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肝脏T1rho MRI扫描优化及对肝纤维化的诊断价值初探 预览
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作者 谢双双 李清 +3 位作者 程悦 陈丽华 张莉 沈文 《放射学实践》 北大核心 2019年第1期35-40,共6页
目的:探讨3.0T肝脏T1rho MRI最简自旋锁定时间(SLT)扫描方案及用于诊断肝纤维化的可行性。方法:前瞻性搜集20例正常志愿者(正常组)和20例慢性肝病且临床疑诊为肝纤维化者(肝纤维化组),均行肝脏T1rho MRI扫描。自旋锁定脉冲设定为500 Hz,... 目的:探讨3.0T肝脏T1rho MRI最简自旋锁定时间(SLT)扫描方案及用于诊断肝纤维化的可行性。方法:前瞻性搜集20例正常志愿者(正常组)和20例慢性肝病且临床疑诊为肝纤维化者(肝纤维化组),均行肝脏T1rho MRI扫描。自旋锁定脉冲设定为500 Hz,SLT为1、10、20、30、40和50 ms。扫描结束后分别采用所有6-SLT(1、10、20、30、40和50 ms)和5种简化SLT组合,即最大SLT为40 ms的5-SLT(1、10、20、30、和40 ms)、最大SLT为50 ms的3-SLT(1、10、50 ms;1、20、50 ms;1、30、50 ms;1、40、50 ms),生成T1rho mapping。通过兴趣区(ROI)放置法测量各组合肝脏的T1rho值。采用配对样本t检验比较各简化SLT组合与6-SLT所测肝脏T1rho值的差异;采用Bland-Altman法分析各简化SLT组合与6-SLT所测肝脏T1rho值的一致性。采用ROC曲线分析6-SLT与简化SLT组合对肝纤维化诊断效能的差异。结果:正常组、肝纤维化组6-SLT和5种简化SLT组合所测肝脏T1rho值分别为(44.86±2.65)ms vs(53.01±5.79)ms、(43.07±3.15)ms vs(50.90±5.62)ms、(45.24±2.62)ms vs(53.22±5.25)ms、(45.11±2.53)ms vs(53.85±5.13)ms、(45.11±2.60)ms vs(52.80±5.53)ms和(45.22±2.64)ms vs(53.68±5.78)ms,两组间的差异均有统计学意义(P值均<0.001),用于诊断肝纤维化的曲线下面积(AUC)分别为0.910、0.895、0.910、0.933、0.917和0.923;5种简化SLT组合与6-SLT相比,诊断效能差异均无统计学意义(P值均>0.05)。其中正常组和肝纤维化组最大SLT为50 ms的3-SLT所测肝脏T1rho值与6-SLT差异均无统计学意义(P>0.05),最大SLT为40 ms的5-SLT所测肝脏T1rho值与6-SLT差异有统计学意义(P<0.01)。Bland-Altman分析结果显示所有3-SLT组合与6-SLT差值的散点分布在正常组和肝纤维化组中均较集中,且3-SLT(1、10、50 ms)组合的差值和95%一致性区间最小,分别为-0.37(-2.12~1.37)、-0.2(-3.7-3.3)。结论:3-SLT和5-SLT均能简化6-SLT(1~50 ms)以测量肝脏T1rho值,可用于诊断肝纤维化,且最大SLT为50 ms的3-SLT� 展开更多
关键词 肝脏 肝纤维化 磁共振成像 磁共振T1rho成像 自旋锁定时间
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基于肝表面智能自动对位法的超声-CT/MR融合成像的可行性研究 预览
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作者 曾庆劲 颜荣华 +5 位作者 吴宇轩 龙颖琳 罗丽萍 李凯 许尔蛟 郑荣琴 《中山大学学报(医学版)》 CAS CSCD 北大核心 2019年第1期117-123,共7页
【目的】探讨基于肝表面智能自动对位法的超声-CT/MR融合成像在肝脏局灶性病变定位的可行性及简便性。【方法】采用飞利浦EPIQ7的PercuNav融合成像系统对30例增强CT或MR发现肝内局灶性病变的患者进行超声-CT/MR融合成像检查。同时采用... 【目的】探讨基于肝表面智能自动对位法的超声-CT/MR融合成像在肝脏局灶性病变定位的可行性及简便性。【方法】采用飞利浦EPIQ7的PercuNav融合成像系统对30例增强CT或MR发现肝内局灶性病变的患者进行超声-CT/MR融合成像检查。同时采用系统配置的基于肝表面智能自动对位法(智能法)和常规内定标人工对位法(人工法)进行融合成像配准,比较两种方法的配准成功率、初步配准误差、微调配准次数。【结果】所有30例患者中,智能法和人工法的配准成功率均为96.67%(29/30),且初步配准误差和微调配准次数两种方法之间比较无统计学差异(P >0.05)。进一步分层分析,左肝病例中,人工法的初步配准误差优于智能法,差异有统计学意义(P=0.00),而微调配准次数虽然人工法少于智能法,但两者比较差异无统计学意义(P=0.09);而在右肝病例中,智能法的初步配准误差和微调配准次数均优于人工法,差异有统计学意义(P<0.05)。【结论】基于肝表面智能自动对位法的超声-CT/MR融合成像技术具有较高的配准成功率,可行性较好;相对于常规的内定标人工对位法,对于右肝病灶其融合成像操作过程更为简便高效,有助于降低对操作者融合成像技术经验的依赖性。 展开更多
关键词 肝脏 融合成像 智能对位 超声 肝表面
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肝脏手术缝合技术与缝合材料选择中国专家共识(2018版)
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作者 中华医学会外科学分会 赵玉沛 +15 位作者 刘连新 蔡建强 曾勇 梁霄 窦科峰 蔡秀军 姜洪池 陈规划 梁力建 李强 梁延波 彭承宏 钦伦秀 张水军 张学文 许戈良 《中国实用外科杂志》 CSCD 北大核心 2019年第1期11-14,共4页
目前,肝脏外科的发展已经从开展和完成半肝切除、右三叶肝切除和尾状叶肝切除等传统观念下难度较大的手术,逐渐转变为如何在保留足够肝脏体积的条件下开展更符合元瘤原则的手术(如静脉入路的解剖性肝切除),以及完成以往无法完成的手术[... 目前,肝脏外科的发展已经从开展和完成半肝切除、右三叶肝切除和尾状叶肝切除等传统观念下难度较大的手术,逐渐转变为如何在保留足够肝脏体积的条件下开展更符合元瘤原则的手术(如静脉入路的解剖性肝切除),以及完成以往无法完成的手术[如联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)]等。微创技术在肝切除术中的应用和普及对术中出血控制要求更加严格,创面止血、血管胆管缝合重建也变得更加困难,而规范、科学地完成肝脏血管和胆管的缝合是预防术后大出血和胆漏的重要环节。为指导临床相关工作,中华医学会外科学分会组织国内部分专家,经反复讨论,制定本专家共识。 展开更多
关键词 肝脏 腹腔镜 肝切除 缝合技术 缝合材料
Pure three-dimensional laparoscopic full left hepatectomy of a living donor for an adolescent in China
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作者 Jiu-Lin Song Hong Wu Jia-Yin Yang 《中华医学杂志:英文版》 SCIE CAS CSCD 2019年第2期242-244,共3页
To the Editor:Living donor liver transplantation (LDLT) has expanded the donor pool in countries with low cadaveric organ donation rates.Generally, a left-side liver allograft is sufficient and safe for child and adol... To the Editor:Living donor liver transplantation (LDLT) has expanded the donor pool in countries with low cadaveric organ donation rates.Generally, a left-side liver allograft is sufficient and safe for child and adolescent recipients.[1] For the sake of the donor's cosmetic demands and for early functional rehabilitation, laparoscopic technology has been used in live hepatectomy since 2002.[2] Three-dimensional visualization provides better depth perception and tactile feedback than does conventional two-dimensional laparoscopy.[3] In this report, we presented a case of pure three-dimensional laparoscopic full left live hepatectomy. 展开更多
关键词 LIVING DONOR LIVER transplantation expanded LIVER
Iron and liver fibrosis:Mechanistic and clinical aspects
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作者 Kosha J Mehta Sebastien Je Farnaud Paul A Sharp 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第5期521-538,共18页
Liver fibrosis is characterised by excessive deposition of extracellular matrix that interrupts normal liver functionality.It is a pathological stage in several untreated chronic liver diseases such as the iron overlo... Liver fibrosis is characterised by excessive deposition of extracellular matrix that interrupts normal liver functionality.It is a pathological stage in several untreated chronic liver diseases such as the iron overload syndrome hereditary haemochromatosis,viral hepatitis,alcoholic liver disease,non-alcoholic fatty liver disease,non-alcoholic steatohepatitis and diabetes.Interestingly,regardless of the aetiology,iron-loading is frequently observed in chronic liver diseases.Excess iron can feed the Fenton reaction to generate unquenchable amounts of free radicals that cause grave cellular and tissue damage and thereby contribute to fibrosis.Moreover,excess iron can induce fibrosis-promoting signals in the parenchymal and non-parenchymal cells,which accelerate disease progression and exacerbate liver pathology.Fibrosis regression is achievable following treatment,but if untreated or unsuccessful,it can progress to the irreversible cirrhotic stage leading to organ failure and hepatocellular carcinoma,where resection or transplantation remain the only curative options.Therefore,understanding the role of iron in liver fibrosis is extremely essential as it can help in formulating iron-related diagnostic,prognostic and treatment strategies.These can be implemented in isolation or in combination with the current approaches to prepone detection,and halt or decelerate fibrosis progression before it reaches the irreparable stage.Thus,this review narrates the role of iron in liver fibrosis.It examines the underlying mechanisms by which excess iron can facilitate fibrotic responses.It describes the role of iron in various clinical pathologies and lastly,highlights the significance and potential of iron-related proteins in the diagnosis and therapeutics of liver fibrosis. 展开更多
关键词 IRON LIVER PATHOLOGIES LIVER FIBROSIS Hepatic stellate cells Cirrhosis
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Intestinal permeability after Mediterranean diet and low-fat diet in non-alcoholic fatty liver disease
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作者 Marco Biolato Fiorella Manca +7 位作者 Giuseppe Marrone Consuelo Cefalo Simona Racco Giacinto A Miggiano Venanzio Valenza Antonio Gasbarrini Luca Miele Antonio Grieco 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第4期509-520,共12页
BACKGROUND In non-alcoholic fatty liver disease(NAFLD),a high-fat or high-fructose diet increases intestinal permeability and promotes derangement of the gut-liver axis.We hypothesize that,diet could be able to modula... BACKGROUND In non-alcoholic fatty liver disease(NAFLD),a high-fat or high-fructose diet increases intestinal permeability and promotes derangement of the gut-liver axis.We hypothesize that,diet could be able to modulate intestinal permeability in patients with NAFLD.AIM To detect diet-induced modification of intestinal permeability in patients with NAFLD undergoing a Mediterranean diet or a low-fat diet.METHODS The current study was a dietary intervention for non-diabetic,patients with biopsy-verified NAFLD and increased transaminases.A crossover design was employed:participants underwent 16 weeks of Mediterranean diet,16 wk of free wash-out,and 16 weeks of low-fat diet.Both diets were hypocaloric and no consumption of supplements was allowed.All patients were followed bimonthly by a dietitian.Evaluations of clinical and metabolic parameters were completed at baseline and at the end of each dietary period.Intestinal permeability was assessed by chromium-51 ethylene diamine tetraacetate excretion testing(51Cr-EDTA).RESULTS Twenty Caucasian patients,90%male,median age 43 years,body mass index(BMI)30.9,with biopsy-verified NAFLD were enrolled.At the end of 16 weeks of a Mediterranean diet,a significant reduction in mean body weight(-5.3±4.1 kg,P=0.003),mean waist circumference(-7.9±4.9 cm,P=0.001),and mean transaminase levels[alanine aminotransferase(ALT)-28.3±11.9 IU/L,P=0.0001;aspartate aminotransferase(AST)-6.4±56.3 IU/L,P=0.01]were observed.These benefits were maintained after 16 wk of wash-out and also after 16 wk of low-fat diet,without further improvements.Fourteen of the 20 patients had intestinal permeability alteration at baseline(mean percentage retention of 51Cr-EDTA=5.4%),but no significant changes in intestinal permeability were observed at the end of the 16 wk of the Mediterranean diet or 16 wk of the low-fat diet.CONCLUSION Mediterranean diet is an effective strategy for treating overweight,visceral obesity and serum transaminase in patients with NAFLD.If the Mediterranean diet can improve intest 展开更多
关键词 LIVER STEATOSIS Gut-liver axis NUTRITION PERSONALIZED medicine VISCERAL obesity
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不同吸附剂在双重血浆分子吸附系统治疗肝衰竭中的临床研究
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作者 闫国胜 李丽丽 +2 位作者 姜少利 孟松 吴晨晨 《中华肝脏病杂志》 CAS CSCD 北大核心 2019年第1期51-55,共5页
目的探讨双重血浆分子吸附系统(DPMARS)治疗肝衰竭中不同吸附剂(活性炭与吸附树脂)组合的疗效对比。方法回顾性分析2016年6月至2018年5月郑州市第六人民医院住院的152例肝衰竭患者,分为DPMARS碳罐组77例、DPMARS树脂组75例。比较两组患... 目的探讨双重血浆分子吸附系统(DPMARS)治疗肝衰竭中不同吸附剂(活性炭与吸附树脂)组合的疗效对比。方法回顾性分析2016年6月至2018年5月郑州市第六人民医院住院的152例肝衰竭患者,分为DPMARS碳罐组77例、DPMARS树脂组75例。比较两组患者治疗前、治疗后的肝功能、凝血酶原活动度(PTA)、血白蛋白、肿瘤坏死因子α(TNFα)、白细胞介素6(IL-6)等指标的变化。两组间比较采用两独立样本t检验,疗效比较用χ^2检验。结果治疗后两组患者临床症状均有不同程度的改善,碳罐组好转率为89.6%(69/77),树脂组好转率为90.7%(68/75),差异无统计学意义(χ^2=0.048,P=0.975);两组间不良反应率比较,差异无统计学意义(χ^2=0.235,P=0.995)。与治疗前比较,治疗后碳罐组和树脂组总胆红素(t值分别为3.735,3.728,P值均<0.001)、丙氨酸氨基转移酶(t值分别为5.117、5.203,P值均<0.001)、TNFα(t值分别为3.158、3.094,P值均<0.05)、IL-6(t值分别为3.647、3.559,P值均<0.05)均显著降低,差异有统计学意义。而白蛋白、PTA治疗前后比较,P值均>0.05,差异无统计学意义。结论双重血浆分子吸附系统治疗肝衰竭有效,碳罐或者树脂罐均可与特异性胆红素吸附柱组合成DPMARS应用于临床,且二者疗效差异无统计学意义。 展开更多
关键词 人工 治疗 肝衰竭 双重血浆分子吸附系统 活性炭
Elastography-based screening for esophageal varices in patients with advanced chronic liver disease
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作者 Rafael Paternostro Thomas Reiberger Theresa Bucsics 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第3期308-329,共22页
Elastography-based liver stiffness measurement(LSM)is a non-invasive tool for estimating liver fibrosis but also provides an estimate for the severity of portal hypertension in patients with advanced chronic liver dis... Elastography-based liver stiffness measurement(LSM)is a non-invasive tool for estimating liver fibrosis but also provides an estimate for the severity of portal hypertension in patients with advanced chronic liver disease(ACLD).The presence of varices and especially of varices needing treatment(VNT)indicates distinct prognostic stages in patients with compensated ACLD(cACLD).The Baveno VI guidelines suggested a simple algorithm based on LSM<20 kPa(by transient elastography,TE)and platelet count>150 G/L for ruling-out VNT in patients with cACLD.These(and other)TE-based LSM cut-offs have been evaluated for VNT screening in different liver disease etiologies.Novel point shear-wave elastography(pSWE)and two-dimensional shear wave elastography(2D-SWE)methodologies for LSM have also been evaluated for their ability to screen for“any”varices and for VNT.Finally,the measurement of spleen stiffness(SSM)by elastography(mainly by pSWE and 2D-SWE)may represent another valuable screening tool for varices.Here,we summarize the current literature on elastography-based prediction of“any”varices and VNT.Finally,we have summarized the published LSM and SSM cut-offs in clinically useful scale cards. 展开更多
关键词 ELASTOGRAPHY LIVER STIFFNESS SPLEEN STIFFNESS Shear wave Magnetic resonance ELASTOGRAPHY VARICES Portal hypertension Cirrhosis ADVANCED chronic LIVER disease
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Machine perfusion of the liver:Which is the best technique to mitigate ischaemia-reperfusion injury?
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作者 Yuri L Boteon Simon C Afford 《世界移植杂志》 2019年第1期14-20,共7页
Longstanding research describes the mechanisms whereby the restoration of blood flow and reoxygenation(reperfusion)aggravates the ischaemic injury caused by a period of anoxia to a donor liver.This phenomenon,called i... Longstanding research describes the mechanisms whereby the restoration of blood flow and reoxygenation(reperfusion)aggravates the ischaemic injury caused by a period of anoxia to a donor liver.This phenomenon,called ischaemia-reperfusion injury(IRI),leads to parenchymal cell death,microcirculatory failure,and inflammatory immune response.Clinically,IRI is the main factor responsible for the occurrence of posttransplant graft dysfunction and ischaemic-type biliary lesions.While extended criteria donor livers are more vulnerable to IRI,their utilisation is required to address the shortfall in donor organs.Thus,the mitigation of IRI should drive the setting of a new benchmark for marginal organ preservation.Herein,strategies incorporating different modalities of machine perfusion of the liver to alleviate IRI are discussed in conjunction with advantages and disadvantages of individual protocols.Techniques leading to reperfusion of the liver during machine perfusion(in situ normothermic regional perfusion and ex situ normothermic machine perfusion)may mitigate IRI by shortening the ischaemic period of the organs.This benefit potentially escalates from the minimum level,obtained following just partial alleviation of the ischaemic period,to the maximum level,which can be potentially achieved with ischaemia-free organ transplantation.Techniques that do not lead to reperfusion of the liver during machine perfusion(hypothermic,subnormothermic,and controlled-oxygenated rewarming)optimise mitochondrial oxidative function and replenish cellular energy stores,thereby lowering reactive oxygen species production as well as the activation of downstream inflammatory pathways during reperfusion.Further mechanistic insights into IRI may guide the development of donor-specific protocols of machine perfusion on the basis of the limitations of individual categories of extended criteria donor organs. 展开更多
关键词 Machine PERFUSION of the LIVER ISCHAEMIA-REPERFUSION injury LIVER transplantation ORGAN PRESERVATION ORGAN RECONDITIONING
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Pushing the limits of liver surgery for colorectal liver metastases:Current state and future directions
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作者 Raphael LC Araujo Marcelo M Linhares 《世界胃肠外科杂志:英文版(电子版)》 2019年第2期34-40,共7页
Liver surgery for the treatment of colorectal liver metastases is the standard treatment in a dynamic surgical field with many variables that should be considered in a curative intent scenario.Hepatectomy for colorect... Liver surgery for the treatment of colorectal liver metastases is the standard treatment in a dynamic surgical field with many variables that should be considered in a curative intent scenario.Hepatectomy for colorectal liver metastases has undergone constant changes over the last 30 years,including indications until the need for rescue procedures of recurrent and advanced diseases as well as minimally invasive surgery.These advancements in liver surgery have not only resulted from overall improvements in the surgical field but have also resulted from a better understanding of the biological behavior of the disease,liver regeneration,and homeostasis during and after surgery.Improvements in anesthesiology,intensive care medicine,radiology,and surgical devices have correlated with further advancements of hepatectomies.Moreover,changes are still forthcoming,and both fields of augmented reality and artificial intelligence will likely have future contributions in this field in regard to both diagnoses and the planning of procedures.The aim of this editorial is to emphasize several aspects that have contributed to the paradigm shifts in colorectal liver metastases surgery over the last three decades as well as to discuss the factors concerning patient selection and the technical aspects of liver surgery.Finally,this editorial will highlight the promising new features of this surgery for diagnoses and treatments in this field. 展开更多
关键词 COLORECTAL LIVER METASTASES Cancer HEPATECTOMY LIVER Surgery ONCOLOGY
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Effects of positive acceleration(+Gz stress)on liver enzymes,energy metabolism,and liver histology in rats
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作者 Bin Shi Xian-Qiang Wang +5 位作者 Wei-Dong Duan Guo-Dong Tan Han-Jing Gao Ying-Wei Pan Qing-Jun Guo Hong-Yi Zhang 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第3期346-355,共10页
BACKGROUND Exposure to high sustained+Gz(head-to-foot inertial load)is known to have harmful effects on pilots’body in flight.Although clinical data have shown that liver dysfunction occurs in pilots,the precise caus... BACKGROUND Exposure to high sustained+Gz(head-to-foot inertial load)is known to have harmful effects on pilots’body in flight.Although clinical data have shown that liver dysfunction occurs in pilots,the precise cause has not been well defined.AIM To investigate rat liver function changes in response to repeated+Gz exposure.METHODS Ninety male Wistar rats were randomly divided into a blank control group(BC group,n=30),a+6 Gz/5 min stress group(6GS group,n=30),and a+10 Gz/5min stress group(10GS group,n=30).The 6GS and 10GS groups were exposed to+6 Gz and+10 Gz,respectively,in an animal centrifuge.The onset rate of+Gz was 0.5 G/s.The sustained time at peak+Gz was 5 min for each exposure(for 5 exposures,and 5-min intervals between exposures for a total exposure and non-exposure time of 50 min).We assessed liver injury by measuring the portal venous flow volume,serum alanine aminotransferase(ALT)and aspartate aminotransferase(AST),liver tissue malondialdehyde(MDA),Na+-K+-ATPase,and changes in liver histology.These parameters were recorded at 0 h,6 h,and 24 h after repeated+Gz exposures.RESULTS After repeated+Gz exposures in the 6GS and the 10GS groups,the velocity and flow signal in the portal vein(PV)were significantly decreased as compared to the BC group at 0 h after exposure.Meanwhile,we found that the PV diameter did not change significantly.However,rats in the 6GS group had a much higher portal venous flow volume than the 10GS group at 0 h after exposure.The 6GS group had significantly lower ALT,AST,and MDA values than the 10GS group 0 h and 6 h post exposure.The Na+-K+-ATPase activity in the 6GS group was significantly higher than that in the 10GS group 0 h and 6 h post exposure.Hepatocyte injury,determined pathologically,was significantly lower in the 6GS group than in the 10GS group.CONCLUSION Repeated+Gz exposures transiently cause hepatocyte injury and affect liver metabolism and morphological structure. 展开更多
关键词 Positive ACCELERATION +GZ LIVER function Animal models LIVER METABOLISM ISCHEMIA-REPERFUSION INJURY
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The role of graft reperfusion sequence in the development of non-anastomotic biliary strictures following orthotopic liver transplantation:A meta-analysis 预览
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作者 Mohamed Bekheit Matteo Catanzano +4 位作者 Stuart Shand Irfan Ahmed ELSaid ELKayal Gihan Mohamed Shehata Adel Zaki 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2019年第1期4-11,共8页
Background:Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction.This study was to compare the prevalence of ... Background:Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction.This study was to compare the prevalence of non-anastomotic biliary stricture and other surgical complications based on Clavien-Dindo scoring system,in initial portal reperfusion(sequential)versus simultaneous or initial artery reperfusion.Data sources:Meta-analysis of published studies comparing the outcomes of both techniques was carried out.Data search was conducted across the major databases and studies were selected under the guidance of the Cochrane guidelines for systematic reviews and meta-analysis.Results:Seven studies were included to address the primary and the secondary outcomes.No statistical difference was found in the incidence of non-anastomotic biliary strictures(OR=0.40;P=0.14),regardless of reperfusion technique.The pooled estimate of the Clavien-Dindo grading of complications was not significantly different between the techniques,though Clavien-Dindo II complications were higher in the simultaneous or initial artery reperfusion group than the initial portal reperfusion group(OR=2.73;P=0.01).Similarly,there was no difference in the operative time,hospital stay and other outcomes addressed in this report.Conclusions:The available evidence suggests that there is no significant difference demonstrated in the rate of non-anastomotic biliary strictures or other complications,between the two techniques,except for Clavien-Dindo II complications. 展开更多
关键词 LIVER TRANSPLANTATION ORGAN TRANSPLANTATION LIVER surgery REJECTION
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不用b=0图像的活体组织体素内不相干运动分析:应用在肝脏纤维化评估的一个例子
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作者 王毅翔 《新发传染病电子杂志》 2019年第1期8-14,共7页
体素内不相干运动(intravoxel incoherent motion,IVIM)成像系列的组成一般由开始没有弥散成像梯度磁场的成像(b=0s/mm^2)及一系列不同强度(或不同持续时间)的弥散成像梯度磁场的成像。在人体的许多器官,比如肝脏,b值与成像信号的关系... 体素内不相干运动(intravoxel incoherent motion,IVIM)成像系列的组成一般由开始没有弥散成像梯度磁场的成像(b=0s/mm^2)及一系列不同强度(或不同持续时间)的弥散成像梯度磁场的成像。在人体的许多器官,比如肝脏,b值与成像信号的关系一般分为两部分:①低b值时信号快速下降与组织内的血液灌注导致的快速水分子移位有关;②高b值时信号相对较为缓慢下降与组织内的水分子弥散相关。这些关系大致表现为b值系列与信号的双指数衰减下降关系,并由三个参数来表示即Dslow(D)、Dfast(D^*)、PF(f)。Dslow反映水分子弥散移位的快慢,Dfast反映血液灌注的水分子移位的快慢,PF反映灌注占的百分比。IVIM成像虽然理论上有许多优越性,但是以前常规描述的方式在临床医学中没有实际应用起来,其原因是公式拟合困难,测量结果不稳定。肝脏为富血供器官,适合IVIM观察,但是肝脏同时受到一些生理性运动的影响,比如呼吸运动以及心脏的跳动,左肝还受到胃内容物引起的磁敏感伪影的影响。最近我们发表了两个小型临床研究,第一个研究中有16位健康志愿者及33位乙型肝炎性肝纤维化患者(其中15例为1期肝纤维化);第二个研究中有26位健康志愿者及12位乙型肝炎性肝纤维化患者(其中4例为1期肝纤维化)。这两个研究中所有的健康人与肝纤维化患者均可以通过IVIM区别。而且,第二个研究中有4例活检病理无肝纤维化的患者,其IVIM结果与正常人类似。虽然迄今为止我们的IVIM扫描参数以及数据处理方式尚未最优化,我们推想,优良的结果是基于我们采取了下面的方法:①IVIM数据分析去除b=0的图像;②仔细选择b值分布及合理选择分段拟阀值b;③去除质量不好的图像;④将所有的IVIM参数考虑进临床判断。本文描述的IVIM评估肝脏纤维化的图像采集及图像后处理分析尚未最优化。可以预期,优化后的 展开更多
关键词 体素内不相干运动 弥散成像 肝脏 纤维化
肝移植治疗肝血管源性肿瘤的研究进展 预览
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作者 旦增贡色 淮明生 《实用器官移植电子杂志》 2019年第1期28-30,共3页
至今为止,肝移植(liver transplantation,LT)已是公认的治疗肝细胞性肝癌的有效手段之一,但对于肝血管源性肿瘤(肝海绵状血管瘤、肝上皮样血管内皮瘤、肝血管平滑肌脂肪瘤、肝血管肉瘤)的治疗效果还存在争议。本文就近年来肝移植治疗肝... 至今为止,肝移植(liver transplantation,LT)已是公认的治疗肝细胞性肝癌的有效手段之一,但对于肝血管源性肿瘤(肝海绵状血管瘤、肝上皮样血管内皮瘤、肝血管平滑肌脂肪瘤、肝血管肉瘤)的治疗效果还存在争议。本文就近年来肝移植治疗肝血管源性肿瘤治疗进展进行综述。 展开更多
关键词 血管源性肿瘤 移植治疗 肝移植 肝血管平滑肌脂肪瘤 上皮样血管内皮瘤 肝海绵状血管瘤 肝细胞性肝癌 liver
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NMDA受体2A亚基磷酸化对幼鼠肝缺血再灌注后脑损伤及远期认知功能障碍的影响 预览
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作者 王希辉 于向洋 +1 位作者 喻文立 杜洪印 《天津医药》 CAS 北大核心 2019年第2期140-144,共5页
目的评价肝缺血再灌注(HIR)对幼鼠海马以及远期认知功能的影响,并探讨N-甲基-D-天冬氨酸受体2A亚基(NR2A)磷酸化在其中发挥的作用。方法健康C57小鼠54只,2周龄,体质量6~9 g,采用随机数字表法分为3组(n=18):假手术组(S)、HIR组(I)和NR2A... 目的评价肝缺血再灌注(HIR)对幼鼠海马以及远期认知功能的影响,并探讨N-甲基-D-天冬氨酸受体2A亚基(NR2A)磷酸化在其中发挥的作用。方法健康C57小鼠54只,2周龄,体质量6~9 g,采用随机数字表法分为3组(n=18):假手术组(S)、HIR组(I)和NR2A抑制剂NVP-AAM077处理组(N)。建立70%HIR模型,N组于术后连续3 d每天予NVP-AAM077(10 mg/kg)腹腔注射。S组和I组以相同方式腹腔注射等体积生理盐水。每组随机取10只小鼠于术后3 d处死,分离血清并取脑组织,酶联免疫吸附测定(ELISA)检测血清脑损伤标志物S100β和神经元特异性烯醇化酶(NSE)水平,HE染色观察海马组织病理改变,Western blot检测cleaved caspase-3、NR2A、p-NR2A Y1325蛋白水平。其余小鼠于术后30 d进行Morris水迷宫实验,评价远期认知功能。结果与S组比较,I组与N组血清S100β和NSE水平明显升高,海马组织水肿,细胞排列紊乱,cleaved caspase-3、p-NR2A Y1325蛋白水平升高,平台所在象限滞留时间缩短(P<0.05);与I组比较,N组血清S100β和NSE水平降低,海马神经元病理损伤减轻,cleaved caspase-3、p-NR2A Y1325蛋白水平下降,平台所在象限滞留时间明显延长(P<0.05)。3组之间NR2A表达水平、逃逸潜伏期差异无统计学意义(P>0.05)。结论幼鼠HIR可导致脑损伤和远期认知功能障碍,其机制可能与NR2A Y1325过度磷酸化介导的兴奋性毒性和细胞凋亡有关。 展开更多
关键词 再灌注损伤 海马 受体 N-甲基-D-天冬氨酸 认知 小鼠 近交C57BL
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90天饮水砷暴露对大鼠的肝脏、肾脏和心脏的毒性损伤作用
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作者 吴建美 尹幸念 +2 位作者 姜华 樊树理 曲琳 《医学动物防制》 2019年第3期213-216,308共5页
目的研究90 d饮水砷暴露对饮水砷代谢相关生化指标的影响及对大鼠肝脏、肾脏和心脏的损伤作用。方法将96只SPF级Wistar大鼠随机分为4组,分别为阴性对照组(蒸馏水)和低(50μg/L)、中(150μg/L)、高(450μg/L)剂量组,每组24只,雌雄各半,... 目的研究90 d饮水砷暴露对饮水砷代谢相关生化指标的影响及对大鼠肝脏、肾脏和心脏的损伤作用。方法将96只SPF级Wistar大鼠随机分为4组,分别为阴性对照组(蒸馏水)和低(50μg/L)、中(150μg/L)、高(450μg/L)剂量组,每组24只,雌雄各半,采用自由饮水方式连续染毒90 d,采集大鼠血液,分析活化部分凝血活酶时间(activated partial thromboplastin time,APTT)和凝血酶原时间(prothrombin time,PT);分离血清测定丙氨酸氨基转移酶(alanine aminotransferase,ALT)、肌酐(creatinine,Cr)、尿素(blood urea,BU)和血红蛋白(hemoglobin,Hb)含量;处死各组大鼠,解剖取材,计算脏器系数,HE染色后光学显微镜下观察大鼠心脏、肝脏、肾脏的组织学变化。结果与对照组比较,各剂量染砷组大鼠脏器系数差异无统计学意义(P> 0. 05);低剂量组和中剂量组的APTT和PT较对照组均可见延长趋势,高剂量组雄性PT较对照组有延长趋势(P> 0. 05)。各剂量组雄性大鼠Hb、ALT及低剂量组和高剂量组雌性大鼠ALT较对照组均降低(P> 0. 05);高剂量组大鼠Cr较对照组升高,低剂量组雄性大鼠Cr较对照组升高(P> 0. 05);中剂量组和高剂量组大鼠BU高于对照组,低剂量组雄性BU均高于对照组(P> 0. 05)。与对照组比较,各剂量组大鼠心脏、肝脏、肾脏均出现生不同程度的损伤。结论实验组大鼠经不同剂量的饮水砷染毒90 d后,大鼠血液生化指标受到一定程度的影响,同时出现肝脏、肾脏和心脏不同程度的损伤。 展开更多
关键词 饮水砷 生化指标 肝脏 肾脏 心脏
Aspirin inhibits the proliferation of hepatoma cells through controlling GLUT 1-mediated glucose metabolism
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作者 Yun-xia Liu Jin-yan Feng +8 位作者 Ming-ming Sun Bo-wen Liu Guang Yang Ya-nan Bu Man Zhao Tian-jiao Wang Wei-ying Zhang Hong-feng Yuan Xiao-dong Zhang 《中国药理学报:英文版》 SCIE CAS CSCD 2019年第1期122-132,共11页
Aspirin can efficiently inhibit liver cancer growth,but the mechanism is poorly,understood.In this study,we-report that aspirin modulates glucose uptake through downregulating glucose transporter 1 (GLUT1),leading to ... Aspirin can efficiently inhibit liver cancer growth,but the mechanism is poorly,understood.In this study,we-report that aspirin modulates glucose uptake through downregulating glucose transporter 1 (GLUT1),leading to the inhibition of hepatoma cell proliferation.Our data showed that aspirin significantly decreased the levels of reactive oxygen species (ROS)and glucose consumption in hepatoma cells.Interestingly,we identified that GLUT1 and HIF1α could be decreased by aspirin.Mechanically,we demonstrated that the -1008/-780 region was the regulatory element of transcriptional factor NF-κB in GLUT1 promoter by luciferase report gene assays.PDTC,an inhibitor of NF-KB,could suppress the expression of GLUT1 in HepG2 and H7402 cells,: followed by affecting the levels of ROS and glucose consumption.CoCl2-activated HIF1α expression could slightly rescue the GLUT1 expression inhibited by aspirin or PDTC,suggesting that aspirin depressed GLUT1 through targeting NF-κB or NF-κB/HIFla signaling.Moreover,we found that GLUT1 was highly expressed in clinical HCC tissues relating to their paired adjacent normal tissues.Importantly,we observed that high level of GLUT1 was significantly correlated with the poor relapse-free survival of HCC patients by analysis of public data.Functionally,overexpression of GLUT1 blocked the PDTC-induced or aspirin-induced inhibition of glucose metabolism in HepG2 cells.Conversely,aspirin failed to work when GLUT1 was stably knocked down in the cells. Administration of aspirin could depress the growth of hepatoma cells through controlling GLUT1 in vitro and in vivo.Thus,our finding provides new insights into the mechanism by which aspirin depresses liver cancer. 展开更多
关键词 ASPIRIN GLUCOSE UPTAKE GLUT1 NF-κB liver cancer
Hepatocellular carcinoma:Can LI-RADS v2017 with gadoxetic-acid enhancement magnetic resonance and diffusion-weighted imaging improve diagnostic accuracy?
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作者 Tong Zhang Zi-Xing Huang +8 位作者 Yi Wei Han-Yu Jiang Jie Chen Xi-Jiao Liu Li-Kun Cao Ting Duan Xiao-Peng He Chun-Chao Xia Bin Song 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第5期622-631,共10页
BACKGROUND The Liver Imaging Reporting and Data System(LI-RADS),supported by the American College of Radiology(ACR),has been developed for standardizing the acquisition,interpretation,reporting,and data collection of ... BACKGROUND The Liver Imaging Reporting and Data System(LI-RADS),supported by the American College of Radiology(ACR),has been developed for standardizing the acquisition,interpretation,reporting,and data collection of liver imaging examinations in patients at risk for hepatocellular carcinoma(HCC).Diffusionweighted imaging(DWI),which is described as an ancillary imaging feature of LI-RADS,can improve the diagnostic efficiency of LI-RADS v2017 with gadoxetic acid-enhanced magnetic resonance imaging(MRI)for HCC.AIM To determine whether the use of DWI can improve the diagnostic efficiency of LIRADS v2017 with gadoxetic acid-enhanced magnetic resonance MRI for HCC.METHODS In this institutional review board-approved study,245 observations of high risk of HCC were retrospectively acquired from 203 patients who underwent gadoxetic acid-enhanced MRI from October 2013 to April 2018.Two readers independently measured the maximum diameter and recorded the presence of each lesion and assigned scores according to LI-RADS v2017.The test was used to determine the agreement between the two readers with or without DWI.In addition,the sensitivity(SE),specificity(SP),accuracy(AC),positive predictive value(PPV),and negative predictive value(NPV)of LI-RADS were calculated.Youden index values were used to compare the diagnostic performance of LIRADS with or without DWI.RESULTS Almost perfect interobserver agreement was obtained for the categorization of observations with LI-RADS(kappa value:0.813 without DWI and 0.882 with DWI).For LR-5,the diagnostic SE,SP,and AC values were 61.2%,92.5%,and 71.4%,respectively,with or without DWI;for LR-4/5,they were 73.9%,80%,and 75.9%without DWI and 87.9%,80%,and 85.3%with DWI;for LR-4/5/M,they were 75.8%,58.8%,and 70.2%without DWI and 87.9%,58.8%,and 78.4%with DWI;for LR-4/5/TIV,they were 75.8%,75%,and 75.5%without DWI and 89.7%,75%,and 84.9%with DWI.The Youden index values of the LI-RADS classification without or with DWI were as follows:LR-4/5:0.539 vs 0.679;LR-4/5/M:0.346 vs 0.467;and LR-4/5/TIV: 展开更多
关键词 HEPATOCELLULAR carcinoma Liver IMAGING REPORTING and Data System Magnetic RESONANCE IMAGING DIFFUSION-WEIGHTED IMAGING Diagnosis
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FOXO1在肝脏糖脂代谢中的作用 预览
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作者 赵航 张运佳 +1 位作者 树林一 宋光耀 《基础医学与临床》 CSCD 2019年第1期115-119,共5页
FOXO1作为叉头转录因子家族中的成员,受到蛋白质间相互作用和磷酸化、乙酰化、泛素化等翻译后修饰。FOXO1能够促进糖异生基因G6Pase和PEPCK的表达,同时可结合到ApoC-Ⅲ启动子上,促进ApoC-Ⅲ的表达,加重高三酰甘油血症。FOXO1的磷酸化有... FOXO1作为叉头转录因子家族中的成员,受到蛋白质间相互作用和磷酸化、乙酰化、泛素化等翻译后修饰。FOXO1能够促进糖异生基因G6Pase和PEPCK的表达,同时可结合到ApoC-Ⅲ启动子上,促进ApoC-Ⅲ的表达,加重高三酰甘油血症。FOXO1的磷酸化有助于促进肝脏微粒体三酰甘油转运蛋白MTP表达和极低密度脂蛋白VLDL产生。FOXO1在肝脏的糖脂代谢中的作用提供了胰岛素抵抗、糖尿病治疗的新的靶点。 展开更多
关键词 FOXO1 代谢 肝脏
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低温和摄食对虹鳟脂肪酸合成基因表达的影响 预览
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作者 刘骋跃 周演根 +2 位作者 孙大江 高勤峰 董双林 《中国海洋大学学报:自然科学版》 CAS CSCD 北大核心 2019年第3期63-71,共9页
通过分析低温和摄食对虹鳟(Oncorhynchus mykiss)脂肪酸生物合成相关基因表达的影响,探究其低温适应机制,为虹鳟的成功越冬提供一定的理论依据。本实验设定了正常温度摄食组(NF)、正常温度不摄食组(NU)、低温摄食组(CF)和低温不摄食组(C... 通过分析低温和摄食对虹鳟(Oncorhynchus mykiss)脂肪酸生物合成相关基因表达的影响,探究其低温适应机制,为虹鳟的成功越冬提供一定的理论依据。本实验设定了正常温度摄食组(NF)、正常温度不摄食组(NU)、低温摄食组(CF)和低温不摄食组(CU)4个实验处理,分别测定了虹鳟肝脏和肌肉在1、3、5、7和14d时硬脂酰辅酶A去饱和酶(Stearoyl-Coenzyme A desaturase,SCD)、Δ6-去饱和酶(Δ6 fatty acid desaturase,Δ6 Fad)和延长酶2(Elongation of very long chain fatty acids like2,Elovel2)3个基因的相对表达水平。实验表明:摄食显著影响虹鳟肝脏对脂肪酸的生物合成,在营养供给充足的情况下,主要通过脱酰和重酰化作用(替代作用)来满足机体对单一不饱和脂肪酸(Monounsaturated fatty acid,MUFA)和多不饱和脂肪酸(Polyunsaturated fatty acid,PUFA)的需求;在营养供给不足时,可以通过相关脂肪酸生物合成通路合成MUFA和PUFA。虹鳟肌肉中有大量脂肪沉积,因而短时间的不摄食对其影响较小。当周围环境温度降低时,SCD、Δ6Fad和Elovel2三个基因的表达量均显著上升,表明虹鳟为了适应低温,生物膜磷脂脂肪酸中不饱和脂肪酸的比例上升,虹鳟肝脏和肌肉中MUFA和PUFA生物合成量增加。此外,虹鳟肝脏SCDmRNA的表达量在CF组较低,这可能是因为摄食可以在一定程度上补充MUFA。虹鳟在正常营养条件下,大约在5~7d可适应低温;在长时间的饥饿和低温胁迫下,虹鳟机体内的脂肪酸生物合成会受到影响。 展开更多
关键词 虹鳟 温度 摄食 肌肉 肝脏 SCD Δ6Fad Elovel2
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