Journal of gastroenterology
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Reactivation of hepatitis B virus (HBV) has been reported as a fatal complication following systemic chemotherapy or other immunosuppressive therapy. The risk of HBV reactivation differs according to both the patient's HBV infection status prior to systemic chemotherapy and the degree of immunosuppression due to chemotherapy. For establishing an optimal strategy for hepatitis prevention and treatment, it is necessary to understand the characteristics, the clinical course and the risk factors for HBV reactivation and to recognize the difference between hepatitis B surface antigen (HBsAg)-positive and -negative patients with HBV reactivation. ⋯ Rituximab-plus-steroid combination chemotherapy has recently been identified as a host risk factor for HBV reactivation in hepatitis B core antibody (anti-HBc)-positive and/or hepatitis B surface antibody (anti-HBs) positive--but nonetheless HBsAg-negative--lymphoma patients. For these patients with resolved hepatitis B, preemptive therapy guided by serial HBV-DNA monitoring is a reasonable strategy to enable early diagnosis of HBV reactivation and initiation of antiviral therapy. In this review, we summarize the characteristics of HBV reactivation following rituximab-plus-steroid combination chemotherapy, mainly in HBsAg-negative lymphoma patients, and propose a strategy for managing HBV reactivation.
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To assess the degree of hepatic fat content, simple and noninvasive methods with high objectivity and reproducibility are required. Magnetic resonance imaging (MRI) is one such candidate, although its accuracy remains unclear. We aimed to validate an MRI method for quantifying hepatic fat content by calibrating MRI reading with a phantom and comparing MRI measurements in human subjects with estimates of liver fat content in liver biopsy specimens. ⋯ This MRI method is simple and noninvasive, has excellent ability to quantify hepatic fat content even in NAFLD patients with mild steatosis or advanced fibrosis, and can be performed easily without special devices.
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Randomized Controlled Trial
Efficacy of mosapride citrate in proximal gastric accommodation and gastrointestinal motility in healthy volunteers: a double-blind placebo-controlled ultrasonographic study.
Mosapride citrate, a 5-hydroxytryptamine-4 receptor agonist, enhances antral contractions and gastric emptying, but its effects on proximal gastric accommodation and gastroduodenal motility have not been fully studied. The aim of the present study was to clarify the effects of mosapride citrate on proximal gastric accommodation and gastroduodenal motility in healthy volunteers, using ultrasonography. ⋯ This study shows that mosapride citrate enhances the meal-induced gastric accommodation reflex and promotes adequate gastroduodenal coordination and motility in healthy volunteers.
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Randomized Controlled Trial Comparative Study
Safe and effective sedation in endoscopic submucosal dissection for early gastric cancer: a randomized comparison between propofol continuous infusion and intermittent midazolam injection.
Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) generally takes longer to perform than conventional endoscopy and usually requires moderate/deep sedation with close surveillance for patient safety. The aim of this study was to compare the safety profiles and recovery scores propofol continuous infusion and intermittent midazolam (MDZ) injection as sedation for ESD. ⋯ Based on our results, the ESDs for EGC performed under sedation using propofol continuous infusion were as safe as those performed using intermittent MDZ injection. Propofol-treated patients had a quicker recovery profile than those treated with MDZ. We therefore recommend the use of continuous propofol sedation for ESD, but sedation guidelines for the use of propofol are necessary.
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Comparative Study Controlled Clinical Trial
Natural course of the remnant hepatic functional reserve as estimated by technetium-99m-galactosyl human serum albumin scintigraphy after a hepatectomy.
Technetium-99m-galactosyl human serum albumin (GSA) scintigraphy provides an accurate estimation of the hepatic functional reserve but is not applied after a hepatectomy. The aim of this study was to elucidate the natural course of the remnant hepatic functional reserve (RHFR) after hepatectomy by GSA scintigraphy. ⋯ Remnant hepatic functional reserve estimated by GSA scintigraphy revealed that a larger resected liver volume induced both more serious and continued remnant hepatic dysfunction in comparison to results shown by hematobiochemical tests, while the functional regeneration was also appreciably slower and more gradual in comparison to the volume regeneration.