 698 studies, 18 studies met the selection criteria. However, only 8 studies regarding three NSAIDs (celecoxib, etoricoxib, and diclofenac) demonstrated clinically significant hepatotoxic evidence based on hepatotoxicity justification criteria. Of all the hepatotoxicity events found from the above-mentioned three NSAIDs, diclofenac had the highest proportion, which ranged from 0.015 to 4.3 (×10-2), followed by celecoxib, which ranged from 0.13 to 0.38 (×10-2), and etoricoxib, which ranged from 0.005 to 0.930 (×10-2).

Conclusion: Diclofenac had higher rates of hepatotoxic evidence compared to other NSAIDs. Hepatotoxic evidence is mostly demonstrated as aminotransferase elevation, while liver-related hospitalization or discontinuation was very low.

背景:在包括泰国在内的一些国家,非甾体类抗炎药(NSAIDs)是最广泛使用的药物。非甾体抗炎药与肝脏副作用有关;然而,这些副作用的频率是不确定的。本综述的目的:系统地回顾已发表的评估非甾体抗炎药相关临床显著肝毒性风险的随机对照试验文献。方法:检索文献数据库EMBASE、PubMed和Cochrane图书馆,检索截至2016年7月30日的随机对照试验,确定布洛芬、萘普生、双氯芬酸、吡罗西康、美洛昔康、甲氧胺酸、吲哚美辛、塞来昔布和依托昔布在任何疾病的成人中提供肝毒性结局信息。结果:698项研究中,有18项研究符合入选标准。然而,只有8项关于三种非甾体抗炎药(塞来昔布、依托昔布和双氯芬酸)的研究显示了基于肝毒性证明标准的临床显著肝毒性证据。在上述三种非甾体抗炎药中发现的所有肝毒性事件中,双氯芬酸发生率最高,范围为0.015 ~ 4.3 (×10-2),其次是塞来昔布,范围为0.13 ~ 0.38 (×10-2),依托昔布范围为0.005 ~ 0.930 (×10-2)。结论:与其他非甾体抗炎药相比,双氯芬酸有更高的肝毒性证据。肝毒性的证据主要表现为转氨酶升高,而肝脏相关住院或停药的情况非常低。
{"title":"Hepatotoxicity of Nonsteroidal Anti-Inflammatory Drugs: A Systematic Review of Randomized Controlled Trials.","authors":"Pajaree Sriuttha,&nbsp;Buntitabhon Sirichanchuen,&nbsp;Unchalee Permsuwan","doi":"10.1155/2018/5253623","DOIUrl":"https://doi.org/10.1155/2018/5253623","url":null,"abstract":"<p><strong>Background: </strong>Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most widely used medication in several countries, including Thailand. NSAIDs have been associated with hepatic side effects; however, the frequency of these side effects is uncertain.</p><p><strong>Aim of the review: </strong>To systematically review published literature on randomized, controlled trials that assessed the risk of clinically significant hepatotoxicity associated with NSAIDs.</p><p><strong>Methods: </strong>Searches of bibliographic databases EMBASE, PubMed, and the Cochrane Library were conducted up to July 30, 2016, to identify randomized controlled trials of ibuprofen, naproxen, diclofenac, piroxicam, meloxicam, mefenamic acid, indomethacin, celecoxib, and etoricoxib in adults with any disease that provide information on hepatotoxicity outcomes.</p><p><strong>Results: </strong>Among the 698 studies, 18 studies met the selection criteria. However, only 8 studies regarding three NSAIDs (celecoxib, etoricoxib, and diclofenac) demonstrated clinically significant hepatotoxic evidence based on hepatotoxicity justification criteria. Of all the hepatotoxicity events found from the above-mentioned three NSAIDs, diclofenac had the highest proportion, which ranged from 0.015 to 4.3 (×10<sup>-2</sup>), followed by celecoxib, which ranged from 0.13 to 0.38 (×10<sup>-2</sup>), and etoricoxib, which ranged from 0.005 to 0.930 (×10<sup>-2</sup>).</p><p><strong>Conclusion: </strong>Diclofenac had higher rates of hepatotoxic evidence compared to other NSAIDs. Hepatotoxic evidence is mostly demonstrated as aminotransferase elevation, while liver-related hospitalization or discontinuation was very low.</p>","PeriodicalId":46297,"journal":{"name":"International Journal of Hepatology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2018-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/5253623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35940667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 88
HCV Integrated Care: A Randomized Trial to Increase Treatment Initiation and SVR with Direct Acting Antivirals. HCV综合护理:一项随机试验,以增加直接作用抗病毒药物的治疗起始和SVR。
IF 1.8 Q3 Medicine Pub Date : 2017-01-01 Epub Date: 2017-07-27 DOI: 10.1155/2017/5834182
Erik J Groessl, Lin Liu, Marisa Sklar, Samuel B Ho

Background and aims: Psychiatric or substance use disorders are barriers to successful HCV antiviral treatment. In a randomized, controlled trial (RCT), the effects of HCV Integrated Care (IC) for increasing treatment rates and sustained viral response (SVR) were studied with direct acting antivirals (DAA).

Methods: In 2012-13, VA patients, whose screening was positive for depression, PTSD, or substance use (N = 79), were randomized to IC or Usual Care (UC). IC consisted of brief psychological interventions and case management. The primary endpoint was SVR among patients followed for an average of 16.6 months.

Results: 42% of the study participants were previously homeless and 79% had HCV genotype 1. Twice as many IC participants (45%) initiated treatment compared with UC participants (23%) (χ2 = 4.59, p = 0.032). Among those treated, SVR rates did not significantly differ (IC: 12/18 = 67%; UC: 5/9 = 55%; p = 0.23). Among all randomized participants, IC participants trended toward better SVR rates (30.0% versus 12.8% in UC; p = 0.07).

Conclusions: Although first-generation DAAs are no longer used, this smaller RCT helps confirm the results of a larger multisite RCT showing that Integrated Care results in higher treatment initiation and SVR rates among HCV-infected persons with comorbid psychological disorders. Integrated mental health services can facilitate treatment among the most challenging HCV patients, many of whom have not been successfully treated. This trial is registered with ClinicalTrials.gov number NCT00722423.

背景和目的:精神障碍或物质使用障碍是HCV抗病毒治疗成功的障碍。在一项随机对照试验(RCT)中,研究了HCV综合治疗(IC)与直接作用抗病毒药物(DAA)在提高治疗率和持续病毒反应(SVR)方面的作用。方法:2012- 2013年,筛查为抑郁、创伤后应激障碍或物质使用阳性的VA患者(N = 79)随机分为IC组或常规护理组(UC)。综合干预包括简短的心理干预和病例管理。主要终点是平均随访16.6个月的患者SVR。结果:42%的研究参与者以前无家可归,79%的人患有HCV基因型1。开始治疗的IC参与者(45%)是UC参与者(23%)的两倍(χ2 = 4.59, p = 0.032)。在治疗组中,SVR率无显著差异(IC: 12/18 = 67%;Uc: 5/9 = 55%;P = 0.23)。在所有随机参与者中,IC参与者倾向于更好的SVR率(30.0%对12.8% UC;P = 0.07)。结论:虽然第一代daa不再被使用,但这一较小的随机对照试验有助于证实一项较大的多位点随机对照试验的结果,该结果表明,综合护理在伴有共病心理障碍的hcv感染者中导致更高的治疗起始率和SVR率。综合精神卫生服务可以促进最具挑战性的丙型肝炎患者的治疗,其中许多人尚未得到成功治疗。该试验已在ClinicalTrials.gov注册,注册号为NCT00722423。
{"title":"HCV Integrated Care: A Randomized Trial to Increase Treatment Initiation and SVR with Direct Acting Antivirals.","authors":"Erik J Groessl,&nbsp;Lin Liu,&nbsp;Marisa Sklar,&nbsp;Samuel B Ho","doi":"10.1155/2017/5834182","DOIUrl":"https://doi.org/10.1155/2017/5834182","url":null,"abstract":"<p><strong>Background and aims: </strong>Psychiatric or substance use disorders are barriers to successful HCV antiviral treatment. In a randomized, controlled trial (RCT), the effects of HCV Integrated Care (IC) for increasing treatment rates and sustained viral response (SVR) were studied with direct acting antivirals (DAA).</p><p><strong>Methods: </strong>In 2012-13, VA patients, whose screening was positive for depression, PTSD, or substance use (<i>N</i> = 79), were randomized to IC or Usual Care (UC). IC consisted of brief psychological interventions and case management. The primary endpoint was SVR among patients followed for an average of 16.6 months.</p><p><strong>Results: </strong>42% of the study participants were previously homeless and 79% had HCV genotype 1. Twice as many IC participants (45%) initiated treatment compared with UC participants (23%) (<i>χ</i><sup>2</sup> = 4.59, <i>p</i> = 0.032). Among those treated, SVR rates did not significantly differ (IC: 12/18 = 67%; UC: 5/9 = 55%; <i>p</i> = 0.23). Among all randomized participants, IC participants trended toward better SVR rates (30.0% versus 12.8% in UC; <i>p</i> = 0.07).</p><p><strong>Conclusions: </strong>Although first-generation DAAs are no longer used, this smaller RCT helps confirm the results of a larger multisite RCT showing that Integrated Care results in higher treatment initiation and SVR rates among HCV-infected persons with comorbid psychological disorders. Integrated mental health services can facilitate treatment among the most challenging HCV patients, many of whom have not been successfully treated. This trial is registered with ClinicalTrials.gov number NCT00722423.</p>","PeriodicalId":46297,"journal":{"name":"International Journal of Hepatology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/5834182","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35280502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 8
Predictive Factors for a Long Hospital Stay in Patients Undergoing Laparoscopic Cholecystectomy. 腹腔镜胆囊切除术患者住院时间过长的预测因素。
IF 1.8 Q3 Medicine Pub Date : 2017-01-01 Epub Date: 2017-01-23 DOI: 10.1155/2017/5497936
Wasana Ko-Iam, Trichak Sandhu, Sahattaya Paiboonworachat, Paisal Pongchairerks, Anon Chotirosniramit, Narain Chotirosniramit, Kamtone Chandacham, Tidarat Jirapongcharoenlap, Sunhawit Junrungsee

Background. Although the advantages of laparoscopic cholecystectomy (LC) over open cholecystectomy are immediately obvious and appreciated, several patients need a postoperative hospital stay of more than 24 hours. Thus, the predictive factors for this longer stay need to be investigated. The aim of this study was to identify the causes of a long hospital stay after LC. Methods. This is a retrospective cohort study with 500 successful elective LC patients being included in the analysis. Short hospital stay was defined as being discharged within 24 hours after the operation, whereas long hospital stay was defined as the need for a stay of more than 24 hours after the operation. Results. Using multivariable analysis, ten independent predictive factors were identified for a long hospital stay. These included patients with cirrhosis, patients with a history of previous acute cholecystitis, cholangitis, or pancreatitis, patients on anticoagulation with warfarin, patients with standard-pressure pneumoperitoneum, patients who had been given metoclopramide as an intraoperative antiemetic drug, patients who had been using abdominal drain, patients who had numeric rating scale for pain > 3, patients with an oral analgesia requirement > 2 doses, complications, and private ward admission. Conclusions. LC difficulties were important predictive factors for a long hospital stay, as well as medication and operative factors.

背景。虽然腹腔镜胆囊切除术(LC)比开腹胆囊切除术的优势显而易见,也很受重视,但仍有一些患者术后需要住院超过 24 小时。因此,需要对导致住院时间延长的预测因素进行研究。本研究的目的是找出胆囊切除术后住院时间过长的原因。方法。这是一项回顾性队列研究,分析对象包括 500 名成功的择期 LC 患者。住院时间短的定义为术后 24 小时内出院,而住院时间长的定义为术后需要住院超过 24 小时。分析结果通过多变量分析,确定了十个预测长期住院的独立因素。这些因素包括:肝硬化患者;既往有急性胆囊炎、胆管炎或胰腺炎病史的患者;使用华法林进行抗凝治疗的患者;使用标准压力腹腔积气的患者;术中使用甲氧氯普胺作为止吐药的患者;使用腹腔引流管的患者;疼痛评分标准大于 3 分的患者;口服镇痛药需求大于 2 次的患者;并发症;入住私人病房。结论除药物和手术因素外,LC困难也是导致住院时间延长的重要预测因素。
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引用次数: 0
Shorter Leukocyte Telomere Length in Relation to Presumed Nonalcoholic Fatty Liver Disease in Mexican-American Men in NHANES 1999-2002. NHANES 1999-2002中,墨西哥裔美国男性白细胞端粒长度较短与推定的非酒精性脂肪肝有关。
IF 1.8 Q3 Medicine Pub Date : 2017-01-01 Epub Date: 2017-06-27 DOI: 10.1155/2017/8435178
Janet M Wojcicki, David Rehkopf, Elissa Epel, Philip Rosenthal

Leukocyte telomere length is shorter in response to chronic disease processes associated with inflammation such as diabetes mellitus and coronary artery disease. Data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2002 was used to explore the relationship between leukocyte telomere length and presumed NAFLD, as indicated by elevated serum alanine aminotransferase (ALT) levels, obesity, or abdominal obesity. Logistic regression models were used to evaluate the relationship between telomere length and presumed markers of NAFLD adjusting for possible confounders. There was no relationship between elevated ALT levels, abdominal obesity, or obesity and telomere length in adjusted models in NHANES (OR 1.13, 95% CI 0.48-2.65; OR 1.17, 95% CI 0.52-2.62, resp.). Mexican-American men had shorter telomere length in relation to presumed NAFLD (OR 0.07, 95% CI 0.006-0.79) and using different indicators of NAFLD (OR 0.012, 95% CI 0.0006-0.24). Mexican origin with presumed NAFLD had shorter telomere length than men in other population groups. Longitudinal studies are necessary to evaluate the role of telomere length as a potential predictor to assess pathogenesis of NALFD in Mexicans.

白细胞端粒长度较短是对与炎症相关的慢性疾病的反应,如糖尿病和冠状动脉疾病。1999年至2002年国家健康与营养调查(NHANES)的数据被用于探索白细胞端粒长度与假定的NAFLD之间的关系,如血清谷丙转氨酶(ALT)水平升高、肥胖或腹部肥胖。使用逻辑回归模型来评估端粒长度与NAFLD推定标记物之间的关系,并对可能的混杂因素进行调整。在NHANES中调整后的模型中,ALT水平升高、腹部肥胖或肥胖与端粒长度没有关系(or 1.13, 95% CI 0.48-2.65;OR 1.17, 95% CI 0.52-2.62)。与假定的NAFLD相比,墨西哥裔美国男性的端粒长度更短(OR 0.07, 95% CI 0.006-0.79),使用不同的NAFLD指标(OR 0.012, 95% CI 0.0006-0.24)。墨西哥裔NAFLD患者的端粒长度比其他人群短。纵向研究对于评估端粒长度作为评估墨西哥NALFD发病机制的潜在预测因子的作用是必要的。
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引用次数: 12
Randomized Controlled Study Comparing Use of Propofol Plus Fentanyl versus Midazolam Plus Fentanyl as Sedation in Diagnostic Endoscopy in Patients with Advanced Liver Disease. 比较丙泊酚加芬太尼与咪达唑仑加芬太尼在晚期肝病患者诊断内窥镜中的镇静作用的随机对照研究
IF 1.8 Q3 Medicine Pub Date : 2017-01-01 Epub Date: 2017-09-26 DOI: 10.1155/2017/8462756
Sameh Abdelkhalik Ahmed, Amal Selim, Nehad Hawash, Ahmed Khaled Tawfik, Mohamed Yousef, Abdelrahman Kobtan, Rehab Badawi, Sally Elnawasany, Reham Abdelkader Elkhouly, Amr Shaaban Hanafy, Fatma H Rizk, Loai Mansour, Sherief Abd-Elsalam

Objectives: We aimed to investigate the safety and efficacy of propofol plus fentanyl versus midazolam plus fentanyl as sedative for patients with advanced liver disease presented for gastrointestinal endoscopy.

Methods: A total of 100 patients with liver cirrhosis referred for upper endoscopy were enrolled and divided equally in two groups, midazolam plus fentanyl group and propofol plus fentanyl group. All patients were subjected to history taking, estimation of level of sedation, endoscopist rating, and hemodynamic parameters including oxygen saturation, heart rate, mean arterial pressure, incidence of side effect as (bradycardia, hypotension, hypoxia, nausea and vomiting, cough, shivering, or diplopia), time needed for complete recovery, and time needed for discharge.

Results: There was no statistical significant difference between the studied groups regarding age, sex, weight, Child-Pugh classification score, type and duration of endoscopic intervention, time needed for complete recovery, or time needed for discharge. Complication rates were similar in both groups except for mean arterial blood pressure which was significantly lower in group of patients receiving propofol and fentanyl (P = 0.001).

Conclusion: The use of either propofol or midazolam in combination to fentanyl is effective in sedation of patients with advanced liver diseases presented for upper GIT endoscope. The trial is registered with ClinicalTrials.gov Identifier: NCT03063866.

目的:我们旨在研究异丙酚加芬太尼与咪达唑仑加芬太尼作为胃肠道内窥镜检查的晚期肝病患者的镇静剂的安全性和有效性。方法:选取100例肝硬化上内镜患者,平均分为咪达唑仑加芬太尼组和异丙酚加芬太尼组。所有患者均接受病史记录、镇静水平评估、内镜评估和血流动力学参数,包括血氧饱和度、心率、平均动脉压、副作用发生率(心动过缓、低血压、缺氧、恶心呕吐、咳嗽、寒战或复视)、完全恢复所需时间和出院所需时间。结果:两组患者在年龄、性别、体重、Child-Pugh分级评分、内镜干预类型及持续时间、完全恢复时间、出院时间等方面差异均无统计学意义。两组的并发症发生率相似,但异丙酚和芬太尼组的平均动脉血压明显低于对照组(P = 0.001)。结论:异丙酚或咪达唑仑联合芬太尼可有效镇静上消化道内窥镜下晚期肝病患者。该试验已在ClinicalTrials.gov注册,注册号:NCT03063866。
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引用次数: 7
Imaging the Abdominal Manifestations of Cystic Fibrosis. 囊性纤维化的腹部影像学表现。
IF 1.8 Q3 Medicine Pub Date : 2017-01-01 Epub Date: 2017-01-29 DOI: 10.1155/2017/5128760
C D Gillespie, M K O'Reilly, G N Allen, S McDermott, V O Chan, C A Ridge

Cystic fibrosis (CF) is a multisystem disease with a range of abdominal manifestations including those involving the liver, pancreas, and kidneys. Recent advances in management of the respiratory complications of the disease has led to a greater life expectancy in patients with CF. Subsequently, there is increasing focus on the impact of abdominal disease on quality of life and survival. Liver cirrhosis is the most important extrapulmonary cause of death in CF, yet significant challenges remain in the diagnosis of CF related liver disease. The capacity to predict those patients at risk of developing cirrhosis remains a significant challenge. We review representative abdominal imaging findings in patients with CF selected from the records of two academic health centres, with a view to increasing familiarity with the abdominal manifestations of the disease. We review their presentation and expected imaging findings, with a focus on the challenges facing diagnosis of the hepatic manifestations of the disease. An increased familiarity with these abdominal manifestations will facilitate timely diagnosis and management, which is paramount to further improving outcomes for patients with cystic fibrosis.

囊性纤维化(CF)是一种多系统疾病,包括肝脏、胰腺和肾脏在内的一系列腹部表现。近年来,该病呼吸系统并发症的治疗取得了进展,使得CF患者的预期寿命延长。随后,人们越来越关注腹部疾病对生活质量和生存的影响。肝硬化是CF中最重要的肺外死亡原因,但CF相关肝病的诊断仍面临重大挑战。预测那些有肝硬化风险的患者的能力仍然是一个重大挑战。我们回顾从两个学术健康中心的记录中选择的CF患者的代表性腹部影像学发现,以期增加对该疾病腹部表现的熟悉程度。我们回顾他们的表现和预期的影像学结果,重点是肝病表现诊断面临的挑战。增加对这些腹部表现的熟悉将有助于及时诊断和治疗,这对进一步改善囊性纤维化患者的预后至关重要。
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引用次数: 15
期刊
International Journal of Hepatology
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