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991.
Takamura M Ichida T Yokoyama J Matsuda Y Nomoto M Aoyagi Y 《Journal of gastroenterology》2004,39(7):681-684
We report a 54-year-old Japanese woman who developed liver tumors 102 months after hepatic resection for hepatocellular carcinoma (HCC) and percutaneous transluminal angioplasty (PTA) for membranous obstruction of the inferior vena cava (MOVC), which is one form of Budd-Chiari syndrome. In the present admission workup showed no evidence of co-infection with hepatitis B and C viruses. Dynamic computed tomography (CT) and magnetic resonance imaging showed an enhanced lesion, 1.5cm in diameter, in segment 3 of the liver, and no obstruction of the inferior vena cava after PTA. CT during both arterial portography and hepatic arteriography revealed another lesion, showing different hemodynamics, in segment 2. The patient therefore underwent hepatic resection, and the tumors were diagnosed histologically as HCC. The two tumors differed in their morphological features, one containing abundant fibrous stroma, whereas the other did not. The nontumorous liver tissue showed central zonal fibrosis, i.e., reversed lobulation, and partial expansion of nodule-like formations, indicating lack of progression since the situation seen at the initial hepatectomy. The presence of nontumorous liver tissue showing the above features suggests that, even after successful treatment for relief of congestion, patients who have had MOVC should be followed closely for as long as possible because of the risk of HCC recurrence. This is the first reported case of HCC recurrence after successful treatment of MOVC. 相似文献
992.
993.
Effective treatment of high blood pressure levels represents a crucial point in reducing global cardiovascular risk, and several
studies have clearly demonstrated a significant reduction in cardiovascular and renal morbidity and mortality with a more
intensive blood pressure-lowering treatment. Other factors beyond blood pressure control may be important in reducing the
risk related to hypertension. Pharmacologic agents blocking the renin-angiotensin system, in particular the angiotensin II-receptor
blocker (ARB), a novel class of antihypertensive agents, represent an important addition to the therapeutic options for hypertension
management, and recent large, international, randomized, trials have demonstrated that ARBs have clinical benefits across
the spectrum of disease severity. In this article, we provide some evidence derived from these trials, supporting a role for
ARBs in primary and secondary prevention of cardiovascular and renal disease, beyond blood pressure control. 相似文献
994.
Cotransport of reduced glutathione with bile salts by MRP4 (ABCC4) localized to the basolateral hepatocyte membrane 总被引:16,自引:0,他引:16
Rius M Nies AT Hummel-Eisenbeiss J Jedlitschky G Keppler D 《Hepatology (Baltimore, Md.)》2003,38(2):374-384
The liver is the major source of reduced glutathione (GSH) in blood plasma. The transport protein mediating the efflux of GSH across the basolateral membrane of human hepatocytes has not been identified so far. In this study we have localized the multidrug resistance protein 4 (MRP4; ABCC4) to the basolateral membrane of human, rat, and mouse hepatocytes and human hepatoma HepG2 cells. Recombinant human MRP4, expressed in V79 hamster fibroblasts and studied in membrane vesicles, mediated ATP-dependent cotransport of GSH or S-methyl-glutathione together with cholyltaurine, cholylglycine, or cholate. Several monoanionic bile salts and the quinoline derivative MK571 were potent inhibitors of this unidirectional transport. The K(m) values were 2.7 mmol/L for GSH and 1.2 mmol/L for the nonreducing S-methyl-glutathione in the presence of 5 micromol/L cholyltaurine, and 3.8 micromol/L for cholyltaurine in the presence of 5 mmol/L S-methyl-glutathione. Transport of bile salts by MRP4 was negligible in the absence of ATP or without S-methyl-glutathione. These findings identify a novel pathway for the efflux of GSH across the basolateral hepatocyte membrane into blood where it may serve as an antioxidant and as a source of cysteine for other organs. Moreover, MRP4-mediated bile salt transport across the basolateral membrane may function as an overflow pathway during impaired bile salt secretion across the canalicular membrane into bile. In conclusion, MRP4 can mediate the efflux of GSH from hepatocytes into blood by cotransport with monoanionic bile salts. 相似文献
995.
Distinctive arthritic patterns, some of which may parallel or even precede intestinal disease activity, are seen in inflammatory
bowel disease. Some spondyloarthropathies are associated with transient ileocolic inflammation. Vasculitis frequently affects
the gastrointestinal tract, predominantly manifesting with abdominal pain. In severe cases, intestinal ischemia and perforation
may occur. Various arthritides are thought to be associated with other gastrointestinal diseases, such as celiac disease and
hepatitis. The association between intestinal disease and arthritis is still being investigated. Interactions between the
inflammatory intestinal cells and inflamed synovial cells have been demonstrated. Certain intestinal bacteria such as Klebsiella pneumoniae are suspected to play a role as triggers for the development of arthropathies. Genetic factors, especially human leukocyte
antigen associations, are also being increasingly investigated for better characterization of the types of arthritis and possible
prognostic implications. Various therapies, including nonsteroidal anti-inflammatory drugs, used to treat rheumatologic diseases
have the potential to cause gastrointestinal complications. 相似文献
996.
Georg Spital 《Der Diabetologe》2018,14(8):577-589
Background
Diabetic macular edema (DME) is a common cause of diabetes-related visual impairment that also affects patients of working age. Laser treatment has been the gold standard of DME treatment for decades. The introduction of intravitreal injection therapies, e.?g. anti-VEGF therapy, has widened the range of treatment options. This allows more individualized DME therapy and improves the prognosis for vision.Objectives
This article aims to provide a short overview of current therapy options and their relevance in DME treatment based on recent studies and treatment recommendations.Results
VEGF-Inhibitors represent a first-line treatment and are superior to laser treatment when DME affects the fovea. In addition to ranibizumab and aflibercept, bevacizumab is used off-label. High treatment frequencies with an average of seven to nine injections in the 1st year and monthly controls, if possible using optical coherence tomography, are crucial. The number of injections required decreases thereafter. The gain in visual acuity of on average two to three lines demonstrated in studies is usually not achieved in real life due to under-treatment. Intravitreal steroids provide longer treatment effects, but are second choice due to local side effects, mainly cataract and glaucoma. Laser therapy remains an option (1st choice in extrafoveal DME). In special cases, vitrectomy may be indicated.Conclusions
Modern DME treatment permits individualized therapies based on multimodal diagnostics while taking the patient’s individual situation and wishes into account. However, in order to make effective use of these opportunities , early diagnosis (screening), adequate patient motivation, and appropriate risk factor adjustment are required.997.
Enrique Casalino Donia Bouzid Stephanie Antoniol Philippe Kenway Laurent Pereira Christophe Choquet Emergency Department Study Group on Respiratory Viruses 《Internal and emergency medicine》2018,13(5):673-678
To evaluate the impact of an influenza vaccination (IV) coverage (IVC) in a vaccination campaign of an Emergency Department (EDVC) and its impact on ED time interval quality indicators. We conducted a 4 year observational study, with an intervention during the 4th year. IVC was calculated during pre-and early-epidemic periods. During the final period, a 12 weeks EDVC was implemented. Physicians and nurses were trained and sensitized in the importance of vaccination, and their role in the prevention of severe forms of influenza was reinforced. The vaccine was proposed by physicians and nurses, and delivered by them. Repeated measures ANOVA is a validated method for related not independent groups (https://statistics.laerd.com/statistical-guides/repeated-measures-anova-statistical-guide.php). Overall, IVC was 987/3191 (30.9%) with an increasing trend from 28.8 to 33.2%. In the fourth period, out of 868 patients identified with IV indication, 288 had already been vaccinated (IVC?33.2%). After excluding patients presenting criteria of exclusion, IV was proposed to 475 patients: 317 (66.7%) accepted. The vaccination rate after patient’s acceptance was 89.6% (288/317). At the end of the EDVC, influenza vaccination coverage was 572 (284?+?288)/868 (65.9%). The delay between arrival at the ED and seeing the triage nurse and physician as well as the overall ED length of stay were not modified during the study period and before and during EDVC. EDVC effectively doubled the influenza vaccination coverage, without modifying ED time interval quality indicators. 相似文献
998.
Jessica Ayers Jamie Cook Rachel A. Koenig Evan M. Sisson Dave L. Dixon 《Current atherosclerosis reports》2018,20(6):29
Purpose of Review
This review examines recent randomized clinical trials evaluating the role of coenzyme Q10 (CoQ10) in the management of coronary heart disease.Recent Findings
CoQ10 is one of the most commonly used dietary supplements in the USA. Due to its antioxidant and anti-inflammatory effects, CoQ10 has been studied extensively for possible use in managing coronary heart disease. One of the most common applications of CoQ10 is to mitigate statin-associated muscle symptoms (SAMS) based on the theory that SAMS are caused by statin depletion of CoQ10 in the muscle. Although previous studies of CoQ10 for SAMS have produced mixed results, CoQ10 appears to be safe. Because CoQ10 is a cofactor in the generation of adenosine triphosphate, supplementation has also recently been studied in patients with heart failure, which is inherently an energy deprived state. The Q-SYMBIO trial found that CoQ10 supplementation in patients with heart failure not only improved functional capacity, but also significantly reduced cardiovascular events and mortality. Despite these positive findings, a larger prospective trial is warranted to support routine use of CoQ10. Less impressive are the effects of CoQ10 on specific cardiovascular risk factors such as blood pressure, dyslipidemia, and glycemic control.Summary
Current evidence does not support routine use of CoQ10 in patients with coronary heart disease. Additional studies are warranted to fully determine the benefit of CoQ10 in patients with heart failure before including it in guideline-directed medical therapy.999.
Nidaa Mikail Khadija Benali Besma Mahida Jonathan Vigne Fabien Hyafil François Rouzet Dominique Le Guludec 《Current cardiology reports》2018,20(3):14
Purpose of review
This review analyzes recent studies evaluating the diagnostic value of 18F-FDG-PET/CT for the detection of peripheral emboli and secondary infectious foci in patients with infective endocarditis and cardiac device infections.Recent findings
Detection of extracardiac septic localizations in patients with infective endocarditis and cardiac device infections is crucial, as it may impact the diagnosis, prognosis, and therapeutic management. Recent literature substantiated the clinical usefulness of 18F-FDG-PET/CT in this setting.Summary
18F-FDG-PET/CT has proven its high diagnostic value for the detection of peripheral emboli in patients with infective endocarditis and cardiac device infections, substantially affecting patients’ outcome and treatment. A multimodal approach, combining the high sensitivity of 18F-FDG-PET/CT with morphological imaging seems promising.1000.
Abdallah El Sabbagh Mackram F. Eleid Mohammed Al-Hijji Nandan S. Anavekar David R. Holmes Vuyisile T. Nkomo Gustavo S. Oderich Stephen D. Cassivi Sameh M. Said Charanjit S. Rihal Jane M. Matsumoto Thomas A. Foley 《Current cardiology reports》2018,20(6):47