Rocío González-Grande  Miguel Jiménez-Pérez  Carolina González Arjona  José Mostazo Torres 《World journal of gastroenterology : WJG》2016,22(4):1421-1432

About 130-170 million people, is estimated to be infected with the hepatitis C virus(HCV). Chronic HCV infection is one of the leading causes of liverrelated death and in many countries it is the primaryreason for having a liver transplant. The main aim of antiviral treatment is to eradicate the virus. Until a few years ago the only treatment strategy was based on the combination of pegylated interferon and ribavirin(PEG/RBV). However, in genotypes 1 and 4 the rates of viral response did not surpass 50%, reaching up to 80% in the rest. In 2011 approval was given for the first direct acting antiviral agents(DAA), boceprevir and telaprevir, for treatment of genotype 1, in combination with traditional dual therapy. This strategy managed to increase the rates of sustained viral response(SVR) in both naive patients and in retreated patients, but with greater toxicity, interactions and cost, as well as being less safe in patients with advanced disease, in whom this treatment can trigger decompensation or even death. The recent, accelerated incorporation since 2013 of new more effective DAA, with pan-genomic properties and excellent tolerance, besides increasing the rates of SVR(even up to 100%), has also created a new scenario: shorter therapies, less toxicity and regimens free of PEG/RBV. This has enabled their almost generalised applicability in all patients. However, it should be noted that most of the scientific evidence available is based on expert opinion, case-control series, cohort studies and phase 2 and 3 trials, some with a reduced number of patients and select groups. Few data are currently available about the use of these drugs in daily clinical practice, particularly in relation to the appearance of side effects and interactions with other drugs, or their use in special populations or persons with the less common genotypes. This situation suggests the need for the generalised implementation of registries of patients receiving antiviral therapy. The main inconvenience of these new drugs is their high cost. This necessitates selection and prioritization of candidate patients to receive them, via strategies established by the various national organs, in accordance with the recommendations of scientific societies.  相似文献   

    

Dushant S Uppal  rew Y Wang 《World journal of gastroenterology : WJG》2016,22(39):8670-8683

Achalasia is the most common primary motility disorder of the esophagus and presents as dysphagia to solids and liquids. It is characterized by impaired deglutitive relaxation of the lower esophageal sphincter. Highresolution manometry allows for definitive diagnosis and classification of achalasia, with type Ⅱ being the most responsive to therapy. Since no cure for achalasia exists, early diagnosis and treatment of the disease is critical to prevent end-stage disease. The central tenant of diagnosis is to first rule out mechanical obstruction due to stricture or malignancy, which is often accomplished by endoscopic and fluoroscopic examination. Therapeutic options include pneumatic dilation(PD), surgical myotomy, and endoscopic injection of botulinum toxin injection. Heller myotomy and PD are more efficacious than pharmacologic therapies and should be considered first-line treatment options. Per oral endoscopic myotomy(POEM) is a minimally-invasive endoscopic therapy that might be as effective as surgical myotomy when performed by a trained and experienced endoscopist, although long-term data are lacking. Overall, therapy should be individualized to each patient's clinical situation and based upon his or her risk tolerance, operative candidacy, and life expectancy. In instances of therapeutic failure or symptom recurrence re-treatment is possible and can include PD or POEM of the wall opposite the site of prior myotomy. Patients undergoing therapy for achalasia require counseling, as the goal of therapy is to improve swallowing and prevent late manifestations of the disease rather than to restore normal swallowing, which is unfortunately impossible.  相似文献   

    

Jin-Zhou Zhu  Kelseanna Hollis-Hansen  Xing-Yong Wan  Su-Juan Fei  Xun-Lei Pang  Fan-Dong Meng  Chao-Hui Yu  You-Ming Li 《World journal of gastroenterology : WJG》2016,22(36):8226-8233

AIM To perform a systematic review to grade guidelines and present recommendations for clinical management of non-alcoholic fatty liver disease(NAFLD).METHODS A database search was conducted on Pub Med for guidelines published before May 2016, supplemented by reviewing relevant websites. The Appraisal of Guidelines for Research and Evaluation(ARGEE) instrument Ⅱ was a tool designed to appraise the methodological rigor and transparency in which a clinical guideline is developed and it is used internationally. it was used to appraise the quality of guidelines in this study. The inclusion criteria include: clinical NAFLD guidelines for adults, published in English, and released by governmental agencies or key organizations.RESULTS Eleven guidelines were included in this study. Since 2007, guidelines have been released in Asia(3 in China, 1 in South Korea, and 1 in Japan), Europe(1 in italy),America(1 in United States and 1 in Chile) and three international agencies [European associations joint, Asia-Pacific Working Party and World Gastroenterology Organization(WGO)]. Using the ARGEE Ⅱ instrument, we found US 2012 and Europe 2016 had the highest scores, especially in the areas of rigor of development and applicability. Additionally, italy 2010 and Korea 2013 also presented comprehensive content, rigorous procedures and good applicability. And WGO 2014 offered various algorithms for clinical practice. Lastly, a practical algorithm for the clinical management was developed, based on the recommended guidelines.CONCLUSION This is the first systematic review of NAFLD guidelines. it may yield insights for physicians and policy-makers in the development and application of guidelines.  相似文献   

    

Joo Chun Yoon  Chang Mo Yang  Youkyong Song  Jae Myun Lee 《World journal of gastroenterology : WJG》2016,22(4):1449-1460

Patients infected with the hepatitis C virus(HCV) are characterized by a high incidence of chronic infection, which results in chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. The functional impairment of HCV-specific T cells is associated with the evolution of an acute infection to chronic hepatitis. While T cells are the important effector cells in adaptive immunity, natural killer(NK) cells are the critical effector cells in innate immunity to virus infections. The findings of recent studies on NK cells in hepatitis C suggest that NK cell responses are indeed important in each phase of HCV infection. In the early phase, NK cells are involved in protective immunity to HCV. The immune evasion strategies used by HCV may target NK cells and might contribute to the progression to chronic hepatitis C. NK cells may control HCV replication and modulate hepatic fibrosis in the chronic phase. Further investigations are, however, needed, because a considerable number of studies observed functional impairment of NK cells in chronic HCV infection. Interestingly, the enhanced NK cell responses during interferon-α-based therapy of chronic hepatitis C indicate successful treatment. In spite of the advances in research on NK cells in hepatitis C, establishment of more physiological HCV infection model systems is needed to settle unsolved controversies over the role and functional status of NK cells in HCV infection.  相似文献   

    

Julien Dreyfus;Monika Komar;David Attias;Michele De Bonis;Frank Ruschitzka;Bogdan A. Popescu;Cécile Laroche;Christophe Tribouilloy;Alexander Bogachev Prokophiev;Vaida Mizariene;Jeroen J. Bax;Aldo Pietro Maggioni;David Messika-Zeitoun;Alec Vahanian;Bernard Iung; ; 《European journal of heart failure》2024,26(4):994-1003

Tricuspid regurgitation (TR) is commonly observed in patients with severe left-sided valvular heart disease (VHD). This study sought to assess TR frequency, management and outcome in this population.  相似文献   

    

Pieter Martens;Stephen J. Greene;Robert J. Mentz;Shuang Li;Daniel Wojdyla;Chris J. Kapelios;Wilfried Mullens;Michael E. Hall;Fassil Ketema;Dong-Yun Kim;Eric L. Eisenstein;Kevin Anstrom;James C. Fang;Bertram Pitt;Eric J. Velazquez;W.H. Wilson Tang; 《European journal of heart failure》2024,26(5):1242-1250

Among patients discharged after hospitalization for heart failure (HF), a strategy of torsemide versus furosemide showed no difference in all-cause mortality or hospitalization. Clinicians have traditionally favoured torsemide in the setting of kidney dysfunction due to better oral bioavailability and longer half-life, but direct supportive evidence is lacking.  相似文献   

    

Bonnie Law  Matthew J. Gullo  Mark Daglish  David J. Kavanagh  Gerald F. X. Feeney  Ross M. Young  Jason P. Connor 《Alcoholism, clinical and experimental research》2016,40(5):1058-1064

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Laura H. Corbit  Patricia H. Janak 《Alcoholism, clinical and experimental research》2016,40(7):1380-1389

Loss of flexible control over alcohol use may contribute to the development of alcohol use disorders. An increased contribution of response habits to alcohol‐related behaviors may help explain this loss of control. Focusing on data from outcome devaluation and Pavlovian–instrumental transfer procedures, we review evidence for loss of goal‐directed control over alcohol seeking and consumption drawing from both preclinical findings and clinical data where they exist. Over the course of extended alcohol self‐administration and exposure, the performance of alcohol‐seeking responses becomes less sensitive to reduction in the value of alcohol and more vulnerable to the influences of alcohol‐predictive stimuli. These behavioral changes are accompanied by a shift in the corticostriatal circuits that control responding from circuits centered on the dorsomedial to those centered on the dorsolateral striatum. These changes in behavioral and neural control could help explain failures to abstain from alcohol despite intention to do so. Understanding and ultimately ameliorating these changes will aid development of more effective treatment interventions.  相似文献   

Using Cystic Fibrosis Therapies for Non–Cystic Fibrosis Bronchiectasis     

《Clinics in Chest Medicine》2016,37(1):139-146

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《Clinics in Chest Medicine》2016,37(2):181-189

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